Physician Practice Roundup—CMS' ACO proposal resurfaces discord over pace of risk-based models and more news

A physician in scrubs in a hospital hallway
CMS wants accountable care organizations to take on more risk going forward. (Getty/NanoStockk)

CMS' ACO proposal resurfaces discord over pace of risk-based models

Obama-era healthcare officials have rarely had positive things to say about the Trump administration's actions. But last week, one expressed praise for CMS' most recent proposed rule.

The rule (PDF), which would limit the duration of one-sided risk ACOs, is a step in the right direction, said Farzad Mostashari, M.D., who served as the National Coordinator for Health IT under President Obama.

"The overall framework that they have, … a basic track and then an enhanced track, I think, is a good framework," said Mostashari, who has since founded the ACO company Aledade. (FierceHealthcare)

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‘Dear Doctor’ letters that tell clinicians about a patient’s death reduce opioid prescribing

Doctors that learn of a patient’s death from an opioid overdose then prescribe fewer opioids, a study found.

The San Diego County medical examiner’s office sent more than 400 letters to doctors telling them of a patient’s fatal overdose within 12 months of a prescription. Over the next three months, those who received letters reduced their average daily opioid prescribing by almost 10% compared to prescribers who did not get letters. The letters reminded physicians of safe prescribing practices, according to the study. (Science study)

DOJ expands Medicare Fraud Strike Force to Newark and Philadelphia

The Department of Justice (DOJ) is adding several more cities to its Medicare Fraud Strike Force, a federal program that targets cities with high rates of fraud, waste and abuse. 

A new regional division will be based in Philadelphia and Newark, New Jersey, the agency announced Monday. 

The number of opioids prescribed per capita is notably high in New Jersey and Pennsylvania, according to Nicole Navas Oxman, a spokesperson for the DOJ. (FierceHealthcare)

Mental health, substance abuse treatment have the highest percentage of out-of-network claims

A substantial number of out-of-network claims are associated with patients who have fewer specialists available within their network. That's particularly true when patients seek treatment from mental health and substance abuse providers.

Seeing out-of-network providers can cause patients to pay significantly more in out-of-pocket costs, but some patients are willing to bear this cost under certain conditions. Even aside from controversial "surprise billing" practices, patients may intentionally seek out providers that aren't in their network due to familiarity, reputation or convenience, according to a recent brief from the Kaiser Family Foundation (KFF). 

But patients who sought outpatient mental health services were significantly more likely than other patients to have an out-of-network claim, KFF found in its analysis of people with large employer coverage. Specifically, patients with an outpatient psychotherapy or therapeutic psychiatric claim submitted out-of-network claims at more than triple the rate of patients overall. (FierceHealthcare)