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.
Department of Health and Human Services: (12/14) – HHS announced the distribution of approximately $9 billion in Provider Relief Fund Phase 4 payments to health care providers who have experienced revenue losses and expenses related to the COVID-19 pandemic. The average payment being announced today for small providers is $58,000, for medium providers is $289,000, and for large providers is $1.7 million. More than 69,000 providers in all 50 states, Washington, D.C., and eight territories will receive Phase 4 payments.
White House Briefing Room: (12/10) – The President signed into law the Protecting Medicare and American Farmers from Sequester Cuts Act (S. 610), which delays the Medicare sequester and makes other changes to Medicare payments, and modifies procedures affecting federal budget scorekeeping and federal borrowing.
U.S. Sen. Shaheen (D-NH): (12/8) – Sens. Shaheen (D-NH) and Collins (R-ME) led 20 bipartisan Senators in a letter to Majority Leader Schumer and Minority Leader McConnell urging the extension of the Medicare sequester moratorium as well as the 2021 Medicare physician payment adjustment. Later in the week, the Senate cleared legislation that extends the Medicare sequester moratorium as well as the 2021 Medicare physician payment adjustment until next year. On December 10, the President signed the legislation into law.
U.S. Sen. Boozman (R-AR): (12/6) – Sens. Boozman (R-AR), Padilla (D-CA), Marshall (R-KS), and Tester (D-MT) introduced the Supporting Medicare Providers Act of 2021 (S. 3314), which would extend certain increases in payments for physicians' services under the Medicare program through 2022. On November 18, Rep. Bera (D-CA) and 35 bipartisan cosponsors introduced bipartisan legislation in the House (H.R. 6020).
Fierce Healthcare: (12/10) – The Senate passed legislation that delays nearly 10 percent in Medicare cuts set to take effect next year, giving providers a major boost. With the immediate crisis resolved, provider groups are turning towards a more permanent solution to the issue. The Medical Group Management Association said that Congress needs to refocus policies that “penalize physician practices and the millions of beneficiaries they treat,” Anders Gilberg, senior vice president of government affairs for MGMA, said in a statement.
Fierce Healthcare: (12/14) – Healthcare merger and acquisition activity hit a new stride in 2021, fueled by investor interest in digital health and virtual care as well as the SPAC craze that's pumping a lot of cash into the market. There were over 3,000 total transactions expected by year-end, representing an increase of more than 25 percent as compared to 2020.
Healthcare Dive: (12/13) – The Hospital Price Transparency Rule is providing only a partial picture of the cost of care, limiting its value to patients trying to comparison shop, according to a study published in JAMA. Even with the new regulation in place, patients still may not be able to get accurate estimates of total costs primarily because many services are delivered and billed separately by independent practitioners who are not subject to the new rule. To improve price transparency, the study argues all healthcare entities involved in delivering care should be subject to price transparency requirements.
Health Affairs: (12/13) – A large reason for the complexity of prices in the US health care system is the institutional settings in which prices are set. Prices for health care services in the United States are largely determined through two different processes: administratively, and through negotiations. Administrative prices differ due to the rules and policies that govern prices of the respective public program (e.g., Medicare and many Medicaid plans). Prices for the privately insured population are established through a complex negotiation process between providers and insurers. This negotiation system has resulted in a chaotic landscape with high and variable prices. For hospital services, a recent report finds negotiated prices for hospitals range an average of 247 percent of Medicare.
Modern Healthcare: (12/10) – The smallest and most rural healthcare providers will soon lose access to help in shifting to value-based care unless Congress steps in. Over the past five years, rural providers with fewer than 15 clinicians have been increasingly encouraged to participate in the Merit-based Incentive Payment System value-based payment program that provides financial bonuses or penalties.When Congress created MIPS in 2015, lawmakers also gave the CMS $100 million to create the Small, Underserved, and Rural Support program to help these providers wade through what measures to report and how to keep current with changes to MIPS. But starting Feb. 15, the money is set to run out.
Modern Healthcare: (12/10) – A merger between large, successful, for-profit hospital chains didn't produce significant gains in profitability or health outcomes, new research shows. The acquirer's hospital margins decreased by 3.3 percentage points as cost inflation outpaced revenue growth, according to a peer-reviewed analysis of a 2007 merger involving more than 100 hospitals that tracked financial, management and quality data over an eight-year period. While the combined system improved their electronic medical records, prices rose by 37 percent at hospitals operated by the parent company and there was a negligible impact on care quality, the working paper published in the National Bureau of Economic Research revealed.
Fierce Healthcare: (12/10) – Healthcare mergers and acquisitions surged in 2021, growing 56 percent in the 12 months through Nov. 15 versus 2020. There was particularly high growth among physician medical groups, which saw more than 400 deals, as well as managed care and rehabilitation subsectors, according to a new report from PwC. This compares to about 200 to 250 deals per year between 2017 and 2019. There's the potential for more consolidation and private equity roll-ups in 2022 and beyond as practices have experienced challenging economics and may face 2022 CMS payment cuts.
Commonwealth Fund: (12/10) – The National Academies of Sciences, Engineering, and Medicine and the Commonwealth Fund Task Force on Payment and Delivery System Reform have called for a shift from volume-based to value-based payments that incentivize and hold health care providers accountable for the quality, equity, and cost of care. This shift in how we pay for primary care should be complemented with overall investment increases in primary care. Experts recommend revisiting the Medicare fee schedule, which sets Medicare reimbursement rates but is adapted by most other payers. The article argues that the current fee schedule largely overvalues services provided by specialists, like surgeries, while undervaluing common primary care services, like office visits.
Healthcare Finance: (12/9) – Hospital acquisition of independent physician practices is linked to a small drop in physician compensation, with a 0.8 percent drop in average income, according to new findings published in Health Affairs. This suggests hospitals may not benefit financially when hospitals buy their practices. From 2014 to 2018, hospital ownership of physician practices increased a full 89 percent, and the data from this time period began to uncover differences in compensation among various specialties. Non Surgical specialists, for example, saw their average income dip more than $9,650 annually, or 2.4 percent, while surgical specialists saw their incomes rise a modest 2.1 percent, or about $10,700 on average.
Forbes: (12/9) – CVS Health said it will be acquiring more physician practices and clinics as it expands its diversified strategy to grow its primary care business. CVS said it will be broadening its strategy into a “nationally-scaled next generation primary care model.” This will include more “physician-led primary care centers with integrated virtual and home assets,” Dr. Alan Lotvin, CVS Health’s Executive Vice President & President, Pharmacy Services, said.
Healthcare Dive: (12/8) – Medicare Advantage's quality bonus program has had no observable difference in plan quality despite costly federal investments, a new study suggests, bolstering calls from some stakeholders to substantially revise or even eliminate the program altogether. The study published in Health Affairs analyzed nine claims-based measures of quality for MA beneficiaries versus a control group of commercial enrollees. Program participation was associated with significant quality improvements among MA beneficiaries on four measures, significant declines on four other measures and no significant change in overall quality.
New York Times: (12/6) – Female doctors make less than their male counterparts starting from their very first days on the job, according to a large new study. Over the course of a 40-year-career, researchers estimated, this pay gap adds up to at least $2 million. The survey of more than 80,000 physicians, published in the medical journal Health Affairs, is the largest analysis to date on physician salaries and the first to estimate the cumulative impact of pay gaps in medicine.