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.
GAO: (2/17) - The U.S. Government Accountability Office (GAO) released a capsule on Medicaid in Times of Crisis, which draws from a number of GAO reports to provide examples of how the federal government and states have used Medicaid during pandemics, economic recessions, natural disasters, and other crises. GAO reiterated its recommendation to Congress to consider enacting automatic increases in federal Medicaid spending during recessions.
HHS: (2/16) - HHS announced Biden-Harris Administration appointments. New appointees and their roles are listed on the press release.
IMPACT to Save Moms Act: (2/22) - Sens. Casey (D-PA), Menendez (D-NJ), and Booker (D-NJ) introduced the Innovative Maternal Payment and Coverage To (IMPACT) Save Moms Act (S. 334), which would establish an alternative payment model demonstration project for maternity care provided to pregnant and postpartum individuals under State Medicaid and CHIP programs.
VACCINE Act: (2/18) - Rep. Brown (D-MD) introduced the Vaccine Administration Centralization to Coordinate and Improve National Execution (VACCINE) Act (H.R. 1099), which would establish a national system for individuals to register for the administration of a COVID-19 vaccine.
Advancing Enrollment and Reducing Drug Costs Act: (2/18) - Reps. Pappas (D-NH) and Tonko (D-NY) introduced the Advancing Enrollment and Reducing Drug Costs Act (H.R. 1167), which would provide for the automatic qualification of certain Medicaid beneficiaries for premium and cost-sharing subsidies under Part D of the Medicare program.
Medicare-X Choice Act of 2021: (2/17) - Sens. Bennet (D-CO) and Kaine (D-VA) announced they will reintroduce the Medicare-X Choice Act of 2021, which would create a public option for uninsured individuals, families, and small businesses by expanding on the Affordable Care Act and Medicare by establishing the Medicare Exchange (Medicare-X) Health Plan. Bill textSummary
AJMC: (2/19) - At a recent 2021 AcademyHealth National Health Policy Conference panel, several experts outlined current Medicaid challenges and looked ahead to potential reforms to the program. Sean Cavanaugh, Chief Commercial Officer and Chief Policy Officer at Aledade, said that structural changes in Medicaid will need to take place for the program to see the same kind of benefits as in certain Medicare populations with value-based care. He indicated that any reform that stabilizes coverage for a longer period of time to allow for a lasting provider-patient relationship is a prerequisite for true value-based care.
Health Leaders: (2/18) - Small physician practices and provider groups experienced substantial financial challenges as a result of the COVID-19 pandemic. In a recent episode of the HealthLeaders Finance Podcast, MGMA CFO Akash Madiah discussed long-term strategies that medical groups and physician practices should follow to be more resilient and less vulnerable if new pandemics or industry-changing events occur in the future.
Apple Podcasts: (2/18) - In this episode of the Florida Medical Association (FMA) Medicine Curated podcast, former FMA Board Member Congressman Neal Dunn, MD talks about issues he is working on that will be significant for physicians and the importance of clinicians being engaged in the legislative process.
Escalon Times: (2/17) - The California Medical Association (CMA) recently endorsed the Stopping Doctor Shortages Act legislation introduced by local Congressman Josh Harder (CA-10), which would close a loophole in federal regulations that prevent doctors in California and Texas from qualifying for student loan repayment programs. CMA estimated that the bill could bring 10,000 physicians to the state over the next ten years.
Group of Six: (2/17) - America’s Frontline Physicians: The Group of Six, which includes AAFP among other groups representing frontline physicians, submitted a letter to President Biden outlining their health care priorities with recommendations on issue areas to prioritize during his term. Among these recommendations include expanding health care coverage and access to care, addressing physician workforce issues, and ensuring community-based physicians are prioritized and have access to the COVID-19 vaccine.
Managed Healthcare Executive: (2/22) - Managed Healthcare Executive interviewed Michael Dill, Director of Workforce Studies at AAMC, and Christopher Kerns, MBA, Executive Vice President at Advisory Board about their differing views on what factors are behind the physician shortage in the U.S. When it comes to value-based care, Kerns believes that value-based care provides the necessary incentives to match patient needs with provider expertise, and can help increase the effective reach of primary care providers. Dill countered that people have said payment reform will solve shortage issues for years, yet they persist due to underlying drivers of the shortages like a growing, aging population.
