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07/28/2014

Weekly E-Bulletin


Leapfrog Releases 2014 Survey Results

The 2014 Leapfrog Hospital Safety Survey, which looks at how hospitals across the nation perform in critical areas like avoiding medication errors and hospital-acquired infections, was posted Friday by the Leapfrog Group. Hospitals voluntarily participate in the annual hospital safety survey. In the fall, Leapfrog will issue another report giving each hospital a letter grade — A to F — for safety. Click here to check out your hospital’s scores.

Federal Courts Diverge on Obamacare Subsidies

Two U.S. appeals courts issued contradictory rulings on Obamacare subsidies last week. One upheld them in a victory for the White House. The other dealt a blow to the president’s health law by striking them down for millions of Americans covered through HealthCare.gov. No subsidies were cut off immediately as the legal fight will continue. Click here for the NY Times story. Click here to see what will likely happen next.

Bipartisan Group Wants Answers to Health IT Issues

Senate Democrats are now joining Republicans calling to a deeper look into federal support for health IT funds and whether there is an effort by some organizations to block the exchange of patient health information. U.S. Rep. Phil Gingrey (R-GA) called out Epic in a hearing last week and now the Senate Appropriation Committee is asking the government’s top health IT office to quantify how many organizations are involved in the “information blocking problem.” Click here for more.

Report: Health IT Rush Brings Out “Darker Side” of Issue

The rush by providers to adopt electronic health records to take advantage of incentives under the Affordable Care Act has produced efficiencies and safety benefits in the healthcare industry. But the massive undertaking isn’t fully understood and has a dark side, according to Boston Globe story last week. Click here.

Governments Intervene on Efforts to Expand Narrow Networks

Concern over the expansion of “narrow networks”, where insurers limit the number of contracted physicians and hospitals, has promoted some states and the federal government to intervene. Click here for a good summary story.

Michigan Adopting CMS’ 2-Midnight Standard

The State of Michigan has issued a proposed regulation that would impose the 2-midnight inpatient rule on Medicaid inpatients across the state. Why? Because CMS has implemented it for Medicare, according to the state’s notice. Congressional legislation that has been under development for months to “fix” the 2-midnight rule is now languishing in the Ways and Means Committee and there is no certainty that it will happen this year. Click here for the 2-midnight notice from Michigan.

Numbers of Uninsured Drop By 10 Million

The number of uninsured in the United States continues to fall, according to the latest study published in The New England Journal of Medicine. The report found that more than 10 million people gained coverage under the Affordable Care Act. Click here for the NEJM report. Interestingly, more than 1 million Americans have signed up for coverage AFTER the open enrollment period. Click here for that story.

IRS Posts Employer Mandate Forms

The IRS last week posted drafts of the forms that employers will have to fill out to comply with Obamacare’s employer mandate. An administration official said that it’s continuing to implement the employer mandate along the timeline announced by the administration in the winter. At that time, the administration said that companies with 50-100 employees would not be subject to the mandate until 2016. Companies with more than 100 employees would have to comply next year, although they have two years to phase up to 95 percent of workers covered. Click here for the draft forms.

First Democratic Senator Urges Easing of Employer Mandate

Senator Mark Warner (D-VA) is asking the Obama administration to either quickly make ACA regulations on employers less burdensome or postpone the employer mandate for another year, according to a letter he send to the Administration. He’s the only Democrat so far to ask for another delay, which the administration initially pushed back by one year for all businesses and then by an extra year for mid-sized businesses. Click here for the letter.

Budget Chair Ryan Unveils Anti-Poverty Proposal

House Budget Committee chairman Paul Ryan unveiled his latest anti-poverty pitch last week. While his past budgets have included deep cuts to Medicaid, his new plan would allow states to receive block grant funding for safety-net programs, excluding Medicaid. Click here for a Washington Post summary. Click here for the Budget Committee’s summary.

Pharma, Insurers Battle Over High Cost of Drugs

The battle between Pharma and insurers over the cost of some specialty drugs continues and Congress has jumped into the fray. The focal point is Hep C “miracle drug” Sovaldi and its $84,000 price tag. Click here for an update.

Patient Advocates Release Proposals to Cut Drug Costs to Medicare

Some lawmakers are calling for Medicare to offer rebates and negotiate prices to reap significant savings, according to a report released last week by advocacy groups the Medicare Rights Center and Social Security Works. By significantly reducing the costs of certain drugs, the federal government can secure Medicare savings for the program and its beneficiaries, notes the report. Click here for the report. One of the lawmakers calling for changes is Rep. Henry Waxman (D-CA). Click here for that story.

