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.
HHS: (7/1) - HHS issued Part 1 of an interim final rule related to surprise billing. Among other provisions, the rule bans surprise billing for emergency services, bans high out-of-network cost-sharing for emergency and non-emergency services, bans out-of-network charges for ancillary care (like an anesthesiologist or assistant surgeon) at an in-network facility in all circumstances, and bans out-of-network charges without advance notice. The regulations will take effect for health care providers and facilities on January 1, 2022. For group health plans, health insurance issuers, and Federal Employees Health Benefits Program carriers, the provisions will take effect for plan, policy, or contract years beginning on or after January 1, 2022. Comments will be due 60 days after publication in the Federal Register. Fact sheets on the interim final rule can be found here and here.
CMS: (7/1) - CMS issued a proposed rule that would address health equity for chronic kidney disease and end-stage renal disease (ESRD) by making changes to the End-Stage Renal Disease (ESRD) Treatment Choices (ETC) Model. The proposed changes to the ETC Model build on the current model by proposing to test a new health care approach that rewards ESRD facilities and managing clinicians participating in the model for achieving significant improvement in the rates of home dialysis and kidney transplants for lower income beneficiaries. If finalized, these changes would take effect January 1, 2022. A fact sheet can be found here.
ASPE: (6/28) - HHS Office of the Assistant Secretary for Planning and Evaluation (ASPE) issued a new brief on the impact of COVID-19 on Medicare beneficiary utilization and provider payments in fee-for-service. HHS found that Medicare FFS payments declined sharply at the beginning of the pandemic in March and April, yet by the last two weeks in 2020, the two-week payment amounts for most services had rebounded to slightly above 2019 levels: 5 percent higher for all claims, 8 percent higher for inpatient services, and 6 percent higher for physician services. In addition, there was geographic variation in the magnitude of the payment declines and the rate of recovery across counties and across states. All states had a cumulative payment deficit; it ranged from a low of a 1 percent deficit to as much as a 20 percent deficit. Finally, a surge in telehealth helped offset some of the pandemic-related reduction in primary care visits, but it was not enough to prevent lower overall rates of primary care that persisted throughout 2020
GAO: (6/28) - The U.S. Government Accountability Office (GAO) issued a report on VA’s Veteran Community Care Program, which allows eligible veterans to receive health care from community providers. GAO determined that wait times for community care increased during the pandemic, and reiterated past recommendations to address wait-times and staffing needs.
House Energy & Commerce Committee: (7/2) - House Energy & Commerce Committee Chair Pallone announced a transition of his top Committee staff as longtime Staff Director Jeff Carroll prepares to depart Capitol Hill. With Carroll’s departure, Pallone announced that Deputy Staff Director Tiffany Guarascio has been promoted to Staff Director and General Counsel Waverly Gordon has been promoted to Deputy Staff Director and General Counsel.
Primary Care Enhancement Act: (7/1) - Reps. Blumenauer (D-OR) and Schneider (D-IL) introduced the Primary Care Enhancement Act (H.R. 4301), which would allow individuals with direct primary care service arrangements to remain eligible individuals for purposes of health savings accounts.
Native Behavioral Health Access Improvement Act: (6/30) - Reps. Ruiz (D-CA) and Pallone (D-NJ) introduced the Native Behavioral Health Access Improvement Act and the Native Health and Wellness Act (H.R. 4283), which would improve the public health system in tribal communities and increase the number of American Indians and Alaska Natives pursuing health careers.
(7/5) – In this article, Travis Broome, senior vice president of policy and economics at Aledade, outlines how the Medicare Access and CHIP Reauthorization Act (MACRA) needs to be reimagined to get back on track and live up to its promise to incentivize value-based care. Broome notes that MACRA has neither fueled growth in alternative payment models (APMs) nor imposed significant payment differential based on value in the Merit-based Incentive Payment System (MIPS). To build on the learnings of MACRA, Broome recommends that Congress update MACRA to assign all primary care clinicians not in APMs to virtual groups subject to the full range of MIPS value payment adjustments as originally envisioned by MACRA; give CMS latitude to build specialty-specific versions of MIPS that will be subject to the full range of MIPS value payment adjustments; and extend the AAPM bonus three years and create a timeline for it that encourages participation now.
AAFP: (7/2) - Ada Stewart, president of the American Academy of Family Physicians (AAFP), wrote a blog on the importance of ensuring the perspective of family medicine is heard when developing policies impacting physicians and patients, and that family physicians serve in positions of leadership to do so. Stewart specifically highlighted the appointment of Gerald “Gerry” Harmon, MD as president of the American Medical Association (AMA), the second time in five years that a family physician served as AMA president. AAFP has nearly two dozen members in its official AMA delegation.
