WEEKLY E-BULLETIN


SNFs To Take Large Payment Cut

CMS Friday announced a final rule reducing Medicare skilled nursing facility payments in FY 2012 by $3.87 billion, or 11.1 percent lower than payments for FY 2011. Click here for details.

Hospices Get FY12 Increase

Hospices will be receiving a 2.5 percent increase in their Medicare payments beginning FY12, according to a final rule announced Friday by CMS. Details are here.

IRFs To Get Payment Increase

Inpatient Rehab Facilities will see a 2.2 percent increase in Medicare payments starting in FY12, according to CMS. They will also begin reporting quality data. Initially, they will submit data on two quality measures, a urinary catheter-associated urinary tract infection measure and a measure for new or worsening pressure ulcers, with a third measure—”30-day Comprehensive All Cause Risk Standardized Readmission”–under development. Click here for details.

How Many Pioneer ACOs?

How many organizations filed Letters of Intent for CMI’s Pioneer ACO program? Only the government knows and they’re not telling. Word on the street last week: about 40. No word on whether CMS would find that number a success. USA Today was out with a story (click here to read) about ACOs and how providers are embracing the concept.

IOM: Scrap Current Medical Device Clearance Process

The Institute of Medicine is recommending that the FDA scrap its current medical device clearance process, known as 510(k), and implement a new regulatory framework. The recommendations have the medical device community scrambling. Read the IOM recommendations here. Review the FDA response here.

FDA Wants Medical Device Approval Changes

Earlier last week, the FDA issued new guidance that clarifies when changes or modifications to a previously cleared 510(k) device require a new premarket submission. Click here to review.

Kaiser Poll: Don’t Cut Medicare

Cut the deficit, but don’t cut Medicare, Medicaid or Social Security says a majority of Americans in a new Kaiser Poll. Click here.

Drug Costs About to Fall Dramatically

According to analysts, prescription drug prices are likely to fall significantly over the next year or so. Why? The next 14 months will bring generic versions of seven of the world’s 20 best-selling drugs, including the top two: Lipitor and Plavix. Click here for details.

More Exchange Rules Coming; New Report Covering Strategic Issues

Eligibility and enrollment are the issues that will likely be addressed when CMS issues its next set of Exchange rules in the next few weeks. The first draft rules were issued about three weeks ago, left many unanswered questions, but were generally viewed favorably by states looking for flexibility. Deloitte is out with a new analysis on the Exchanges that provides a great overview of the strategic issues. Click here to read the 12-page report.

RACs Recover $233 Million in Third Quarter

CMS’s RAC program has issued its third quarter report on its recovery success and identified the most significant billing problems. It is all summed up in a single page graphic. Click here.

Did Your Democratic House Member Sign On to IOM Letter?

83 House Democrats sent a letter last week to the HHS Secretary urging adoption of the IOM recommendations that preventive health coverage be provided to women with no copay requirement. Click here to review the letter.

BCBS Wants A Second Internal Appeal Step

Commenting on proposed rules from CMS, Blue Cross and Blue Shield said health insurers should be allowed to require individual policyholders to go through a second level of internal appeals before going to external reviews or litigation. This position was supported by AHIP. The BCBS 12-page comment letter is attached here.

House Committee OKs Children’s GME Bill

A bipartisan group of House members (yes…bipartisan!) approved an extension of the Children’s Hospital Graduate Medical Education law at current funding levels, about $330 million over 5 years. Click here for more.

Implications for Health Care?

The wealth gap in the United States between whites and minorities grew dramatically during the recession, according to a new report from the Pew Research Center. Click here to review.