Health Affairs: Recommendations On Health Care Spending And Value From 21 Experts: Why We Should Implement This Road Map For Action Now (2/8) – “A Road Map for Action" provides recommendations on how to achieve higher value health care spending and growth in our nation. Large scale industry consolidation, lack of price transparency, misaligned payment incentives, and asymmetric information prevent natural market forces from keeping prices competitive. The council recommended a series of state and federal interventions, ranging from increased monitoring, prohibition of anti-competitive contracting terms, and mandatory performance improvement plans. The council agreed that value-based payment is perhaps the only systemic intervention available that can simultaneously address the four levers: price, volume, mix, and growth. The council makes several recommendations to further evolve value-based payment to increase engagement, effectiveness, and long-term savings. We also recognize that fee-for-service (FFS) cannot be the future if we want a fiscally responsible health care system.
RevCycle Intelligence: Long-Term Care ACOs Present an Opportunity for the Most Complex Populations (2/7) – Long-term care residents are historically overlooked and require high-cost, complex health care services. ACOs present an opportunity for providers to earn shared savings while improving care quality for this population. The value-based, coordinated care that ACOs provide members is especially beneficial for high-cost, high-needs populations like long-term care residents who are still covered by Medicare FFS. In terms of increasing participation in long-term care ACOs, aligning incentives with providers who previously did not have incentives focusing on this population is a critical step.
Modern Healthcare: Providers score another win in surprise billing litigation (2/7) – The surprise billing arbitration process unjustly favors insurers, a Texas federal judge ruled Monday, dealing the latest blow to the heavily litigated No Surprises Act. Kernodle kicked the regulation back to HHS to design new regulations around the dispute resolution process, which may face additional legal challenges. Meanwhile, there is a growing backlog of arbitration cases as the federal government has received 90,000 requests from April 15 through Sept. 30. The ruling was well received by providers including the plaintiffs, the Texas Medical Association, which has filed four lawsuits challenging the federal government’s implementation of the No Surprises Act. The initial lawsuit led to a favorable ruling for the association, validating its argument that there was too much emphasis on the qualified payment amount.
Axios: A quarter of hospitals in full compliance with transparency rule (2/6) – Only a quarter of hospitals studied were fully compliant with a federal price transparency rule, according to a new report by Patient Rights Advocate — but compliance is a spectrum. The findings come as Congress has expressed bipartisan concern over compliance with the Trump administration rule and potential interest in legislating on the topic. Only 24.5 percent of the 2,000 hospitals studied were in full compliance with the rule, per the report. 5.8 percent of hospitals were in total noncompliance. The American Hospital Association has also argued that compliance is much higher than some reports have suggested, including an earlier version by Patient Rights Advocate.
Modern Healthcare: Headwinds didn't quell healthcare private equity deals in 2022. (2/6) – Private equity firms had one of their strongest years yet for health care services deal activity in 2022, according to an analysis PitchBook published Monday. An estimated 863 health care services private equity deals were announced or closed last year. That's a nearly 15 percent decrease from 2021, but a more than 18 percent increase from 2020, the market research firm reported. A growing number of “payviders” are investing in clinical operations. Adding to the competition are value-based care enablement companies that provide software and management support to providers adopting value-based contracts and taking on upside risk. More private equity firms are exploring these partnerships as a less capital-intensive option that could culminate in buyouts.
Health Affairs: Adult Primary Care Physician Visits Increasingly Address Mental Health Concerns (2/6) – A high prevalence of mental health diagnoses in adults alongside ongoing shortages of mental health specialists and expansion of the patient-centered medical home have increased the involvement of primary care clinicians in treating mental health concerns. These findings emphasize the need for payment and billing approaches (that is, value-based care models and billing codes for integrated behavioral health) as well as organizational designs and supports (that is, colocated therapy or psychiatry providers, availability of e-consultation, and longer visits) that enable primary care physicians to adequately address mental health needs.
Boston Globe: Why you can’t get in to see your primary care doctor. ‘It’s almost frightening. (2/5) – The reasons for the primary care crunch include rising rates of retirement, not enough MDs entering the field, growing demand for care from a sicker population, and changes in the patterns of well visits since the start of the pandemic. “They are leaving because it’s less enjoyable to practice with short visits where you know you’re not able to meet all the needs of your patient,” said Ann Greiner, CEO of Primary Care Collaborative. “And there’s a high administrative burden — studies show two hours of paperwork and reporting for one hour of clinical care. That’s not a lot of fun.” Increasing consolidation in the market has also contributed to access problems, Greiner said. When formerly independent practices become part of a larger system, physician patient loads typically grow. While that might mean more slots for new patients, it can make it harder to get in for a visit when something urgent comes up.
