PEPC Resources

Letter on Strengthening Innovation in Medicare and Medicaid Act

The Partnership to Empower Physician-Led Care (PEPC) sent a letter to Representatives Sewell, Smith, Cardenas, Shimkust, Schrader, and Wenstrup, expressing concern about the recently-introduced Strengthening Innovation in Medicare and Medicaid Act (H.R. 5742). 

We support value-based care as the future of our health care system and believe that the CMS Innovation Center plays a valuable role in testing a range of new payment and delivery models. 

We believe that guidance and/or “guardrails” around the Innovation Center’s work should focus on the types of innovations that should be tested (e.g. physician-led models that focus on moving clinicians up the risk glidepath) rather than the circumstances under which they should be tested.

Read More

Response to Proposed CMS Stark Law Changes 

The Partnership to Empower Physician-Led Care (PEPC) is pleased to submit our comments on HHS OIG Anti-Kickback Statute. PEPC is a coalition of stakeholders supporting independent physicians and practices in the movement to value-based care.

General Comments:

 1) PEPC supports the addition of new exceptions for value-based arrangements. We propose that CMS require that the value-based arrangements proposed at the exception met a fair market value standard.

 2) We urge CMS not to apply the 15 percent contribution requirement to independent practices and physicians.

 3) While we appreciate CMS modifying the exception for physician recruitment, we believe that this exception could be used anti-competitively and serves to disadvantage recruitment efforts by independent practices.

 4) PEPC strongly supports the addition of specific language that prevents donors of electronic health records items and services from engaging in information blocking.

 5) We support the addition of the exception to protect arrangements involving the donation of certain cybersecurity technology and related services, but urge clarification that the exception should not be used to support intentional or unintentional anti-competitive behavior.

Read More

Response to HHS OIG Anti-Kickback Statute

The Partnership to Empower Physician-Led Care (PEPC) is pleased to submit our comments on HHS OIG Anti-Kickback Statute. PEPC is a coalition of stakeholders supporting independent physicians and practices in the movement to value-based care.

General Comments:

 1) PEPC urges OIG not to apply the proposed 15-percent requirement to independent physicians.

 2) PEPC believes that the proposed cyber security technology safe harbor should not be used to support intentional or unintentional anti-competitive behavior. While we support OIG’s decision, this could be a disincentive for independent practices and physicians given the potential magnitude and cost of administrative burden associated.

 3) PEPC supports the addition of specific language preventing donors from engaging in information blocking.

Read More

Response to Proposed CY 2020 Hospital Outpatient Prospective Payment System Rule 

In light of the recent court decision, PEPC urges CMS to explore regulatory pathways to address site of service payment differentials in a budget neutral manner, which the judge in the U.S. District Court for the District of Columbia indicated would be consistent with the statute. One example could be to prospectively change the manner in which hospitals allocate costs to outpatient cost centers in institutional cost reports, particularly for cost centers where similar services can be provided in physician offices which have no comparable overhead costs.

In the absence of a regulatory solution, we urge CMS to call on Congress to pass legislation to address this issue.

Read More

Response to Proposed CY 2020 Medicare Part B Physician Fee Schedule

PEPC supports the goals of reducing clinician burden and fostering greater alignment to make the transition from fee-for-service to APM participation as smooth as possible. While changes to MIPS may certainly be needed to ensure that the program truly does function as an “on ramp” to participation in an APM, we urge CMS not to lose sight of changes that may need to be made to the APMs themselves to encourage greater participation, particularly by small, independent practices and physicians.

We strongly urge CMS to consider input from our member organizations as it works to identify the right guiding principles, as well as develop and implement MVPs.

Read More.

