News Clips
Health Affairs: Where Does Health Policy Go From Here? Federal Legislative Priorities For 2023 (3/1) – Congress also signaled interest in continuing to support the move to value-based payments. A bipartisan group of representatives requested information about possible updates to the Medicare payment reforms set up in MACRA. In addition, as part of the 2022 omnibus, Congress extended MACRA’s incentive payments for alternative payment models (APMs) for an additional year, although at a lower rate. Congress could also take up unfinished business around helping consumers use their coverage better. In the last Congress, the House passed—by voice vote—a bill to require an electronic prior authorization process within Medicare Advantage plans and greater transparency to make enrollees’ health care services more seamless.
Fierce Healthcare: Aledade notches another acquisition, adds 450 practices to growing network as the primary care market heats up (2/28) – As investment in value-based primary care heats up, Aledade picked up value-based care analytics company Curia to build out its tech capabilities. The acquisition will enhance Aledade’s ability to extract insights from disparate data sources, provide more accurate predictions using past data and optimize primary care workflows through AI algorithms, according to executives. Aledade now boasts it is the largest network of independent primary care in the country, with more than two million patients covered by more than 150 value-based contracts across Medicare, Medicare Advantage, Medicaid and commercial payers.
BCBSA: Delivering Lower Costs for Patients and Taxpayers Through Site-Neutral Payment Reform (2/28) – To lower health care costs and generate a combined $471 billion in savings over ten years for the federal government, private health insurance premiums and— most importantly—consumers’ out-of-pocket costs, BCBSA recommends that Medicare adopt site-neutral payment policies for services that are commonly delivered outside the hospital—excluding rural facilities—at the lower payment rates applicable in non-hospital settings. Medicare’s move to expand site-neutral payments will smooth the way for private plans to also implement site-neutral payment policies.
Health Affairs: Value-Based Care And A Path To Achieve Comprehensive Care In The Safety-Net (2/28) – This Forefront
article demonstrates how safety-net providers can and do succeed in value-based payment (VBP) models with the support of multi-stakeholder alignment and conducive policy environments. Safety-net providers, especially smaller providers, often lack the capital and technical expertise needed to transition successfully into VBP and take on risk. Moreover, safety-net providers often experience long delays in payment reconciliation, which is challenging without reliable cash flows. Additionally, compared to other providers, safety-net organizations lack equal access to technology platforms to facilitate data sharing. Policymakers have retooled models to increase upfront funding.
JAMA: Association of Evaluation and Management Payment Policy Changes With Medicare Payment to Physicians by Specialty (2/28) – US primary care physicians (PCPs) have lower mean incomes than specialists, likely contributing to workforce shortages. In 2021, CMS increased payment for evaluation and management (E/M) services and relaxed documentation requirements. Among US office-based physicians receiving Medicare payments in 2020 and 2021, E/M payment policy changes were associated with changes in Medicare payment by specialty, although the payment gap between primary care physicians and specialists decreased only modestly (two percent reduction). If policy makers want to shrink the primary care/specialist pay gap, they may need to focus on broader changes to Medicare’s physician payment policies and other tools such as primary care payment reform that are explicitly targeted to primary care physicians.
STAT: Government antitrust officials consider letting physician-owned hospitals expand (2/27) – Some government antitrust regulators are hinting at their support for expanding physician-owned hospitals, another sign of the Biden administration’s increasing scrutiny of consolidation among the nation’s health systems. The subject came up in a paper about physician-owned hospitals written by a notable list of authors, including antitrust lawyers from the DOJ and the FTC. The authors argue that lifting an Obamacare provision that keeps physician-owned hospitals from getting paid by Medicare or Medicaid would go a long way toward alleviating the problems that arise from hospital consolidation because doctor-owned facilities compete against large hospital systems and help control prices.
STAT: Nonprofit hospitals are failing Americans. Their boards may be a reason why (2/27) – A study
published in the Journal of General Internal Medicine examined the professional backgrounds of the board members at 15 of U.S. News & World Report’s 20 highest-ranked hospitals, all nonprofit academic medical centers. These 15 publicly listed the 529 members on their boards. Forty-four percent came from the financial sector, representing investment funds, real estate, and other entities. Less than 15 percent were health care workers: 13.3 percent were physicians and 0.9 percent were nurses. That we couldn’t find a list of board members for five of the top 20 hospitals demonstrates a potential lack of transparency. Patients, health care workers, and community members have few mechanisms to hold nonprofit hospital leaders accountable.
National Association of Community Health Centers: Closing the Primary Care Gap (2/27) – Both primary care providers and specialists are more concentrated in highly populated urban areas that are home to higher income, majority-insured populations. This pattern leaves fewer providers to care for rural communities that are more sparsely populated and may have a lower median household income. A variety of factors are also leading to consolidation, and clinic closures across the landscape of primary care practices are exacerbating the problem of unequal distribution. Some areas where this has occurred are left with one primary care practice, if any, to serve an entire county. Providers who remain in these communities can only appropriately treat a limited number of people; the remaining population must negotiate distance, time, and cost barriers to find health services outside their local community. These barriers lead to delays in care, poorer health outcomes, and wider health disparities.
