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): (10/20) – CMS and the CMS Innovation Center published their white paper, “Driving Health System Transformation – A Strategy for the CMS Innovation Center’s Second Decade.” The new strategy includes lessons learned over the past decade that have shaped its vision for the next 10 years: a health system that achieves equitable outcomes through high-quality, affordable, person-centered care. The paper also lays out the five strategic objectives that will support this transformation: Drive Accountable Care, Advance Health Equity, Support Innovation, Address Affordability, and Partner to Achieve System Transformation. Full White Paper
Department of Health and Human Services (HHS): (10/14) – HHS announced the availability of $100 million in American Rescue Plan (ARP) funding for state-run programs that support, recruit, and retain primary care clinicians who live and work in underserved communities. This funding represents a five-fold increase to the Health Resources and Services Administration’s (HRSA) State Loan Repayment Program (SLRP), and helps improve health equity by ensuring that clinicians working in high-need communities remain in them.
Health Affairs: (10/14) – Authors from Aledade argue that the Medicare Shared Savings Program (MSSP) provides the most useful common infrastructure, or “chassis,” on which to test new innovations with only a fraction of the effort it takes to build a new model from the ground up. Rather than continuing to create new population health models from scratch, this approach would mark a fundamental shift whereby CMS acknowledged that the MSSP infrastructure is the starting point for many providers, not a competitor to new Innovation Center models.
MGMA: (10/13) – MGMA and other leading health organizations wrote to CMS to express concern with how existing agency policies to set financial spending targets or benchmarks for ACOs are not fair for many because of the ongoing COVID-19 pandemic. They argue that further policy changes are needed to ensure the shift to value is not derailed by the highly unusual circumstances of the pandemic.
AAFP: (10/13) – AAFP joined with other physician groups to write a letter to COVID-19 Coordinator Jeff Zients and Surgeon General Murthy urging them to make it simpler for office-based physicians, including primary care physicians and pediatricians, to access COVID-19 vaccines. The groups argue that office-based physicians are in the best position to reach the unvaccinated, help people overcome vaccine hesitancy, and determine the need for and timing of additional doses for their elderly patients and those with underlying medical conditions.
Fierce Healthcare: (10/20) – The Biden administration issued a strategic plan Wednesday to make value-based care payment models more equitable and streamlined to foster more participation from providers and patients over the next decade. Key goals of the refresh include judging the success of models not just on whether they save Medicare money but also whether they improve health equity. CMMI officials said to expect fewer models in the near future, noting that too much overlap has caused confusion and consternation among providers. Officials also pledged to provide more actionable data and payment flexibility for providers to help entice greater participation.
Health Affairs: (10/14) – The authors argue that assessing whether a CMMI model will save money if expanded is not an exact science. However, the statutory criteria for nationwide expansion are very strict: CMS must certify that, if expanded, the model would reduce spending without reducing quality (or improve quality without increasing spending).It is impossible to know with certainty if an APM will save money in the future. In this spirit, demanding near certainty of savings will prevent diffusion of programs we expect will save money (without harming quality). Taxpayers and beneficiaries will be best served by continuing models expected to save money over the long run, even if we cannot be sure these expectations will be borne out.
Health Affairs: (10/14) – On August 25, the Centers for Medicare and Medicaid Services (CMS) released performance results for the eighth performance year (2020) of the Medicare Shared Savings Program (MSSP). The results for this year need to be interpreted carefully given that the majority of the performance year occurred during the global COVID-19 pandemic. To help accountable care organizations (ACOs) during the public health emergency, CMS introduced multiple flexibilities to the MSSP in an interim final rule effective May 2020 (and later a final rule effective January 2021 that will affect MSSP’s 2021 performance year). The flexibilities include changes to: shared savings and losses calculations (such as carving out certain COVID-19 episodes of care); quality reporting; benchmarks; and beneficiary assignment, including an expanded definition of primary care services to include telehealth codes for telephone communications, e-visits, and virtual check-ins. This post outlines key findings from the performance data and Milliman Torch Insight data.
Bloomberg: (10/13) – Two former Medicare officials recently co-authored a critique of what they call the Medicare Advantage “money machine” on the blog of the journal Health Affairs.They urged Congress to make the risk-adjustment program “resistant to gaming.” The authors say it distracts doctors from focusing on patients’ needs and diverts billions of dollars in public funds.
Becker's Hospital Review: (10/13) – A recent survey conducted by Dynata for EmblemHealth found that only one in four American consumers knew what "value-based care" was. Of those consumers who knew what value-based care was (approximately 250 of about 1,000 surveyed), only a quarter could accurately define it. Of respondents familiar with the term, most heard it from a health insurance plan (58 percent), followed by a physician (40 percent) and the media (27 percent).
Fierce Healthcare: (10/13) – The American Hospital Association has tapped a new industry analysis highlighting several acquired hospitals’ poor financials as its latest evidence in support of unfettered provider consolidation. The report shows that financial distress was cited as a key factor in roughly 20 percent of 463 analyzed hospital acquisition deals closed between 2015 and 2019.One in three of these distressed organizations had declared bankruptcy prior to the deal, according to the report. However, following the close, the report found that more than 80 percent of those hospitals “were saved from bankruptcy and remain operational today.”
Fierce Healthcare: (10/13) – Several medical groups say a new round of cuts to Medicare payments set to go into effect in 2022 will derail their move to value-based care and impact hiring of new staff. Providers are facing 9.75 percent in cuts to Medicare reimbursements in the next year. In the survey, 22 percent of respondents said they will no longer accept Medicare patients if the cuts were to go in effect.
Brookings Institute: (10/13) – In this article, authors Michael Chernew and Michael McWillliams provide a sketch of a multi-track population-based payment model designed to serve as a foundational piece of that system. They start with some background on the importance of payment reform in traditional Medicare and design lessons from APMs to date. They then sketch out proposed payment system and discuss the rationale for its key features. Their vision includes recommendations for a multi-track population-based payment model, which they lay out in the sketch of the model’s major elements (tracks, participation incentives, benchmarks, risk adjustment and health equity, and ACO definition).
Becker's Hospital Review: (10/13) –An opinion piece co-authored by Donald Berwick, MD and Richard Gilfillan, MD chalks up the surge of Medicare Advantage offerings in recent years to the system being a "money machine" for payers. The authors argue that the “gold rush” is driven by the anticipated growth of Medicare spending, historic CMS overpayments to Medicare Advantage plans, heavy marked subsidies and the Direct Contracting Model, which privatizes the landscape.