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.
Center for Medicare and Medicaid Innovation (CMMI): (8/3) – The third evaluation report for the Part D Enhanced Medication Therapy Management Model was posted. The Enhanced Medication Therapy Management (MTM) Model—which began in January 2017— is a 5-year Model to test whether modifications to traditional MTM requirements incentivize better medication management interventions, and thereby lead to improved therapeutic outcomes and reduction of Medicare expenditures. ReportSummary
CMMI: (8/2)– The Frontier Community Health Integration Project Demonstration was extended. The Frontier Community Health Integration Project Demonstration aims to develop and test new models of integrated, coordinated health care in the most sparsely-populated rural counties with the goal of improving health outcomes and reducing Medicare expenditures.
CMMI: (8/2) – The Rural Community Hospital Demonstration was extended. The goal of the program is to test the feasibility and advisability of cost-based reimbursement for small rural hospitals that are too large to be Critical Access Hospitals.
Centers for Medicare & Medicaid Services (CMS): (8/2) – CMS issued the final rule for fiscal year (FY) 2022 Medicare Hospital Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS). As part of the rule, CMS is finalizing policies for the Shared Savings Program to allow eligible ACOs participating in the BASIC track’s glide path the option to elect to forgo automatic advancement along the glide path’s increasing levels of risk and potential reward for performance year (PY) 2022. Under this policy, prior to the automatic advancement for PY 2022, an eligible ACO may elect to remain in the same level of the BASIC track's glide path in which it participated during PY 2021. Final ruleFact sheet
Sen. Portman (R-OH): (8/1) – On Sunday, Sens.Portman (R-OH), Sinema (D-AZ), Collins (R-ME), Manchin (D-WV), Romney (R-UT), Warner (D-VA), Murkowski (R-AK), Shaheen (D-NH), Cassidy (R-LA), and Tester (D-MT) released the text of the bipartisan infrastructure agreement Invest in America Act (H.R. 3684).There are several pay-fors related to health including delay of the Medicare Part D drug rebate rule. Bill text
Rep. Duncan (R-SC): (7/28) – On July 28, Reps. DelBene (D-WA), Welch (D-VT) and Duncan (R-SC) introduced the Seniors’ Chronic Care Management Improvement Act (H.R.4755), which would remove cost-sharing responsibilities for chronic care management services under the Medicare program. Bill textSummary
Florida Politics: (8/2) The Florida Medical Association has selected Dr. Doug Murphy, an OB/GYN from Ocala as its next president. He was installed in the role on Saturday, July 31.
American Medical Group Association: (7/29) – The American Academy of Family Physicians (AAFP) and Medical Group Management Association (MGMA) wrote a letter to Rep. DelBene (D-WA) expressing their support for the Seniors’ Chronic Care Management Improvement Act of 2021. The legislation would remove the patient cost-sharing obligations from the Chronic Care Management (CCM) code, allowing potentially millions of chronically ill Medicare beneficiaries to benefit from the care coordination and care management services the code supports.
PR Newswire: (7/28) – MGMA published a new data report illustrating significant differences in how physician-owned medical practices and hospital-owned medical practices weathered the pandemic and are navigating the economic recovery. Physician-owned medical practices had bigger cost and revenue swings than their hospital counterparts largely driven by how they approached patient access, physician productivity, and operating costs. All practice types reported pronounced decreases in productivity levels in 2020 versus 2019, though hospital-owned practices fared much worse; hospital-owned entities experienced three times greater declines in productivity compared to physician-owned entities.
WBUR: (7/27) – Dr. Ada Stewart, president of the AAFP, spoke to WBUR about why her group is backing vaccine mandates for health care workers. AAFP believes that vaccination is the primary way to combat the pandemic and to avoid the return of stringent public health measures.
