Welcome to this week's edition of the 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: (2/12) - CMS announced, in accordance with the Executive Order signed by President Biden, that the Special Enrollment Period (SEP) for the Health Insurance Marketplace would be available to consumers beginning February 15 and would continue through May 15, 2021. This will be available in 36 states that use the HealthCare.gov platform, and 13 states and D.C. that operate their own Marketplace platforms plan to offer a similar opportunity.
White House: (2/10) - On February 10, President Biden and Vice President Harris announced members of the Administration’s COVID-19 Health Equity Task Force. The Task Force is chaired by Dr. Marcella Nunez-Smith.
White House: (2/9) - President Biden announced that starting February 15, Federally Qualified Community Health Centers (FQHCs) will begin directly receiving vaccine supply. The initial phase will include at least one Community Health Center in each state, expanding to 250 centers in the coming weeks. Information
Protecting Providers Everywhere (PPE) in American Act: (2/12) - Sens. Durbin (D-NJ) and Cassidy (R-LA) introduced the Protecting Providers Everywhere (PPE) in America Act (S. 308), which would establish a pilot program to address shortages of testing equipment and personal protective equipment through enhanced domestic production.
House Ways & Means Committee: (2/11) - The House Ways & Means Committee completed two days of markups and passed its portion of the FY2021 budget reconciliation bill. The bill includes several health provisions, including supporting health coverage and improving health care affordability, and protecting the elderly and stopping the COVID-19 virus in nursing homes.
H.R. 1025: (2/11) - Reps. Schrier (D-WA), Castor (D-FL), and Fitzpatrick (R-PA) introduced legislation (H.R. 1025) which would renew the application of the Medicare payment rate floor to primary care services furnished under the Medicaid program.
Retirement Freedom Act: (2/8) - Sens. Cruz (R-TX) and Paul (R-KY) introduced the Retirement Freedom Act (S. 275), which would allow individuals to choose to opt out of the Medicare part A benefit. Bill text
IMPACT to Save Moms Act: (2/8) - Rep. Schakowsky (D-IL) and 33 cosponsors introduced the Innovative Maternal Payment and Coverage To (IMPACT) Save Moms Act (H.R. 950), which would require the Secretary of Health and Human Services to establish and implement a Perinatal Care Alternative Payment Model Demonstration Project. One-pager
Politico: (2/15) - To build confidence in the COVID-19 vaccine, practitioners and vaccine advocates alike are trying to coordinate advocacy campaigns to dispel misinformation about the vaccine. This led members of the California Medical Association to create the grassroots #ThisIsOurShot social media campaign, where health care workers shared their experiences receiving the vaccine with the goal of increasing vaccination rates and dispelling misinformation.
AAFP: (2/15) - On February 10, AAFP wrote a letter to Congressional committee leaders calling for legislative action to bolster and improve access to primary care. As the committees began budget reconciliation processes to enact President Biden’s American Rescue Plan, the letter urged Members of Congress to strengthen primary care by concentrating on Medicaid payment, the primary care workforce, and relief for high-deductible health plan enrollees.
Apple Podcasts: (2/11) - In the latest Medicine Curated podcast, Florida Medical Association (FMA) CEO Tim Stapleton talks with Dr. Kelly Tice Wells, an FMA member and Medical Director of Medical Affairs for Florida Blue, about her work in health equity and how her public health background informs what she does today. Dr. Wells also talks about what physicians can do to reassure their patients who have concerns about receiving the COVID-19 vaccine, stating that patients trust their doctors and want to go to physicians with whom they have a relationship for guidance.
Health Business Group: (2/11) - In this episode of the HealthBiz podcast, Aledade Chief Medical Officer Dr. Emily Maxson discusses the role of primary care and how physicians have fared during the pandemic, as well as her hopes for the future.
The New York Times: (2/10) - As the vaccine distribution rollout continues, primary care providers have felt increasingly frustrated and excluded from efforts to help vaccinate more individuals. Aledade CEO Farzad Mostashari has witnessed the struggle to get his patients vaccinated. He emphasized the importance of using the systems patients normally utilize to receive vaccinations, which is primary care doctors patients know and trust. Several primary care practitioners have expressed similar sentiments, expressing the need for individual practices to be involved in the process.
KOLD News 13: (2/16) - Primary care doctors in Arizona want to help seniors who have struggled to make online appointments to receive the COVID-19 vaccine, saying that making vaccine doses available in their offices would aid in this process. Patients have turned to their primary care doctors to receive answers to their questions about vaccine distribution, emphasizing the importance of getting vaccines into the hands of primary care physicians that patients typically receive immunizations from.
