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.
Centers for Medicare and Medicaid Services (CMS): (11/4) – On November 4, CMS and the Department of Labor’s Occupational Safety and Health Administration (OSHA) issued regulations with comment for COVID-19 vaccinations and testing. CMS is requiring workers at health care facilities participating in Medicare or Medicaid to have received the necessary shots to be fully vaccinated – either two doses of Pfizer or Moderna, or one dose of Johnson & Johnson – by January 4th. OSHA requires that employers with 100 or more employees ensure each of their workers is fully vaccinated or tests for COVID-19 on at least a weekly basis. CMS RuleFAQ OSHA Rule OSHA Fact Sheets FAQs
House Energy and Commerce Committee: (11/5) – On November 5, the House passed by a 228 to 206 vote the $550 billion Bipartisan Infrastructure Deal (Infrastructure Investment and Jobs Act (H.R.3684). The package now heads to the President’s desk for signature. Fact sheet
U.S. Sen. Baldwin (D-WI): (11/2) – Sens. Braun (R-IN) and Baldwin (D-WI) introduced the Healthy Competition for Better Care Act (S. 3139), which would ban anti competitive terms in facility and insurance contracts that limit access to higher quality, lower cost care. Bill textSummary
DotMed: (11/8) – Federal regulations are straining healthcare providers’ ability to offer quality care to patients. That’s what the majority of 420 medical group practices told the Medical Group Management Association for its 2021 Annual Regulatory Burden Report. And while 95 percent say that a reduction in regulatory burdens would allow them to reallocate resources better, 91 percent have only seen these regulations increase over the past 12 months.
California Medical Association: (11/8) –In the wake of the U.S. Food and Drug Administration’s (FDA) emergency-use approval of the Pfizer-BioNTech vaccine against COVID-19 for kids ages 5 through 11, a coalition of physician groups and immunization experts, is urging parents and caregivers to get all eligible children vaccinated as soon as possible. The American Academy of Pediatrics, California (AAP-CA), California Academy of Family Physicians (CAFP), California Medical Association (CMA) and California Immunization Coalition (CIC) represent thousands of front-line physicians and experts in providing primary and preventive health care to California’s children.
MedPage Today: (11/3) – Physicians will see a nearly four percent cut in the "conversion factor" used to determine their fee-for-service Medicare payment under the 2022 Physician Fee Schedule (PFS) final rule. Although the American Academy of Family Physicians (AAFP) decried the conversion factor cut, the group expressed approval of several other provisions in the rule. "We're pleased CMS is ... increasing payment rates for vaccine administration and chronic care management services," AAFP President Sterling Ransone, Jr., MD, said in a statement. "This will facilitate Medicare beneficiaries' access to recommended vaccines and care management services and enable family medicine practices to continue providing these high-value services."
Modern Healthcare: (11/8) – The Medicare Payment Advisory Commission (MedPAC) commissioners agreed that it's worth exploring whether administratively setting a factor to forecast cost trends for accountable care organizations could make it easier for high-performing organizations to share in savings each year. But the panel questioned whether a viable benchmark system for ACOs is even possible in a voluntary program. This could set the stage for future MedPAC sessions on mandatory ACO participation, and shows that MedPAC commissioners are moving in the same direction as CMS, which said in an October white paper that it aims to have all Medicare beneficiaries in a value-based care arrangement by 2030.
Forbes: (11/6) – The Centers for Medicare and Medicaid Innovation (CMMI) plans to shift the focus of alternative payment models from Medicare to Medicaid. Last month, the policy and programs group director at CMMI, Ellen Lukens, said that “models have been predominantly Medicare-oriented, and have disproportionately served white beneficiaries.” By contrast, relatively few models have centered around Medicaid beneficiaries. Going forward, policymakers will explicitly address barriers to participation in CMMI models by healthcare providers that serve a high proportion of underserved. Policymakers also want to entice more underserved patients to register to participate in pilot programs.
Fierce Healthcare: (11/5) – Consolidation among standalone prescription drug plans in Medicare Part D caused offerings to decline by 23 percent for 2022, a new analysis by Kaiser Family Foundation finds. It pointed to consolidations among plans sponsored by Centene and Cigna as key drivers in the decline. Cigna acquired Express Scripts, and Centene acquired WellCare.
Fierce Healthcare: (11/4) – New bipartisan legislation aims to outlaw several practices employed by hospitals critics say harm competition, including requirements for payers to contract with affiliated providers. The legislation introduced by Sens. Mike Braun, R-Indiana, and Tammy Baldwin, D-Wisconsin, aims to ensure more affordable contracts between payers and providers.
Health Affairs: (11/2) – As private equity firms continue to increase their ownership stake in various health care sectors in the US, questions arise about potential impacts on the organization and delivery of care. Relative to non acquired hospitals, private equity acquisition was associated with a higher probability of adding specific profitable hospital-based services (interventional cardiac catheterization, hemodialysis, and labor and delivery), profitable technologies (robotic surgery and digital mammography), and freestanding or satellite emergency departments. Moreover, private equity acquisition was associated with an increased probability of providing services that were previously categorized as unprofitable but that have more recently become areas of financial opportunity (for example, mental health services).
Fierce Healthcare: (11/2) – Hospitals recently acquired by private equity firms tend to adopt profitable new services and technologies more quickly than their unacquired counterparts. Across a sample of roughly 5,000 hospitals reviewed from 2004 to 2018, researchers also found that the private-equity-acquired hospitals were, to a lesser extent, more likely to avoid or ditch services with “unreliable” revenue streams or competition from other nonprofit hospitals.The collective findings suggest private-equity-acquired hospitals more strongly adapt their operations in response to a profit incentive and, as such, adapt more quickly to prevailing industry trends, the researchers wrote.
Brookings Institution: (10/5)– institutional private investment in health care, particularly in physician practices and staffing companies, has increased markedly in recent years, raising concerns that an influx of profit-driven entities into the sector might raise the cost or reduce the quality of patient care. Private equity’s growing investment in physician practices may be accelerating horizontal consolidation in certain specialties, which a large body of evidence suggests increases prices and/or reduces the quality of care on net. Driven by tax and regulatory advantages, private equity might distort the organizational form of physician practices away from physician ownership. This plausibly could harm patient care and employed physicians (e.g., if anecdotal reports that private equity relies more heavily on employee noncompete and nondisclosure agreements are indicative of broader trends).