| “We believe it is important to maintain a level competitive playing field for all ACOs. Model designs that discourage inclusion of hospitals undermine the objective of ACOs, which is to coordinate care across all providers to improve care, as well as potentially jeopardize access to needed patient care. Changes are needed to speed progression to advanced risk-based models. Congress can further incent providers to participate in ACOs by lowering the APM Incentive Payment thresholds in MACRA to ensure more clinicians have the opportunity to become a Qualifying APM Participant and participate in Advanced APMs and by extending the 5% bonuses available to QPs participating in Advanced APMs.” | ||
| -Blair Childs, Senior Vice President of Public Affairs, Premier |
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A JAMA study reports that compared with unaffiliated clinicians,
system-affiliated clinicians were significantly more likely to
be female (46% vs 37%), primary care physicians (36% vs 30%),
and classified as safety net clinicians (12% vs 10%) and
significantly less likely to be specialists (44% vs 55%). The
mean final MIPS (Centers for Medicare & Medicaid Services
Merit-based Incentive Payment System) performance score for
system-affiliated clinicians was 79.0 vs 60.3 for unaffiliated
clinicians. The percentage receiving a negative (penalty)
payment adjustment was 2.8% for system-affiliated clinicians vs
13.7% for unaffiliated clinicians; 97.1% vs 82.6%, respectively,
for those receiving a positive payment adjustment; and 73.9% vs
55.1% for those receiving a bonus payment adjustment. Source: JAMA, Association of Clinician Health System Affiliation With Outpatient Performance Ratings in the Medicare Merit-based Incentive Payment System |
|
KHN: Total number of rural
hospital closures, 2005-2020 1. 2020: 172 (as of 8/14/20) 2. 2019: 159 3. 2018: 141 4. 2017: 127 5. 2016: 117 6. 2015: 106 7. 2014: 89 8. 2013: 73 9. 2012: 59 10.2011: 50 11.2010: 45 12.2009: 42 13.2008: 32 14.2007: 26 15.2006: 17 16.2005: 9 Source: KHN, Prognosis for Rural Hospitals Worsens With Pandemic |
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Rapid Increases in Medicaid Enrollment: A Review of Data
from Six Months In May, Families USA analyzed early trends in Medicaid enrollment related to COVID-19.1. That analysis highlighted states with early spikes in enrollment in the wake of the pandemic. Not surprisingly, an updated review of this data shows even more states seeing large increases throughout the summer. While there is wide variation among states, we observed continuous increases of month-over-month enrollment across the 38 states analyzed, with the eight states reporting August enrollment numbers showing big jumps in that month. Families USA, September 2020 Pandemic pushes providers to take more serious look at shift to value More providers are looking at moving to value-based care as a result of the COVID-19 pandemic, UnitedHealth Group CEO David Wichmann said Thursday. In particular, there was a strong surge of interest in moving to value-based care models at the outset of the pandemic when providers saw volumes flag and financial pressures grow amid stay-at-home orders. Fierce Healthcare, September 11, 2020 Independent, smaller hospitals will need to make tough choices Independent hospitals could need to make drastic decisions such as reducing service lines or workforces to survive the cash crisis caused by the COVID-19 pandemic, a new analysis finds. The analysis, published Thursday from consulting firm Kaufman Hall and the law firm Waller, projects an increased number of independent hospitals and smaller systems partnering up due to massive financial damage caused by COVID-19. Kaufman Hall also finds that more integrated and larger systems with more access to capital are better positioned. Fierce Healthcare, September 4, 2020 How Obamacare helped millions who lost their jobs during Covid-19, in 3 charts The Covid-19 pandemic has been the first serious test for the Affordable Care Act as a new social safety net — and the law’s provisions have proven adept, if imperfect, in protecting Americans from losing health insurance in the middle of an infectious disease outbreak and an economic crisis. Vox, August 26, 2020 Definitive Healthcare Highlights Impact of COVID-19 in 2020 Healthcare Survey Definitive Healthcare, the leading provider of data, intelligence, and analytics on the healthcare provider market today released results from its 2020 Healthcare Trends Survey. Amidst the COVID-19 landscape, Definitive Healthcare polled more than 2,300 healthcare leaders ranging from pharmaceutical, biotechnology, and medical device industries to healthcare IT, consulting, payer, provider organizations, and more to determine (1) which trends they felt will have the greatest impact on the healthcare industry in the next year and (2) in what areas telehealth will have the greatest staying power. Definitive Healthcare, August 27, 2020 |
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Private Health Plans Pay Hospitals
247% of What Medicare Would Pay Prices paid to hospitals nationally during 2018 by privately insured patients averaged 247% of what Medicare would have paid, with wide variation in prices among states, according to a new RAND Corporation study. RAND, September 18, 2020 Urban Hospitals of Last Resort Cling to Life in Time of COVID Victor Coronado felt lightheaded one morning last month when he stood up to grab an iced tea. The right side of his body suddenly felt heavy. He heard himself slur his words. “That’s when I knew I was going to have a stroke,” he said. Kaiser Health News, September 17, 2020 541 ACOs in the Medicare Shared Savings Program saved Medicare $1.2 billion In 2019, 541 accountable care organizations in the Medicare Shared Savings Program generated $1.19 billion in total net savings to Medicare, the largest annual savings for the program to date, according to Centers for Medicare and Medicaid Services Administrator Seema Verma. Healthcare Finance News, September 15, 2020 Uninsured Americans increased even before pandemic, Census Bureau finds The number of people without health insurance increased last year, even before the coronavirus pandemic struck, according to new federal figures released Tuesday. The Hill, September 15, 2020 Obamacare Co-Ops Down From 23 to Final ‘3 Little Miracles’ New Mexico Health Connections’ decision to close at year’s end will leave just three of the 23 nonprofit health insurance co-ops that sprang from the Affordable Care Act. One co-op serves customers in Maine, another in Wisconsin, and the third operates in Idaho and Montana and will move into Wyoming next year. All made money in 2019 after having survived several rocky years, according to data filed with the National Association of Insurance Commissioners. Kaiser Health News, September 9, 2020 Cigna Will Expand Obamacare To 300 Counties In 10 States For 2021 Cigna will increase the number of counties it will offer individual coverage under the Affordable Care Act by 27% to more than 300 counties across 10 states next year. Cigna is the latest health insurer to increase its individual product offerings to more states, joining companies like Centene, Oscar Health and several Blue Cross and Blue Shield plans that have been expanding their individual coverage under the ACA known as Obamacare. Forbes, September 9, 2020 Payer Seeks to Democratize Social Determinants of Health Data Blue Shield of California has partnered with a third-party vendor to make social determinants of health data accessible to anyone. Payers and providers talk extensively about sharing social determinants of health data and other information with each other, but some payers are starting to consider ways to “democratize data.” HealthPayerIntelligence, September 2, 2020 Georgia Governor Wants Out of Obamacare Health Exchange Under a proposal from Republican Gov. Brian Kemp, Georgians seeking to purchase health insurance would no longer have the option of shopping for plans on one website as they can now on the Obamacare site Healthcare.gov. Instead, they would have to seek out commercial insurance plans on their own. PEW Stateline, September 2, 2020 CMS finalizes $3.5B boost in acute hospital spending in new rule The Trump administration finalized a rule that increases payment rates for general acute care hospitals by up to 2.9% and boosts add-on payments for new technologies in the next federal fiscal year. Fierce Healthcare, September 2, 2020 |
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