RevCycle Intelligence: The Most Successful Alternative Payment Models from CMMI, To Date (12/13) – CMMI has launched more than 50 alternative payment and care delivery model tests, with 33 models now or still operational, according to CMMI’s sixth report to Congress on its progress. To date, six model tests have delivered statistically significant savings. Further, two of those six models have shown significant improvements in quality and four have met the criteria to be eligible for expansion. CMMI plans to broaden the definition of success for its models, adding metrics around health equity, person-centered care, and health system transformation.
Fierce Healthcare: Value-based payment system shortchanges PCPs, says study (12/13) – The Medicare Merit-based Incentive Payment System (MIPS) unfairly penalizes physicians caring for a patient population with more complex medical needs, according to a study in JAMA Network. In a cross-sectional study of 80,246 primary care physicians, researchers concluded that “MIPS scores were inconsistently related to performance on process and outcome measures, and physicians caring for more medically complex and socially vulnerable patients were more likely to receive low MIPS scores, even when they delivered relatively high-quality care.” The MIPS program, as currently structured, also has the potential to exacerbate health inequities, the study said.
Medical Economics: Fighting burnout through value-based care (12/12) – The transition from fee-for-service or volume-driven health care to value-based care is a clear path to helping alleviate the conditions that create physician burnout. With other care delivery models, providers are incentivized to treat as many patients as possible, impacting their ability to engage patients and provide appropriate care. Value-based care puts more emphasis on coordination and prevention, which better aligns with the values of most primary care physicians. Compared to fee-for-service care, value-based care allows providers to be more intentional about the care they provide for their patients. They can be more attentive during appointments, better manage their time and build trust with patients, while not having to worry about meeting a quota of patients to ensure payment. This can enhance the quality of care and lessen the workload providers must manage, helping alleviate burnout.
RevCycle Intelligence: Providers Leaving No Stone Unturned to Stop Medicare Payment Cuts (12/12) – Health care industry groups representing over 1 million physicians and other clinicians have joined together to urge Congress to prevent a 4.5 percent Medicare payment cut starting Jan. 1, 2023. “This desperately needed relief will help provide crucial short-term financial stability for practices until permanent, bipartisan payment reforms are enacted,” says a letter organized by the American Medical Association (AMA) and signed by all 50 state medical associations. The letter was sent to House leaders Nancy Pelosi and Kevin McCarthy, as well as Senate leaders Chuck Schumer and Mitch McConnell. A letter circulated in early November and led by Sens. Stabenow (D-MI) and Barrasso (R-WY) urged Congress to address the looming Medicare payment cuts to ensure continued patient access to care. Bipartisan legislation is on the table, with the Supporting Medicare Providers Act of 2022 looking to avert the 4.42 percent cuts to the Medicare physician pay rate.
Healthcare Dive: Variability in Medicare direct contracting savings illustrates promises, pitfalls of value-based care (12/12) – Direct contracting entities in the GPDC Model had a roughly two percent net savings rate on average, with a few major outliers, according to a Healthcare Dive analysis of recently released data from the CMS. Overall, the 53 DCEs generated $70 million in net savings for Medicare in 2021, according to the financial and quality results. In a positive sign for value-based care buy-in, GPDC grew to 99 participants with an estimated 1.8 million beneficiaries in the 2022 performance year. Many of those organizations are expected to stay on when the model transitions to ACO REACH in 2023.
Healthcare Innovation: Vermont All-Payer ACO Makes Progress on Cost, Quality Goals (12/9) – The second evaluation report on Vermont’s All-Payer ACO Model (VTAPM) Agreement found that although the pandemic and a cyberattack on the University of Vermont Health System posed unique challenges in 2020, the Medicare ACO initiative continued to reduce spending and utilization in payment year 3 relative to a comparison group. The initiative also continued to see progress toward population health improvement goals. As hospitals and providers gain more experience and continue to address the challenges they have faced, the report says, the VTAPM may have a stronger impact on spending, utilization, and quality of care.
STAT: If you think health care is dysfunctional now, just wait until after January 1 (12/8) – As an emergency medicine doctor, I find myself increasingly having to address problems that would better be served by a primary care physician. It’s a shame that primary care physicians are so undervalued by the U.S. health care system’s reimbursement structure, because the work they do is so important. In addition to being important for patients, this work is also incredibly cost-effective. When factored in with other projected Medicare cuts, the total cuts physicians can expect to see are closer to 8.5 percent. The downstream effects of Medicare’s cuts would be devastating. There is still time to act. Congress has the power to avert these pay cuts and there is currently a bill in the U.S. House of Representatives, the Supporting Medicare Providers Act of 2022 (H.R. 8800), aimed at doing just that.
Health Affairs: The Longitudinal Impact Of A Multistate Commercial Accountable Care Program On Cost, Use, And Quality (12/7) – This study assessed the performance of ACOs in a large commercial population over the course of an extended period, adding a broad multistate view to prior commercial plan studies. We found that contracting with the ACO was associated with incremental cost savings, particularly in the fully insured population. Furthermore, providers were associated with superior or equivalent performance across all quality measures, suggesting that the observed cost savings did not compromise the quality of care.
STAT: Deferral of primary care signals a troubled future for Americans’ health (12/7) – Primary care visits are down 10.3 percent on average across U.S. cities relative to pre-pandemic levels. The negative ripple effects of patients not engaging in routine primary care are evident. From a public health perspective, health care delivery organizations and health care stakeholders in both the private and public sectors should be educating Americans about the importance of preventive care. Traditional health care providers, as well as new entrants must also find ways to reach and engage patients who remain reluctant to seek routine care. Health care providers need to act now to get people back on track and engaged with their care, which starts by better understanding and meeting the needs of the various patient populations and markets they serve.
Urban Milwaukee: Stop the Hospital Merger Mania (12/7) – Analyses of post-merger effects always uncover major price increases to the customers. The higher prices come with no discernible increase in quality. The rising cost/prices are killing the budgets of businesses and households, which are the ultimate payers of both the public and private sectors of health care in America. Health care bills are the leading cause of personal bankruptcy in the country. Dr. Jesse Ehrenfeld, senior associate dean of the Medical College of Wisconsin and president-elect of the American Medical Association, recently co-wrote: “Research clearly demonstrates the ills of monopoly – hospital consolidation leads to higher insurance premiums, higher prices for hospital services, higher consumer cost-sharing, all the while generating reductions in patient experience. Consequently, boosting competition in the hospital market is a worthy objective for the next Congress.”
Economic Opportunity Institute: Controlling Health Care Costs in Washington (12/7) – A lack of governmental regulation, as well as increasing market consolidation and a lack of transparency, drive our health care costs to exorbitant proportions. Hospitals and providers are increasingly merging under unified ownership. Consequently, they are more able than ever to exert significant leverage and set prices for services and products to maximize revenue, rather than based on operating costs to provide quality and accessible care. Federal agencies such as the Federal Trade Commission lack the capacity, resources, and regulatory authority to effectively evaluate and curtail potential harmful effects of health system mergers and acquisitions, which are very difficult to reverse once in place.