Welcome

We are a health care consulting firm working at the intersection of health care and government — widely respected for our expertise in congressional and regulatory matters, health policy analysis and solutions, CMS pilots and demos, federal grants development, managed care contracting and association management. more…

Latest on Regulation, Bills, & Reform

Latest E-Bulletins

08/25/2014

Weekly E-Bulletin


FBI Warns Health Care Systems on Data Hacking Efforts; 90% of Providers Have Exposed Patient Data

On the heels of major data hacking against Community Health Systems, the FBI is warning healthcare providers that the agency “has observed malicious actors targeting health care related systems, perhaps for the purpose of obtaining Protected Healthcare Information and/or Personally Identifiable Information,” according to a Reuters report last week. The FBI sent an alert to the private sector last week. Click here for more. Recent numbers show 90% of health care organizations have exposed their patients’ data — or had it stolen — in 2012 and 2013, according to privacy researchers at the Ponemon Institute. Click here.

Report: Secretive AMA Committee Helps Keep Health Care Prices High

One of the reasons for soaring health care prices in the U.S., according to a new investigative report, lies with a secretive committee run by the American Medical Association. With the assent of the government, this committee has enormous power to determine Medicare prices by assessing the relative value of the services that physicians perform. For decades, the committee has done so in a way that has skewed Medicare fees in favor of expensive specialists over ordinary general practitioners. Click here for the story. The AMA has responded. Click here.

Study: VBP Programs Penalizing Providers, Creating Wrong Incentives

Value-based purchasing programs often penalize providers for costs that are beyond their control, which may discourage them from seeing the sickest patients, according to a study released last week from the Center for Healthcare Quality and Payment Reform. Specifically, the report shows how the spending measures can: Inappropriately assign accountability to physicians and hospitals for services they did not deliver and cannot control, while at the same time failing to hold healthcare providers accountable for most of the services they do deliver; and financially penalize physicians and hospitals who care for patients with complex problems and who deliver evidence-based services to their patients. Click here for this interesting and detailed report. Click here for the news story.

UPMC, Highmark Call It Quits

Pittsburgh-based Highmark Blue Cross Blue Shield and the University of Pittsburgh Medical Center (UPMC) are calling it quits after decades of working together. Competition among healthcare insurers and providers, spurred by the Affordable Care Act, have sparked this separation, as more and more insurers are making moves to become healthcare providers, reports NPR. Click here for the story.

California Anthem Smacked with Narrow Network Lawsuit

A consumer watchdog has hit California’s Anthem Blue Cross with a class-action lawsuit for allegedly misleading millions of members about whether physicians and hospitals were participating in new plan networks, according to the LA Times. Insurers often offer narrow networks as a way of keeping premiums low for individual policies and many insurers in California, including Anthem, are sticking with this narrow-network mindset leading into 2015. Click here for the story.

MA Plans: The Good and the Bad

Medicare Advantage plans are underperforming traditional Medicare in one respect: They cost 6 percent more, according to a recent analysis. However, they outperform traditional Medicare in another way: They offer higher quality. That’s according to research summarized recently by health economists at Harvard. It raises a difficult question: Is the extra quality worth the extra cost? Click here to read more.

Average Obamacare Premiums to Rise 8.2 percent

Average Obamacare premiums will rise 8.2 percent next year, according to an analysis from PriceWaterhouseCoopers (PWC). That figure relies on the 29 states that have so far released premium data for 2015. It varies from state to state. Click here for the PWC analysis which includes a national map showing state-by-state variances.

Study: Common Factors Identified for ACO Success

Accountable care organizations often involve high-need, high-cost patients, which can make for a very expensive and challenging program to manage. But a team of researchers has identified effective ACOs that successfully implement complex care management interventions that insurers and providers can use to bolster their own programs, lower costs and improve care. The Commonwealth Fund study focused some of the key common factors to the 18 successful ACO programs identified in the brief. Click here for the study.

