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11/24/2014

Weekly E-Bulletin


Key House Committee Floats Major Pro-Hospital Legislation

After months of discussions, the House Ways and Means Commission has issued a “discussion draft” of legislation targeting issues that have been particularly troublesome to the nation’s hospitals for the past two years and, in some instances, longer.  The proposal would repeal the 2-midnight rule, create a short-stay payment system, reform the RAC program, create a new hospital payment program for claims that have been stuck in the HHS appeals process, repeal the 96-hour rule for CAHs, and impose numerous other hospital provisions.  Before you get too excited…it is unlikely the entire package will pass Congress this year.  However, it could pass the House and certainly be a starting point when the new Congress convenes in January.  Click here for Strategic Health Care’s 10-page executive summary.  Click here for the committee’s 146-page summary.  Click here for an good and brief update on the Medicare claims appeals process at HHS.

Dozens of CAHs Losing Status

CMS last week released a list of counties and parishes that will lose their rural designation that allows acute care facilities within their boundaries to receive extra payments as critical access hospitals.  The CMS list includes 72 counties and parishes in more than 30 states or Puerto Rico. Several dozen CAHs could lose their special status; however, there is a process to reapply – although the probability of success is probably slim for most.  Click here for CMS’ list of impacted counties – the names of the hospitals were not disclosed.

Senators Line Up for CAHs in Letter to President

27 U.S. Senators last week sent a letter to President Obama urging him NOT to include budget cuts to CAHs in Administration’s next federal budget proposal, likely to be released in the first quarter of next year.  Click here to see a copy of the letter with signatures.  A similar letter was sent by dozens of House members and more than 165 CAHs also signed a letter to the President with a similar message.

As Hospitals Struggle with High Drug Costs, Government Starts to Listen

The struggle of hospitals and pharmacies against spikes in drug costs seems to have gotten the attention of the government: lawmakers announced hearings on the subject, and the Department of Justice is investigating price increases for generics.  Click here for this very good report with a focus on Ascension Health.

Name Brand Drug Prices Continue to Soar: Study

New data from AARP shows prices for brand name prescription drugs continue to skyrocket, particularly for older Americans. Analysis of 227 such drugs shows an average cost increase of nearly 13 percent in 2013, compared with a general inflation rate of 1.5 percent during that year. Click here for the detailed AARP report that includes the top 25 drugs.

Worldwide Rx Spending Skyrocketing

Worldwide spending on medicines will reach almost $1.3 trillion by 2018, as new treatments for hepatitis C and cancer come to market and as people around the globe use rising incomes to buy pharmaceuticals.  Click here for the report.

New Study Says Hospital Outpatient Departments Care for Poorer, Sicker Patients

The battle over equalizing provider payments when they are performed for similar services heated up last week with two new reports.  A new study from KNG Health Consulting for the AHA detailed how hospital outpatient services for cancer care are often focused on patients that are poorer and sicker than patients treated in other settings.  Click here for this excellent study.  Another report released last week said payments to providers should be equalized when they are providing a similar service.  The Committee for a Responsible Federal Budget report offered numerous other provider payment reduction suggestions as a means to pay for a permanent fix to the Medicare physician payment formula.  Click here for that report.

Immigration Orders May Bring Some Immigrants Into Health Coverage

President Barack Obama’s executive order on immigration reform stopped short of offering healthcare coverage to people who are in the U.S. illegally, but the action should make it easier for them to obtain insurance, according to various media report.  All told, the plan would affect 4 million immigrants who are in the country without legal permission. Click here for the Politico story on how this may impact health care coverage.

Study:  Hospitals Charge Private Insurers More than Government Payers

Hospitals charge private insurers about twice as much on average for certain procedures than they do government payers, according to a new study. That’s based on a survey of more than 3.3 million hospital discharges in 162 counties in six states that occurred in 2006.  The average charge to Medicare for the procedures–treating acute myocardial infarctions and knee arthroplasties–was $7,628 in 2012 dollars. For private payers, it was $13,713. For those heart attack patients, it was $11,000 charged to Medicare versus $23,485 charged to private payers. Among those undergoing knee surgery, Medicare was charged $10,824, versus $21,098 charged to private payers. Click here for the study.

Hospitals Pocketing Manufacturer Credits for Cardiac Devices: OIG Audit

Hospitals that received manufacturer credits for replacing cardiac medical devices didn’t pass the savings along to Medicare through required claims adjustments, an Office of Inspector General audit found.  Click here.  A study of 641 claims filed in Kentucky, Ohio and West Virginia in 2011 revealed a $547,553 overpayment on 86 claims as a result of this problem. Consequently, “hospitals across the United States may be pocketing millions of dollars in taxpayer money annually by charging Medicare for replacement cardiac medical devices they received for free,” The Washington Times reported. Click here.

New HHS Proposal Makes Many Health Exchange Changes for Consumers

In a proposed regulation posted Friday afternoon, HHS says an enrollee — when they first sign up for coverage on an exchange — could opt into being automatically re-enrolled into a lower cost plan. That approach could be triggered if the person’s premium for their current plan increases by a certain amount, such as 5 percent to 10 percent.  HHS wants to set future annual exchange open enrollment periods so that they begin Oct. 1 and end Dec. 15. Those dates for choosing a plan would apply for coverage that kicks in starting Jan. 1, 2016. For plan year 2016, HHS says that open enrollment would begin on Oct. 1 and end Dec. 15 of the previous calendar year. Click here for more details on the new rule.  Click here for the 324-page rule.

