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.
GAO: (6/1) - The Health Resources and Services Administration (HRSA) estimates that about 25% of the U.S. population lives in an area with too few primary care physicians. Its National Health Service Corps programs offer scholarships and loan repayments to primary, dental, or mental health care providers in exchange for working in areas where there are shortages. An FY20 GAO report found that about 14,000 recipients provided care at about 7,000 sites, recipients were most commonly nurse practitioners (26%), physicians (15%), and licensed clinical social workers (12%), and about 57% of new applicants received funding.
HHS: (5/28) - President Biden released the Fiscal Year (FY) 2022 Budget, which proposes $131.8 billion in discretionary budget authority and $1.5 trillion in mandatory funding. The budget invests in enhancing the health of Americans by tackling major challenges including the COVID-19 pandemic, increasing numbers of Unaccompanied Migrant Children, climate change, the opioid and substance use crisis, ensuring that all HHS programs equitably address all of the country’s diverse populations, and more. The Global and Professional Direct Contracting model is highlighted as a “priority initiative.”
CMS: (5/28) - CMS announced the Next Generation ACO Model Performance Year 6 model benchmark methodology.
CMS: (5/28) - CMS released an informational bulletin that provides an update for states on the status of COVID-19 vaccines for adolescents ages 12 and older and reminds states of the important role outreach and education can play in ensuring equitable access to the vaccine for those newly eligible for the COVID-19 vaccine.
HHS: (5/27) - HHS Secretary Becerra formally swore in Chiquita Brooks-LaSure as Administrator of CMS. The Senate voted 55-44, with five Republicans joining all Democrats in supporting the nomination.
CMS: (5/26) - CMS released a notice of proposed rulemaking (NPRM) proposing a delay of six months to the multiple best-price provisions related to value-based purchasing arrangements and the reporting of multiple best prices to CMS for purposes of the Medicaid Drug Rebate Program (MDRP), which is now proposed to become effective July 1, 2022. In the current rule, it would go into effect January 1, 2022. Comments are due by July 27.
ASPE: (5/25) - ASPE published an environmental scan as background information to assist the Physician-Focused Payment Model Technical Advisory Committee (PTAC) in preparing for a discussion on the role care coordination can play in optimizing health care delivery and value-based transformation. This scan analyzed 19 CMMI models with a care coordination component that are ongoing, under development, or recently completed. Evaluations of care coordination interventions have yielded mixed results with respect to impact on avoidable health care utilization. The selected CMMI models that were analyzed in this environmental scan have shown minimal impact on emergency department (ED) visits, hospitalizations, and readmission. Effectively coordinating care, especially for high-cost patients, may present an opportunity to improve care while reducing costs. Evaluations of the models also found minimal Medicare net savings after accounting for shared savings and additional payment. For providers, research identified challenges related to defining staff roles, communicating across providers (including lack of EHR interoperability), and facing resource constraints that impede adoption of effective care coordination.
Doctors of Community Act: (6/2) - House Energy and Commerce Committee Chairman Frank Pallone, Jr. (D-NJ) and Senate Health, Education, Labor, and Pensions (HELP) Committee Chair Patty Murray (D-WA) introduced the Doctors of Community (DOC) Act (H.R. 3671), which would permanently authorize the Teaching Health Center Graduate Medical Education (THCGME) program to support the training of primary care medical and dental residents with a focus on supporting residents in high-need communities. In a press release, Rep. Pallone said the DOC Act will address the shortage of vital frontline primary care providers by providing “permanent, reliable funding to train the next generation of primary care providers in some of the most medically underserved communities across the country.” Bill text One-pager
Inside Health Policy: (5/26) - More than 155 House Democrats are pressuring the Biden Administration to add Medicare benefits, paid for with government drug price negotiation, to the American Families Plan. President Biden’s budget request makes clear that he intends to keep those health care measures separate from his two-part legislative package of the American Jobs Plan (infrastructure) and the American Families Plan. The letter from House Democrats states that the American Families Plan should include measures to lower the Medicare age; cap annual spending for Medicare beneficiaries; add dental, vision and hearing benefits to Medicare; and direct the program to negotiate drug prices.
Ensuring Access to Primary Care for Women & Children Act: (5/26) - Sen. Brown (D-OH) and eight cosponsors introduced the Ensuring Access to Primary Care for Women & Children Act (S.1833), which would extend the application of the Medicare payment rate floor to primary care services furnished under Medicaid and apply the rate floor to additional providers of primary care services.
