Administrative Updates

CMS: (1/6) – CMS announced the release of new resources highlighting strategies ACOs and End-Stage Renal Disease Seamless Care Organizations (ESCOs) use to improve quality of care, lower health care costs, and enhance the beneficiary experience. These resources include: an ACO care transformation toolkit; four case studies featuring specific ACO and ESCO initiatives from Fresenius Kidney Care, Nebraska Health Network, OneCare Vermont, and UC San Francisco Health; and a tip sheet highlighting strategies for enhancing education and expanding the use of home dialysis.

CMS: (12/29) - CMS extended the Community Health Access and Rural Transformation (CHART) Model Community Transformation Track application deadline to March 16, 2021. The Community Transformation Track will provide up-front funding to up to 15 rural communities across the country.

CMS: (12/22) - CMS released a letter to state health officials on resuming normal operations of Medicaid, CHIP, and basic health program operations upon conclusion of the COVID-19 PHE. The letter outlines COVID-19 flexibilities and termination dates.

CMS: (12/22) - CMS released its 2020 list of quality and efficiency measures under consideration. All but three measures under consideration rely on digital data collection. Of the non-digital measures, two are measures aimed at assessing COVID-19 vaccinations among health care personnel and patients in ESRD facilities, and the other reflects key patient-reported health outcomes. Final measures will be available for public comment in the Federal Register.

HHS: (12/22) - HHS OIG issued a report finding that total Medicare spending increased slightly because of increased utilization for certain high-priced tests. Despite payment rate reductions on many lab tests, Medicare Part B spending increased slightly to $7.68 billion, a $93 million increase from 2018. Similarly, Medicare expenditures on the top 25 tests increased slightly in 2019.

CMS: (12/22) - CMS posted the financial and quality results for performance year 4 for the Comprehensive ESRD Care Model.

CMS: (12/21) - CMS posted the 2019 year in review and calendar year Medicare payment fact sheets for the Comprehensive Primary Care Plus model. In its third year, the model included 2,837 primary care practices and served roughly 17 million patients.

Legislative Updates

Senate Judiciary Committee: (12/22) - The Senate passed by unanimous consent the Competitive Health Insurance Reform Act of 2020 (H.R. 1418), which would declare that nothing in the McCarran-Ferguson Act modifies, impairs, or supersedes the operation of antitrust laws with respect to the business of health insurance, including the business of dental insurance. Having passed the House on September 21, 2020, the bill now moves to the President for signature.

Sen. Warren: (12/21) - Sen. Warren (D-MA) introduced the Expanding COVID-19 Testing Capacity Act of 2020 (S. 5082), which would provide Federal support for COVID-19 testing. Bill text One-pager

Sen. Scott: (12/19) - Sen. Scott (R-FL) introduced the Set Testing and Objectives Plan (STOP) COVID-19 Act (S. 5073), which would establish a program to support county and municipal government entities in reducing the spread of COVID-19 through standardized testing and evaluation measures.

Member News

Modern Healthcare: (1/5) – In the latest stimulus and government funding bill, Congress recalibrated the Medicare Physician Fee Schedule to give primary care providers a pay increase, which is the biggest investment in primary care in 30 years. This increase was offset with cuts to other specialties because of budget neutrality requirements. Stephanie Quinn, senior vice president of advocacy, practice advancement, and policy at AAFP, commented that there is a ‘zero-sum game’ every year, and requisite cuts were needed to offset payment of a new code.

STAT: (1/4) - Shawn Martin, chief executive of AAFP, and Emily Maxson, chief medical officer at Aledade, note in this article that despite being included with tier 1a for COVID vaccine administration, independent primary care doctors are still being left behind in the vaccine rollout, despite their integral role in the health care system.

Primary Care Speaks As One (December) - Several primary care groups, including AAFP, launched the new Primary Care Speaks As One, calling for a unified paradigm for primary care financing. The group’s vision is that clinicians will be able to offer care that achieves better health, seamless integration of care, health equity, and lower costs by fundamentally changing how primary care services are financed.

