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This Week in Physician-Led Care

September 30 to October 7, 2020

Welcome to this week's edition of 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

CMS: (10/2) — CMS released a fact sheet on the Accountable Health Communities Model, which includes information on how the model is implemented and a snapshot of data on demographics of beneficiaries participating in the model as well as their self-reported health-related social needs. The first AHC Model evaluation report is anticipated in 2021 and will include a more in-depth analysis of data from the AHC Model.

CMS: (10/1) — CMS announced that 2021 Medicare Advantage and Part D plan information is now available on In addition, for the first time, seniors will be able to find through Medicare Plan Finder on more than 1,600 prescription drug plans to choose from that will offer insulin at no more than a $35 monthly copay beginning in January. Medicare Open Enrollment begins on October 15, 2020, and ends on December 7, 2020.

CBO: (10/1) — Congressional Budget Office (CBO) issued a report which examines policy approaches that could achieve near-universal health insurance coverage. The approaches examined would provide nearly all people in the United States with financial protection against high-cost medical events, increase overall access to health care, and decrease the costs that providers incur when they provide medical services to uninsured people. The approaches also would increase federal subsidies for health care.

GAO: (10/1)— The Government Accountability Office (GAO) released testimony for the House Small Business Committee hearing on preventing fraud and abuse within the Paycheck Protection Program (PPP) and SBA’s Economic Injury Disaster Loan (EIDL) program. The testimony discusses the need to identify and respond to fraud risks associated with these programs. GAO notes that proactively managing fraud risks, even during emergencies, helps ensure that taxpayer dollars and government services serve their intended purposes.

HHS: (9/30) — HHS announced funding for health information exchange organizations (HIEs) to improve HIE services so that public health agencies can better access, share, and use health information during public health emergencies.

ASPE: (9/29) — HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) released a report on the impact of COVID-19 on Medicare health services and payments. HHS notes that most health care providers have faced a significant reduction in volume. Despite overall trends, HHS found substantial variation across services types and geographies.

Legislative Updates

Continuing Appropriations Act: (10/1) — President Trump signed into law the Continuing Appropriations Act, 2021 and Other Extensions Act (H.R. 8337), which extends funding for several Medicare and Medicaid programs, among others. On September 30, the Senate passed by the legislation by an 84-10 vote.

Updated Heroes Act: (10/1) — The House passed by a 214-107 vote an updated version of the Heroes Act (H.R. 8406), which would provide $2.2 trillion in emergency supplemental appropriations for the fiscal year ending September 30, 2021. The legislation includes funding for small businesses, funds to bolster education and child care, and supports testing, tracing and treatment. On September 29, Rep. Lowey (D-NY) and ten cosponsors introduced the legislation. One-pager Section-by-section Bill text

COVID PREPARE Act: (9/30) — The House passed by voice vote the COVID PREPARE Act (H.R. 7496), which would require Federal agencies to submit plans for responding to any resurgence of COVID–19. The bill now heads to the Senate for consideration.

Primary and Behavioral Health Care Access Act: (9/30) — Sen. King (I-ME) introduced the Primary and Behavioral Health Care Access Act (S. 4761), which would require group health plans and health insurance issuers offering group or individual health insurance coverage to provide for 3 primary care visits and 3 behavioral health care visits without application of any cost-sharing requirement. 

Member News

Florida Medical Association: (10/5) — The latest episode of FMA’s podcast Medicine Curated features FMA’s Assistant General Counsel Mary Thomas and discusses the current regulatory landscape in Florida and how it is impacting patient care and physicians.

MGMA: (10/2) — MGMA released the Better Performers Data Report, which analyzes the performance and practices of successful medical groups from 3,864 organizations. Of the organizations surveyed, 1,036 organizations stood out in four main categories: operations, profitability, productivity, and value.

Aledade: (9/29) — Colleen Wagner, Executive Director for West Virginia at Aledade, wrote this blog on Aledade’s efforts to form an ACO of 10 FQHCs across the state of West Virginia. Every one of the FQHCs in Aledade’s ACOs earned shared savings of more than $9 million in 2019, with scores of 92 percent or more on their quality metrics and reduced inpatient admissions by 7 percent.

Delaware Public: (9/27) — Delaware’s Department of Human and Social Services has approved Aledade to launch its ACO for Delaware Medicaid patients.

News Clips

Knox: (10/6) - Dr. Mark Fourre, President of Pen Bay Medical Center and Waldo County General Hospital, reflects on the importance of expanding primary care to make communities healthier and expand access to care and equity for vulnerable groups.

