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.
Join the Partnership to Empower Physician-Led Care (PEPC) and our panel of experts to discuss the impact of provider consolidation on the health care system, as well as actions policymakers can take to promote competition across providers.
Department of Health and Human Services (HHS): (9/28) – HHS awarded nearly $1 billion in American Rescue Plan funding to nearly 1,300 Health Resources and Services Administration (HRSA) Health Center Program-funded health centers to strengthen primary health care infrastructure and advance health equity and health outcomes in medically underserved communities.
Physician-Focused Payment Model Technical Advisory Committee (PTAC): (9/27) – On September 27, PTAC hosted a theme-based discussion on Social Determinants of Health (SDOH) and equity. The discussion is designed to give Committee members information about current perspectives on how efforts to address SDOH and equity can be further optimized in the context of APMs and value-based care generally, and in the context of PFPMs specifically. As has been the custom, PTAC released a related RFI.
Quality Payment Program:(9/27) – Through the targeted review period, CMS identified two issues with the MIPS payment adjustment scoring that they updated on September 27. The first was CMS determined that the complex patient bonus wasn’t added to the final scores of Medicare Shared Savings Program (Shared Savings Program) Accountable Care Organizations (ACOs). This issue affected every Shared Savings Program ACO with MIPS eligible clinicians. CMS also determined that their system didn’t recognize patient-reported outcome measures as outcome measures.
Senate Finance Committee: (9/20) – Senate Finance Committee Chair Wyden (D-OR) sent a letter to CMS Administrator Brooks-LaSure commending the Administration’s recent actions to increase price transparency. Specifically, Chair Wyden commended the administration’s proposed Outpatient Prospective Payment System (OPPS) and Ambulatory Surgical Centers (ASC) Payment System rule’s efforts to standardize cost estimator tools so they accurately reflect the actual cost of care which is meaningful for patients and consumers shopping among providers.
Bloomberg Law: (9/27) – The deadline for Provider Relief Fund reporting used to be 30 days after a provider received payment, but in June, the HHS pushed it back to 90 days. While the HHS still recommends that hospitals comply with the Sept. 30 deadline, it will not penalize hospitals that don’t during the grace period. Claire Ernst, director of government affairs for the Medical Group Management Association said the grace period, while helpful, still won’t solve the many problems providers are facing related to the pandemic assistance fund.
American Academy of Family Physicians: (9/23) – AAFP wrote a letter encouraging the Biden Administration to center its vaccination efforts on primary care practices to slow the COVID-19 public health emergency. AAFP wrote that additional resources are needed to support primary care practices as the U.S. enters the next phase of the fight against the pandemic.
Fierce Healthcare: (9/28) – Nearly three-quarters of metropolitan statistical areas (MSA) are concentrated health insurance markets, according to a new study from the American Medical Association. The analysis found that 73 percent of MSAs are highly concentrated, based on Department of Justice and Federal Trade Commission horizontal merger guidelines. In 91 percent of markets, a single insurer had a market share of 30 percent or more, and in 46 percent of markets, a single payer's market share was at least 50 percent. Fifty-seven percent of markets saw their concentration index rise, and the increase was at least 500 points in 21 percent of markets.
Harvard Business Review: (9/28) – There is widespread agreement that the United States must expand and improve primary care in order to achieve better health outcomes at a lower cost. But current efforts to wring “value” from primary care by focusing on diagnostic algorithms and quality metrics reveal fundamental misunderstandings of primary care’s purpose. The attempts to apply processes and technology designed for subspecialty care to the delivery of primary care have proven insufficient to support the complex work of the primary care team.
Fierce Healthcare: (9/27) – Spectrum Health and Beaumont Health’s announced merger is still plowing ahead, but the Michigan health systems recently acknowledged that the process is taking “longer than originally anticipated” due to regulatory holdups. In a Sept. 24 update, the systems pointed to the multi-industry “tidal wave” of merger and acquisition filings the Federal Trade Commission (FTC) said in August could delay its standard review process. The providers also noted that they are responding to the agency’s request for additional information on the merger, “which the organizations understand has become increasingly common,” they wrote.
AJMC: (9/25) – After five years, the Oncology Care Model (OCM) is scheduled to come to an end in a few short months, but a successor program is not in place. During a panel at the Patient-Centered Oncology Care conference, the panelists were largely in agreement that there is going to be a gap between models and the next one will likely be mandatory. Originally, the successor to OCM was supposed to be the Oncology Care First model, but there has been little news since it was first announced.
JAMA Network: (9/24) – After the implementation of Maryland’s all-payer model, which caps hospital expenditures and mandates reductions in avoidable complications, this study found that the rates of avoidable complications decreased and that there was a slower increase in hospital costs among surgical patients
Milbank Memorial Fund: (9/23) –This brief details which practices are used to stifle competition, describes the variation in state laws, and offers best practices to state policymakers seeking to address provider market power. Although litigation can address the use of anticompetitive contracting practices by dominant firms, passing legislation to prohibit the use of these terms in health insurance contracts allows state officials to avoid expending the time and resources needed for trial. Furthermore, laws prohibiting potentially anticompetitive contract terms apply uniformly to all health insurers and providers, fostering a more competitive market for health care services.
Modern Healthcare: (9/23) – CMS is reevaluating hospitals' applications for exceptions from reimbursement cuts to their off-campus outpatient facilities following pushback from the industry. In January, CMS rejected more than 60 percent of the mid-build exceptions, which is designed to preserve higher payments if hospitals document that their off-campus outpatient departments were under construction when the Bipartisan Budget Act passed in 2015. Without the exception, reimbursement rates drop to 40 percent of the full outpatient prospective payments system rate.
Health Leadership Council: (9/21) – The Healthcare Leadership Council (HLC) is one of over 60 healthcare organizations signing a letter to the leadership of the Center for Medicare and Medicaid Innovation (CMMI) recommending that greater transparency and communication with healthcare stakeholders can enable CMMI to achieve its “full potential as an agent of patient-centered health transformation.”
RevCycleIntelligence: (9/21) – Advanced primary care tied to a person-level payment model is key to improving outcomes and reducing costs, at least according to the Duke Margolis Center for Health Policy and Morgan Health, a new business unit from JPMorgan Chase focused on improving employer-sponsored healthcare. Employer-sponsored healthcare is the primary source of coverage for Americans today. Yet, the private sector faces many challenges with getting this population high-quality, affordable care, the two organizations explain in a new report.
InsideHealthPolicy: (9/20) – House Energy & Commerce Chair Frank Pallone recently pledged to work with lawmakers from both parties moving forward to avert physician pay cuts, but the New Jersey Democrat said now’s not the time to act given CMS just received comments on its proposed 2022 fee schedule. Lawmakers from both parties want to eventually stop the cuts, but E&C Democrats rejected a GOP bid this week to add a pay fix to the emerging budget reconciliation bill.
Sept. 29-30 - National Association of Accountable Care Organizations (NAACOS), “Fall Conference.” Virtual.