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.
CMS: (8/24) – CMS released 2022 results for the Medicare Shared Savings Program (MSSP). In 2022, the program saved Medicare $1.8 billion compared to spending targets. Like prior years, physician-led (or low-revenue) ACOs achieved higher savings than other ACOs, with $228 per capita in net savings (about 60 percent more than high-revenue ACOs).
Federal Trade Commission: (8/22) – The Federal Trade Commission (FTC) announced the appointment of Henry Liu to serve as Director of the FTC’s Bureau of Competition, which enforces antitrust laws.
House Budget Committee: (8/25) – House Budget Committee Chair Arrington (R-TX) and Rep. Burgess (R-TX) announced that the Committee has launched a new Health Care Task Force, which will be led by Rep. Burgess. The Task Force issued a request for information (RFI), soliciting feedback from independent experts and stakeholders on solutions to improve outcomes and reduce federal health care spending. RFI responses are due by October 15, 2023.
Aledade: (8/24) – Aledade
released a statement on the 2022 MSSP results. “Today’s results prove that once again MSSP continues to be a success for patients, health care professionals and American taxpayers. After 10 years, one thing is clear – allowing primary care to assume accountability for the total cost and quality of care for their patients works.”
California Medical Association: (8/22) – California Medical Association is urging all physicians to contact their Congressional representatives and urge them to cosponsor the “Strengthening Medicare for Patients and Physicians Act of 2023” (H.R. 2474), a bipartisan bill that provides an automatic annual inflation update based on the Medicare Economic Index (MEI) – a reasonable market basket of physician practice costs.
Medical Economics: Majority of independent practice owners say the industry is threatened (8/29) – When asked about the state of independent health care physicians today, over a third rated it as poor or terrible, while 32 percent said it was acceptable and 27 percent said it was good, with six percent putting it as excellent. Some had concerns about the future of the industry, with 29 percent rating it either extremely or very threatened, and 44% rating it as somewhat threatened. The survey found a gap between practice owner’s perceptions of the industry and the state of their own practice. Most (44 percent) rated their practice as good, and 18 percent as excellent.
Med City News: Team-Based Primary Care Offers a Solution for an Underachieving Healthcare System (8/28) – One of the most powerful solutions we have to support individuals who need the most complex support and care coordination is one that considers whole-person health: team-based primary care. Primary care that is focused on whole-person health is the foundation of a well-functioning health care system. Without it, prevention, early diagnosis and treatment, and care of chronic conditions are delayed, missed, or ignored. Social needs are unidentified and unmet, and health care dollars are spent on care that is fragmented, less effective, and more expensive.
Alabama Political Reporter: Opinion | Federal legislation needed to prevent corporate hospitals from raising costs (8/28) – When looking closer at this trend of consolidation of medical practices, a concerning pattern emerges. New corporate hospital owners will raise the cost of care even though there is no change in services delivered. The vehicle to increase patient expenses? Tacking on hospital facility fees. The Site-based Invoicing and Transparency Enhancement Act (SITE) in the Senate and the Facilitating Accountability in Reimbursements Act (FAIR) in the House would be crucial steps towards ensuring medical bills are more reasonable – regardless of where care is delivered. Site-neutral billing is a solution that would prevent hospitals from charging exorbitant prices for medical procedures. This would also benefit the Medicare program by ensuring costs remain consistent across the board.
Kaiser Family Foundation: Understanding Mergers Between Hospitals and Health Systems in Different Markets (8/23) – A growing body of evidence shows that consolidation in health care provider markets has led to increases in prices without clear evidence of increases in quality. Policymakers and regulators have historically focused on consolidation within the same geographic area, but there have been a large number of mergers and acquisitions between hospitals and health systems that operate in different regions, including several multi-billion dollar deals over just the past couple of years. Some experts have raised concerns that cross-market mergers could result in hospitals and health systems raising their prices. It is also possible that cross-market mergers could result in the elimination of service lines by some acquired hospitals, which may reduce access to care. This issue brief explains the role and implications of cross-market mergers in hospital and health system markets and describes the approaches that government antitrust agencies have taken in reviewing these types of transactions.
