MedPAC Report to Congress: Curb Advanced Imaging

Despite an intense lobbying effort over the past couple of months, doctors and the imaging industry last week were unable to turn aside MedPAC recommendations designed to curb the use of costly advanced diagnostic imaging services.  Specifically, MedPAC recommended that:

  • HHS should accelerate and expand efforts to package separate services in the physician fee schedule into larger units for payments.
  • Congress should tell HHS to apply a multiple procedure payment reduction to the professional component of diagnostic imaging services provided by the same doctor in the same session.
  • Congress should tell HHS to reduce the physician work component of imaging and other diagnostic tests ordered and performed by the same doctor.  Click here to read the latest MedPAC report. (227 pages – and it’s full of very good information.  MedPAC offers some ideas on how to fix the Medicare physician payment problem.)


Medicaid Managed Care Growing:  New MACPAC Report

Medicaid managed-care enrollment grew from 15 percent of enrollees in 1995 to 47 percent in 2009, according to a new report released last week by the Medicaid and CHIP Payment and Access Commission.  Click here to read the report.  The percentage of Medicaid beneficiaries who are in risk-based managed-care plans is continuing to increase as state officials expand the programs further to populations that traditionally have been a small fraction of those enrolled in managed care.


For-Profit Medicaid Plans Spend More on Admin:  New Report

Medicaid managed care plans that are owned by publicly traded, for-profit companies spent an average of 14 percent of premiums on administrative costs, higher than the average of 10 percent spent by non-publicly traded plans, according to a Commonwealth Fund study last week.  Click here to see the 18-page report.


AARP, GOP Spat Over New Ad

The AARP is out with a new TV ad that is ruffling feathers on Capitol Hill.  As negotiators seek a compromise on massive spending cuts, the AARP offers some suggestions of its own.  Click here to see the 30 second spot.  Republican Congressman Tom Price smacked the AARP with a press release.  Read here.


McKinsey Report Continues Under Attack

The controversy around the report from McKinsey released two weeks ago – saying that as many as 30 percent of all employers will drop their employee health insurance under the health care reform law — continues.  Last week, Senate Finance Committee Chairman Max Baucus (D-Mont.) sent a letter to McKinsey Consulting Company Managing Director Dominic Barton, calling on the company to release the methodology behind a health care survey it published in early June. Click here to read the letter.


FDA Faster Than Europe:  New Report

New cancer drugs reach patients in the U.S. more quickly than patients in Europe, according to a new study in Health Affairs.  Click here.  This comes as the FDA is under increasing pressure to approve drugs more quickly and Congress is in the process of updating the laws government the FDA.


Medicaid Spending to Decline in 2012; States Hurting

The Congressional Budget Office estimates that federal Medicaid spending will decline in 2012 for only the second time in the 46-year history of the program. But states say they will have to have to spend more on Medicaid as they struggle to make up for the loss of federal money.  The FMAP increase to states, enacted with the stimulus package shortly after Obama was elected, expires at the end of the month.  Congress has no plans to extend it.  A very good NY Times article on the subject is here.


New CMS Reg on Mini-Med Waivers

CMS mini-med waivers will soon be gone.  CMS announced last week that come September it’s closing down its controversial mini-med waiver application process.  CMS issued guidance to allow limited benefit, or “mini-med” plans, to apply for or renew a temporary waiver from annual limit restrictions through 2013.  In 2014, annual limits for new health plans will be banned.  Click here for details.


CMS Announces New Anti-Fraud Effort

CMS last week awarded Northrop Grumman a new $77 million contract to fight Medicare fraud BEFORE it happens.  Northrop Grumman will deploy algorithms and an analytical process that looks at CMS claims – by beneficiary, provider, service origin or other patterns — to identify potential problems and assign an “alert” and assign “risk scores” for those claims.  These problem alerts will be further reviewed to allow CMS to both prioritize claims for additional review and assess the need for investigative or other enforcement actions. Click here to learn more.


New CMS Rule on Mental Health Centers

CMS last week issued a proposed rule designed to improve the quality and safety of treatment provided to more than 25,000 Medicare beneficiaries who receive care at Community Mental Health Centers (CMHCs) each year.  The rule would establish conditions of participation (CoPs) for CMHCs for the first time. The proposed rule includes health and safety standards for CMHCs that participate in the Medicare program.  Click here to read more.


Health Care Consolidations Will Continue:  New Report

In a report out last week from PriceWaterhouseCoopers, mergers in the healthcare sector are expected to continue.  According to the PwC mid-year 2011 report:   ”Managed care companies will continue to pursue growth opportunities abroad to diversify geographic risk.  The medical device industry will consolidate to achieve cost savings and diversify product portfolios, driven by the need to combat the impact of federal excise taxes, downward pressure on pricing and reimbursement and declining procedure volumes in certain high cost treatment areas.  Well financed hospital systems will continue to expand their footprint as struggling providers seek better capitalized merger partners.  Pharmaceutical companies will reshuffle portfolios and utilize acquisitions (in the U.S. and abroad) to bulk up their pipeline of new products as they deal with significant amounts of patent expiration and use divestitures as another way to return value to shareholders.”  Click here to read more on M&A trends.


Hospitals, Doc Offices About the Same on Medical Errors

Your chances of suffering harm because of a medical error are about the same in a doctor’s office as in a hospital, according to a new study out last week.  click here for details.


Physicians Continue Selling to Hospitals

Another report out, this from Accenture, detailing the trend of community physicians selling their practices to health systems.  Click here to read the report out last week.  Click here to see the press release.


Still Time to Sign-Up For Rural Grants Collaborative

The government will issue more than $80 billion in health care grants this year and millions of dollars are targeting rural America.  Today Strategic Health Care is helping more than 40 hospitals find and get federal grant funds.  To help rural hospitals take advantage of these funds, our Grants Division is starting a new Rural Hospital Grants Collaborative for rural hospitals with 60 or fewer (staffed or licensed) beds.  By working together, rural hospitals will receive professional grant writing services, development expertise, grant identification, ongoing training and consulting at a deeply discounted rate. If you’re interested in learning more, Strategic Health Care is sponsoring two national webinars:

  • To register for the webinar on Wednesday, June 29th at 1 pm EDT, click here: www.meetme.net/shc1
  • To register for the webinar on Thursday, June 30th at 11 am EDT, click here:  www.meetme.net/shc2

If you have questions, please call either Gwen Mathews or Simone Hall at 202-266-2600.