WEEKLY E-BULLETIN


Dec. 5, 2011


Physician Payment Fix in the Works

Congressional leaders are in active discussions on how to fix – at least for a year – the physician’s Medicare payment system.  A House vote on a solution could come as early as this week.  Without a fix, docs take a 27.4% Medicare pay cut Janauary 1.  The cost of a one year fix is about $21 billion over 10 years.  A two year fix costs $38.6 billion.  Most everyone want to fix it, but not everyone agrees on how to pay for it.  There’s some discussion about taking funds from the CMS Innovation Center.  A new CBO analysis of the financial cost of a fix can be found here.

Other Medicare “Fixes” Under Discussion

Several other Medicare payment fixes — known as “Extenders” because they extend current payment policies that would otherwise expire soon — are also under development.  Their total cost is about $1 billion, so they don’t get quite as much attention.  It is very likely that the extender package could be attached to the doc fix bill.  They include Section 508 wage index adjustments, ambulance add-on services and an outpatient hold harmless provision for rural and Sole Community hospitals.  The AHA weighed in last week urging Congress to extend. The AHA letter can be found here.

CMS’ Tavenner Wins Praise

Marilyn Tavenner, tapped by the White House to replace Don Berwick at CMS, is receiving bi-partisan praise in Congress and support from the health communtiy.  Click here for a Capitol Hill media report.  She is getting some challenge from GOP stalwarts in the Senate.  Click here to see what the GOP Policy Committee had to say. Berwick’s last day was Friday.

Berwick Says System is Fraught with Waste

In a final interview upon his departure from CMS, Don Berwick identified five of the biggest problems confronting America’s health care system.  Click here to read the interview.


Meaningful Use Requirements Delayed

HHS officials last week announced that the agency plans to delay the start of Stage 2 of the Meaningul Use requirements of EHR from 2013 to 2014.  Under current rules, providers that participate in the program this year would have to satisfy Stage 2 standards in 2013, whereas providers who waited until 2012 to participate wouldn’t have to satisfy requirements until 2014–a prime reason for some providers to hold off attesting in Stage 1 until 2012. Under the proposed delay, providers who attest to Stage 1 of Meaningful Use this year will not have to meet Stage 2 criteria until 2014.  Click here for details.

More Docs Adopting EHR Systems

Physicians are adopting EHR systems now more quickly, according to a new national survey by the CDC.
In 2011, 57% of office-based physicians used electronic medical record/electronic health record systems, with use by state ranging from 40% in Louisiana to 84% in North Dakota.  Click here to see how your state ranks.

Provider Contracting with DOD Could Get Easier

The Senate has passed the Defense Authorization bill that contains an amendment that would loosen the restrictions on providers who contract with DOD for health care services.  The bill must still pass the House, but the provision is considered a big win for thousands of providers.  Click here for a one-page summary prepared by our policy team.

More Jobs in Hospital Administration than Patient Care: New Report

More Americans are working according to the new jobs report out Friday.  This inlcudes more jobs at hospitals, but according to a USA Today story last week, more jobs are being created in administration than direct patient care.  Click here.

DME Competitive Bidding Program Expands

Round 2 competitive bidding for Medicare DME gets underway today, according to CMS.  The competitive bidding process will be expanded from 9 to 91 metro areas of the country.  CMS touts and explains the changes here.

Medicare Expands Obesity Coverage

Medicare announced last week it is expanding its coverage for obesity screening and counseling.  For a beneficiary who screens positive for obesity with a body mass index ≥ 30 kg/m2, the benefit would include one face-to-face counseling visit each week for one month and one face-to-face counseling visit every other week for an additional five months. Click here for details.

$220 Million in Exchange Funds Released; 29 States Now on Board

HHS last week awarded nearly $220 million in Affordable Insurance Exchange grants to 13 states to help them create Insurance Exchanges. HHS also announced that states that run Exchanges have more options than originally proposed when it comes to determining eligibility for tax credits and Medicaid. And states have more time to apply for “Level One” Exchange grants.  29 states have taken the federal Exchange funds.  Last week’s takers were: Alabama, Arizona, Delaware, Hawaii, Idaho, Iowa, Maine, Michigan, Nebraska, New Mexico, Rhode Island, Tennessee, and Vermont. Click here for more.


CMS Issues Final MLR Regulation

CMS on Friday issued a final regulation that will ensure health insurance companies spend at least 80 percent of consumers’ health insurance premiums on medical care.  Insurance companies that fail to meet the new standard are required to provide a rebate to consumers.  These are modifications to the current rules that took effect almost a year ago.  Agents and brokers are not exempt from the final MLR calculation. Click here for details.  At least 64 percent of “credible” insurers would have met the ACA’s medical loss ratio standards for this year, according to a very interesting GAO report released last week. Click here to see it.

Number of Uninsured Kids Drop

The uninsured rate for children decreased during the recession, according to a new report released lat week by the Georgetown University Center for Children and Families.  Medicaid and the Children’s Health Insurance Program are credited for the overall decline among uninsured children. From 2008 through 2010, the uninsured rate dropped to 8 percent from 9.3 percent.  Click hereto see the 9-page study.

Report Recommends Giving State Power to Manage Private Hospitals

Give the New York health commissioner more power to manage private hospitals — this is the conclusion of a new report issued last week on how to restructure Brooklyn’s failing hospitals and health system.  Click here for the NY Times story.