Healthcare Snapshot - May 2024

The U.S. Senate Finance Committee recently released "Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options in Medicare Part B." This white paper is in response to the Committee hearing held on April 11, 2024, where PSW CEO, Melanie Matthews, spoke about the advantages of ACOs. The white paper explores reform through Advanced Alternative Payment Model (AAPM) bonuses and changes to the Merit-Based Incentive Program System (MIPS).

The Pay PCPs Act was also recently introduced by Senators Sheldon Whitehouse (D-RI) and Bill Cassidy, MD (R-LA). This act would create "hybrid payments" for primary care providers under the Medicare Physician Fee Schedule Rule. Hybrid payments would be paid in the form of prospective-based payments similar to those being tested in the ACO REACH and ACO Primary Care Flex Models. The act would also reduce cost sharing for Medicare beneficiaries that have designated a specific provider as their primary care provider and create an advisory committee under CMS to provide feedback and support on payment rate setting.

PSW is encouraged by this recognition of the need for payment reform and looks forward to future changes to bolster provider payments.

The PSW Care Management Team followed up with a patient who felt lost after visiting the Emergency Department for breathing problems and pneumonia. The Nurse Care Manager helped them by arranging a meeting with a Nurse Practitioner, refilling their medications, and enrolling them in the Remote Patient Monitoring program.

They also helped the patient find a Primary Care Provider (PCP) despite their fear of doctors. Positive changes were facilitated, such as smoking less and accessing assistance from Medicaid and foodbanks. As a result, the patient remains enrolled in PSW services, regularly connects with their care team, and has a newly positive attitude towards improving their health.

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