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: (6/9) - Today, CMS announced an additional payment amount for administering in-home COVID-19 vaccinations to Medicare beneficiaries who have difficulty leaving their homes or are otherwise hard-to-reach. There are approximately 1.6 million adults 65 or older who may have trouble accessing COVID-19 vaccinations because they have difficulty leaving home. To better serve this group, Medicare is incentivizing providers and will pay an additional $35 per dose for COVID-19 vaccine administration in a beneficiary’s home, increasing the total payment amount for at-home vaccination from approximately $40 to approximately $75 per vaccine dose. For a two-dose vaccine, this results in a total payment of approximately $150 for the administration of both doses, or approximately $70 more than the current rate.
CMS: (6/7) - CMS released a new guide for the Accountable Health Communities Health-Related Social Needs Screening Tool to quickly identify health-related social needs, such as food insecurity, housing instability, and lack of access to transportation, among community-dwelling Medicare and Medicaid beneficiaries. The Screening Tool enables staff to take the next step of connecting beneficiaries with community resources that can address their unmet needs. The guide also provides key insights for implementing universal screening for health-related social needs based on the experiences of organizations participating in the Accountable Health Communities Model.
CMS: (6/3) - CMS released an Informational Bulletin providing general information on the Medicaid, the Children’s Health Insurance Program (CHIP), and the Basic Health Program (BHP) related provisions in the American Rescue Plan Act (ARP) of 2021.
GAO: (6/2) - GAO announced two new members of the Medicare Payment Access Commission (MedPAC). The newly appointed members are Stacie B. Dusetzina, PhD, Associate Professor of Health Policy and an Ingram Associate Professor of Cancer Research at Vanderbilt University Medical Center in Nashville, TN, and Lynn Barr, MPH, Founder and Executive Chairwoman of Caravan Health in Kansas City, MO. Their terms began in May 2021 and will expire in April 2024.
GAO: (6/1) - GAO issued a report of the National Health Service Corps programs for Fiscal Year (FY) 2020, finding 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%).
House Energy & Commerce Committee: (6/1) - Rep. Pallone (D-NJ) introduced the Doctors of Community (DOC) Act (H.R. 3671), which would reauthorize the program of payments to teaching health centers that operate graduate medical education programs. Sen. Murray (D-WA) introduced companion legislation in the Senate on June 7 (S. 1958).
CMA: (6/8) - California Medical Association hosted a webinar entitled “Virtual Grand Rounds: Ethics in a Pandemic and the State of COVID-19 in California.” The COVID-19 pandemic has brought medical ethics to the foreground, as many have had to make complex decisions during this crisis as individuals, health care providers, public health leaders and elected officials. In this Virtual Grand Rounds, participants heard from experts on medical ethics and how these ethics relate to the individual and collective experience of the COVID-19 pandemic.
Aledade: (6/7) - On Aledade’s “ACO Show,” Josh and Brian are joined by Shawn Martin, the Executive Vice President and CEO of the American Academy of Family Physicians (AAFP). Representing over 137,000 family physicians and medical residents, the AAFP is the largest physician organization dedicated to primary care. They discuss the need for a new payment model that better rewards longitudinal care and the growing interest in family medicine among medical residents.
AAFP: (6/2) - AFFP shared an article for practical ideas for collaboration between clinical pharmacists and primary care doctors, assuring clinical pharmacists are working at the top of their licenses while expanding the ability of primary care doctors to resolve complex clinical challenges and enhance quality of care for their patients. Clinical pharmacists are among the least understood members of health care teams. The duration of their education and clinical training surpasses that of nurse practitioners and physician assistants, yet clinical pharmacists are often relegated to episodic consultations for individual patients or limited clinical care in supply-based assignments well below their doctorate degrees. With high ratios of education and training to sphere of practice, clinical pharmacists are capable of stepping into the challenges of daily clinical care, making substantial contributions to care teams, and building robust population health programs.
RevCycleIntelligence: (6/8) - Some independent primary care practices joining health system-led Medicare accountable care organizations (ACOs) raised their prices after what researchers called “soft consolidation,” according to a new study out of Harvard University. Under soft consolidation, practices are never formally acquired by a health system. Rather, the practices jointly negotiate prices with payers in conjunction with the health system. Another common example is the formation of a clinically integrated network under which independent providers bargain together. Using commercial claims and data on health system membership and ACO participation, this study found some abrupt, large price increases for independent primary care practices that joined health system–led ACOs but were not acquired by systems.
Modern Healthcare: (6/7) - Groups representing some of the largest employers in the U.S. are urging Congress to take on hospitals, arguing consolidation and unfair pricing is driving health care costs up at an unsustainable rate. Corporations previously tended to stay out of controversial health care fights on Capitol Hill that would create more government intervention in private markets. Lawmakers are working on legislation that would ban "all-or-nothing" clauses in contracts between providers and payers requiring they cover every service and product at all of a system's hospital if they want any access. The proposal is also expected to ban "anti-tiering" and "anti-steering" clauses that make it difficult for employers and plans to guide enrollees to other, lower-cost, high-quality providers.
State of Reform: (6/4) - The University of Utah David Eccles School of Business brought five health care experts together recently to discuss the tools necessary to make the transition to value-based care in the state. In a panel entitled “Making the Transition to Value” for Global Value-Based Symposium, the speakers discussed the need for multidisciplinary teams that have aligned goals and the need for collaborative technology. The panel also discussed how value-based care models need a process to avoid burnout.