Fierce Healthcare: (2/16) - Primary care practices are doing what they can to support their patients in receiving the COVID vaccine, including by referring patients to a known source for where to get the vaccine and sharing educational information with patients. A survey revealed that 30 percent of doctors are proactively notifying their patients on how to get the vaccine. Primary care practices are growing increasingly concerned about being left out of the vaccine distribution process, as it has the potential to put patients’ health at risk.
Revcycle Intelligence: (2/16) - More managed care organizations are turning to capitation reimbursement models to transition to value-based care. One such kind of capitation model is primary care capitation, which refers solely to primary care clinical services and ties reimbursement to a predetermined set of services.
Medical Economics: (2/15) - In this article, Texas Area Medical Director for Partners in Primary Care Patricia Hayes, MD states that for value-based care to succeed, the leadership charged with implementing it must fully commit to doing it right. This involves properly staffing and resourcing a care team to carry out value-based care and educating physicians starting in medical school on value-based care models.
Healio: (2/11) - New survey data from the Larry A. Green Center and the Primary Care Collaborative found that one in four primary care clinicians and eight in ten practices were ready and willing to participate in vaccine distribution, despite challenges with receiving the vaccine, pandemic-related staffing shortages and financial concerns. The survey also found that one in three primary care providers are not part of state and regional vaccine rollout planning efforts.
Managed Healthcare Executive: (2/11) - The Next Generation ACO program was scheduled to end in 2020, however was given a one-year reprieve as a result of the COVID-19 pandemic. Groups such as the National Association of ACOs (NAACOS) are advocating for CMS to permanently extend the program given the savings the model has generated for the Medicare program, with $204 million in net savings generated in 2019.
Inside Health Policy: (2/11) - Democrats on the House Energy & Commerce Committee rejected an amendment to the committee’s budget reconciliation legislation from Rep. Guthrie (R-KY) that would have provided an additional $35 billion in provider relief funds, including $5 billion for Medicaid and rural providers. Chair Pallone (D-NJ) stated he did not want to take any money away from other elements in the relief package such as vaccines and testing.
AJMC: (2/11) - This study looked at key characteristics of outcomes-based quality measures to inform future Alternative Payment Models (APMs) that are more patient-centered. The study explored gaps in current APM quality measures and engaged multiple stakeholders to identify and prioritize key characteristics of measures to guide future APM development. A framework was recommended to guide deliberations among payers, providers, patients, and other APM stakeholders when selecting outcomes-based measures for future APMs or value-based models.
Revcycle Intelligence: (2/10) - A new Urban Institute study found that Medicaid physician reimbursement rates are significantly lower than commercial payer and Medicare payments for the same services, despite growing enrollment in the program. Medicaid physician reimbursement was 72 percent of Medicare physician reimbursement for 27 common procedures in 2019, with primary care experiencing a lower Medicaid-to-Medicare physician fee index of 0.67 compared to 0.72 for other services.
Revcycle Intelligence: (2/10) - As the US enters its second year of the COVID-19 pandemic, one way that can help primary care providers maintain financial stability is through targeted federal relief given the financial challenges such practices have faced as a result of the pandemic. A brief by the Robert Wood Johnson Foundation and Urban Institute found that the Provider Relief Fund did little to help independent primary care practices, which instead relied more on funding from the Paycheck Protection Program and advanced Medicare reimbursements. Additional targeted funds could help support providers most in need and ensure primary care practices have the resources needed to provide care.
Modern Healthcare: (2/10) - Due to concerns that it could lead to confusion among Medicare beneficiaries and operation and financial challenges for providers, advocates are calling for CMS to delay the implementation of the Geographic Direct Contracting model (“Geo”) until these issues are resolved or addressed. Experts weighed in with concerns about overlap among payment models and its potential to cause confusion for beneficiaries and providers, as well as concern over the potential for duplicative care or competing care management programs within DCEs.
Bloomberg Law: (2/10) - Elizabeth Fowler, who formerly worked in the Obama administration and helped draft and implement the Affordable Care Act, has emerged as a top contender to lead the CMS Innovation Center (CMMI) to continue the focus on shifting the health care system toward value-based care.
AJMC: (2/10) - America’s Health Insurance Plans recently held a webinar on the value-based insurance design (VBID) model and outlined key goals and guidelines for those looking to implement the model. Mark Atalla, who led the VBID model at CMMI, discussed the expansion and growth of the model over the last six years, noting that the model now provides targeted benefits to 1.6 million beneficiaries. The model has been instrumental in addressing cost concerns due to COVID-19, with VBID principles being used at the federal level to eliminate cost sharing for testing in the first COVID response act.
Med City News: (2/10) - COVID-19 has added to the burnout physicians were already facing prior to the pandemic, largely due to long hours, administrative burden, and reluctance for technology adoption. To ensure the transition to value-based care does not add to this burden, health systems need to ensure physicians are engaged as part of ongoing value-based care transition planning and strategy. This article shares three core priorities to drive physician engagement and adoption of value-based care.