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: (6/13) – CMS added an additional track to the Maryland Total Cost of Care Model’s Maryland Primary Care Program (MDPCP) that rewards or penalizes primary care practices in the state for their performance on the cost and quality of care furnished to Maryland Medicare beneficiaries. In the new track, called Track 3, participating practices and partner Care Transformation Organizations will receive a flat visit fee for select primary care services and a prospective population-based payment that are adjusted with a positive or negative Performance Based Adjustment. MDPCP Track 3 begins on January 1, 2023, and will continue through December 31, 2026.
HHS: (6/13) – HHS, through the Office for Civil Rights (OCR), issued guidance on how covered health care providers and health plans can use remote communication technologies to provide audio-only telehealth services when such communications are conducted in a manner that is consistent with the applicable requirements of the HIPAA Privacy, Security, and Breach Notification Rules, including when OCR’s Notification of Enforcement Discretion for Telehealth is no longer in effect.
Government Accountability Office: (6/9) - The U.S. Government Accountability Office (GAO) is now accepting nominations of individuals for the Physician-Focused Payment Model Technical Advisory Committee (PTAC). Letters of nomination are due by July 11, 2022 and appointments will be made in October 2022.
HHS: (6/9) - HHS, through the Health Resources and Services Administration (HRSA), announced the launch of the Building Bridges to Better Health: A Primary Health Care Challenge, a national competition with a total of $1 million in cash prizes to encourage innovation through technical assistance to health centers. Competition participants will accelerate the development of low-cost, scalable solutions to help HRSA-supported community health centers to improve patient access to primary care and strengthen the link between health care and social services.
CMS: (6/6) - CMS published a blog post outlining additional details on the CMS National Quality Strategy: A Person-Centered Approach to Improving Quality, which was initially released in April 2022. The strategy focuses on a person-centric approach from birth to death as individuals' journey across the continuum of care, as well as across payer types, including traditional Medicare. The blog notes how the CMS National Quality Strategy will support the agency’s approach to value by increasing alignment across quality reporting and value-based payment programs, accelerating the path toward value, and addressing upstream drivers of health
Senator Murphy: (6/13) – A bipartisan group of Senators, led by Sens. Murphy (D-CT) and Cornyn (R-TX), announced a bipartisan gun safety framework to protect America’s children, keep schools safe, and reduce the threat of violence. The proposal increases investment in children and family mental health services, provides funding for school-based mental health and supportive services, and invests in programs that increase access to mental and behavioral health services via telehealth, among others.
Gold Card Act of 2022: (6/9) - Reps. Burgess (R-TX), Gonzalez (D-TX), and Jackson (R-TX) introduced the Gold Card Act of 2022 (H.R. 7995), which would exempt qualifying physicians from prior authorization requirements under Medicare Advantage plans
PATH Workforce Integration Act: (6/9) - Reps. Roybal-Allard (D-CA) and Smith (D-WA) introduced the Professional's Access to Health (PATH) Workforce Integration Act (H.R. 8019), which would authorize the Secretary of HHS to award grants for career support for skilled internationally educated health professionals. One pager
Aledade: (6/13) – ACOs offer a flexible way to incentivize physicians and improve quality in partnership with payers. Downside risk models typically offer a higher percentage of the shared savings if the ACO successfully manages costs. Aledade
released a checklist to help practices to evaluate their current ACO’s downside risk readiness.
AAFP: (6/10) – In this blog, the American Academy of Family Physicians (AAFP)
discusses its recent call for swift finalization of a proposed rule that would benefit millions of patients by clarifying the health insurance affordability provisions of the Affordable Care Act, otherwise known as the “Family Glitch.” In a letter sent to the IRS on June 2, AAFP noted that “the proposed rule would address the family glitch eligibility barrier for premium tax credits and improve affordable health insurance coverage.”
Medical Group Management Association: (6/10) – In this episode of the MGMA Week in Review podcast, MGMA features articles on value-based care analytics, the step therapy prohibition, and using a people-first strategy as your leadership style.
California Medical Association: (6/7) – In 2019, the California Medical Association (CMA) Physician Services Organization (PSO) partnered with Aledade
to help primary care practices and community health centers succeed in value-based care. For the most recent reporting year (2020), practices in Aledade's Medicare Shared Savings Program ACOs earned an average of $198,000 each in shared savings revenue.
Healthcare Innovation: (6/14) – While primary care is the most impactful instrument the U.S. health care system has to prevent disease, improve health and lower mortality rates, it is under-resourced with only five to seven percent of health care dollars spent on primary care. This underinvestment can not only lead to poorer health outcomes for patients, but burnout of primary care providers due to high patient caseloads and a lack of time and resources. This article calls for a need for new care models, specifically a value-based care team approach, to reduce such caseloads while addressing the complex needs of older patients.
