Welcome to this week's edition of the 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.
White House: (5/4) - The Biden Administration announced its new goal to administer at least one vaccine dose to 70 percent of the US adult population by July 4, 2021. New efforts will include increasing walk-in appointments, pop-up clinics, and mobile units to make vaccines more readily available, with additional funding going to states and rural communities to support vaccine education and on-the-ground outreach efforts.
(5/3) – HHS, through HRSA, announced a new program covering costs of administering COVID-19 vaccines to patients enrolled in health plans that either do not cover vaccination fees or cover them with patient cost-sharing. The COVID-19 Coverage Assistance Fund (CAF) addresses an outstanding compensation need for providers on the front lines vaccinating underinsured patients given providers cannot bill patients for COVID vaccine fees. The CAF, which is funded through the Provider Relief Fund Program, will compensate providers for eligible claims at national Medicare rates which increased in March, to reflect newer information on the true costs associated with administering the vaccines. CAF also builds on the HRSA COVID-19 Uninsured Program, which has been reimbursing providers for vaccine administration fees associated with uninsured individuals.
White House: (5/3) - The Biden Administration announced that the HHS Administration for Community Living would release $1.4 billion in funding from the American Rescue Plan for Older Americans Act programs, including to support vaccine outreach and coordination, address social isolation, provide family caregiver support, and offer nutrition support. It will also fund justice programs to ensure the safety and protection of older adults.
HHS: (4/29) - HHS – through the American Rescue Plan – awarded over $32 million to expand COVID-19 training and support for HRSA Health Center Program-supported health centers. The health centers, which include Primary Care Associations, National Training and Technical Assistance Partners, and Health Center Controlled Networks, will use the funds to provide health centers with critical COVID-19 related training, technical assistance, and health information technology support.
NIH: (4/29) - The National Institutes of Health (NIH) announced $29 million in additional grants for the NIH Community Engagement Alliance (CEAL) Against COVID-19 Disparities. The funding, supported by the American Rescue Plan, will provide $15 million to 11 teams already conducting research and outreach to help strengthen COVID-19 vaccine confidence and access, as well as testing and treatment, in communities of color. An additional $14 million will fund 10 new research teams to extend the reach of COVID-19 community-engaged research and outreach.
CMS: (4/29) - CMS issued a final rule to extend and change the Comprehensive Care for Joint Replacement (CJR) model. The final rule revises the episode definition, payment methodology, and makes other modifications including extending the model for an additional three performance years through December 31, 2024 for certain participant hospitals. Information
CDC: (4/28) - CDC released an assessment finding that fully vaccinated adults 65 years and older were 94% less likely to be hospitalized with COVID-19 than people of the same age who were not vaccinated. Further, people 65 and older who were partially vaccinated were 64% less likely to be hospitalized with COVID-19 than people who were not vaccinated.
GAO: (5/3) - GAO announced the appointment of five new members to the Medicaid and CHIP Payment and Access Commission (MACPAC), and named the Commission’s Chair and Vice Chair and reappointed two members. The newly appointed members are Heidi L. Allen, Robert Duncan, Laura Herrera Scott, and Verlon Johnson. Their terms will expire in April of 2024. In addition, Dennis Heaphy was newly appointed to serve out the remaining term of Thomas Barker, which will expire in April of 2022. Current members Melanie Bella and Katherine Weno have been reappointed. In addition, Melanie Bella and current member Kisha Davis have been named the Commission’s Chair and Vice Chair, respectively.
Health Care PRICE Transparency Act: (4/29) - Sens. Braun (R-IN), Grassley (R-IA), Ernst (R-IA), Barrasso (R-WY), and Tillis (R-NC) introduced the Health Care PRICE Transparency Act (S. 1524), which would amend the Public Health Service Act to provide for hospital and insurer price transparency.
Medicare Buy-In and Health Care Stabilization Act: (4/28) - Reps. Higgins (D-NY), Larson (D-CT), Courtney (D-CT) and Welch (D-VT) introduced the Medicare Buy-In and Health Care Stabilization Act (H.R.2881), which would provide for an option for individuals who are ages 50 to 64 to buy into Medicare, to provide for health insurance market stabilization, and for other purposes.
National Association of ACOs: (5/4) - Eleven leading health care groups, including AAFP and MGMA, sent a letter to HHS Secretary Xavier Becerra calling on the Biden Administration to delay and make significant changes to the way accountable care organizations (ACOs) report and are measured on quality in the Medicare Shared Savings Program (MSSP). The groups outline six recommendations based on input from ACOs, including to delay the mandatory reporting of eCQMs and MIPS CQMs for at least three years and to limit ACO reporting to ACO assigned beneficiaries only.
