News Clips
CNN: Opinion: How to fix American health care, according to 6 experts (10/18) – With the recent political focus on corporate power and the ills of monopoly, the hospital industry is no exception and has come under the policy microscope. Ninety percent of metropolitan statistical areas are considered highly concentrated for hospital care, with hospitals buying up physician practices and driving further consolidation. Researchers have demonstrated the harms of this lack of competition, with hospital consolidation leading to higher insurance premiums, higher prices and consumer cost-sharing, and decline in patient experience. And with consolidation tied to outcomes such as mortality, addressing hospital monopoly power is not just an issue of finances: It could be a matter of life or death.
Health Affairs: Using The Medicare Shared Savings Program To Innovate Primary Care Payment (10/17) – A bold approach to improving mental health and addressing inequity at a large scale would focus on primary care payment in the MSSP. This would provide a solid chassis on which to ultimately integrate multiple payment innovations into Medicare’s flagship value-based payment program. We envision a voluntary payment option available to MSSP ACOs, structured as a hybrid of population-based payments (PBPs) and fee-for-service (FFS). While all ACOs could benefit from hybrid payment, CMS should initially offer it only to ACOs composed of independent practices—those not employed by or contracting with hospitals in clinically integrated networks. Targeting ACOs with independent practices would have the desirable effect of giving practices an incentive to remain independent, dampening vertical market consolidation that has contributed to rising health care prices. Physician-led ACOs have also shown better savings performance, on average, than ACOs that include hospitals.
Forbes: Have We Overcomplicated The American Physician Burnout Conversation? (10/17) – In the last few decades, small, intimate, family-owned practices have merged into large multispecialty groups, often owned by hospitals and other entities. The discussions of the causes of burnout seem endless and complicated. But what it boils down to is that our health care system has taken a group of people who are trained to be professionals and agents on behalf of their patients and wrapped a lot of painful bureaucracy and infrastructure around them, leaving them feeling invisible. The departure from solo and small-group medical practice was as much an active decision for some as an economic imperative. And those who work for larger health care systems today face a new challenge compounding the burnout issue: lack of competition. It’s one thing to feel invisible in the midst of a large corporate health system. But the issue is made exponentially worse when alternatives are few and far between. In the era of “big health care,” physicians feel like they don’t matter. They feel smaller and smaller and more invisible in the context of behemoth organizations whose leadership and direction feels far removed from—and sometimes utterly disinterested in—the frontlines of care delivery.
RevCycle Intelligence: Staff, Technology Investments Help Practices Shift to Value-Based Care (10/17) – Staffing and technology are the top investment areas for primary care practice leaders as they manage the challenges of shifting from FFS models to value-based care, according to a report from Humana and the Medical Group Management Association (MGMA). More than two-thirds of primary care practice leaders said that the level of quality care provided to patients was better in value-based care than in FFS models. In addition, 43 percent of respondents reported that value-based care helped improve financial performance compared to 31 percent who said the same about FFS.
RevCycle Intelligence: Healthcare Merger and Acquisition Revenues Totaled $8.3B in Q3 2022 (10/14) – Health care merger and acquisition activity was low in the third quarter of 2022, with just ten transactions generating $8.3 billion in revenue, according to Kaufman Hall’s latest M&A Quarterly Activity Report. Activity declined from Q2 when 13 transactions generated a record high of $19.2 billion. However, the trends were consistent with merger and acquisition activity running below pre-pandemic levels. In addition, the number of transactions and revenue volumes were up compared to Q3 2021.
STAT: The future for practicing physicians in a corporate world (10/14) – By 2020, for the first time, less than half of U.S. physicians worked in physician-owned settings: more than 300,000 U.S. practicing physicians were employed by hospitals, and another 122,000 were employed by corporations of various kinds — health insurers, pharmacy chains, private equity-backed companies. In accepting employment, physicians old and young shifted their business risk to corporate enterprises, which absorbed the resultant decline in productivity and negative practice cash flows in exchange for achieving overarching corporate objectives: increased hospital admissions, imaging scans, and surgeries; the redirection of patient flows away from hospitals; or increased prescriptions or traffic in retail stores. Viewing employment as a solution to work-related stress and burnout has proven simplistic, and many of the clinicians seeking shelter from these problems have not found it.
Healthcare Innovation: NAACOS: CMS Must Work with ACOs to Pilot EHR-Derived Quality Data Reporting (10/14) – The National Association of ACOs urged CMS to test-pilot the reporting of quality data pulled from electronic health records (EHRs) before making such reporting mandatory. NAACOS’s leaders are pointing out the challenges that ACO leaders face in managing reporting derived from a variety of different EHRs at the same time.
Kaiser Health News: As Giant Hospitals Get Bigger, An Independent Doctor Feels the Pinch (10/13) – According to a nationwide survey conducted by the Physicians Foundation in 2020, an estimated eight percent of physicians closed their practices in the early months of the pandemic, and an additional four percent planned to do so. Grants, loans, and other assistance intended to help hospitals and doctors remain solvent went disproportionately to wealthy hospitals that did not need the money as urgently as independent practices and struggling rural hospitals did. The loss of independent physician practices threatens to fundamentally reshape the historical relationship between doctors and patients as more doctors become beholden to their employers instead of the people they treat. Research shows that when doctors work for hospital systems they tend to refer patients for extra testing and more intense treatment, which means higher profits for hospitals, Richman said. “Studies show physicians practice in a different way,” he said. “You no longer have physicians competing to keep patients based on quality.”
Health Payer Intelligence: Healthcare Utilization Lower for MA Beneficiaries with Complex Care Needs (10/13) – Among Medicare beneficiaries with complex care needs, those enrolled in Medicare Advantage had lower acute health care utilization than traditional Medicare beneficiaries, including lower rates of hospital stays and emergency department visits, a study published in JAMA Health Forum found. Medicare beneficiaries with complex, co-occurring, chronic conditions tend to experience high acute care utilization rates and poor health outcomes. Medicare Advantage plans have components that may help address the needs of these beneficiaries, such as care management, supplemental benefits, and value-based contracting.
Bipartisan Policy Center: The Future of Telehealth After COVID-19 (10/12) – CMS should permanently maintain all telehealth and audio-only flexibilities for providers participating in APMs with two-sided risk arrangements, including using audio-only visits and establishing virtual first relationships with specialists. During the pandemic, providers participating in value-based payment arrangements were better positioned to leverage other revenue sources (e.g., shared savings, monthly capitated payments) for financial stability. Telehealth flexibilities could be positioned, alongside a suite of other financial incentives, to entice providers into value-based payment. Recognizing the financial incentives that APM providers face, as well as the additional flexibility already afforded to these providers, stakeholders interviewed by BPC broadly agreed that providers participating in two-sided risk arrangements should permanently maintain all current telehealth and audio-only flexibilities.
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