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.
CMS: (8/30) – CMS announced that the Medicare Shared Savings Program saved Medicare $1.66 billion in 2021 compared to spending targets. This marks the fifth consecutive year the program has generated overall savings and high-quality performance results. Low-revenue ACOs achieved $237 per capita in net savings, nearly double that of high-revenue ACOs ($124). A health equity analysis demonstrated that lower income individuals or members of racial or ethnic communities appeared to represent a disproportionately smaller share of the Medicare population assigned to ACOs.
CMS: (8/26) – CMS announced the availability of new data files for six CMS Innovation Center (CMMI) models through the CMMI Model Data Sharing (CMDS) Initiative. These files provide information on entities, providers and/or beneficiaries participating in specific models. The six models include: Global and Professional Direct Contracting (GPDC) Model, Oncology Care Model (OCM), Bundled Payments for Care Improvement Advanced (BPCI Advanced) Model, Comprehensive Primary Care Plus (CPC+) Model, Kidney Care Choices (KCC) Model, and Primary Care First (PCF) Model.
CMS: (8/25) – CMS issued the Radiation Oncology Model final rule, announcing its decision to delay the start date of the model to a date yet to be determined through future rulemaking.
CMS: (8/25) – CMS released the latest enrollment data highlights for Medicare, Medicaid and CHIP for May 2022. This data showed over 88.9 million enrollees in Medicaid/CHIP, over 64.5 million enrollees in Medicare (34.8 million enrollees in FFS and 29.6 million enrollees in Medicare Advantage), and over 14.5 million applicants in state-based and Federal Marketplaces.
Inpatient Rehabilitation Therapy Act of 2022 : (8/26) – Rep. Courtney (D-CT) and Thompson (R-PA) introduced the Access to Inpatient Rehabilitation Therapy Act of 2022 (H.R. 8746), which would preserve expanded access to skilled rehabilitation therapies for Medicare patients, flexibilities currently in place and tied to the Public Health Emergency (PHE). Press release
AAFP: (8/25) – The White House’s August 24 announcement that the federal government would cancel up to $20,000 of federal student loan debt for millions of Americans aligns with debt forgiveness policies for which the AAFP has steadily advocated. AAFP is now sharpening its advocacy focus on the Resident Education Deferred Interest Act (S. 3658/H.R. 4122), legislation that would allow medical students to qualify for interest-free deferment on their student loans while in a residency training program, and has launched a new Speak Out campaign to let members contact their legislators directly to support passage of the REDI Act.
Modern Healthcare: (8/30) – CMS reported that more than half of ACOs in the Medicare Shared Savings Program generated savings in 2021. While performance declined from the prior year, when the ACOs saved $1.9 billion, this is the fifth consecutive year the program netted savings. Low-revenue ACOs created $237 in per capita net savings last year, while high-revenue ACOs garnered $124 per capita. ACOs comprising mostly primary care providers saw $281 in per capita net savings, compared to $149 for ACOs composed of fewer than 75% primary care clinicians.
Fierce Healthcare: (8/30) – This article highlights a recent study of hospitals across six southeastern states which found that COVID-related spike in health care-associated infections, such as central-line-associated bloodstream infections (CLBSIs) and ventilator-associated events (VAEs), was significantly more severe among smaller community hospitals than their larger academic medical center counterparts. The researchers suggested that smaller community hospitals’ fewer resources and lack of an on-staff infectious disease specialist could have driven the disparities, and suggested several potential policy solutions including telehealth service expansions and reimbursement model adjustments.
Medical Economics: (8/30) – After years of experimenting and incentives, value-based payment models seem to be gaining traction. Slightly more than 60 percent of health care payments in 2020 included some form of quality and value component. However, the authors note that many obstacles remain and that incentives haven’t changed much, noting that most value-based payments are still built on FFS. Significant barriers faced by practices, particularly small ones, include the upfront cost of the technology and personnel they need to compile, analyze and report data showing they have met a payer’s quality metrics.
Healthcare Innovation: (8/29) – Research demonstrates that hospital and pharmacy price increases for commercially insured patients are driving increases in costs, indicating that hospital market power and associated price discrimination have driven prices upward. These trends are expected to continue, as market consolidation appears likely to only increase, creating upward pressure on prices, especially in the commercial market. In addition, limited market competition and a lack of regulatory levers should mean continued high growth in pharmacy prices.
AJMC: (8/28) – This article offers a primary care physician’s perspective on the impact of health plan reporting requirements on provider burden and burnout, and provides recommendations for how technology can ease burden and improve care delivery through data and analytics integration. Specifically, the author recommends: coordinating quality and risk program needs to reduce duplicative outreach to providers and patients, sharing analytically identified opportunities that enable providers to address patient care and documentation needs in the same care encounter, streamlining provider messaging to ensure reporting and documentation requirements are clear, and sharing data and results with providers that demonstrate the value of quality and risk program efforts.
Fierce Healthcare: (8/25) – A recent study found that care for enrollees in a Medicare Shared Savings Program (MSSP) ACO resulted in substantially higher spending than for those enrolled in Medicare Advantage for four diseases. In a commentary accompanying the study, authors note the growing trend toward vertical integration between plans and health care systems in the MA program, adding that “under vertical alignment, health systems receive a fully-capitated payment to care for their MA enrollees, which may provide an even stronger incentive to reduce spending for their MA enrollees. If a health system performs well in reducing spending, they may stand to profit more than they could under the shared savings in MSSP alone.”
STAT News: (8/25) – This article offers the perspective of a surgeon who participated in the Medicare Bundled Payments for Care Improvement Advanced (BPCI-A) and argues that the program is pushing the best, lowest-cost surgeons out of Medicare. The author suggests three changes to help prevent this exodus, and save Medicare money. First, incentivize surgeons by setting a nationwide 90-day bundle price, rather than one that differs from hospital to hospital. Second, surgeons who do not meet the bundle price should not bear personal financial responsibility for the overage to enable surgeons to care for sicker patients. Third, review surgeons who repeatedly exceed the negotiated price and provide retraining to meet cost goals or potentially expel them from Medicare.