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…
US News Releases Best Hospitals List
U.S. News & World Report last week published its annual rankings of the nation’s Best Hospitals. The 2014-15 rankings cover nearly 5,000 medical centers across the country and span 16 medical specialties from cancer to urology. Hospitals with very high scores in at least six specialties earned a spot on the Honor Roll. Just 17 hospitals made this year’s list. Click here to see the honor roll list. Click here for a state-by-state breakdown of selected hospitals.
Congressman Tackles EPIC During Committee Hearing; Call for Investigation
Health IT giant EPIC came into some criticism last week during a congressional hearing on health IT. Rep. Phil Gingrey (R-GA), a physician, questioned whether EPIC was being subsidized by the HITECH act to create and promote closed systems. He says the committee should investigate. Click here for the exchange before the House committee – it runs about 3 minutes. All the testimony is also included on this site.
Observation Status Debate Continues to Rage
The government’s battle with providers over Medicare observation status made it into the pages of USA Today last week with a story emphasizing how patients can be impacted by this policy. Click here.
New GOP Bill Would Stop Home Health Cuts
Two Republican lawmakers introduced industry-backed legislation last week to replace Medicare pay cuts for home health services that took effect in January with a value-based payments plan that aims to cut hospital readmissions, starting in 2019. The bill would undo the current pay cuts, which industry says add up to 14 percent reduction in reimbursement over four years, based on the 2010 budget baseline. Companies that perform well would get bonuses, and Medicare would cut pay for those in the lowest 40 percentile of performers. Total spending on bonuses would equal between half and 70 percent of savings from penalties. Click here for a one-page summary of the bill.
Provider Market Power, by State, Is the Focus of New Report
A new report released last week provides a comprehensive evaluation of state laws addressing the power of health care providers to negotiate higher prices. This report catalogues the laws and regulations state governments are using to maintain or increase competition in health care markets, which the recent wave of mergers among hospitals and other consolidation among providers has significantly reduced. There is state-by-state information. Click here for a copy of the interesting report from the National Academy of Social Insurance and Catalyst for Payment Reform.
CMS Issues Part D Guidance for Hospice
CMS last week issued revised guidance on Medicare Part D payment of drugs for beneficiaries enrolled in hospice care. The agency said the document supersedes portions of its March 10 guidance to address operational and beneficiary access concerns raised by the field. Click here for to see the new guidance.
Patient Safety Focus of Congressional Hearing
Patients today are no safer from harm caused by preventable errors than they were 15 years ago, a leading healthcare expert testified before the Senate Subcommittee last week. In terms of error reduction and quality improvement, “we have not moved the needle in any meaningful, demonstrable way overall,” testified Ashish Jha, M.D., a professor at Harvard School of Public Health. Click here to see the hearing and review the public testimony.
New QIO Contracts Issued by CMS
CMS last week awarded 14 Quality Improvement Organizations five-year contracts to work with health care providers on strategic quality initiatives and provide technical assistance to participants in CMS value-based purchasing programs. Each of the recipients, known as Quality Innovation Network-QIOs, will work with providers in specific states. Many providers will now be working with different QIOs. Click here for the state-by-state list. Click here to participate in a CMS webinar on this issue Wednesday, July 23 at 11 a.m. EDT.
Report Smacks Efficacy of Proton Therapy
“With the number of proton therapy centers in the United States expected to double in the next few years, Medicare and seniors face the prospect of rapidly increasing prices for prostate cancer treatment, with no proven benefits for beneficiaries.” That’s the conclusion of a report out last week from the Center for American Progress. Click here for their 4-page analysis.
Study: Number of RNs on the Rise
The number of registered nurses across the country continues to rise, reaching 2.7 million in 2012 and growing even more since then, according to a study published in Health Affairs (click here). The RAND Corporation found that the number of nurses surpassed the predicted 2.2 million in 2012, in part because of roughly 136,000 nurses who delayed retirement because of economic uncertainty, the study suggests (click here). Between 1969 and 1990, about 47 percent of nurses still worked by age 62 and 9 percent still worked at age 69. However, those percentages increased from 1991 to 2012, with 74 percent of nurses working at 62 and 24 percent working at age 69, according to the study.
KY Okays New Prescriptive Authority for NPs
Starting last week, nurse practitioners in Kentucky who have completed a four-year collaboration with a physician will be allowed to prescribe routine medications without a doctor’s involvement, a major shift that could help improve consumers’ access to care. The law that makes this possible passed after five years of legislative debate. Nurse practitioners are fighting in other states for more authority to treat patients at a time of rising concern over the impact of the federal health law. Click here for the story.
Study: Nurses Could Play Larger Role in Chronic Care Management
Giving nurses a larger role in care for chronic conditions such as high blood pressure, high cholesterol and diabetes could help offset the primary care physician shortage, according to a new study published in the Annals of Internal Medicine. Researchers reviewed 18 studies on registered nurses’ effectiveness in leading management of the three chronic conditions, six of which were randomized controlled trials. Nurses in all 18 studies were able to change doses of medications prescribed by physicians, and nurses in 11 could independently start patients on new ones. Click here for the study.
