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This Week in Physician-Led Care

October 28 to November 5, 2020

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. 

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Administrative Updates

HHS: (10/30) – HHS issued frequently asked questions (FAQs) on vaccine distribution and planning. The FAQs cover questions related to funding for vaccine administration, allocation and supply chain, and communication and information requirements.

CMMI: (10/30) – CMMI announced 51 direct contracting providers and accountable care organizations that are participating in the Direct Contracting Model, the new risk model that evolved from the Next Generation ACO model.

CDC: (10/30) – CDC released a report on trends in the use of telehealth during the COVID-19 pandemic, noting that telehealth could have multiple benefits during the pandemic by expanding access to care, reducing disease exposure for staff and patients, preserving scarce supplies of personal protective equipment, and reducing patient demand on facilities.

HHS: (10/30) – HHS published the final 2020-2025 Federal Health IT Strategic Plan. The Plan outlines federal health information technology (health IT) goals and objectives, with a focus on individuals’ access to their electronic health information. Blog

CMS: (10/30) – CMS released part II of the 2022 MA and Part D rate notice. Comments on the proposals set forth in both Part I and Part II of the Advance Notice must be submitted by Monday, November 30, 2020. Fact sheet

CMS: (10/29) – CMS released the final Transparency in Coverage rule intended to make health care price information accessible to consumers and other stakeholders. Starting on January 1, 2023, the rule will require health plans to offer an online shopping tool that will allow consumers to see the negotiated rate between their provider and their plan, as well as a personalized estimate of their out-of-pocket cost for 500 of the most shoppable items and services. Starting on January 1, 2024, these shopping tools will be required to show the costs for the remaining procedures, drugs, durable medical equipment, and any other item or service they may need. Fact Sheet

HHS ONC: (10/29) – HHS ONC released an Interim Final Rule with Comment that extends the compliance dates and timeframes necessary to meet certain requirements related to information blocking and Conditions and Maintenance of Certification (CoC/MoC) requirements. Fact sheet

CMS: (10/28) – On October 28, CMS issued the fourth Interim Final Rule with Comment (IFC) intended to remove regulatory barriers and ensure consistent coverage and payment for the administration of an eventual COVID-19 vaccine for millions of Americans. The IFC establishes that any vaccine that receives FDA authorization, either through a EUA or licensed under a Biologics License Application (BLA), will be covered under Medicare as a preventive vaccine at no cost to beneficiaries. The IFC also implements provisions of the CARES Act that ensure coverage of a COVID-19 vaccine by most private health insurance plans without cost-sharing from both in and out-of-network providers during the course of the PHE. 

CMS: (10/27) – CMS Administrator Verma issued a blog highlighting 2019 Quality Payment Program performance results. Overall, 538,323 eligible clinicians participated in MIPS as individuals or groups and 416,281 eligible clinicians participated in MIPS through APMs. In addition, 85.22% of MIPS eligible clinicians in small practices were engaged in the program.

Legislative Updates

Rep. Bera: (10/30) – Rep. Bera (D-CA) and seven bipartisan cosponsors introduced the Holding Providers Harmless From Medicare Cuts During COVID-19 Act of 2020 (H.R. 8702), which would provide for an increase in payment under part B of the Medicare program for certain services in response to COVID-19. 

Rep. Pascrell: (10/29) – Rep. Pascrell (D-NJ) led seven Representatives in a letter to HHS Secretary Azar calling for increased transparency of the Provider Relief Fund (PRF) passed by Congress as part of the CARES Act to support frontline health care providers battling COVID-19. In the letter, the members seek answers on a series of HHS guidance that relax reporting requirements for money dispersed to health care providers as required by Congress.

Member News

Revcycle Intelligence: (10/28) – Health care industry leaders at MGMA’s Medical Practice Excellence Conference shared best practices and strategies for medical practices to remain financially and operationally stable during COVID-19. 

Fierce Healthcare: (10/27) - CEO of Penn Medicine Kevin Mahoney believes the pandemic was a “clarion call” for the health care industry to move to value-based payment models, calling for health systems to shift to meet patients where they are. Aledade CEO Farzad Mostashari said physician practices engaged in VBC and payment contracts have weathered the storm better than those that rely on FFS payments.

News Clips

Health Affairs: (November 2020) – Using 2018 national family medicine data, this study found that 95 percent of family medicine-affiliated practices used electronic health records in 2018. There was, however, a wide variance in whether those EHRs met meaningful use criteria. The study found that achieving patient-centered medical home transformation across all practices requires a coordinated approach that aligns strong financial incentives with tailored technical assistance.

