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.
PEPC has worked to engage key members of Congress, expanding the list of congressional signers to an upcoming bipartisan letter to Congressional leaders. The letter emphasizes the need to prioritize reforming the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and establish a stable payment mechanism that appropriately pays for health outcomes. The letter will be sent mid-July.
Federal Trade Commission: (6/27) – The Federal Trade Commission released a proposed rule with changes to the Hart-Scott-Rodino (HSR) Form and accompanying instructions. The proposed changes are intended to enable the FTC to use resources more efficiently and effectively, primarily focusing on transactions that may harm competition. On average, the FTC estimates that proposed changes will increase merging entities reporting burden from 37 to 144 hours per filing.
Payment Model Technical Advisory Committee: (6/27) – The Physician-Focused Payment Model Technical Advisory Committee (PTAC) released a request for input on specialty integration in population-based models. PTAC is seeking information on stakeholders’ experiences related to improving specialty integration in population-based models, including nesting of episode-based or condition-specific models in population-based total cost of care models.
Congressional Budget Office: (6/26) – The Congressional Budget Office (CBO) sent a letter to Senate Budget Chair Whitehouse (D-RI) on CBO’s work related to climate change and health care delivery systems. The letter states that CBO is working to provide more information to Congress about the impact of delivery system reforms on overall trends in health spending, with a particular focus on policies aimed at improving the quality of care while controlling cost growth. CBO is currently assessing the impact of accountable care organizations.
Aledade: (7/3) – Aledade released a blog post, “Value-Based Care: The Proven Way to Tackle Growing Health Care Expenditures While Improving Patient Outcomes.” The post notes that, “with an aging population on the rise, the urgency of value-based care is becoming increasingly clear for our nation, and this new model of care also presents an opportunity for practices, health centers and clinics alike to deliver better care and make a big impact on total health care spend.”
California Medical Association: (7/3) – California Medical Association (CMA) highlighted that the nation’s physicians called for a multipronged campaign to overhaul the outdated Medicare payment system during the American Medical Association’s annual meeting. Physicians from across the country spoke of their intense frustration with the flawed payment formula and the need for Congress to fix it, warning that patient access and survival of practices are at risk.
Medical Group Management Association: (6/22) – Medical Group Management Association (MGMA) submitted a statement for the record following the Energy and Commerce hearing, “MACRA Checkup: Assessing Implementation and Challenges that Remain for Patients and Doctors.” Among its recommendations were that Congress:
Reform Medicare Part B to provide annual inflation-based physician payment updates based on the Medicare Economic Index;
Provide positive financial incentives to support practices transitioning into value-based care;
Oppose efforts to use sequestration and PAYGO rules to offset unrelated congressional spending to the detriment of Medicare providers; and
Advance policies that incentivize and reward Part B providers to reduce the total cost-of-care in the Medicare program.
Modern Healthcare: How shifts in primary care are influencing broader changes (7/5) – Some doctors now in practice also say they are burned out, facing cumbersome electronic health record systems and limits on appointment times, making it harder to get to know a patient and establish a relationship. Others are retiring or selling their practices. Hospitals and other corporate entities are on a buying spree, snapping up primary care practices. Patients who seek care at these offices may not be seen by the same doctor at every visit. Health policy experts say increased access to alternatives can be good, but forgoing an ongoing relationship to a regular provider is not, especially as people get older and are more likely to develop chronic conditions or other medical problems.
Politico: GOP Presses CMS on Doc Panel (7/5) – Congressional Republicans are angry that CMS has ignored recommendations from the Physician-Focused Payment Model Technical Advisory Committee. The criticism is the latest levied by Republicans on the Center for Medicare and Medicaid Innovation. They have complained that savings from the center’s payment models are sparse and the process for model approval not transparent. Congress could introduce reforms to CMMI as part of an overhaul of MACRA. A subcommittee of the House Energy and Commerce Committee held a hearing on the issue in June, but prospects for action this year are dim.
Medical Economics: How AI can add value to value-based care (6/29) – With all the recent buzz around generative artificial intelligence (AI) related to ChatGPT, it's reasonable to have mixed reactions to emerging technologies. However, many AI technologies — including optical character recognition, natural language processing and machine learning — are widely established and have proved highly reliable in driving health care innovation for payers, providers and patients. AI has enormous potential to accelerate value-based care models and is already critical for success in risk adjustment, quality improvement and member management programs. Employing AI-driven technology ensures accurate and timely compliance with industry regulations, mitigates audits and fines, and helps forecast accurate reimbursements.
Healthcare Dive: Primary care compensation growth outpacing other specialties (6/29) – Medical groups and healthcare organizations reported a 6.1 percent increase in primary care compensation in 2022 compared to 2021 in the AMGA’s most recent compensation survey published on Wednesday. That’s compared to 1.5 percent and 1.6 percent increases for medical and surgical specialties, respectively. The nation’s primary care workforce has shrunk in size in recent years due to rampant consolidation, closures and neglect that only worsened during the pandemic. By one estimate, America’s primary care practices lost over $15 billion in 2020 during a catastrophic plummet in patient visits. Declining financial health has pushed practices to consolidate or close altogether. By one estimate, the country could be short by as many as 55,000 primary care doctors by 2032. Congress is currently debating changes to existing physician payment systems to better nudge providers toward value-based models and provide more reliable reimbursement.
