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12/15/2014

Weekly E-Bulletin


Numerous Health Care Provisions Included in Final FY15 Spending Bill

Most of the federal government is now funded through September 2015 afer a 56 to 40 vote in the Senate passing the $1.1 trillion spending package, okayed by the House last week. Included in the final legislation were numerous health care provisions. It also did NOT include numerous other provisions, like another ICD-10 delay. Our team pulled together an excellent summary of those provisions in a single document that you can review by clicking here. The health insurance industry has already blasted the provision that makes budget neutral risk corridor payments to insurers, saying it will result in higher costs for consumers. Click here.

Growth of Mayo Clinic Empire Detailed in Report

The Mayo Clinic Care Network, an ambitious effort by the Rochester-based health system to expand its reach and secure its place in an era of rapid changes in health care, has signed up 31 affiliates in 18 states, Mexico and Puerto Rico in just four years. A detailed report in the Minneapolis Star Tribune reveals just how extensive the empire has grown. Click here.

Providers Seek and Often Get Help of Elected Officials Over CMS Payment Issues

Medicare said waste, abuse, and fraud accounted for about $34.6 billion in improper payments to providers in 2013, and CMS got about $9 billion back through investigations and audits. But politics can get in the way: while contractors can suspend payments and revoke billing privileges for doctors and hospitals under investigation, providers sometimes get help fighting back from elected officials. Click here for the report.

CFPB Provides New Details, Requirements on Medical Debt

The Consumer Financial Protection Bureau will require major credit reporting firms to file regular reports on how they handle consumer disputes, following a new report that raises concerns about medical debt errors on consumer credit reports. The report, which CFPB released last week, found half of all debt on credit reports is from medical expenses, a “staggering” amount, the bureau said. The report also found that one out of five consumers — or 43 million Americans — have overdue medical debt on their credit reports. Click here for the CFPB report.

Update on Health Exchange Sign Up and Last Minute Rush

Millions of people who bought insurance through the exchange in this inaugural year of coverage under the health care law must decide by today, December 15, whether to switch plans for 2015 if they want a new plan starting Jan. 1. If they do nothing, most of the 6.7 million people who remained enrolled as of last month will automatically be re-enrolled in their current plans or similar ones. Click here for the story. There could be a last minute sign up boom, according to the Wall Street Journal. Click here.

Half of Doctors Listed As Serving Medicaid Patients – Aren’t: OIG Report

Large numbers of doctors who are listed as serving Medicaid patients are not available to treat them, federal investigators said in a new report last week. Many of the doctors were not accepting new Medicaid patients or could not be found at their last known addresses, according to the report from the inspector general of HHS. The study raises questions about access to care for people gaining Medicaid coverage under the Affordable Care Act. Click here for the NY Times report.

Major Insurers Worry Over COOP Funding

Some major insurers worry that consumer operated and oriented plans (CO-OPs) have an unfair advantage over their competition in healthcare markets because they receive millions in federal funding to operate their business, according to a Kaiser Health News report. To boost membership in their second year of operation, at least six CO-OPs have significantly dropped 2015 premiums. Some, such as HealthyCT, lowered premiums by an average of 8.5 percent, while other CO-OPs, such as Land of Lincoln Health in Illinois, cut rates by an average of 20 percent to 30 percent. Click here for the story.

Suit Filed Against Sovaldi Pricing

Philadelphia’s Transportation Authority has filed a class action lawsuit against Gilead Sciences Inc. over the “exorbitant” price it is charging for the hepatitis C drug Sovaldi, Reuters reports. This could have far reaching implications for these high cost block buster drugs. Click here for the story.

Long-Term Care Facilities Wasting $2 Billion in Drugs…Legally

As much as $2 billion a year in drugs is being wasted at long-term facilities. Meds that could be reused are being thrown out while one in four people in the U.S. struggle to afford their prescriptions. By law, nursing homes are forbidden from giving one patient’s pills to another, even if the person down the hall has the same prescription. So perfectly safe, up-to-date medications – already paid for, often by federal or state governments – are being discarded by more than 16,000 nursing homes and other long-term care facilities around the country. Click here for the story.

Senators’ Bill Would Streamline FDA Process for New Anti-Biotics

Sens. Michael Bennet (D-CO) and Orrin Hatch (R-UT) have introduced a bill in the final days of the 113th Congress that they say would create a new drug approval pathway, streamlining access to and encouraging the development of new antibiotics for patients resistant to existing drugs. The bill would permit the FDA to speed up the approval process for antibiotics with identifiable, limited patient populations. The labels of such drugs would require a special designation from the FDA, indicating the intended use would be for limited, high-risk populations. Click here for more and a copy of the bill.

Study: Socio-Economic Status Impacts Hospital Readmissions

A patient’s race, employment status and level of education, attributes known as socioeconomic status, have a direct impact on hospital 30-day readmissions for heart attack, heart failure, and pneumonia, according to a study released alst week. The analysis found that facilities that provide a significant amount of care to low-income, uninsured, and vulnerable populations, commonly referred to as Safety-Net Hospitals, as well as many non-safety net hospitals providing care to patients from high need communities, experience higher than average reimbursement penalties. Click here for the study.

