Becker's Hospital Review

33 33 CEO/STRATEGY AHA says payer consolidation, not hospital prices, raises healthcare costs By Morgan Haefner I n a letter to Senate Judiciary Committee Chairman Chuck Grassley, R-Iowa, the American Hospital Associ- ation argued that contract negotiations between hos- pitals and commercial payers are not driving healthcare costs up. The Oct. 22 letter responded to an inquiry Mr. Grassley sent to the Federal Trade Commission Oct. 10 asking the agency to investigate contracts between hospital systems and insurers, according to The Wall Street Journal. At the time, Mr. Grassley asked the FTC to examine whether contracts between health systems and payers are limiting competition and causing healthcare costs to rise. He cited a recent article in The Wall Street Journal that documented secret contract terms barring health insurers from excluding market-dominant providers from their network and prohibiting insurers from steering pa- tients toward less-expensive rivals. However, the AHA said the article "misconstrued the dy- namics between hospitals and commercial health insur- ers as it pertains to contract negotiations." "The overwhelming majority of hospitals and health sys- tems are not the drivers in contract negotiations with commercial health insurers," the AHA continued. "When evaluating the relative bargaining power between com- mercial health insurers and hospitals and hospital sys- tems, it is highly relevant that these insurers typically op- erate in markets where they have high market shares and face little competition." n NewYork-Presbyterian CEO: 'We have to have universal coverage' By Alyssa Rege S teven Corwin, MD, president and CEO of New York City-based NewYork-Presbyterian Hospital, told Busi- ness Insider the U.S. must figure out a way to provide all citizens with insurance, but the popular "Medicare for All" may not be the answer. Dr. Corwin noted hospitals and the healthcare industry at large do a lot of very "expensive things," and those costs really add up for patients. One way to bring down those costs is to focus on preventive care, which may eliminate some trips to the hospital in the first place. However, pa- tients need insurance to receive that type of care. "We have to have universal coverage," Dr. Corwin told the publication. "Let's forget the mechanism of getting universal coverage, but I think everybody's gotta be in- sured." Democrats have recently begun to tout the benefits of Medicare for All, a form of universal coverage that would expand Medicare to all Americans. While Dr. Corwin told Business Insider he does not sup- port the movement, the idea of universal coverage would be much simpler for patients than the current system. He cited two major questions about the Medicare for All movement: the type of tax structure that would be neces- sary to support the initiative and whether the movement would be in the best interest of the U.S. "I think we should have that debate," Dr. Corwin said. n A third of ACOs may leave MSSP under new rule, survey finds By Morgan Haefner T he National Association of ACOs found more than a third of ACOs said they are likely to leave the Medicare Shared Savings Program if a proposed rule takes effect. Here are five things to know: 1. CMS issued a proposed rule Aug. 9 that would make sweeping changes to MSSP, in- cluding overhauling the way ACOs share in risks and rewards. e redesigned program — which CMS dubbed "Pathways to Success" — would expand ACO participation agree- ments from three years to five years and of- fer eligible ACOs two participation options: "basic" and "enhanced." 2. e basic track would allow ACOs to par- ticipate under an upside-only agreement for one to two years before gradually phasing in higher levels of risk. Under the enhanced track, ACOs would take on risk and qualify as advanced APMs immediately. 3. NAACOS' online poll of 127 member ACOs found only 27 percent supported the proposal. More than 60 percent opposed the rule. 4. e plurality of ACOs said the biggest challenge they would face under the new rule would be a cut in shared savings rates from 50 percent to as low as 25 percent. 5. Over half (55 percent) of respondents iden- tified the ability to choose an assignment methodology each year, regardless of MSSP track or level, as the biggest opportunity for ACOs under the proposal. n

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