HealthCare Roundtable e-News – March 2, 2022

CMS Looks to Revamp Direct Contracting Through New ACO REACH Demo

CMS announced last week that it will work towards rebuilding its Global and Professional Direct Contracting Model demonstration in order to focus more on health equity. The new Accountable Care Organization (ACO) REACH initiative is meant to be better overseen by the agency than the previous model after concerns from ACOs and other advocates were raised.

The Trump administration had previously designed a three-track direct contracting model that the Biden administration put on hold in March 2021. In December, Rep. Pramila Jayapal (D-Wash.) and Dr. Susan Rogers, president of Physicians for a National Health Program, contributed an article to The Hill calling for the administration to roll back the demonstration to protect traditional Medicare. Rogers and the Physicians for a National Health Program raised concerns that MA plans acting as direct contracting entities threaten the division between MA and fee-for-service.

According to CMMI Director Liz Fowler, the agency is looking to build the model so that individuals in Traditional Medicare can receive “greater support managing their chronic diseases, facilitate smoother transitions from the hospital to their homes, and ensure beneficiaries receive preventive care that keeps them healthy.” (InsideHealthPolicy)

“Under the ACO REACH Model, health care providers can receive more predictable revenue and use those dollars more flexibly to meet their patients’ needs – and to be more resilient in the face of health challenges like the current public health pandemic. The bottom line is that ACOs can improve health care quality and make people healthier, which can also lead to lower total costs of care,” said Fowler in a press release Thursday.

The move to revamp the model received praise from the National Association of ACOs, who backed the agency’s plan to keep the model but increase the focus on equity, hike provider governance and improve risk adjustment. Concerns were raised by Physicians for a National Health Program, however, which advocates for a single-payer system and called the new program “Direct Contracting in disguise.” (InsideHealthPolicy)

Texas Judge Grants Providers a Win in Battle Over Surprise Billing Rule

A federal judge recently granted a win to providers in a battle over the Biden administration’s surprise billing rule. District Judge Jeremy Kernodle sided with the Texas Medical Association in their charge that HHS violated the statute when it directed arbiters to look at the medium in-network rate when resolving disputes, as well as their position that the administration failed to give stakeholders an opportunity to comment before the interim rule came out.

As it stood, the interim final rule (IFR) barred balance billing for out-network services and established an independent dispute resolution process to address fights over payment. Providers argued that Congress intended arbiters to equally weigh the QPA and five other factors listed in the statute, while insurers and stakeholders claim that Congress wanted the QPA to be the main factor for determining payment.

Those who supported the judge’s decision are calling the ruling, “a major victory for patients and physicians.” The American Medical Association, one of the organizations praising the decision, had previously challenged the IFR in a separate case that was recently consolidated with a similar challenge by the Association of Air Medical Services (AAMS) and is ongoing in the U.S. District Court for the District of Columbia. While providers are celebrating, those who backed the IFR called the decision “harmful and a judicial overreach,” claiming the result isn’t surprising and that it’s still early in the judicial process. (InsideHealthPolicy)

The Justice Department had requested the court remand the IFR back to HHS and other agencies so that it could be reworked, though the judge ultimately ruled that the offending sections of the rule cannot be fixed. The court also rejected the department’s request to narrow the ruling to the plaintiffs and applied the ruling nationwide. (InsideHealthPolicy)

HHS is currently weighing the next steps, according to an agency spokesperson when asked by Inside Health Policy whether the department plans to issue any guidance on how arbiters should proceed with the key parts of the rule now vacated.

Senate Committee Confirms Califf to Lead FDA

On February 15th, a Senate panel voted 50-46 to confirm former FDA commissioner Robert Califf as the agency’s new chief. Califf, who was nominated by President Biden back in October of 2021, will replace Janet Woodcock who has been serving as acting FDA chief since Biden took office in January 2021.

Republican Sens. Bill Cassidy (La.), Mike Braun (Ind.), Steve Daines (R-Mont.), Roger Marshall (Kan.), Tim Scott (S.C.), Tommy Tuberville (Ala.), and Jerry Moran (Kan.) all voted “no,” while Republican Sens. Roy Blunt (Mo.), Susan Collins (Maine), Lisa Murkowski (Alaska), Mitt Romney (Utah) and Pat Toomey (Pa..) voted in favor of Califf. Sen. Richard Burr (R-N.C.), who also voted in favor of Califf, commented that Califf understands what it takes to lead the agency and knows how to turn research into solutions.

“FDA has an opportunity to be forever changed for the better, but it needs effective leadership to get there,” Burr said. “Dr. Califf knows the agency well and understands the value of innovation underway in academia and knows firsthand how the private sector is advancing cutting edge science that can benefit all Americans.” (InsideHealthPolicy)

Michelle McMurry-Heath, president and CEO of Biotechnology Innovation Organization, praised Califf’s confirmation, calling him an “excellent choice” to lead the agency, especially given his past experience at FDA and his work in the clinical trial space. Several Democrats expressed their dissatisfaction with the president’s nomination, but many came around to support Califf after he promised strong action in the accelerated approval space and assured lawmakers he would strengthen his ethics commitment. Sen. Joe Manchin (D-W.Va.) remained opposed and ultimately voted “no” on the nomination. (InsideHealthPolicy)

Health Experts Discuss Health Equity and the Future of Diverse Health on CMS Panel

During a roundtable discussion last week, CMS Administrator Chiquita Brooks-LaSure and a panel of Black women doctors discussed the critical roles that schools, colleges, and universities will play in advancing the equity of care for Black communities across the country. Panelists for the discussion included Anita Jenkins, CEO of Howard University Hospital, Kimberlee Wyche-Etheridge, senior vice president for health equity for the Association of State and Territorial Health Officials, and Ala Stanford, founder and CEO of Black Doctors COVID-19 Consortium.

Among the key topics for discussion included the role that historically black colleges and universities (HBCUs) to build a strong pipeline of talented health care providers and public health experts, as emphasized by Brooks-LaSure. The panel discussed the need for HBCU-trained medical professionals as a solution to both workforce concerns and healthcare inequities, with three of the panelists requesting that CMS increase its support in these areas.

Earlier in the month, Reynold Verret, president of HBCU Xavier University of Louisiana, told a Senate health committee panel that the health care industry has historically supported only a narrow group of middle and high school students interested in a career in medicine.

“Much more must be done to develop a representative community of health care providers, physicians, and scientists to reduce and eliminate health disparities…America cannot afford to develop only a subset of its talent, forsaking many whose contributions are needed and losing them due to socioeconomic barriers,” said Verret. (InsideHealthPolicy)