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News Clips
Medical Economics: Drive better outcomes with a strong patient-provider relationship (7/9) – An analysis from Arcadia found that the top quartile of Medicare Accountable Care Organizations (ACOs) has a 29 percent higher rate of primary care physician (PCP) visits compared to organizations with lower performance. A separate analysis looked at patients with a low or no PCP relationship and found that they have less consistent management and documentation of chronic conditions and lower quality gap closure rates. Additionally, patients with a single provider relationship have an average of 22 percent lower rates of emergency department visits, including avoidable visits, compared to patients with multiple provider relationships.
NEJM: Medicare Advantage and Consolidation’s New Frontier — The Danger of UnitedHealthcare for All (7/6) – Vertically integrated health care entities — which combine multiple aspects of the supply chain — have promised to facilitate care coordination and generate increased efficiencies owing to reduced transaction costs and economies of scale. Yet there remains little evidence that such desired efficiencies have resulted. It’s plausible that this new wave of consolidation — which largely excludes hospitals — will be different. Since insurers seek to reduce the total cost of their beneficiaries’ care, they can implement incentives for providers to prevent expensive emergency department visits and hospitalizations and can steer patients toward lower-cost sites of care. Furthermore, in the context of rampant market consolidation, payer-led integration may offer physician organizations an alternative to hospital or private-equity–backed acquisitions.
Medical Economics: Revitalizing health care: Addressing physician burnout with sustainable practices (7/8) – Physician burnout has increasingly become a pain point in the health care industry, affecting not only doctors' well-being but potentially the quality of care they provide as well. As a primary care physician with vast health care experience, I have witnessed firsthand the profound impact that overwork and insufficient support can have on physicians, as well as ways to mitigate and altogether prevent burnout. Physician longevity and retention are best achieved through a proper work-life balance. The value-based care model at my current practice has smaller patient panels; providers see around 10 patients per day and have greater autonomy, which translates into more personalized patient care and more rewarding patient-physician relationships. This is the essence of why many of us choose to practice medicine.
Bloomberg: FTC Ban on Worker Noncompete Agreements Delayed by Judge (7/3) – A federal judge delayed implementation of the US Federal Trade Commission’s near-total ban on noncompete agreements, the first salvo in the high-stakes legal fight over how much freedom workers should have to switch jobs within an industry. US District Judge Ada Brown in Dallas sided with the US Chamber of Commerce and a Texas-based tax firm that claimed in a lawsuit the agency lacks authority to craft rules defining unfair methods of competition.
JAMA: Scaling the CMS Cardiovascular Risk Reduction Model (7/5) – The Million Hearts Cardiovascular Risk Reduction Model met the CMS Innovation Center criteria for success, but CMS has not announced its expansion. There are at least three approaches to scaling Million Hearts. First, CMS could incorporate elements into Medicare’s existing infrastructure by adding a cardiovascular care management code to the Physician Fee Schedule and including composite cardiovascular quality measures in value-based payment programs. Second, CMS could leverage its statutory authority to create a new approach to scaling quality-oriented payment models. Lastly, CMS could incorporate required CVD risk assessment and CVD-specific care management fees into any model that includes care management fees or primary care investments.
AJMC: Best Practices for Implementing AI Into Value-Based Care (7/2) – AI can significantly enhance value-based care by optimizing various aspects of patient management and health care delivery. First, predictive analytics. Algorithms can analyze vast amounts of data to predict disease outbreaks, patient deterioration, and even readmissions. There's also personalized treatment plans that AI can tailor to help patients based off their patient data, genetic, work, lifestyle, and environmental factors. The customization can lead to more effective treatments and improve patient adherence. There's also operational efficiency. AI can streamline administrative tasks such as scheduling, billing, managing patient records, reducing the burden on providers, and lowering the operational costs.
Health Affairs: The Road To Value Can’t Be Paved With A Broken Medicare Physician Fee Schedule (7/1) – Value-based payment has been promoted for increasing quality, controlling spending, and improving patient and practitioner experience. Meanwhile, needed reforms to fee-for-service payment (the Medicare Physician Fee Schedule) have been ignored as policy makers seek to move payment toward alternatives, even though the fee schedule is an intrinsic part of Alternative Payment Models. In this article, the authors show how value-based payment and the fee schedule should be viewed as complementary, rather than as separate silos. The fee schedule can accommodate bundled payments and population-based payments that are central to Alternative Payment Models. CMS should correct misvalued services and establish a hybrid payment for primary care that blends fee-for-service and population-based payment. Second, Congress should alter the thirty-five-year-old statutory basis for setting Medicare fees to allow CMS to explicitly consider policy priorities such as workforce shortages in refining fee levels.