New York Times: Doctors Aren’t Burned Out From Overwork. We’re Demoralized by Our Health System. (2/5) – Doctors have long diagnosed many of our sickest patients with “demoralization syndrome,” a condition commonly associated with terminal illness that’s characterized by a sense of helplessness and loss of purpose. American physicians are now increasingly suffering from a similar condition, except our demoralization is not a reaction to a medical condition, but rather to the diseased systems for which we work. Thousands of U.S. doctors now appear to feel similarly. One report estimated that in 2021 alone, about 117,000 physicians left the work force, while fewer than 40,000 joined it. This has worsened a chronic physician shortage, leaving many hospitals and clinics struggling. And the situation is set to get worse. One in five doctors says he or she plans to leave practice in the coming years.
Forbes: Leaders Are Restoring Trust In Healthcare—But How? (2/5) – As healthcare progresses, the FFS model should be gradually phased out and replaced with value-based payment models emphasizing quality patient care over quantity. Through prepaid, value-based health care models, organizations can become more adaptable in delivering higher levels of medical service and response times during public crises. But, for such models to be successful, organizations must prioritize transparent communication between patients and providers. As James Mountford, the director of quality at the Royal Free London hospital, said in an interview, “The shift from volume to value represents a fundamental rethinking of health systems worldwide. Value can only be defined by what matters to patients and populations, and working towards it puts patients, staff and those funding health systems—on the same side.”
Fierce Healthcare: Aledade, Mark Cuban's drug company and a handful of others are public benefit corporations. Could it be the Rx to improve healthcare? (2/3) – Health tech unicorn Aledade recently announced that it made the strategic decision to become a public benefit corporation (PBC). The company joins just a handful of others in health care that are structured this way. The PBC structure helps create alignment among stakeholders and build trust, Mostashari said. "I don't think that there is a trade-off between either you do things that are good for society or you make profits in your business. That might be true for FFS businesses. It's not true for Aledade."
Minnesota Nurses Association: Minnesota nurses urge passage of hospital merger bill in first committee hearing (2/3) – Nurses with the Minnesota Nurses Association (MNA) urged passage of legislation to provide critical public oversight of proposed hospital mergers during the bill’s first hearing in the Minnesota House Commerce Finance and Policy Committee. The proposed legislation, introduced by Rep. Robert Bierman as an amendment to HF402, would give the Minnesota Department of Health the authority to review – and approve or deny – hospital mergers in the state on the basis of their impacts on Minnesota patients and communities. The new legislation would provide a serious public review process for proposed mergers, beginning with notice at least 180 days in advance. The legislation allows for a public input process, so that patients, workers and communities could have their voices heard on the potential impact of a corporate health care consolidation in our state. Following this investigation, the Commissioner of Health would determine whether a merger or consolidation “will benefit the public good or improve health outcomes,” and if those benefits outweigh “any anticompetitive effects of the proposed transaction.”
Health Affairs: Workforce Composition In Private Equity–Acquired Versus Non–Private Equity–Acquired Physician Practices (1/31) – Using clinician-level data linked to practice acquisition information, this study estimated changes in clinician workforce composition in private equity-acquired practice sites relative to non-private equity-acquired independent practice sites for dermatology, ophthalmology, and gastroenterology specialties. The clinician replacement ratio was higher for private equity-acquired practices compared with non-private equity-acquired controls, as well as within each specialty and clinician type (physician versus advanced practice provider). Relative to non-private equity-acquired control practices, we also found significant yearly increases in the number of advanced practice providers at private equity-acquired practices after acquisition.
Milbank Quarterly: Strengthening the Center for Medicare and Medicaid Innovation’s Approach to Constructing Alternative Payment Models (1/31) – This article provides guidance to CMMI’s vision by examining challenges within CMMI’s strategy for model building and offering solutions to mitigate these issues. These strategies include engaging beneficiaries in APM incentives, expanding operational flexibility to improve clinical behaviors (e.g., waivers), rectifying issues with conflicting model incentives, building voluntary short-term and mandatory long-term incentives to mitigate selection bias, and transitioning to an overriding population-based model to constrain net costs.