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
Hearing on “Health Care Transparency: Lowering Costs and Empowering Patients”—Senate Special Committee on Aging
The Senate Special Committee on Aging held a hearing on July 11 to discuss the need for transparency and competition in the U.S. health care system. Families USA’s Senior Director of Health Policy, Sophia Tripoli, testified before the committee on how a lack of transparency, high rates of hospital consolidation, and high and rising prices hurt consumers, employers, and taxpayers. Access her full written testimony here, and watch her live testimony here.
Hearing on “What Can Congress Do to End the Medical Debt Crisis in America?”— Senate Committee on Health, Education, Labor, and Pensions
The Senate Health, Education, Labor, and Pension (HELP) Committee held a hearing on July 11 with experts on potential policy options to address medical debt. Medical debt, which disproportionately impacts people of color, creates a financial burden on patients that may result in delaying necessary health care or making choices between care and other necessities.[1]
With Bipartisan Vote, Sanders Leads HELP Committee Investigation into Bankruptcy of Steward Health Care and Subpoenas Its CEO –Senate Committee on Health, Education, Labor, and Pensions
The Senate HELP Committee, in a bipartisan vote, authorized an investigation into the bankruptcy of Steward Health Care and issued a subpoena of the company’s CEO.
This is the first subpoena issued by the HELP Committee since 1981 and compels Dr. Ralph de la Torre, Steward’s CEO and Chairman, to testify at a hearing on September 12 titled, “Examining the Bankruptcy of Steward Health Care: How Management Decisions Have Impacted Patient Care.” Steward is being investigated for the management of their finances and the impact of closures on patients. [1] https://unduemedicaldebt.org/the-problem-with-medical-debt/ |
The Latest from the Biden Administration
CY 2025 Outpatient Prospective Payment System (OPPS) Proposed Rule—CMS
CMS released their annual OPPS proposed rule for the calendar year 2025. The proposed rule includes establishment of a federal Condition of Participation (COP) for obstetric (OB) services, updates to existing COPs in relation to OB services, and updates to Hospital Outpatient Quality Reporting (OQR) Program measures. Importantly, the rule has two major omissions in the areas of advancing stronger hospital price transparency and comprehensive site neutral payment policy. Comments on the proposed rule are due September 9.
CY2025 Medicare Physician Feed Schedule (MPFS) Proposed Rule—CMS
CMS released their annual MPFS Proposed Rule for calendar year 2025. The proposed rule includes new bundled payment codes for Advanced Primary Care Management (APCM) services, the addition of audio-only services for telehealth services, changes to beneficiary attribution into accountable care organizations (ACOs), and a new Health Equity Benchmark Adjustment (HEBA) for the Medicare Shared Savings Program (MSSP). Comments on the proposed rule are due September 9. CMS Proposed Rule to Impact Billing Abuses in the Medicare Shared Saving Program-CMS
CMS released a proposed rule titled “Medicare Program: Mitigating the Impact of Significant, Anomalous, and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year 2023.” The proposed changes to MSSP exclude payment for two Durable Medical Equipment, Prosthetics, Orthotics & Supplies payment codes that CMS identified as particularly susceptible to fraudulent billing. Ensuring that financial benchmarks for ACOs participating in MSSP are calculated using accurate payment code data is critical to determining which providers are generating savings by delivering high-value care to their patients.
CMS Announces First States to Participate in AHEAD Model- CMS
CMS announced that Connecticut, Hawai’i, Maryland, and Vermont will be the first states participating in their All-Payer Health Equity Approaches and Development (AHEAD) model. The model is a voluntary total cost of care model, scheduled to operate for a total of eleven years, through 2034. The model builds off similar state models and includes hospital global budgets and an emphasis on primary care participation.
CMS Launches Making Care Primary Model- CMS
CMS launched a voluntary primary care model focused on improving care management, care integration, and “community connection.”[1] There are eight states initially selected to participate: Colorado, Massachusetts, Minnesota, New Mexico, New Jersey, New York, North Carolina, and Washington. The model will support primary care providers entering alternative payment models for the first time. Funding and technical assistance offered to these providers will help to build primary care capacity, transition providers toward receiving population-based payments, and implement quality improvement frameworks to optimize care coordination and address health equity.
[1] https://www.cms.gov/priorities/innovation/innovation-models/making-care-primary |
State Updates
PA HB2339: -Pennsylvania State General Assembly
The Pennsylvania House of Representatives passed a bill to amend the Health Care Facilities Act by adding a chapter. The bill includes requirements for hospital price transparency and would prohibit hospitals from collecting medical debt from patients, and reporting debt to a credit reporting agency, if they fail to meet the transparency requirements. The bill is now in the Senate Health and Human Services Committee. PA HB2344-Pennsylvania State General Assembly
The Pennsylvania House of Representatives passed legislation that would amend the Health Care Facilities Act by adding a chapter. The bill would give the Office of the Attorney General the authority to oversee when for-profit and non-profit hospitals change hands or undertake major corporate or financial restructuring. The bill is now in the Senate Health and Human Services Committee.
