HealthCare Roundtable e-News – October 30, 2023


The Roundtable is pleased to welcome our newest Corporate Member!


Merative is a data, analytics and technology partner for the health industry, including providers, payers, life sciences companies and governments. With trusted technology and human expertise, Merative works with clients to drive real progress. Merative helps clients reassemble information and insights around the people they serve to improve healthcare delivery, decision making and performance. Merative Health Insights delivers an integrated data warehouse and analytics portfolio that’s easy to access. Helping you get the information you need to reach your goals of optimized program performance and improved population health. Merative, formerly IBM Watson Health, became a new standalone company as part of Francisco Partners in 2022.

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Top News

Senators Introduce Bill to Expand Medicare Access for Retired First Responders

U.S. Senators Sherrod Brown (D-OH), Richard Blumenthal (D-CT), and John Fetterman (D-PA) have introduced the Expanding Health Care Options for First Responders Act. This bill aims to allow retired first responders, including police officers, firefighters, and emergency medical services personnel, to buy into Medicare starting at age 50. Many first responders retire early due to the physically demanding and often dangerous nature of their work, leaving them with gaps in healthcare coverage until they become eligible for Medicare at 65. The proposed legislation would ensure that retired first responders aged 50 and older have access to affordable and comprehensive health insurance with the same benefits as the existing Medicare program. The bill also allows for tax credits, subsidies, and contributions from their former employers or pension plans, all while ensuring that it does not negatively impact the existing Medicare program.

This initiative has received widespread support from numerous organizations representing first responders, including the Fraternal Order of Police, the International Association of Fire Fighters, the International Union of Police Associations, the National Association of Police Organizations, the National Conference on Public Employee Retirement Systems, the National Sheriffs’ Association, and the National Troopers Coalition. These organizations recognize the need to provide quality healthcare options for those who have dedicated their lives to protecting their communities. Companion legislation has also been introduced in the House by U.S. Representative Dean Phillips (D-MN-3).


Trilliant health data reveals a declining trend in preventive care following the pandemic

Trilliant Health report analyzed the trends shaping the health economy in 2023 and found significant trends in various areas such as a decline in physical and mental health status of Americans, an eroding commercial market, and increased investments of several biopharmaceutical manufacturers in oncology, immunology and rare disease. Despite a growing burden of disease, demand for healthcare is projected to remain tepid over the next five years, which will affect all healthcare stakeholders. The data showed a 6 percent fall in primary care visits between 2021 and 2022, continuing the dip in primary care visits. Meanwhile, urgent care visits rose by nearly 14 percent between 2021 and 2022 and emergency department visits rose by more than 3 percent. The decline in preventive care may suggest that health systems are not investing as much in primary care and primary care payment models need to better reward high-quality primary care.

Administrative Action

The Centers for Medicare and Medicaid Services (CMS), together with NORC at the University of Chicago, released the first annual report of the Global and Professional Direct Contracting Model (GPDC) for Performance Year (PY) 2021. GPDC (now known as ACO REACH) is a voluntary, accountable care organization (ACO) model that builds on CMS’ previous ACO initiatives to improve beneficiary health outcomes, improve quality of care, and reduce costs by offering participating Direct Contracting Entities (DCEs) greater flexibility and options to take on financial risk. The first annual evaluation report provides several initial findings of the model’s results, including that in PY 2021, there were no significant impacts on gross or net Medicare expenditures, standard DCEs reduced high-cost acute hospital spending and utilization by 3.5% and standard and new entrant DCEs reduced unnecessary emergency department visits. These results are unsurprising, as the first year of any new model demonstration is primarily focused on setting up population health management infrastructure and crafting high-impact strategies focused on reducing unnecessary utilization of services while promoting enhanced primary care. Notably, GPDC is the precursor to the current ACO REACH demonstration, which officially began in January 2023 for new and continuing participants (fact sheet | annual report).

Congressional Action

  • A group of 91 bipartisan congress members in the United States House of Representatives recently sent a letter to the U.S. Department of Health and Human Services (HHS) Secretary Xavier Becerra that expressed concerns with the Center for Medicare and Medicaid Services’ (CMS) proposed rule that was issued on September 1, 2023. The rule would establish minimum staffing requirements and standards for nursing homes, which these representatives believe would consequently lead to nursing home closures throughout the country. The coalition of representatives explained that the proposed rule would require nursing homes across the country to hire 13,000 registered nurses and 76,000 nursing assistants. These requirements would increase the safety thresholds by around 1%, while costing the industry between $1.5 to $.6 billion to fully implement. In addition to the letter, Representative’s Pence and Fischbach have introduced H.R. 5796 – the Protecting Rural Seniors Access to Care Act. The bill would prevent CMS from implementing the proposed rule until the agency can prove that it will not result in nursing homes closures.
  • The House Energy and Commerce (E&C) Committee Subcommittee on Health recently held a hearing on “Supporting Access to Long-Term Services and Supports: An Examination of the Impacts of Proposed Regulations on Workforce and Access to Care.” Committee members discussed at length CMS’ recently proposed rule on Medicaid Access, which establishes an 80% payment threshold for direct care workers, and proposed rule on Nursing Facilities, which establishes minimum staffing levels for these facilities. Key considerations and unintended consequences with implementing the rules were discussed, highlighting the unrealistic nature of the requirements, its operational challenges, and the underlying issues that drive workforce shortages. House Republicans argued that the proposed rules would disproportionately affect rural and smaller providers, so much so that they would face closure under the new mandates. In contrast, House Democrats supported the implementation of the proposed rules stating that they will lead to better recruitment and retainment of the direct care workforce.

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