Court Strikes Blow Against Health Care Law

A federal appeals court has struck down the requirement in President Obama’s health care overhaul package that virtually all Americans must carry health insurance or face penalties.  A divided three-judge panel of the 11th Circuit Court of Appeals on Friday struck down the so-called individual mandate, siding with 26 states that had sued to block the law.  It’s the first time a judge appointed by a Democrat sided against the law.  Click here to read more on the ruling.  Click here to see the White House response.

CMS Issues New Exchange Rules; Treasury Offers New Tax Credit

The state health exchanges got a boost Friday when CMS and Treasury issues new regulations providing new benefits and guidance.  When fully implemented, individuals would receive tax credits of about $5,000 a year.  CMS says its rules will make it easier to enroll and maximize choice.  Click herefor details.  Click here to review the tax credit rules.  Click here to see how much $$$ has been doled out to each state for their exchange, thus far.  And who is really going to make good money from the Exchanges?  Health IT companies, of course.  Click here.

PGPs Having Trouble Achieving Savings?

CMS’ Physician Group Practice Demonstration Program announced its latest results last week and found that ony 4 of the 10 participants will split $29.4 million in bonuses in the final year of the five-year demonstration.  CMS also said all 10 groups will continue to participate in the new PGP transition demonstration — a two-year supplement to the original demonstration.  ACOs were designed, in part, on the experience of the PGPs.  Click here for details.

SuperCommittee Selected; The Lobbying Begins

Speculation is running rampant in DC about whether the new legislative supercommittee will be successful in finding a deficit reduction solution of at least $1.2 trillion that will get enough votes to pass Congress by December 23.  The 12 committee members:  GOP Senators Portman (OH), Toomey (PA) and Kyl (AZ); Dem Senators Murray (WA), Kerry (MA) and Baucus (MT) and House GOP Henserling (TX), Camp (MI) and Upton (MI), and Dems Van Hollen (MD), Clyburn (SC) and

Beccera (CA).  Click here for a good summary story from the Washington Post.

3-Day Payment Window Could Bring Admin Nightmare

A little-noticed provision of in the 2012 hospital and physician payment rules would expand the 3-day payment window bundling rules to hospital wholly-owned or -operated physician practices.  Although CMS describes this as a clarification of existing policy, the 3-day window was rarely applicable because the policy required an exact match between the principal ICD-9 CM diagnosis codes for the outpatient services and the inpatient admission prior to a change in the statute last year. The statutory change broadens the applicability of the payment window policy in hospital-owned or hospital-operated physician offices or clinics (that is, clinics that are not provider-based but are wholly owned or operated by the hospital) for services that are related to the subsequent hospital admission, regardless of the ICD-9 CM diagnosis code reported.

The administrative and compliance cost associated with this policy may be greater than direct financial impact of the change.  Many hospital-owned clinics do not operate on the same IT platforms, and most offices submit their bills to CMS immediately, meaning billing processes and timing would need to be adjusted across the system.  To read the physician rule discussion and submit comments, click here. To read the discussion of the policy in the final IPPS rule, click here.  For more info, call Marian Lowe at Strategic Health Care at 202-266-2600.

Investigation into Health IT and Medical Errors Urged

At least one member of Congress is raising red flags and asking for an investigation into the use of Health IT to reduce medical errors.  The chairwoman of the House Subcommittee on Health Care and Technology, Rep. Renee Ellmers (R-NC) sent a letter last week to the HHS Secretary urging such an investigation.  Click here to read her letter.

National Health IT To Roll Out Info Campaign

The Office of the National Coordinator for Health IT announced it is rolling out a national campaign in mid-September to get the public more plugged into their own health care.  Click here.

More CT = Less Admissions:  New Study

There’s been a big jump in the number of CT scans in emergency departments, according to a new study, and that increase may be the cause of declining admissions.  Click here for more.

CMS Announce New Coverage Decisions

CMS last week proposed two coverage decisions for Medicare beneficiaries—for “high intensity” behavioral counseling and screening for sexually transmitted infections and for behavioral therapy forcardiovascular disease.  Click here to see the STI proposal.  Click here for the cardio proposal.

MACs Not RACs to Send Demand Letters

Providers should look for demand letters for recovery audit contractor-identified overpayments from their Medicare Administrative Contractors (MACs) starting Jan. 1, 2012.  CMS will require MACs instead of RACs to send demand letters and follow the same process for other payment recoupments.  Click herefor more.

Are You Keeping an Eye on the Government’s Comparative Effectiveness Developments?

AHRQ’s latest comparative effectiveness results were announced last week with a report on the best way to manage sleep apnea. Click here.