Group Letter on CMMI Direct Contracting Request for Information on Proposed Geographic Population-Based Payment Model

In partnership with the Alliance for Innovative Primary Care, American Academy of Family Physicians, Medical Group Management Association, National Association of Accountable Care Organizations, Next Generation ACO Coalition, National Coalition on Health Care and the Patient-Centered Primary Care Collaborative, PEPC wrote to CMMI Director Adam Boehler encouraging the adoption of guardrails in the Direct Contracting Geographic PBP Model to preserve choice and competition for traditional Medicare beneficiaries. Examples of such guardrails include prohibiting geographic direct contracting entities (DCEs) from using their market power to mandate or require providers in a specific area to contract with them, or to require patients to see providers with whom they have a negotiated relationship. We also strongly urged CMMI to consider the implications of model overlap in a particular region, specifically by not allowing geographic DCEs to displace or take precedence over existing risk-taking entities working to achieve value-based care. Finally, we encouraged CMS to continue to directly contract with ACOs in the Medicare Shared Savings Program, the Next Generation ACO Program and other CMMI models.

Read More

Group Letter on Next Generation ACO Expansion

PEPC joined with other organizations including the American College of Physicians, AMGA, America’s Physicians Groups, Health Care Transformation Task Force and the Next Gen ACO Coalition to encourage HHS to expand the duration and scope of the Next Generation ACO model to be a permanent, voluntary offering in the performance-based risk model portfolio beginning with the 2021 performance year.

Read More

Response to ONC Proposed Rule on 21st Century Cures Implementation

ONC Health IT Certification Program

1) We supported adoption of the U.S. Core Data for Interoperability (USCDI) data set. We recommended that ONC prioritize data elements necessary for value-based care for future versions, and that ONC release greater specificity regarding the process and timeline for updating USCDI in the final rule.

2) PEPC supported inclusion of the electronic health information (EHI) export criteria as a tool to enable EHR switching, and encouraged ONC to implement the criteria in a standards-based way to reduce burden on providers.

Information Blocking

1) We strongly supported efforts to discourage anti-competitive information blocking, and encouraged ONC to explicitly state that providers who choose not to share information with other providers for competitive reasons are information blocking.

2) We urged ONC to consider an information blocking exception for small practices that are acting in good faith.

3) We recommended that ONC explicitly clarify that health care providers are not captured in the definitions of health information network (HIN) and health information exchange (HIE).

4) With respect to the definition of EHI, we suggested that ONC consider a phased in approach to information sharing, focusing first on information needed to support value-based care (e.g., USCDI).

5) We recommended that HHS ensure that provider information blocking disincentives are appropriate given the size and reach of the provider organization, and that HHS consider stronger disincentives for providers who information block to obtain or retain a competitive advantage over another provider.

6) We recommended that ONC provide technical assistance to support small and mid-sized practices in understanding and navigating these new requirements, coupled with a communications campaign to ensure that providers understand what is permitted for other providers, IT vendors and other stakeholders.

Read More

Response to CMS Proposed Rule on Interoperability and Patient Access

PEPC strongly supported CMS’ proposal to use Medicare and Medicaid Conditions of Participation (CoPs) to encourage hospitals to electronically share information with community providers to support safe, effective transitions of care between hospitals and community providers. We urged CMS to expand its proposal to include patients presenting in the emergency department even if not admitted to the hospital. Finally, we supported making the CoP flexible enough to allow hospitals to use their preferred technological approach to send notifications and recommended that CMS consider other policy options for replacing and/or clarifying the “reasonable certainty” standard included in the proposed regulation.

Read More

PEPC also joined 30+ organizations from across the health care system in reiterating their joint support for use of CoPs to encourage hospitals to share event notifications with community providers.

Read More

Response to CMS Proposed Rule on Medicare Shared Savings Program (MSSP) and Accountable Care Organizations – Pathways to Success

To ensure accountable care organizations (ACOs) remain a viable and attractive value-based care option for independent physicians, PEPC recommended the following to CMS:

1) We recommend that CMS finalize proposals to adopt revenue-based risk under the BASIC Tack while continuing to offer physician-led ACOs the opportunity to spend adequate time in a one-sided, shared savings-only model.

