News Clips
National Academies Press: (5/18) - After the release of its recent report on implementing high quality primary care, the National Academies of Sciences, Engineering, and Medicine (NASEM) released a policy brief outlining recommended actions on payment reform. The brief asserts payment should be increased to reflect the outsized benefit primary care has on the health and well-being of society and flexible enough to allow practices to meet the specific needs of the population they serve, and outlines specific actions for how to achieve such goals.
Xtelligent Media: (5/17) - In the latest episode of the Healthcare Strategies podcast, LeChauncy Woodward, MD, director of Humana Integrated Health System Sciences Institute, and Tray Cockerell, strategic relationship executive at Humana, discuss how value is perceived in the health care sector today and how the industry can unify around patient-centered, value-based care.
America’s Physician Groups: (5/17) - The America’s Physician Groups (APG) Direct Contracting Coalition sent a letter to HHS Secretary Xavier Becerra in response to the recent letter sent to him by Reps. Pascrell, Pocan, Porter, and Dogget about concerns over the Direct Contracting model. APG shared details around the model that stand in contrast with what was written in the letter by Members of Congress, refuting that the model poses risks to Medicare beneficiaries and urging the model and DCE pilot programs to continue.
Fierce Healthcare: (5/17) - HHS recently filed a brief asking the Supreme Court to pass on reviewing an appeals court decision upholding HHS’ site neutral payment policy, which would bring Medicare payments to hospital-affiliated clinics in line with independent practices for providing the same services. The American Hospital Association had requested the judicial review by the Supreme Court in February, as it does not support this policy and claims hospital outpatient departments serve more complex, poor Medicare patients.
JAMA Health Forum: (5/14) - Concern has recently grown around whether the Merit-based Incentive Payment System (MIPS) has increased administrative burden for Medicare providers and the lack of transparency around what providers pay to participate in the program. This study looked at the costs for independent practices to participate in MIPS in 2019, finding significant time and financial costs associated with participation. On average, it cost practices $12,811 per physician participating in MIPS in 2019, and physicians spent over 53 hours per year on MIPS-related activities (equivalent to $7,000 per physician).
Revcycle Intelligence: (5/14) - A recent survey of physicians published in the American Journal of Accountable Care looked at how the four evaluation components of the Merit-based Incentive Payment System (MIPS) helped improve value in health care. Of the respondents, 55 percent believed value would increase through activities performed in the quality domain, 70 percent in the improvement activities domain, 54 percent through activities in promoting interoperability, and 71 percent in activities relating to cost. The survey also found that process quality was the most significant driver of value in each domain.
Milbank Memorial Fund: (5/13) - The Committee on Implementing High-Quality Primary Care, which was behind the NASEM report on the subject, put forth a default national payment strategy that would involve risk adjusted capitation, fee for service, and patient assignment that looks largely similar to the Comprehensive Care Plus model that will end soon, in order to move the payment system toward value. The author of this article makes the case for a hybrid payment methodology as an easier step for implementing high quality primary care, with upfront dollars which come with a patient empanelment requirement and encourage team-based care, and reduced fee-for-service payments. However, such a model must be viewed as a transition to a more sustainable, comprehensive population-based payment system, rather than the ultimate solution.
HIT Consultant: (5/13) - Data is essential for value-based care, but despite the proliferation of technological breakthroughs in the health care system that have reduced the cost of data storage and made data more accessible, approaches to value-based care have not taken off in the same way. The author outlines what has led to this, and emphasizes the need for shared definitions of value for providers and patients and a prioritization of value and outcomes over services rendered.
JAMA Network: (5/12) - Many primary care providers have been hesitant to move toward capitation models, as historically it seemed like a way for payers to reduce payments to such providers and was perceived as something that would increase referrals to specialty providers. The decline in revenues and increase in financial uncertainty experienced by many providers during the COVID-19 pandemic may lead providers to reconsider such models and an increase in adoption of capitation, however historical concerns of providers must be addressed. This article outlines seven design elements to consider in implementing a successful primary care capitation initiative.
Managed Healthcare Executive: (5/12) - COVID-19 could drive up consolidation in the provider market, as many practices have experienced financial uncertainty throughout the pandemic. Smaller providers that have experienced sharp declines in patient visits and revenues could be targets for mergers and acquisitions by large hospitals or health care systems, and several studies have shown that such anticompetitive practices do not always lead to lower costs or better value. This article provides background on current research around this topic and trends to expect moving forward.
JD Supra: (5/12) - Part three in the JD Supra New Opportunities in Value-Based Care series focuses on the Stark Value-Based Arrangement exception that protects compensation relationships in a value-based arrangement that is pursuing a value-based purpose. This exception, which allows parties to create a value-based arrangement where no risk is assumed by the participant, is outlined in this brief.
Modern Healthcare: (5/12) - In a recent hearing, HHS Secretary Becerra said HHS is considering extending an upcoming deadline for hospitals and providers to use federal COVID-19 provider relief funds, which were set to expire June 30. Hospitals and providers have called on HHS to extend this deadline and distribute remaining funds. As of March 1, $24 billion in unused funds remained in the Provider Relief Fund. Secretary Becerra said he is focused on ensuring the relief funds are being used appropriately.
Health Affairs: (5/10) - As telehealth has played a major role in health care delivery during the COVID-19 pandemic, policy makers are beginning to consider how to maximize telehealth benefits post-pandemic. Telehealth can provide an opportunity to rethink care delivery under alternative payment models (APMs) and test novel solutions. This blog outlines barriers to effective care management and how telehealth can overcome them to improve outcomes within APMs.
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