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10/27/2014

Weekly E-Bulletin


$840 Million in Grants Announced To Fund Innovative Delivery Strategies

HHS last week announced it would spend up to $840 million over the next four years to fund innovative healthcare strategies designed to improve patient care and lower costs. The initiative aims to support networks that help doctors access information and improve health outcomes. The agency believes the Transforming Clinical Practice Initiative will save between $1 billion and $4 billion. Click here for a detailed summary.

  • Click here for a summary of the funds to develop Practice Transformation Networks
  • Click here for a summary of the funds to develop Support and Alignment Networks

Strategic Health Care’s CMS/CMMI innovation response team is prepared to lead your health system’s application process. Email me asap (Paul.Lee@shcare.net) if you would like to discuss. Letters of Intent to CMS are due by November 20.

More Hospital Time on Ebola Means Less Time for Other Demands, Like Flu

The more time hospitals spend on Ebola can mean less time to handle day-to-day demands, particularly the Enterovirus D-68 outbreak and the approaching flu season. Infection prevention and control at hospitals can range from ensuring that nurses and doctors are washing their hands and wearing face masks to coordinating whether or not a certain patient really needs an antibiotic, in order to reduce the prevalence of drug-resistant bugs. Click here for the NPR report.

Dallas Hospital Helped NY Hospital Prepare for Ebola

The Ebola drama that unfolded in Dallas last month — the response from the hospital, CDC, other government officials — helped pave the way for New York City’s response, according to reports in the NY Times. Click here for a very good story on the contrast of responses and how we all went to school on the Dallas experience. The CDC issued a report about New York City readiness even before a patient showed up. Click here.

Dallas Presbyterian Hospital Announces Changes Based on Ebola Experience

THR Presbyterian Hospital announced some changes, saying it had learned from its experiences treating Ebola and was sharing them with other hospitals in a stark then-and-now PowerPoint presentation. Patients will be asked about their travels within five minutes of entering the ER. Electronic medical records will highlight that information in a large red box. Nurses and doctors are encouraged to talk face to face rather than rely solely on records. There’s also a new triage procedure. Click here for the hospital’s announcement. Click here for their excellent 32-slide PowerPoint presentation that outlines all their changes. Click here for the hospital’s webpage with its complete response.

Nurses Want Congress To Mandate Protocols

Nurses put themselves at risk by caring for Ebola patients — now they want support from Congress for mandated protocols. Click here for the story.

Report Says Training Is the Key To Effective Ebola Response

Even with protocols and protective gear, hospital workers who have not undergone training might still be at risk, according to experts. For that, CDC resources are sorely lacking in good tools. Although the CDC has a host of instruction sheets and detailed documents, that information then needs to be interpreted and recommunicated. Click here for a report from Scientific American.

Three States Impose Mandatory Quarantine for Ebola Workers

The governors of New York, New Jersey and Illinois on Friday imposed a mandatory 21-day quarantine for medical workers returning from the countries hit hardest by the epidemic. The new quarantine rules came amid a deepening debate across the country over whether federal restrictions need to be tightened for anyone arriving in the United States from the Ebola-stricken countries of West Africa. Click here for the story.

Federal Ebola Response Squads Readied

To combat Ebola potentially spreading in the United States, federal response squads are getting prepared to rush to any U.S. city if another Ebola case emerges. The government has also created a second team to prepare hospitals where subsequent Ebola cases could turn up. Click here for details.

HRSA Says Rx Companies Should Refund 340B Orphan Drug Monies

Some drug manufacturers should refund hospitals participating in the 340B Drug Pricing Program for certain orphan drugs they charged hospitals at non-discounted prices, the Health Resources and Services Administration told drug manufacturers last week. HRSA, which oversees the 340B program, sent letters to more than 50 drug manufacturers on Oct. 7 regarding this issue. In a related development, the 340B Coalition is urging Genentech to rescind its decision to move certain cancer drugs to specialty distribution. Click here for the letter.

Medicare’s Self-Referral Ban Is Thriving on a Loophole

Self-referral has become common practice among many U.S. physician groups, which refer anything from lab services to MRIs to entities from which they benefit financially, according to a Wall Street Journal report. That wasn’t the intention of Congress two decades ago, when it passed the so-called Stark Law banning self-referral when the patient is covered by Medicare or another government plan. The law, named after former Rep. Pete Stark (D-CA), includes an “in-office ancillary services” exception—intended for simple, routine procedures such as in-office blood tests that would let doctors make patient care more efficient. Click here for the report.

Study Says Hospital-Owned Physician Groups Cost More

A new study finds that hospital ownership of physician groups in California led to a 10 to 20 percent increase in overall costs. Researchers conducted the study to determine whether total expenditures per patient were higher in physician organizations owned by local hospitals or multi-hospital systems compared with physician organizations owned by participating physicians. Click here for the abstract. Click here for the LA Times story.