CVS Inks Deals with 4 Large Health Providers
CVS Caremark announced last week it has entered into new clinical affiliations with four major health care providers to enhance access to high-quality, affordable health care services for patients. The collaborating health care providers include ProHealth Physicians in Connecticut, Texas Health Resources in Texas, Palmetto Health in South Carolina and The Baton Rouge Clinic in Louisiana. Click here for details.
On-Line Doctor Consult Service Grows for Employers
Home Depot and T-Mobile are among the employers offering Teladoc, an online doctor-consultation service for employees. Costs for online physician services can be a quarter of an in-office visit. Eighteen percent of employers offer telemedicine, compared with 15% in 2012, according to a report. Click here for more.
HHS Launches $100 Million Medicaid Improvement Program
HHS last week launched a new initiative, allocating more than $100 million in technical support to collaborate with states to improve Medicaid programs and lower costs. The Medicaid Innovation Accelerator Program will provide data analytics, help states enhance their quality measurement and advance effective sharing of best practices among all states, according to a letter CMS sent to all state Medicaid directors. Click here to read the letter.
GAO: Medicaid Doc Payments Lower than Private Insurance
Payments to physicians under Medicaid fee-for-service and managed care for the 26 evaluation and management services, such as office visits and emergency care, that GAO reviewed, were generally lower than private insurance. Specifically, in the 40 states where GAO compared Medicaid FFS payments to private insurance, FFS payments were 27 to 65 percent lower than private insurance in 31 states; and in the 23 states where GAO compared managed care payments to private insurance, managed care payments were 31 to 65 percent lower than private insurance in 18 states. Click here for the new GAO report.
VA Health System Fix Would Cost Almost $18 Billion
Fixing the problems that led to the waiting-list scandal at the Department of Veterans Affairs will cost $17.6 billion over the next three years, the agency’s acting secretary told lawmakers last week, requiring the hiring of about 1,500 doctors, 8,500 nurses, and other clinicians. Click here for the NY Times story.
NIH Starts Early Warning Drug System
An innovative National Drug Early Warning System is being developed to monitor emerging trends that will help health experts respond quickly to potential outbreaks of illicit drugs such as heroin and to identify increased use of designer synthetic compounds, according to an NIH announcement last week. The system will scan social media and Web platforms to identify new trends as well as use conventional national- and local-level data resources. Click here for details.
MedPAC Data Report Released
Spending on home health and skilled nursing care are driving post acute payment growth in Medicare, according to one of the best summaries of health care spending data released late last week by MedPAC. If you want to know what goes into shaping the government’s thinking about future health care policy, this is a must-read. Click on any of the chapters below:??
- Section 1: National health care and Medicare spending
- Section 2: Medicare beneficiary demographics
- Section 3: Medicare beneficiary and other payer financial liability
- Section 4: Dual-eligible beneficiaries?
- Section 5: Quality of care in the Medicare program?
- Section 6: Acute inpatient services
- Section 7: Ambulatory care
- Section 8: Post-acute care
- Section 9: Medicare Advantage
- Section 10: Prescription drugs
- Section 11: Other services
CBO 25-Year Spending Report Focuses on Health Care
The Congressional Budget Office last week released its spending projections for the next 25 years and finds that government health care programs increase from 5 percent of the economy to 8 percent. The aging of the population continues to be the primary driver of growth. Click here for a very interesting overview with graphs. Click here for a related analysis from the NY Times.
GAO Report Details State-by-State Medicaid Per Beneficiary Spending
A new report from GAO estimates wide variation among states in Medicaid spending per enrollee, overall and for each of four main eligibility groups—children, adults, disabled, and aged. This report examines (1) Medicaid spending per enrollee by state; (2) selected factors that influence Medicaid spending per enrollee, by state; and (3) how states account for factors that influence expected per-enrollee spending when setting rates for Medicaid managed care plans. States with the highest per-patient spending include New York, Minnesota and North Dakota; lowest states include California, Mississippi and Tennessee. Click here for the report.
CMS Awards $7 Billion Contract to Reform Medicare
CMS has awarded a $7 billion contract to 15 companies tasked with overseeing massive reforms of Medicare, Medicaid and CHIP to help reduce costs and improve quality. The contractors that will divvy up the award include: Abt Associates Inc., Acumen LLC, American Institutes for Research, Arbor Research Collaborative for Health, Booz Allen Hamilton Inc., Deloitte, IMPAQ International, The Lewin Group, Mathematica Policy Research, NORC at the University of Chicago, RAND Corporation, RTI International, Social & Scientific Systems Inc., Truven Health Analytics, and Regents of The University of Colorado. Click here to see the contract details.
Insurers Wants Brokers, Agents Excluded from MLR
The health insurance industry is urging lawmakers to amend the Affordable Care Act’s medical-loss ratio provision, according to reports last week. It wants payments to brokers and agents excluded from administrative costs, claiming their inclusion in MLR calculations hurts insurers’ bottom lines and will drive up premiums. Removing broker commissions would make it easier for insurers to meet MLR requirements and save them money; however, it also would slash rebates given to consumers. Click here for the story.
CMS To Expand Star Rating System
CMS plans to add a rating system using stars to its Home Health Compare, Dialysis Facility Compare and Hospital Compare websites to make it easier for consumers to understand the ratings. The additions will be made throughout the rest of this year and into 2015, CMS Deputy Administrator Dr. Patrick Conway wrote in a blog post. The websites are all part of Medicare.gov. Click here to read the details in his blog.