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News Clips
RevCycle Intelligence: (9/13) – America’s Health Insurance Plans (AHIP) commissioned a survey of 1,000 Americans who were covered by employer-sponsored health plans and found strong bipartisan support for protections against hospital monopolies and increased transparency around health care mergers and deals. Over three-quarters of consumers supported preventing hospitals from consolidation, mergers, and acquisitions that involved bringing other medical practices into one hospital system and consumers also indicated support for protections against site-based cost increases.
Modern Healthcare: (9/12) – In comment letters on the proposed Medicare Physician Fee Schedule, groups representing health care providers requested that CMS eliminate the distinction between high- and low-revenue accountable care organizations (ACOs), but it appears unlikely the agency will make this change. Overall, providers are generally supportive of CMS' plans, including proposed benchmarking changes, but suggest some additions, such as allowing ACOs to choose pre-COVID-19 years as benchmarks.
Commonwealth Fund: (9/12) – In this article, the authors argue that policymakers should focus on three areas to advance primary care payment reform, increase equity, and improve outcomes. First, primary care and behavioral health must be integrated to create a system that is responsive to physical, behavioral, and social needs. Second, Medicare payment policies should move away from a reliance on FFS payments, which the authors argue undervalue and restrict innovation, and CMS should use its authorities to achieve primary care payment reform within permanent programs, such as the Medicare Shared Savings Program (MSSP). Finally, Congress can provide resources to close the gap in payment for Medicaid services, as compared to those paid by Medicare and commercial insurers, to strengthen primary care and advance equity for Medicaid beneficiaries. CMS should also provide guidance to state Medicaid agencies to implement hybrid payment approaches for primary care.
Forbes: (9/12) – A study looking examining wait times among over 1,000 physician offices, including family medicine, dermatology, obstetrics/gynecology, orthopedic surgery and cardiology, in 15 major U.S. cities found that patients are waiting an average of 26 days for a scheduled appointment with a doctor. The average wait time is up 8 percent from 2017, a significant indicator that the nation is experiencing a growing shortage of physicians.
Modern Healthcare: (9/9) – A growing number of hospitals are outsourcing outpatient services for their poorest patients by setting up independent, nonprofit organizations, known as federally qualified health center look-alikes, to provide primary care. These clinics are paid significantly more by Medicare and Medicaid than if they would if the sites were owned by hospitals and help reduce losses from uninsured patients who might have been using the emergency room for primary care. Nationally, 108 look-alike health centers operate today, an increase from 87 in 2020.
Wall Street Journal: (9/8) – The pandemic has made consumers more comfortable with innovations that more seamlessly blend the home and the clinic, such as telehealth and hybrid-care startups. This contributed to a wave of initial public offerings in 2021, as companies sensed an opportunity in the primary-care crisis. These companies can realign incentives and are able to compensate primary-care physicians at a higher rate than the typical family doctors. Many of these companies provide care through value-based care models. The author claims it is too soon to tell whether value-based care will benefit patients, or just insurers’ and physicians’ bottom line.
Fierce Healthcare: (9/8) – ACOs are warning that the loss of the 5 percent bonus payment, which is paid to physicians participating in alternative payment models who meet quality thresholds, could affect the recruitment and retention of physicians if it expires at the end of the year. CMS Administrator Chiquita Brooks-LaSure reiterated her support for the bonus payment at the National Association of ACOs (NAACOS) conference last week, but stressed it is in Congress’ hands and said that ACO advocates must help lawmakers understand why the payments are so vital, including underlining the benefits of value-based care as a whole.
RevCycle Intelligence: (9/7) – Physician advocacy groups are calling on CMS to reverse proposed Medicare Physician Fee Schedule updates, which would slash Medicare payment for physicians next year, warning that the difference between the costs of running a physician practice and actual Medicare payment could incentivize providers to consolidate further as they also face administrative and financial burdens of participating in Medicare. The author notes that nearly three-quarters of physicians are now employed by hospitals, health systems, and other corporate entities and the top ten largest health systems control about a quarter market share because of consolidation.
Modern Healthcare: (9/6) – Experts are forecasting years of potential uncertainty as health care employers are reevaluating how they compensate physicians in light of the pandemic, significant proposed changes to the Medicare Physician Fee Schedule, and increasing demand for physicians. The author notes that volatility of patient volumes during the pandemic caused employers to question if productivity-based compensation (e.g., work relative value units or RVUs) should be the primary mechanism to determine physician compensation, and many are incorporating elements of value-based payment, such as tying FFS to quality.
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