News Clips
Virginia Mercury: Concerned physician: Hospitals buy practices and charge patients more for the same services (10/25) – I am a physician who has served the Northern Virginia community for over 12 years, and I have seen many trends in health care that aren’t in the best interest of our patients. Hospital consolidations are one such trend, where large systems buy up other hospitals, independent physician offices and freestanding diagnostic and care facilities – and then add extra, unnecessary charges on patients’ medical bills for providing exactly the same services. I am hopeful this unethical practice will end. Ensuring patients pay the same price for the same service is an important step toward holding prices in check and making health care affordable. Congress is considering proposals to stop these medically unnecessary fees, and to help rein in already unaffordable health care costs.
Modern Healthcare: ACO REACH predecessor saved $371.5M in 2022 (10/23) – The Global and Professional Direct Contracting Model went out a winner in its second and final year by saving Medicare $371.5 million in 2022, a more than fivefold improvement from the prior year, CMS announced. CMS credited the $301.1 million increase in savings to growth in the number and experience of Direct Contracting participants, and to an extension of the amount of time organizations had to manage patient care. Ninety-nine Direct Contracting entities managed care for fee-for-service Medicare enrollees last year, up from 53 in 2021, the agency said. CMS measured savings over 12 months in 2022, compared with nine months the year before.
RevCycle Intelligence: Reducing Barriers to MIPS, Advanced APMs Could Promote Participation (10/23) – Reducing barriers to Advanced Alternative Payment Model (APM) participation for physicians in rural areas could help promote value-based care and control rising Medicare spending, according to research from the US Government Accountability Office (GAO). Both Medicare enrollment and spending are expected to increase in the coming years, highlighting the urgency to control expenditures within the program. Medicare payments to physicians account for around 18 percent of spending. In 2021, Medicare payments to 1.3 million physicians and other providers totaled $93 billion. Incentivizing high-quality, efficient care not only improves patient experiences but can also help reduce Medicare spending.
Health Affairs: Reducing Hospital Costs Without Hurting Patients (10/20) – The battle for site neutral payment unfortunately remains incomplete. Significant variation in payment and policy remains between the two settings—hospital outpatient departments and independent physician offices—complicating transparency and increasing costs. For example, payment for drugs entails distinct coding at each type of site, and payment rules for infusions and injections differ between hospital outpatient sites and the physician office fee schedule. We recommend a simple reform: Pay for common ambulatory services under the rates, codes and policies in the physician fee schedule regardless of location. Congress could repurpose some of the resulting savings towards providing an annual update to services billed to the physician fee schedule. This would provide long-term inflationary updates and financial support for independent practices, bolstering them as a vehicle to increase competition among health care providers.
Fierce Healthcare: Lawmakers mull lifting ban on physician-owned hospitals as doc lobbying groups claim major cost savings (10/19) – A new analysis backed by doctor lobbying groups suggests that physician-owned hospitals could have fueled about $1.1 billion in savings across 20 of Medicare’s most expensive conditions in 2019— though the hospital industry is sticking firm to its stance that the broadly restricted facilities are a detriment to the U.S. health care system. The technical report, commissioned by the Physicians Advocacy Institute and The Physicians Foundation, concluded that the Medicare program and its beneficiaries’ total payments at traditional hospitals would have been 8.6 percent and 15.2 percent (depending on the condition) lower if reimbursed at the same rate as a POH. It was entered into the record Thursday during a House Committee on Energy and Commerce hearing that discussed the ban and other physician concerns including site-neutral payments and updates to the Medicare Physician Fee Schedule.
Health Affairs: Medicare Accountable Care Organizations In 2022: Renewed Growth And Improved Savings Show Small Rebound From The COVID-19 Pandemic (10/19) – Overall, the 2022 MSSP results indicate continued progress in the nation's largest ACO program. There was a modest increase in the number of MSSP participants, which is a positive movement after a drop in recent years, and the program achieved modest savings. There were also promising results for smaller, less experienced ACOs and those serving underserved populations. However, further analyses are needed to demonstrate that targeted support can help smaller, less-resourced ACOs with participation and savings over time. The increased prevalence of value-based care enablers and focused policy flexibilities may partially explain improving performances of newer ACOs, as those ACOs may have better access to upfront capital and technical assistance. Related, we find that safety net organizations have been able to succeed in the MSSP program, consistent with last year's findings. Approximately one quarter of ACOs included FQHCs, and more ACOs are moving to build a larger network of FQHCs.
