News Clips
Healthcare Dive: FTC withdraws ‘outdated’ antitrust policy statements. Hospitals cry foul. (7/18) – The FTC withdrew two antitrust policy statements on merger enforcement in health care markets, arguing they’re outdated and no longer reflect market realities. The now-defunct statements were not legally binding, but included language outlining when hospital and provider consolidation and partnerships were generally safe from antitrust scrutiny, including safe harbors for purchases of small hospitals. Research has shown that hospital consolidation results in higher prices for consumers, with little or no corresponding increase in the quality of care.
Fierce Healthcare: As value-based health moves from philosophy to reality, providers, payers focus on equity and interoperability (7/17) – Equity was at the forefront of Reuters’ value-based health conference in Philadelphia last month. Over two days, executives from ACOs, health systems and payers spoke about interoperability, population health, social determinants, the cost of care and taking on risk. Across the board, speakers agreed that the transition to value-based care (VBC) is both inevitable and critical to improving the health care system. While to date, adoption of VBC has been relatively slow, some predicted that is soon to change, spurred on by federal efforts.
Modern Healthcare: Proposed cuts to Medicare physician payments spark calls for overhaul (7/14) – Doctors would receive a 1.25 percent pay cut next year under the Medicare PFS proposed rule, fueling requests to tie the reimbursement rate to inflation. Although physician associations described the proposed cuts as untenable, they lauded the proposed boost to primary care and the proposed changes to ACOs. CMS estimates the proposed rule would increase MSSP by up to 20 percent next year, in part by accounting for beneficiaries who seek primary care through nurse practitioners, physician assistants and clinical nurse specialists. The proposed rule also addresses several issues that NAACOS has been advocating for, "including improvements in quality reporting, more fair benchmarking policies, a smooth transition to a new risk-adjustment model and keeping advanced payments for new ACOs who transition to risk, helping ACOs who serve high-cost beneficiaries and others.”
American Enterprise Institute: Ten Health Care Ideas for No One in Particular (7/12) – Give Medicare Beneficiaries a New Primary Care Option. Primary care physicians help patients navigate an increasingly complex medical care environment. However, Medicare and most other insurers continue to pay for the services these physicians provide on a piecemeal basis, which creates unnecessary hassles for patients and misaligned incentives. The better approach would be to pay each primary care physician a reasonable monthly fee to provide a defined list of services, including ready access for both in-person and video appointments, preventative care (such as vaccinations), and chronic care management. Giving Medicare beneficiaries the power to choose the physicians who will serve in this role for them would foster competition and improve the quality of the care they receive.
American Medical Association: AMA examines decade of change in physician practice ownership and organization (7/12) – Physicians are less likely to work in a private practice than 10 years ago due to economic, administrative, and regulatory burdens that have driven physicians to shift traditional business models for medical practices, according to a newly released biennial analysis of physician practice arrangements by the American Medical Association (AMA). According to the analysis, four of five physicians indicated the need to better negotiate favorable payment rates with payers was a very important or important reason in the sale of their practice to a hospital or health system. Next were the need to improve access to costly resources and the need to better manage payers’ regulatory and administrative requirements. Each was flagged by about 70 percent of physicians as a very important or important reason.
Medical Economics: American Heart Association calls for transition to value-based payments (7/11) – The American Heart Association (AHA) wants the U.S. health care system to shift away from its current reliance on fee-for-service payments in favor of a value-based payment (VBP) system. The AHA policy statement contains recommendations for value-based care delivery and payment models, including integrating person-centered process and outcomes quality metrics; ensuring clinicians have resources and capabilities to implement best practices; and aligning value-based care and payment programs across public and private payers.
Health Affairs: Advancing Equity Versus Quality In Population-Based Models: Lessons From The New Proposed Rule (7/10) – In its Proposed Rule released in May 2023, CMS put forward a significant change to the Hospital Value-Based Purchasing (VBP) program. Hospitals serving a greater percentage of dual-eligible patients would receive an equity adjustment that increases their quality performance scores – and in turn, performance scores for the payment program overall. While potentially beneficial for population-based care, the proposed equity adjustment should be recognized for what it is and despite its name, what it is not (a way to incentivize greater equity in outcomes between historically marginalized and other populations). Amid efforts to scale up population-based models nationwide, this recognition can help policymakers precisely align program design with policy intent. Doing so can encourage an array of policy strategies alongside bonus point-based adjustments that directly address health inequities.
New York Times: Who Employs Your Doctor? Increasingly, a Private Equity Firm. (7/10) – In recent years, private equity firms have been gobbling up physician practices to form powerful medical groups across the country. Historically, doctors’ practices have been relatively small, and owned by doctors themselves. But that model has been rapidly declining as the business of medicine has become more complex and the insurance companies that negotiate with doctors over prices have become bigger. Nearly 70 percent of all doctors were employed by either a hospital or a corporation in 2021, according to a recent analysis from the Physicians Advocacy Institute. Critics of the industry have also raised concerns about the medical care delivered by private equity-owned health care companies, arguing that the industry’s emphasis on profits could cause patient harm. But little rigorous research has been published on patient care in the office-based medical specialties that the new paper focuses on.
Health Affairs: Advancing Equity Versus Quality In Population-Based Models: Lessons From The New Proposed Rule (7/7) – Health care spending is still on the rise, with median costs per person increasing to over $6,000 in 2021, according to a new analysis from the Health Care Cost Institute (HCCI). Market consolidation continues to impact medical prices and overall health care spending. The Healthy Marketplace Index shows that most hospital markets lacked competition in 2021 and two-thirds of the 183 metropolitan areas studied became less competitive over time. HCCI notes that a potential factor in market consolidation is the degree to which patients from one metropolitan area seek care in a neighboring region.
The Hill: Inaction on Medicare payment reform jeopardizes quality care - op-ed by Bruce Scott, AMA President-Elect (7/6) – The need to transform the deeply flawed Medicare physician payment system into one that will not only sustain but strengthen physician practices could not be more critical. Unless we change course, continued access to quality, affordable care will be jeopardized for tens of millions of patients who need it most. Ultimately, Medicare payment reform should help create a system that is financially stable and predictable for both patients and physicians. The ideal system will protect and advance value-based care, while safeguarding access to high-quality care where it is needed most. Congress must cooperate to ensure Medicare can continue to play a critical role in the delivery of high-quality, affordable health care for so many of our country’s most at-risk patients.
Medscape: How Small Practices Are Surviving and Thriving, Part 1 (7/5) – Small-town physicians offered these five tactics for making a small-town practice work successfully: (1) Develop relationships with specialists in your nearest large facility for referrals. (2) Consider joining an ACO to improve workflow, diversify revenue streams, and maintain independence. (3) Create a culture that's welcoming to all incoming young professionals. (4) Host medical students and residents as part of their education. (5) Recruit more than one physician if possible. "It's really scary for new physicians to go out and practice on their own right out of training. Most rural communities need more than one more doctor anyway, and this gives them a built-in support system from the beginning.”
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