News Clips
AJMC: (4/20) - CMMI Director Liz Fowler gave her first public remarks at the opening plenary of the NAACOS Spring 2021 Conference, highlighting priorities for CMMI and next steps for models that have been paused or delayed. Fowler acknowledged that some CMMI models have been put on hold while the Innovation Center undergoes continued review, but that the commitment to value-based care is as strong as ever. She also emphasized that CMMI will prioritize health equity in every stage of CMMI’s models.
Health Affairs: (4/19) - As the health care system continues to shift toward value-based payment arrangements, there is growing concern that organizations caring for populations with greater social risk factors may be unfairly penalized. The authors of this blog, two current MedPAC Commissioners, propose two policy approaches to address this issue: 1) providing upfront supplemental payments to providers who care for higher-risk populations, and 2) adjusting performance incentive payments so those serving a larger population with greater social risk would receive larger rewards for an equivalent level of outcome.
Fierce Healthcare: (4/19) – The American Hospital Association (AHA) published a study reviewing claims from a five percent sample of Medicare beneficiaries who had at least one visit to an outpatient setting between January 1, 2012 and June 3, 2019. Findings suggest that Medicare patients who receive care in a hospital outpatient department are more likely to be poorer and have more severe chronic conditions compared to Medicare patients treated in an independent physician office. AHA used this study to reinforce its position against site neutral payments, claiming it could threaten access to care for vulnerable populations.
Health Affairs: (4/19) - The rise in specialist referrals and visits over the past several years has led to increased costs without evidence of significantly improved outcomes. This article proposes the following solutions for putting the primary care physician back at the center of providing care: 1) get the economic incentives right to reward primary care physicians for lowering costs and improving quality of care; 2) reform medical education to be re-oriented around primary care; 3) use Medicare Advantage more broadly; 4) expand the use of e-consults; and 5) refocus and repurpose continuing medical education.
Managed Healthcare Executive: (4/16) - Advocates for accountable care organizations (ACOs), such as NAACOS, are beginning to push for changes to bolster CMS’ ACO programs and encourage more risk taking within payment arrangements. Given the decrease in participants in the Medicare Shared Savings Program, NAACOs President and CEO Clif Gaus said making incentives to participate more attractive and the risks more manageable would lead more providers to participate.
Healthcare Finance News: (4/16) - Following the news that CMS would not be accepting new applicants for the Global and Professional Direct Contracting model, several provider groups through the America’s Physician Groups Direct Contracting Coalition sent a letter to CMMI Director Liz Fowler urging her to reconsider opening up another opportunity for prospective applicants to apply to the model. The groups who signed the letter viewed this announcement as a step backwards in the progress of the movement toward value-based care and a move that will impact potential participants who had made substantial investments to meet the requirements by the model start date.
Fierce Healthcare: (4/16) - According to the Medscape Physician Compensation Report 2021, physician salaries have rebounded despite the extreme volatility experienced as a result of the ongoing pandemic. The average salaries for primary care physicians stayed relatively constant at $242,000 from $243,000 the previous year. The report cited the pivot to telehealth, leveraging government recovery programs, and an increase in demand for services toward the end of 2020 as reasons behind this trend.
Milbank Memorial Fund: (4/15) - As states and payers continue to invest in primary care, many are employing strategies such as measuring primary care spending as a percentage of total health care costs and establishing benchmarks for increasing spending. To improve uniformity in defining primary care spend, this brief proposes a standard definition and measurement methodology to allow policymakers to quantify total investment in primary care and enable comparisons of spending across and within states, payers, and health care systems.
Managed Healthcare Executive: (4/14) - Leaders at the Leonard Davis Institute of Health Economics at the University of Pennsylvania have released recommendations to transform the health care system into one that focuses on value. Among suggestions include increasing the number of involuntary value-based programs, slowing down the introduction of new programs, and for CMS to favor programs with two-sided risk, among other recommendations.
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