Americans for Prosperity: New report shows how government rules deny Americans access to hospital care and other health care services (2/27) – AFPF’s new report, “Permission to Care,” highlights the harmful impact that certificate of need (CON) laws in eight states have had over the last few years. In each, AFPF discovered that CON application denials have caused health care need to go unfulfilled, quashed millions or billions of dollars in ready-to-go health care investments, or both. One of the most common obstacles to derail CON applications only adds insult to the injury: opposition from existing providers who fear new competition. And the victims are often the most vulnerable and at-risk human populations.
Healthcare Dive: Partisan gridlock shouldn’t threaten true value in healthcare – op-ed by Mike Pykosz, CEO of Oak Street Health (2/24) – But, there is one area upon which both parties have long agreed: value-based care, the idea that providers should be rewarded for patient health outcomes, rather than the number of services they provide. These models create incentives for more preventative care and stronger provider relationships — all while driving down unnecessary costs and improving health outcomes. Because value-based care results in lower costs, and therefore net savings to the government, taxpayers ultimately benefit alongside patients. And, politically, improving value-based care is something that meets the health care priorities of both parties. We have been nurturing value-based models as the solution to many of our longstanding health challenges over the years, and now we’re on the cusp of seeing real impact. Measured reforms that strengthen the programs and create regulatory certainty offer wins to both sides of the aisle and, most importantly, a win for our rapidly aging population desperately in need of better care.
RevCycle Intelligence: NAACOS, AMA Push for Long-Term Value-Based Care Efforts (2/24) – Twelve health care organizations, including the American Academy of Family Physicians (AAFP) and Medical Group Management Association (MGMA), have urged congressional leaders to engage with stakeholders and consider long-term approaches for furthering value-based care. The organizations sent a letter
to Senate Finance Committee Chair Wyden (D-OR) and Ranking Member Crapo (R-ID) and House Energy and Commerce Committee Chair Rodgers (R-WA) and Ranking Member Pallone (D-NJ). The organizations highlighted the importance of removing barriers to APM participation, as these models can help improve care coordination delivery. Reducing regulatory burdens with flexibilities and waivers for clinicians moving to risk would also help advance value-based participation, the groups wrote. The letter asked the lawmakers to provide a broader pathway for more clinician types to engage in APMs. Congress should work with the CMS Innovation Center and direct CMS to redesign its evaluation strategies to isolate specific innovations while controlling for other variables.
Health Affairs: Accountable Care In 2023: Evolving Terminology, Current State, And Priorities (2/24) – Accountable care is still a work in progress, and must be complemented by reinforcing policy reforms to make real progress toward these person-centered goals. Building on trends to date, there are a range of policy areas that could accelerate progress in expanding access to accountable care. We highlight four major policy priorities here. (1) Making investments in accountable care more attractive relative to FFS-based care. (2) Advancing health equity through accountable care, including through the ACO REACH model. (3) Integrating specialty care and engaging specialist providers in accountable care. (4) A clearer pathway for multipayer alignment to reduce administrative burdens and increase the impact of accountable care reforms.
Wall Street Journal: Modernize Medicare Without Cutting Benefits or Raising Taxes – op-ed by Bobby Jindal and Newt Gingrich (2/23) – First, establish site-neutral payment policies. Medicare pays hospitals more than independent outpatient facilities, such as surgery centers, to perform the same procedures. This creates an incentive for medical systems to purchase independent practices so they qualify for the higher, hospital level reimbursement. There are legitimate reasons why someone with high comorbidities would need to have a procedure done in a hospital rather than a surgery center, but we can fairly compensate hospitals for these special cases through a risk-adjustment program. The Department of Health and Human Services estimates this plan would be budget neutral. The Committee for a Responsible Federal Budget estimates that establishing site-neutral payment policies would reduce Medicare spending by more than $150 billion and save seniors nearly $100 billion in premiums and cost sharing over 10 years.
Becker's Hospital Review: Senators introduce bill to expand physician-owned hospitals (2/22) – A proposed bill in the U.S. Senate would expand the rights of physician-owned hospitals — including some privileges that were rescinded more than a decade ago. Sen. Lankford (R-OK) has reintroduced the Patient Access to Higher Quality Health Care Act, alongside several other Republican lawmakers. If passed, the law would remove the Affordable Care Act's ban on the creation and expansion of new physician-owned hospitals, which has been in place since 2010. Mr. Lankford and Brian Miller, MD, a practicing hospitalist and assistant professor of medicine at the Johns Hopkins University School of Medicine in Baltimore, argued the bill would increase competition in a Feb. 20 opinion piece
for The Wall Street Journal.
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