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: (4/19) – CMS released a report, "The Disparities in Health Care by Race, Ethnicity, and Sex," focused on national racial, ethnic, and sex differences in patient experience and clinical quality of care in Medicare Advantage (MA). A substantial proportion of clinical care scores were below the national average for American Indian/Alaska Native, Black, and Hispanic MA enrollees. Across racial and ethnic groups, there were few differences in scores by sex on either the patient experience or the clinical care measures.
White House: (4/18) – President Biden signed an Executive Order seeking to make long-term care more accessible and affordable and provide support for care workers and family caregivers. This includes directing the CMS Innovation Center to consider testing a new dementia care payment model that will include support for respite care and provide more support to family caregivers. Fact Sheet
MedPAC: (4/13) – During the Medicare Payment Advisory Commission (MedPAC) April public meeting, commissioners voted in support of advancing a recommendation on site neutral payments. Specifically, MedPAC recommends, “Congress should more closely align payment rates across ambulatory settings for selected services that are safe to provide in all settings and when doing so does not pose risk to access.”
California Medical Association: (4/18) – The California Medical Association released a press release, “APM incentive payment extended through 2023.” California Medical Association strongly supported the alternative payment model (APM) extension, which allowed eligible APM participants for the 2023 performance period to receive a 3.5 percent APM Incentive Payment in the 2025 payment year. Without this, there would have been a one-year gap with no statutory incentives for Advanced APM participation.
Public News Service: Survey: Hospital Consolidation Makes Employee Healthcare Tougher in TX (4/19) – Small businesses owners in Texas are looking for help from lawmakers as the cost they pay to provide employees with health care coverage continues to rise. A surveyby Small Business for America's Future found participants believe hospital consolidations are a prime reason for the increased costs, and 80 percent claim they're making care availability and quality in their communities worse and more expensive. As a result of consolidations in their region, small business owners surveyed said 61% of people have fewer choices about where to receive care. A majority of the 1,000 survey participants said it's important federal and state governments intervene.
Modern Healthcare: Congress should adopt site-neutral post-acute payments: MedPAC (4/18) – MedPAC will recommend Congress lower the payments to all post-acute care settings except long-term care hospitals and look to adopt smaller, site-neutral policies that should be phased out if and when a unified payment system is implemented. Given the high payment variance between settings despite having a patient base with similar conditions and comorbidities, Congress tasked MedPAC with evaluating a prototype payment system for all post-acute care providers–skilled nursing facilities, inpatient rehab facilities, home health and long-term care hospitals–that would be based on patient characteristics, not the setting, and use patient stays as the unit of service with a common set of risk adjusters.
Politico: How a health equity tool might backfire (4/18) – CMS implemented a new payment model this year that aims to award doctors and medical groups more money to treat underserved populations with greater medical needs. The government relies, in part, on the Area Deprivation Index to adjust payments to providers, and it’s an important part of the Biden administration’s ACO REACH program, a Medicare pilot that offers provider groups a set amount of money each month to treat a roster of underserved patients. The ADI uses several factors, including home value, to measure socioeconomic disadvantage in every census block in America. But in parts of the country where extreme wealth and poverty live side by side, the ADI metric can produce distorted results. Home values tend to be higher in urban areas, even in places rife with poverty and poor health outcomes.
Fierce Healthcare: Report: Hospitals, payers making strides on price transparency compliance (4/18) – Nearly 5,400 hospitals, or 84 percent of the roughly 6,400 applicable hospitals, have posted a machine-readable file with pricing data as of the end of Q1 2023, according to the company’s second Price Transparency Impact Report. Payer compliance, though “far from perfect,” has increased at a faster rate than seen among hospitals, the company wrote. Per the report, the initial 68 payers whose price transparency data was online rose to 111 by October, spiked to 164 just a month later and now sit at 183 as of the end of March. Slow price transparency compliance has landed hospital groups on hot seat throughout the last couple of years.
Healthcare Finance: Most payers used outcomes-based contracting in 2022 (4/14) – More than half of payers, 58%, had at least one outcomes-based contract (OBC) in place during the 2022 plan year, and respondents to a new Avalere survey who are utilizing at least one OBC indicated oncology, cardiology, and endocrinology as the top therapeutic areas in which OBCs came into play last year. The majority of respondents also said they're using OBCs for "mostly new products, but some existing products," reflecting growing interest among stakeholders to align payment with clinical benefit, particularly for new products that have limited real-world benefit.