Physician Recruitment Getting Tougher, More Expensive

Hospital executives are challenged to recruit physicians, given their costs and the limits of the labor pool, but their inability to get ahead of the issue may start to hurt their organizations’ bottom lines, reported Fortune magazine.  By 2020, the nation will be short by about 91,000 doctors, with half of the deficit in primary care, based on data from the Association of American Medical Colleges. And while medical school enrollments are at an all-time high, the number of residency positions–which are funded by the federal government–has gone mostly unchanged for years.  Click here for the report.

House GOP Sues Obama Administration Over ACA

House Republicans filed a long-threatened lawsuit Friday against the Obama administration over unilateral actions on the health care law that they say are abuses of the president’s executive authority.  Click here for the story.

Obamacare Enrollment Overstated

The Obama administration inadvertently added 380,000 standalone dental subscribers to its total count of Affordable Care Act healthcare subscribers, according to an HHS announcement.  The agency said the accurate number of Americans who obtained healthcare through state and federal exchanges is roughly 6.7 million as of Oct. 15. This has fired up a number of Republicans in Congress.  Click here for the story.

NYTimes Editorial Board Weighs In on GOP’s Anti-ACA Efforts

The New York Times editorial board made a case over the weekend for the new Republican congress to keep the provisions in the Affordable Care Act they are threatening to eliminate.  All of the provisions they are targeting should be retained, according to the Times  — they were put in the reform law for good reasons. Some may need adjustments now that they are in effect. “But the Republicans are not interested in improving any provisions. They are bent on destruction.” Click here for the editorial.

Insurers Benefiting from ACA Enrollment

Combined 2nd quarter 2014 results for seven of the largest U.S. health plans indicated enrollment growth of almost 5 million, according to an analysis out last week. Aggregate figures reflected gains in both risk-based and self-funded medical membership. Most industry leaders realized significant gains in individual, non-group business as the individual mandate of the Affordable Care Act (ACA) took effect this year. Financial performance overall was generally favorable but year-over-year profits were down for some of the leaders.  Click here.  Click here for a good NYTimes story on how insurers have become Obama allies because of the Affordable Care Act.

Medicaid Enrollment Up Significantly

Medicaid and CHIP enrollment has grown by over 9.1 million people since last fall, CMS reported last week.  In states that have expanded Medicaid, enrollment has increased by about 23 percent, while in 23 non-expansion states, it’s up by 6 percent.  As of September, CMS said 68 million people were participating in the two programs — a 16 percent increase over average monthly enrollment from July to September 2013. Click here for the report.

New Proposed Regs Issued for Multi-State Plan

The Office of Personnel Management has published a proposed rule for the Multi-State Plan Program, a provision of Obamacare designed to offer at least two federally administered plans in all 50 states.  About 371,000 people are enrolled in MSPs, which were offered by Blue Cross Blue Shield plans in 30 states and the District of Columbia in Obamacare’s first year.  For 2015, 11 Consumer Operated and Oriented Plans will offer MSPs as well. Combined with expanded Blue Cross offerings, MSPs will be available in 36 states.  Click here for the 83-page proposal.

GAO Says HHS Falls Short on Price, Quality Transparency 

The GAO is out with a scathing report on the lack of transparency on price and quality on the various HHS consumer websites.  CMS websites “lack relevant information on cost and provide limited information on key differences in quality of care, which hinders consumers’ ability to make meaningful distinctions among providers based on their performance.” Click here for the GAO report.

CMS Creates Office of Data and Analytics

CMS late last week announced the creation of the Office of Enterprise Data and Analytics (OEDA) which will be led by Niall Brennan, the agency’s first Chief Data Officer (CDO), and tasked with overseeing improvements in data collection and dissemination as the agency strives to be more transparent. OEDA will help CMS better harness its vast data resources to guide decision-making and develop frameworks promoting appropriate external access to and use of data to drive higher quality, patient-centered care at a lower cost.  Click here for more. 

Kaiser Opens Clinics at Target

Kaiser Permanente clinicians will now staff clinics at three San Diego-area Target stores, the two companies announced last week, with a fourth opening Dec. 6.  The retail clinics will accept other insurance in addition to Kaiser and are working out contracts with Medicare, MediCal and Blue Shield of California along with additional insurers. Click here for details.

Highmark Paying More for Tele-Dermatology

Pittsburgh-based Highmark says it recognizes the importance of technology. That’s why the insurer decided to cover online visits via Iagnosis, a tele-dermatology solution, for 5.2 million of its members.  While insurers are slowly incorporating telemedicine into their health plan offerings, many doctors worry the increased use of online visits with patients could lead to wrong diagnoses.  Click here for the story.

Homeland Security To Grant Protection for Selected West Africans in US

The Department of Homeland Security will grant temporary protected status to people from the three West African countries most affected by Ebola who are currently residing in the United States, department officials said late last week. People from Liberia, Guinea, and Sierra Leone in the United States as of Thursday may apply for protection from deportation, as well as for work permits, for 18 months.  Click here for details.

Congressional GOP Bills Would Briefly Ban Visas from Certain Ebola-Hit Countries

House and Senate Republicans last week introduced bills to temporarily ban visas to residents of the countries hardest hit by Ebola.  The visa ban would apply to permanent residents or nationals who are habitual residents of a country that the CDC says has “widespread transmission of Ebola,” according to the Senate bill. It would exempt aid workers and foreign military who must travel to the United States.  Click here for the 5-page Senate bill.

9 of 10 Americans Who Are Excessive Drinkers Are Not Alcohol Dependent: CDC

Nine out of ten Americans who are excessive drinkers are not actually dependent on alcohol, according to a study from the Centers for Disease Control and Prevention and Substance Abuse and Mental Health Services Administration.  Click here for the report.

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