AJMC: (11/3) - Although there is uncertainty among providers participating in APMs stemming from the general election and upcoming Supreme Court case on the ACA, providers are still planning to continue participation in these models.

Revcycle Intelligence: (11/2) - CMS has promoted a goal of transitioning as close to 100 percent of reimbursements tied to value-based contracts by 2025, although less than 20 percent of Medicare spending is currently value-based. To be successful in these models, providers must develop a deeper understanding of value-based programs, opportunities for revenue growth, and their risk of loss.

Medscape: (11/2) – The number of primary care providers is increasing per capita in the United States, but primary care providers are still disproportionately concentrated in urban centers. Researchers also found that there were more primary care physicians per capita in counties with higher household incomes and counties with a higher proportion of college graduates.

Fierce Healthcare: (11/2) - Health IT company Cerner announced value-based care has gained significant traction during the pandemic, as it has been one of the biggest shifts observed as the company helped provider clients navigate COVID-19. Cerner officials stated that several clients are increasingly moving toward capitation or value-based agreements.

Fierce Healthcare: (10/30) - Blue Cross Blue Shield of North Carolina is partnering with Caravan Health to bring its Blue Premier program to community and rural providers in the state and establish a joint ACO that will allow VBC initiatives to reach community and rural hospitals.

Revcycle Intelligence: (10/30) - Despite challenges faced by the pandemic, some provider organizations have continued to engage in major health care merger and acquisition deals. This article outlines 10 major deals announced in 2020.

Medscape: (10/30) - A survey by the Physicians Foundation revealed that two-thirds (67 percent) of physicians support a two-tiered health care reform plan that combines private insurance with a single-payer option. Additionally, 49 percent of physicians supported maintaining or improving the current ACA-influenced system as their second favored option.

Modern Healthcare: (10/30) – HHS issued guidance allowing health care providers that received COVID-19 Provider Relief Fund grants to use funds to pay for supplies needed for COVID vaccine distribution. The guidance also expanded the number of providers that could receive grants and clarified what expenses and lost revenues could legally count toward the grant.

HealthLeaders: (10/30) – In an interview with HealthLeaders, CMS Administrator Seema Verma spoke on the final price transparency rule, the administration’s plans to advance value-based care, and how CMS plans to assist health systems in dealing with the pandemic.

Revcycle Intelligence: (10/29) – Health systems are facing a loss of $227K per employed physician across specialties as a result of COVID-19, while hospitals continue to underperform due to the virus. This amounts to a 14.1 percent loss from January to August 2020 compared to the same period the previous year.

mHealth Intelligence: (10/29) – During an episode of the Healthcare Strategies podcast, experts commented on how telehealth and in-person care should be considered complementary rather than competitive services. Sutter Health is creating strategies that integrate virtual and in-person care to focus on value and treat the whole patient.

The Hill: (10/29) - Independent family physicians have been hit hard financially during COVID-19, and without help the majority of practices may be forced to shut down. The disappearance of independent family physicians would result in lack of access to critical care in underserved communities that rely on primary care services.

Healthcare Dive: (10/28) – A JAMA Network Open study found that the number of primary care physicians increased significantly from 2009 to 2017, but growth was more pronounced in urban areas compared to rural areas. Rural clinician shortages are likely associated with the gap in population health outcomes between rural and urban residents that could be fixed by policy interventions.

American Medical Association: (10/28) – A new AMA survey of 3,500 physicians revealed the financial pressures physician practices have faced during the ongoing pandemic. Physicians on average experienced a 32 percent drop in revenue since February, with one in five physicians experiencing a 50 percent or more drop in revenue. The number of in-person visits also fell from 97 per week to 57.

Nextgen Healthcare: (10/27) – CMS Administrator Seema Verma has spoken at multiple events about how some VBC models have failed to deliver on lowering costs and increasing higher quality care. As a result, providers may have to brace for more downside risk, mandatory models, and permanent changes as CMS pivots its strategy.

HIMSS: (10/27) – HIMSS held a webinar called “Interoperability Breakthroughs to Advance Value-Based Care and Improve Clinical and Financial Outcomes,” where panelists discussed how interoperability is fueling innovation and disruption in health care.

Revcycle Intelligence: (10/27) - Several major provider groups signed a letter asking Congress to extend a congressionally-enacted moratorium on the application of the Medicare sequester cuts into 2021, given the continuation of the public health emergency and continuing financial challenges faced by physicians.




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