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: (5/3) – The COVID-19 pandemic has put extreme stress on the health care workforce, leading to workforce shortages as well as increased health care worker burnout, exhaustion, and trauma. This report describes workforce shortages both prior to and during the pandemic, COVID-19 impacts on the mental and physical health of the health care workforce, and an overview of federal interventions and investments to support the health care workforce during the pandemic. Report
CMS: (4/28) – CMS released the January 2022 Medicaid & Children’s Health Insurance Program (CHIP) Enrollment Data Highlights. The report showed 86,953,387 individuals were enrolled in Medicaid and CHIP in the 51 states that reported enrollment data for January 2022.
CMS: (4/28) – CMS released enrollment figures for Medicare. As of January 2022, over 64.2M people are enrolled in Medicare.
NEJM: (4/27) – Liz Fowler, Doug Jacobs, Meena Seshamani and Purva Rawal released an opinion piece in the New England Journal of Medicine about their vision for accountable care across CMS. They stressed greater integration between the Medicare Shared Savings Program and CMS Innovation Center models. They also listed as a priority, including providers who have not traditionally participated in ACO models, into the next generation of ACO models.
Modern Healthcare: (5/3) – Texas passed a statewide prior authorization “gold card” law. The measure requires insurers to exempt providers from pre-authorization for certain services if they achieve a 90 percent approval rate for the service over six months. This would help alleviate some of the prior authorization burden. Nearly 90 percent of providers said prior authorization felt very burdensome, according to a 2021 Medical Group Management Association survey.
AJMC: (5/2) – Early evidence shows that Advanced Care Planning (ACP) done well in an accountable care organization (ACO) can reduce inpatient hospital usage and result in a reduction of the total cost of care by nearly $9500 per patient.10 The goal of this editorial is to confirm this evidence at scale through a pilot project run by Aledade. To improve patient care at the end of life, Aledade set out to solve several challenges: the lack of publicly available tools to predict which patients would benefit most from ACP, the challenges that physicians experience with conducting comprehensive ACP in busy primary care practices, and the excess of unwanted and costly end-of-life treatment.
Medical Economics: (4/29) – MGMA Vice President of Industry Insights Andy Swanson recommends that in order to attract and retain staff, medical practices should actively recruit employees who want to work part-time. At a medical practice, that could look like a 9 a.m.-to-2 p.m. shift three days a week for one front desk staffer, and another team member takes that shift the other two days.
American Academy of Family Physicians (AAFP) (4/28) – AAFP is launching a new Commission on Diversity, Equity and Inclusiveness in Family Medicine and has selected the 10 inaugural members. The new commission will work to ensure that DEI is at the foundation of everything the Academy does. The commission will meet in June with a full agenda that will focus on examining the DEI work that the Academy has already done and setting the commission’s scope for ongoing work.
RevCycleIntelligence: (5/2) – The CMS Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model reduced Medicare fee-for-service episode payments for both surgical and medical episodes. CMS launched the BCPI Advanced Model in October 2018, building upon the original BCPI initiative. he model aims to test if linking payments for an episode of care can reduce Medicare spending while maintaining or improving care quality.
Modern Healthcare: (5/2) – Large not-for-profit health systems are recording investment income windfalls that are offsetting significant operating losses. St. Louis-based Ascension recorded a $640.1 million operating loss on $19 billion in revenue through the first nine months of its 2022 fiscal year. Nearly $900 million in non-operating income, $736.4 million of which was attributable to investment income, more than offset those losses. That was down from nearly $4.5 billion in non-operating gains in the same prior-year period.
Health Affairs: (5/2) – Vertical integration in health care has recently garnered scrutiny by antitrust authorities and state regulators. Vertical integration and joint contracting with small and medium health systems rose from 19.5 percent in 2013 to 32.8 percent in 2017 for primary care physicians and from 26.1 percent to 37.8 percent for specialists. We found that vertical integration and joint contracting led to price increases from 2013 to 2017, from 2.1 percent to 12.0 percent for primary care physicians and from 0.7 percent to 6.0 percent for specialists, with the greatest increases seen in large health systems.
MedCity News: (5/2) – Health systems are prioritizing efforts to improve interoperability between EHRs and aggregate patient data for a more complete picture. By demand and necessity, EHRs and other vendors are following suit. The government is also helping the process by adopting new standards like the Fast Healthcare Interoperability Resources (FHIR) that lays out how healthcare information can be exchanged. But full interoperability and data standardization remain the holy grail: mysterious and elusive.
Fierce Healthcare: (4/29) –The recent scuffle over the Direct Contracting model should push providers and regulators to do a better job of showcasing the importance of value-based care, a top Biden administration official said. Center for Medicare and Medicaid Innovation (CMMI) Director Liz Fowler spoke during the National Association of Accountable Care Organizations’ (NAACOS) spring meeting on the agency's strategy for improving participation among providers in value-based care.
Healthcare Dive: (4/29) – Controversy around a direct contracting model the Biden administration rebranded and redesigned earlier this year following pressure from progressive Democratic lawmakers and single-payer advocates was excessive and not based in fact, according to some members of the accountable care community. NAACOS felt these concerns were “very false and misleading,” said David Pittman, NAACOS senior policy adviser, at NAACOS spring conference. “If politics could kill an ACO model, that would be devastating.”
AJMC: (4/29) – At the opening session of the NAACOS spring conference, Center for Medicare Director Dr. Meena Seshamani, offered insights on how the Biden administration plans to improve alignment between Medicare, models, and the organizations. Creating synergy between CMS and CMMI to align models and allow for upscaling of successful models is also top of mind for Seshamani.
RevCycle Intelligence: (4/29) – Value-based payment programs tie healthcare reimbursement rates to quality care by offering providers incentive payments to meet specified quality measures during and after healthcare delivery. As the industry moves away from fee-for-service models and toward value-based care models, CMS has implemented several programs to improve patient care, advance population health, and lower healthcare costs. This article provides an overview of those programs.
RevCycleIntelligence: (4/28) – Value-based payment models that shared five-year expected savings offered stronger incentives for clinicians to implement preventive interventions for postpartum depression compared to models that offered shared savings over just one year. Most value-based payment models offered shared savings based on reductions in the total cost of care, which represents how much was spent over the episode or the past year.
Fierce Healthcare: (4/28) – The Biden Administration wants to change how benchmark payments to accountable care organizations are calculated to make it easier for providers in the Medicare Shared Savings Program (MSSP) to qualify for savings. CMS leaders outlined several changes they are pursuing to get more providers involved in value-based care in an article in The New England Journal of Medicine.