Families USA's Center for Affordable Whole Person Care Newsletter |
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This newsletter will be sent out every other month to bring you the latest news from the front lines of the health care value movement and our work to rein in health care industry abuses and reorient economic incentives to ensure affordable, quality, equitable care and health for all. We'd love to hear from you! Please contact Mike Persley, Strategic Partnerships Campaign Manager, at [email protected] if you have any news to share for our next issue. |
News from Congress
H.R. 4366: Consolidated Appropriations Act, 2024 - House, Senate, and President Biden
After passing the U.S. House and Senate, President Biden signed H.R. 4366 into law. The law averts a partial government shutdown and includes key health care extenders such as eliminating scheduled reductions to Medicaid Disproportionate Share Hospital program, mitigating cuts to the Physician Fee Schedule, and extending the Teaching Health Center Graduate Medical Education Program, the National Health Service Corps, and the Community Health Center Fund. Left of out this package, however, was the Lower Costs, More Transparency legislation, which contained key reforms on price transparency and site-neutral payments.
Senate Committee on the Budget Hearing: “How Primary Care Improves Health Care Efficiency" - Senate Committee on the Budget
The Senate Committee on the Budget held a hearing on the importance of primary care where witnesses noted concerns with the fee-for-service payment system, the Relative Value Scale Update Committee (RUC) and the Medicare Physician Fee Schedule having devalued primary care relative to specialty services, leading to a compensation gap.
Families USA submitted a Statement for the Record to the Senate Budget Committee detailing policy on health care payment and delivery reform that values and invests in primary care. Specifically, the statement advocates for establishing new methods that more accurately determine physician payment rates that have historically under-reimbursed – including high-value services like primary care – as well as moving toward value-based care through the development of a primary care hybrid model within the Medicare Shared Savings Program.
House Energy and Commerce Health Subcommittee Hearing: “Health Care Spending in the United States: Unsustainable for Patients, Employers, and Taxpayers” - House Energy and Commerce Health Subcommittee
The House Energy and Commerce Health Subcommittee held a hearing on the growing cost of health care and what factors are causing cost increases for consumers across the nation. Sophia Tripoli, Senior Director of Health Policy at Families USA, testified at this hearing on the health care affordability crisis and how trends in health care industry consolidation have eliminated competition and allowed monopolistic pricing to push our nation’s families to the brink of financial ruin. To view her testimony, visit this link.
Senators Cortez Masto, Blackburn, Thune, Barrasso, Stabenow, and Warner Announce Formation of Medicare Payment Reform Working Group – U.S. Senate
U.S. Senators Catherine Cortez Masto (D-NV), Marsha Blackburn (R-TN), John Thune (R-SD), John Barrasso (R-WY.), Debbie Stabenow (D-MI), and Mark Warner (D-VA) announced the formation of a Medicare payment reform working group. The primary goal of this group is to investigate and propose long-term reforms to the physician fee schedule and make necessary updates to the Medicare Access and CHIP Reauthorization Act. H.R. 7591 – National Patient Safety Board Act of 2024 – U.S. House of Representatives
Representatives Nanette Diaz Barragán (D-CA) and Michael Burgess, M.D. (R-TX) introduced H.R. 7591, which seeks to address safety in the health care system by establishing an independent board within the U.S. Department of Health and Human Services to reduce and prevent patient injury, harm, and death. The creation of a National Patient Safety Board is a critical step in ensuring patients receive high quality care and preventing medical errors, which cost 250,000 lives and $17 billion to the health care system every year. This legislation is supported by a broad swath of stakeholders, including members of the National Patient Safety Board Advocacy Coalition.
To learn more about this issue, please join Families USA on Tuesday, April 2, at 1:00 pm ET for a webinar: First Do No Harm: Addressing the Patient Safety Crisis. |
The Latest from the Biden Administration
Biden-Harris Administration Announces New ACO Primary Care Flex Model - CMS
Beginning January 1st, 2025, CMS will test a new payment model for primary care within the Medicare Shared Savings Program. Participants will receive a one-time Advanced Shared Savings Payment and monthly prospective, population-based payments. Approximately 130 Accountable Care Organizations will be selected to participate in this model, which tests whether improved payment for primary care will empower providers to utilize innovative, team-based, and person-centered approaches to primary care. The model will run for four years and is open to participants who are low revenue ACOs in the Shared Savings Programs.