News Clips

Revcycle Intelligence: (1/5) - This article breaks down how funding from the CARES Act and Provider Relief Fund were allocated across the United States. Of note, medically underserved areas appear to have received higher total payments and average payments from the Provider Relief Fund compared to counterparts in resource-rich areas, helping providers in struggling areas to remain open during COVID peaks.

Health Affairs: (1/4) - The Catalyst for Payment Reform and the Source on Healthcare and Price and Competition at UC Hastings College of the Law created a public database cataloguing state health care antitrust laws and pending legislation in order to better support states in advancing competition in health care markets. This article highlights three types of state legislation that could help maintain or encourage competition in the face of provider closures and acquisitions: bans on anticompetitive clauses in provider contracts, certificate of public advantage laws, and modifications to scope-of-practice laws.

Modern Healthcare: (12/31) - While medical students and residents are increasingly learning about value-based care, the opportunity to practice such learnings is limited in a largely fee-for-service health system. This article discusses the important role medical schools and residency programs can play in preparing physicians for a value-based care system.

Health Payer Intelligence: (12/31) - Payers are looking to build on the momentum around value-based care throughout the pandemic to enhance their value-based strategies moving forward. As such, some payers are leveraging artificial intelligence to broaden the evidence base used in value-based arrangements.

Milbank Memorial Fund: (12/30) - Value-based payment has potential to spur innovation in upstream prevention, but there is uncertainty about the conditions under which value-based payment will encourage health care providers to innovate to address upstream social risks. This cross-sectional study of social risk screening by U.S. physicians explores the role value-based payment can play in promoting innovation to address social risks.

Revcycle Intelligence: (12/29) - A new AMGA report revealed that medical group financial performance generally improved prior to COVID, with independent medical groups generating a profit in 2019. The profit per provider for independent medical groups increased from $5,200 in 2018 to $12,434 in 2019, and independent groups performed better financially compared to health systems. 

Inside Health Policy: (12/28) - Several groups are pushing for the incoming Biden Administration to halt the Geographic Direct Contracting model from being implemented. In addition to a previous letter sent to the current administration by NAACOS, the Center for Medicare Advocacy and the Commonwealth Fund have called for the model to be suspended, citing several remaining unanswered questions around operational aspects of the model and the model’s impact on Medicare spending, care coordination, and beneficiary choice of providers.

WXYZ Detroit: (12/28) - Some independent primary care physicians in Detroit have expressed feeling overlooked while the COVID-19 vaccine distribution has begun among frontline health care workers in the state. Independent practices in the state have expressed concern, as the Michigan Department of Health and Human Services has not provided a timeline for when such practices can expect to receive the vaccine.

Managed Healthcare Executive: (12/26) - In the fifth part of MHE’s State of the Industry survey, respondents were split on the effect of the pandemic on the shift to value-based care. About 46 percent of respondents indicated that the pandemic had no effect on their organization’s relationship with value-based care, while nine percent said it had a negative effect. Additionally, 44 percent of respondents noted some level of increase in value-based arrangements, and the majority of respondents said downside risk has not yet taken hold.

Fierce Healthcare: (12/23) - In this article, CMMI Director Brad Smith outlines how the Geographic Direct Contracting Model is a win for beneficiaries, communities, and health care stakeholders, as it is an important step forward for value-based care at the regional level.

AJMC: (12/22) - As the shift to value-based care continues, the need for value assessment research to be more inclusive of the patient perspective has grown. This article outlines how the health care field can better align value with patient-centered outcomes that can be captured, measured, and operationalized.

Events

January

• January 14 - California Medical Association, “Telehealth Series for Small and Medium Sized Practices: (Pt. 9) Telehealth 2021 Overview.” Virtual.

If you would like your event to be included in the next newsletter, please email kristen@physiciansforvalue.org.