On April 29, the U.S. House Committee on the Judiciary, Subcommittee on Antitrust, Commercial, and Administrative Law, will hold a hearing entitled “Treating the Problem: Addressing Anticompetitive Conduct and Consolidation in Health Care Markets.” The hearing will examine proposals to lower pharmaceutical drug prices and address consolidation in the markets for hospital care, health insurance, prescription drugs, and other health care products and services.
PEPC submitted a statement for the record for the hearing, highlighting concerns around increasing consolidation in the provider market and the urgency it creates to ensure that value-based care is a path to sustainability for practices and physicians who are independent and wish to remain so.
PEPC highlighted evidence of the detrimental impact of provider consolidation in the following areas:
- Provider consolidation leads to higher costs without measurable improvements in quality.
- Without further action by Congress and/or the Administration, provider consolidation is expected to continue and accelerate as a result of the COVID-19 pandemic.
- There is an urgent need for Congress and the Administration to ensure that value-based care models are fully leveraged as an option to keep provider markets competitive.
PEPC proposed several recommendations for Congress and/or the Administration to take action, including:
- Expand Medicare site neutral payment policies to additional services/procedures proven to increase in cost after a practice’s acquisition without an increase in quality.
- Enforce information blocking regulations to ensure that patient information is not used as a strategic asset to retain patients.
- Implement recent CMS regulations establishing a new Medicare/Medicaid Condition of Participation requiring event notifications to be shared with a patient’s provider of record when they go to the ER, or are admitted or discharged from the hospital, in a manner that requires hospitals to send notifications to a practice’s roster of patients.
- Build new physician-led model options based on successful underlying chassis (e.g., CPC+, MSSP, etc.) to encourage providers to enter into value-based care models with predictable implementation and proven results.
- Ensure options for providers to join entry-level value-based care models with a glidepath to greater amounts of risk and/or more sophisticated requirements while also clearly communicating the bridge or “off ramp” to another model at the end of the model test.
- Revise regulations and/or pass legislation directing the Secretary to remove an ACO’s own beneficiaries from an ACO’s benchmark, thus putting rural and urban ACOs on even footing with respect to their ability to be rewarded for care improvements and cost reductions.
Read the full written testimony here.