Families USA's Center for Affordable Whole Person Care Newsletter

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 Admin State Updates Value in the News Resources

News from Congress

The Pay PCPs Act of 2024 - Senators Sheldon Whitehouse (D-RI) and Bill Cassidy (R-LA)

Senators Whitehouse (D-RI) and Cassidy (R-LA) introduced legislation to better support and improve pay for high-quality primary care providers. If passed, the bill would task the Centers for Medicare and Medicaid Services (CMS) with establishing hybrid payments to reward primary care providers who provide high-quality primary care to patients; lowering the cost-sharing of primary care for Medicare beneficiaries; and creating a technical advisory committee to assist in accurately determining Physician Fee Schedule rates. The hybrid payments would consist of a prospective, per-beneficiary per-month payment for certain primary care services and continued fee-for-service billing for services not covered. The Senators also released an RFI alongside this legislation, asking stakeholders to weigh in on the bill and related questions. Comments are due back to the Senators’ offices by July 15th.

The Health Over Wealth Act - Senator Ed Markey (D-MA)

Senator Markey (D-MA) released a discussion draft of legislation that would require greater transparency into health care entity ownership, put in safeguards to protect health care workers, and protect health care access. If passed, the bill would require for-profit health care entities (including those owned by private equity firms) to report their ownership and finances to the Department of Health and Human Services (HHS). Private equity firms would be required to maintain specific funds covering up to five years of operating costs for risk mitigation, obtain licenses to invest in health care entities, and submit certain transactions to HHS for approval. Additionally, prior to a hospital’s closure or service reductions, HHS would evaluate whether the hospital’s choice would negatively impact a community’s access to services and could require hospitals to maintain essential services.

Hearing on “Breaking Up Health Care Monopolies: Examining the Budgetary Effects of Health Care Consolidation” – House Budget Committee

The House Budget Committee held a hearing to discuss the impact of health care consolidation on health care spending. Families USA’s Senior Director of Health Policy, Sophia Tripoli, testified before the committee. She spoke about the harmful impact of health care consolidation on high and rising health care prices and the deleterious impacts of private equity ownership in health care. Tripoli cited patient stories and proposed legislative solutions to these problems, including strengthening price transparency, enacting site-neutral payment policy, banning anti-competitive contracting, and strengthening FTC oversight authority. You can view her written testimony here and watch her oral testimony here.

Hearing on “Rural Health Care: Supporting Lives and Improving Communities” – Senate Finance Committee

The Senate Finance Committee convened for a hearing with experts on rural health care to discuss the array of issues that rural hospitals are facing, including closures, staffing shortages, and rising costs. Legislators also touched on maternal health care deserts, the advantages of expanding telehealth services, and access to oral health care. The hearing underscored the importance of supporting rural hospitals and health care centers.

White Paper on “Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options in Medicare Part B” - Senate Finance Committee

Senate Finance Chair Ron Wyden (D-OR) and Ranking Member Mike Crapo (R-ID) published a white paper outlining policy concepts related to reforming the way physicians are paid by Medicare and meeting the needs of those with chronic illness. The white paper signals where the bipartisan committee leads are exploring for physician payment reform including ways to incentivize alternative payment models that reward providing better care at a lower cost and ways to bolster primary care.

The Latest from the Biden Administration

FY25 Inpatient Prospective Payment System (IPPS) Proposed Rule - CMS

CMS released their annual IPPS Proposed Rule for fiscal year 2025. The proposed rule includes the following:

Increasing operating payment rates for general acute care hospitals by 2.6 percent.

Continuation of the Low Wage Index Hospital Policy to mitigate wage disparities between high and low wage areas.

Adjustment to payments for Medicare Disproportionate Share Hospitals to make payments more accurate to the level of care provided.

The addition of seven new quality measures and removal of five existing quality measures under the Hospital Inpatient Quality Reporting Program.

Creation of Transforming Episode Accountability Model (TEAM), an alternative payment model to provide targeted acute care hospitals with bundled prices to cover specific episodes of care.

The rule also contains several RFIs, including questions about strengthening Critical Access Hospitals (CAHs) and maternity care. Comments on the Proposed Rule and the RFIs are due back to CMS by June 10th.

Biden-Harris Administration Acts to Improve Access to Kidney Transplants - CMMI

The Centers for Medicare and Medicaid Services Innovation Center (CMMI) announced an Increasing Organ Transplant Access (IOTA) Model. The model aims to increase access to kidney transplants for people living with end-stage renal disease (ESRD). IOTA will be a mandatory model for half of transplant hospitals and will offer performance incentives tied to improving health equity, efficiency, and quality of care. Alongside the model, CMS released a Proposed Rule and RFI seeking input from the public on the implementation of the model and related questions. Comments must be submitted to CMS by July 16th.

Federal Agencies Launch Portal for Public Reporting of Anticompetitive Practices in the Health Care Sector - Federal Trade Commission (FTC), Department of Justice (DOJ), and Department of Health and Human Services (HHS)

The FTC, DOJ, and HHS launched HealthyCompetition.gov, a new website where people can submit examples of behavior that threatens competition in the health care sector, such as price fixing, mergers or “roll-ups”, or preventing transparency in information. The complaints that are submitted to the website will be evaluated by the departments as a part of their efforts to stop monopolistic, anti-competitive practices that undermine the delivery of health care, and ensure healthy and fair competition in the hospital market that provides better health care quality and lower prices.

Proposed Final Noncompete Rule – Federal Trade Commission

The FTC finalized a rule banning new noncompete clauses for all workers and rendering all existing non-compete clauses unenforceable, effective September 4th, 2024. Although this rule does not impact non-profit entities such as non-profit hospitals, the FTC estimates the rule will save between $74 and $194 billion in physician services over the next decade. Without non-compete clauses, physicians, nurses, and other health care providers will be free to start their own practices or switch firms to achieve better salaries, labor practices, and working conditions.