Medscape: (6/14) – To help protect the viability of independent physician practice, the American Medical Association (AMA) decided it will issue a report at least every two years in collaboration with the Privacy Practice Physicians Section to communicate their efforts to support such medical practices. The AMA, which considered this report at its recent annual meeting of its House of Delegates this week, noted that now is the right time to highlight this issue given the impact of the pandemic on physicians in independent practice. The AMA also recently released a blog
on how private practices can participate in prospective payment models, which outlined policies adopted by the Delegates to support physicians in doing so.
RevCycle Intelligence: (6/14) – The American Hospital Association (AHA) has recommended changes to the CMS Radiation Oncology (RO) Model following the agency’s decision to delay the model’s start date. In a letter to CMS Administrator Chiquita Brooks-LaSure, AHA expressed support for the original goals of the RO Model to ensure fair and predictable payments for radiation oncologists, but noted that payment cuts and accompanying administrative burden have warped the model’s intentions.
Wall Street Journal: (6/13) – Arnold Ventures LLC is providing financial backing to three lawsuits against giant hospital systems in Wisconsin, Connecticut, and North Carolina, alleging the systems used their market power to squash competition and illegally inflate prices. The support from Arnold Ventures LLC, which hadn’t been previously reported, shows how scrutiny of dominant hospital systems is escalating following an extended period of industry consolidation and action from the federal government to address hospital consolidation that has harmed consumers.
Healthcare IT News: (6/10) – The connection between health equity and value-based care is accelerating. In this episode of HIMSSCast, Lynn Carroll, COO of HSBlox, noted there is a need to bring non-traditional organizations into value-based efforts.
AJMC: (6/9) – This blog by National Association of ACOs CEO Clif Gaus outlines how the Accountable Care Organization Realizing Equity, Access, and Community Health (ACO REACH) model provides the next great opportunity in moving a health care payment system toward paying for value, and rewarding preventive care and keeping patients healthy. CMS evolved the Global and Professional Direct Contracting (GPDC) Model to a more traditional ACO model, adding numerous beneficiary protections and creating the first Medicare payment model with serious, tangible health equity requirements. The ACO REACH Model will officially launch next year after a summer-long application process.
Boston Globe: (6/9) – Facility fees, which hospitals are allowed to charge to cover the costs of remaining open around the clock, increase the price of health care and appear to be the largest driver of the substantial increase in hospital prices in recent years. The federal government is pushing back by implementing a site-neutral payment policy for Medicare to lower patients’ health care costs. Medicare will pay for outpatient care provided at hospital clinics at the same rate as outpatient care provided at a freestanding clinic.
The National Law Review: (6/8) – The new, value-based ACO REACH Model reflects the Biden-Harris Administration’s mission in promoting health equity, with a strong focus on improving access to health care for individuals in underserved communities. Payments to participating accountable care organizations (ACOs) in this model will be based, in part, on the “measurable reductions in health disparities within their participating beneficiaries.” The ACO REACH Model has five policy mechanisms guiding its mission of improving health equity and reducing disparities, including creating a new benefit enhancement.
Milbank Memorial Fund: (6/8) – The Biden Administration has begun to focus on antitrust and monopoly activity in health care to protect consumers from high costs and inadequate access to care. Whereas health care consolidation was primarily an “insiders” game in the past, the author of this blog writes on how Democrats and Republicans alike are part of the new antitrust movement.
Healthcare IT News: (6/8) – Value-based contracts and ACOs as payment mechanisms help make health care affordable. In this episode of HIMSS TV, Summit Health Chief of Population Health Jamie Reedy discusses how the company's data strategy supports Medicare ACOs and over 30 value-based contracts.
Kaiser Family Foundation: (6/8) – As mental health concerns have risen over the past decade — and reached new heights during the pandemic — there’s a push for primary care doctors to provide mental health care. Research shows primary care physicians can treat patients with mild to moderate depression just as well as psychiatrists — which could help address the nationwide shortage of mental health providers. Primary care doctors are also more likely to reach patients in rural areas and other underserved communities, and they’re trusted by Americans across political and geographic divides.
AJMC: (6/6) – A new study in Health Affairs found that patients in the Comprehensive End-Stage Renal Disease (ESRD) Care Model saw a decrease in hospitalizations and readmissions compared with the accountable care organization (ACO) model. The researchers concluded that their research has policy implications for other Medicare populations with chronic disease, considering the benefits of specialty-focused ACO models. In addition, primary care ACOs could benefit by adopting some of the strategies used by ESRD Seamless Care Organizations (ESCOs) to care for high-need patients.
SpringerLink: (6/6) – A new analysis shows patients are getting more face time with physicians, likely due to the larger physician workforce, but that Black and Hispanic patients receive less time with their doctors. The study, published in the Journal of General Internal Medicine, found that the time all patients spent with physicians increased between 1979 and 2018 from 40 to 60.4 minutes per year, while time spent with primary care doctors had fallen since 2005. This reduction may explain why rates of hypertension and diabetes, conditions mostly managed in primary care, are increasing.