Welcome to The Partnership to Empower Physician-Led Care weekly newsletter, which includes news from our members, legislative and Administration updates, news clips, and studies about value-based care, primary care, and independent physicians.
CMS: (2/14) – CMS leaders published an article in Health Affairs, "Hospital Price Transparency: Progress And Commitment To Achieving Its Potential," which discusses hospitals compliance with price transparency requirements. From 2021 to 2022, CMS found that hospital compliance with requirements increased from 27 percent to 70 percent. The article states that CMS leaders are exploring additional policies to increase compliance, as well as examining ways to make health care pricing information more usable for consumers.
CMS: (2/14) – CMS released a report, which was required by President Biden's Executive Order “Lowering Prescription Drug Costs for Americans,” announcing three new models for testing by the CMS Innovation Center. The Medicare High-Value Drug List Model would create a standard list of high-value generic medications with predictable co-payments for Medicare Part D enrollees. The Cell & Gene Therapy Access Model would test a new approach to outcomes-based agreements to increase access to high-cost specialty drugs for Medicaid beneficiaries. The Accelerating Clinical Evidence Model would adjust Medicare Part B payment amounts for Accelerated Approval Program drugs to incentivize expedited and completed confirmatory clinical trials. Fact SheetQ&A Document
White House: (2/13) – The White House announced the nomination of Rebecca Kelly Slaughter for Commissioner of the Federal Trade Commission (FTC), stating that Slaughter is “a proponent of greater resources, transparency, and comprehensive use of the FTC’s authorities” and “outspoken about the growing threats to competition and the broad abuse of consumers’ data. Targeted merger retrospectives, corrective enforcement, and expansion of the Commission’s rulemaking authorities are among the approaches that she championed during her previous time at the FTC.
CMS: (2/10) – CMS leaders published a blog, “Addressing Rural Health Inequities in Medicare,” which outlines steps CMS is taking to support rural providers and expand access to high-quality, coordinated care through value-based arrangements, such as through incorporating advance incentive payments into the Medicare Shared Savings Program (MSSP) to incentivize and support rural providers joining accountable care organizations (ACOs).
Truth in Healthcare Marketing Act: (2/9) – Reps. Bucshon (R-IN) and Scott (D-GA) reintroduced the Truth in Healthcare Marketing Act (H.R.5510), which aims to ensure patients receive accurate health care information by prohibiting misleading and deceptive advertising or claims about holding a health care license. Bill Text
AAFP, CMA, MGMA: (2/13) – American Academy of Family Physicians (AAFP), California Medical Association (CMA), and Medical Group Management Association (MGMA), along with other physician organizations, sent a letter to CMS Administrator Brooks-LaSure urging CMS to finalize proposed Medicare Advantage and Part D plans prior authorization reforms such as requiring Medicare Advantage plans to establish a Utilization Management Committee to review their clinical coverage criteria and ensure consistency with traditional Medicare guidelines.
AAFP, MGMA: (2/13) – AAFP and MGMA
along with ten other health care organizations, sent a letter to Congressional leaders of the Senate Finance Committee, House Energy & Commerce Committee, and the House Ways & Means Committee. The letter outlines value-based care priorities including extending the original five percent advanced alternative payment model (APM) incentive payments, removing barriers to APM participation, and working with CMS to provide a more predictable pathway for more clinicians to engage in APMs.
Medical Group Management Association: (2/10) – MGMA released their comments on prior authorization policies in the 2024 Medicare Advantage and Part D proposed rule. In the comment letter, MGMA urged CMS waive prior authorization requirements for providers who are participating in value-based care models of care, as they are already incentivized to control costs and deliver high-quality care.
California Medical Association: (2/8) – CMA released a statement applauding the U.S. District Court ruling on the No Surprises Act, stating that “"the Court’s decision is in keeping with the clear language of the No Surprises Act and Congress’ intent to provide a balanced process for health plans and physicians to resolve out-of-network payment disputes.”
Axios: Doctors prod Congress to do more on Medicare pay(2/15) – Top doctors groups are pressing Congress to overhaul the way Medicare pays physicians just as lawmakers are getting pulled into the politically charged debate over possible cuts to entitlement programs. The American Medical Association and nearly 100 other physician groups recently called for "long-term, substantive payment reforms," saying Medicare payments to clinicians have declined 22 percent from 2001 to 2021, when adjusted for inflation. The pleas come at a politically loaded moment, with Medicare emerging as a 2024 campaign issue and both parties vowing to save the program.
The Hill:Health care cronyism is fueling hospital consolidation and rising medical costs – op-ed by Dr. DiGiorgio, UCSF (2/14) – Health care consolidation is a problem. Large hospital conglomerates are expanding, purchasing smaller hospitals and independent clinics. This isn’t market- or patient-driven consolidation. It isn’t bottom-up emergence of economies of scale. This is government regulation putting a finger on the scale and giving larger institutions an unfair advantage over their competition. Congress and the Biden administration should send a clear message: The 340B discount is for hospitals that primarily serve vulnerable patients. It is not a revenue stream to drive consolidation. Any serious effort at addressing health care consolidation must address 340B.
New York Times: According to Medical Guidelines, Your Doctor Needs a 27-Hour Workday (2/14) – Suppose an American doctor wanted a gold star when seeing patients and followed all of the guidelines for preventive, chronic and acute disease care issued by well-known medical groups. That could require nearly 27 hours per day, a team of doctors wrote in a study last year. Guidelines can serve a purpose, but “deciding what to prioritize in a busy primary care practice is a big challenge." To assume that patients and clinicians can sort and prioritize recommendations over multiple visits, “wishes away the fundamental problem that many patients cannot get primary care, see the same clinician or have unhurried consultations.”
