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.
Rep. Brown (D-OH): (10/5) – Rep. Brown (D-OH) sent a letter, signed by 27 Congressional Democrats, to House and Senate leaders urging them to take action to prevent cuts to Medicare payments that are scheduled to go into effect in 2023. Letter
Medical Group Management Association: (10/11) – Medical Group Management Association (MGMA) released its 2022 Annual Regulatory Burden survey report. The report notes that 90 percent of survey respondents believe health care consolidation is increasing, with the overwhelming majority (seventy-eight percent) viewing the overall effect of consolidation on the health care system as negative.
Aledade: (10/10) – Aledade released a blog post summarizing their comments on quality measurement in the proposed 2023 Physician Fee Schedule (PFS). CMS has set an intention to move the Advanced Payment Model Performance Pathway to all-payer, all-patient, all-provider, all-location electronic measurement (all-payer eCQMs). While Aledade views this as a powerful tool for real-time monitoring of performance and prospective intervention, all-payer eCQMs are inferior to the current sampling methodology for reporting purposes. The blog post notes that the move to all payer eCQMs does not align with payment policy or patient preferences, would be cost- and time-intensive for practices and health centers, and would create a scenario where one ACO’s report card would become less comparable to another ACO’s report card.
American Academy of Family Physicians: (10/10) – American Academy of Family Physicians (AAFP) Family Medicine Action Center released a form to write, call or tweet members of Congress and urge them to take action to stop Medicare payment cuts in 2023. AAFP is also urging Congress to enact annual positive Medicare physician payment updates to account for growing practice costs and address Medicare budget neutrality limitations, which prevent investment in primary care.
MGMA: (10/7) – MGMA published results from the Physician Burnout, Engagement, and Retention Survey, commissioned by Jackson Physician Search in partnership with MGMA. The survey found that 35 percent of physicians experiencing burnout reported a significant increase in burnout in 2022 and more than half reported they had considered leaving their current employer for another. The results indicated that while administrators acknowledge worsening levels of burnout in physicians, physicians often don’t perceive enough is being done to mitigate that burnout or engage them. Further, organizations with physician retention programs found them effective in engaging doctors and preventing turnover.
Aledade: (10/6) – Aledade released a blog post summarizing their comments on the Medicare Shared Savings Program (MSSP) benchmarking changes in the proposed 2023 PFS. The blog post notes that the proposed 2023 PFS contains important proposals that will help MSSP grow and thrive and bring us closer to the goals of increasing access to accountable care, improving health equity, and improving the alignment of MSSP with other value-based efforts. Aledade also notes that CMS’ proposed fix to the rural glitch includes national cost trends, which differ significantly and persistently from local cost trends and will cause significant distortions in where ACOs locate, and suggests alternative proposals
to calculate the regional benchmark trend without including the ACO’s beneficiaries.
AAFP: (10/6) – AAFP released a press release which highlights a September 26 letter
to HHS Secretary Becerra in which AAFP, MGMA, and it’s co-signatories urged HHS to delay the October 6th information blocking deadline. The post also notes an August 18 letter, also signed by PEPC and MGMA, which raised similar concerns while calling for a delay and asking regulators to “create a culture of learning on information sharing to ensure that health data is flowing across the entire ecosystem” rather than a culture focused on penalties. While supporting federal efforts to improve interoperability and end unnecessary limits on the sharing of patients’ health information, AAFP has steadily raised concerns about administrative complexity built into recent rulemaking.
Health Affairs:(10/12) – While varied in structure, alternative payment models serve as a mechanism to coordinate care across clinicians and provide flexibility in the way care is delivered; they have also proven successful in advancing the Triple Aim for adult populations and there is a large opportunity to use these advanced APMs to evolve the way we deliver care for children with medical complexity, reduce inequities, and improve the lives of patients and their families.
Medical Economics: (10/11) – A joint study between MGMA and Humana took a close look at value-based care and how practices approach it. The study, presented at MGMA 2022 conference in Boston, found that 67 percent of respondents agreed that value-based care was better in the level of quality care provided to patients. The biggest challenges identified to adding more value-based care contracts was a lack of staff resources, lack of control over patient care-seeking behavior, and lack of control over other providers.