ACO Survey Reveals Level of Health IT Engagement

Eighty-six percent of ACOs responding to a survey have EHR systems and 74% have disease registries. Fewer than half participate in health information exchanges, 26% offer video-based telemedicine and 28% use health IT for revenue cycle management. Just over one-third of ACOs surveyed were more than two years old. Click here for more.

Brief: Payers, Regulators Should Team Up to Fight Drug Costs

The fight over high cost of certain prescription drugs continues to heat up in Washington, as battle lines are drawn between Big Pharma, the insurance industry, the providers and large companies. Over the years, insurers have tried–with varying degrees of success–to rein in prices and moderate the costs of prescription drugs. But to ensure consumers can afford specialty tier drugs, a new issue brief from the Robert Wood Johnson foundation recommends payers team up with state and federal regulators to combat the soaring prices. Click here for this report.

Medicare Part D Success Story

More than 37 million seniors are now enrolled in Medicare Part D — an increase of 15 million since the program’s start in 2006 — and their monthly premiums and drug costs have been fairly stable for four years, according to a report released last week by the Kaiser Family Foundation. The analysis shows that beneficiaries in stand-alone plans typically pay $2 for a month’s supply of a preferred generic, $5 for a non-preferred generic and $40 for a preferred brand-name medication. While their cost for a brand-name drug is up 43 percent since 2006, their portion of generic drugs is unchanged. Click here for the report.

Physician Assistant Growth Skyrockets

The nation had 95,583 certified Physician Assistants at the end of 2013, although 475 were living abroad, according to a national PA certification commission report released last week. They estimate the nation will have more than 125,000 PAs by the end of 2017. Sixteen states had the highest concentration of PAs with more than 40 per 100,000 residents: Alaska, Connecticut, Colorado, Idaho, Maine, Maryland, Montana, Nebraska, New Hampshire, New York, North Carolina, Pennsylvania, South Dakota, Vermont, Washington and West Virginia. Six states had the lowest concentration of PAs with less than 20 per 100,000 residents: Alabama, Arkansas, Indiana, Louisiana, Mississippi and Missouri. Click here for this very good report.

New DEA Rule Reclassifies Hydrocodone

The Drug Enforcement Administration issued a final rule last week to reclassify hydrocodone painkillers like Vicodin from a schedule III controlled substance to the more restrictive schedule II category. For patients, the change means no refills without a new prescription and new safety requirements for how the drugs are stored. Click here for the new rules.

Study: Individual Mandate Makes a Big Difference

How much difference does the individual mandate make? According to a study released last week, using Massachusetts “Romneycare” as an example, researchers say ‘quite a lot.’ After reform, coverage on Massachusetts’s individual market grew from 70 percent of potential enrollees in 2006 to almost 92 percent in 2010. The analysis found that insurers’ average costs per policyholder dropped to 9 percent of the pre-reform base of $5,721. Consumers’ premiums also dropped to less than a quarter of the pre-reform base average. Click here for the study.

More Employees Join Employer Health Plans

Provisions of the Affordable Care Act, like the individual mandate, are causing an increase in employees signing up with their employer’s health insurance, according to reports last week. This increase, if it is permanent, is going to cost employers money. But it illustrates how the Affordable Care Act is set up to build on the country’s existing insurance system rather than tear it down. Click here for the story.

7 Million Americans May Be Eligible to Sign Up for Insurance Now

Enroll America released a new analysis last week finding that 7 million Americans — including 2.7 million uninsured — are potentially eligible to sign up for exchange coverage even though open enrollment closed in March and the next official window does not begin until November. Click here for their report and a state-by-state analysis of how many persons could sign up now.

Device Tax Collections Falling Way Short

A new Treasury Department inspector general audit found that medical device tax revenue amounted to $913.4 million in the first half of 2013, significantly less than the $1.2 billion the IRS had estimated it would collect. The tax is falling short of its revenue target because thousands of companies aren’t paying it, according to the audit released last week. The audit says the IRS needs to do a better job policing the tax. The tax agency, however, doesn’t have adequate tools to identify which companies owe it, the audit said. Click here for more.

