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.
PEPC: (8/18) – Through an advocacy letter
to HHS Secretary Becerra, PEPC and twenty seven other national organizations expressed their increasing concerns about the complexity as well as the lack of a clear and consistent understanding of the information blocking regulations across the community. MGMA and partner organizations requested additional clarity and guidance surrounding information blocking regulations from HHS.
CMS: (8/23) – CMS released the Integrated Care for Kids (InCK) Model Evaluation: Report 1, which describes findings from the pre-implementation period (2020-2021). The InCK Model aims to improve outcomes for Medicaid-enrolled children, with a particular focus on those with complex physical and behavioral health needs . By the end of the pre-implementation period, seven organizations progressed to the five-year implementation period.
Tri-Agencies: (8/19) – The U.S. Departments of Labor, Health and Human Services, and the Treasury issued final rules concerning standards related to the arbitration process implementing the No Surprises Act (NSA). In addition to issuing the final rules, the departments issued Frequently Asked Questions with additional guidance on key topics. News ReleaseFAQS
CMS: (8/19) – CMS officials published a Viewpoint piece in JAMA Health Forum discussing how the CMS Innovation Center's primary care models are informing the next generation of advanced primary care models.
HHS: (8/19) – HHS released a report on current projections of the number of individuals predicted to lose Medicaid coverage at the end of the COVID-19 PHE due to a change in eligibility or administrative churning. The report also predicts eligibility for alternative insurance coverage among those predicted to lose Medicaid eligibility and highlights legislative and administrative actions that can help minimize disruptions in coverage.
CMS: (8/18) – CMS released a roadmap for the end of the COVID-19 Public Health Emergency (PHE), including the current status of existing PHE waivers and flexibilities. CMS also shared information on what health care facilities and providers can do to prepare for future public health events, along with fact sheets designed to help the health care sector transition to operations once the PHE ends. RoadmapFact Sheets
CMS: (8/18) – CMS released the Mandatory Medicaid and CHIP Core Set Reporting proposed rule to promote consistent use of nationally standardized quality measures in Medicaid and CHIP. The rule proposes requirements for mandatory annual state reporting of three different quality measure sets designed to measure the overall national quality of care for beneficiaries, monitor performance at the state level, and improve quality care. Comments are due by October 21.
CMS: (8/15) – CMS announced a listof provisionally accepted ACO REACH applicants and Implementation Period #3 (IP3) ACOs. The redesigned ACO REACH Model reflects the priorities of the Biden-Harris Administration and responds to feedback from stakeholders and participants. The new cohort will begin participation in the ACO REACH Model on January 1, 2023.
Senate Finance Committee: (8/24) – Chairman Ron Wyden sent a letter
to 15 state insurance regulators asking for information on complaints they have received on Medicare Advantage and Part D plan marketing from 2019 through 2022.
MGMA: (8/19) – MGMA recently released its 2022 MGMA DataDive Practice Operations survey report offering brand-new benchmarks related to the shift to value-based reimbursement and quality measure performance, detailing key performance indicators (KPIs) that reflect incredible operational changes that have evolved patient engagement and impacted medical practices’ financial resilience.
AAFP: (8/18) – In a recent news release, AAFP highlighted policies in the Inflation Reduction Act of 2022 that it supports, including extension of the enhanced premium tax credits for individuals and families purchasing health insurance from the Patient Protection and Affordable Care Act marketplace and policies that eliminate cost-sharing for vaccines recommended by the Advisory Committee on Immunization Practices.
NCSL: (8/24) – The National Conference of State Legislators released a report highlighting strategies used by states to assess and address the impact of mergers and acquisitions on health care costs. These actions include legislation that would authorize various entities to approve transitions and oversee the consolidation process, implementing certificate of need (CON) laws, and implementing certificate of public advantage (COPA) programs.
Healthcare Finance: (8/23) – This article outlines CMS’ recently released information bulletin which details actions that states can take using existing Medicaid authorities to drive better health outcomes for nursing home residents. This guidance grew out of a comprehensive set of reforms
announced earlier this year and provides examples of current state Medicaid initiatives that support this work, which CMS expects will improve pay, training, and retention efforts.
Fierce Healthcare: (8/23) – This article highlights a recent study, which found primary care physicians need 26.7 hours per day to follow national recommended guidelines for preventive care, chronic disease care and acute care while seeing an average number of patients. The authors advocate for team-based care as a mechanism for decreasing the amount of physician time required per day for these critical tasks, but acknowledge ongoing models to widespread adoption of team-based models.
USC Schaeffer: (8/22) – This White Paper examined price changes across California hospital systems between 2012 and 2018, finding wide variance. Average price growth was high among for-profit systems (31 percent over the study period), while non-profit and public systems had lower average price growth (13 percent) than non-system hospitals (15 percent). These averages mask wide variation, with 8 hospitals increasing prices 127 percent overall, compared to prices decreasing in 13 of 37 health systems. The authors note that pricing differentials may stem from a variety of factors, including market competition and concentration, costs, and organizational mission. Further, the relatively slow price growth of non-profit systems may highlight that system participation sometimes helps limit cost growth through economies of scale in purchasing, administration and expensive medical technologies.
Fierce Healthcare: (8/18) – This article highlighted an American Hospital Association (AHA) report
which stated that patient acuity has increased over the past two years, likely a result of delayed or avoided care, driving increases in hospitals’ spending and highlighting the need for additional support from Congress. Specifically, the AHA calls for ending cuts to Medicare payments, extending or cementing waivers supporting patient care efficiency and access, extending health coverage subsidies, and preventing improper business practices from commercial payers’ such as burdensome administrative hurdles.
Fierce Healthcare: (8/16) – This article provides an overview of the Federal Trade Commission’s (FTC) recently released policy paper, which discourages states from adopting certificates of public advantage (COPA) legislation. Cautioning that hospital mergers permitted under these laws still bring many of the detrimental effects of consolidation, the FTC cites four recent hospital mergers allowed under COPA legislation and resulted in substantial price increases and reduced quality of care.
JAMA: (8/15) – This viewpoint highlights the important role of payment reform in achieving health equity, which must reconcile existing tensions between financial incentives and equity goals. The authors note the importance of participation by organizations serving marginalized communities, appropriate spending targets, quality measurements that include equity measures and social drivers, and carefully designed performance-based incentives so as to not undercut equity.