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.
CMS: (8/6) – CMS and HHS released a proposed rule that would rescind the Most Favored Nation Model interim final rule with comment period that appeared in the November 27, 2020, Federal Register. The Most Favored Nation Model proposed to link Medicare drug prices to cheaper prices paid abroad.
Sen. Murkowski (R-AK): (8/10) – The U.S. Senate passed the Infrastructure Investment and Jobs Act, legislation which provides investments for core infrastructure—roads, bridges, rail, transit, ports, airports, energy, water systems, and broadband. The bill provides $550 billion in new spending over five years. The bill passed the senate 67-30 and now goes to the House for consideration.
Senate Budget Committee: (8/9) – Senate Budget Committee Chairman Bernie Sanders (I-VT) Monday joined with Majority Leader Chuck Schumer (D-NY) to introduce the $3.5 Trillion FY 2022 budget resolution. The resolution would allow Medicare to cover hearing, dental and vision benefits, close the Medicaid coverage gap and address health equity issues, among many other health priorities. SummaryResolution text
Sen. Cassidy (R-LA): (8/6) – On August 6, the Senate passed the Dr. Lorna Breen Health Care Provider Protection Act (S.610) by voice vote. The bill would establish grants and requires other activities to improve mental and behavioral health and prevent burnout among health care providers. The bill now goes to the House for consideration.
Rep. O'Halleran (D-AZ): (8/6) – Reps. O’Halleran (D-AZ), McKinley (R-WV), Kind (D-WI), and Wenstrup (R-OH) introduced the Rural Medical Residency Expansion Act (H.R. 4970), which would direct the Secretary of Health and Human Services to establish a grant program to encourage the development and expansion of approved medical residency training programs in rural areas.
Sen. Lujan (D-NM): (8/5) – Sen. Schatz (D-HI) and 18 cosponsors introduced the State Public Option Act (S.2639), which would establish a State public option through Medicaid to provide Americans with the choice of a high-quality, low-cost health insurance plan. Rep. Schrier (D-WA) and 14 cosponsors introduced companion legislation in the House (H.R. 4974). Bill textSummary
Modern Healthcare: (8/5) – Aledade’s Dr. Emily Maxson, spoke to Modern Healthcare about the need for interoperable data systems, electronic data exchange and the use of common data standards. Even if a practice gets sent relevant data from providers and insurers as part of value-based care arrangements, it can be difficult to get the information in a way that easily integrates with clinical systems. “If you still have messages coming in on a fax machine, they have to be updated and scanned—and those PDFs aren’t searchable,” Maxson said. “You lose the option to do sophisticated things that integrate those data elements because they’re hiding in an attachment, so to speak.”
The American Academy of Family Physicians (AAFP): (8/5) – AAFP submitted a letter to HHS Secretary Xavier Becerra and CMS Administrator Chiquita Brooks-LaSure affirming their support for CMS’s proposal to create a monthly special enrollment period for individuals (and their dependents) who are eligible for advance premium tax credits and whose household income is expected to be no greater than 150 percent of the federal poverty level. If finalized, AAFP wrote the rule “would increase enrollment opportunities for low-income individuals and ultimately enable them to receive essential primary and preventive care.”
mHealth Intelligence: (8/10) – Independent medical practices are emerging from the chaos of the pandemic on stronger footing partially due to telehealth. A new report from Kareo finds that more than half the practices saw patient visits stay the same or grow in 2020, and three-quarters expect to see growth in 2021. In the meantime, the telehealth adoption rate among practices jumped from 22 percent in 2019 to 41 percent in 2020 to 80 percent at the end of that year. While much of the growth can be attributed to the adoption of connected health platforms and tools to make up for the loss of in-person traffic, experts say these practices now have the confidence to plan a long-term telehealth strategy that combines the two.
CVS: (8/10) – Aetna, a CVS Health company, announced an innovative health care solution, Aetna Virtual Primary Care, that provides primary health care services virtually on demand. Members have access to a diverse panel of physicians and coordinated care from a consistent team of specialists based on their health needs. Members can also access $0 co-pay virtual primary care visits and select in-person services at MinuteClinic and CVS HealthHUB locations.
Healthcare Dive: (8/9) – Delaware lawmakers passed a sweeping healthcare bill this summer that puts caps on hospital price growth and compels insurers to boost investment in primary care. The multi-pronged bill also forces certain payers to tie nearly half of their business to alternative payment models by 2023, and create shared accountability for both the cost and quality of care. Essentially, it forces payers and providers to enter into these arrangements faster, hoping to pay for quality rather than quantity of care.