Fierce Healthcare: (6/3) - A group of bipartisan lawmakers want the Center for Medicare and Medicaid Innovation (CMMI) to be more transparent in its handling of value-based care models as the center continues a major overhaul of its demonstrations. The 24 lawmakers sent a letter to CMMI Director Liz Fowler on Wednesday seeking more insight into the Center’s decision-making process on the value-based care models it oversees. The letter comes less than a month after Democrats were concerned over several parts of the Direct Contracting Model.
Fierce Healthcare: (6/3) - The Biden administration is exploring making more payment models mandatory in the future as it implements a more patient-centric vision for value-based care. Center for Medicare and Medicaid Innovation (CMMI) Director Liz Fowler detailed parts of this vision on Thursday during an interview with Health Affairs Editor-in-Chief Alan Weil. Fowler said voluntary models come with major disadvantages that make it harder to generate health systemwide savings. Fowler added that the shift toward more mandatory models was already underway during the Trump Administration and reiterated there will not be a change in approach under the Biden Administration.
Kaiser Health News: (6/3) - Chiquita Brooks-LaSure said her top priorities as CMS Administrator will be broadening insurance coverage and ensuring health equity. Brooks-LaSure also suggested the Biden Administration would support efforts in Congress to ensure coverage for the millions of Americans in the so-called Medicaid gap. Brooks-LaSure said she would prefer states use the additional incentive funding provided in the recent American Rescue Plan toward expanding their Medicaid programs, but if states fail to take up the offer, the public option or other coverage avenues would be explored.
Health Leaders: (6/3) - In a recent interview with Health Leaders Media, former CMS Administrator Seema Verma shared her thoughts on the Biden Administration health care agenda and what drove her to health policy as a career. On Biden’s agenda, she said that she appreciated that the administration was focused on the vaccine rollout but is concerned about addressing key problems in the health care system. She mentioned coverage expansion as an example, noting how she believes this is a short-term fix and not something that addresses underlying issues of why health costs are increasing. She also noted concern about the delays in CMMI model implementation and hopes the Biden Administration will be strong in enforcing price transparency guidelines.
HITConsultant: (6/2) - New MedPAC Commissioner Lynn Barr released an Op-Ed detailing her commitment to ACOs for rural areas. She writes that despite savings and advancements for ACOs in the general public, rural health providers continue to lag behind on ACO transformation. Earlier this year, CMS announced the CHART ACO program would be delayed for a year. She said the CHART ACO model was an imperfect solution, but it would have gotten momentum going in rural areas. Now, private organizations like Caravan will have to step in to fill that void. She asks that CMS prioritize rural providers in future ACO models.
Fierce Healthcare: (6/2) - The National Association of ACOs (NAACOS) sent a letter to CMS calling for additional flexibility in the application cycle for the Medicare Shared Savings Program (MSSP). NAACOS says accountable care organizations need more time to meet key deadlines to apply for MSSP for 2022. The letter to newly confirmed CMS Administrator Chiquita Brooks-LaSure comes as the group is working to reverse a slide in ACO participation that started during the Trump Administration.
Center for Health Care Strategies: (6/2) - Value-based payment (VBP) is an important strategy for states seeking to promote innovative primary care approaches through Medicaid managed care. To date, primary care VBP models have been successfully used by states to incentivize quality improvement and support providers in adopting core primary care functions. Significant opportunities to advance primary care VBP still exist, largely because most Medicaid VBP is based on fee-for-service reimbursement. As states, payers, and providers gain experience in VBP, they may consider implementing prospective payment models that support practices in offering more comprehensive care, such as through integrating physical and behavioral health care, addressing health-related social needs (HRSNs),and creating opportunities to advance health equity.
Bloomberg Law: (6/2) - At a recent National Academy of Medicine event, CMMI Director Liz Fowler said the only way to transform the U.S. health care system to reward doctors and hospitals for positive patient outcomes may be to mandate it. “Our health system can’t resist the siren song of the status quo,” said Fowler. Making doctors, hospitals, and insurance companies uncomfortable in traditional Medicare might be the only way to push actual change, and staying in Medicare fee-for-service is “too comfortable.”
Milbank Memorial Fund: (6/1) - The COVID-19 pandemic has accelerated the shift to telehealth as a prominent care delivery mode. Not all health care providers and patients are equally ready to take part in the telehealth revolution, which raises concerns for health equity during and after the COVID-19 pandemic. Without proactive efforts to address both patient- and provider-related digital barriers associated with socioeconomic status, the wide-scale implementation of telehealth amid COVID-19 may reinforce disparities in health access in already marginalized and underserved communities. To ensure greater telehealth equity, policy changes should address barriers faced overwhelmingly by marginalized patient populations and those who serve them. To address this issue, this study analyzed data about small primary care practices’ telehealth use and barriers to telehealth use collected from rapid-response surveys administered by the New York City Department of Health and Mental Hygiene’s Bureau of Equitable Health Systems and New York University from mid-April through mid-June 2020 as part of the city’s efforts to understand how primary care practices were responding to the COVID-19 pandemic following New York State’s stay-at-home order on March 22.
June 10 - Physician-Focused Payment Model Technical Advisory Committee, "PTAC Public Meeting." Virtual.