Fact Sheet: President Biden Takes New Steps to Lower Prescription Drug and Health Care Costs, Expand Access to Health Care, and Protect Consumers - The White House
In his annual State of the Union Address, President Biden highlighted the Biden-Harris Administration’s continued efforts to keep health insurance premiums low through the American Rescue Plan and Inflation Reduction Act, expand the impact of prescription drug provisions of the Inflation Reduction Act, close the Medicaid Coverage Gap, make care more accessible, ensure access to mental health care by working to finalize the mental health parity rule, and prevent surprise medical bills.
CMS Releases New Independent Dispute Resolution Reports for the No Surprises Act - CMS
CMS released new data from the No Surprises Act’s Independent Dispute Resolution (IDR) process, revealing that providers are winning roughly 70% of IDR cases. Additionally, resolved disputes are resulting in significantly higher payments to providers than anticipated, ranging at the median between 100% to 916% of the Qualifying Payment Amount (QPA), depending on specialty. As drafted in the No Surprises Act statute by Congress, the IDR process was intended to center payments around the QPA, but repeated litigation including lawsuits led by the Texas Medical Association (TMA) - TMA II and TMA III - has erased guardrails surrounding the IDR process, potentially resulting in these much larger payments to providers, which would impact health care premiums over time.
Data Book: Beneficiaries Dually Eligible for Medicare and Medicaid – MedPAC and MACPAC
MedPAC and MACPAC released new data from 2021 on dually eligible beneficiaries for Medicare and Medicaid. The data shows enrollment, utilization, and spending data for these beneficiaries by state as well as by gender, race, ethnicity, urbanicity, and health conditions. Dual-eligible beneficiaries were more likely to be exclusively enrolled in managed care [either a Medicare Advantage (MA) plan or other type of Medicare health plan] than non-dual Medicare beneficiaries (46 percent vs. 38 percent). Among those exclusively enrolled in managed care, more than half of dual-eligible beneficiaries (54 percent) were enrolled in D–SNPs, which are specialized MA plans that exclusively serve dual-eligible beneficiaries.
Federal Trade Commission, the Department of Justice and the Department of Health and Human Services Launch Cross-Government Inquiry on Impact of Corporate Greed in Health Care – FTC, DOJ, HHS
The Federal Trade Commission (FTC), Department of Justice (DOJ), and Department of Health and Human Services (HHS) have launched an inquiry, including a public Request for Information (RFI), into private equity firms’ and other corporations’ increasing consolidation in the health care market. Comments on the RFI will be accepted until May 6th, 2024. Comments will inform future priorities and actions on competition in health care and ensuring patients have access to affordable, high-quality health care.
CMS Announces New Model to Advance Integration in Behavioral Health - CMS
CMS announced a new model to test approaches for addressing the behavioral and physical health, as well as health-related social needs, of people with Medicaid and Medicare. The Innovation in Behavioral Health (IBH) Model’s goal is to improve the overall quality of care and outcomes for adults with mental health conditions and/or substance use disorders by connecting them with the physical, behavioral, and social supports needed to manage their care. Under this model, community-based behavioral health practices will form inter-professional care teams consisting of behavioral and physical health providers, as well as community-based supports. The model will launch in Fall 2024 and is anticipated to operate for eight years in up to eight states.
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State Updates Recommendations to the California Health Care Affordability Board: Proposed Statewide Spending Target – California Office of Health Care Affordability The California Office of Health Care Affordability has made a final recommendation to adopt a five-year, single fixed-value statewide spending target of 3.0% for 2025-2029. This recommendation uses median household income as the basis to inform the spending target. A 3.0% target places California on the path of a more sustainable, affordable, and equitable health care system, slowing the trajectory of growth and improving affordability for all.
