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.
CMS: (4/6) – CMS announced it is extending the timeline to review data for the Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model participants, in response to stakeholder feedback. The period for data review is extended to at least eight weeks after distribution of baseline data and preliminary Target Prices.
CMS: (4/5) – CMS issued the Contract Year 2024 Policy and Technical Changes to the Medicare Advantage Program, Medicare Prescription Drug Benefit Program, Medicare Cost Plan Program, and Programs of All-Inclusive Care for the Elderly Final Rule. The rule implements changes related to Star Ratings, marketing and communications, health equity, provider directories, coverage criteria, prior authorization, network adequacy, and other programmatic areas. Fact SheetPress Release
CMS: (4/5) – CMS announced additional details on the Medicare Advantage Value-Based Insurance Design (VBID) Model Extension. The model, which is extended from 2025 to 2030, will include several new policies intended to more fully address the health-related social needs of patients, advance health equity, and improve care coordination for patients with serious illness.
Doctors of Community (DOC) Act: (4/11) – House Energy and Commerce Ranking Member Pallone (D-NJ) and Reps. Vasquez (D-NM) and Ruiz (D-CA) introduced the Doctors of Community (DOC) Act (H.R. 2569), which would permanently authorize the Teaching Health Center Graduate Medical Education (THCGME) program to support the training of primary care medical and dental residents, with a focus on supporting residents in high-need communities. Bill Text
Strengthening Medicare for Patients and Providers Act: (4/3) – Reps. Ruiz (D-CA), Bucshon (R-IN), Bera (D-CA), and Miller-Meeks (R-IA) introduced the Strengthening Medicare for Patients and Providers Act (H.R. 2474), which would change the physician payment rate above the current law by providing an annual Medicare physician payment update tied to inflation, as measured by the Medicare Economic Index (MEI). Bill Text
California Medical Association: (4/10) – California Medical Association (CMA) released a statement applauding the Strengthening Medicare for Patients and Providers Act (H.R. 2474). “CMA physicians have been sounding the alarm that health equity and health care access in the Medicare program are deteriorating and we need Congress’s leadership to restore the promise of Medicare to our patients. Congress must shore up the viability of physician practices to meet the mountain of growing health care needs in our communities.”
American Academy of Family Physicians (AAFP): (4/6) – American Academy of Family Physicians (AAFP) responded to the to the Federal Trade Commission’s (FTC) notice of proposed rulemaking (NPRM) to ban noncompete clauses, stating that "noncompete agreements in health care threaten to disrupt patient access to physicians, deter advocacy for patient safety, limit physicians’ ability to choose their employer, stifle competition, and contribute to an increasingly concentrated healthcare market."
Aledade:(4/6) – Aledade CEO Farzad Mostashari was crowned the winner of the #FierceMadness tournament. Aledade has averted nearly 100,000 hospitalizations, reduced cost of care by an average of six percent and drove $1 billion in funding to community primary care practices. It reached those achievements with just five percent market share, so there's still plenty of room to grow, but the results so far have made people in the industry sit up and take notice, Mostashari said.
Medical Group Management Association (MGMA): (4/4) – Medical Group Management Association (MGMA) released a statement on the Strengthening Medicare for Patients and Providers Act (H.R. 2474), stating that “MGMA strongly supports the Strengthening Medicare for Patients and Providers Act. Medical practices are in no way immune to record inflation, staffing shortages, and across the board cost increases. This legislation would allow Medicare to more accurately reflect the impact of the broader economy on practices’ financial stability.”
MGMA: (4/4) – MGMA released a statement on the 2024 Medicare Advantage and Part D final rule, stating that MGMA supports action by CMS to “reign in detrimental prior authorization practices. We are thankful that the agency heeded our call to finalize the continuity of care provision, limiting dangerous disruptions and delays to necessary patient care. This rule is a step in the right direction to adequately address prior authorization reform.”