RevCycle Intelligence: NAACOS Offers Guidance for Hybrid Primary Care Payment Model in MSSP (4/14) – NAACOS is calling on CMS to establish a hybrid primary care payment model in the Medicare Shared Savings Program (MSSP) using two possible approaches that will provide flexibility ACOs. The first approach consists of CMS paying prospective and per-visit payments directly to the primary practices, with a portion paid to the ACO. The second approach would include CMS making payments directly to the ACO, which then administers the capitated payments to participating primary care practices. This approach is similar to the methodology being tested in the ACO REACH model. Primary care access suffered during the COVID-19 pandemic due to a lack of investment and administrative burden. Research has shown that shifting primary care payment toward hybrid models that include prospective population-based payments and per-visit payments may help create a stronger primary care system.
Becker's ASC Review: 14% of physicians participate in value-based care models: Medscape (4/14) – Though value-based care is rising in popularity, it is not yet the industry standard. Medscape released its "Physician Compensation Report 2023" April 14. The report includes responses from 10,011 physicians in more than 29 specialties. Here is the percentage of physicians that participate in each payment model, according to Medscape:
Fee-for-Service: 46 percent
Value-based: 14 percent
Bundled: 10 percent
Capitation: 6 percent
Concierge practice (monthly or annual access fee): 2 percent
Other: 13 percent
JAMA: Hospital Consolidation: The Rise of Geographically Distant Mergers (4/13) – The dearth of empirical evidence applying to geographically disparate cross-market mergers, such as those with hospital systems in different states, has made antitrust enforcement more challenging. Consistent with this lack of evidence, the Federal Trade Commission has not taken action to curtail cross-market mergers. However, state regulators have been more assertive in addressing anticompetitive practices that may be enabled or abetted by cross-market mergers. More intentional policy action will require further investigation around key dimensions of cross-market mergers such as common payer customers across the merging hospitals, sensitivity of price effects to geographic radius, and impact on quality of care.
KaufmanHall: M&A Quarterly Activity Report: Q1 2023 (4/13) – In the final quarter of 2022, we noted an uptick in transaction activity with 17 announced transactions. That activity level was almost matched in Q1 2023, with 15 announced transactions. The trend toward larger transaction size was maintained, with the average size of the seller, or smaller party, just below the historic high reached in 2022. Total transacted revenue for the quarter was also near historic highs. Before the COVID-19 pandemic struck in 2020, smaller independent hospitals and health systems were pursuing partnership opportunities to ensure their continued strategic and financial viability. These pressures have only intensified over the past three years. The stress on frontline staff during the peak of the pandemic prompted early retirements and moves to contract or non-clinical positions, driving up labor demand, and therefore, costs. Inflationary pressures drove up non-labor expenses as well.
Milbank Quarterly: Colorado Multi-Payer Collaborative: Lessons Learned for Primary Care Improvement (4/13) – The Colorado Multi-Payer Collaborative (MPC) was a voluntary association of health care payers that convened from 2012 through 2021 to coordinate efforts to improve primary care and reform health care payment in the state. As part of the MPC, members participated in federal primary care transformation initiatives such as Comprehensive Primary Care (CPC), Comprehensive Primary Care Plus (CPC+), and the Colorado version of the State Innovation Model (SIM).This report summarizes observations from interviews with members of the MPC, state and federal collaborators, and health care practitioners who participated in primary care transformation initiatives undertaken by the MPC. Some of the observations and lessons learned were gleaned from a survey of providers that the MPC conducted in the spring of 2022.
Commonwealth: What Can We Learn From Medicaid About Making ACOs Equitable? (4/12) – Accountable care organizations (ACOs), designed to hold health care providers responsible for the quality and overall cost of patient care, have played a leading role in U.S. efforts to improve health system performance. While much of the experimentation with ACOs has focused on the Medicare program, Medicaid ACOs have been established in more than a dozen states. Much less is known, however, about the design of Medicaid ACOs and their impact on patients and costs. Medicaid ACOs have achieved improvements in health care quality, costs, and, to a lesser degree, equity. Barriers to their adoption include competing policy priorities and local stakeholder resistance. CMS could encourage broader adoption of ACOs in Medicaid by offering greater flexibility to meet local needs and provider capabilities while streamlining the process through which states can introduce new payment models.