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.
HHS: (3/22) – Building on the June 2021 Physician Focused Payment Model Technical Advisory Committee (PTAC) theme-based discussion on care coordination, PTAC conducted a quantitative analysis of the use of Chronic Care Management (CCM) and Transitional Care Management (TCM) reimbursement codes in 2019 to provide additional context regarding this issue. The analysis examined the proportion of “potentially eligible” beneficiaries who received CCM and TCM services in 2019; CCM and TCM use by patient characteristics; and practice-level use of CCM and TCM. Analysis
Federal Trade Commission: (3/22) – The Federal Trade Commission and U.S. Department of Justice will host a series of listening forums to hear from those who have experienced firsthand the effects of mergers and acquisitions beyond antitrust experts, including consumers, workers, entrepreneurs, start-ups, farmers, investors, and independent businesses. One of the forums will be specifically about merger activity in the health care industry.
White House: (3/18) – The “Dr. Lorna Breen Health Care Provider Protection Act (H.R. 1667), which authorizes programs to improve mental and behavioral health among health care providers, became law.
Rep. Mondaire Jones (D-NY): (3/16) – Rep. Jones (D-NY) and 11 cosponsors introduced the Prohibiting Anticompetitive Mergers Act of 2022 (H.R. 7101), which would prohibit certain anticompetitive mergers, amend the Clayton Act to permit the Federal Trade Commission and the Department of Justice to reject proposed acquisitions, and implement procedures for retrospective reviews and breaking up anticompetitive consummated acquisitions. Sen. Warren (D-MA) and 8 cosponsors introduced the companion legislation in the Senate (S.3847).Bill text
Medical Economics: (3/21) – The number of medical students matching to family and internal medicine residency programs declined this year, according to results of the 2022 National Resident Matching Program Main Residency (NRMP) match. An analysis of Match Day results from the American Academy of Family Physicians (AAFP) shows the number of medical students and graduates matching to family medicine residencies fell from 4,493 in 2021 to 4,470, despite 91 more positions being offered.
Fierce Healthcare: (3/16) – Lawmakers shouldn’t heed a key Medicare advisory panel’s recommendation to freeze physician payments for the 2023 fiscal year, according to provider groups that stress practices are still feeling the brunt of the pandemic. The Medicare Payment Advisory Commission (MedPAC) recommended in a report to lawmakers that clinician payments are adequate, and they don’t need a bump in 2023. The panel felt physicians are expected to have a major rebound in 2023. The Medical Group Management Association said in a statement that it was “deeply troubled” by MedPAC’s decision.
Modern Healthcare: (3/22) – The ACA’s cap on the amount of revenue payers can pocket—through medical loss ratio requirements—and the rise of Medicare Advantage have prompted private payers to purchase physician practices and employ thousands of doctors. These strategic shifts have increased vertical consolidation across the healthcare industry, leaving observers and regulators to weigh the impact on access, quality and cost, and question what will be appropriate antitrust oversight.
Modern Healthcare: (3/22) – Federally qualified health centers, long accustomed to getting by on volume-based public insurance reimbursements and government support, are experimenting with value-based care. Modernizing may be their best path to sustainable, high-quality care but community health centers can’t simply copy the models other providers have implemented.
Modern Healthcare: (3/21) – The Center for Medicare and Medicaid Innovation announced last month that it's rebranding the Global and Professional Direct Contracting model into an Accountable Care Organization model called ACO REACH.Elizabeth Fowler, director of CMMI, joins the Check Up to discuss the new ACO REACH model and changes to direct contracting.
Fierce Healthcare: (3/21) – Center for Medicare and Medicaid Innovation Director Liz Fowler said that a requirement for creating such a plan—which outlines how it will treat underserved patient populations—is likely to be a permanent part of payment models going forward. The center included the requirement in the recently launched ACO REACH payment model which is an overhaul of Direct Contracting.
Modern Healthcare: (3/21) – Health insurers Anthem and Aetna began denying providers' claims that include consultation codes this year, joining the growing ranks of payers cutting reimbursement amid an industrywide coding change. Consultations are a type of evaluation and management service provided at the request of another physician. Medicare stopped paying claims that include consult codes in 2010. Instead, providers bill for inpatient or outpatient visits using codes that pay less.
Fierce Healthcare: (3/17) – Value-based care can drive down acute care episodes such as hospitalizations and emergency room visits among Medicare Advantage beneficiaries, a new study shows. The research, published in JAMA Network Open and led by analysts at Humana and Harvard, found MA members treated by doctors in advanced value-based care models saw 5.6 percent fewer hospitalizations and 13.4 percent fewer emergency department visits compared to those treated in fee-for-service arrangements.
Fierce Healthcare: (3/17) – The Biden administration revamped the Direct Contracting payment model after major criticism from progressive lawmakers. But the House Progressive Caucus still wants to get rid of the model, now rebranded as ACO REACH. The caucus released a list of recommendations for executive actions it calls for the administration to take including quickly ending the ACO REACH payment model.
Congressional Progressive Caucus (CPC): (3/17) – On March 17, the CPC released their recommendations for executive action. One of their recommendations was to “quickly transition away from the ACO REACH pilot program, which allows third-party middlemen to manage care without seniors’ full understanding or prior consent, and often through for-profit businesses with incentives to restrict care.”
Modern Healthcare: (3/16) – The American Hospital Association and the Federation of American Hospitals want federal regulators to deny a Texas physician-owned hospital's request for an exception to rules that prevent it from expanding its facilities. The hospital trade associations say there isn't demonstrated need for the expansion and that granting one could set a bad precedent because there's no process to revoke an expansion exception. The two groups also want the Centers for Medicare and Medicaid Services to reverse the recent policy change that eased restrictions on expansion for physician-owned hospitals that serve high percentages of Medicaid patients.
JAMA Network: (3/16) – In a recent interview, Center for Medicare Director Meena Seshamani spoke with JAMA Associate Editor Karen Joynt Maddox, MD, MPH about her aspirations for the future of Medicare and how clinical experience influences her approach to leading Medicare initiatives. Video