CT Mirror: Prevent rising healthcare costs by stopping healthcare mergers (4/11) – Health care consolidation in Connecticut is a cause for concern. In just over 20 years, the number of independent hospitals in the state has shrunk from 23 to six. Since the ACA encouraged individuals to seek treatment in outpatient settings, hospital systems responded by scooping up outpatient practices and urgent care providers to capitalize on those revenues and secure referrals. Another factor expediting consolidation is that independent providers are drowning in paperwork. The administrative burden on providers to gain approvals for procedures, for example, spreads resources thin in a small practice or hospital.
JAMA: Reconciliation Payments in the Bundled Payments for Care Improvement Advanced Program and Reductions in Clinical Spending Needed for CMS to Avoid Financial Losses (4/11) – BPCI Advanced program is designed to encourage reductions in clinical spending and generate financial savings for CMS. Participants receive positive reconciliation payments (bonuses) if spending is below their target or owe negative reconciliation payments (penalties) if spending exceeds their target. For CMS to avoid financial losses, reductions in clinical spending must equal or exceed the sum of reconciliation payments paid to participants.
RevCycle Intelligence: Clinician-Owned Practices Improve Quality Without the Burnout (4/10) – Workplace cultural and structural factors in clinician-owned practices that result in lower levels of staff burnout may also enable quality of care improvements, according to a recent study in JAMA Health Forum. Researchers analyzed over 700 small- and medium-sized primary care practices’ improvements in quality of care measures, including aspirin prescribing, blood pressure control, and smoking cessation counseling, as well as levels of staff burnout. Of the quality and well-being PD practices, more were owned by clinicians (55.6 percent) compared to hospitals, health systems, and HMOs (18.8 percent). “This study is unique in identifying factors associated with improving both quality of patient care and staff experience,” author Lisa S. Rotenstein, MD, MBA said. “Our findings add to a growing body of research suggesting positive satisfaction, engagement and utilization outcomes among clinician-owned practices.”
AJMC: Championing Value-Based Primary Care: How Practices Can Support and Optimize Health Outcomes (4/10) – Karen S. Johnson, PhD, vice president of practice advancement for the AAFP, spoke on the challenges and opportunities in sustainably supporting value-based payment in primary care. Despite spending more of its gross domestic product on health care than any other country, the United States continues to rank last among high-income nations in measures of health care affordability, administrative efficiency, equity, and outcomes. A major issue perpetuating these disparities in health system performance continues to be the underinvestment in primary care, Johnson noted.
Healthcare Finance: Healthcare private equity deals hit $90B in 2022 (4/10) – Private equity in health care saw its second highest year on record in 2022, closing on roughly $90 billion worth of deals, according to a report from consulting from Bain and Co. In September AHIP released a brief on private equity investments in health care, saying the need of these firms to achieve high returns, including through the use of provider consolidation, directly conflicts with the goal of lowering costs. Over the past decade, there has been a rise in private equity investments in fee-for-service health care ventures. At least 70 percent of physicians in the U.S. are directly employed by a corporate entity or employed by a hospital-owned by a corporate entity, most often a private equity firm, according to AHIP.
STAT: UnitedHealth’s physician buying spree continues with takeover of Crystal Run (4/10) – The transaction also serves as another example of how difficult it is for regulators to scrutinize deals made by large health care conglomerates. Based on federal reporting rules, UnitedHealth does not have to publicly disclose any of these relatively smaller provider buyouts because they don’t make up a “significant” proportion of its business. The pandemic sharply diminished cash flows at physician practices, which already had been struggling to pay for new technology and medical records systems, said Rob York, a director at the health care consulting group Chartis. To avoid those financial headaches and general burnout associated with medical practice today, physicians have increasingly decided to sell their practices. In 2020, there were 187 physician group deals, according to data from Irving Levin Associates. That has since soared to 457 in 2021 and 608 in 2022.