Senate HELP Committee: (5/26) - Senate HELP Committee Chair Murray (D-WA) and House Energy & Commerce Committee Chair Pallone (D-NJ) issued a request for information (RFI) requesting information on design considerations for legislation to develop a public health insurance option. Comments are due by July 31.RFI
Conrad State 30 & Physician Access Act: (5/25) - Rep. Schneider (D-IL) and 38 bipartisan cosponsors introduced the Conrad State 30 & Physician Access Act (H.R.3541), which would provide incentives to physicians to practice in rural and medically underserved communities. Sen. Klobuchar (D-MN) and nine cosponsors introduced companion legislation in the Senate (S.1810).
Primary and Behavioral Health Care Access Act: (5/25) - Reps. Underwood (D-IL), Schrier (D-WA) and Porter (D-CA) introduced the Primary and Behavioral Health Care Access Act (H.R.3550), which would require group health plans and health insurance issuers offering group or individual health insurance coverage to provide for three primary care visits and three behavioral health care visits without application of any cost-sharing requirement.
American Association of Family Physicians: (6/1) - As part of AAFP’s Leading Physician Well-being certificate program, the American Foundation for Suicide Prevention presented on Physician Mental Health: Preventing Suicide and Building Resilience. During the session, attendees learned how to identify those physicians and trainees most at risk; develop strategies to dispel stigma and prevent barriers in seeking positive culture changes and become familiar with how to approach a colleague when they might be struggling.
Modern Healthcare: (5/26) - A new survey found that primary-care providers got roughly half their typical pay increase in 2020 as volumes dried up and some practices froze salaries to shore up expenses during the COVID-19 pandemic. Primary-care providers' total compensation rose 2.6% in 2020 from the prior year, while pay for advanced practice providers grew 1.3% in that time, according to data released by the Medical Group Management Association (MGMA). MGMA's data cover more than 185,000 providers across more than 6,700 organizations and was captured during surveys conducted in January and February 2021.
American Association of Family Physicians: (5/26) - AAFP member Kisha Davis, M.D., M.P.H testified at the Senate Finance Committee’s hearing entitled “COVID-19 Health Care Flexibilities: Perspectives, Experiences, and Lessons Learned.” She stressed to lawmakers that Medicare and Medicaid telehealth policy must increase equitable access to health care; promote high-quality, comprehensive, continuous care; and lessen physicians’ administrative burdens.
California Medical Association:(5/26) - California Medical Association (CMA) President Peter N. Bretan, MD, released a statement in response to the Public Option proposal announcement by Senator Patty Murray and Representative Frank Pallone. CMA appreciates efforts by Senator Murray and Congressman Pallone to expand health care choices for the uninsured, and believes the country must first rebuild health care infrastructure in the wake of the COVID-19 pandemic and take other important steps before we can have a meaningful discussion over a public option. Dr. Bretan writes that the immediate goal should be to bolster the Affordable Care Act (ACA).
Spotify: (5/24) - On Aledade’s podcast, The ACO Show, Dr. Joshua Israel, Medical Director at Aledade and Dr. Wanda Filer, chief medical officer at VaxCare and a practicing physician, discussed the challenges that primary care physicians are experiencing with vaccine administration. Vaxcare is a vaccine management solution that helps practices manage vaccine inventory and distribute vaccines.
Modern Healthcare: (5/31) - The pandemic led the way for virtual care to become more mainstream in the U.S., which could pose a threat to smaller practices that may not have made the transition to telehealth prior to the pandemic and therefore might not have the infrastructure to provide virtual care. A 2020 survey by Primary Care Collaborative and the Larry A. Green Center found that 6% of primary care physicians said their practices had closed and 35% said they had furloughed staff as a result of excess expenses, lower patient volume and a surge of non-traditional providers of primary care. Nearly 80% of respondents reported fewer patient visits during the pandemic compared to before. Sabrina Corlette, a research professor with Center on Health Insurance Reforms at Georgetown University McCourt School of Public Policy, said some traditional primary care providers see the rise of telehealth companies offering virtual services as a threat to their business model. Corlette said despite the potential for cost saving, she is wary of telehealth and virtual care companies marketing themselves to uninsured people as real coverage rather than a supplement to insurance if they only offer primary care services and not coverage for hospitalization, pharmaceuticals, medical emergencies and chronic diseases.
Effingham Daily News: (5/30) - The Illinois Rural Community Care Organization, LLC (IRCCO), a statewide Accountable Care Organization (ACO) to serve rural Illinois, announced it is partnering with Collaborative Health Systems, a management services organization, to expand value-based care in Illinois. Through the agreement, rural and critical access hospitals and providers have agreed to enter into a joint venture partnership with IRCCO and Collaborative Health Systems to help improve quality outcomes and lower health care costs for Medicare beneficiaries living in Illinois rural communities. IRCCO, a collaborative organization focused on delivering primary care, chronic disease management, care coordination and social services locally, was established in 2014 by the Illinois Critical Access Hospital Network (ICAHN), a trade association of critical access hospitals serving rural Illinois communities.