MU Stage 2 Attestation “A Disappointment”

The attestation numbers for Stage 2 of the Meaningful Use program continue to disappoint, with only 3,655 eligible professionals and 164 eligible hospitals and critical access hospitals receiving payments for meeting the requirements through October 2014, according to CMS’ latest data. Click here to see CMS’ 12 PowerPoint slides with all the data.

More Servicemembers Lost to Suicide than Combat: Pentagon Report

The Pentagon reported last week that 224 servicemembers committed suicide in the first half of this year, including 144 active military, 38 members in the reserve and 44 National Guard members. The number of suicides dropped slightly between the first quarter of the year and the second. For two consecutive years, the U.S. has lost more servicemembers to suicide than combat. Click here for the 3-page Pentagon report.

Study: Too Many Breast Cancer Patients Receiving Too Much Radiation

Two-thirds of women who have lumpectomies for breast cancer are receiving radiation treatment that lasts nearly twice as long as necessary, a new study reports. The conventional, longer treatment lasts five to seven weeks. But four rigorous studies and guidelines from a leading radiology society conclude that three to four weeks of more intense radiation is just as effective. Women overwhelmingly prefer the shorter course of radiation, studies have found. It is also less expensive. Click here for the study in JAMA. Click here for the NY Times report.

Emergency Docs: Patients Risking Health with Too Many Urgent Care Center Visits

Amid the healthcare industry’s efforts to reduce the overuse of emergency departments, a new poll indicates too many patients may seek treatment at urgent care centers instead, posing a risk to their health. The poll, conducted by the American College of Emergency Physicians, surveyed nearly 3,000 ED physicians, 86 percent of whom indicated that there’s at least one urgent care center within 10 miles of their workplace. More than half the physicians said these urgent care centers were marketing themselves as alternatives to visiting the ED. Click here for the poll.

Regs Would Require Hospitals to Have Same Gay, Straight Rights

The Obama administration proposed new regulations last week that would require hospitals to give the same rights to gay spouses of patients as are offered to straight couples, regardless of where they live, as long as the marriage is legal somewhere in the U.S. Click here for to see the 26-pages of proposed regs.

$36 Million To Go To Health Centers

HHS announced last week $36.3 million in funding to 1,113 health centers in all 50 states, the District of Columbia, and seven U.S. Territories to recognize health center quality improvement achievements and invest in ongoing quality improvement activities. The health centers receiving awards are proven leaders in areas such as chronic disease management, preventive care and the use of EHRs to report quality data, according to HHS. Click here to see where the money is going by state.

California Battling Worst Whooping Cough Epidemic in 70 Years

California is battling the worst whooping cough epidemic to hit the states in seven decades, the AP reports. The state’s last epidemic was in 2010, but despite an aggressive public health campaign in response, the current outbreak is worse, raising questions about the effectiveness of the pertussis vaccine. A total of 9,935 cases were reported to the California Department of Public Health from Jan. 1 to Nov. 26 — the highest number in 70 years. Click here for the CDPH summary report. Meantime, this flu season looks like it could be worse than usual, due to an aggressive strain of influenza virus that might flout the protection provided by this year’s vaccine, according to the CDC. Click here.

Round Two of DME Competitive Bidding Starts January 22

CMS last week said the bidding window for Round Two of the Medicare durable medical equipment and supplies competitive bidding program will be open from Jan. 22 to March 25. The agency must rebid contracts under the program at least every three years. Click here for more from CMS.

Health Spending Showing Growth

Health spending through October showed signs of acceleration from the low growth in 2013, according to monthly health economic indicators from Altarum Institute released lasdt week. Spending on health care services grew 5.4 percent in the third quarter compared to the same quarter in 2013. Health care prices, however, grew more slowly. Prices overall were 1.5 percent higher than in October 2013, two-tenths below the September year-over-year reading. Hospital prices grew 1.1 percent in October, the lowest increase since September 1998. Click here for the report.

4.5 Percent of High School Students Use e-Cigs in Last 30 Days

Forty states have enacted laws prohibiting the sale of electronic nicotine delivery systems, including e-cigarettes, to minors, but 10 states and the District of Columbia still permit such sales, according to a report published by the CDC. More than 16 million children aged 17 and under reside in states not covered by these laws. The latest data from the National Youth Tobacco Survey showed 4.5 percent of all high school students and 1.1 percent of all middle school students had used e-cigarettes within the past 30 days in 2013. Click here for further details.

CDC’s Anti-Tobacco Campaign A Success

About 100,000 people quit smoking in 2012 because of the CDC’s anti-tobacco campaign, according to a study released last week. The CDC’s “Tips From Former Smokers” initiative cost $48 million, or about $480 for every person who threw away their cigarettes in 2012, the study found. Its bottom-line conclusion: “Tips” was extremely cost-effective, even after factoring in the expense of counseling and tobacco-cessation medications. Click here for the study.

Ebola Innovations Receive USAID Awards

Three innovations — redesigned protective gear with “integrated cooling features” so health care workers can better endure the temperatures of Ebola hot zones; an antiseptic solution that’s applied to the skin and blocks transmission of the deadly virus for hours; and a spray-on barrier that uses electrostatic fields to kill and repel microbes and prevent surface contamination — selected from more than 1,500 submissions, were highlighted last week as USAID announced the first award recipients of the “Grand Challenge for Development” to benefit frontline workers fighting Ebola in West Africa. Click here for the USAID announcement.

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