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…
Mass Gen Tops US News’ Hospital Rankings for 2015-2016
In the 2015-2016 rankings, Massachusetts General topped the list, edging out the Mayo Clinic. Other top-ranked hospitals include University of Texas MD Anderson Cancer Center in Houston (No. 1 in the nation in Cancer), the Cleveland Clinic in Ohio (No. 1 nationally in Cardiology & Heart Surgery) and the Hospital for Special Surgery in New York, New York (No. 1 in Orthopedics). They also include 15 hospitals that ranked among the top 20 nationally in at least half a dozen different specialties, earning them each a berth on the Best Hospitals Honor Roll. Click here for the 2015-2016 rankings. Click here for the regional rankings.
$110 Million in New Opioid Abuse Funding Announced
HHS announced Saturday more than $110 million in funding for states and community health centers to help combat opioid abuse and expand treatment and services for substance abuse. The Health Resources and Services Administration will make that new funding available, while SAMHSA has awarded $11 million to 11 states to increase access to treatment for opioid use disorders. The SAMHSA grants will provide states up to $33 million over three years. Click here for details. Click here for the list of 11 state agencies getting the SAMHSA money.
Senate Rejects ObamaCare Repeal in Rare Sunday Session
The Senate on Sunday rejected a GOP-led amendment to repeal ObamaCare that fell several votes short of a 60-vote threshold to advance. The largely symbolic vote, which was attached to a three-year highway funding bill, marked the Senate’s first attempt to repeal ObamaCare since Republicans took control of the chamber in January. Click here for the story.
Medicare Trust Fund Doing a Bit Better: Annual Report
The main trust fund that finances Medicare’s hospital insurance coverage will run out in 2030, the program’s trustees said in a report issued last week, adding that while this is unchanged from last year’s projection the long-term funding outlook has improved. The trustees have previously projected that the hospital trust fund would run out by 2024 or by 2026. Click here for the trust fund report. Another key point: by 2048 physician pay will be worse under the new formula than under the Sustainable Growth Rate formula that Congress replaced, unless providers change how they deliver care or Congress steps in to increase pay rates.
MedPAC Director Pushes Hospital Site Neutral Payments at Hearing
As the House Ways & Means health subcommittee continues work on a hospital reform bill, the subcommittee last week questioned MedPAC’s Executive Director on site neutral payment reforms — particularly between inpatient and outpatient settings — and the chairman of the committee said the area was ripe for reform. Click here for a good summary of the hearing and to see the testimony of MedPAC’s Director.
CMS Announced New Hospice Payment Demo
CMS last week announced that 140 hospices will participate in a new payment model demonstration. CMS originally anticipated selecting at least 30 Medicare-certified hospices to participate in the model and enrolling up to 30,000 beneficiaries throughout a 3-year period. Due to robust interest, CMS has invited over 140 Medicare-certified hospices to participate in the model and expanded the duration of the model to 5 years. This will enable up to 150,000 eligible Medicare and dually eligible beneficiaries to participate. Click here for details, including the list of participating hospices.
GAO Says Thousands of Physicians Billing Medicare Are Using Questionable Addresses
Thousands of medical providers signed up to bill Medicare using questionable addresses, and dozens of doctors enrolled despite disciplinary actions by state medical boards, according to a congressional probe of the $600 billion-a-year taxpayer-funded program. Medicare records listed doctors and other providers as practicing at invalid addresses, such as commercial mailbox stores, construction sites and, in one case, a fast-food restaurant, according to a report by the Government Accountability Office that examined data through March 2013. The GAO report includes numerous pictures of questionable physician offices. Click here for the GAO report. Click here for the WSJ story.
BCBS Report Examines Wide Variation in Angioplasty Costs
The Blue Cross Blue Shield Association was out with a new report last week examining angioplasties performed among patients who were not experiencing a heart attack, in both inpatient and outpatient facilities, across 86 of the 100 largest Metropolitan Statistical Areas (MSAs). The findings reveal that variations in cost within a market are significant, varying by as much as 532 percent. Variation in cost across markets is also significant and can vary by as much as 295 percent. Click here for the complete report.
Health Care Prices Continue Slowest Growth on Record
On the heels of the Medicare Trust Fund report, comes another report showing the price of health care has grown more slowly than core consumer prices – what Americans spend on everything except food and energy – over the past five years. It’s the first time that’s happened since record-keeping started in 1959. That’s a remarkable break from decades of health-care prices outpacing inflation, but consumers shouldering a greater share of their medical costs may not notice the difference. Click here for details.
Anthem To Buy Cigna; Aetna-Humana Deal To Get Scrutiny
Anthem agreed to buy Cigna for $48 billion in an announcement Friday, capping months of merger frenzy among top U.S. health insurers that is set to reshape the industry. The deal, combining the second- and fifth-largest health insurers by revenue, would create a company with a huge footprint in commercial insurance, the type of coverage provided to employers and consumers. Click here for the WSJ story. Click here for a good Washington Post story on what this all could mean. Click here for a NYTimes summary of the scrutiny the deals will get. The AMA sounded the alarm bells, saying the mergers will reduce competition and choice. Click here. The House Judiciary Committee is expected to start hearings in September to dive into the insurance consolidations.
$15 Billion Saved Annually If Medicare Drug Prices Equaled Medicaid, VA
The federal government could save at least $15 billion annually if Medicare paid the same rates for drugs as Medicaid and the Veterans Benefits Administration, according to a study released last week. The analysis also compared U.S. pharmaceutical prices to those in 30 other countries, concluding that 27 of them pay less than half as much for brand-name drugs. The authors sent a letter to Congress with recommendations for legislation that would reduce drug costs for Medicare beneficiaries. Click here for the study.