Healio: (5/28) - Researchers found no association between low-value services and patients’ ratings of their health care experiences, an analysis of Medicare claims showed. Patient experiences and ratings are often used “to incentivize quality improvement through public reporting and performance-based payments,” according to researchers. The widespread use of patient-reported health care experiences may “encourage physicians to provide more low-value services (care that is not associated with a clinical benefit), out of a belief that responding to patient demand or the perception that more care is better will improve their ratings,” Prachi Sanghavi, PhD, an assistant professor of biological sciences in the department of public health sciences at the University of Chicago, and colleagues wrote in JAMA Internal Medicine.
Health Payer Intelligence: (5/28) - Blue Cross and Blue Shield of North Carolina (Blue Cross NC) and Mission Health have signed an agreement that will expand the benefits of value-based care to members across Western North Carolina and increase access to care for Medicaid beneficiaries. Once the contract takes effect on January 1, 2022, Mission Health will join Blue Premier, Blue Cross NC’s value-based care program which ensures that providers are paid for the quality of care they provide, not the quantity. Blue Cross NC members in western North Carolina currently may receive care from six hospitals and over 1,000 physicians that are part of Mission Health’s system. This collaboration will provide members with high-quality, coordinated care that is more affordable, according to the press release.
PubMed: (5/27) - This paper investigates the consequences that patients face when their regular general practitioner (GP) closes down her practice, typically due to retirement. The study found that patients who experience a discontinuity of care persistently adjust their ambulatory utilization pattern by shifting visits away from GPs (-12%) toward specialists (+11%) and hospital outpatient facilities (+6%). These results have potential implications for health policy in that practice closures lead to more fragmented care which may entail inefficiencies, and closures deteriorate access to primary care in regions with low physician density.
Modern Healthcare: (5/27) - Some experts believe health systems may be using their post-COVID-19 publicity to pressure insurers into rate increases, pointing to a rash of recent tense negotiations erupting into the public sphere. Over the past 10 years, the number of payer and provider disputes that have gone public has decreased, as hospitals have consolidated their systems and strong-armed insurers into all-in-one contracts. The pandemic has stalled some negotiations as health care organizations try to gain back money lost from canceling elective procedures, while health insurers try to keep costs down. However, hospital systems may not have lost nearly as much as they anticipated during the pandemic. At the end of the year, sicker, commercially insured patients helped bump up hospitals' bottom lines and strategic cost-cutting measures helped trim down expenses. New price transparency rules will provide more insight into how contracts work out, although most major hospitals are still not posting their pricing. Greater insight into prices paid will make public perception of health systems an even more critical negotiation tactic going forward.
RevCycle Intelligence: (5/25) - CMS announced it will be reweighting the cost performance category under the Merit-Based Incentive Payment System (MIPS) from 15% to zero percent for the 2020 performance period to provide additional COVID-19 relief and account for the lack of reliable data. The MIPS cost performance category was originally weighted at 15%. Now, those points will be redistributed to other categories and will impact reimbursements paid out to eligible clinicians in 2022.
Fierce Healthcare: (5/24) - Physicians and consumers’ trust in the U.S. health care system dipped over the course of the COVID-19 pandemic, as did doctors’ trust in health care organization leadership, according to a recent survey. On the other hand, consumers’ trust in doctors themselves has generally held steady during the pandemic, and physician respondents often said their trust in nurses or fellow physicians had increased over the course of the public health emergency. For physician respondents, the decline in health care system trust was most prominent among those who already held a poor view of the system prior to COVID-19. The pandemic also had a net negative impact on physicians’ trust in health insurance companies and government health agencies, but slightly increased the overall sample’s faith in hospitals and pharmaceutical companies. The poll was conducted by NORC at the University of Chicago on behalf of the American Board of Internal Medicine Foundation. The research organization distributed its general public surveys to a sample of 2,069 adults between Dec. 29, 2020, and Jan. 26, 2021, and its physician survey to 600 clinicians between Jan. 22, 2021, and Feb. 5, 2021.
National Bureau of Economic Research: (May 2021) - The organizational structure of U.S. health care has changed dramatically in recent years, with nearly half of physicians now employed by hospitals. This trend toward increasing vertical alignment between physicians and hospitals may alter physician behavior relative to physicians remaining in independent or group practices. The authors found a relatively modest positive effects (point estimates of 7% or lower) on total Medicare payments per episode, characterized by an increase in billable activity among other integrated physicians alongside a large decrease in activity among non-integrated providers. Acquiring hospitals ultimately capture more revenue following a physician practice acquisition; yet, the smaller overall bundle of care generates no net savings to Medicare due to location-based payment rules favorable to hospitals.