WEEKLY E-BULLETIN


Confidential Pioneer ACO Analysis Surfaces

A confidential draft document detailing how many aspects of the Pioneer ACO could be interpreted and implemented by CMS was circulating around Washington late last week.  A copy of the 43-page report is attached here.


Congress to CMS: Re-Evaluate Coding Creep Payment Hit

45 Senators and a majority of the House (219 members) have signed letters to CMS urging the agency to re-evaluate its proposal to impose a ‘coding creep’ adjustment on hospitals in FY2012.  The view the letter from the House, click here.  The Senate letter is attached here.  Unfortunately, if past experience is any guide, CMS will ignore the requests.


Bundled Payments Program Coming Soon 

A bundled payments program will be rolling out in the coming weeks from CMS, according the White House Deputy Chief of Staff Nancy-Ann DeParle.  She told the Center for American Progress last week that interested providers could start implementing this model as early as this year.  The Center for American Progress has a new report on bundling and recommendations.  Click here.


Senate Committee Recommends Changes to Cut Drug Costs

The Senate’s Special Committee on Aging is out with a list of 9 recommendations it says will reduce the cost of prescription drugs in the United States, including a significant expansion of the 340b program.  Click here to read the three pages of recommendations.


MedPAC Out With 2011 Medicare Data Book

One of the best resources in Washington is out for 2011:  MedPAC’s Health Care Spending and the Medicare Program – Data Book.  Click here to read this great report.


CMS Releases Discharge Planning Checklist

CMS has unveiled a six-page discharge planning checklist with more than a dozen questions, including questions on post-discharge care and medical equipment. The pamphlet can be downloaded by clicking here.


CO-OPs Get Regs

HHS is out with a proposed regulation establishing CO-OPs, the new Consumer Operated and Oriented Plan program. The CO-OP program will provide loans and grants to develop the new nonprofit health cooperatives that will be sold as qualified health plans that promote care coordination through state insurance exchanges in the individual and small group insurance markets. $3.8 billion in start up loans is being made available.  Click here for a CMS summary.  Read the 59-pages of regs here.


CLASS Act Support Group Emerges

One of the programs created in the Affordable Care Act and increasingly targeted for elimination by both Democrats and Republicans is the CLASS Act.  The new program that provides new long term care coverages for the elderly.  Long term care interests, organized labor and others have formed a coalition designed to protect it and they sent a letter to Congress last week urging that CLASS be protected.  The letter is attached here.


FDA to Regulate Mobile Apps

The FDA last week announced new guidance regarding the use of certain mobile apps.  The draft guidance document defines the mobile medical applications designed for mobile computing devices and smartphones that the agency intends to regulate, and delineates mobile medical applications that affect or could affect the performance or functionality of currently regulated medical devices. These include mobile medical apps that are either used as an accessory to medical devices already regulated by the FDA or which transform a mobile communications device into a regulated medical device. A number of medical imaging categories are included in the draft.  Click here to review the guidance.


SAHMSA Gives Update on America’s Mental and Substance Abuse Health

SAHMSA??’s new report on America’s mental health and substance abuse was issued last week. Nationally in 2008-2009, 4.6 percent of adults aged 18 or older had serious mental illness in the past year. Rhode Island had the highest rate (7.2 percent), while Hawaii and South Dakota shared the lowest rate (3.5 percent). In 2008-2009, the national rate of past year any mental illness among adults aged 18 or older was 19.7 percent. The highest rate occurred in Rhode Island (24.2 percent), while the lowest rate was in Maryland (16.7 percent). Across age groups, the highest rate of past year any mental illness was among 18 to 25 year olds (30.5 percent nationally). Click here to read the 318 page report.


IOM Recommends Eight New Preventive Services for Women

A new report from the Institute of Medicine recommends that eight preventive health services for women be added to the services that health plans will cover at no cost to patients under the Affordable Care Act. The ACA requires plans to cover the services listed in the HHS comprehensive list of preventive services.  The report suggests the following additional services:  counseling on sexually transmitted infections; counseling and screening for HIV; contraceptive methods and counseling to prevent unintended pregnancies; lactation counseling and equipment to promote breast-feeding; screening and counseling to detect and prevent interpersonal and domestic violence; yearly well-woman preventive care visits to obtain recommended preventive services; screening for gestational diabetes; human papillomavirus (HPV) testing as part of cervical cancer screening for women over 30. Click here to read the IOM recommendations.


TRICARE to Cost Sole Community Hospitals More

TRICARE is revamping the way it pays sole community hospitals for inpatient services.  The change will save the government about $31 million the first year.  Click here to review the proposed rule.


New OIG Report on Hospices with Nursing Home Patients

The HHS OIG is out with a report saying hospices with a high percentage of nursing home patients received larger Medicare payments than hospices in general in 2009.  Read the 30-page report here.