Bain & Company: (10/11) – A recent Bain survey shows that 25 percent of US clinicians are considering switching careers, primarily due to burnout. Clinicians at management-led practices, such as those operated by a hospital, health system, or private equity fund are considerably worse off, giving a Net Promoter Score of six points, compared with 40 points for those at physician-led practices. To improve well-being, satisfaction, and retention, physicians report the most important criteria being better compensation, support to deliver high-quality patient care, a more manageable workload, flexible work arrangements, and more clinically focused job responsibilities.
RevCycle Intelligence: (10/11) – A recent retrospective, registry-based cohort study
published in JAMA Network Open found no association between participation in the Oncology Care Model (OCM) and the likelihood of patient receipt of novel therapies across a range of cancer types, despite stakeholder concerns that the OCM may have discouraged the use of novel anticancer therapies because of the model’s incentives to reduce overall cancer care spending. Additionally, the study found that Black patients were much less likely to receive a novel therapy and showed a large increase in the receipt of novel therapies for Black patients treated by oncologists in the OCM. “This finding raises the possibility that the OCM might have helped narrow racial disparities in patient access to novel therapies,” researchers wrote in the study. CMS’ Innovative Center recently revamped its strategy for designing alternative payment models and advancing health equity is now a pillar of its strategy and will be explicitly addressed in future models.
Healthcare Dive: (10/11) – About 35 percent of physicians experiencing burnout said those feelings significantly increased in 2022, and over half of polled physicians said they’ve considered leaving their current employer for another, up from 46 percent last year, according to a small survey out Friday from the MGMA
and Jackson Physician Search. A separate MGMApoll
also found 40 percent of medical practices surveyed had a physician resign or retire early due to burnout in the past year. This survey follows other recent reports analyzing the trajectory of burnout among physicians compared to other health care staff. To mitigate burnout and turnover, medical groups should address streamlining clinical workflows, managing workload equity amid staffing shortages and improving communication between physicians and administrators to encourage quality and honest feedback.
AJMC: (10/9) – Dr. Mark Fendrick, director of the value-based insurance design (V-BID) Center at the University of Michigan, suggests additional VBID elements that Congress should adopt. Dr. Fendrick hopes that Congress will build upon the insulin out-of-pocket cap of $35 implemented for Medicare, and extend the policy to commercial plans. Further, Fendrick would like to see the Internal Revenue Service expand the list of chronic disease services that could be covered on a pre-deductible basis.
RevCycle Intelligence: (10/7) – A recent study published in JAMA Health Forum found that ACOs that serve a high proportion of racial and ethnic minorities were more likely to exit the Medicare Shared Savings Program (MSSP) compared to ACOs serving mostly White beneficiaries. “This study underscores the importance of effective risk-adjustment methods that incorporate not only medical but also social risk factors to ensure that ACOs are not penalized for taking on patients with complexities, especially because a disproportionately high percentage of these patients are likely to be members of racial and ethnic minority groups,” researchers wrote. Future policy changes should have an equity-centered approach to ensure that the MSSP and other ACO programs, including the upcoming ACO REACH model, are not exacerbating racial disparities.
Health Affairs: (10/6) – This brief synthesizes key research studies on administrative spending and waste’s role in excess health spending. Administrative spending accounts for 15-30 percent of total health care spending, at least half of which is wasteful. The authors list targeted reforms which they believe are realistic and actionable in the near future including the creation of a centralized claims clearinghouse, a fully electronic prior authorization system, harmonized quality reporting, and the standardization of provider directories. The authors believe that there is a strong case for government intervention and that these policies would also lessen provider burden.
HIT Consultant: (10/5) – Whether organizations participate in government programs or create value-based care models in partnership with payers, they need to demonstrate that they are in fact providing high-value care. This requires tracking a wide range of metric including improved outcomes, lower costs, fewer barriers to care access, improved efficiency, higher patient and clinician satisfaction. Despite the clear value proposition for gathering data at the point of care, most provider organizations have been slow to do so at a large scale. Applying artificial intelligence to clinical workflows behind the scenes can ease the burden of data capture at the point of care while making data usable downstream for decision support and a range of administrative functions. This provides organizations with a single version of the truth that is preserved and that can be leveraged to improve clinical and financial outcomes, which is critical to success in any value-based care model. More importantly, it ensures that using technology no longer gets in the way of practicing medicine and instead serves as a tool that helps clinical staff make the rights decisions for the right patients at the right time.