RevCycleIntelligence: (8/3) – With the new Executive Order on Promoting Competition in the American Economy, antitrust enforcement should continue to be top of mind for hospital and health system leaders engaging in merger and acquisitions deals. The executive order highlights the FTC’s ability to challenge healthcare merger and acquisition deals that were not previously challenged by an administration and even ones that already occurred. Healthcare lawyers expect that leaders should be prepared to demonstrate the value a consummated merger or acquisition has created one, two, even four years later.
Healthcare Dive: (8/3) – In a win for providers, CMS dropped a requirement that would have forced hospitals to disclose their contract terms with Medicare Advantage plans from its final inpatient pay rule for 2022. The rule also included a 2.5 percent pay bump for acute hospitals, which is lower than the 2.8 percent proposed in the initial draft of the rule released in April and lower than the 2.9 percent pay bump for the 2021 fiscal year.
Fierce Healthcare: (8/2) – On Sunday, the Senate released text for the $1 trillion bipartisan infrastructure package. While most of the new funding in the package goes toward infrastructure projects such as new roads or information technology, there are several healthcare-related provisions that could impact the industry. The bill would delay until 2026 a controversial Part D rebate rule, resume Medicare sequester cuts and require drugmakers to refund Medicare for any discarded drugs.
Health Affairs: (8/2) – In this Health Affairs article, Michael Chernew and others write that the theory of hospital cost shifting posits that reductions in public prices lead to higher commercial prices. The cost-shifting narrative and the empirical strategies used to evaluate it typically assume no connection between public prices and the number of hospitals operating in the market (market structure). The authors raise the possibility of “consolidation-induced cost shifting,” which recognizes that changes in public prices for hospital care can affect market structure and, through that mechanism, affect commercial prices.
Health Affairs: (8/2) – As policy makers consider telehealth in the post-pandemic period, they must make decisions about payment parity—whether to continue reimbursing clinicians equivalent amounts for in-person and telehealth visits. Because many tensions about payment parity are rooted in volume-based reimbursement, the author argues another way to help resolve the debate is to test telehealth within dedicated value-based payment models. Value-based payment models could be designed to evaluate the impact of telehealth use on relevant clinical, quality, and spending outcomes.
Healthcare Dive: (8/2) – A new study conducted by the Larry A. Green Center and Primary Care Collaborative found that 40 percent of doctors worry primary care will disappear in five years while 21 percent say they plan to leave primary care within three years.That ongoing fatigue hints at potential threats to the U.S.' primary care workforce, which has already shrunk in size in recent years due to rampant consolidation, closures and neglect. By one estimate, America's primary care practices lost over $15 billion in 2020 during a catastrophic plummet in patient visits during the COVID-19 pandemic.
Fierce Healthcare: (7/30) – For Rep. Suzan DelBene (D-WA), a major proponent of legislation in Congress on value-based care, a key driver is making sure that providers have the tools to succeed in payment models and figuring how Congress can help make that happen. DelBene is the lead sponsor in the Value in Health Care Act, bipartisan legislation recently reintroduced that intends to get more providers into value-based care payment models. DelBene has also co-sponsored other legislation aimed at improving value-based care in rural areas, including a bill to combat a “rural glitch” that penalizes accountable care organizations in rural areas.
Modern Healthcare: (7/29) – The number of doctors employed by private equity and health insurers is growing more rapidly than the number employed by hospitals according to a study by Avalere. The number of doctors employed by private equity and health insurers grew 31 percent between 2019 and the beginning of this year, to now represent 20 percent of doctors overall. However, hospitals are still the biggest employment category, with 49 percent of doctors being employed by hospitals.
Medical Economics: (7/28) – While the COVID-19 pandemic introduced a lot of uncertainty among independent physicians, they are still optimistic about the future of their practice. The State of the Independent Practice report from medical software company Kareo gathered survey responses from 1,300 independent practices across 50 specialties. The report found that 75 percent of practices expect to grow this year, up from 59 percent in 2019. Meanwhile, only 6 percent of practices believe they will shrink, and 18 percent think their practice will stay the same.