Healthcare Dive: (10/5) - During their October meeting, MedPAC Commissioners advocated for implementing changes to Medicare advanced alternative payment models. Commissioners proposed condensing the number of models, making them more cohesive, and testing models for longer periods of time to yield more favorable results.

Behavioral Healthcare Executive: (10/5) - Ed Jones, Ph.D., the senior vice president for the Institute of Health and Productivity Management, reflects on how any decision to incorporate behavioral healthcare into the primary care setting must engage primary care providers in the process.

Medical Xpress: (10/5) - During the early phases of the COVID-19 pandemic, there has been a significant decrease in primary care visits with telemedicine acting as an imperfect substitute for in-office visits.

mHealth Intelligence: (10/5) - While patients have been turning to telehealth to access urgent care during the COVID-19 pandemic, many are not keeping up with annual visits or undergoing basic wellness tests.

Richmond Times Dispatch: (10/4) - A shortage of primary care physicians is expected as the U.S. population ages and older primary care doctors retire. The Association of American Medical Colleges projected that 21,000 more providers will be needed by 2033 to address this shortage.

Radiology Business: (10/2) — In the continuing resolution bill passed on October 1, the Senate approved the extension of the repayment terms for Medicare advances granted to physicians during COVID-19. This will give radiologists and other providers one year after the Medicare Accelerated and Advance Payment Program loan was issued to begin repayments.

American Academy of Pediatrics: (10/1) — Value-based care (VBC) has been rapidly adopted in the financing of pediatric care, with most pediatric VBC programs focused on addressing social determinants of health. This article provides an equity lens for identifying and addressing social needs within a pediatric VBC framework.

Healthcare Innovation: (10/1) - The current and former MedPAC chairs discussed current ACO structures in a recent joint appearance, both celebrating progress ACOs have made on cost savings and highlighting barriers to program success.

Fierce Healthcare: (10/1) — The rapid adoption of digital health technologies in response to the COVID-19 pandemic has accelerated the role technology can play in care delivery over the next five years. Physicians say that for technology to address their biggest needs, technology companies need to consider factors such as interoperability, improved workflow, automation, and data security.

American Journal of Preventive Cardiology: (10/1) - A study looking at COVID-19 infection severity and elderly Medicare patients with prior cardiovascular risk revealed that high-touch care with frequent preventive visits with primary care providers and specialists has resulted in higher use of cardiovascular medications, fewer hospitalizations, and lower health care costs.

Managed Healthcare Executive: (9/30) - There have been mixed results on whether doctors will embrace value-based care programs as a result of the COVID-19 pandemic. This article looks at four current value-based efforts to assess progress in moving away from FFS.

Modern Healthcare: (9/29) - House Democrats introduced a new COVID-19 relief bill, which would include a provision to provide health care providers with $50 billion in new grant funds. This funding is intended to support health care providers who have experienced a loss in revenue and additional expenses as a result of the pandemic.

PR Newswire: (9/28) - Harvard Pilgrim Health Care pledged $3 million in support of independent primary care practices located in Massachusetts, New Hampshire, Connecticut, and Maine. These grants will support practices in providing safe care to patients during the COVID-19 pandemic while helping practices to purchase additional PPE, support telehealth infrastructure, implement social distancing guidelines, and other safety measures.

Studies and Reports

JAMA Network Open: (10/2) — A study conducted by researchers from Johns Hopkins and Stanford assessed primary care encounters and the quality of telehealth visits during the COVID-19 pandemic. Researchers found that the structure of primary care delivery had changed as a result of the pandemic largely due to an uptick in telemedicine use. However, telemedicine has led to less frequent assessments and evaluations of cardiovascular risk factors, which can be detrimental to patients with chronic conditions.

AJMC: (10/2) - Commercial insurers have been slow to follow Medicare in its effort to embrace condition-specific bundled payments (CSBP). One report found that 2 percent of commercial payments flow through CSBP models. Successful plans have closely aligned providers and payers who seamlessly share data.

New England Journal of Medicine: (10/1) — A new study found that a contributing factor to the gender pay gap among primary care physicians is that female primary care physicians spend more time in direct patient care per visit, leading to fewer visits conducted on average compared to male colleagues. On average, female physicians spent 15.7 percent more time with a patient and generated 10.9 percent less revenue from office visits.

Modern Healthcare: (10/1) —Findings from a recent NEJM study highlighting reasons for the gender pay gap among primary care physicians challenge the assumption that the pay gap is a result of female physicians working less than their male colleagues. Study findings could help support arguments for moving away from fee-for-service visits to rely less on volume and address the gender pay gap.




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