Progress Toward Advanced Explanation of Benefits (AEOB) Rulemaking and Implementation - CMS

CMS released an update on their progress towards implementation of the Advanced Explanation of Benefits (AEOB), which would provide a personalized, good faith estimate (GFE) of the expected charges for a health care item or service to uninsured or self-pay patients. CMS is monitoring the release of new technology to facilitate implementation of the AEOB and will continue to work toward implementation of this provision in the

Antitrust Division’s Task Force on Health Care Monopolies and Collusion – Department of Justice

The DOJ announced the formation of a new task force to guide the Antitrust Division’s enforcement strategy and policy approach in health care. This task force will consider widespread competition concerns including payer-provider consolidation, serial acquisitions, labor and quality of care, medical billing, and misuse of health care data.

State Updates

California adopts new statewide health care cost growth target – Office of California Health Care Affordability

Following an earlier recommendation to set a statewide health care cost growth target of 3%, the Office of California Health Care Affordability (OCHA) has adopted a 3.5% cost growth target beginning in 2025. It will progressively lower across a period of five years until it reaches a 3% target in 2029.

NJ AB382: Health Care Consumer’s Out-of-Network Protection, Transparency, Cost Containment and Accountability Act - New Jersey State Assembly

New Jersey State Assemblyman Robert Auth (R) introduced legislation that would create a physician medical dispute resolution peer review process to supplant the current ‘baseball’ style arbitration, in which providers and insurers each submit one offer to an independent arbiter, who selects from the two offers. The bill also includes patient protections for out-of-network surprise billing or balance billing situations.

PA HB2012: Pennsylvania Open Markets Act – Pennsylvania State House of Representatives

Pennsylvania State Representatives Pisciottano (D) and others introduced legislation that would restrict health care provider acquisitions. If passed, the bill would require 120-day notice of health care transactions and strengthen the Attorney General’s oversight of proposed health care transactions and enforcement of violations.

CA AB-3129: Health care system consolidation – California State Assembly

Originally introduced by Assembly Member Wood (D), AB-3129 was advanced to the CA Senate Appropriations Committee. If passed, the bill would build on the authority of California’s Office of Health Care Affordability. It would strengthen the Attorney General’s oversight over private equity involvement in health care and establish strong restrictions on private equity firms from acquiring physician and behavioral health practices.

Health Care Value in the News

Hospital Pricing   

Hospital prices paid by private insurers vary widely, report finds - Axios

Health Equity  

Medical Debt Affects Much of America, but Colorado Immigrants Are Hit Especially Hard - KFF

Pillars, Policies, And Plausible Pathways Linking Digital Inclusion And Health Equity – Health Affairs

Payment Reform  

Future Bundled Payment Models Need To Engage Physician Group Practices – Health Affairs

Tame The Private Equity Beast By Shifting Its Focus To Value-Based Care – Health Affairs

Can ACOs Flex While Supporting Specialty Care? - Health Affairs

No Surprises Act

Collusion in Health Care Pricing? Regulators Are Asked to Investigate - NYT

Insurers Reap Hidden Fees by Slashing Payments. You May Get the Bill - NYT

A first look at outcomes under the No Surprises Act arbitration process - Brookings

Hospital Consolidation  

Steward Health, Nation’s Largest Physician-Owned Hospital Operator, Files for Bankruptcy - WSJ

Ten Things to Know About Consolidation in Health Care Provider Markets - KFF

Evidence On Private Equity Suggests That Containing Costs And Improving Outcomes May Go Hand-In-Hand – Health Affairs

Price Transparency

State Efforts To Improve Price Transparency – Health Affairs

Site Neutral Payments  

Former HHS secretaries: Congress should adopt site-neutral payments for health care - STAT

Hospitals Are Adding Billions in ‘Facility’ Fees for Routine Care - WSJ

‘Site-neutral’ payments for chemotherapy could save Medicare billions – Washington Post

Families USA Resources

Publications and Reports

Navigating America’s Health Care Woes: A Call for True Payment Reform

In this Insights Column, Families USA breaks down the need to move away from existing fee-for-service payment architecture. The blog includes patient stories about their inability to access affordable, high-quality care and the ongoing policy solutions that can address this all-too-common experience.

National Patient Safety Board: A Step Towards Safer, High-Quality Care

Families USA makes the case for the importance of a National Patient Safety Board, which uses existing data, patient-reported accounts, and input from a public-private partnership team to prevent medical errors like surgical mistakes and avoidable infections. For more information, check out Families USA’s recent webinar with the National Patient Safety Board Advocacy Coalition.

Resources from our Partners

Coalition Against Surprise Medical Billing (CASMB)

Myths & Facts on Implementation of the No Surprises Act

Commonwealth Fund

How U.S. Health Care Providers Are Addressing the Drivers of Health

Georgetown Law: O’Neill Institute for National & Global Health Law

Recent Developments In No Surprises Act Implementation

Third Way

Same Service, Same Price: Tackling Hospitals’ Add-On Facility Fees

Upcoming Events

Please join Families USA on Thursday, June 20, at 1pm ET, for our latest webinar, The Weight of High Hospital Prices: Keeping Workers and Small Businesses Under Water.

Our nation's health care affordability crisis not only harms patients and their families, it is actively hurting workers and small businesses. High and rising hospital prices are a hidden driver of stagnating wages for workers and higher operating costs for small business owners. Families USA along with leading labor and small business groups will break down what is at stake and how we can work towards solutions.

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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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