Modern Healthcare: New payment models test ability to identify underserved communities (6/28) – Last year, CMS started using the area deprivation index to adjust payment rates and quality incentives in some models to encourage participating providers to offer care to disadvantaged populations. CMS has incorporated the tool into ACO REACH and the Medicare Shared Savings Program and is considering adding it to Medicare Advantage Star Ratings. Regulators are monitoring the implementation of the benchmarking methodology and will make adjustments based on evidence that arises within each model, a CMS spokesperson wrote in an email. "CMS is aware of concerns some providers have shared with the use of the ADI and is examining other variables that might be added to the composite measure used in ACO REACH," the spokesperson wrote.
Fierce Healthcare: MA enrollees see fewer inpatient stays, ER visits than those in traditional Medicare: report (6/28) – Medicare Advantage beneficiaries have fewer inpatient hospital stays and emergency department visits than beneficiaries in traditional fee-for-service (FFS) Medicare, according to a report by Avalere Health. In addition, MA beneficiaries have fewer chronic conditions, according to the analysis. The report looks at hypertension, hyperlipidemia and diabetes and compares the two populations in terms of clinical problems, utilization, spending and outcomes related to those conditions. Researchers found that MA serves a higher population of individuals with clinical and social risk factors, and more racial or ethnic minorities (28.1 percent in MA; 12.8 percent in FFS).
D Magazine: One Procedure, Two Prices: Is Site Neutrality the Next Healthcare Reform? (6/27) – Health care reformers have set their eyes on ensuring that the federal government pays the same price for procedures no matter where they happen. Called site neutrality, advocates see the price discrepancies as an inefficiency that needs fixing, while hospital advocates say reimbursement reductions would devastate the care they provide. According to the CBO, payment to hospital outpatient departments is set to grow faster than other segments of the health care industry. The CBO predicts a 100 percent increase in Medicare payments to hospital outpatient departments between 2020 and 2030. Medicare payments for inpatient services are expected to grow by about 42 percent, and payments to physicians are predicted to grow by 28 percent. Even as state-level reforms fall short, momentum is building at the federal level to significantly expand site-neutral policies, pitting policymakers and payers against the hospital lobby.
Modern Healthcare: Healthcare deals may slow under FTC proposal (6/27) – Health care companies pursuing mergers would have to disclose more information about the transactions under a new FTC proposal that could slow health care deal-making. The antitrust agency voted Tuesday to publish a proposed rule that would, in part, require merging parties to disclose any minority investors in an effort to weed out any conflicts of interest; information about prior acquisitions; supplier agreements; subsidies from foreign entities, and workforce data, including information on executives and board members. The proposal is part of the federal government's effort to clamp down on anticompetitive mergers and acquisitions. The FTC is in the process of updating its merger guidelines, which will factor in worker-specific impacts of transactions, among other issues.
Modern Healthcare: New research may sway physician-owned hospital debate (6/26) – Physician-owned hospital prices were about a third lower than at traditional hospitals in the same market, a study found, potentially fueling debate over legislation that would remove the ban on building more physician-owned hospitals. Estimated prices negotiated between hospitals and commercial insurers for eight common procedures were 33.7 percent lower at physician-owned hospitals compared with traditional hospitals in their markets, according to a peer-reviewed analysis of more than 150 physician-owned and 1,100 non-physician-owned hospitals. Sen. Lankford (R-OK), along with a dozen other Republican senators, introduced a bill in February that would allow new physician-owned hospitals and permit them to participate in Medicare and Medicaid. Rep. Burgess (R-TX) led the legislation’s introduction in the House.
Axios: States look to crack down on health care mergers (6/26) – California and New York are among the states that are heightening scrutiny of health care mergers, by giving attorneys general the ability to block deals or creating new processes to review whether certain acquisitions could drive up costs or lead to the elimination of services. The activity could augment the work of the Justice Department and FTC, which are increasingly focused on anticompetitive behavior in the sector but usually limits merger reviews to deals valued at more than $101 million. Starting in January, California companies will have to give a state entity created last year called the Office of Health Care Affordability 90 days notice of deals projected to be finalized on or after April 1, 2024.
JAMA Viewpoint: Medicare Physician Payment in Need of Major Repair (6/22) – The physician payment system needs repair. The growing gap between practice costs and payment rates, exacerbated by the COVID-19 pandemic, resurgent inflation, and commercial payers’ decreasing and distorting RBRVS values, has stretched many practices to their limits and likely accelerated market consolidation. Medicare payment rates have lagged inflation for two decades, and the blame falls squarely on Congress. Physicians have experienced a relentless demand to increase productivity, leading to shortened patient visits, growing burnout, and even moral injury. Both CMS and commercial insurers have failed to implement dozens of voluntary, innovative alternative payment models shown to improve value and free physicians to advance quality care.
Medical Economics: MACRA gets checkup from Dr. Congress (6/22) – In written testimony to the subcommittee, Aisha Pittman, National Association of Accountable Care Organizations (NAACOS), called MACRA “a step in the right direction,” but said “more needs to be done to drive long-term system transformation.” Among NACCOs’ recommendations for encouraging more participation in APMs were to:
Develop a long-term approach that provides adequate provider payment and provides incentives to participants in APMs, and Advanced APMs;
Better align the incentives between Medicare Advantage (MA) and APMs in traditional Medicare so that APMs can provide comparable benefits to those offered MA patients, such as telehealth visits, transportation benefits, and home visits; and
Ensure that new payment models developed by the Centers for Medicare and Medicaid Services Innovation Center have a more predictable pathway for being implemented and are not discarded due to overly stringent evaluation criteria.