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.
Medical Group Management Association: (5/4) – The goal of value-based care payment arrangements is to transform clinical care practices by rewarding high-value care via changes in payment mechanisms. In this MGMA member spotlight, Coastal Carolina Care shares the impact of the five percent APM incentive payment on their practice’s success in the Medicare Shared Savings Program (MSSP).
American Academy of Family Physicians: (5/2) – AAFP recently offered CMS guidance on ensuring Medicaid beneficiaries’ access to timely and comprehensive care — including primary care and behavioral health care — while calling out barriers such as low Medicaid physician payment and burdensome administrative processes. The letter to CMS Administrator Brooks-LaSure was sent in response to a request for information titled “Access to Coverage and Care in Medicaid and the Children’s Health Insurance Program,” published Feb. 17 in the Federal Register. Letter
Health Affairs: (5/9) – There is strong evidence that, compared to non-duals, duals have less access to high-quality care including some of the most innovative ACO models. Duals are also less likely to access needed specialty care than other Medicare beneficiaries. In this article, the authors argue that CMS should take action within its quality measurement and incentive programs to remedy such inequities by updating current incentive structures within Medicare that disincentivize care of duals and to instead reward clinicians and health systems for providing high-quality care to this population.
California Health Care Foundation: (5/9) – Alternative Payment Models (APMs) are designed to create a financial responsibility for the provider to be accountable for the provision of optimal, evidence-based care for their patients and incentivizes an efficient use of health care dollars. This issue brief explores how Medi-Cal, California’s Medicaid program, has been developing APMs to align with federal initiatives and state financial and policy goals. It looks at the benefits of APMs and barriers to adoption.
Fierce Healthcare: (5/9) – Intermountain Healthcare is teaming up with West Coast venture capital firm General Catalyst to inject digital innovation across its health system. The collaboration will involve jointly exploring opportunities within the Intermountain system and within healthcare in general to accelerate the shift to value-based care through digital and other solutions offered by companies in the VC firm's network of "Health Assurance.
Forbes: (5/9) – Nearly three in four doctors now work for a hospital, health system, or corporate entity, according to new data from Avalere. That's a seven percent increase from a year ago—and an almost 20 percent jump since 2019. In other words, the independent physician is becoming an endangered species. The corporatization of medicine is severely limiting competition in the healthcare marketplace. And that's leading to higher prices for patients—and lower pay for providers.
Connecticut Mirror: (5/9) – Across the country, hospital mergers are changing the ways in which people access health care. Most hospitals are no longer independent but instead part of larger health systems that own multiple facilities. In Connecticut, two systems — Yale New Haven and Hartford HealthCare — are on the brink of owning more than half the 27 hospitals in the state.
American College of Physicians: (5/6) – Patients and physicians alike can encounter frustrations during the referral process and follow-up coordination of care.In a new policy paper titled “Beyond the Referral: Principles of Effective, Ongoing Primary and Specialty Care Collaboration,” the ACP outlines how care coordination between clinicians should be improved to eliminate fragmented care, lower risks for errors and relieve patient and clinician frustration.
RevCycleIntelligence: (5/6) – With an abundance of differing data, the industry remains divided on how healthcare mergers and acquisitions impact practice management, such as healthcare costs and patient quality of care. This article provides an overview of the evidence around the impact of mergers and acquisitions on health care costs, quality and worker satisfaction and morale.
State of Reform: (5/4) – Colorado is poised to pass a bill requiring hospital price transparency for medical debt collection.The bill unamimously passed the Senate positioning the bill to be signed into law by Gov. Jared Polis. The bill would prohibit a hospital from pursuing collection actions against a patient for medical services if the hospital is not in compliance with federal hospital price transparency laws.
Health Leaders Media: (5/3) – Investing in primary care is associated with better quality medical care, fewer hospital visits, and savings of $2.4 billion annually in California, according to a new study. The report -- Investing in Primary Care: Why It Matters for Californians with Commercial Coverage -- looked at eight health plans covering 80 percent of commercially insured adults in California, almost 14 million people. The report finds that primary care spending, as a percentage of overall spending, varied widely among the health plan products, from a low of 4.9 percent to a high of 11.4 percent.
Medical Economics: (5/3) – Private equity’s (PE) role in primary care is growing and could harm both the quality and cost of care unless legislators and health care policymakers act to slow its growth. Practices acquired by PE firms often face pressure to increase their revenue through overutilization, up-coding and more aggressive risk coding. PE firms will often pay more to buy practices, sometimes as much as 12 times its valuation, and enough to persuade practice owners to sell to them, in a period where the pressures and challenges of remaining independent are high.