Biosimilars Making Market Entrance, Could Lower Drug Costs

Last week marked the start of what’s expected to become a multibillion-dollar market, as the FDA accepted its first application for a biosimilar from Sandoz, the arm of Novartis that makes generics. It’s for a version of Amgen’s Neupogen — a costly agent that helps prevent infections in cancer patients whose immune systems are suppressed by chemotherapy. Congress passed the Biologics Price Competition and Innovation Act in 2009 to help bring them to the market. Click herefor the Sandoz announcement. Another report says biologics could help bring down the cost of drugs because they will compete with traditional pharmaceuticals. Click here.

Medical Tourism Trend Increasing

Cost challenges under healthcare reform have caused major U.S. health insurers to jump onto the medical tourism trend. Some uninsured or underinsured Americans already travel overseas for bargain priced elective procedures and treatments. Now UnitedHealth Group, WellPoint and Humana are looking to curb expenses by encouraging their members to receive medical tourism procedures abroad through cross-border plans. Click here for the story.

Consumers to Save $330 Million This Year with Insurance Rebates

An HHS report released last week shows that last year alone, consumers nationwide saved $3.8 billion up front on their premiums as insurance companies operated more efficiently. Additionally, consumers nationwide will save $330 million in refunds, with 6.8 million consumers due to receive an average refund benefit of $80 per family. This standard and other Affordable Care Act standards contributed to consumers saving approximately $4.1 billion on premiums in 2013, for a total of $9 billion in savings since the Medical Loss Ratio program’s inception. Click here for HHS’ 3-page report with graphs.

Regs Conflict Could Means Consumers Pay Less

Conflicting regulations could allow consumers to avoid paying their December premiums, according to media reports last week. Federal guidance released July 16 gives people a three-month grace period to pay a premium without losing coverage. But if they enroll in a new policy for 2015, insurance companies can’t apply new premiums to outstanding 2014 debt. So if people don’t pay for December 2014 by February 2015, insurers have no way to force their hand. Click here for details.

GAO: Investigators Find Fraudulently Sign Up for Obamacare

Congressional investigators using fake identities were able to obtain taxpayer-subsidized health insurance under President Barack Obama’s law, according to a new GAO report. The nonpartisan Government Accountability Office says its undercover investigators were able to get subsidized health care under fake names in 11 out of 18 attempts. The GAO is still paying premiums for the policies, even as the Obama administration attempts to verify phony documentation. Click here for the GAO report.

Suit: Tennessee Blocking Access to Medicaid

The Southern Poverty Law Center has filed a lawsuit against the state of Tennessee, accusing it of using Obamacare to block access to Medicaid. The center says in a class-action lawsuit filed last week that Tennessee has shifted Medicaid enrollment to the federal health exchange, which cannot adequately sign up low income Tennesseans in the health care program, still run by the state. The state — which did not expand Medicaid under the Affordable Care Act — also no longer accepts paper applications, which the law center says is illegal under Medicaid law. Click here to see the suit.

Medicare Patient’s Out of Pocket Costs Rising

Medicare patients have seen their out-of-pocket costs rise significantly since 2000, and the increase is especially acute for those who are older, female, have chronic conditions or frequently stay in the hospital. A new analysis from the Kaiser Family Foundation looks at the three main ways seniors and others on Medicare pay for their health care: monthly premiums, cost sharing for Medicare-covered benefits and costs for services not covered by the program. Click here for details.

Children with Medicaid More Likely To Go To ER

Children with Medicaid coverage were more likely to go to the emergency room in 2012 than uninsured kids or those with private plans, according to new CDC data. While the top overall reason for ER visits reflected a serious medical problem, Medicaid kids were more likely to go for a different reason: The doctor’s office was not open. In total, about 18 percent of kids from all groups went to the ER at least once in 2012, and for three quarters of them, their last visit was on a night or weekend. Click here for the CDC details.

CDC: HPV Vaccine Not Used Enough

Only 57 percent of adolescent girls and 35 percent of adolescent boys received at least one of the three necessary doses for the HPV vaccine in 2013, CDC reported last week. While that’s a slight increase over 2012, officials aren’t much closer to their goal of 80 percent. Click here for more from the CDC.

UHC Makes Health App Available to All

UnitedHealthcare has made its free mobile app, Health4Me, available to all consumers. The app gives all users access to an array of health care information, including the ability to review market average prices for more than 520 medical services. It also allows users to locate nearby health care providers, and convenience care, urgent care and emergency care facilities. Click here for details.

Best Hospital Lists

In case you missed it:

  • U.S. News released its 2014-15 Best Hospitals list two weeks ago. Click here for a state-by-state breakdown.
  • Truven’s Top 100 Hospitals for 2014 was released in March, click here. Click here for the their Top 15 Health Systems.

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