Health Affairs: (2/22) - With the issue of Medicare solvency looming due to the negative impacts of COVID and other factors, the benefits of the digital era have become more prominent. Modernizing the Medicare program by updating its coverage and payment approaches to digital technology is key to realize more value from modern program operations and benefit designs.
Healthcare Innovation: (2/18) - The Southwestern Health Resources Accountable Care Network (SWHR) has been a top performer in the Next Gen ACO model. The clinically integrated network coordinates care for nearly 100,000 Medicare beneficiaries in North Texas and saved over $52 million in 2019. SWHR has saved nearly $120 million since joining the Next Gen ACO model in 2017.
Revcycle Intelligence: (2/18) - An analysis by Avalere showed a dramatic reduction in Medicare fee-for-service utilization as a result of the COVID-19 pandemic, with the largest decrease happening in April 2020 when outpatient claims dropped by 51 percent. This has affected both hospital systems and primary care practices, and providers have noted an increase in patients experiencing social determinants of health or other adverse health impacts as a result of deferred care.
Healthcare Dive: (2/17) - According to a survey by the Primary Care Collaborative and Larry A. Green Center, about a third of primary care providers have not had contact with their local health department and a quarter did not know how to advise patients calling about obtaining the COVID vaccine. Only 19 percent of providers reported that they were currently administering the vaccine. The majority of providers, however, have received at least the first dose of the vaccine.
PR Newswire: (2/17) - Preferred Primary Care Physicians, an independent physician-led organization in Pennsylvania, has invested in a total care model that provides affordable health coverage to Medicare beneficiaries, making it the first physician group in the state to take responsibility for the quality and cost of care for seniors. The Preferred Senior Care Advantage initiative is an innovative contracting approach with five of the largest insurance plans in the state and through CMS, where the patient’s primary care provider directs 70 to 80 percent of their overall health care expenditures.
AJMC: (2/17) - In this video, Sachin Jain, MD, MBA, FACP, President and CEO of SCAN Group and SCAN Health Plan, discussed a paper he co-authored on the need to ensure that value-based payment models do not create incentives that ultimately harm vulnerable populations. He notes how data can play a role to prevent this from happening, as it can help create a higher degree of specificity for who exists within a population to pay organizations more accurately.
Healio News: (2/17) - The financial challenges placed on physician practices as a result of COVID, combined with ongoing changes in the health care landscape, have led to more practices merging or consolidating with more financially stable practices or health systems. While this article largely focuses on trends in consolidation of orthopedic practices, this trend will likely continue across the health care sector, as there was a 21.7 percent physician group merger and acquisition transaction increase between 2018 and 2019.
Revcycle Intelligence: (2/17) - A new RAND Corporation study found that while low-value care spending for Medicare fee-for-service dropped three percent from 2014 to 2018, two-thirds of low-value care spending went towards three services - opioids for back pain, antibiotics for upper respiratory infections, and preoperative laboratory testing. The study suggests that policymakers should continue with payment reforms that promote value-based care, such as capitation payments, that can incentivize clinicians to reduce low-value care use across a range of clinical areas.
NEJM: (2/17) - Payment reform for primary care services has been a policy agenda item for over a decade, with questions about how best to pay for primary care, how much to pay, and how rapidly change needs to be implemented emerging as urgent considerations due to factors such as practices considering permanent closure or consolidation. This article explores important considerations and barriers for accelerating the shift to comprehensive payment reform in primary care.
Modern Healthcare: (2/17) - A report by the Leonard Davis Institute of Health Economics at the University of Pennsylvania found that HHS needs to overhaul its approach to value-based payment to control spending and ensure widespread transformation in the Medicare program. CMS must develop a clear vision for the future of value-based payment, simplify and align its models across payers, and mandate participation in advanced payment models when possible to push more payers and providers to adopt value-based care.