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.
It’s Health Care Value Week! PEPC and several of our members are pleased to be supporting organizations of Health Care Value Week 2023. Don’t miss Friday’s session on "Barriers and Opportunities for Independent Physicians in Value-Based Care" featuring Anders GIlberg, MGMA Senior Vice President of Government Affairs and Kristen McGovern, PEPC Executive Director!
CMS: (1/24) – CMS released the second interim evaluation report of the Rural Community Hospital Demonstration (RHCD), a budget neutral demonstration which tests whether cost-based reimbursement for Medicare inpatient services can increase the financial viability of small rural hospitals. The evaluation found new RCHD hospitals’ Medicare financial viability improved, with large improvements in Medicare margins, but financial improvements stagnated for continuing hospitals. Evaluation Summary
CMS: (1/23) – CMS Administrator Brooks-LaSure and CMS Innovation Center Director Dr. Fowler provided remarks during Health Care Value Week 2023, reflecting on progress towards the Innovation Center strategy goals, sharing perspectives on the launch of the ACO REACH model, and discussing where CMS is headed in 2023. CMS aims to release three to four new payment models on advanced primary care, population and condition-specific accountable care models, and a state total cost of care model. (Note: sessions are archived for Value Week registrants)
American Academy of Family Physicians: (1/24) – American Academy of Family Physicians (AAFP) signed a letter sent to congressional leadership urging action to control health care consolidation and boost price transparency across the market. The letter outlines policies solutions including making pricing and health data more accessible to consumers, implementing site neutral payments, and ensuring the Federal Trade Commission has the resources to fight mergers and acquisitions deemed unfair.
MGMA, AAFP: (1/23) – Medical Group Management Association (MGMA) and AAFP, along with over 100 coalition partners, sent a letter urging Congress to reform the Medicare payment system and explore long-term payment solutions. “These year-over-year cuts, combined with a paucity of available alternative payment/value-based care models, clearly demonstrate that the Medicare payment system is broken. These systemic issues will continue to generate significant instability for health care professionals moving forward, threatening patient’s timely access to essential health care services.”
Fierce Healthcare: 'Podnosis': Fierce's JPM Week panel about big retailers reshaping primary care and Ramita Tandon on Walgreens' drug research plans (1/25) – During the J.P. Morgan Healthcare Conference earlier this month, Fierce hosted its annual JPM Week event. First up, a panel on what big retailers have to gain by moving into health care. Forrester’s Natalie Schibell, VillageMD’s Tim Barry and primary care doctor Katherine Gergen Barnett, M.D., discuss what these changes will mean for primary care doctors and patients.
Harvard Medical School: Care Costs More in Consolidated Health Systems (1/24) – Health care integration has long been touted as a panacea for reining in health care costs and boosting quality of care. But integrated health systems appear to be failing on both fronts, according to the results of a new nationwide studyled by researchers at Harvard and the National Bureau of Economic Research. “One of the key arguments for hospital mergers and practice acquisition was that health systems would deliver better-value care for patients. This study provides the most comprehensive evidence yet that this isn’t happening,” said study first author Nancy Beaulieu.
RevCycle Intelligence: Just A Few Health Systems Dominate Medicare Inpatient Spending (1/24) – Medicare inpatient spending is highly concentrated in many parts of the US, causing concerns about the impact hospital consolidation will have on prices in the future. In 10 states plus DC, just two hospital systems account for the majority of Medicare inpatient hospital spending in the state, the Commonwealth Fund reports. They found that two-thirds of Medicare inpatient spending was attributable to two health systems, and in 16 states plus DC, a single system accounted for a least a quarter of all Medicare spending on hospital inpatient services that year.
Health IT Security: How An Independent Practice Recovered From a Third-Party Ransomware Attack (1/24) – Bujold wrote about the ransomware attack and how his practice handled it in a reflection piece published in the Annals of Family Medicine. Bujold noted a unique aspect of operating an independent practice that he has learned over the years — you must be comfortable taking on a variety of roles and responsibilities. “You have to have the medical knowledge, which I think we all have. Then, you have to have business savviness, and that includes managing people and understanding how business interplays with medicine. You also have to have a really good understanding of information technology and how it can help you and how it can hurt you,” Bujold said.
Fierce Healthcare: Blues to press Congress to expand site-neutral payment reforms to more outpatient clinics (1/24) – The Blue Cross Blue Shield Association (BCBSA) released several policy priorities for the current Congress as part of a new report Tuesday. Some of the policies focus on changing Medicare reimbursement rates to pay the same amount to clinics whether they are independent or affiliated with a hospital. Other reforms focus on prescription drugs and spurring more participation in value-based care. “We’re very concerned about the increasing acquisition of physician practices by hospitals in the healthcare system,” said Kris Haltmeyer, vice president of policy analysis for BCBSA.
