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: (2/21) CMS announced the request-for-applications (RFA) is now available for the two-year extension of the Bundled Payments for Care Improvement (BPCI) Advanced Model, which tests whether linking payments for an episode of care will encourage health care providers to make changes to improve care coordination and reduce expenditures while maintaining or improving quality of care. The RFA deadline is May 31, 2023.
Sen. Lankford (R-OK): (2/21) – Sen. Lankford (R-OK) and Dr. Miller, Johns Hopkins University School of Medicine, published an op-ed advocating for ending the ACA’s ban on physician-owned hospitals, arguing that this would promote competition and give rural communities another option to maintain local high-quality care and encourage local investment in existing hospitals.
Patient Access to Higher Quality Health Care Act: (2/21) – Sen. Lankford (R-OK), along with 12 other senators, announced the reintroduction of the Patient Access to Higher Quality Health Care Act, which removes the ACA ban on the creation and expansion of new physician-owned hospitals and allows physician-owned hospitals to participate in Medicare and Medicaid. Rep. Burgess (R-TX) is leading the reintroduction in the House. Bill Text
Truth in Healthcare Marketing Act: (2/16) – Sen. Kennedy (R-LA) introduced the Hospital Transparency Compliance Enforcement Act (S. 468), which would strengthen enforcement of hospital price transparency requirements and increase penalties for noncompliance. Press release
Aledade: (2/21) – Aledade announced it added more than 450 primary care practices, including nearly 60 health centers, to its nationwide network for 2023, making it the largest network of independent primary care in the country. Aledade also announced the acquisition of Curia, a value-based care analytics company. The acquisition will enhance Aledade’s ability to extract valuable insights from disparate data sources, provide more accurate predictions using past data and optimize primary care workflows.
Aledade: (2/16) – Aledade released a blog post, “Health Care Value Week Connects the Value-Based Care Community to Kick Off Advocacy for 2023.” PEPC was proud to be a supporting organization of Health Care Value Week 2023, which provided Aledade with an opportunity to celebrate the progress made in value-based care while continuing to discuss the evolving value-based health care landscape with stakeholders and policymakers.
Axios: Hospital outpatient billing draws bipartisan heat (2/22) – Hospitals could be playing defense this year as bipartisan scrutiny builds in Congress over the way facilities charge more for outpatient services that can be done in less-expensive settings, like a private doctor's office. So-called site-neutral payment reforms could save Medicare upward of $100 billion over a decade, according to various projections, and those with private health insurance could see savings, too. Rep. Kuster (D-NH) plans to team with Rep. Spartz (R-IN) on a House billaddressing the issue, Kuster's office said.
Milbank Memorial Fund: The Health of US Primary Care: A Baseline Scorecard Tracking Support for High-Quality Primary Care (2/22) – The 2021 National Academies of Sciences, Engineering, and Medicine (NASEM) report Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care proposed the development of a scorecard to better monitor and ensure accountability for progress toward high-quality primary care in the United States. This first national primary care scorecard finds a chronic lack of adequate support for the implementation of high-quality primary care in the United States across all measures, although performance varies across states.
Fierce Healthcare: CMS: Tighter price transparency enforcement, standardized requirements for hospitals are on the horizon (2/21) – CMS leaders say the agency has handed out nearly 500 warnings to hospitals falling short on price transparency as of January and plans to streamline enforcement and standardize hospital reporting requirements. Enforcement of the transparency requirements has also included more than 230 requests for corrective action plans, CMS wrote last week in an article for Health Affairs. Seshamani and Jacobs said compliance with these requirements has increased substantially during the two years since enforcement began.
RevCycle Intelligence: AMGA Calls on Congress to Advance Value-Based Care, Support Providers (2/21) – Congress should focus on advancing value-based care by investing in proper infrastructure, incentivizing patient engagement, and supporting continuous telehealth coverage, according to the American Medical Group Association (AMGA). The organization sent a letter to congressional leaders expressing appreciation for their efforts to support health care providers throughout the COVID-19 pandemic. However, the letter urged leaders to improve the Medicare program to help boost value-based care delivery. Medicare reimbursement cuts, workforce shortages, and inflation have led to consistent burdens for providers and patients, AMGA said. These conditions make it difficult for providers to transition to value-based care. Thus, Congress should establish a more sustainable Medicare payment system.
