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.