Washington Examiner: Lower costs and more choice in the healthcare system require competition - op-ed by Charlie Kateb, Americans for Prosperity (3/15) – Without meaningful competition from physicians, large hospital chains have merged with their competitors and monopolized the health care system throughout the United States. Today, 80 percent of hospital markets are considered by the Federal Trade Commission to be “highly concentrated.” Ending the ban on physician-owned hospitals would bring down prices by making hospitals compete. It’s a critical step toward delivering a personal option in healthcare that gives the public the affordability, choice, and control they deserve.
Advisory Board: CMS has a new MA proposal — and payers and providers are pushing back (3/14) – Insurers argue that changes to the Medicare Advantage risk model will result in a net cut next year. Meanwhile, MGMA wrote in a letter that CMS should delay implementing the proposed changes until it's able to study the effect the changes will have on physician groups and patients. "While MGMA shares concerns about abuse in the Medicare Advantage program, we are concerned that this overhaul of the CMS-HCC model may result in unintended consequences that could impact beneficiary access to care and impede important value-based care initiatives critical to the success of medical group practices.”
Fierce Healthcare: Surveyed physicians say prior authorization harms patient outcomes, burns healthcare resources (3/14) – Current prior authorization practices drive worse patient outcomes and increased utilization of health care resources due to unnecessary encounters or ineffective care, a majority of physicians said in a survey conducted by the American Medical Association. Released this week, the December poll
of 1,001 practicing physicians outlined unintended outcomes resulting from treatment approval processes required by payers in a bid to control costs. Last week during a webinar discussion on rising clinician burnout, Resneck and U.S. Surgeon General Vivek Murthy, M.D., fingered prior authorization as a contributor to skyrocketing levels of burnout experienced by much of the nation’s clinical workforce.
Fierce Healthcare: Oak Street Health: Medicare Advantage advance notice could divert resources from dual eligibles (3/14) – A new analysis finds a change to Medicare Advantage risk adjustment could make it harder for providers to coordinate care for dual-eligible Medicare-Medicaid beneficiaries and people of color. Primary care center company Oak Street Health released an analysis recently that charges the proposed 2024 advance notice - which lays out pay rates and policies for Medicare Advantage - moves resources away from treating dual eligibles and other underserved beneficiaries. The proposed rule has already come under fire by insurers over a change to the pay rates.
Forbes: It's Time For Medicare To Move Beyond Location, Location, Location (3/13) – Site-neutral payments are neither a new nor controversial idea. Cost savings are not the only benefit of site-neutral payments - MedPAC and other experts have shown that Medicare payment differentials encourage hospitals to buy physician practices. If anything, independent physicians have a leg up on their corporate counterparts. With a smaller, more consistent roster of patients, independent physicians can spend more time with those under their care. That's good news, considering truncated doctor visits are associated with subpar care, and can strain the doctor-patient relationship. Site-specific Medicare reimbursements encourage waste and sap competition. Shifting to a site-neutral payment model would save money for patients and taxpayers and preserve the dwindling number of independent physicians. Talk about a win-win.
JAMA: Why Are Some Value-Based Programs Successful? (3/13) – Probably the most important recommendation is to increase patient engagement. There are many different value-based programs. The multitude of programs, their sometimes-complicated design, and the limited success of many of them may be associated with a lack of patient and clinician engagement. If there is a growing consensus on what interventions are most successful, then thinking about how to engage patients, clinicians, and others may be an important strategy to enhance their success. It is important to have a comprehensive approach to the intervention. Combining programs that individually have been successful increases the possibility that when they are combined into one larger program, they will be able to show improvements in the short period of time that is allowed for most evaluations. It is critical for a value-based program to be successful out of the gate so that it can align with the short time horizon typical to most evaluations.
Milbank Memorial Fund: A Step Forward for Health Care Market Oversight: Oregon Health Authority’s Health Care Market Oversight Program (3/13) – The choices made in implementing the Health Care Market Oversight Program (HCMO) program offer multiple valuable considerations for other states seeking to address harmful consolidation in health care markets. To implement an effective market oversight program: (1) State policymakers need a detailed understanding of the drivers of health care costs in the state. (2) State legislators should aim to give a health care market oversight program as much authority as possible to allow flexibility. (3) States should strike a balance when deciding the breadth of review to use state resources effectively. (4) States should strive for a high-level of transparency and public participation, as both are critical to effectively review transactions and minimize the risk of regulatory failure. (5) Any imposed conditions should be enforceable and targeted.
JAMA: Association of Primary Care Visit Length With Potentially Inappropriate Prescribing (3/10) – In a large, multistate sample of primary care visits, we found an association between visit length and some potentially inappropriate prescribing measures. Our analyses highlight the fundamental tension between the volume incentives embedded in fee-for-service reimbursement systems and quality of care. While our results do not suggest an optimal visit length, they do suggest that physicians’ time is not always allocated based on patient complexity. Such findings suggest opportunities for a more equitable distribution. While risk adjusting visit length to match individual patients’ needs may be prohibitively complex from a logistical standpoint, practice leads could consider building in more flexibility than typically exists now.
Roll Call: Noncompete rule puts doctors, hospitals at odds (3/9) – Hospitals and physicians are squaring off over a proposed Biden administration rule that would ban noncompete agreements. Physicians say the clauses are so common that they have no option but to sign them, limiting their career growth, contributing to burnout and forcing them to leave their communities for other jobs. Hundreds of physicians have filed comments with the FTC supporting the rule, detailing stories of being locked into jobs they didn’t want to be at anymore because they were restricted from working at “competitors” within the same city, county or even state for a certain amount of time after their departure. Others said they missed out on opportunities that would have made them feel more fulfilled or had to move their families to accept a job outside of the noncompete zone.
Medical Economics: Physician burnout influencing post-COVID hiring trends (3/9) – Health care organizations continue to feel the impact of COVID-19 on staffing. While the physician shortage has been decades in the making, COVID-induced stress and burnout has exacerbated the issue. Initial assessments predicted a spike in early physician retirements and a mass exodus of physicians of all ages. A 2022 MGMA STAT poll found 40 percent of medical practices had seen a physician retire early or leave the practice due to burnout. However, as the dust settles post-pandemic, it seems burned out physicians may not be exiting the profession en masse, but many are making changes that reflect shifting priorities and new expectations about what a physician career looks like.