Bloomberg: Axing Health-Care Antitrust Safety Zones Will Impact Transactions (2/21) – The Department of Justice’s Antitrust Division recently withdrew its support for three joint policies with the Federal Trade Commission, which each created antitrust safety zones in the health-care industry. A 2011 policy created a safety zone for accountable care organizations (ACOs). This move shifts the landscape for antitrust enforcement and may change longstanding analyses for health care industry transactions and collaborations. One area of immediate concern for ACOs is the treatment of competitively sensitive information, such as compensation arrangements with competing providers, or other financial information that would be relevant to accounting for shared savings. ACOs should reevaluate both their ongoing need for any information exchange and the safeguards in place to avoid any implication that the information facilitates potential collusion, such as price fixing.
Kaiser Health News: Senators Say Health Worker Shortages Ripe for Bipartisan Compromise (2/17) – Senators are eying the growing shortage of health care workers in the United States as one of the few problems where there is room for bipartisan solutions, even in a deeply divided Congress gearing up for a presidential election cycle. We are going to produce legislation, and I think people will be surprised about the level of bipartisan supporters,” Sen. Sanders (I-VT) said. He called for the committee to “produce something meaningful.” Members on both sides of the aisle recognized growing levels of burnout in the medical professions; the costs and challenges of working underserved areas; and financial incentives that steer younger professionals toward more lucrative specialties and higher-income areas.
Becker's ASC Review: Is private practice possible for young physicians in 2023? 5 experts weigh in (2/17) – I do think it is feasible for new young physicians to begin private practice in 2023, but the headwinds continue to grow every year. It is increasingly difficult to negotiate fair contract pricing with insurance companies, and the delay tactics they employ in providing contracts make the first two years in practice particularly grueling. Hospitals tend to offer little assistance anymore since they prefer to employ physicians in order to control their referral patterns. All of that being said the reward of having some semblance of independence from the often suffocating effect of hospital or large group practice employment is quite significant. For the independent-minded and business-savvy individual, the opportunity to begin and grow a practice still exists and can be very rewarding.
Bloomberg Law: Hospital Price Caps Among State Ideas to Lower Health-Care Costs (2/17) – The Indiana Senate passed Senate Bill 7 Feb. 7 by a 45-5 vote. That bill would bar newly hired physicians from entering into noncompete clauses with employers. That doesn’t affect hospital costs, but would help the state keep more physicians. Senate Bill 6, approved by the Health and Provider Services Committee Jan. 9, requires site-neutral payments. In Connecticut, Gov. Ned Lamont (D) is calling for passing legislation that would cap hospital out-of-network rates at Medicare rates, as well as prohibit anticompetitive contracting practices between health plans and hospitals.
STAT: Here’s another sign the Biden administration is taking a harsher stance on hospital consolidation (2/17) – The Biden administration this month quietly rescinded pivotal, Obama-era guidelines that let physicians sidestep antitrust scrutiny if they were pursuing certain kinds of “value-based” care — yet another sign that it’s taking a closer look at consolidation among doctors and hospitals. The withdrawal of that joint statement is a sign that antitrust authorities are more worried about the power of big health care systems to jack up prices than they were when Medicare officials for the Obama administration were harping on the importance of health care coordination and value-based pay. Regulators have always understood that there’s a trade-off between the greater efficiency expected from better coordination among health care providers and the market power, and prices, that accompany that coordination.
Health Affairs: ACO Benchmarks Based On Area Deprivation Index Mask Inequities (2/17) – In this article, we focus on how the ADI is being used in Medicare ACO initiatives to target support for organizations caring for disadvantaged and marginalized groups. Targeting support is important but complicated because of the great variety of communities across the country, including differences in cost of living and population density. The ADI has been a useful tool for many research efforts, and it offers several advantages including accessibility, timeliness, and ease of use. Nonetheless, the first applications of ADI within Medicare payment policy have significant limitations that need to be addressed to ensure that Medicare is successful in its efforts to achieve health equity. While our focus is on the ACO-related policies, we note that CMS has also communicated the prospect of using ADI in the Medicare Advantage Stars program.