Reference Pricing Gaining Traction

Reference pricing–a cap on what payers would cover for certain medical procedures–is slowly gaining traction in the healthcare sector, according to a new report. The California Public Employees Retirement System has saved some $6 million with a $30,000 cap on what it would pay for knee and hip replacement surgeries, with the patients paying any differences out of their pockets. The patients themselves have saved $600,000 in out-of-pocket costs to date. Click here for more.

HealthGrades Promoting Upgraded Doc, Hospital Comparison Site

You may have already seen the TV ads promoting this one: the first comprehensive physician rating and comparison database launched last week in time for open enrollment on federal and state health exchanges, as well as for many employer-provided plans. The new version of the website Healthgrades.com uses about 500 million claims from federal and private sources and patient reviews to rate and rank doctors based on their experience, complication rates at the hospitals where they practice and patient satisfaction. Click here for the story. Click here to go to the site.

On-Line Medical Price Shopping Saves Consumers Money

Consumers who used an online tool to price-shop for medical services saved money, according to a new study that health economists hailed as evidence that market forces could pressure providers to lower health care costs. According to the study, 6 percent of lab test claims, 7 percent of advanced imaging claims and 27 percent of all clinician office visit claims were associated with a consumer price search prior to use of the service. Click here for the study.

Report: Physicians Changing Antibiotics Prescription Practices

Physicians across the country are recasting their in-office policies regarding the dispensation of antibiotics over mounting concerns about resistance, finds a new report from Consumers Union. Pediatricians are being advised to not prescribe antibiotics as a first resort when treating young children for ear infections, the seven-page report says. In hospital settings, medical teams are increasingly creating antimicrobial stewardship programs. Click here for the report.

Arkansas’ Private Medicaid Option Plan Touted as Success; Other States Considering Expansion

Less than a year after low-income Arkansans started receiving health coverage under the Affordable Care Act’s controversial Medicaid expansion, the state is declaring its so-called “private option” experiment a success. Hospitals saw fewer uninsured patients, state coffers were spared millions in health care costs and private insurers reported record-low premium hikes. Most important, Arkansas’ uninsured rate fell from 23 percent to 12 percent, the sharpest drop in the country. Click here for an update on Arkansas and the state of Medicaid expansion across the country.

New Report Reveals More Details on Industry Payments to Physicians

Mandated by the Sunshine Act, on September 30th, CMS publicly released the first set of data that shows $3.5 billion paid by the medical industry (pharma, medical devices) to over half a million doctors and teaching hospitals in the last five months of 2013. A subset of data includes two categories of payments. The first category are the payments that are made for reasons such as travel reimbursement, royalties, speaking and consulting fees and the second are payments which are made as research grants. Click here for the newest detailed report on these payments. Click here for the upgraded CMS site that allows you to search for physicians and teaching hospitals.

Senators Plan $10 Billion Boost for Bio Research

Aides to Senators. Elizabeth Warren (D-MA) and Orrin Hatch of Utah, the top Republican on the Senate Finance Committee, met with industry representatives this week to discuss their plan to boost funding for biomedical research by $1 billion annually over 10 years, according to people familiar with the discussion. Click here for the Wall Street Journal report.

UPMC, Highmark Continue High Profile Court Battle

“It’s like fourth grade,” Judge Dan Pellegrini said of a court hearing last week regarding the ongoing dispute between Pittsburgh health giants Highmark and the University of Pittsburgh Medical Center. The state wants Highmark to include UPMC providers at in-network rates, but the two sides disagreed about what it meant when both said seniors still would have access to UPMC providers, reports the Pittsburgh Post-Gazette. Click here.

Medical Malpractice Payments Remain at Historic Low

Medical malpractice payments last year remained at a historic low even though they increased slightly compared to payments in 2012, according to a Public Citizen report last week. The value of malpractice payments on behalf of physicians in 2013 was $3.3 billion, compared with $3.1 billion in 2012, and payments last year accounted for about .11 percent of national health care costs. Click here for the report.

Analysis: Insurer’s Business Model Must Change

Competition among health systems and pressure to cut costs will transform–if not doom–health insurance companies in their current form, according to an article by a Stanford professor in Fortune magazine. Calling the existing healthcare payment system “a bureaucracy that would make Kafka blush,” the researcher says payers must reinvent their way of doing business. They must adapt or die. Click here for the story.

Study: Medicare Spending Slowdown Caused Largely by Part D

Much attention has focused on the remarkable slowdown in Medicare spending over the past few years. Spending per beneficiary actually shrank by one percent this year (or grew only one percent if one removes the effects of temporary policy changes). Despite constituting barely more than 10 percent of Medicare spending, a new analysis shows that Part D has accounted for over 60 percent of the slowdown in Medicare benefits since 2011 (beyond the sequestration contained in the 2011 Budget Control Act). Click here for the report in Health Affairs.

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