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News Clips
Medical Economics (6/9) Value-based care, independent physicians, lifestyle choices all part of MAHA – Value-based care, independent and rural physicians, and lifestyle choices all will have a role in Making America Healthy Again, according to Medicare’s top leaders. The third pillar for MAHA is to drive patient choice and promote competition in the market, Sutton said. “We are also interested in finding ways to make it easier for providers who practice independently to engage in our models. We often hear from providers and payers that engaging in value-based care has been overly complicated, and the administrative burden is a major barrier. For this reason, the innovation center will seek to simplify and standardize our portfolio of models where possible, and we will look for ways to create more predictability in our work, such as the standardized quality measures, improved and simplified benchmarking that does not present opportunities for arbitrage and providing fewer mid-model changes due to upfront design considerations that ensure they were aligned with our statute.”
American Medical Association (6/9) AMA draws a line on corporate intrusion into physician autonomy – Corporate investment can offer an alternative to selling a practice to a hospital or health system, and physician-owners can possibly benefit from being freed of business, financial, and operational administrative responsibilities, leaving more time for a focus on patient care. The risks to physicians include a loss of independent authority over clinical and operational matters. Decisions made by corporate investors on matters often characterized as operational or administrative may in some cases intrude on clinical decision-making and physician autonomy, as well as affect quality of care and patient outcomes. According to newly strengthened AMA guidance on corporate relationships, the clinical and business decisions that should remain in the ultimate control of the physician include but are not limited to: being responsible for the ultimate overall care of the patient, including treatment options available to the patient and determining how many patients a physician shall see in a given period of time or how many hours a physician should work.
Health Affairs (6/9) Medicare Site-Neutral Payment Policies: Effects Of Proposals On Hospitals And Beneficiary Groups – Medicare pays hospital outpatient departments higher rates than ambulatory surgical centers and physician offices for providing similar health services. Policy makers are considering aligning payments across sites of care, but concerns have arisen about the potential disproportionate impacts of “site-neutral” payments on vulnerable providers and beneficiaries. We assessed the effects of three policy options on types of hospitals and beneficiaries. We found annual Medicare payment reductions ranging from $212 million to $7.36 billion across these options; variation was due to the scopes of services and types of hospital outpatient departments included. Small and rural hospitals paid under Medicare’s outpatient prospective payment system would absorb the smallest shares of proposed cuts across the options, commensurate with their outpatient volumes. The effects of the policy options varied little by hospital type; more comprehensive options would yield larger payment reductions from all hospital types. Site-neutral payments would not have substantially different effects on beneficiary groups defined by dual-eligibility status or age.
Medical Economics (5/29) Is CMS going to wreck ACOs with bad math? – Aledade and other ACOs are pressing CMS to correct what they say is a major misstep in a financial benchmark model that could significantly reduce their earnings and possibly force some practices out of value-based care and discourage others from joining. The controversy centers on CMS’s Accountable Care Prospective Trend (ACPT), a metric used to project cost growth in the Medicare Shared Savings Program. The metric was meant to provide more stability by forecasting national Medicare cost trends for each year of an ACO’s five-year contract. But CMS’s attempt at setting that number was not only late—it was also dramatically off what really happened in the marketplace. “We’re 11 months into the first performance period, and they give us a number, and it looks wildly wrong,” says Sean Cavanaugh, chief policy officer, Aledade, and a former CMS official. “In March of 2025 we got the prospective number for 2024. That’s the first big stumbling block—this is actually now a retrospective number.”
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