Fierce Healthcare: (7/1) - The Medical Group Management Association (MGMA) wrote to the Occupational Safety and Health Administration (OSHA) asking for more time to update their policies and procedures to comply with an emergency protection standard intended to help protect front-line workers. MGMA, among other groups, is concerned about a lack of time to submit comments and implement procedures to comply with the emergency standard. MGMA in particular would like to see the standard pulled or at a minimum have the effective date delayed, given providers are already meeting federal and state requirements to protect health care workers.
Healthcare IT News: (7/6) - As several articles have noted over the past few months, providers that were ready to leverage digital tools to deliver care remotely experienced success when value-based care models were in place early on in the pandemic. According to health economist Jane Sarasohn-Kahn, virtual technologies are poised to make a difference in value-based care models. She highlights Mayo Clinic and Kaiser Permanente as two examples of health systems that invested about $100 million into a company that offers a technology platform that enables providers to address acute clinical conditions in a patient’s home, enabling the home to become part of the continuum of care. A full interview with Sarasohn-Kahn on how virtual technologies can help providers succeed under value-based care models can be found here.
AJMC: (7/4) - In this episode of the MJH Life Sciences’ Medical World News, Dr. Norman Chenven, vice chairman of the Council of Accountable Physician Practices (CAPP) spoke about a recent report by CAPP and the National Alliance of Healthcare Purchaser Coalitions about opportunities for purchasers and physicians to accelerate care delivery, innovation, and value. Chenven noted how roundtable discussions between health care purchasers and physician practices have highlighted their aligned interest in having patients managed by a primary care physician.
Forbes:(7/1) - In this article, Founder and CEO of Curation Health Kevin Coloton outlines how the health care industry can drive change through value-based care, acknowledging what has led to the slow shift toward value-based care and what is needed to continue this movement forward. Coloton highlights conversations with health plans, and how there is consensus that physicians’ decisions - specifically those related to diagnosis, treatment, and documentation of chronic conditions - remains the most significant factor driving value-based care outcomes and finances.
WRAL Tech Wire: (7/1) - Blue Cross and Blue Shield of North Carolina (Blue Cross NC) announced it will invest in a joint venture with Deerfield Management Company to provide services for physicians, particularly independent practice physicians. The purpose of the joint venture is to “enable physicians to focus more on high-quality, cost-effective patient care while also offering practices the ability to grow more sustainably as value-based care expands,” according to a press release by the health plan. Blue Cross NC President and CE), Dr. Tunde Sotunde, said the health plan wants to empower independent physicians by supporting their practices to ensure they are able to carry out the work needed to provide high quality care to patients.
Modern Healthcare: (6/30) - As more primary care providers begin to move toward value-based payments, investors like Independent Health are starting to back digital health startups that help physicians navigate the transition to value-based care. Independent Health, for example, implemented a primary care capitated program that has moved 630 providers to accept a 10 percent up-and-downside adjustment for effectively managing the health care of 20,000 patients. Such investments will hopefully inspire more physicians to stick with independent practices that are more narrowly focused on care for individual populations.
Managed Healthcare Executive: (6/30) - COVID has caused many providers and health plans to reconsider traditional approaches to managing care. The experiences faced during COVID points to four ways to strengthen payer-provider partnerships to reduce risk on the road to value-based care: 1) work with providers to develop a longitudinal view of members’ health history; 2) bolster providers’ response by sustaining the financial health of those in shared-risk contracts; 3) make it easy for providers to improve population health; and 4) be vigilant around fraud, waste, and abuse prevention - but don’t let a small group of bad actors influence your entire approach.
Revcycle Intelligence: (6/30) - According to Jack Resneck, Jr., MD, president-elect of the American Medical Association (AMA), the solution to alternative payment model (APM) success is implementing patient-centered models developed by front-line physicians. In a recent AMA article, Resneck wrote that “not only are the innovative interventions unreimbursed, but for most interventions, the physician practice takes a second hit from the loss of revenue for avoided services.” Resneck outlined three components APMs should have to be successful: flexibility to provide patients with all the services they need; payments to physicians that support the cost of the care being delivered; and hold physicians accountable for the spending and care quality that is in their control, but not for the things they cannot control (i.e. rising drug costs or flaws in patient attribution methodologies).
Revcycle Intelligence: (6/29) - According to a study by Avalere and the Physicians Advocacy Institute, hospitals and corporations now own nearly half of physician practices in the United States. Researchers found that, from January 1, 2019 to January 1, 2021, hospitals and other corporate entities acquired 20,900 physician practices, representing a 25 percent increase in corporate-owned practices overall. An additional 12 percent more physicians were employed by hospitals or other entities, with 48,400 physicians leaving independent practices to become employed by hospitals during this time.