Bundled Payments Summary; Opportunity

CMS’ bundled payments demo announced two weeks ago may be an excellent opportunity for many hospitals to improve efficiencies around specifics DRGs, align more closely with selected physicians and make some money.  Unlike the ACO demo, bundled payments offers significantly more flexibility to providers.  Click here to read an excellent summary developed by our policy team.

If you want to know more about how to submit a successful Bundled Payments application to CMS, please call or email me.  We will schedule a conference call with you to discuss the opportunity.  Our health policy team, which has already submitted successful applications for other hospital demo projects, is well prepared to help a hospital determine whether bundled payments is a good fit and then submit a detailed application.  Letters of intent are due by September 22 for Model 1 and November 4 for Models 2-4.  Our brief above describes the differences between the models and time lines.

Incentive Payments Rule for ePrescribing Announced

CMS announced its final rule for getting incentive payments for ePrescribing in calendar year 2011. Hardship exemption requests for the 2012 ePrescribing payment must be received by Nov. 1, 2011. Click here for a good CMS summary. Click here to review the 72-page rule.

Health Care Jobs Increase

It seems the only real bright spot on the jobs front in August – according the Labor Department’s monthly jobs report released Friday – is health care.  Health care employment rose by 30,000 in August. Ambulatory health care

services and hospitals added 18,000 and 8,000 jobs, respectively. Over the past 12 months, health care employment has grown by 306,000. Click here to see the report.

Hospital-Based Radiology Encouraged in New Report

Hospitals looking for ways to add new revenue streams may be looking to put comprehensive radiology services back into the hospital, according to a new report.  The Value-Added Services of Hospital-Based Radiology Groups report says the value-added services fall into 6 categories: (1) patient safety, (2) quality of the images, (3) quality of the interpretations, (4) service to patients and referring physicians, (5) cost containment, and (6) helping build the hospital’s business. If the hospital allows its radiology department to become fragmented by the intrusion of other specialists or teleradiology companies in remote locations, most of these added values would be lost, and chaos could ensue.  Click here to read the report.

Insurance MLRs Exceeded Requirements:  GAO

The GAO was out with a report last week that said  from 2006 through 2009, the average health insurance plan spent more on medical claims than required under the health care reform law.  The report found that “medical loss ratios” on average generally have exceeded the requirements of the affordable Care Act, even before taxes and fees are deducted as allowed under regulations implementing the provision. The deductions will make it easier for insurers to meet the law’s requirement.  Click here to see the GAO report.

Association Insurance Subject to Rate Reviews

CMS last week released an amendment to final regulations that say individual and small group health insurance sold through associations will be subject to the health reform law’s rate review requirements effective Nov. 1.  On September 1, the rate review process went into effect for other plans in the individual and small group markets. Click here to read the new rule.

PBMs Recommend Payment Cuts

How would the nation’s pharmacy benefit managers change the laws to help save government funds?  Their trade association last week sent a letter outlining their ideas to Congress’ deficit reduction supercommittee.  They say their solutions would save $100 billion over 10 years.  Click here to read the letter.

Initial PDUFA Deal Reached

The FDA last week released the first draft of the agreement with industry for the reauthorization of the Prescription Drug User Fee Act (PDUFA).  The current law will expire in September of next year.  New legislation is required for the FDA to continue collecting user fees from drug companies. FDA has said it intends to submit its final recommendations on user fees to Congress in January 2012.  Click here to review the 32-page draft.

GOP Govs Offer 31 Medicaid Policy Suggestions

GOP governors issued a report last week on ways to fix Medicaid.  They offered 31 recommendations.  Click here to review the 16-page report.

State Exchange Designs Must Consider Children

Children are at risk of “falling through the cracks” if states do not put safeguards in their insurance exchange designs, according to a new report from the National Governors Association.  Click here to read the 9-page report.

ACA Repeal Would Cost Retirees More for Rx

Retirees with high outpatient drug use would be most affected by repeal and would need to save an additional 30 to 40 percent to make up the shortfall if the Affordable Care Act is repealed, according to a report out last week from the Employee Benefits Research Institute.  Click here to read the 7-page report.