Kaiser Health News: Doctors Are Disappearing From Emergency Rooms as Hospitals Look to Cut Costs (2/13) – This staffing strategy has permeated hospitals, and particularly emergency rooms, that seek to reduce their top expense: physician labor. While diagnosing and treating patients was once their domain, doctors are increasingly being replaced “midlevel practitioners” who can perform many of the same duties and generate much of the same revenue for less than half of the pay. Critics of this strategy say the quest to save money results in treatment meted out by someone with far less training than a physician, leaving patients vulnerable to misdiagnoses, higher medical bills, and inadequate care. And these fears are bolstered by evidence that suggests dropping doctors from ERs may not be good for patients.
Wall Street Journal: The Medicare Status Quo Can’t Last – Op-ed by Seema Verma (2/12) – It’s time to change Medicare’s and Medicaid’s reimbursement schema by moving them toward a value-based reimbursement model. Mr. Biden spoke of a broad need for more competition in America, and he’s right. He could start by fixing broken federal policies that benefit health care monopolies. While plenty of providers embrace value-based care, others refuse to change. That’s because many of them are sitting in monopolistic positions in their respective markets, crowding out competition. Finally, more needs to be done to enforce price-transparency regulations for both payers and hospitals. Competition and market forces can’t work without transparent prices.
The Brunswick News: Hospitals can handle competition (2/12) – The other circumstance, now established as a clear trend, is consolidation. Hospital systems have been buying up one another’s facilities, and independent physician groups, in a bout of both horizontal and vertical integration. So far, this trend has not meant a moderation of health care prices. Along with more pricing power, larger hospital systems are concentrating their financial wherewithal. So, even to the extent Certificate of Need (CON) repeal would force them to face more competition, they ought to have the resources to survive. The exceptions to this trend are mostly in rural areas. But while they might be more vulnerable to competition, they’re also less likely to face it. An area that can barely sustain its existing hospital probably won’t attract much new competition.
Health Affairs: Bold Action Can Fix Our Healthcare System – Dr. Chris Chen, CEO of ChenMed (2/12) – There is a way to improve our healthcare system, but it requires a shift in power away from the incumbents to primary care physicians (PCPs). We’ve seen that when the healthcare model revolves around PCP leadership and PCPs are willing to take responsibility for cost, quality, and patient satisfaction, healthcare outcomes improve while costs go down—for both patients and healthcare providers. PCPs can be the change healthcare needs by moving away from the FFS model to a full-risk, value-based care, or full-risk capitation, approach. Bold ideas alone won’t inspire practices to move to the full-risk, value-based care model. We need bold physician leaders willing to enter the most underserved communities and provide better health and more health equity, at lower costs.
Washington Post: Can family medicine improve America’s mental health? (2/10) – Primary care providers are at the forefront of the nation’s deepening behavioral health crisis because when patients walk into a doctor’s office, they bring all their needs with them. A growing number of providers are integrating behavioral health and primary care to improve the continuity of treatment and lower barriers to access. Now, the federal government is trying to bring down those barriers, too, by awarding 24 medical schools and hospitals a total of $60 million to train the next generation of primary care physicians — family medicine doctors, pediatricians, internists — to address behavioral health needs.
Health Care Dive: Tipping point is in sight: Value-based care is driving meaningful financial results (2/10) – With 48 percent of the eligible Medicare population enrolled in Medicare Advantage plans and, the CMS committed to having 100 percent of enrollees in a value-based care program by 2023, the tailwinds are pushing at-risk arrangements forward in a big way. Health system leaders are also pushing it forward. At least five presenting CEOs at the JPMorgan conference said that taking on full risk gives them the freedom to do what is right for the patient. Not only does this encompass health care services as we typically think of them, but it also addresses housing insecurity, nutrition, and other social determinants of health. One CEO said that “taking risk for the health of underserved populations is the best way to provide the services that are needed.”
STAT: What a hospital oligopoly looks like (2/10) – By the most common measures of market concentration, the Orlando hospital market is a highly concentrated oligopoly. But those numbers didn’t surprise experts who have spent decades studying hospital consolidation. “The majority of geographic areas are dominated by one or two health systems. That is very typical,” added Martin Gaynor, a health economist at Carnegie Mellon University. But over the past two decades, hospitals have turbocharged their dominance by consistently acquiring other nearby hospitals and doctor practices. Research has repeatedly shown hospital consolidation leads to higher prices and no better quality for patients and workers. That’s because in places like Orlando, hospitals hold more negotiating leverage with health insurance companies.
Peterson-KFF Health System Tracker: Ongoing challenges with hospital price transparency (2/10) – In this analysis, we focus on the quality and usefulness of the hospital price transparency data. We find that currently the data are challenging to use for several reasons: specification of what services prices correspond with is inconsistent, especially for episodes of care; data quality can vary widely, with questionably low and high values for negotiated rates; and crucial pieces of information for interpreting the applicability of price are missing, such as contracting method and payer class. These challenges do not result necessarily from lack of compliance with the rule; rather, these findings highlight its shortcomings in facilitating price comparisons. The complexity of using the data is largely due to a lack of standardization and specification in the reporting requirements.
Commonwealth Fund: Value-Based Care: What It Is, and Why It’s Needed (2/7) – Value-based care ties the amount health care providers earn for their services to the results they deliver for their patients, such as the quality, equity, and cost of care. Through financial incentives and other methods, value-based care programs aim to hold providers more accountable for improving patient outcomes while also giving them greater flexibility to deliver the right care at the right time. Experts agree that these longstanding, widespread problems stem in part from the misaligned incentives built into the nation’s traditional, FFS payment model. Value-based care programs aim to change that dynamic, so physicians earn more for delivering health care that helps patients get better, while also keeping costs down.