April 30 - May 15, 2025

Welcome to The Partnership to Empower Physician-Led Care biweekly newsletter, which includes news from our members, legislative and Administration updates, news clips, and studies about value-based care, primary care, and independent physicians. 

 PEPC Statement on CMMI Strategy

PEPC applauds the Centers for Medicare and Medicaid Services Innovation Center (CMMI) for its commitment to ensuring that value-based care is a path to sustainability for independent practices and physicians in its new strategic direction to Make America Healthy Again. Evaluations of past and current CMMI models clearly demonstrate that independent practices and physicians are able to achieve quality improvements and cost savings in traditional Medicare. We are thrilled to see this reflected in CMMI’s new strategy and look forward to working with CMMI to further develop and implement model design components that break down barriers to greater participation.

 Administration News  

CMS (5/9) Primary Care First Third Evaluation Report – CMS released the third annual report for the Primary Care First Model. The evaluation did not find improvements in the model’s primary outcomes of reduced expenditures or hospitalizations, likely due to several factors including participants already being high performers. Last month, CMS announced that the model would be ending in December 2025, one year earlier than initially planned.

CMS (5/16) Request for Information: Health Technology Ecosystem – CMS released a request for information on the health technology ecosystem. This RFI seeks input from the public, including value-based care entities, regarding the market of digital health products for Medicare beneficiaries as well as the state of data interoperability and broader health technology infrastructure. Comments are due June 16.

 Legislative News  

Energy & Commerce Committee (5/11) – The House Energy & Commerce Committee advanced its legislation for budget reconciliation. The bill includes an update to the Medicare Physician Fee Schedule, eliminating the split conversion factor in 2026 and replacing it with an update of 75 percent of the Medicare Economic Index (MEI) and 10 percent of MEI in 2027 and in subsequent years.

Same Care, Lower Cost Act (5/6) – Sen Kennedy (R-LA) introduced the Same Care, Lower Cost Act which would implement site neutral payment policies in Medicare. Specifically, it would direct HHS to make 66 ambulatory payment classifications (APCs) identified in the Medicare Payment Advisory Commission’s (MedPAC) June 2023 report eligible for site-neutral payments and give the HHS Secretary authority to add additional APCs for site neutrality consideration.

SMART Health Care Act (5/6) – Rep. Spartz (R-IN) introduced the Stopping Medicare Abuses to Restore Trust in Health Care Act. The legislation would Implement site neutral Medicare payments for all on-campus outpatient payments in non-rural hospitals and lift the ACA provision banning physician-owned hospitals in rural communities, among other reforms aimed at lowering costs, improving access and increasing competition.

News Clips  

Health Affairs (5/6) Restraining Health Spending While Protecting Access: Potential For Bipartisan Action – This article spotlights lasting policy reforms with potential for bipartisan action, including site-neutral payments in Medicare and restraining health care consolidation. Transitioning to site-neutral payments for lower-complexity services—in which Medicare pays the same amount for a given service regardless of the care setting—is a sensible reform that could yield substantial savings for both taxpayers and beneficiaries. Decades of consolidation have left some hospital markets extremely concentrated, a situation that is very difficult to ease or correct. One potential approach to addressing such situations is to offer hospitals in highly concentrated markets a simple choice: either remain consolidated and accept a cap on prices (set lower than current commercial hospital payment rates) or voluntarily divest some holdings to reduce consolidation in their region below a defined concentration threshold.

Health Affairs (5/8) A More Holistic Approach To Measurement For Value-Based Care – Although methodological and logistical issues remain, payers, providers, and patients stand to reap significant benefits from considering the characteristics (that is, reliability and validity) of measure sets used in value-based care to prune the set of quality measures that meet the intent of the measure set. CMS’s existing consensus-based entity (CBE) may be well-positioned to evaluate a measure set’s fit for purpose. CMS sponsors a CBE to identify, classify, vet, and endorse measures that meet well-defined criteria, including importance, feasibility, usability, reliability, and validity.

Fierce Healthcare (5/9) AI assistants essential for value-based care, report finds – Artificial intelligence assistants could ease the transition to value-based care for primary care practices, a new report by Phyx Primary Care found. Primary care practices report that the transition to value-based care is often long and results in a mix of billing practices. In a study of 120 physicians who had used an AI scribe for 30 days or more, providers reported a 40 percent reduction in clinical review time for complex patients and a 32 percent decrease in physician burnout.

Modern Healthcare (5/13) Downside risk, upside payment highlight new CMS innovation agenda – The Centers for Medicare and Medicaid Services is rolling out a broad new agenda for its innovation center that could lead to requirements that participants in value-based care programs to take on downside risk, the agency announced Tuesday. The plan prioritizes shared risk and prospective payments, streamlined quality measurement, artificial intelligence and other technologies, and Medicare Advantage payment models.

Events

May

• May 19, 2025 – Duke Margolis Center for Health Policy, “New Directions for Accountable Care: Understanding Opportunities Within CMMI’s Updated Strategy.”
• May 19, 2025 – Brookings Institution, “Payer-provider vertical integration: Trends, tradeoffs, and policy options.”
  
• May 20, 2025 – CMS, “Improving Technology to Empower Medicare Beneficiaries RFI Q&A Call.”

If you would like your event to be included in the next newsletter, please email sarah@physiciansforvalue.org