2) We recommend that CMS incentivize physician-led ACOs to participate in Pathways to Success by increasing the minimum shared savings rate and reducing the minimum savings rate for these ACOs.

3) We support proposals to provide more predictable and accurate risk adjustment and benchmarks that work for physician-led payment models.

4) We recommend that CMS remove an ACO’s own beneficiaries from the regional comparator.

5) We support CMS’ proposal to recognize positive and negative changes in patient health status, but recommend that CMS allow for a slightly higher adjustment to capture outlier cases and create predictability.

6) We strongly encourage CMS not to mandate beneficiary opt-in as a primary or sole mechanism for attributing patients to an ACO.

Read More

Webinar on Proposed Changes to the Medicare Shared Savings Program (MSSP)

PEPC hosted a webinar on August 20, 2018 on proposed regulatory changes to the Medicare Shared Savings Program (MSSP) and the impact on independent physicians and practices.

Listen Now

Webinar Slides

Response to House of Representatives Healthcare Innovation Caucus Request for Information

PEPC encouraged the Caucus to consider the important role of physicians in leading new payment and delivery models, making three specific recommendations for the Caucus’ future work: 1) prioritize physician-led advanced alternative payment models; 2) take action to reduce regulatory incentives that undermine physician independence, create excessive consolidation, and thus drive up costs; and 3) harmonize quality measures across new and existing models to the extent possible.

Read More

Response to CMS Request for Information on Interoperability and Health Information Exchange

PEPC noted that timely access to critical health information is fundamental to value-based care, and that independent physicians and practices seeking to adopt these models must have access to important clinical information about their patients to succeed under new models. We believe that it is appropriate for CMS to use health and safety standards to encourage hospitals to electronically share information with community providers to support safe, effective transitions of care between hospitals and community providers; and to encourage hospitals to notify community providers when their patients present in the emergency room.

Read More

Response to CMS Request for Information Regarding Direct Provider Contracting

PEPC encouraged the Centers for Medicare & Medicaid Services to prioritize physician-led alternative payment models, and recommended five principles for CMS to consider when developing new models or refining existing approaches to value-based care.

Read More

Letter to CMS Administrator Seema Verma Supporting Independent Practice

Stakeholders encourage CMS to expand opportunities for physicians and physician-led groups to take financial responsibility for their patients.

Read More

Other Policy Documents

CMS Administrator’s Blog Post on Health Care Competition 

Read More 

HHS, DOL and Treasury Report on Reforming America’s Health Care System Through Choice and Competition

This report identifies four areas where federal and state rules inhibit adequate choice and competition. HHS, Department of Labor, and Treasury offered recommendations for improving public policy in health care workforce and labor markets; health care provider markets; health care insurance markets; and consumer-driven health care. 

Read the Report 

Read a Summary of Recommendations 

HHS OIG Report on the Medicare Shared Savings Program

HHS Office of Inspector General (OIG) found 1) high-performing ACOs were more likely to include only physicians. In 2015, about 45 percent of high-performing ACOs were made up solely of physicians, compared to 36 percent for other ACOs. 2) the number of physician-led ACOs participated in the program has declined over time. In 2013, 42 percent of ACOs were made up solely of physicians; this decreased to 34 percent of ACOs in 2015. Of the ACOs that were made up of both physicians and other entities, 75 percent included hospitals in 2015.
Read More 

Executive Order Promoting Healthcare Choice and Competition Across the United States

The President directed the Administration to ensure that government rules and guidelines meet several policy goals, including re-injecting competition into healthcare markets by lowering barriers to entry, limiting excessive consolidation, and preventing abuses of market power.
Read More

HHS Request for Information (RFI) on Promoting Healthcare Choice and Competition Across the United States
Read More 

Report on Making Health Care Markets Work: Competition Policy for Health Care 

Report by the Brookings Institution, Carnegie Mellon University, and the USC Schaeffer Center for Health Policy and Economics.
Read More