Weekly Roundup (August 14-August 18, 2023)
Physician payment, coding, coverage, and quality reporting news highlights.
This week there were lots of stories on the first anniversary of the Inflation Reduction Act (IRA). But, I must admit the health policy news that truly riveted me this week was the JAMA research letter on a successful pig-to-human kidney xenotransplant. It makes me giddy thinking about what that potentially means for those waiting for organ transplants. Now, on to the Weekly Roundup!
PAYMENT/FUNDING
CMS Reduces Surprise Billing Administrative Fee After Recent Court Ruling. The Centers for Medicare and Medicaid Services (CMS) reduced the administrative fee for the independent dispute resolution (IDR) process from $350 (increase established in January 2023) to its original price of $50. This fee is paid by both parties involved in the dispute. Not surprisingly, this 600% price increase was quite controversial, and the reinstatement to the $50 payment level resulted from a challenge by the Texas Medical Association (TMA), which stated that the steep increase “dramatically curtailed many physicians' ability to see arbitration” when challenging a health plan’s payment for out-of-network services. The U.S. District Court for the Eastern District of Texas ruled in favor of TMA. CMS notes that they are not required to issue refunds for fees paid before the court ruling.
As previously reported, CMS temporarily suspended the IDR portal due to this court decision. CMS has indicated that they are working on additional guidance.
PAYMENT INNOVATION/ QUALITY
CMS Announces Changes to ACO REACH for 2024. On August 14, 2023, CMS announced it was making changes to its Accountable Care Organization Realizing Equity Access and Community Health (ACO REACH). Of note, CMS is proposing changes to the original health equity measures. In particular, due to the measure's methodology, the Area Deprivation Index (ADI) has been criticized as less accurate in identifying social risk in urban areas. ACO REACH was designed to promote health equity by incentivizing medical groups to treat underserved patients with enhanced payments. In such a model, health equity measures are critical.
The agency is also implementing several other changes in 2024 in response to stakeholder feedback. The changes include reducing beneficiary alignment minimums to increase predictability for model participants, revising the risk adjustment methodology to protect against risk growth, and maintaining consistency across CMS payment models.
ACO REACH replaced the Global and Professional Direct Contracting Model, a controversial model established during the previous Administration. There are currently 132 participants in ACO REACH, which began on January 1, 2023, and runs through the performance year 2026.
Request for Applications (RFA) for the Making Care Primary Model Now Available. CMS has released an RFA detailing model payment, care delivery, quality, and other policies for the Making Care Primary (MCP) Model. Interested applicants may apply to the model when the Application Portal opens later this month. Announced on June 8, this value-based primary care model will provide participants with additional revenue to build infrastructure and will be tested in eight states over ten years (July 1, 2024-December 31, 2034). The model provides pathways for small, independent, rural, and safety-net primary care organizations to enter value-based care arrangements.
To be eligible to apply to participate in MCP, an organization must: be a legal entity formed under applicable state, federal, or Tribal law authorized to conduct business in each state in which it operates; be Medicare-enrolled; bill for health services furnished to a minimum of 125 attributed Medicare beneficiaries; and have the majority (at least 51%) of their primary care sites (physical locations where care is delivered) located in an MCP state.
CMS will answer questions during office hours from 2-3 PM ET on August 21, 2023, for those considering applying. More information can be found on the MCP Model webpage.
Joint Commission and the NQF Announce Alliance. On August 16, 2023, the Joint Commission announced it acquired the National Quality Forum (NQF). The NQF will maintain its independence in convening and developing consensus-based measures. This alliance aims to improve the alignment of measures to streamline the quality reporting requirements for all.
NQF convenes stakeholders to develop quality measures. Until May 2023, CMS contracted with NQF as the consensus-based entity (CBE) for performance measurement, providing endorsement and maintenance of healthcare performance measures. The Joint Commission accredits and certifies hospitals and healthcare organizations.
FUNDING OPPORTUNITIES
Funding Opportunity for County and State Medical Associations on Drivers of Health. The Physicians Foundation is awarding five non-renewable, one-year grants for up to $75,000. The application deadline is September 18, funding decisions will be made by October 31, and the project start date is January 2, 2024.
