|
News Clips
STAT: FTC’s proposed ban on noncompete agreements could be a game changer for some physicians (1/10) – Independent medical practice has been steadily eroded by hospital employment, as well as by private equity and corporate acquisitions, to the point where less than half of physicians in the U.S. work in private practices. The ban of noncompete agreements will not uniformly tilt power relationships across the medical profession. Yet for primary care physicians and subspecialists, where repeat or continuing patient relationships are common, the effect of the FTC’s ban would be nothing short of revolutionary. A more dynamic professional marketplace benefits patients and their physicians.
Health Affairs: Risk Adjustment And Promoting Health Equity In Population-Based Payment: Concepts And Evidence (1/10) – We found that current risk adjustment for the community-dwelling Medicare population overpredicts annual spending for Black and Hispanic beneficiaries by $376–$1,264. The risk-adjusted spending for these populations is lower than spending for White beneficiaries despite the former populations’ worse risk-adjusted health and functional status. Thus, continued movement from fee-for-service to population-based payment models that omit race and ethnicity from risk adjustment (as current models do) should result in sizable resource reallocations and incentives that support efforts to address racial and ethnic disparities in care. These findings also suggest that adding social risk factors as predictors to spending models used for risk adjustment may be counterproductive or accomplish little.
Health Affairs: Working With ACOs To Address Social Determinants Of Health (1/10) – Many ACOs are already screening patients for social risks, developing partnerships with community based organizations (CBOs), and establishing processes for closed-loop referrals. But it is not clear how much data need to be collected before policy will pivot toward direct investments in community-based services. While advancing health equity is a major focus of the Biden administration, we believe that the policy discussions have not paid sufficient attention to addressing gaps in community social service resources.
Health Affairs: Risk Adjustment: It’s Time For Reform (1/9) – Risk-adjustment reform should address concerns related to both coding intensity and predictive accuracy. We recommend that reforms to risk adjustment should accomplish key goals including the following: (1) Modernize the CMS-HCC risk-adjustment model paradigm by taking advantage of advancements in applied that incentivize better care over coding in value-based models. (2) Counterbalance or at least neutralize “gaming” incentives that cause providers and plans to see coding as economic value added. (3) Continue to improve payment accuracy for patients the current model fails to adequately address, such as those with complex chronic conditions or significant unmet social needs. (4) Advance health equity goals by ensuring that payments adjust to better meet the whole-person related resource needs of underserved populations and that these needs are properly measured and accounted for in ways that go beyond traditional measures of disease burden for the general population.
Patient Engagement IT: Is ACO REACH Model Poised to Bring Health Equity to Value-Based Care? (1/9) – CMS launched the ACO REACH model in February 2022 as a replacement for the Global and Professional Direct Contracting model. The agency said ACO REACH will promote health equity and address health disparities while centering provider-led organizations. Value-based care is difficult, and some industry experts have lamented that FQHCs and other safety-net clinics are disadvantaged in practice transformation, likely because they have fewer resources. Something like the ACO REACH model is a key solution to ensure traditionally marginalized patients—who mostly visit FQHCs or else get their care from high-acuity settings like the emergency department—would be left behind.
Kaiser Health News: More Orthopedic Physicians Sell Out to Private Equity Firms, Raising Alarms About Costs and Quality (1/6) – Orthopedic surgeons, long seen as fiercely independent, are rapidly catching up with other specialist physicians in selling control of their practices to private equity investment firms. Proponents say private equity investment has the potential to reduce total spending and improve quality. It also could help the doctors shift to value-based payment models. But critics warn that profit-hungry private equity ownership alternatively could result in higher prices and less access to care. Critics also worry that investors will put pressure on doctors to see more patients and use more non-physician providers in ways that could lead to poorer care.
Modern Healthcare: FTC proposes ban on employee noncompete clauses (1/5) – The FTC seeks to ban noncompete clauses, contract provisions used by many health care employers that allegedly suppress wages, limit innovation and deter new businesses. Researchers estimate that at least 40 percent of physicians are held to restrictive covenants that typically prevent them from working for competitors within a 30-mile radius for one or two years. The proposed rule would apply to independent contractors and anyone who works for an employer, whether paid or unpaid. It would generally not apply to other employment restrictions, such as nondisclosure agreements, unless they are so broad they function as de facto noncompete provisions.
RevCycle Intelligence: Financial Challenges for Health Systems Will Likely Persist in 2023 (1/5) – Hospitals and health systems will likely face another year of financial challenges in 2023 as they expect to continue grappling with inflation, staffing shortages, and low margins, according to data from Deloitte. Health systems have been struggling with workforce shortages since the beginning of the COVID-19 pandemic. Staffing shortages have impacted patient care and have also increased burnout among workers. Shifting to new payment models was a top priority for health plan executives, but hospitals may be focused on minimizing their financial losses instead. This may present barriers for health plans when it comes to moving their network providers into new value-based payment models. However, leveraging value-based care may help hospitals attract and maintain patients, which could help stabilize their finances, according to Deloitte.
Commonwealth Fund: Which Parts of the United States Have the Most Consolidated Medicare Hospital Spending? (1/4) – Hospital and health care consolidation has been found to harm access to care, quality of care, and provider choice for Medicare beneficiaries. Using Medicare claims data from 2021 analyzed by CareJourney, a health care analytics company, we examined the concentration of traditional Medicare spending within regional health care markets known as hospital referral regions (HRRs). Two hospital systems accounted for more than half of traditional Medicare inpatient hospital spending in 258 HRRs and accounted for more than three-quarters of spending in 110 of the total 306 HRRs in the U.S. In 10 states plus the District of Columbia, two hospital systems account for the majority of Medicare inpatient hospital spending in the state.
American Enterprise Institute: Price Transparency 2.0: Helping Patients Identify and Select Providers of High-Value Medical Services (1/4) – Policymakers in the United States have an opportunity to convert bipartisan support for transparent health care prices into savings for patients and taxpayers. Four changes to the current suite of requirements would improve results: (1) pricing disclosure of standardized, consumer-focused bundles of services; (2) mandatory (and enforced) provider participation in the disclosure system with regularly scheduled updates; (3) guaranteed access to care for all consumers at the disclosed prices, irrespective of their insurance coverage; and (4) coordination of insurance payments with transparency efforts to ensure patients can benefit fully when choosing low-priced options.
Forbes: Beyond Burnout: A Breaking Point In Healthcare (1/4) – Our health care system is approaching a critical condition. In a time when everyone is talking about the need for more doctors and nurses, it is alarming to see record levels of burnout and hear that many are considering quitting their jobs. As of late 2021, U.S. News & World Report found that 20 percent of health care workers had quit their jobs since the start of the Covid-19 pandemic, and this trend is not slowing down. Perhaps more alarming is that we are on track to experience a shortage of doctors while our population continues to grow and age. Unless something changes, we are on course for a breaking point in health care.
U.S. News: The Hidden Crisis in Primary Care (1/4) – There is a hidden health care crisis in America. Too few U.S. medical school students are choosing to go into primary care, and the current primary care physician workforce is not growing fast enough. The structural problems within our primary care system extend to financial incentives. In addition to inequitable pay, primary care physicians also work long hours and see far too many patients, with an average visit length of 18 minutes. This does not allow enough time to establish relationships with patients and address their complex needs – which increasingly include chronic disease management along with psychiatric and social concerns – much less complete their administrative tasks. Getting more doctors to enter – or stay – in primary care is a complicated challenge, but a good start would be investing more in the public health care system and its primary care physicians.
|