Washington Post: Primary care saves lives. Here’s why it’s failing Americans. (10/17) – The country’s belief in market forces supports the predominant fee-for-service model, which compensates doctors for performing procedures on sick people rather than preventing people from falling sick. “The market isn’t going to work. This is a public policy issue,” said Koller, who worked with Phillips on a May 2021 report for the National Academies of Sciences, Engineering, and Medicine on implementing high-quality primary care. The report’s key recommendation is to shift away from America’s fee-for-service system to a model that rewards primary-care teams for looking after people. It calls on the Centers for Medicare and Medicaid Services, which drives much of the health-care marketplace, to increase the overall portion of its spending going to primary care. The report also charges HHS with providing accountability.
STAT: When Medicare paid doctors differently, fewer patients had heart problems (10/17) – Doctors lowered the incidence of heart disease and strokes among their patients when Medicare rewarded them for focusing on sicker patients, according to research of a pilot program released Tuesday in the Journal of the American Medical Association. The pilot program didn’t increase overall costs at all. The five-year pilot program is one of many that Medicare has run since the Affordable Care Act created an office to test whether Medicare payment policies can influence doctors in ways that keep patients healthier. That Obama-era initiative has not worked out as well as was hoped, but the Million Hearts Cardiovascular Disease Risk Reduction Model is one of the initiative’s bright spots. Patients of doctors in the pilot experienced a 3.3 percent lower rate of heart disease and stroke than those in the control group. Results across all outcomes were better for medium-risk patients, but there was one standout finding: High-risk patients in the pilot had a 14.4 percent lower death rate specifically from coronary heart disease compared to high-risk patients in the control group.
Healthcare Innovation: Aneesh Chopra: Risk-Based Contracting Is Succeeding—Right Now (10/17) – Aneesh Chopra spoke recently with Healthcare Innovation regarding this moment in the ongoing evolution of value-based care delivery in U.S. health care, and particularly around the subjects of alternative payment models (APMs) and accountable care organizations (ACOs), both those models and programs being developed and managed by CMS, via the Medicare Shared Savings Program (MSSP) and ACO REACH. “We are in a “Tale of Two Cities”: we have seen consistent and improved MSSP performance that has unequivocally delivered results to taxpayers and patients. ACO REACH will show that the possibilities can expand to capitated models and offer early evidence that we can do more, if we can deliver on these total-cost-of-care models. I see MSSP and ACO REACH as building on each other, where one is demonstrating real-world evidence that we can accelerate the benefits of VBC through these models. While MSSP and REACH have certainly captured a sizable portion of the market in terms of provider participation rates; at the same time, a majority of providers are not enrolled.”
Pennsylvania Gazette: Without antitrust law, Pennsylvania lacks regulatory muscle needed for oversight of hospital deals (10/17) – The community impact of hospital acquisitions by large systems can include higher medical costs. Increases of 20 to 30 percent in commercial health insurance are common after such mergers, while studies have shown that the quality of medical care is sometimes worse. The effects of decreased competition on prices are clear, underscoring the need for a public notification requirement in Pennsylvania. Because big health systems bill more for medical care than smaller community hospitals, consolidation can increase consumer medical costs by raising the cost of services. Smaller, independent hospitals charge substantially less than large health systems, even in the same geographic area.
Fierce Healthcare: FTC is full steam ahead on sweeping noncompete ban, reinforcing antitrust, agency head tells docs (10/12) – Health care lobbying organizations’ efforts to carve out industry-specific exemptions in recently proposed Federal Trade Commission (FTC) policies are unlikely to see their requests reflected in the regulator’s final rulemaking, Commissioner Lina Khan suggested this week. Speaking in a keynote panel at the American College of Emergency Physicians’ (ACEP’s) annual meeting this week, Khan outlined major proposals and enforcement actions that she described as much-needed updates to decades-old competition policy. These efforts included January’s proposed ban on noncompete agreements, new merger and acquisition guidance for antitrust enforcement, at least three cases of successful litigation to block noncompetitive health system mergers and last month’s lawsuit targeting a private equity firm’s alleged “roll-up scheme” in the Texas anesthesia market.
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