The grants will fund on-the-ground initiatives that integrate drivers of health into medical practices. The Physicians Foundation has identified five health drivers impacting a patient’s well-being: food security, housing stability, transportation access, utilities access, and interpersonal safety. The impetus for this funding opportunity is partially the result of a 2022 survey by the organization where 80% of physician respondents indicated that they believed “that the United States cannot improve health outcomes or reduce healthcare costs without addressing drivers of health.”
ARPA-H Launches Digital Health Security Project: Will Seek Proposals for Novel Solutions to Address Cyberattacks on the U.S. Healthcare System. The average cost of a breach in the healthcare industry is estimated to be over $10 million, the highest of all sectors, and the number of cyberattacks on healthcare systems grows steadily each year. On August 17, 2023, the Advanced Research Project Agency for Health (ARPA-H) announced they are launching the Digital Health Security (DIGIHEALS) project. The agency will seek proposals that apply technologies developed for national security to civilian health systems, clinical care facilities, and personal health data.
Established over a year ago by the Biden Administration, ARPA-H seeks to fund innovative projects addressing challenges in the healthcare system that cannot be addressed through traditional research or the commercial sector.
CODING
Registration is open for September 12 ICD-10 Meeting. Members of the public can register for this virtual-only meeting. Several ICD-10-PCS procedure codes with scheduled implementation dates of April 1, 2024, will be discussed at the meeting. CMS also indicated that they are seeking comments on two therapeutic agents: (131I)-apamistamab (used in the treatment of Acute Myeloid Leukemia) and Talquetamab (used in the treatment of adults with relapsed or refractory multiple myeloma). Comments are due on October 13, 2023. CMS will not make presentations on these therapeutic agent topics at the September meeting, although slides are available on the website.
COVERAGE
Updates to Acupuncture for Chronic Low Back Pain, NCD, Effective January 1, 2024. CMS released an MLN article (MM13288) detailing updated frequency edits for acupuncture for low chronic low back pain.
OPPORTUNITIES TO ENGAGE
National Telehealth Conference, September 12. Registration is now open, and public and private stakeholders are invited to attend. Hosted by the Health Resources and Services Administration, the conference will cover a range of topics, including the adoption of telehealth, the expansion of broadband connectivity to improve health equity, tele-behavioral as a model for integrating telehealth into other services, telehealth’s impact on the healthcare workforce, and the future of telehealth. This is an entirely virtual event.
CLIMATE CHANGE
Air pollution and dementia. Results from a National Institutes of Health (NIH) study “suggests reducing exposure to airborne particulates may decrease dementia risk.” The link between air pollution and dementia has been previously studied.
How healthcare providers can help address climate change. This article posted on Medscape this week recommends five steps providers can take to reduce the impact of climate change on their practice.
Increase the primary care workforce: The authors suggest that these providers are in a position to help patients make decisions, such as biking versus driving, when possible.
Move more care into the home. Services like telehealth can reduce carbon emissions.
Rethink supply chains. More local supply chains can help the local economy and reduce carbon emissions.
Make prudent use of medical supplies. This can have a positive impact on the climate but also may provide cost savings and improve efficiencies.
Ensure vulnerable communities are represented when planning climate policies. Climate change can disproportionately impact marginalized communities, negatively impacting their health. A healthcare provider, often viewed as a trusted advisor, can ensure these communities are included in decision-making that affects community health.
Articles that Grabbed Our Attention
This week, these articles grabbed our attention; we thought they would also interest you.
The Hidden Fee Costing Doctors Millions Every Year (ProPublica - August 14, 2023)
Anesthesia Clinical Workload Estimated From Electronic Health Record Documentation vs. Billed Relative Value Units (JAMA Network - August 11, 2023)
Health Care CEOs Hauled in $4 Billion Last Year as Inflation Pinched Workers, Analysis Shows (STAT News – August 17, 2023)
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For more information and questions, please contact:
Sheila Madhani, MA, MPH
Madhani Healthcare Consulting, LLC
Email: smadhani@madhani-health.com
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Tel: (202) 679-2977