House Bill 1327 – Indiana General Assembly
Indiana State Representative Donna Schaibley (R) introduced House Bill 1327, which would require ownership transparency for hospitals, physician group practices, and insurers in the state. If passed, ownership information of these entities would be collected by the state government and posted on a public website. Failure to comply with this regulation would result in a fine for the entity. The bill has passed the House and has been referred to the Indiana State Senate. SB 15: Health Care Consolidation Oversight Action – New Mexico Governor’s Office
After advancement by both chambers of the state legislature, SB 15 was signed into law by New Mexico Governor Michelle Lujan Grisham. The bill gives New Mexico’s Superintendent of Insurance the power to review and approve, approve conditionally, or disapprove transactions involving hospitals in New Mexico. Transactions include mergers, acquisitions, and affiliations which could change ownership. It will also grant the office post-transaction oversight over hospitals. HB 1508: Improving consumer affordability through the health care cost transparency board - Washington Governor’s Office
After advancement by both chambers of the the state legislature, HB 1508 was sent to Governor Jay Inslee’s desk. The bill would direct Washington’s Health Care Cost Transparency Board to conduct an annual survey about underinsurance among the state’s residents, as well as authorize the Transparency Board to mandate performance improvement plans or civil monetary fines to payers and providers who frequently exceed the state’s health care cost growth benchmarks. Letter to Steward Health CEO: “Years of Mismanagement, Scheming, and Profiteering Now Pose Urgent Threat to Hospitals in Massachusetts” – Senators Elizabeth Warren and Ed Markey
Senators Elizabeth Warren (D-MA) and Ed Markey (D-MA) are investigating the troubling transactions since 2010, which have left Steward Health’s Massachusetts hospitals with crippling debt. As these hospitals near closure, the Senators are seeking answers about the role that private equity firm Cerberus Capital Management has played in mismanagement, private equity schemes, and executive profiteering while patients, unpaid vendors, and employees of the health system have suffered. |
Families USA Resources
Publications and Reports Report: The Weight of High Hospital Prices is Keeping American Workers Underwater
Families USA issued a new report detailing the impact of high and rising hospital prices on workers’ wage stagnation and income inequality. In particular, high hospital prices are helping to drive historic increases in health insurance premiums. Families USA conducted an original analysis and determined that low- and middle-income workers could lose nearly $20,000 in wages between 2020-2030 if policymakers fail to take action and rein in high and rising hospital prices. A Pro-Consumer Policy Agenda to Achieve Meaningful Health System Transformation
Families USA, alongside the American Heart Association, National Consumers League, the National Partnership for Women and Families, and Third Way, introduced a new policy agenda discussing payment and care delivery reform. The agenda outlines six policy priorities that will shift America’s health care payment system away from the inefficiencies of fee-for-service and toward population- and value-based care that meet the health and health care needs of people in the United States.
Report: Behind the Cost of Care: An Analysis of High and Irrational California Health Care Prices
Families USA issued a new report that dives into the health care affordability crisis plaguing Californians as a result of the giant health care corporations that dominate local markets and increase prices year after year. The paper explores the need for innovative policy solutions, such as the new California Office of Health Care Affordability, which holds the potential to provide real relief from years of health care cost growth.
Report: Understanding the Biggest Threats to the No Surprises Act Achieving Its Full Potential
Families USA issued a new report discussing challenges faced by the No Surprises Act, including more than 25 lawsuits aimed at key provisions in the law, inundation of the Independent Dispute Resolution Process with more disputes than anticipated, and noncompliance by providers or insurers that could place a burden on consumers to know their surprise billing rights and to request their rightful protections. Report: The Human Impact of Payment Reform
Families USA issued a new report, which demonstrates, through patients’ stories, how people across the United States have been negatively impacted by the current fee-for-service system and how payment and care delivery reform can improve the patient experience, lower costs, and help people get access to the health and health care that they deserve.
Families USA submits Comments on CMS 2025 Medicare Advantage and Part D Advance Notice for Changes to Medicare Advantage Payment Policies
Families USA submitted comments to applaud CMS’ work in reining in corporate abuses within the Medicare Advantage program and made recommendations for changes to the 2025 Rate Announcement. These recommendations include applying a higher coding adjustment factor, excluding information collected exclusively through in-home risk assessments, and initiating longer-term reforms the CMS-HCC Risk Adjustment Model. Resources from our Partners Center for American Progress (CAP) Ending Chevron Deference Commonwealth Fund Report Shows Dispute Resolution Process in No Surprises Act Favors Providers
Georgetown Law: O’Neill Institute for National & Global Health Law No Surprises Act Litigation: Where We Are and What Comes Next Leukemia & Lymphoma Society Healthcare Consolidation Is Raising Prices and Jeopardizing Cancer Care: Policymaker Recommendations National Patient Safety Board: Advocacy Coalition
U.S. House Bill to Establish an NPSB, and Email Your Representative Patient Rights Advocate
Sixth Semi-Annual Hospital Price Transparency Compliance Report Upcoming Events
Please join Families USA on Tuesday, April 2, at 1:00 pm ET for First Do No Harm: Addressing the Patient Safety Crisis. This webinar will explore how the creation of a National Patient Safety Board would be a first step in addressing the patient safety crisis, allowing for data aggregation and analysis, identification of patterns and causes of harm, and creation and dissemination of autonomous solutions that can improve the quality of our care.
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If you would like to reach out, please contact Mike Persley, Strategic Partnerships Campaign Manager, at [email protected] |
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