News Clips
Real Clear Health: The Shocking Bipartisan Congressional Coalition to Lower Healthcare Costs (12/18) – Medicare pays hospitals a “facility fee” as part of every service it provides to Medicare patients. This perverse incentive results in consolidation, as hospitals buy up all the local independent physician offices leading to even higher prices. A 2018 study found that hospitals were acquiring record numbers of physician practices and raising prices on average 14 percent. Now, over a third of doctors work directly for a hospital or in practice, at least partially owned by a hospital, and that number continues to rise. The new hospital-owned practices are able to get higher Medicare reimbursements, but they also extract more from patients in out-of-pocket expenses and insurance companies, which leads to higher patient premiums. The cycle of rising prices will not stop unless we take action. Fortunately, members of Congress have identified these problems and have several proposals that would improve our current situation. The Bipartisan Primary Care and Health Workforce Act seeks to implement “site-neutral” policies—that is, giving the same reimbursement for outpatient care regardless of the location or owner of the physician practice. For payment purposes, it should not matter whether a physician practice is owned by a hospital or the doctors themselves.
Health Affairs: Private Equity: The Metastasizing Disease Threatening Health Care (12/18) – At least 386 US hospitals are currently owned by private equity firms. That represents 9 percent of all private hospitals and 30 percent of all proprietary for-profit hospitals. More than a third (34 percent) of private equity-owned hospitals serve rural populations, which are already experiencing a lack of access to high-quality care. This trend has produced troubling impacts for patients and health care workers across the country. We have seen private equity firms aggressively loot safety-net hospitals, strip out valuable real estate, cut critical but less profitable services, and exploit government funding programs designed to support and stabilize health care access. The consequences have been borne by health care workers and the communities they serve. Private equity’s hospital profiteering has resulted in dangerous conditions, closures, and reduced access to services, declining quality, and fraud. Despite the growing threat they pose to critical health care services, private equity firms are largely able to operate in the shadows. And aside from a few recent actions by the Federal Trade Commission (FTC), Washington—under Democratic and Republican administrations—has largely been asleep at the wheel, or has willingly looked the other way.
Fierce Healthcare: Fees charged by hospitals for colonoscopy procedures 50% higher than surgical centers, study finds (12/15) – A new price comparison study finds over 50 percent higher facility fees for commercially insured colonoscopies performed in hospitals rather than ambulatory surgery centers (ASCs), suggesting that “money has apparently been left on the table” for employers and consumers. Published in JAMA Health Forum, the analysis reviewed data on 13,287 facility fees charged by roughly 3,600 hospitals and 17,000 ASCs across the country. Hospitals contend that higher payments they receive for services that can be delivered in other settings are needed to support the broader array of care capabilities offered in their facilities. Advisory group recommendations and the recent passage of a bill containing site-neutral payment provisions for Medicare Part B drugs through the House, however, suggest that momentum is turning against hospitals on the issue.
Medscape: 10% of US Physicians Work for or Under UnitedHealth. Is That a Problem? (12/14) – The company added 20,000 physicians in the last year alone, including a previously physician-owned multispecialty group practice of 400 doctors in New York. They join the growing web of doctors — about 90,000 of the 950,000 active US physicians — working for the UnitedHealth Group subsidiary, Optum Health, providing primary, specialty, urgent, and surgical care. Amar Desai, MD, chief executive officer of Optum Health, shared the updated workforce numbers during the health care conglomerate's annual investor conference this week. Health care mergers and consolidations have become more common as physician groups struggle to stay afloat amid dwindling payer reimbursements. Although private equity and health systems often acquire practices, payers like UHC are increasingly doing so as part of their model to advance value-based care.
STAT: It’s time to rethink the Medicare annual wellness visit (12/12) – It’s time to rethink the AWV. Primary care practice has evolved in ways that challenge the value of an actual visit as a sensible way to help patients achieve preventive care goals and establish clinician-patient relationships. Value-based care has inspired innovation in proactive outreach approaches to population management. Use of patient portals and text messaging are effective, low-cost options, which may include both reminders as well as assistance with scheduling evidence-based interventions like mammography, colorectal cancer screening, and vaccination. Patients can easily complete the questionnaire portion of the AWV asynchronously through portal or text-based platforms alone or with caregiver assistance. Artificial intelligence will undoubtedly soon add to improved methods for outreach.
RevCycle Intelligence: Understanding the Value-Based Reimbursement Model Landscape (12/11) – The Centers for Medicare and Medicaid Services (CMS) aims to have all traditional Medicare beneficiaries under a value-based care model by 2030. Although the pace may be slow, the health care industry is shifting away from fee-for-service payments toward value-based reimbursement models. According to the Health Care Payment & Learning Action Network (LAN), over half of health care payments in 2022 were made through value-based reimbursement models. However, transitioning to value-based reimbursement is not easy for all health care organizations. These models require extensive data analytics capabilities, population health management programs, and the ability to successfully use electronic health records (EHRs) for documentation and reporting. Fortunately for providers, alternative payment models come in various shapes and sizes to suit several different needs and competency levels.
Politico: ‘Let’s go’: Trump’s HHS secretary wants CMS to ditch value-based experiments (12/11) – CMS should start implementing value-based care models in Medicare and stop “dabbling” with experiments, former HHS Secretary Alex Azar said. “Honestly, at this point, we have enough muscle memory in the system,” he said during a virtual event Monday sponsored by the Bipartisan Policy Center, a D.C.-based think tank. “It’s time to stop doing demonstration projects and simply implement change.” Azar — who ran HHS for the last three years of the Trump administration — believes the time for running more experiments has ended, even as the Biden administration has pared down the number of demonstrations it is doing. “We know it’s time to pay based on the total cost of care and stop dabbling with experiments,” he said. “We’ve learned enough, let’s go.”
Advisory Board: How physicians feel about employment, in 4 charts (12/8) – Among the survey participants, 90 percent were employed by hospitals or health systems, and 50 percent were from pediatrics, family medicine, and internal medicine specialties. Overall, 58 percent of respondents said ownership trends reduced the quality of patient care. Only 18 to 20 percent of respondents said ownership changes had improved the quality of care for patients. Some of the top negative impacts of employment identified by respondents were reduced physician autonomy on care delivery decisions (83%), increased administrative burden (75 percent), and an increased focus on financial incentives (72 percent).
US of Care: People Agree that Health Care is Too Expensive & Demand Lawmakers Take Action to Lower Costs, Limit Fees, and Increase Hospital Billing Transparency (12/8) – Voters overwhelmingly support policy solutions that limit facility fees. Nearly three in four voters (74 percent) want policymakers to ban facility fees everywhere for outpatient, same-day services, regardless of the service or where care is being provided. 47 percent of voters strongly support this. This policy is supported across demographics, insurance status, and party affiliation.
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