RevCycle Intelligence: Key Plans for Advancing Accountable Care, Value-Based Payment (11/14) – Mark McClellan, MD, PhD, director of the Duke-Margolis Center for Health Policy and Robert J. Margolis professor of business, medicine, and policy at Duke University, shared the new definition of accountable care at the Health Care Payment Learning and Action Network (LAN) Summit last week. “Accountable care is care that centers on the patient and aligns a care team to support shared decisionmaking and helps realize equitable, comprehensive, high-quality, affordable, longitudinal care.” Data released at LAN Summit revealed that almost 20 percent of healthcare payments from major public and private payers are risk-based, while another 40 percent are tied to quality and value. Nonetheless, progress toward value-based care payment has been slow, albeit steady.
Healthcare Innovation: What Impact Could an HHS Office of Primary Care Have? (11/14) – The U.S. Department of Health & Human Services is seeking to strengthen primary care by working across HHS agencies and offices as well as with other federal offices and departments. A new publication from the Milbank Memorial Fund argues that for this effort to be successful, it will require congressional support for the creation of a robust Office of Primary Care, with dedicated funding and staffing. The authors say that the timing of this opportunity is critical, because primary care has been losing ground in federal policy and in investment across all payers.
Medical Economics: Pay flexibility in smaller practices (11/14) – With fewer regulations regarding pay, small physician practices may be able to adjust pay for medical assistants more quickly than large health systems that must study potential financial ramifications, says Ron Holder, MHA, chief operating officer for the Medical Group Management Association. Staffing in physicians’ practices, hospitals, and health care systems is expected to be one of the top administrative challenges facing the sector in 2023.
Kaiser Health News: Sick Profit: Investigating Private Equity’s Stealthy Takeover of Health Care Across Cities and Specialties (11/14) – Private equity is rapidly moving to reshape health care in America, coming off a banner year in 2021, when the deep-pocketed firms plowed $206 billion into more than 1,400 health care acquisitions. As private equity extends its reach into health care, evidence is mounting that the penetration has led to higher prices and diminished quality of care, a KHN investigation has found. KHN found that companies owned or managed by private equity firms have agreed to pay fines of more than $500 million since 2014 to settle at least 34 lawsuits filed under the False Claims Act, a federal law that punishes false billing submissions to the federal government with fines.
Fierce Healthcare: Hospital groups tell lawmakers looming Medicare cuts 'not sustainable' as officials come back (11/14) – The groups, led by the American Hospital Association and the Federation of American Hospitals, wrote
to congressional leadership Monday calling for a waiver to the four percent in mandatory cuts to Medicare payments expected to start next year. Other major priorities include extending a five percent bonus to physicians who participate in value-based care programs and legislation to remove a 4.5 percent cut to Medicare payments for physicians.
Med City News: 5 Trends for Health Plans to Watch (11/13) – As the health care system evolves, so does the notion of value and what it means in terms of value-based contracts. From 2021 to 2025, value-based contracts are projected to grow to cover 22 percent of insured lives in the U.S. – nearly 65 million people. Health plans can help providers deliver value to patients while also supporting the move to value-based care. This includes working with providers to support patients with telehealth and other digital health tools. It also involves meeting the unique needs of members to drive actions such as completing a missed cancer screening or attending a prenatal care appointment.
Healthcare Finance: FTC refocusing on anti-competitive practices (11/11) – The Federal Trade Commission is refocusing and strengthening its policy of enforcing the federal ban on unfair methods of competition, the agency said by statement Thursday, and this could have ramifications on the health care industry. Potentially anti-competitive practices have crept their way into healthcare, particularly when it comes to hospital consolidation. A new Health Affairs analysis released this week found that while hospital consolidation within markets has become a common practice, consolidation across markets is on the rise. Economic theory predicts – and evidence is emerging – that cross-market hospital systems raise prices by exerting market power across markets when negotiating with common customers, primarily insurers. Since more than half of mergers and acquisitions over a nine-year period qualified as cross-market, evidence is emerging that this trend could have negative effects on market competition, enabling hospital systems to increase prices through cross-market power.
Fierce Healthcare: CMS looking at quality metrics to get ACA exchange plans into value-based care (11/10) – Officials with CMS spoke Thursday at the LAN Summit on value-based care, and one of the key takeaways was how agency officials are pushing to align quality standards across government programs like Medicare, Medicaid and the ACA exchanges to spur greater investment in value-based care. The agency is trying to align its quality metrics across the center’s various programs to send a signal to providers on where to focus their efforts. This effort to align quality standards can also help ease administrative burden and with it provider burnout, which has been made much worse by the COVID-19 pandemic, she added.
RevCycle Intelligence: Increase in Cross-Market Hospital Systems May Hurt Market Competition (11/10) – Over half of hospitals that underwent a merger or acquisition between 2010 and 2019 were located in a different commuting zone than the acquirer, signifying a rise in cross-market hospital systems and cross-market power, according to a Health Affairs study. A cross-market hospital merger occurs when the merging hospitals do not compete for the same patients due to location or services offered. Cross-market mergers can impact stakeholders differently. Since payers need to include hospitals across markets in their network, they could potentially enable cross-market hospital systems to exert market power across the markets when negotiating contract.
RevCyle Intelligence: Value-Based Payment, Fee-for-Service Levels Hold Steady (11/9) – Value-based payment levels barely moved in 2021, with some movement in the downside financial risk category, according to the latest data from the HCP LAN. The majority of health care payments—59.5 percent—from 63 commercial plans, five state Medicaid programs, and Medicare were tied to value and quality in some capacity, the annual APM Measurement Effort report showed this year. The remaining 40.5 percent of payments stemmed from fee-for-service models. The bottom line: The transition to value-based care and ultimately downside risk APMs—a major goal for the federal government—will be a marathon, not a sprint.
Commonwealth Fund: Making Health Care Consolidation Work for Patients: An Interview with Commonwealth Fund President David Blumenthal (11/9) – We know that horizontal consolidation increases prices and it’s hard to find evidence of quality improvement. There’s less data on vertical integration though it seems to have the same effect. As our population ages, a larger and larger proportion of health care will be consumed by Medicare beneficiaries. That will give government more and more leverage. I find it hopeful because of Medicare’s increasing interest — which enjoys bipartisan support — in value-based purchasing: using payment to encourage providers to prioritize quality, safety, and equity as well as monetary returns. We need lots of experience to figure out what works. But we’ve made a start. I hope that private purchasers will follow suit once Medicare has shown the way.