CBS News: Doctor shortages distress rural America, where few residency programs exist (4/10) – More than 100 million people, or nearly one-third of the nation, have trouble accessing primary care, according to a recent study. This number has nearly doubled since 2014. The pandemic worsened provider shortages nationwide, but the problem is more acute in rural areas, which have long struggled to recruit and retain doctors and other medical professionals. Experts say expanding the number of medical residency training programs in rural areas is key to filling gaps in care because many doctors — including more than half of family medicine physicians — settle within 100 miles of where they train. And while the number of training programs has increased in rural areas during the past few years, research shows 98 percent of residencies nationwide are in urban areas.
Star Press: Hicks: Some more truth about hospital monopolies (4/9) – The main issue is whether or not Indiana’s large hospital monopolies are overcharging, and whether that is tied to their high levels of monopolization. Not surprisingly, I think the evidence is pretty clear. The nation’s most respected think tank, the Rand Corporation, has completed five different studies of the issue, using data provided by hospitals and insurers. They report Indiana statewide has among the very highest prices in the country, and in at least one place the highest. Another group of academic economists created the "healthcare pricing project" that collected data for more than a decade. In a series of papers published in the leading economics journals over the last decade, they report a nearly exact same set of findings. Indiana has a hospital monopoly problem.
Axios: Hospitals' off-site fees draw lawmakers' scrutiny (4/7) – More than two years after Congress acted to shield patients from surprise medical bills, lawmakers are turning to another source of unexpected medical costs: the fees that hospitals tack on for services provided in clinics they own. The fees have caught the attention of Congress, which could take up price transparency legislation. But five states are currently considering laws to curb facility fees for certain services or strengthen existing laws, per the National Academy for State Health Policy, which has proposed model legislation: Connecticut, Colorado, Texas, Indiana, and Massachusetts.
Fierce Healthcare: New bipartisan bill aims to tie doc pay to inflation amid industry concerns (4/7) – A new bipartisan House bill seeks to tie physician payment rates to inflation as doctor groups have implored lawmakers to overhaul the federal pay process. Doctor groups have sought in recent years to persuade Congress to make changes to the Physician Fee Schedule to make the payment rule more favorable. “I am deeply concerned about the impact the outdated Medicare physician payment rate is having on health care access for my constituents,” said Rep. Ruiz (D-CA), one of the bill’s lead sponsors and a doctor himself. “That is why I am announcing legislation that will move us away from a system where every year seniors’ access to care is threatened due to uncertainty over potential cuts.”
Health Affairs: Differences In Use Of Services And Quality Of Care In Medicare Advantage And Traditional Medicare, 2010 And 2017 (4/6) – Researchers compared quality and utilization measures in Medicare Advantage and traditional Medicare in 2010 and 2017. Even as Medicare Advantage enrollment grew to encompass an increasing proportion of the eligible Medicare population, most HEDIS quality performance measures for Medicare Advantage health maintenance organizations (HMOs) and preferred provider organizations (PPOs) were consistently better than those for traditional Medicare, and the differences generally widened over time. The use of ED visits, outpatient visits, and inpatient admissions in both Medicare Advantage HMOs and PPOs was lower than in traditional Medicare in 2010 and 2017, as was the use of discretionary procedures.
Health Affairs: Medicaid Episode-Based Bundled Payments Can Improve Health Equity For Justice-Involved Individuals (4/6) – There is growing concern that many existing value-based payment models do little to address health inequity. In response, in tandem with its 10-year strategy document, the Innovation Center is developing next-generation value-based payment models in ways that better promote health equity such as adjusting for social risk, including measures of individual and neighborhood markers of socioeconomic disadvantages. With the Innovation Center’s efforts in mind, we propose a different strategy to target high-need, socially disenfranchised populations with known costly poor health and social outcomes. We propose creating bundled payments around episodes of care—not defined by a health episode, such as an acute myocardial infarction or surgical joint replacement, as with traditional bundled payment models, but instead defined by an episode of social disruption, such as release from incarceration or housing instability after eviction, which are associated with increased health care use and poor health outcomes.