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.
Centers for Medicare and Medicaid Services (CMS): (11/2) – CMS issued a final rule that includes updates on policy changes for Medicare payments under the Physician Fee Schedule (PFS), and other Medicare Part B issues, on or after January 1, 2022. In the rule, CMS finalized a longer transition for Accountable Care Organizations (ACOs) to prepare for reporting electronic clinical quality measures/Merit-based Incentive Payment System clinical quality measures (eCQM/MIPS CQM) under the Alternative Payment Model (APM) Performance Pathway (APP), by extending the availability of the CMS Web Interface collection type for an additional three years, through performance year (PY) 2024. Quality Payment Program Fact SheetFact Sheet
CMS: (11/2) – CMS released afinal rule that will further advance its commitment to increasing price transparency, holding hospitals accountable and ensuring consumers have the information they need to make fully informed decisions regarding their health care. The Calendar Year (CY) 2022 Hospital Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Center (ASC) Payment System Final Rule with Comment Period will strengthen enforcement of price transparency requirements for hospitals, and increase Medicare beneficiary quality and safety by halting the phased elimination of the Inpatient Only (IPO) list for surgical procedures. Fact Sheet
CMS: (10/29) – CMS released the End-Stage Renal Disease (ESRD) prospective payment system final rule. CMS is making changes to the ESRD Quality Incentive Program (QIP) and the ESRD Treatment Choices (ETC) Model, and updating ESRD PPS payment rates in an effort to reduce health care disparities among patients with chronic kidney disease and ESRD. CMS is also finalizing changes to the ETC Model to test a new payment incentive that rewards ESRD facilities and clinicians who manage dialysis patients for achieving significant improvement in the home dialysis rate and kidney transplant rate for lower-income beneficiaries. Fact sheet
Aledade: (11/1) – In 2020, in spite of headwinds from the COVID-19 pandemic, independent primary care practices in Aledade’s physician-led ACOs more than doubled their shared savings revenues, earning an average of $198,000 each in the Medicare Shared Savings Program (MSSP).
Health Leaders Media: (10/29) – The coronavirus pandemic has increased the regulatory burdens on medical practices, according to a new survey report from the Medical Group Management Association (MGMA). Three-quarters of survey respondents report that regulatory requirements are a significant driver of healthcare consolidation and that prior authorization was identified as the most burdensome regulatory issue. Additionally, most survey respondents reported that Medicare's Merit-based Incentive Payment System is a regulatory exercise that does not cover the cost of participating in the program.
Healio: (10/27) – The American Academy of Family Physicians new President Sterling Rangone detailed the organization’s commitment to value-based care: “Our current healthcare system is set up in such a way that primary care physicians, especially family physicians, have been dis-incentivized — we’re not paid what we're worth to the health care community. If we can change the focus of our healthcare system to one that is primary care-centered, we can save lives and have a healthier population...The version I am proposing will also allow us to be paid for our value, instead of the antiquated fee-for-service system.”
Wall Street Journal: (11/2) – The Biden administration on Tuesday finalized a regulation that will sharply increase the financial penalties for larger hospitals that don’t make their prices public. The new rule, which will take effect at the start of 2022, will also crack down on practices that made hospitals’ prices hard to find and access, including the use of special coding embedded in hospital webpages that prevents Google and other search engines from displaying price pages in search results.
Fierce Healthcare: (11/2) – CMS released on Tuesday the final physician fee schedule rule that sets out payment rates for 2022. A 3.75 percent temporary pay bump given to physicians for 2021 is expected to expire unless Congress acts. Physician groups have been imploring lawmakers to step in and continue the pay bump past this year. Physician groups decried the looming cuts, especially as providers continue to deal with the COVID-19 pandemic. "These Medicare cuts will further exacerbate our pandemic-strained healthcare system and cause further delay in care to the patients who need it most," said David Hoyt, executive director of the American College of Surgeons, in a statement.
Center for Healthcare Strategies: (11/2) – As value-based payment (VBP) becomes widespread, including in state Medicaid programs, VBP programs increasingly include children. However, the majority of VBP programs serving children essentially treat them like “little adults,” rather than addressing their unique health care needs. Since children and adults have fundamentally different health care needs, it is important for stakeholders to consider how to best leverage VBP models to improve quality of care for children.
Health Care Exec Intelligence: (11/1) – Payers can structure their health plans and their health plan networks in a variety of ways, but the provider-sponsored plan model has played a unique role in pursuing value-based care priorities. Because the payer behind a provider-sponsored health plan model is a health system, the health plan may be able to communicate more clearly with its provider network. The partners may not face the same trust issues that health plans encounter when operating in other structures. Trust and communication are essential to a strong value-based care approach.
PE Hub: (11/1) – Value-based care has emerged as a must-have for investors. Investors say there is no other market where trillions of dollars of spend are going to be rethought, reanalyzed and reallocated over the next 15-20 years, which has generated a significant amount of interest. Investors also say that value-based care is unique as there is a potential to do good and better reach patients who the traditional fee-for-service structure has failed to serve. While the movement to value-based care started with primary care, investors expect the specialty value based care market to grow significantly.
Medical Economics: (11/1) – The last decade has seen a major and accelerating shift in the basic structure of the U.S. healthcare system. The entrance of for-profit organizations and venture capital investors into the direct or indirect provision of physician services has accelerated as have practice acquisitions by insurance companies and other for-profit entities. Consolidation across the industry is also increasing. Massive hospital mergers and the move to vertical integration across sectors among some of the largest healthcare players, such as CVS’s purchase of Aetna, should give us pause.
Fierce Healthcare: (10/31) – The Centers for Medicare & Medicaid Services (CMS) finalized a rule that updates payment rates for the End-Stage Renal Disease Prospective Payment System (ESRD PPS) and makes changes to the quality incentive program and the ESRD Treatment Choices (ETC) model. The goal of the changes is to encourage dialysis providers to decrease disparities in home dialysis and transplant rates,through rewarding providers that improve rates of home dialysis and kidney transplants among low-income Medicare and dual-eligible beneficiaries. It marks the first CMS Innovation Center model to directly address health equity.
Fierce Healthcare: (10/31) – The Texas Medical Association (TMA) has brought a lawsuit against the Biden administration arguing that the interim final rule on surprise billing goes against the intent of Congress and will ultimately harm patients. Filed Thursday in the U.S. District Court for the Eastern District of Texas, the case (PDF) is an escalation of the broad pushback the Department of Health and Human Services (HHS) received from providers after releasing the interim final rule in late September.
Medical Economics: (10/28) – While primary care physicians are essential in helping patients preserve their health, identify challenges, and obtain appropriate care, the bulk of a patient's treatments will likely be administered by specialists. Traditional fee-for-service models preclude a primary care physician's ability to benefit financially from their vital role in reducing the cost of a patient's care over time. Value-based models are designed to reward health care providers who improve patient care while contributing to an overall reduction in cost. For these physicians, total cost-of-care agreements represent an opportunity to participate in the savings they help achieve by reducing the patient's likelihood of requiring costly emergency department care or hospitalization due to unmanaged conditions or previously undetected disease.