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.
ASPE: (8/7) – The Assistant Secretary for Planning and Evaluation (ASPE) released a report on newly available ownership data of Medicare-enrolled hospitals. Nearly half of the 4,644 hospitals are non-profit (49 percent), 36 percent are for-profit, and 15 percent are government-owned. Chains with at least three hospitals constitute most hospitals (56 percent) and nine chains have at least 50 hospitals each. HHS intends this data to inform discussions of competition and consolidation in health care markets.
Bipartisan Senators Letter on Nonprofit Hospitals: (7/27) – Senate HELP Ranking Member Cassidy (R-LA) and Sens. Warren (D-MA), Warnock (D-GA), and Grassley (R-IA) sent a letter to Internal Revenue Service (IRS) Commissioner Werfel and Treasury Inspector General for Tax Administration Commissioner Killen raising concerns over the tax-exempt status of nonprofit hospitals and asking a series of questions related to oversight.
STAT: Senators push IRS to launch nonprofit hospital probe (8/14) – “These practices — along with lax federal oversight — have allowed some nonprofit hospitals to avoid providing essential care in the community for those who need it most,” wrote the senators. Sen. Grassley, in particular, has been waging this war for some time. He launched committee probes into nonprofit tax practices during his time as Finance Committee chairman. In 2020 he issued a report delving into the “aggressive debt-collection practices” of two nonprofit hospital systems.
Medical Group Management Association (MGMA): (7/27) – Medical Group Management Association’s (MGMA) new data summary report, Missing Pieces for Revenue Recovery in the Post-Pandemic Era, reveals a comprehensive picture of the financial performance of medical groups in the post-pandemic era. The data shows that median support staff in physician-owned primary care practices have dropped by more than three full-time-equivalent (FTE) roles since the start of the COVID-19 pandemic.
California Medical Association (CMA): (7/27) – California Medical Association (CMA) is urging members of Congress to provide a Medicare inflation update. “CMA is strongly supporting the Strengthening Medicare for Patients and Providers Act (H.R. 2474), a bipartisan measure now pending in Congress, which would provide the crucial link between the Medicare physician payment schedule and the MEI, and finally put physicians on an equal fiscal footing with other entities drawing Medicare payment. Physicians can contact their representatives in Congress through this portal to urge passage of H.R. 2474.”
American Medical Association: Lack of timely MIPS data hobbles doctors’ value-based care efforts (8/16) – To be successful in advancing value-based care, physicians in Medicare’s Merit-based Incentive Payment System (MIPS) need timely access to that kind of data. While Congress recognized the critical importance of data sharing with physicians in MACRA statute that created MIPS by requiring timely performance feedback, CMS has dragged its feet in meeting this statutory obligation. To address these problems, the AMA is calling on Congress to:
Direct CMS to improve timely access to MIPS feedback reports and claims data as required by MACRA.
Exempt from MIPS penalties any physician who does not receive at least three quarterly MIPS feedback reports during the performance period.
Commonwealth Fund: Promoting Health Equity by Changing How We Pay for Care (8/15) – Reforming how we pay for care through value-based payment (VBP) may offer a solution. In VBP arrangements, providers are paid based on results, including the cost and quality of care. By paying providers in ways that make them focus on improving health, instead of providing specific services, providers have greater flexibility to deliver efficient and equitable care. With VBP, providers can address the underlying causes of health inequities, instead of just treating the effects. A health center in California, for example, used VBP to manage transportation problems and expand access to care by sending community health workers to visit patients at home to manage their chronic conditions.
Modern Healthcare: CMS unveils ACO REACH makeover (8/14) – CMS debuted a slate of changes to ACO REACH that are designed to boost participation in the value-based care program. CMS updated the health equity benchmark adjustment to include data about Medicare enrollees who receive low-income subsidies, as well as those who reside in locations identified under the state-based area deprivation index, which the agency contends will add more underserved Medicare beneficiaries who live in high cost-of-living areas to ACOs. The agency will also offer up to $30 per beneficiary, per month to ACO REACH participants that serve the neediest enrollees. The National Association of ACOs praised the modifications to ACO REACH. "We appreciate that CMS continues to improve on the ACO REACH model by addressing many concerns raised by NAACOS members," President and CEO Clif Gaus said in a news release.
