News Clips
Health Affairs: Consolidation And Mergers Among Health Systems In 2021: New Data From The AHRQ Compendium (6/20) – Consolidation of health care providers into vertically integrated health systems continued through the COVID-19 pandemic, resulting in ever greater concentration in the U.S. health care system. Among key findings from the recently released 2021 Compendium is the fact that although the number of systems changed little between 2018 and 2021, there was considerable churn due to mergers and acquisitions, and increasing physician affiliation with health systems. What is more, consolidation trends led to increased variation in system size in 2021, with fewer large systems at the top of the size distribution and the addition of new smaller systems at the bottom.
Healthcare Finance: AMA pushes to end noncompete clauses in physician contracts (6/20) – The American Medical Association’s (AMA) House of Delegates voted last week to oppose noncompete contracts for physicians in clinical practice who are employed by for-profit or nonprofit hospitals, hospital systems or staffing company employers. The use of noncompete agreements has been extensive in the health care system, affecting up to 45 percent of primary care physicians. Trends show more physicians are working directly for a hospital or for a practice that is at least partially owned by a hospital or health system rather than in a private practice. Recently graduating trainees entering the workforce may be especially vulnerable to the negative effects of non-compete contracts, which can limit their opportunities for career advancement and restrict their ability to provide care in underserved areas.
Modern Healthcare: Providers, CMS pin hopes on revised Medicare Shared Savings Program ACOs (6/16) – A crucial deadline has arrived that could help determine whether the federal government's ambitious long-term plan to promote value-based care in Medicare will come to fruition. Health care providers had to submit applications by Thursday to participate in FFS Medicare Shared Savings Program (MSSP) accountable care organizations (ACOs) next year, an initiative central to the CMS’ aspiration that every Medicare enrollee be treated under value-based care by 2030. Participation has plateaued since 2019, prompting CMS to modify the program's incentives last year to lure more providers. According to CMS, 10.9 million people are under the care of 480,000 providers that are part of 456 MSSP ACOs. As it remade the MSSP, CMS addressed, but did not entirely revamp, the benchmarking methodology that discouraged participation over the past several years, said Sean Cavanaugh, chief policy officer at Aledade.
Health Affairs: Value-Based Care Fuels Innovation, Not Consolidation (6/16) – The assertion that the rules of value-based care inevitably incentivize corporate consolidation is unfounded. In point of fact, the current generation of value-based programs has birthed a period of intense innovation that may well serve as a counterforce to consolidation. We have yet to encounter plausible evidence that value-based care is a driving force behind health care consolidation, rather than a separate enterprise happening during a preexisting trend of increased consolidation across industries. These challenges are not inherent to value-based care programs, but insofar as they threaten the next chapter of health care’s necessary evolution, government can mitigate them. The Innovation Center is continuing to invest in models that counter certain dangers of consolidation, such as minimizing the control entities such as ACOs have on patients’ care.
MedPage Today: AMA to Amp Up Hospital Consolidation Scrutiny (6/16) – The AMA’s Private Practice Physicians Section made the case for the AMA to move beyond its prior resolution for a one-time study on the consolidation of hospitals and health systems. The independent physicians argued that health care consolidation strips physicians of their autonomy and places limits on how and where physicians practice medicine, driving increased burnout. "Hospitals push us around," said Michael Brisman, MD, a delegate from New York, speaking on his own behalf. Hospitals arbitrarily take away physicians' operating room time and prohibit them from buying needed equipment, he said. "The entire health care industry is consolidating into one big clotted mass that is of no use," he said, which is why it's important to make the data available and produce annual reports that can be used in advocacy with legislatures.
JAMA: Medicare Modernization—The Urgent Need for Fiscal Solvency (6/16) – The Medicare program is at a fiscal and policy crossroads. Programmatic reforms, including decoupling Medicare from administrative pricing, offers an opportunity to achieve fiscal responsibility and provides a framework for prospective, population-based program budgeting for the first time in the program’s history, saving the program for future generations and improving outcomes for patients, orientating Medicare toward health rather than sickness. Now is the time to double down on the transition from volume to value.
Becker's Hospital Review: Site-neutral pay reignited for HOPDs (6/16) – MedPAC again advised CMS to move toward site-neutral pay for outpatient procedures to prevent consolidation and directing services to the highest pay setting in a June 15 report to Congress. Pay differential between hospital outpatient departments, ASCs and physician offices has led to hospitals purchasing ASCs and office-based practices, increasing the pay rate for procedures, according to the report. "Based on the recent growth in hospital acquisition of physician practices and our own empirical analysis, the Commission recommends that Congress more closely align payment rates across ambulatory settings for selected services that are safe and appropriate to provide in all settings and when doing so does not pose risk to access," the report read.
Politico: Is a new doctor payment policy in the House? (6/15) – The House Energy and Commerce Committee will examine how Medicare pays doctors. The panel’s Investigations and Oversight Subcommittee will hold a hearing next week to get an update on the 2015 Medicare Access and CHIP Reauthorization Act. Doctors have complained that their Medicare payments are effectively being cut under the current system, fueling consolidation among doctors and hospitals. Lawmakers also want to know why the transition to value-based care, which pays doctors based on the level of care provided instead of the volume of items and services, has slowed despite efforts under MACRA.
New York Times: The Moral Crisis of America’s Doctors (6/15) – As the focus on revenue and the adoption of business metrics has grown more pervasive, young people embarking on careers in medicine are beginning to wonder if they are the beneficiaries of capitalism or just another exploited class. In the past, one privilege conferred on physicians who made these sacrifices was the freedom to control their working conditions in independent practices. But today, 70 percent of doctors work as salaried employees of large hospital systems or corporate entities, taking orders from administrators and executives who do not always share their values or priorities.
Medical Economics: Physician groups praise new Medicare primary care payment model, but ACOs have questions (6/9) – Physicians groups praised a new Medicare payment model that will start a 10-year test period in 2024. But the advocate group for ACOs questioned a potential limit on participation by physician practices already using that method. CMS announced the new MCP Model would begin in eight states starting next year. The goal is to improve access and quality of care patients, especially in rural and underserved areas, by helping primary care physicians better coordinate care for multiple chronic disease. AAFP voiced support for the MCP model. However, the National Association of ACOs (NAACOS) praised some elements of the model, but said it would force physicians to choose between MCP and participating in an ACO.
MedPage Today: Healthcare Mergers Need More Regulation and Oversight, Senators Told (6/9) – Congress must act to rein in consolidation in the health care system while still encouraging competition, Shawn Martin of the AAFP said Thursday during a Senate hearing. "A competitive health care marketplace benefits patients," Martin said. "Congress must reform Medicare and Medicaid FFS payment, advance site-neutral payment policies, implement billing and price transparency legislation, and bolster support for primary care practices to enter into alternative payment models." On the enforcement side, Congress should "implement additional reforms to address consolidation, including improving federal regulators' antitrust enforcement authorities and their resources, and restricting the use of unreasonable non-compete agreements in physician employment contracts," he added.
Health Affairs: Policy Design Tools for Achieving Equity Through Value-Based Payment, Part 2 (6/8) – Value-based payment programs can be designed to focus explicitly on addressing inequities, improving on historical precedent and ushering in a generation of payment models that promote health equity in the US. However, activity does not necessarily equal progress, and policymakers must implement change in a systematic, coordinated way to advance equity through payment reform. They can begin doing so by identifying equity challenges and developing a set of policy tools for each value-based payment design consideration.
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