Welcome to this week's edition of the 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.
CMS: (5/14) - CMS released data highlighting the continued impact COVID-19 is having on Medicaid and Children’s Health Insurance Program (CHIP) beneficiaries and utilization of health services. CMS found that from March through October, 2020, beneficiaries have forgone millions of primary, preventive and mental health care visits. Further, while utilization rates for some treatments have rebounded to pre-pandemic levels, mental health services show the slowest rebound.
CMS: (5/13) - CMS Deputy Administrator & Director of the CMS Innovation Center (CMMI) Fowler issued a blog on the recently announced winner and runner-up of the CMS Artificial Intelligence (Ai) Health Outcomes Challenge. The AI Challenge was the first prize competition operated by the CMS Innovation Center, and the Innovation Center’s first initiative focused on AI-driven health care solutions. CMS notes the potential to use AI to help design and implement CMMI models, including tools to help support clinicians.
CMS: (5/13) - CMS released guidance on how states can receive the 10-percentage point enhanced funding provided through the American Rescue Plan to increase access to home and community-based services (HCBS) for Medicaid beneficiaries.
White House: (5/13) - President Biden announced $7.4 billion from the American Rescue Plan to recruit and hire public health workers to respond to the pandemic and prepare for future public health challenges.
HHS: (5/12) - HHS announced new efforts to vaccinate migratory and seasonal workers in the Food and Agriculture sectors. HHS will be using a data-driven approach to focus on key target regions, utilizing health centers serving a large number of migratory and seasonal agricultural workers and partnering with jurisdictions to better reach these workers.
HHS: (5/12) - HHS Secretary Becerra – following a bipartisan confirmation by the Senate – formally swore in Andrea Palm as Deputy Secretary. Palm previously served as the Secretary-designee of Wisconsin’s Department of Health Services and in several leadership roles at HHS during the Obama-Biden Administration.
White House: (5/11) - President Biden announced additional efforts to get Americans vaccinating including free rides to vaccination sites from Lyft and Uber, vaccination clinics at community colleges, and additional resources for states’ community outreach efforts.
CMS: (5/10) - CMS released guidance for providers and state surveyors outlining the new requirements for admission, discharge, and transfer electronic patient event notifications for surveyors assessing compliance with the revised Conditions of Participation (CoPs) in the Interoperability and Patient Access final rule published May 1, 2020.
CMS: (5/10) - CMS released frequently asked questions (FAQs) for the Interoperability and Patient Access final rule.
ONC: (5/10) - HHS Office of the National Coordinator for Health IT (ONC) issued a blog on information blocking, which went into effect on April 5, 2021. The blog details health information exchange (HIE) perceptions of information blocking and additional insights for the future of information blocking.
Rep. Pascrell: (5/13) - Reps. Pascrell (D-NJ), Pocan(D-WI), Doggett (D-TX), and Porter (D-CA) sent a letter to CMS asking for an immediate freeze of the Direct Contracting model, arguing that it lacks oversight to protect Medicare beneficiaries’ care. The Members of Congress expressed concern that funneling people into Medicare Advantage would create more barriers and provide fewer consumer protections for beneficiaries, and that the model creates additional risks for beneficiaries without adding value.
Improving Seniors’ Timely Access to Care Act: (5/13) - Rep. DelBene (D-WA) and 96 bipartisan cosponsors introduced the Improving Seniors’ Timely Access to Care Act (H.R. 3173), which would establish requirements with respect to the use of prior authorization under Medicare Advantage plans.
H.R. 3219: (5/13) - Rep. Rush (D-IL) and Rep. Davis (D-IL) introduced legislation (H.R.3219) which would provide funding relating to COVID-19 for high Medicaid providers.
HEALTH for MOM Act: (5/13) - Sen. Portman (R-OH) and Sen. Stabenow (D-MI) introduced the Harnessing Effective and Appropriate Long Term Health for Moms on Medicaid (HEALTH for MOM) Act (S.1622), which would provide States with the option to provide coordinated care through a pregnancy medical home for high-risk pregnant women.
HERO Act: (5/12) - The House passed by a 349-74 vote the Helping Emergency Responders Overcome (HERO) Act (H.R. 1480), which would provide critical mental health resources to our nation’s first responders and health care providers. It now goes to the Senate for consideration.
Accelerating Kids’ Access to Care Act: (5/11) - Rep. Clark (D-MA) and Rep. Herrera Beutler (R-WA) introduced the Accelerating Kids’ Access to Care Act (H.R.3089), which would streamline enrollment under the Medicaid program of certain providers across State lines. Sens. Grassley (R-IA), Bennett (D-CO), Brown (D-OH) and Portman (R-OH) introduced companion legislation in the Senate (S. 1544).
Aledade: (5/17) - As CMS is preparing to end the Comprehensive Primary Care Plus (CPC+) model, practices enrolled in the model have two options for 2022 - participate in the Primary Care First (PCF) model or return to traditional fee-for-service. This Aledade blog provides information on both options and possible directions practices can choose to go. Aledade calls for either choice to be paired with participation in an MSSP ACO to improve return on investment from care coordination and population health processes that practices have developed in CPC+.
California Medical Association: (5/14) - Peter Bretan, Jr., MD, President of the California Medical Association (CMA), recently commented on the revised budget proposal released by Governor Newsom last week, saying he was encouraged by the prioritization of health care and expansion of coverage for California residents. Bretan said CMA shares the goals of developing the CalAIM program and that physicians should be engaged early in the process to ensure patients get the services they need.
Healio: (5/14) - The National Academies of Sciences, Engineering, and Medicine recently published a report on the need to make high-quality primary care available across the US, outlining five key objectives (payment, access, workforce, digital health, and accountability) to achieve this goal. AAFP is one of the 17 groups that sponsored the report, with AAFP President Ada Stewart recently saying that the report “clearly spells out the case for increased investment in our primary care system and ensuring everyone in our country has access to high-quality primary care.”
LRV Health: (5/13) - On the latest episode of the LRV Health “Healthcare is Hard: a Podcast for Insiders” podcast, Aledade Founder & CEO Farzad Mostashari discusses what led him to found Aledade and the importance of preserving the autonomy of independent practices to drive real value in health care.
AAFP: (5/13) - In a recent letter to HHS, AAFP commented on proposed changes to the HIPAA privacy rule, stating that patients should control when and where their information is shared, and physicians should not be charged with the increased administrative burden of counseling them on associated risks to their privacy.
MedPage Today: (5/12) - A group of health care organizations, including MGMA and AAFP, sent a letter to HHS Secretary Xavier Becerra earlier this month outlining their concerns about the Medicare Shared Savings Program (MSSP) quality policies finalized during the previous administration. The letter highlighted the new CMS Alternative Payment Model Performance Pathway quality measures, with the groups noting that this policy lacked adequate input from stakeholders without transparency around why such measures were deemed more appropriate than current measures ACOs are evaluated on. The groups asked for more time before the changes are finalized.
On May 19, the U.S. Senate Committee on the Judiciary, Subcommittee on Competition Policy, Antitrust, and Consumer Rights, will hold a hearing entitled “Antitrust Applied: Hospital Consolidation Concerns and Solutions.”
PEPC submitted a statement for the record for the hearing, highlighting concerns around increasing consolidation in the health care market and the urgency it creates to ensure that value-based care is a path to sustainability for practices and physicians who are independent and wish to remain so. PEPC highlighted evidence of the detrimental impact of hospital consolidation and proposed several recommendations for Congress and/or the Administration to take action.
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.