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.
HHS: (4/20) – CMS released data on mergers, acquisitions, consolidations, and changes of ownership from 2016-2022 for hospitals and nursing homes enrolled in Medicare. Analyses of this dataset demonstrate 347 changes in ownership among hospitals and more than 3000 among skilled nursing facilities between 2016 and 2021, with wide variation across states.Full report
CMS: (4/18) – CMS released the FY 2023 Inpatient Prospective Payment System (IPPS) and Long-Term Care Hospital (LTCH) Prospective Payment System (PPS) rule. The IPPS includes a proposed increase in operating payment rates that is projected to be 3.2 percent. The rule includes three health equity-focused measures in hospital quality programs, seeks stakeholder input related to documenting social determinants of health in inpatient claims data, and proposes a “Birthing-Friendly” hospital designation. Fact sheetHealth equity fact sheetProposed rule
CMS: (4/13) – CMS announced the fourth annual report for the Medicare Care Choices Model. The model provides an option for Medicare beneficiaries to receive hospice care, while continuing to receive services provided by other Medicare providers. SummaryAnnual report
Sen. Booker (D-NJ): (4/13) – Sen. Booker (D-NJ) and Rep. Sewell (D-AL) introduced the John Lewis Equality in Medicare and Medicaid Treatment (EMMT) Act that would require the Center for Medicare and Medicaid Innovation (CMMI) to work with experts to consider health disparities when developing payment models. Bill text
Medical Group Management Association: (4/6) – An MGMA Stat poll asked medical practices what staff role was most difficult to recruit. The majority (44 percent) said medical assistants, followed by nurses (27 percent), administrative/billing staff (18 percent) and other clinical staff (10 percent).
California Medical Association: (4/4) – CMA is sponsoring AB 2132 to establish the California Future Physicians Fund, which would create a pilot program to provide scholarships to students in underserved communities from undergrad through medical school. Following the completion of their residency programs, these students will continue to provide care in the same communities they were educated in for a specified period of time.
Modern Healthcare: (4/19) – One year ago, the 21st Century Cares Act regulations took hold designed to get data moving freely from providers to patients took hold. The regulations have been expected to force a “culture change” in healthcare, according to Micky Tripathi, who leads the Office of the National Coordinator for Health IT ( ONC). The Cures Act requirements shift the mindset in healthcare from sharing data only when it’s permitted under HIPAA to assuming that data should almost always be shared. It has required hospitals and health systems to revamp how they think about providing patients with health data, a process that hasn’t been without growing pains.
Healthcare Dive: (4/19) – CMS is planning to hike inpatient hospital payments by 3.2 percent for fiscal year 2023, an increase of $1.6 billion, according to the Inpatient Prospective Payment System proposed rule. The American Hospital Association decried that increase as too low and "simply unacceptable" considering inflation and rising hospital labor costs. The group said its members "continue to face a range of challenges that threaten their ability to continue caring for patients and providing essential services for their communities."
Healthcare Dive: (4/18) – Doctors' incomes are on the rise again, after stagnating and in many cases declining when practices closed and patients stayed home at the start of the COVID-19 pandemic. Pay increases by specialty ranged from 13 percent for otolaryngology to one percent for critical care. The 2022 report also showed that gender and racial and ethnic gaps persist.
PitchBook: (4/18) – Healthcare deals among private equity firms hit the ground running in the first quarter of this year. PE firms homed in on investments in value-based care (VBC)—including both providers and technology solutions—in Q1. Companies combating kidney disease attracted significant attention from VBC investors.
Fierce Healthcare: (4/16) – A jury in Denver acquitted dialysis provider DaVita and its former CEO Kent Thiry of charges that they conspired with competing employers not to hire each other's key employees. The verdict, which came after two days of deliberations, marks a resounding defeat for government prosecutors who had targeted the dialysis giant’s non-poaching agreements with rival companies in an unprecedented criminal conspiracy case. The Department of Justice argued that the agreements are anti-competitive and violate the Sherman Antitrust Act.
Managed Healthcare Executive: (4/14) – New research shows a wide gap between what health systems say is value-based care and how physicians are compensated. Researchers at RAND Corporation analyzed the payment practices that 31 physician organizations used with their frontline physicians. They found the payment methods were designed to maximize health system revenue by incentivizing doctors to deliver more services. Specifically, the volume-based compensation was the most common component of the primary care physicians’ (PCPs) base compensation in 26 physician organizations.
Modern Healthcare: (4/14) – Healthcare workers, researchers and observers warned federal regulators during a public listening session that consolidation harms employees and patients. The Federal Trade Commission and Justice Department asked for input as they rework their horizontal and vertical merger guidelines. Most speakers claimed that mergers and acquisitions involving hospitals, physicians, pharmacy benefit managers and insurers have increased prices, stifled wages and reduced care quality.
MedPage Today: (4/14) – Expect more consolidation in the healthcare industry in the coming year, said Ricky Goldwasser, managing director at Morgan Stanley, during the annual "Wall Street Comes to Washington" event sponsored by the Brookings Institution. "We think that we're definitely going to see more consolidation," Goldwasser said at the virtual event. "I think that we're going to see small-scale players sort of merging with others to create scale."
American Hospital Association: (4/14) – Following their recent request for information on ways to modernize merger guidelines, the FTC and DOJ held a forum to hear from health care providers, consumers and advocates who have experienced firsthand the effects of mergers and acquisitions in health care. Many of the comments focused on pharmaceutical benefit manager mergers, private equity acquisitions, and hospital consolidation. Lisa Goldstein, senior vice president at Kaufman Hall, said consolidation has helped some financially distressed hospitals avoid bankruptcy and closure. Sean May, vice president at Charles River Associates, said hospital mergers are associated with improvements in clinical quality outcome measures at acquired hospitals, including a statistically significant reduction in inpatient readmission rates.
Fierce Healthcare: (4/14) – UnitedHealth Group executives said that its Optum Health subsidiary, which is one of the country's largest physician groups, is building out value-based care partnerships at a faster rate than was expected. In its earnings report, UHG said it initially projected that 500,000 new patients would be treated in value-based arrangements. It's upping that projection to 600,000.
Fierce Healthcare: (4/13) – Hackensack Meridian Health and Englewood Health have given up their fight against the FTC and dropped their plans for a merger. The proposed deal, first announced in late 2019, would have placed three of Bergen County, New Jersey’s six inpatient general acute care hospitals under the control of the state’s largest healthcare system.
Health Affairs: (4/4) – Commercial health plans pay higher prices than public payers for hospital care, which accounts for more than 5 percent of US gross domestic product. The authors found that average commercial-to-Medicare price ratios were relatively stable, but trends varied substantially across Hospital Referral Regions (HRRs). Among HRRs with high price ratios in 2012, ratios increased by 38 percentage points in regions in the top quartile of growth and decreased by 38 percentage points in regions in the bottom quartile.