Is a Bronze Level Health Plan Being Planned?

Could there be another metal level created on the state health exchanges? Legislation allowing a new copper-coverage tier would result in 350,000 more Americans retaining their employer-sponsored health insurance in 2016, according to an estimate released last week by the Council for Affordable Health Coverage. It would also mean significant savings: $5.8 billion for taxpayers on ACA exchange subsidies and $5.5 billion for companies in employer mandate penalties. Click here for the report.

Report: Congress Unlikely to Make Big Health Care Policy Changes

The Bipartisan Policy Center (BPC) has turned more pessimistic about the prospect of Congress comprehensively changing the health care system and is instead focusing on smaller reforms that Congress can make when it next deals with the Medicare physician pay formula (early next year) and on changes CMS can make administratively. The BPC has issued a new report that examines some of the opportunities. Click here for the analysis that covers bundled payments, PCMH, ACOs and other models. Republican health policy guru Avik Roy says the GOP should be focused on reducing health care costs. Click here for his piece in Forbes last week.

Cost of Tests in California Hospitals Varies Widely

Researchers studied charges for a variety of tests at 160 to 180 California hospitals in 2011 and found a huge variation in prices, according to reports last week. The median charge for a basic metabolic panel, which measures sodium, potassium and glucose levels, among other indicators, was $214. But hospitals charged from $35 to $7,303, depending on the facility. None of the hospitals were identified. Click here for the story.

CDC: U.S. Birth Rates Plummeting

Birth rates for U.S. teenagers in the United States have fallen significantly since peaking in 1957, according to new data from the CDC. The rate fell 57% between 1991 and 2013. The 2013 preliminary rate (26.6 per 1,000 aged 15–19) is less than one-third of the historically highest rate (96.3 in 1957). During 1991–2012, rates fell for all race and Hispanic ethnicity groups, with the largest declines measured for non-Hispanic black teenagers. In the more recent period, 2007–2012, the declines have been steepest for Hispanic teenagers. Click here for the CDC report. Click here for the story on how Colorado led the way.

Health Care Costs Continue to Slow

Health care costs continue to grow slowly — between 0.1 and 0.3 percent from June to July, according to the Bureau of Labor Statistics last week. The slowdown in cost growth is good news for the entire federal budget, including Obamacare — if it lasts. Click here for the report.

PCORI Offers $90 Million for New Research Grants

The Patient-Centered Outcomes Research Institute last week announced up to $90 million in funding to study practical comparative questions faced by patients, clinicians and other health care decision makers. Any research organization, including hospitals and health care systems, may submit a letter of intent to apply for up to $10 million in funding to support large clinical or observational studies that compare alternatives to prevent, diagnosis, treat or manage a disease or symptom; improve health care system-level approaches to managing care; or eliminate health or health care disparities. Click here for details.

Organ Donation Community Sets New Goals

The Donation and Transplantation Community of Practice has announced the collective goal of increasing the number of organ transplants by 1,000 in each of the next five years. Nearly 29,000 organs were transplanted last year. The partners will promote the education and training of health care professionals to build a culture of donation and transplantation in each hospital, and foster and share best practices to increase the number of lives saved through transplantation each year. Click here for details.

CMS Wants Input for Innovation Model

CMS last week released a Request for Information seeking input from stakeholders on the possibility of the Innovation Center testing innovative models to increase the engagement of Medicare and Medicaid beneficiaries and CHIP beneficiaries in their health and health care. Comments must be received by 11:59 p.m. on September 15, 2014. Click here for further details from CMS.

Hedge Funds Buying Up Drug Companies

The 50 largest hedge funds snapped up shares of big health care names such as Allergan, Actavis, and Covidien in the second quarter in an effort to capitalize on the wave of mergers and acquisitions in the sector, according to data from FactSet. Click here for the story from CNN.

View all ebulletins