- 118 cancer physicians from across the country signed on to a report urging action to lower the cost of oncology drugs. Click here. Pressure is mounting on drug companies to more thoroughly explain the rapid growth in prices. Click here.
Insurers, Others Seeks Rx Performance Pricing
UnitedHealthCare is now negotiating payment reductions to pharmaceutical companies when drug performance falls short, according to published reports. Express Scripts and CVS are pursuing similar strategies. Click here for more.
FDA Okays New, Pricey Biologic to Lower Cholesterol
Sanofi and Regeneron said they will offer the new cholesterol-lowering biologic Praluent at a price that equates to about $14,600 a year. The price for the just-approved drug, which will be self-injected by patients every two weeks, is much higher than the dollars-per-month cost of generic statin medications. However, the two companies said Praluent is priced below any other patient-administered biologic of its type on an annual basis. Click here for the FDA announcement. Click here for the Regeneron release.
Another Co-Op to Shut Down
Louisiana Health Cooperative, a nonprofit plan seeded with $65.8 million in federal loan dollars under the ACA, is shutting down because of financial difficulties. The insurer will continue to provide coverage to its 17,000 customers through the end of the year, but will not sell plans for 2016. The Louisiana plan will become the second co-op insurer to shut its doors. CoOportunity Health, which operated in Iowa and Nebraska, was shut down by regulators earlier this year after piling up huge losses. Many other co-ops have sustained heavy losses in the first two years of exchange operations. Click here for more on the Louisiana Co-Op.
Hospitals Paying a Heavy Price in States Not Expanding Medicaid
In the 20 states that have yet to expand Medicaid eligibility under the Affordable Care Act, local and regional hospitals are paying the price. according to a new report. A particularly sharp contrast is occurring between Illinois, an expansion state, and Georgia, which has not expanded eligibility. In the former, the Cook County Health & Hospitals System has reported its first profit in 180 years of operation, Reuters has reported. But Grady Health System continues to struggle financially and remains dependent on some extent to the philanthropy from the locals. Click here for the story. Click here for the Northwestern, Columbia study that underscores these findings.
CMS Guidance Helps States Develop Better IT Systems for Medicaid
CMS last week issued more guidance to states on how various human services programs — such as SNAP and TANF — have to split costs related to upgrading Medicaid eligibility and enrollment systems from which they would benefit. Essentially, the administration has provided an exception to certain OMB requirements, so states can develop IT systems that benefit Medicaid and other human services programs, but the latter don’t have to share in as many costs. Click here for a copy of the guidance.
Study: Value-Based Care Falling Short on Incentive Payments
The move from volume-based to value-based care was supposed to transform how the industry paid physicians. But little has changed, according to a new study in the Annals of Family Medicine. Bundled or incentive payments make up only a portion of a large mosaic of how doctors are paid. Researchers surveyed 632 different medical practices–both affiliated with accountable care organizations and not–and found that physicians were paid with salaries, fee-for-service based on quality scores and other metrics. Click here for the study. Click here for the Washington Post story.
MA Plans with Larger Low Income Beneficiaries Are Penalized Financially: Study
A new analysis released last week show that Medicare Advantage plans covering a greater number of lower income beneficiaries are penalized financially through the federal scoring system. A disproportionately high number of enrollees are lower-income and minority beneficiaries. Among minority beneficiaries, Hispanics are twice as likely and African–Americans are 10 percent more likely to enroll in MA. Concern has been raised that the Stars rating system penalizes plans that have large enrollments of Low-Income Subsidy (LIS) and dual-eligible beneficiaries. Click here for the study.
Obama Administration Urges States To Push Against Large Insurance Premium Increases
The Obama administration is asking state insurance regulators to take a closer look at rate requests before granting them in the 2016 cycle. Under the Affordable Care Act, state agencies largely retain the right to regulate premiums in their states. So far only a handful have finalized premiums for the coming year, for which enrollment begins in November. Click here for the report.
$142.5 Million Awarded by PCORI for Research
The Patient-Centered Outcomes Research Institute last week awarded $142.5 million in funding to 34 research networks to participate in the second phase of its National Patient-Centered Clinical Research Network. The expanded PCORnet includes 13 Clinical Data Research Networks, which involve two or more health care systems, and 21 Patient-Powered Research Networks, run by groups of patients and their partners. Click here for the list of recipients.
CMS Targets Major Metro Areas to Extend Home Health and Ambulance Moratorium
CMS on Friday extended by six month a moratorium on the opening of new home health and ambulance companies in several major metro areas across the United States. Ft. Lauderdale, Miami, Chicago, Detroit, Dallas, Houston – are targeted for home health. Philadelphia and Houston are targeted for ambulance. Click here for the CMS announcement.
Retail Health Clinics Proliferating; Need Better Outcome Reporting: Study
CVS, Walgreens, Kroger, Walmart, Target and RiteAid – in that order — dominate the retail clinic market, according to a new report funded by the Robert Wood Johnson Foundation. There are more than 1,600 retail clinic sites across the United States with just over 100 having health system affiliations. For a closer look at this issue, click here.
Stillbirths Exceed Infant Deaths for the First Time: CDC
For the first time, there were more stillbirths than infant deaths in the U.S., according to a CDC report that found both were declining, but infant death rates were falling faster. The report also found disparities in fetal death rates. Teens, women over age 35, and women who are black, Hispanic, American Indian or of Alaska Native descent were among groups facing higher likelihood of fetal death. Click here for details from the CDC.