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.
Centers for Medicare & Medicaid Services (CMS): (7/13) – On July 13, the CMS released the FY22 Physician Fee Schedule (PFS) proposed rule. In the rule, the agency is recommending steps that continue the Biden-Harris Administration’s commitment to strengthen and build upon Medicare by promoting health equity; expanding access to services furnished via telehealth and other telecommunications technologies for behavioral health care; enhancing diabetes prevention programs; and further improving CMS’s quality programs to ensure quality care for Medicare beneficiaries and to create equal opportunities for physicians in both small and large clinical practices. Proposed rulePFS fact sheet, QPP fact sheet
White House: (7/9) – On July 9, President Biden issued an Executive Order (EO) on Promoting Competition in the American Economy. The Executive Order addresses for specific areas of health care competition including: 1) prescription drugs; 2) hearing aids; 3) hospitals; and 4) health insurance. Fact sheet.
CMS: (7/8) – CMS updated its Quality Payment Program Participation Status Tool based on the first snapshot of Alternative Payment Model (APM) data. The first snapshot includes data from Medicare Part B claims with dates of service between January 1, 2021 and March 31, 2021. The tool includes 2021 Qualifying APM Participant (QP) status and Merit-based Incentive Payment System (MIPS) APM participation status.
CMS: (7/6) – CMS announced Dr. Meena Seshamani, M.D., Ph.D. as Deputy Administrator and Director of Center for Medicare. Dr. Seshamani started July 6.
Medicaid Saves Lives Act: (7/12) – The Medicaid Saves Lives Act (S.2315) would provide health care insurance to Americans with low incomes in the twelve states that have refused to expand their state Medicaid programs under the Affordable Care Act. The bill would direct the CMS to create and standup a federal Medicaid look-alike program would provide the same full, essential benefits of Medicaid, and that is run and administered by CMS.
Axios: (7/12) – House Democrats on Monday advanced a spending bill for the Department of Health and Human Services excluding the Hyde Amendment, a provision that bans federal funding for most abortions. The measure provides nearly $120 billion for the federal health department, $129 million below President Joe Biden's budget request. Funding for the Centers for Disease Control and Prevention would be $10.6 billion, $1 billion more than Biden proposed. Bill text
California Medical Association(CMA): (7/13) – California Medical Associates, TMA, along with the California Hospital Association (CHA) and the Texas Hospital Association (THA) sent a joint letter to the Department of Education in response to the request for comments on rulemaking related to the Public Service Loan Forgiveness Program (PSLF). CMS urged the department to reopen the regulations and fix the PSLF program to allow all eligible California physicians to participate. CMA Vice President of Federal Government Relations Elizabeth McNeil also testified on behalf of CMA, CHA, TMA and THA before the Department of Education during their recent hearings on this issue.
Aledade: (7/7) – Aledade and the Community Health Center (CHC) Association of Mississippi today announced results from year-one of their collaboration designed to serve the Medicaid population through Aledade’s primary care-centered accountable care organizations (ACOs). Over 11,000 Mississippi Medicaid patients saw their Aledade primary care physician in 2020, a 106 percent increase from 2019. This is especially significant in light of the COVID-19 pandemic, as this joint effort ensured that some of the highest-risk patients received necessary care and services.
Medical Group Management Associates (MGMA): (7/7) – In this episode of the MGMA Insights podcast, Dan Dooley, vice president of physician services, R1 RCM, discusses what practices need to do to prepare the revenue cycle for value-based care.
EHR Intelligence: (7/13) – Primary care teams at two Veterans Health Administration (VHA) medical centers found an event notification EHR integration for admissions and discharges improves care coordination, according to a new study published online in JAMIA.
MedCity News: (7/13) – Value based care shifts the emphasis of care to preventative and proactive measures. However, without the proper tools to collect and analyze patient and claims data – including social determinants of health (SDOH) such as a patient’s socioeconomic status, housing security and access to food, medications and transportation – it is extremely difficult for providers to be proactive. For value based care to be effective, it must be accompanied by advanced analytics to be able to make the connections between physical conditions and behavioral health components and to be able to view trends across communities to improve population health outcomes.
Fierce Healthcare: (7/12) – Some provider groups believe that the President’s Executive Order on Promoting Competition in the American Economy is misplaced and will add bureaucratic red tape to merger agreements. For example, the American Hospital Association stated that mergers with larger systems can help rural communities as it gives such providers “scale and resources needed to improve quality and decrease costs.”
Modern Healthcare: (7/8) – Hospital buyers have fewer independent hospitals to target, and have turned to similarly sized systems to create regional hubs. The total revenue among hospitals that announced deals in the first half of 2021 was $17.2 billion, which was the second-highest tally since 2015, Kaufman Hall data show. However, the number of transactions fell, signaling that larger health systems aim to join forces. The average size of the smaller hospital involved in the transaction was $638.6 million, which doubled the trailing five-year average.
Health Affairs: (7/8) – Accumulated pricing distortions in physician payments that favor proceduralists have led a skewed physician workforce. Select specialties have incomes that are multiples of their peers. As a result, workforce shortages have emerged in primary care and other similar cognitively focused specialties such as infectious diseases, endocrinology, and neurology. CMS has begun to address these distortions, but the agency’s efforts may inadvertently worsen relative compensation for some cognitively focused practitioners.
Forbes: (7/7) – In declining to hear the hospital industry’s challenge to Medicare’s new site-neutral payment policy, the Supreme Court avoided blocking a major step toward a true value-based healthcare system. For the first time – and despite the strenuous resistance from provider and hospital groups, the national conversation is finally focused on what kind of care a patient receives, not simply who pays for it or where it takes place.
Fierce Healthcare: (7/7) – Hospitals “routinely” charge uninsured and cash-paying patients rates higher than those negotiated by payers, according to a recent Wall Street Journal report reviewing hospitals’ newly available price transparency data. Among a sample of 1,550 hospitals, 21% billed these patients at the highest rates for the majority of the healthcare services included in the WSJ’s analysis. For 11% of the hospital sample, the cash rates for every reviewed service were higher than insurers’ rates or were tied for the highest rate.
MedPage Today: (7/6) – Medicare ACOs face multiple changes and challenges. Challenges include proposed changes to collection of quality data; methodology issues such as the “rural glitch” that disadvantage one type of ACOs over another; model-specific decisions including the decision not to extend the Next Generation ACO model beyond the end of 2021; and lack of clarity on the general path for streamlining CMMI models per recent MedPAC recommendation.