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04/21/2014

Weekly E-Bulletin


OIG Recommends Major Payment Cuts to Hospital Outpatient Services

The HHS Office of the Inspector General is recommending major payment reductions in Medicare hospital outpatient rates, in a report made public last week. First, the OIG recommends that CMS seek legislation giving the agency the authority to cut the payment rates. Second, the OIG recommends that CMS cut most hospital outpatient rates to equal rates paid to ambulatory surgery centers – which is estimated to save the government as much as $15 billion from 2012 through 2017. Click here to read the OIG report.

Recent Surges In Health Spending Raising Questions

Policy experts wonder whether the government and private businesses can control spending as the economy gets stronger and millions more Americans gain coverage. This NY Times report discusses the recent surge in health care spending and whether it presages the end of historic lows in health care spending. Click here.

340B Rx Program Gets Support From Key Senators

The Health Resources Services Administration is developing a new regulatory framework for the 340B drug assistance program that provides significant discounts to providers that meet certain conditions. A battle between providers and the pharmaceutical industry has been waging for several years as pharma claims that some providers have been abusing the program. Several key US Senators added their voice to the regulatory debate in a letter to HRSA last week. Click here for a copy of the letter.

Tax Exempt Hospitals Changing Collections Policies

Some nonprofit hospitals go to great lengths to collect from poor people, although the Affordable Care Act ratchets back some of those efforts, no longer allowing liens, jail time or the passing of adverse information to credit reporting agencies. The new federal health care law also requires hospitals to make their financial assistance policies publicly available, and to limit the bills for poor and uninsured patients to what Medicare fee-for-service would pay, or an estimate of what Medicare would pay. As a result, the new health care law will, for the first time, bring some uniformity to public reporting on the value of charity care that nonprofit hospitals provide. Click here for the story.

OIG Says Congress Should Close Dually Eligible Payment Loophole

The HHS Inspector General is recommending that CMS ask Congress to prevent states from using a financing loophole to get federal funding for dually eligible beneficiaries with nearly no investment from states. The recommendation responds to findings that Iowa paid $1 per beneficiary each month in cash assistance, and in return the federal government paid the state $39 million, which is not illegal, but the Inspector General believes it should be. Click here for the OIG report.

Bundled Payments Increasing In Use

The number of hospitals, hospital systems and physician groups that use bundled payments is slowly increasing, although many providers say they are still uncertain about participating in this form of healthcare finance. Those are the findings of a new KPMG survey released last week. Forty-four percent of the 140 providers surveyed said they already use bundled payments, up from 38 percent last October. Click here for details.

Obama Announces 8 Million Have Signed Up

Eight million people have signed up for health care through new insurance exchanges, President Barack Obama announced last week, besting expectations and offering new hope to Democrats who are defending the law ahead of the midterm elections. Click here for the AP story. Click here for a good month-by-month summary of how Obamacare got to 8 million. Click here for the story on why so many have signed up. Click here for Obama’s video announcement. Click here for a good summary on what’s next for Obamacare.

Newly Insured Increase By 4 percent

Four percent of Americans are newly insured this year, reporting that they have health insurance now but did not last year. A little more than half of that group, or 2.1% of the U.S. population, got their new insurance through health exchanges. The rest got it using some other mechanism. Click here for more from Gallup.

UnitedHealth To Expand Exchange Strategy

The nation’s largest health insurance company, UnitedHealth Group, said last week its first-quarter earnings dipped slightly due to costs and fees related to the Affordable Care Act, but the company sees growth from the law and is looking to expand its offerings on government-run exchanges next year. UnitedHealth projects its revenue to grow five percent this year to a “range of $128 billion to $129 billion” as it gains new customers from newly insured customers under the health law via exchanges, expanded Medicaid health programs for the poor and its Medicare Advantage business. Click here for the Forbes report.

Gallup Polls Shows Which States Have Greatest Decline in Uninsured

States that have expanded Medicaid and opened their own exchanges have seen a higher rate of decline in the number of uninsured, compared to other states, a new poll shows. The 21 states and the District of Columbia, which have done both, saw an average decline in uninsured of 2.5 percent, according to a poll released by Gallup. The other 29 states that didn’t enact both measures had a dip in uninsured of less than 1 percent on average. Click here for details.

Report: Providers Should Work Together on Price Transparency

Hospitals and health plans should serve as front-line resources on healthcare price information for patients who want to make more informed decisions about their healthcare, according to a new report. But the government and employers should also help consumers understand healthcare prices, according to an HFMA report released last week by a task force promoting guidelines and recommendations for price transparency. Click here for the report.

Hospitals File Suit Against 2-Midnight Rule

The American Hospital Association, several state associations and hospitals last week filed suit against CMS’ 2-Midnight rule. Click here for the story. Is it too little, too late? That’s the subject of the analysis in this report. Click here.

NQF Recommends Socioeconomic Adjustments to Quality Measures

The National Quality Forum (NQR) has issued a draft report that recommends risk adjusting quality measures for hospitals’ patient mixes to reflect socioeconomic factors such as insurance coverage, race, and income. Among its eight key recommendations is distinguishing different methods for the different purposes of measurement: sociodemographic adjustment for accountability and stratification for identifying disparities. Click here for the NQF report. The public comment period ended last week.

GAO Reports Says Advanced Imaging Use Declining

The Government Accountability Office last week issued a report that found that the number of advanced diagnostic imaging services provided to Medicare beneficiaries in the office setting—an indicator of access to those services—began declining before and continued declining after an accreditation requirement went into effect on January 1, 2012. The rate of decline from 2009 to 2010 was similar to the rate from 2011 to 2012 for MRI; CT; and nuclear medicine, including PET services. Click here for the GAO report.

