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News Clips
NIHCM: Private Equity Ownership of Physician Practices Is Rising (6/25) – A novel study revealed significant growth in private equity firm acquisition of physician practices between 2012 and 2021, raising concerns about the potential impact on local health care market competition, quality, and pricing. The study found that private equity firms’ market share exceeds 30 percent and 50 percent in some local markets, with significant geographic and specialty-type variation. As private equity involvement in health care continues to grow, these findings are relevant to policymakers and regulatory agencies focused on understanding health care market concentration and its implications across health care.
Med City News: Can Providers Scale Value-Based Care Sustainably? (6/20) – The way value-based care is currently practiced at health systems results in hours of new administrative tasks for physicians, including increased responsibilities for documentation, care coordination, patient engagement, preventive care outreach, and the tracking of financial and population health metrics. Without addressing this problem, value-based care models will never be able to reach true scale. Finding ways to eliminate physicians’ administrative burden will allow them to restore joy in their work and return to the reason most of them got into the field: to help patients. This will likely create a virtuous feedback loop of performance — in other words, it’s easier to provide exceptional care experiences when you’re not bogged down by hours of stressful tasks.
Fierce Healthcare: Lawmakers press CMMI's Fowler on lack of cost savings for alternative payment models (6/18) – Republicans took issue with CMMI’s spending and lack of savings since the center's establishment in 2010 by the Affordable Care Act, which projected it would save nearly $80 billion over two decades. According to a September 2023 report by the Congressional Budget Office, CMMI spent $5.4 billion more than it saved in its first decade. In the next decade, CBO estimates CMMI will increase spending by over a billion dollars. Republicans tempered their criticisms with recognition that CMMI’s Accountable Care Organization REACH model has been successful in driving ACO creation and bringing more value-based care into the system. Fowler repeatedly stressed that CMMI views all its programs as successful because they generate important lessons for the Center. She also said that Congress should look at how CMMI is improving quality of care, which is another one of its statutory mandates.
Medical Economics: Simplifying value-based care is paramount to a successful transition (6/18) – The US health care industry continues a predominant fee-for-service provider reimbursement model, despite trying to shift to a value-based care model for now approaching two decades. Moreover, providers continue to be consumed in a figurative avalanche of paperwork. It is a challenging system for both practitioners and patients, often delivering unpleasant experiences for both. There are general steps that health care providers can take to ease the transition to value-based care and be prepared for the future. Decision support systems can be implemented for efficiently managing patient care and maximizing quality through systematic workflows and assignment of care personnel. This helps to optimize quality outcomes cost effectively. These systems can also be used to track and report quality and costs. However, leadership and standards are imperative to making a full transition to value-based care work. These are the critical elements that we are still waiting for.
Health Leaders Media: Healthcare Spend Is Big, And Getting Bigger. Can VBC Make An Impact? (6/17) – For value-based care to truly have an impact on health care spending, hospital executives and payers will need to work together to examine what types of value-based care models will create an impact specific to their organization. And while this type of care is fondly spoken about among health executives, implementation will require strategic plans in order to be beneficial to the industry. As health care spending expands above the GDP, population growth rates, and overall inflation, it may not be sustainable. “Its long-term sustainability is in question unless monetary policies enable other industries to grow proportionately and/or taxpayers agree to pay more for its services. These data confirm its unit costs and prices are problematic.”
Wall Street Journal: What Happens When Your Insurer Is Also Your Doctor and Your Pharmacist (6/17) – Much like the rest of the U.S. economy, America’s health care system has consolidated in recent decades, creating giant hospital systems, chain-owned medical practices and vertically integrated insurance conglomerates. Immense scale can drive efficiencies and reduce the cost of care. But in the highly complex and opaque world of U.S. health care, where giant companies always seem to be a step ahead of regulators, it also raises potential conflicts of interest and opportunities to game the system. The benefits of size often flow to those companies, not patients or the employers and taxpayers footing much of the bill.
New York Times: Guest Essay - Even Doctors Like Me Are Falling Into This Medical Bill Trap (6/14) There’s a movement afoot to make so-called site-neutral payments the law, meaning that Medicare would pay doctors the same price for an outpatient procedure no matter what type of outpatient setting it’s performed in. Though at least 16 states have passed laws requiring transparency about facility fees, headwinds are still stiff. Congress inserted a site-neutral payment rule into the Bipartisan Budget Act of 2015, but ferocious lobbying exempted nearly all existing hospital outpatient departments. It’s time for Congress to protect patients from both unfair pricing schemes and health care deception. MedPAC, the nonpartisan Medicare Payment Advisory Commission, recently recommended to Congress a basic set of site-neutral policies. It would apply site-neutral payments to a handful of low-risk procedures — some imaging, medication injections, simple office procedures — and this would apply to all HOPDs.
STAT: Op-Ed - Certificate of need laws con rural patients out of health care (6/14) Certificate of need (CON) laws restrict access to health care services by artificially limiting the establishment and expansion of health care facilities. In some cases, CON schemes prevent providers from offering low-cost alternatives to hospital care. For example, CON laws barred an ophthalmologist from performing eye surgeries at his facility in North Carolina, and blocked an aspiring entrepreneur from opening a birthing center in Georgia. In other cases, CON programs stopped construction of hospitals in counties without one. In South Carolina, legal wrangling over certificate of need delayed the opening of a hospital for nearly two decades after the state identified the need for one in York County. Decades after their implementation, the touted benefits of certificate of need laws have not been realized. Instead, the regulations have unnecessarily limited the supply of, and access to, quality health care options for all Americans. The rollback and repeal of CON laws will allow patients and providers to access each other without the unnecessary intrusion of the government.
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