Fierce Healthcare: Most Americans support value-based care but prefer other terms, research finds (8/22) – Most Americans support the idea of value-based care but don’t understand or resonate with the term, according to new research from United States of Care. USofCare is a self-described nonpartisan think tank focused on building a more equitable health care system. It found that people desire targeted improvements to their care experience and believe the health care system is too fragmented with little coordination between providers. They also think too much time is spent waiting versus seeing their doctors, and they worry that people with money are prioritized in getting appointments and the care they desire. In total, 64 percent of people in the national survey supported value-based care over the fee-for-service model.
Health Affairs: Making Equity Primary In The Making Care Primary Model (8/21) – CMMI announced the launch of Making Care Primary (MCP), the latest iteration in a series of primary care-focused accountable care models beginning with the Comprehensive Primary Care Initiative launched in 2012. The MCP model, which will be implemented over a 10.5-year period, shares several features with its predecessor models in its design, including a component of value-based payments, an emphasis on care management and supporting primary care infrastructure, and multi-payer alignment. However, a central component of the MCP model that is new to CMMI’s primary care portfolio is its explicit emphasis on embedding health equity in one of the model’s aims: to “achieve equitable health outcomes through widely accessible high quality, affordable, person-centered care with accountability for outcomes.” While we applaud CMMI for seeking to incorporate equity into primary care alternative payment model (APM) design, the model fails to directly incentivize primary care practices to close health disparities or, surprisingly, truly hold them accountable for achieving equitable health outcomes.
Health Affairs: Distinctive Features In The Making Care Primary Model (8/21) – MCP poses several potential implications for accountable care organization policy. First, the emergence of MCP creates a decision point for clinicians and groups currently participating in other accountable care models. Organizations in models such as the Primary Care First or ACO REACH models as of this past May are ineligible to join MCP. Unlike other models, MCP does not involve any financial downside adjustment based on performance – a design feature that may be particularly appealing to eligible organizations. Second, MCP could generate insights that inform policymakers about future accountable care policy. In particular, the new program serves as a potential test bed for using capitation-based payments to pay for primary care services. Policymakers could use these learnings to consider capitation-based primary care payments in accountable care policy more broadly. Both steps – monitoring enrollment shifts from other models to MCP; considering how learnings could inform primary care payment in future models – can support new program success and the ability of other accountable care models to continue emphasizing global outcomes.
Fierce Healthcare: ACOs delivered bigger 2022 savings than in 2021: CMS (8/24) – CMS announced that the MSSP has saved a net $1.8 billion in 2022 for accountable care organizations, which is the second-highest annual savings since the program began 10 years ago. It is also the sixth consecutive year the program has generated savings, according to a news release. In 2021, CMS said it saved Medicare $1.66 billion. ACO leaders praised the program Thursday, calling the MSSP a success for all parties. “Since its inception, Aledade has brought in more than $650 million in savings directly to community primary care practices and generated $1.2 billion in Medicare shared savings,” said Aledade CEO Farzad Mostashari, M.D., in a statement. “As a result, physician practices working with us have been able to address workforce shortages, develop new programs for patient outreach and care, and identify new solutions to serve their communities.”
Modern Healthcare: CMS tries luring providers to revamped Medicare ACOs (8/17) – CMS has a plan to kickstart provider participation in one of its largest alternative payment models, but providers say they're leery that recent changes to the MSSP will prove sufficiently enticing to holdouts. These technical updates set the program up for short-term success, said Sean Cavanaugh, chief policy officer at Aledade, a physician enablement company. But CMS did not address long-term issues that have dissuaded providers from participating in the payment model, said Cavanaugh. “They're trying to find a balance,” Cavanaugh said. “The program is supposed to save the government money, so you can't just give it all to the providers. But how do you make this a model that all providers can be in and say, ‘This will work for me 10 to 15 years down the line?’”
Medical Economics: Proposed rule banning noncompete agreements draws mixed reaction from health care execs (8/16) – A Federal Trade Commission (FTC) proposal to prohibit noncompete agreements is splitting the health care community, with some organizations saying the agreements are needed to protect health care systems’ interests and others saying they are an unfair means of controlling the health care labor force. The American Medical Association (AMA) said the organization “opposes the use of unreasonable noncompetes, but AMA does not support an outright ban on noncompetes.” The American Hospital Association (AHA) opposes the proposed prohibition on noncompetes, particularly for physicians and senior executives. Chad Golder, JD, the AHA’s deputy general counsel, says noncompetes can benefit physicians, patients and hospitals.