CA AB-3129: Health care system consolidation – California State Assembly
Originally introduced by Assembly Member Wood, AB-3129 advanced to the California Senate Appropriations Committee. If passed, the bill would build on the authority of California’s Office of Health Care Affordability and strengthen the Attorney General’s oversight of private equity’s involvement in health care. The bill would establish restrictions on private equity firms acquiring physician and behavioral health practices. Speaker Longhurst, Senate Majority Leader Townsend Issue Statement on ChristianaCare’s HB 350 Lawsuit—Delaware House Democrats
ChristianaCare, the largest hospital system in Delaware, filed a lawsuit against Delaware House Bill 350, a recently passed bill that establishes a review board to oversee hospital spending in the state. The lawsuit claims that the bill violates Delaware’s state constitution and was filed with the Court of Chancery, Delaware’s court of origin. It is awaiting a hearing date.
Fourth Evaluation Report: Evaluation of the Vermont All-Payer Accountable Care Organization Model: 2018-2022- NORC at the University of Chicago
CMS launched the Vermont All-Payer Accountable Care Organization (ACO) Model (VTAPM) in 2017. This model aimed to test whether scaling an ACO structure across all major payers in the state would support broad care delivery transformation and ultimately reduce statewide spending and improve population health outcomes The recently released fourth evaluation of the VT All-Payer ACO model showed that between 2018 and 2022 the VTAPM Medicare ACO cut gross spending by almost $800 per beneficiary per year. The VTAPM model was associated with improvements in primary care utilization, access to mental health services and treatment for substance use disorders.
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Health Care Value in the News
Publications and Reports
Congress Must Act: Stop Big health Care Corporations From Taking Advantage of Rural Communities
Families USA’s new factsheet highlights how large health care corporations and their anti-competitive behaviors particularly harm rural communities, who already face more limited access to care, higher health care costs and premiums and worse health outcomes.
Families USA Submits Comments on the Increasing Organ Transplant Access Model
CMS has introduced the Increasing Organ Transplant Access (IOTA) Model. Families USA strongly supports the work of CMMI to explore and implement promising new mandatory payment models for qualifying hospitals. Areas of improvement include improving data collection and metrics on health equity, improving health equity through increased performance-based payments, and improving shared decision making.
Families USA Submits Response to Request for Information on New Legislation to Improve Primary Care
Families USA joined 19 other organizations (including consumer, provider, and employer advocacy groups) in submitting recommendations on the bipartisan Pay PCPs Act. The recommendations are aimed at ensuring access to an affordable, equitable, effective and comprehensive primary care system.
Consumers for Fair Hospital Pricing Legislative Agenda
Consumers for Fair Hospital Pricing, coalition of leading organizations representing families, individuals and health care consumers, developed a set of legislative policy priorities that focuses on three key areas that are critical to making hospital care higher quality and more affordable for our nation’s families.
Families USA Statement for the Record for Hearing on the Transition to Value Based Care
Families USA submitted a statement for the record for the E&C Health Subcommittee hearing “Checking-In on CMMI: Assessing the Transition to Value-Based Care.” The statement highlights the ways in which CMMI has already been leading the way by making major investments in the health care system that have triggered key transformational changes to the way health care is paid for and delivered.
Families USA Comments on Proposed Medicare Hospital Inpatient Prospective Payment System (IPPS) Regulation for Calendar Year 2025
Families USA submitted comments on the proposed Medicare Hospital Inpatient Prospective Payment System (IPPS) regulation for Calendar Year 2025. The policy recommendations in the comment would go a long way to catalyze the transformational change needed in our payment system to drive equitable, high-value care in health care markets throughout the U.S.
Families USA Comment on Tri-Agency Consolidation Request for Information Families USA responded to the Request for Information (RFI) on Consolidation in Health Care Markets. The response was focused on the effects of consolidation, the claimed business objectives for transactions, and the need for government action. |
Upcoming Events
Please join Families USA on Thursday, August 29, at 3pm ET for our latest webinar, Families USA 2024 MPFS and OPPS Rules Webinar. This webinar will run through Families USA’s key recommendations across several areas spanning both MPFS and OPPS, including:
- Updates to Advanced Primary Care Management (APCM) payment codes
- Beneficiary attribution to ACOs
- Health Equity Benchmark Adjustment (HEBA) in the Medicare Shared Savings Program.
- Concern over the lack of proposed updates to strengthen federal hospital price transparency and comprehensive site neutral payment policies.
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Updates to the Hospital Outpatient Quality Reporting (OQR) Program
- Establishment of a Condition of Participation (COP) for obstetric (OB) services and updates to established COPs to include OB services.
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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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