NPR: Why hundreds of doctors are lobbying in Washington this week (2/17) – About 350 physicians who came to Capitol Hill this week to lobby Congress on behalf of the American Medical Association. Although they left their white coats at home, they were still there as doctors. Their goal was to build support for the organization's "Recovery Plan for America's Physicians" — a wish list that includes a pay raise, relief from insurance company prior-authorization demands, and more federally funded residency slots to train more physicians. They reminded Congress that Medicare payments to doctors do not include an automatic adjuster for inflation, even though hospitals and nursing homes get that. As a result, they argue, Medicare pay to physicians has fallen 22 percent since 2001. They want Congress to update their pay to keep up with inflation. Doctors say if current trends continue they may have to limit the number of Medicare patients they see.
Center for American Progress: Empowering State Attorneys General To Fight Health Care Consolidation (2/17) – As health care markets become more concentrated, strong antitrust enforcement becomes increasingly important to reining in rising health care costs. State legislatures can protect consumers by requiring notice of mergers to the attorney general; empowering the attorney general to conduct review of the merger with authority to approve or disapprove the merger; establishing agencies dedicated to producing the economic research necessary to successfully challenge mergers; and prohibiting abusive insurance contracting terms. By equipping antitrust enforcers with the tools and resources needed to successfully challenge anticompetitive activity, legislators can prevent further consolidation of their state’s health market and protect their residents’ access to affordable health care.
Healthcare Finance: MGMA presses CMS on prior authorization reform (2/16) – Medical Group Management Association (MGMA) is pressing CMS to reform the prior authorization process for health care services, calling it "routinely the most burdensome issue facing medical group practices." The group also wants to waive prior authorization requirements for providers who are participating in value-based models of care. "Groups who are part of value-based care models are already incentivized to control costs and deliver high-quality care," MGMA wrote. "It is unnecessary and a further impediment to delivering care to require these group practices to go through the motions of seeking prior authorization approvals when their costs are already controlled."
Forbes: Why Healthcare Spending’s Tipping Point Is In Sight (2/16) – Provider organizations can also take steps to reclaim some of their autonomy. We’re seeing larger consolidated provider groups, hospitals and community health plans provide direct-to-employer solutions that include narrow networks, which are insurance-type offerings that employers can deliver to their employees based on the geographic areas of their staff. Providers need to remember that they are the true value creators. They are the deliverers of care and navigators of health for patients. Ultimately, they own the decision for which channels they use to deliver that value, as well as how they wish to define what truly matters to them.
Forbes: 5 Leading Healthcare Trends For 2023 (2/16) – As health care providers continue to emphasize patient-centered care, it is no surprise that access to health data is one of the top trends for 2023. By leveraging this data, providers can ensure they are delivering care that is tailored to individual preferences and needs. This year, I think there will be a need for solutions that tackle the data access challenge by improving platform interoperability through centralized data hubs, such as the National Directory of Health Care Providers and Services. Centralizing this data will support not only personalized medicine but also the shift toward value-based care models by enabling accurate risk adjustment and quality evaluation methods while enhancing benchmarking and patient attribution methods.
Committee for a Responsible Federal Budget: Site-Neutral Payments Would Lower Private Health Costs, Encourage Competition (2/15) – Site-based incentives also encourage vertical integration – with hospitals purchasing physician practices and converting them to hospital outpatient departments to garner higher payments. This consolidation increases the pricing power of large hospital systems, enabling them to demand higher prices in negotiations with commercial insurers. Moving the commercial market toward site-neutral payment policies would reduce national health expenditures, allowing for lower premiums and cost sharing. In full, policies that encourage site-neutral payments in the commercial insurance market could:
Reduce total national health expenditures (NHE) by up to $458 billion.
Reduce commercial premiums by up to $386 billion and patient cost sharing by $73 billion.
Reduce the federal budget deficit by up to $117 billion.