Health Affairs: The Effect Of Next Generation Accountable Care Organizations On Medicare Expenditures (7/1) – The Next Generation Accountable Care Organization (NGACO) model (active during 2016–21) tested the effects of high financial risk, payment mechanisms, and flexible care delivery on health care spending and value for fee-for-service Medicare beneficiaries. Sixty-two ACOs with more than 4.2 million beneficiaries and more than 91,000 practitioners participated in the model. The model was associated with a $270 per beneficiary per year, or approximately $1.7 billion, decline in Medicare spending. After shared savings payments to ACOs were included, the model increased net Medicare spending by $56 per beneficiary per year, or $96.7 million. Annual declines in spending for the model grew over time, reflecting exit by poorer-performing NGACOs, improvement among the remaining NGACOs, and the COVID-19 pandemic. Larger declines in spending occurred among physician practice ACOs and ACOs that elected population-based payments and risk caps greater than five percent.
STAT: Medicare’s big experiment to fix kidney failure care hasn’t worked so far, studies say (6/30) – The End-Stage Renal Disease Treatment Choices (ETC) model is a historic effort, both because it’s the largest such experiment in the history of American health care and because, unlike previous CMS Innovation Center pilot programs, it’s mandatory. Those sticks and carrots don’t seem to be doing much. In a paper published in JAMA Health Forum on Sunday, researchers report a null effect: Providers enrolled in the experiment aren’t moving more patients to home dialysis or transplant than those in the control group. To those who’ve kept a close eye on the ETC model, the results are unsurprising. Studies after the first year of the program (2021) showed a similarly flat line. But now, experts are wondering whether the program is still a good idea. Should ETC continue in its current version until June 2027, as planned, or get a makeover? Should it continue at all?
Medical Economics: Experts offer suggestions to improve value-based care at national level (6/27) – Value-based care can make Medicare patients healthier while sustaining physicians’ practices, but it needs fine tuning within the U.S. health care system to optimize outcomes. A panel of experts shared their opinions in the “Hearing on Improving Value-Based Care for Patients and Providers,” convened June 26, 2024, by the Health Subcommittee of the House Ways & Means Committee. Representatives, physicians and an administrator exchanged their views about what works to help patients, and a lot that could be better. “Simply put, the current system, fee for service, that model in health care is not working,” said Subcommittee Chair Rep. Vern Buchanan (R-Florida). “Paying for each medical service without regards to patients’ outcome leads to inefficient care delivery, providers burnout and no improvement on patients’ care. This is not the way health care should be delivered in our country.”
Med Page Today: CMS Needs to Do a Better Job With Value-Based Care, Experts Tell House Panel (6/27) – Value-based care is a good idea but the CMS need to improve its implementation, doctors and a health care executive told members of the House Ways & Means Health Subcommittee. "I am a proponent of the need to move to value-based care, improving quality while decreasing wasteful spending and ensuring access," Robert Berenson, MD, an institute fellow at the Urban Institute in Washington, D.C., said at Wednesday's subcommittee hearing on improving value-based care for patients and providers. "However, I believe that value-based payment as a mechanism to promote better care delivery has gotten off track and needs a thorough reevaluation and reformulation."
JAMA: Misaligned Pharmacy Incentives in Value-Based Care (6/27) – Public and private payers are increasingly transitioning from traditional fee-for-service to value-based care (VBC) arrangements, in which health care organizations are accountable for certain cost and quality metrics. The purpose of these VBC contracts is to incentivize clinician groups, typically organized into accountable care organizations (ACOs), to deliver cost-effective care and avoid low-value health care services. VBC contracts set targets for year-on-year growth in total health care spending, with financial penalties for ACOs if spending exceeds targets. Pharmacy spending is a major contributor to rising health care costs in the US, increasing by 16% from 2016 to 2021, with growth concentrated in brand-name and specialty drugs. As a result, mitigating pharmacy spending growth represents a meaningful opportunity for ACOs to meet targets and lower health care spending. However, there are unique challenges in the misaligned incentives that ACOs face when attempting to control pharmacy spending: new high-cost medications with clinical promise and lack of transparency regarding true pharmacy-related costs.
Healthcare Innovation: NAACOS Leaders' Recommendations on Medicare Payment Reform (6/26) – Medicare payment to physicians has not kept up with rising costs. This underinvests in primary care and limits availability of resources needed to move to value-based care models. When fee-for-service payments are inadequate, clinicians are unable to make the needed investments to innovate care. Therefore, it’s essential that Congress stabilize Medicare’s physician payment system to account for inflation. In its work, Congress needs to address APM incentives in both the short and long term. For the short term, lawmakers should extend the current incentives to allow more time to pass more substantial payment reforms. Along with a short-term extension of bonuses, Congress should address challenges with the existing incentive structure.
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