AAFP: (5/4) - A recent report released by the National Academies of Sciences, Engineering, and Medicine (NASEM) calls for strengthening primary care in the US, proposing several policy recommendations that reinforce advocacy positions of the AAFP that the fee-for-service heath care design promotes misaligned incentives. Additionally, AAFP was one of the co-sponsors of the study leading up to the report and will participate in stakeholder and lawmaker briefings accompanying the report’s publication.
MedPage Today: (4/30) - In the latest article for the “After the Pandemic'' series, MedPage Today interviewed Anders Gilberg, Senior Vice President for Government Affairs at MGMA, on the lasting effects COVID-19 will have on medicine and the delivery of health care. He noted how medical practice executives in independent groups have expressed concern about the impact the pandemic will have on industry consolidation, as well as what he would like to see around telehealth reimbursement rates post-pandemic.
Aledade: (4/29) - In this blog, Aledade compares the Direct Contracting model to the Medicare Shared Savings Program (MSSP). The blog outlines the difference between Direct Contracting and MSSP, the three types of Direct Contracting arrangements, and why MSSP is still the best bet for practices. Aledade also published another blog with 10 things to know about the Direct Contracting model.
JAMA Network: (5/4) - The National Academies of Sciences, Engineering, and Medicine (NASEM) released its “Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care” report. NASEM organized a committee to study the state of primary care, and to develop an implementation plan that builds upon the recommendations of the 1996 Institute of Medicine report entitled “Primary Care: America’s Health In a New Era” to strengthen primary care services in the US. The report calls for an implementation plan with five objectives that emphasize the need for a federal coordinating function and an evaluation and reporting infrastructure for report recommendations and their influence on health outcomes, which are outlined in this article.
Kaiser Health News: (5/4) - In its recently released report on primary care, the National Academies of Sciences, Engineering, and Medicine (NASEM) called for broad recognition that primary care is a “common good.” Notably among its several recommendations was that all patients in the US across payers should select a primary care provider or be assigned to one, which could significantly change the way health care is delivered. This concept, known as empanelment, has been noted as a way to increase sustained relationships with primary care providers to increase high-quality care.
Health Affairs: (5/3) - Vertical integration has increased in the health care system in recent years, with hospitals and health systems having direct ownership of physician practices. In a new Health Affairs study, researchers looked at the impact of vertical integration on referral patterns for common diagnostic tests and procedures and the associated spending. The study found that vertical integration, combined with differences in Medicare payments between hospitals and non-hospital providers, leads to higher spending in Medicare for these services.
Healthcare Exec Intelligence: (5/3) - Last month, some health insurers allowed cost-sharing waivers for COVID-19 treatment to expire, leaving some to wonder if now is the time to shift financial responsibility back to patients. In this episode of the Healthcare Strategies podcast, Mark Fendrick, Director of the University of Michigan Center for Value-Based Insurance Design, was disappointed in this move, stating that the health care industry needs to bolster high-value spending and the role value-based care can play in this process of determining new cost-sharing strategies.
Milbank Memorial Fund: (5/3) - CMS has launched three primary care models over the past several years to align multiple payers with Medicare - Comprehensive Primary Care, Comprehensive Primary Care Plus, and Primary Care First. This brief looks at state Medicaid agencies’ decision-making around participating in such models, finding that alignment with existing state primary care programs and goals was important for state Medicaid agencies to consider model participation.
Health Affairs: (5/3) - More physicians in the US have been transitioning from independent practice to hospital employment, which has raised concern around whether employed physicians will increase referrals for unnecessary hospital-based services. This study looked at claims to identify if hospital-physician integration is associated with inappropriate referrals for MRIs for three common conditions, finding that such actions increased by over 20 percent after a physician transitioned to hospital employment.
Milbank Memorial Fund: (4/29) - COVID-19 has altered the way primary care has been delivered and accessed by patients. In this report, authors document and analyze trends in primary care over the course of the pandemic and make recommendations to primary care clinical team members, health care industry leaders, and policy experts for care strategies to advance primary care moving forward.
Modern Healthcare: (4/28) - A new study found that primary care providers have a tendency to overestimate the risk of common conditions, including cardiac ischemia and breast cancer, based on symptoms and test results. Although those surveyed were often those who worked with sicker patients which could have contributed to inflated probability estimates, the misaligned incentives that often result from fee-for-service can also be a factor in this trend.
Managed Healthcare Executive: (4/28) - In the most recent episode of the Tuning in to the C-Suite’s Meet the Board podcast, Doug Chaet, President of Value Evolutions and Chairman of the American Association of Integrated Healthcare Delivery Systems, speaks on his thoughts toward value-based care, ACOs, and more.
Healthcare Innovation: (4/27) - A recent survey from the Larry A. Green Center and the Primary Care Collaborative found that 38 percent of primary care providers reported that their practice was administering the COVID vaccine and 42 percent indicated their practice was increasingly partnering with public health and local organizations to prioritize people for vaccination. However, the data revealed that primary care practices indicated they can be doing more to aid in the vaccine distribution process.