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: (4/27) – CMS issued a proposed rule for the FY2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Rates. The proposed rule would update Medicare payment policies and rates for operating and capital-related costs of acute care hospitals and for certain hospitals and hospital units excluded from the IPPS for FY2022. Notably, CMS proposes to allow ACOs participating in the Medicare Shared Savings Program (MSSP) BASIC track’s glide path the opportunity to maintain their current level of participation for PY2022. A fact sheet with more information can be found here.
HHS: (4/27) - HHS announced the availability of $1 billion for HRSA-Health Center Program funded health centers to support major construction and renovation projects across the country, made available through the American Rescue Plan. The funding would help ensure equity in access to COVID-19 response efforts and high quality primary health care services by funding capital needs and the purchase of new facilities, expansion and renovation of existing facilities, and new equipment.
HHS: (4/27) - HHS announced several new Biden Administration appointments to serve across HHS agencies, including CMS.
FDA: (4/23) - The CDC’s Advisory Committee on Immunization Practices (ACIP), the FDA and the CDC announced that the recommended pause regarding the use of the Johnson & Johnson (Janssen) COVID-19 Vaccine in the U.S. should be lifted and use of the vaccine should resume.
CMS: (4/23) - CMS posted a case study on Health Net of West Michigan, an organization participating in the Accountable Health Communities Model. The case study explores building community partnerships to address social needs.
HHS: (4/22) - HHS launched the new ‘We Can Do This: Live’ initiative to connect Americans with facts and information on vaccines from doctors, scientists, and health professionals through high-impact digital platforms.
CMS: (4/21) - CMS announced it will make $80 million available in grants to Navigators in Federal Marketplaces for the 2022 plan year. The funding, which will be used for outreach and education efforts, is the largest allocation CMS has made available for Navigator grants to date and represents an eight-fold increase in funding from the previous year. HHS Press release
CMS: (4/21) - CMS released the 12th update to the Market Saturation and Utilization Tool to allow CMS to monitor market saturation as a means to help prevent potential fraud, waste, and abuse (FWA). Release 12 adds four reference periods for a total of eighteen, twelve-month reference periods, for State/County data, and nineteen health service areas, and adds one reference period for the Core-Based Statistical Area (CBSA).
Sen. Sanders: (4/25) - A group of 17 Senators led by Sen. Sanders (I-VT) and Sen. Cardin (D-MD) sent a letter to President Biden urging him to include proposals such as reducing the Medicare eligibility age, expanding Medicare benefits to include hearing, dental, and vision care, implementing a cap on out-of-pocket expenses under traditional Medicare, and negotiating lower drug prices as part of his forthcoming American Families Plan.
Hazardous Pay for Frontline Workers Act: (4/21) - Rep. Payne (D-NJ) and seven cosponsors introduced Hazardous Pay for Frontline Workers Act (H.R.2744), which would provide hazardous duty pay for Federal employees who may be exposed to COVID-19, and for other purposes.
Medicare at 50 Act: (4/21) - Sen. Stabenow (D-MI) and 18 cosponsors introduced the Medicare at 50 Act (S.1279), which would provide for an option for any citizen or permanent resident of the United States age 50 to 64 to buy into Medicare.
Suicide Prevention Assistance Act: (4/19) - Rep. DeSaulnier (D-CA) introduced Suicide Prevention Assistance Act (H.R.2648), which would establish a grant program to provide self-harm and suicide prevention services in primary care offices, and for other purposes.
Aledade: (4/27) - Aledade announced a collaboration with Aetna on a new initiative to expand physician-led, value-based care across Louisiana and Georgia. The collaboration would enable physicians in Aledade’s ACOs to deliver high-quality, coordinated care to patients covered by Aetna Medicare Advantage plans in both states.
AAFP: (4/26) - Each year, the AAFP sends its Residency Census to every family medicine program across the US. Doing so helps inform AAFP policies and position papers, create a complete picture of current family medicine residents, and visualize the pipeline of the family medicine workforce.
The Hill: (4/25) - The White House is looking to family physicians to be a key part of the next phase of the COVID-19 vaccine distribution, something advocates in this space have been pushing for from the start of the vaccine rollout. AAFP President Ada Stewart said family physicians are “one of the most trusted folks when it comes to vaccines” and could help address vaccine hesitancy associated with the COVID-19 vaccine. Aledade CEO Fazard Mostashari acknowledged that while primary care providers are now receiving increased attention in vaccine allocation, it was a “mistake” that states had not included them in this process from the start.
