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News Clips
JAMA: Accountable Care Organization Leader Perspectives on the Medicare Shared Savings Program (3/15) – In this qualitative study, interviews were conducted with leaders of 49 ACOs of differing sizes, leadership structures, and geographies from MSSP between September 29 and December 29, 2022. Five major themes emerged: (1) ACO leaders reported a focus on annual wellness visits, coding practices, and care transitions; (2) leaders used both relationship-based and metrics-based strategies to promote clinician engagement; (3) ACOs generally distributed half or more of shared savings to participating practices; (4) ACO recruitment and retention efforts were increasingly influenced by market competition; and (5) some hospital-associated ACOs faced misaligned incentives.
NEJM: Vertical Integration and the Transformation of American Medicine (3/14) – In the past decade, hospital acquisition of physician practices has become a dominant trend in American medicine — one that has transformed the organization and delivery of health care in the United States. From July 2012 through January 2018, the share of practices owned by a hospital increased from 14 percent to 31 percent, according to data from the Physicians Advocacy Institute; from January 2019 to January 2022, hospitals acquired 4800 additional practices, and about 58,000 more physicians became hospital employees. With more physicians working in hospital-owned practices and more patients receiving care from hospital-employed physicians, the quality and cost of U.S. health care has become increasingly linked to the success or failure of these arrangements.
Forbes: Site-Neutral Payments Are Long Overdue. So Why Did The Senate Just Cut Them? (3/12) – A few weeks ago, the Senate stripped the Act of the very provisions designed to enforce site-neutral payments which would have benefited the patient-consumer and saved Medicare billions of dollars. Site-neutral payments ensure reimbursement is tied to a given procedure or service rather than to the site where care is delivered. Instituting site-neutral payments is an overdue reform to the current payment model that some may be surprised to learn isn’t the case already. Under the current model, a particular procedure that can be performed at a variety of sites—such as a physician’s office, outpatient clinic or hospital—costs significantly different amounts depending on the location of care. But if it’s the same procedure, then why the price difference?
JAMA: Physician Perspectives on Private Equity Investment in Health Care (3/11) – Physicians expressed largely negative views about private equity’s (PE’s) effects on the health care system, with concerns about physician well-being, health care spending, and equity. Most respondents (60.8 percent) viewed PE involvement in health care negatively, while 10.5 percent viewed it as positive or somewhat positive and 28.8 percent were neutral. Compared with the non-PE–employed group, PE-employed physicians were less likely to report high professional satisfaction and autonomy compared with non-PE physicians, and fewer reported being extremely likely or somewhat likely to remain with their employer. These estimates of PE-involved physicians mirror those in the literature and suggest new areas for inquiry around clinical practice and workplace experience.
Health Affairs: Aligning Accountable Care Models With The Goal Of Improving Population (3/11) – This article argues that a complete transition to global payment models, such as those employed by ACOs, combined with a shift to population health-focused performance measures should be used to encourage health care organizations to play a leadership role in improving health and eliminating health inequities within the US population. We take this stance for three reasons. First, life expectancy is powerfully influenced by modifiable clinical and behavioral risk factors that are already the direct responsibility of primary care. Second, providers can improve these if they have the tools, incentives, and flexibility needed to do so, as we discuss below. Third, if sufficiently motivated to improve health, we suggest (with some evidence) that providers can and will reach out to collaborate across sectors to work upstream to improve the vital conditions essential to health and well-being in the communities they serve and advocate for the policy changes required to do so.
Medical Economics: The road to real value-based care (3/11) – Value-based care models have existed for fifteen years but have not made meaningful changes to health care delivery or spending in the United States. The COVID-19 pandemic and ensuing financial strain on hospital systems have made it evident that more dramatic and rapid change is required. The time has come for primary care to drive the innovative change in health care delivery and financing. Key drivers of change will be forward-thinking independent practice associations, medical groups, and health systems. These entities must determine how to work together to embrace ambulatory-first contracting strategies, and to expand delivery of care outside the walls of traditional acute care hospitals, while enhancing the access to critical care which only hospitals can provide.
Ames Times: Gigantic Medicare savings demonstrate importance of efficient care, ACOs (3/8) – As a New York Times story showed, that $3.9 trillion in Medicare savings is equal to 85 percent of all the COVID-19 pandemic relief, and is 1.8 times the military spending on the wars in Iraq and Afghanistan, and 5 times the cost of all military spending in one year. The recent controversial bill for Ukraine military aid, costing $60 billion, is only 1.5 percent of the savings from Medicare’s recent savings compared to what was expected. The causes of this huge savings on what was predicted for Medicare spending are multiple, and include policy changes of the ACA that reduced Medicare’s payments to hospitals and providers. But most of the $3.9 trillion in savings has not been due to these policy shifts; it is more likely due to changes in public health and the practice of medicine. Other Obamacare payment policy changes since 2011 have also helped, by introducing what is known as “value-based care” incentives, and consequently many physicians have emphasized more preventive care and use of outpatient settings for cheaper care than in hospitals.
AJMC: Delivering on the Promise of Accountable and Value-Based Care (3/7) – One solution that we must consider is accountable care organizations (ACOs). ACOs aren’t new, and they have been touted as a solution to the problems experienced every day in doctors’ offices across the country, but doubt about ACOs still exists. That may be because some see value-based care as too good to be true or feel we are too far into an FFS model and there is no easy way to transition. But I’ve seen firsthand how physicians can adapt and embrace the model—and when they do, practices change for the better, and most importantly, patients see improvements in their health, life, and relationships, both with their health care providers and in their own personal lives.
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