News Clips
Forbes: (4/12) – Attend any healthcare conference and you’ll quickly discover that it’s become downright fashionable for healthcare leaders to talk about their unwavering commitment to “value-based care.” The expression has become ubiquitous in healthcare circles. But in an era when many “value-based groups” are backed by venture capital, owned by private equity firms, or publicly traded, is the decision to deny a specialist referral or the latest new pharmaceutical being made to optimize care or to protect quarterly earnings?
Healthcare Dive: (4/12) – U.S. nonprofit hospitals often get tax breaks worth far more than they spend on charity care and community investment, according to a new report from the Lown Institute. Prominent systems such as Providence, Trinity Health, Mass General Brigham and the Cleveland Clinic had some of the largest of these "fair share deficits," the healthcare think tank said. The Lown Institute found 227 of the 275 hospital systems it studied spent less on charity care and community investment than the value of their tax exemptions.
Modern Healthcare: (4/11) – A big Chicago-area doctor’s group and its private-equity backers are squaring off with a downstate hospital in a fight with potentially big implications for Illinois’ healthcare industry. Blessing Health System, a nonprofit three-hospital chain based in Quincy, opposes neighboring Quincy Medical Group’s plan to build a “small format” nonprofit hospital 2 miles from Blessing’s Quincy hospital, which is a so-called “safety-net” facility serving many Medicare and Medicaid patients. Blessing is urging Illinois hospital regulators to block QMG’s plan, arguing the proposed hospital would siphon off profitable surgeries and privately insured patients that keep Blessing afloat financially.
Reuters: (4/11) – For health care providers and payers, changes to the Stark Law, the Anti-Kickback Statute, and the reimbursement landscape encourage providing care that addresses social determinants of health for certain patient populations. Research shows that when medical care is delivered alongside non-medical services that affect health, patients, providers, and the health care system overall are better off. New opportunities in the fraud and abuse laws for value-based arrangements and payments for non-medical services to address social determinants of health have opened the door for innovation.
Health Leaders Media: (4/11) – The National Association of ACOs (NAACOS) has created a task force, aimed at developing recommendations to meet electronic clinical quality measures (eCQMs). CMS has set federal benchmarks on digital quality but the goal is challenging for ACOs who often work with a variety of electronic health record (EHR) platforms and healthcare sites. A NAACOS survey taken last year found that more than three-quarters of ACOs are working with at least six EHRs, and 37 percent are using data from at least 15 EHRs.
Healthcare Finance News: (4/8) – Healthcare mergers and acquisitions data shows only 12 transactions recorded during the first quarter of the year, continuing a downward trend: To date, it's the lowest number of consolidations since Kaufman Hall first started tracking these statistics in 2016. What's more, most of the 12 deals were smaller transactions, according to the firm's newest data. This trend is a departure from previous quarters, when high-priced "mega" mergers offset the declining number of deals in terms of the sheer dollars being transacted.
Modern Healthcare: (4/8) – Medicare pay advisors said Friday they have zeroed in on a strategy to streamline Medicare alternative payment models, which includes removing the ratcheting effect that makes earning shared savings increasingly difficult for accountable care organizations. The Medicare Payment Advisory Commission (MedPAC) suggested reducing the number of risk tracks in population-based models. Providers currently have seven tracks to choose from, with five in the Medicare Shared Savings program and two in the ACO REACH model.
AAMC: (4/8) – In last week’s MedPAC meeting, commissioners discussed preferences for improving CMS’ portfolio of APMs, following last years’ recommendation to Congress that the agency adopt a more harmonized portfolio of models. They discussed a potential set of principles for allocating savings and losses between ACOs and providers in episode models to balance the incentives in each model. Commissioners provided feedback on how to ensure participation in episodes does not discourage ACO participation, while acknowledging the successful care delivery improvements driven by episodic payment tests.
Fierce Healthcare: (4/8) – A federal grand jury originally indicted Denver-based DaVita and its ex-CEO on three counts of conspiring with competing employers not to hire one another's senior-level employees. DaVita and Thiry allegedly struck anti-poaching agreements with two other healthcare companies. The Department of Justice (DOJ) contends that the agreements are anti-competitive and violate the Sherman Antitrust Act. It's the first-ever criminal trial for labor-related antitrust violations.
American Journal of Managed Care: (4/7) – At a recent conference, Dora Hughes, Chief Medical Officer for CMMI, spoke to how the agency is trying to understand how factors like recruitment, payment, and care delivery are geared towards promoting health equity. She also said CMMI is trying to recruit safety-net providers, including independent providers, federally qualified health centers, rural health clinics, or behavioral health clinics, “in part because we need to increase the number of beneficiaries from underserved populations who are participating in our models." “The key to getting to more diverse beneficiaries is by increasing safety-net providers in our models,” Hughes said.
Health Affairs: (4/6) – The forthcoming ACO Realizing Equity, Access, and Community Health (REACH) model makes several foundational advances required for promoting equity through payment model design. These advances include intentional planning on how participants will improve health equity, collection of data on individual-level social determinants, and use of financial incentives directly tied to equity. In this article, the authors outline how the REACH model takes several foundational steps needed to prioritize equity in health care payment. The authors also describe the work that we believe still needs to be done.
Healthcare Finance News: (4/6) – Intermountain Healthcare, headquartered in Salt Lake City, and Colorado-based SCL Health, have finalized their merger after getting official approval from the Colorado attorney general's office. The AG's office issued an opinion allowing the merger to proceed. The combined nonprofit health system will adopt the moniker of Intermountain Healthcare, and will encompass 33 hospitals and 385 clinics spread across six states, with roughly 58,000 employees.
American Journal of Managed Care: (4/5) – In his most recent column, Michael Chernew discusses the issue of continuous testing of CMMI models. Chernew said many of the ACO models are being tested to find changes to make to the Medicare Shared Savings Program, but there is a general problem with short-lived models ending and being replaced by new ones.
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