It’s been a while since my last post. I hope everyone is enjoying their summer. In California we’re dealing with very serious wildfire threat. Please hold space in your thoughts and prayers for all of those in harms way – especially the first responders putting their lives on the line for people, their animals and property.
Today, while scanning my twitter stream, I noticed a thread by Farzad Mostashari, MD, co-founder and CEO of ACO management company Aledade.
Considering the drift we’re experiencing in the absence of health policy clarity, the former National Coordinator for Health Information Technology offers his insights via this medium to senior health policy officials including Health and Human Services (HHS) Secretary Alex Azar and Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS).
Since the election of 2016 and preceded principally by Republican leadership bully pulpit messaging of an impending material health policy shift enabled via non-stop ‘ObamaCare is failing’ narratives – proffered by Donald Trump and echoed relentlessly by a mostly health policy illiterate Congress – we’ve been in a conflicted state as to the likely directional vectors reforming our ‘cottage’ industry’s $3.3 trillion spend in 2016 with a per capita $10,348 figure, accounting for 17.9% of U.S. Gross Domestic Product.
This is troublesome given the absence a clear path or unified agenda according to CMS:
‘under current law, national health spending is projected to grow at an average rate of 5.5 percent per year for 2017-26 and to reach $5.7 trillion by 2026. While this projected average annual growth rate is more modest than that of 7.3 percent observed over the longer-term history prior to the recession (1990-2007), it is more rapid than has been experienced 2008-16 (4.2 percent).
In the recent survey titled ‘Third annual study of physicians and health plan executives‘ Quest Labs discloses ‘stalled progress on the road to value based healthcare, noting that 67% of health plan executives and physicians believed the U.S. has a fee-for-service healthcare system versus a value-based care system (27%).
This is noteworthy given several decades of ‘managed care innovation’ designed to advance the value based healthcare agenda. Clearly there is and has been resistance to this shift, health policy benchmarks advanced by HHS and CMS notwithstanding.
Now back to today’s timely thread advanced by Dr. Mostashari – the context for which is ACOs skittish over MSSP rule delay as CMS silence creates mounting uncertainty c/o @DB_Sweeney at Fierce Healthcare.
It’s July 30, which is a hugely significant date to ACOs- It’s normally the day before the deadline to submit applications to @CMSGov for new and renewing ACOs. But the whole cycle has been delayed waiting for @OMBPress to get the MSSP proposed rule out.
The administration has committed to accelerating the pace of alternative payment models and making improvements to shared savings programs. @SecAzar has appointed @AdamCMMi to help accelerate value-based payments. @SeemaCMS has spoken clearly about the need for reforms.
The ACO notice of proposed rule making was received at OMB on May 1, nearly 3 months ago! This is what regulatory uncertainty looks like, and it’s hurting physician practices and businesses who are waiting to make significant financial decisions. @MickMulvaneyOMB
There are thousands of physician practices who are weighing whether to move towards what congress asked them to do in #MACRA- move away from fee for service and towards alternative payment models. In many cases, physician-led ACOs are being weighed against joining the hospital.
There are hundreds of practices who are finishing their existing ACO contract periods and considering whether they move to 2-sided risk models as per admin pref, or drop out of the program, depending on whether the benchmark problems and unpredictability have been addressed.
These delays mean that ACOs will have a very short amount of time to make financially significant decisions in great uncertainty.
Every day of delay at OMB magnifies the probability of fewer physicians taking on advanced alternative payment models
That would be an “own goal”.
Recent converts notwithstanding, those of us who’ve been at this re-tooling or paradigm shift away from volume to ‘value based’ incentives – via a series of innovative delivery system models – for a while do get that ‘healthcare is complicated’. So aligning the stakeholders to move the needle from volume to value is a condition precedent in an already transformation resistant ecosystem.
Let’s keep it up and weigh in via this and other social mediums to keep the pressure on health policy leadership!