WJCT: (4/22) - Florida has more COVID cases tied to variants than any other state in the US. Florida Medical Association member Dr. Ashley Norse, the Director of Emergency Medicine at University of Florida Health Jacksonville, is urging Floridians to get vaccinated as part of a campaign called #TakeItFromADoctor to ensure those diagnosed with COVID will keep from getting sick from the virus.
Medpage Today: (4/27) - Despite positive progress made in the movement toward value-based care, issues around quality and cost still persist as the health system continues to move toward value. A recent policy brief and white paper out of the University of Pennsylvania found that a long-term strategy is needed to focus on expanding payment models to address such issues. This article outlines several of the recommendations posed to CMS in the white paper as CMS seeks to complete the transition to value-based care, highlighting the pandemic as a catalyst for these recommendations to move forward.
Healthcare Dive: (4/26) - According to a new survey by the Larry A. Green Center and the Primary Care Collaborative, primary care practices are beginning to play a more substantial role in the vaccine distribution process for COVID-19, with about four out of 10 practices (or 38 percent) now administering the vaccine. Of those surveyed, only 19 percent have been able to obtain a steady supply of vaccines and 70 percent said the level of burnout and mental exhaustion they are experiencing has reached an all-time high.
Health Payer Intelligence:(4/26) - More evidence is pointing toward physicians choosing value-based and risk-based contracts when contracting with health plans a year into the pandemic. Payers like Blue Cross and Blue Shield of North Carolina (Blue Cross NC) are taking action to support independent practices at risk due to declines in revenue during COVID. Blue Cross NC launched the Accelerate to Value program, which provides financial viability to independent practices to support their transition to value-based care arrangements in exchange for such practices providing access to care for its members and joining a Blue Premier ACO by December 31, 2020. This article outlines other best practices for supporting the transition to value-based care.
Physicians Practice: (4/26) - In this blog, Dr. Michael Attanasio, a Doctor of Osteopathy at Ritner Medical Associates, outlines his practice’s experience during the pandemic and how key features of value-based care can help position practices to be more resilient, adaptable, and future-oriented in the challenges that often face independent practices.
Revcycle Intelligence: (4/26) - Several physician and hospital groups are urging CMS to provide another opportunity for applicants to apply to the Direct Contracting model, following an announcement that the application is closed to future cohorts. America’s Physician Group led a group of providers in a letter to CMMI Director Liz Fowler, noting that this action will hinder the progress in the movement toward value-based care.
eMarketer: (4/26) - According to a Moody’s quarterly report, mergers and acquisitions among hospitals, health systems and health insurers are expected to increase throughout the remainder of 2021. Healthcare CFOs have noted that COVID-19 has acted as a catalyst for increased M&A activity, with 28 percent indicating they would pursue a health care merger and 18 percent indicating they would pursue an acquisition. Many health systems are expected to diversify their services with digital health capabilities.
Fierce Healthcare: (4/23) - A series of quarterly reports from Moody’s Investors Service highlighted how mergers and acquisitions in the health care sector are expected to increase throughout the remainder of 2021. Hospitals and health systems will likely target geographic expansion and revenue diversification in M&A activity, while smaller hospitals and independent practices will continue to feel the financial strain from COVID-19. The reports suggest that independent physicians will be more open to considering affiliations with larger health systems that can offer them financial incentives.
Modern Healthcare: (4/22) - In this episode of the Beyond the Byline podcast, Modern Healthcare finance reporter Tara Bannow and hospital operations reporter Alex Kacik talk about why fee-for-service payment is at odds with population health efforts.
Modern Healthcare: (4/22) - In a letter to CMS, Premier said accountable care organizations (ACOs) need more time to adjust to new quality reporting requirements set to take effect in 2022 in the Medicare Shared Savings Program (MSSP). While Premier ultimately supports the policy changes included in the new quality reporting requirements, such as fewer quality measures and allowing ACOs to report such measures outside the CMS Web Interface, the group is advocating for CMS to delay or provide an exemption of such requirements in 2022 to allow more time to transition following the ongoing pandemic.
Medical Economics: (4/21) - At the NAACOS 2021 Spring Conference, Mark McClellan, Director and professor at the Duke Margolis Center for Health Policy at Duke University, said that better alignment and sustainable models are needed for value-based care plans to take advantage of advances in technology and care. He also noted that primary care physicians have served a critical role in coordinating care in a cost-effective manner, and more resources need to be invested to support them.
AJMC: (4/21) - Getting high performers into APMs and keeping them engaged to set new benchmarks will require a shift in Medicare policy on pricing and evaluating APMs. To address the way target prices are set, this article recommends the following changes: stop charging the goal posts to reduce program uncertainty; include an explicit margin to make continued investments in process improvement possible; and consider using approved clinical models to set base costs of care.