Med City News: Cancer Moonshot: Would It Even Be Possible in Today’s Fee-For-Service World? (8/11) – In fee-for-service, health care providers are paid based on the individual care services provided, regardless of the effectiveness of that care. Such a model incentivizes high volumes, quick office visits, and reactive health care–wherein the physician is responding to a patient’s concerns but does not necessarily invest in forward-thinking strategies that would keep patients healthy and functional at home. In a fee-for-service world, it is difficult to stand up programs to address care coordination or electronic symptom reporting and capture because there isn’t always an easy billable code associated with such services.
Elevance Health: Costs and Quality After Independent Hospitals Are Acquired by Health Systems (8/11) – Independent hospital mergers with health systems have exposed consumers, employers, and other payers to higher prices without a commensurate increase in quality of or access to hospital care. Instead, quality and access generally declined, while hospitals realized cost savings, following acquisition. Hospital acquisitions have consolidated care in fewer and larger health systems. This brief presents the key findings from an analysis, conducted in partnership with researchers at the University of Pennsylvania, that compared independent hospitals that merged with a hospital system and hospitals that remained independent. It describes how prices, costs, and quality change when previously independent hospitals are acquired by systems.
Modern Healthcare: Medical coworking companies seek to attract independent physicians (8/8) – Coworking business owners and some physicians say this medical model could help bolster the shrinking independent doctor landscape. An American Medical Association report released in July found that fewer physicians own practices—44 percent in 2022 versus 53.2 percent a decade ago. Women are even less likely to own practices: Last year, 35.7 percent of women physicians were owners, compared with 48.6 percent of men, the report found. Dr. Stacey Bartell, medical director for career and practice at the American Academy of Family Physicians, said doctors could turn to independent practice in a coworking space for multiple reasons, particularly in the wake of the COVID-19 public health emergency.
Kaiser Family Foundation: Understanding the Role of the FTC, DOJ, and States in Challenging Anticompetitive Practices Of Hospitals and Other Health Care Providers (8/7) – This issue brief explains the role of federal and state antitrust agencies in challenging anticompetitive practices among health care providers, including the legal authority of federal and state agencies, the role that they play in enforcing antitrust laws, and proposed options for strengthening their authority. The brief focuses on health care providers, though many of the principles discussed in this issue brief apply to the practices of other health care entities as well, such as health insurers and pharmacy benefit managers (PBMs) (which are currently being reviewed by the FTC). While the focus of this brief is on the role of government agencies, antitrust law also authorizes private parties, such as employer health plans, to challenge anticompetitive practices in the courts.
Health Affairs: Tying Equity To Reimbursements (8/7) – In December 2022, CMS proposed a bold initiative to tie reimbursements to health equity. The proposal puts forth a set of new and revised provisions targeting specific pathways that are set to enhance health equity. While it takes a much-needed step toward actualizing a commitment to health equity, more than good intentions are required to ensure its success. Several key decisions are yet to be made, which could derail this promising initiative’s ability to make meaningful inroads toward health equity. Here, we point to several critical considerations that need to be addressed by 2024, when the initiative will take effect, including modifications to the roles of health care providers, organizations, and policy makers.
Wall Street Journal: Efforts to Spotlight Private Equity’s Healthcare Stakes Struggle for Traction (8/6) – Democratic lawmakers seeking more information about private equity’s role in the health care sector have made little progress, as several bills have stalled in the face of opposition from industry groups. Some medical companies would be required to disclose ownership by private-equity and other financial firms under proposals advanced this year by Democratic lawmakers and regulators, who cited concerns about how private-equity investment in the medical sector affects patients and workers. Other lawmakers have questioned the disclosure push on the grounds that much private-equity ownership information in the health care sector is already public. The Health and Human Services Department and Medicare administrators already have the power to ask for ownership information, and under the Biden administration have been publicizing more data.
Health Affairs: Facility Fees 101: What is all the Fuss About? (8/4) – Policy makers are increasingly turning their attention toward the prices health care providers charge private insurers, employer health plans, and their enrollees, and for good reason: Analyses highlight that private insurers pay nearly 2.5 times Medicare rates for hospital care and 1.2 times Medicare rates for physician care at the median. There is also considerable evidence that the prices providers negotiate with private insurers are increasingly a function of local provider market concentration as opposed to the resources necessary for providing care. One component of provider pricing growing in prominence is hospitals charging “facility fees” for care provided in outpatient and physician office settings that hospitals own or control. Facility fee charges are becoming more common as hospital systems have accelerated their purchase of ambulatory settings and practices, leading to higher overall costs for outpatient care.