Survey: ICD-10 Delay Probably Widely Supported

A NueMD survey, conducted before Congress decided to postpone the ICD-10 transition date, found that over 50% of 1,300 responding health care professionals suggested ICD-10 be delayed or not be implemented at all. Respondents were most worried about the negative impact of ICD-10 implementation on claims processing. Click here to see the survey results. Nine major organizations wrote to CMS last week urging the agency to limit the delay to no more than 1-year. Click here for their letter.

Medicare Advantage Payment Changes Not Widely Embraced

CMS’ recent reversal of proposed payment cuts to Medicare Advantage plans has yet to gain a lot of supporters, according to press reports last week. CMS announced insurers will see a 0.4 percent boost–an increase slightly higher than what insurers requested. However, insurance analysts still predict lower payments to private Medicare Advantage plans in 2015. Some insurers also still expect to see Medicare Advantage rates drop next year, including Aetna and Humana. Click here for more.

GOP Governors Urge President to Strengthen Medicare Advantage

Republican Governors Rick Scott (FL), Bobby Jindall (LA) and Rick Perry (TX) blasted CMS’s latest Medicare Advantage rates as “little more than political theater,” and in a letter to President Barack Obama asked that the administration “take real, meaningful steps to strengthen” the program. Click here to read their letter.

Telemedicine Payments May Take Hold

Mississippi is now implementing a first-of-its-kind law, enacted in March, requiring private insurers, Medicaid and state employee health plans to reimburse medical providers for services dispensed via computer screens and telecommunications at the same rate they would pay for in-person medical care. The diabetes disease management services offered in the telemedicine project will be free to poor uninsured participants. But under the new law, the costs of remote monitoring of other participants with insurance coverage or Medicaid will be reimbursed. Click here for the Pew report.

Study: 12 Million May Have Outpatient Diagnostic Errors

Outpatient diagnostic errors—missed opportunities to make a timely or correct diagnosis based on available evidence—occur in about 5 percent of adults in the United States, according to a new study published last week. The study estimates that approximately 12 million adults in the United States could experience an outpatient diagnostic error each year. Click here for the BMJ clinical report. Click here for the AHRQ report. Click here for the Fox News report.

Medical Groups Urge Review of Costs in Recommending Treatments

Some of the most influential medical groups in the nation are now recommending that doctors weigh the costs, not just the effectiveness of treatments, as they make decisions about patient care. For example, the society of oncologists is developing a scorecard to evaluate drugs based on their cost and value, as well as their efficacy and side effects. It is expected to be ready by this fall. Click here for the story.

Expensive Hep C Drugs Selling Fast

Sales of two new Hepatitis C drugs – costing between $66,000 and $84,000 per regimen — are soaring, according to reports last week. Combining the two—which some doctors are prescribing as an off-label alternative to the U.S. Food and Drug Administration’s approved uses for the drugs—costs $150,000. Click here for the Wall Street Journal report.

CDC: Major Diabetes Complications Declining

Rates of five major diabetes-related complications have declined substantially in the last 20 years among U.S. adults with diabetes, according to a new CDC study. Rates of lower-limb amputation, end-stage kidney failure, heart attack, stroke, and deaths due to high blood sugar (hyperglycemia) all declined. Cardiovascular complications and deaths from high blood sugar decreased by more than 60 percent each, while the rates of both strokes and lower extremity amputations – including upper and lower legs, ankles, feet, and toes – declined by about half. Rates for end stage kidney failure fell by about 30 percent. Click here for more from CDC.

Herbal Therapy Seems To Be Gaining in Acceptance at Hospitals

Though herbal therapy has been practiced in China for centuries, it is still an afterthought in the U.S., in part because pharmaceutical remedies are usually easier to obtain. Now that’s beginning to change: in January, the Cleveland Clinic opened a Chinese herbal-therapy ward. In the past three months, therapists at the clinic have seen patients suffering from chronic pain, fatigue, poor digestion, infertility and sleep disorders. Click here for the story.

“Meaningful Use” Criteria Criticized, Supported

A recently released AHRQ study says the criteria for Stage 1 and Stage 2 Meaningful Use, while surpassing the 2013 goals set forth by HHS for EHR adoption, fall short of achieving meaningful use in any practical sense. At present, large-scale interoperability amounts to little more than replacing fax machines with the electronic delivery of page-formatted medical records. Click here for the report. Not everyone agrees with the findings. Click here for a very good counter argument.

FDA Urges Shift in Certain Procedure in Uterine Surgery

Doctors should stop using a procedure performed on tens of thousands of American women a year in the course of uterine surgery, because it poses a risk of spreading cancerous tissue, the FDA said last week. The procedure, power morcellation, involves using a device to cut tissue into pieces that can be pulled out through the tiny incisions made during minimally invasive surgery. Click here for the FDA announcement.

CDC: Strategies Working in Reducing Racial, Ethnic Health Disparities

Evidence-based interventions at the local and national levels provide promising strategies for reducing racial and ethnic health disparities related to HIV infection rates, immunization coverage, motor vehicle injuries and deaths, and smoking, according to a new report by the CDC’s Office of Minority Health and Health Equity. Click here for the CDC report.

Elec-tile Dysfunction” Is Focus of New Political Ad

It’s the political “silly season,” as an election year is often called and House Speaker John Boehner (R-OH) is getting his share of it in a new political ad from his Tea Party primary opponent. Entitled “elec-tile dysfunction,” this ad should put a smile on your face! Click here.

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