WEEKLY E-BULLETIN


Some in GOP, Most Dems, Want War Savings for Doc Payment Fix

A variety of news reports last week have many in the GOP warming to the idea of using war savings for a permanent Medicare doc payment fix. Click here for one of those stories. Most health care lobbying groups and Hill Democrats agree with this approach. Most Republicans continue to be against it, including Ways and Means Chairman Rep. Dave Camp (R-MI). The AMA is also pushing this approach (click here to read their letter to Congress.) The House-Senate conference committee meets for a second time on Wednesday to work on an agreement. The current SGR fix expires February 29. Meanwhile, the Coalition to Protect America’s Health Care launched a new national television ad urging Congress not to cut Medicare payments to hospitals. Click here to see the 30-second spot.

New Medicaid Reg Would Save States Billions for Drugs

CMS issued a draft rule Friday that is expected to save states and individuals about $17.7 billion over five years. The rule implements specific provisions in the Affordable Care act. The proposed regulation reduces costs through a number of improvements, including: Aligning reimbursement rates to better reflect the actual price the pharmacy pays for the drug; Increasing rebates paid by drug manufacturers that participate in Medicaid, and Providing rebates for drugs dispensed to individuals enrolled in a Medicaid managed care organization. Click here for details.

Innovation Center: New Summary of Projects; More GOP Attacks

The CMS Innovation Center issued a summary report last week – a year after it started – detailing its 16 projects already underway. CMS said it is “learning from previous CMS projects and feedback from the healthcare community. Click here for the 8-page report; the last 3 pages summarize all of the current demos in chart summary form. The report comes on the heals of a Congressional Budget Office review of CMS demo projects from previous year that was not too complimentary. Click here for that report. Meantime, House Ways and Means GOP leaders sent a two-page letter to the HHS Secretary calling the Innovation Center into question and requesting significant information about its operation. Click here to see the letter.

GAO: MA Plans’ Risk Scores Higher than Traditional Medicare

Both parties are calling for action in the wake a new report out last week from the GAO that found that diagnostic coding differences exist between MA plans and Medicare FFS. The GAO estimated that before CMS’s adjustment, 2010 MA beneficiary risk scores were at least 4.8 percent, and perhaps as much as 7.1 percent, higher than they likely would have been if the same beneficiaries had been continuously enrolled in FFS. The higher risk scores were equivalent to $3.9 billion to $5.8 billion in payments to MA plans. Both GAO and CMS found that the impact of coding differences increased over time. This trend suggests that the cumulative impact of coding differences in 2011 and 2012 could be larger than in 2010. Click here for a copy of the report.

Comparative Effectiveness Research Agency Issues National Agenda, Seeks Comment

The Patient Centered Outcomes Research Institute last week issued its first national priorities agenda. PCORI focuses on “comparative clinical effectiveness” research. These are studies that compare options for preventing disease and providing treatment and care. The 53-day comment period started January 23. Click here to read the 22-page report. Click here for comment instructions.


Wellpoint to Pay Primary Care Docs More

Starting this summer, WellPoint Inc., which insures some 34 million Americans, will offer primary-care doctors a fee increase, typically of around 10%, with the possibility of additional payments that could boost what they get for treating the patients it covers by as much as 50%. The new approach could pour an additional $1 billion or more into primary care. Click here for details. Meanwhile, WellPoint’s fourth-quarter net income sank 39 percent as medical claims increased, mostly because of a $50 million hit from the health insurer’s Medicare Advantage business. But the company forecast earnings growth in 2012. Click here for the story.

Study: Essential Health Benefits Impact on Rx Availability Could Be Significant

The impact of Essential Health Benefits could be significant for pharmaceuticals, according to a new report from Avalere in a study funded in part by Pfizer. If states adopt the minimum drug coverage requirement in HHS’s EHB bulletin, they would dramatically reduce the number of drugs covered by some of HHS’s suggested benchmark plans. Click here to read the study.

HHS Lists Top Three Small Group Plans by State to Help with EHB Selection

More on the EHB front: HHS has posted a list of the largest three small-group products by state to help states choose a benchmark plan for essential health benefits. Click here for the HHS list.

Early Elective Newborn Deliveries Down: LeapFrog

Hospitals are making progress in eliminating early elective newborn deliveries, according to a new report from the Leapfrog Group last week, which announced that 39% of reporting hospitals kept their early elective delivery rate to 5% or less, compared to 30% of reporting hospitals last year. According to Leapfrog, there is still wide variation among hospitals. Rates of early elective deliveries ranged from less than 5%, which is Leapfrog’s target for all hospitals, to over 40%. Click here for details. Read more here from the March of Dimes.

AMA Lobbying Against ICD-10 Start Date

The American Medical Association is lobbying Capitol Hill in an effort to enlist their support to stop next year’s mandatory implementation of ICD-10. Click here for a story that includes the AMA letter to congressional leadership.

New IT Help for Rural Providers; New Health IT Recommendation from Policy Center

Rural health care providers are being given some new tools to help them in adopting information technologies. the resource comes from HHS’s Rural Assistance Center. Click here for details. The Bipartisan Policy Center released a report last week full of health IT recommendations to better align incentives with results. Click here to see the 48-page report.

FTC Sues to Stop Omnicare Takeover of PharMerica

The Federal Trade Commission sued to block Omnicare, Inc.’s hostile acquisition of rival long-term care pharmacy provider PharMerica Corporation, alleging that the combination of the two largest U.S. long-term care pharmacies would harm competition and enable Omnicare to raise the price of drugs for Medicare Part D consumers and others. Click here for details.

CDC: Employed vs. Unemployed and Their Health Care Differences

From 2009–2010, 48.1% of unemployed adults aged 18–64 years had health insurance compared with 81.4% of employed adults; among the insured, a higher proportion of the unemployed had public insurance – according to a new report from the CDC. Click here for details comparing the employed and unemployed and their health care.

ANA Award 6 Hospitals for Nursing Quality

The American Nurses Association announced last week their top 6 hospitals for “outstanding nursing quality.” The winners are: Robert Wood Johnson University Hospital, New Brunswick, NJ – Academic Medical Center; Parkview Whitley Hospital, Columbia City, IN – Community Hospital; Poudre Valley Hospital, Fort Collins, CO – Teaching Hospital (5-time winner); Shriners Hospital for Children-Chicago, Chicago, IL – Pediatric Hospital; The Burke Rehabilitation Hospital, White Plains, NY – Rehabilitation Hospital; Linden Oaks Hospital, Naperville, IL – Psychiatric Hospital. Click here for more.