Modern Healthcare: (8/9) – The uneven distribution of COVID-19 relief funds to hospitals demonstrates the need for a standardized database of key financial metrics policymakers can use to guide future decisions. Researchers from the Urban Institute and Harvard University wrote a paper bringing attention to the imprecise methods HHS used to distribute more than $130 billion in Provider Relief Fund grants. The federal government handed out most of that money based on health systems' sizes without considering other factors, such as liquidity, solvency, capital investments or overall financial health.
Fierce Healthcare: (8/9) – Senate Democrats want to give Medicare the power to negotiate for lower drug prices, add new benefits to Medicare and close a Medicaid coverage gap in a new $3.5 trillion infrastructure package. Democrats unveiled on Monday their budget resolution for the package, the first step to passing the legislation in the Senate. The budget resolution, set to be considered in the chamber this week, outlines ambitious and long-held Democratic healthcare policies that the final legislation is likely to include.
Modern Healthcare: (8/9) – Nurse practitioners were the most recruited providers among physicians and advanced practitioners, according to a new report by search firm Merritt Hawkins. This marks the first time in the report's 27-year history that physicians did not hold the top spot. For the past 14 years alone, family physicians were the most recruited position, Merritt Hawkins said.
American Medical Association: (8/9) – Though the total percentage of physicians who are practice owners is declining as more doctors are employed by larger physician groups or health systems, some physician specialties—particularly surgical specialists—are more likely than other physicians to have ownership stakes, the research indicates. The statistics are based on data the AMA collected from 3,500 physicians in the 2020 Physician Practice Benchmark Survey conducted last fall.
Philadelphia Inquirer: (8/7) – Economic forces are making it increasingly difficult for physicians to remain in private practice. Cuts to Medicare payments for imaging tests performed by cardiologists, orthopedists, and oncologists in their offices make their practices less lucrative. And many payers, including Medicare and some private insurers, are increasingly basing reimbursement on value-based purchasing, which compares the amount paid for services with their clinical value. Administering these arrangements piles on yet more practice overhead expenses.
Fierce Healthcare: (8/6) – Nearly 20 Senate Democrats reintroduced legislation Friday to create a new Medicaid-based public option, reinforcing their commitment to a key priority. The legislation would let states create a Medicaid buy-in program for all residents regardless of their income, helping state residents who may make too much to qualify for Affordable Care Act (ACA) income-based subsidies on the exchanges but don’t have employer coverage.
Modern Healthcare: (8/5) – Acquisitions of physician practices by hospitals and other corporate entities occur with little regulatory scrutiny or oversight. These transactions make good business sense for corporations, but the longer-term impact on patients is much less certain. Kelly Kenney, CEO of the Physicians Advocacy Institute, calls for regulatory guardrails around these acquisitions to protect against anti competitive repercussions–like less choice and higher prices for patients–that have been shown to accompany healthcare market consolidation.
Health Payer Intelligence: (8/5) – The commercial payer industry has struggled to exhibit the same results in value-based care that government programs have. Part of the reason for the decreased traction in the commercial payer space is that employers helm the decision-making, which can create a barrier between payers and providers.
RevCycle Intelligence: (8/4) – Medicare funds are dwindling and revenues are declining. This financial strain could result in closures and acquisitions, paving the way for hospital cost shifting. A Harvard Medical School research team studied the relationship between public payment and the hospital sector’s market structure in a recent study published in Health Affairs. The study revealed that hospitals with a higher share of Medicare patients often had lower revenue and a greater chance of closure or acquisition compared to those that were not as reliant on Medicare.
Modern Healthcare: (8/4) – Merger filings are surging, which will delay regulatory reviews this year, the Federal Trade Commission advised companies. Filings have already exceeded 2,000 through July, up from 815 during the same period last year and 1,136 in 2019, according to federal data. Businesses can complete their proposed mergers before the FTC finishes its reviews, but regulators can still retroactively challenge the transactions if they violate antitrust laws, the FTC warned.
Modern Healthcare: (8/3) – Many private equity firms are investing in startups that facilitate the move away from fee-for-service. Primary care providers like Oak Street Health are receiving public evaluations of up to $9.5 billion, due to investors looking to profit off industry trends toward value-based care.