Fierce Healthcare: CMMI Director Liz Fowler: Expect advance primary care, total cost models to be released in 2023 (1/24) – The Biden administration is planning to release three to four new payment models on advance primary care and another enabling states to assume the total cost of care for Medicare, a top official shared. CMMI Director Liz Fowler, Ph.D., detailed the center’s plans for this year during the Value-Based Payment Summit on Monday. In addition to the new models on advance primary care, the center is planning to roll out a new model that enables states to manage the total cost of care.
Modern Healthcare: Hospital price transparency: fines or full compliance? (1/24) – As of the end of September, 65 percent of U.S. hospitals had posted the rates they negotiated with commercial insurers, according to data from data aggregator Turquoise Health. That marks a significant improvement from June 2021, when researchers from Michigan State University and Johns Hopkins University found fewer than half had posted machine-readable files with negotiated prices. While hospitals have made considerable progress in fulfilling key elements of the price transparency law, it has required a lot of work from hospitals, particularly smaller facilities that have been acutely impacted by labor shortages and other financial pressures. "The federal government should make the compliance burden as low as possible while maintaining the usability of the data."
Health Affairs: Private Sector Health Care Prices—Defining The Terms Of The Policy Debate (1/23) – Publicly available cost information can be used to calculate a hospital’s “breakeven,” the rates a hospital must receive from its commercial payers to cover its costs without a profit (usually calculated as a multiple of Medicare rates). Knowing the gap between a provider’s breakeven and its negotiated commercial prices, and how it compares to state-wide or national averages, can help stakeholders identify market outliers, address provider consolidation, identify a price range for rate negotiations, and other policy uses.
Med City News: What Prescription Drug Pricing Can Learn From Value-Based Care Models (1/23) – If Medicare and Medicaid programs embrace value-based contracting, it could have a domino effect on the private sector, causing more private insurers to also consider the model. This is actually more possible today than ever before; as the Inflation Reduction Act has given Medicare the ability and authority, for the first time, to negotiate prices with pharmaceutical companies. With the right approach, it is indeed possible to bring prescription drugs into the realm of value-based medicine. And the time is now.
Politico: Hospitals Are a Problem. Competition Is the Answer. (1/19) – Policymakers should pay renewed attention to physicians as a competitive threat to hospital dominance. Hospitals have been acquiring physician practices at a rapid rate and nearly three-quarters of America’s physicians are now employed by hospitals or corporate entities. The dynamic consequences of these acquisitions — the harm to innovation — are probably even more costly. Controlling physicians means controlling referrals, and hospitals rely on referrals for their most lucrative services. Reciprocally, the biggest threat to hospital dominance is if physicians direct their patients elsewhere, and the current market now offers real alternatives to traditional hospital care: specialty providers, regional providers with telemedicine follow-ups, hospital-at-home care and even physician practices that expand into secondary care. Moreover, many of these new practice models are built atop digital analytics, virtual technologies and innovative financing that have the potential to produce new care models that might upend hospital monopolies altogether.
RevCycle Intelligence: Healthcare Private Equity Down But Not Out, Report Finds (1/19) – Health care private equity activity remained strong despite rising interest rates, high inflation, and other market factors, according to a new report from Bain & Company. During the first half of 2022, health care private equity went toe to toe with the record-setting pace of 2021 both in terms of deal volume and value, the report stated. However, activity slowed in the second half of the year, causing the number of deals to fall between 20 to 30 percent compared to 2021’s all-time high of 515 deals. Despite these concerns though, 2022 is still poised to be the second-highest year on record for healthcare private equity in terms of disclosed deal value and deal count.
Modern Healthcare: Hospital M&A volume reaches decade-plus low (1/18) – The number of hospital merger and acquisition transactions reached a new low in 2022, although more deals are expected this year. There are fewer financially distressed hospitals to acquire after years of consolidation, and potential buyers are being more careful as they manage higher labor and supply costs, declines in investment income, heightened regulatory scrutiny and Medicare reimbursement cuts. But amid that financial pressure, midsized and large systems will still look to sell hospitals in smaller markets, said Jake Aygun, director of the M&A group at Ponder & Co.
Fierce Healthcare: Providers seek more incentives in ACO REACH to target highly underserved areas (1/18) – The new value-based care model ACO REACH has been touted as the first ever to hold providers accountable for tackling health equity. But some providers say the Biden administration isn't offering enough financial incentives for them to fully reach patients in extremely underserved communities. Stakeholders such as NAACOS have reached out to the CMS to address the issue. One of the biggest problems is a 3% cap on risk scores for new providers that stays in place for 24 months. Another issue surrounds how the equity benchmark adjustment is calculated.
Healthcare Finance: CMS releases three initiatives to grow Medicare ACO participation (1/18) – To advance its goal of having 100 percent of people in traditional Medicare in an accountable care relationship in seven years, CMS has announced three initiatives in the Medicare Shared Savings Program and the ACO REACH and Kidney Care Choices models. More than 700,000 healthcare providers and organizations will participate in at least one of the three initiatives this year, CMS said. These programs are expected to grow and provide care to more than 13.2 million people with Medicare.