Feb. 13, 2012

Physician Payment Fix Deadline: 16 Days

Congressional conferees remain stymied over a solution to the physician Medicare payment problem.  While it appeared for a while early last week that the GOP might consider using war savings to pay for a fix, leaders including Speaker Boehner threw cold water on the idea. Then it leaked that GOP congressional conferees are considering using a 3-year retrospective documentation and coding adjustment to help pay for an extension of the doc fix. The coding offset would apply to fiscal years 2010 to 2012. CMS already made $6.9 billion in retrospective coding offsets for FYs 2008 and 2009 to recoup what it claimed were overpayments to hospitals as the result of the implementation of the new Medicare-Severity Diagnosis-Related Groups. The list also includes nearly $7 billion in cuts to payments for hospital outpatient evaluation and management services. The American Hospital Association is estimating that proposed payment reductions would result in a 9.7%, or $11 billion, cut to hospital payments. Click here to read Politico’s update on the congressional discussions.

30,000 Primary Care Docs Needed by 2015

For the Obama health reform program to work, the United States needs about 30,000 more primary care physicians by 2015, according to reports out last week. Read the very interesting Washington Post story here.

Obama 2013 Budget Out Today; Medicare Cuts Likely

The Obama Administration’s FY2013 budget is expected to be made public today. Press reports say it will call for continued Medicare spending reductions. Click here for a NY Times preview.

$40 Million Announced in New HHS Grants

To help reduce the increasing number of preterm births and ensure more babies are born healthy, HHS announced more than $40 million in grants to test ways to reverse that trend, as well as a public campaign to reduce early elective deliveries. More than half a million infants are born prematurely in America each year, a trend that has risen by 36 percent over the last 20 years. Click here for details.  The Innovation Center will host a webinar that will provide an overview of the program and application process. Wednesday, February 15, at 3:00 p.m. ESTClick here to join.

Our Strategic Health Care team of 35 grant writers is well prepared to help your organization succeed in securing federal grants. Click here to learn more.

RAC Program Recovered Less Last Year

Medicare’s audit recovery program (RAC) took back less than half the amount in provider overpayments in 2011 as it did in 2010, according to a CMS report out last week. The program also returned less than a fifth of identified overpayments to providers during the same time period. Click here for the two-page RAC overview from CMS.

New Study: Orthopedic Surgeons Spend $2 Billion on Defensive Medicine

The practice of defensive medicine among orthopedic surgeons is a significant factor in healthcare costs, contributing some $2 billion in unnecessary spending per year in the U.S., according to a study released last week. Click here for details.

New Regs to Make Health Insurance Info Easier to Understand

HHS last week announced a new regulation that will require health insurers to provide consumers with clear, consistent and comparable summary information about their health plan benefits and coverage. The new forms, which will be available beginning, or soon after, September 23, are designed to help 150 million Americans with private health insurance. Click here for details. To view the template for the summary of benefits and coverage, click here.

$150 Million More for Alzheimer’s: HHS

The government is increasing its financial commitment to fight Alzheimer’s disease, including immediately making an additional $50 million available for cutting-edge Alzheimer’s research. The announcement came last week from HHS. In addition, the administration announced that its Fiscal Year 2013 budget will boost funding for Alzheimer’s research by $80 million. Also included is an additional $26 million in caregiver support, provider education, public awareness and improvements in data infrastructure. Click here for more.

New CMS Post Acute Study Suggests Common Payment System

According to a new CMS study released to Congress last week, evidence supports the potential for development of a common payment system for the three inpatient Post Acute Care settings: LTCHs, IRFs, and SNFs. This system would calculate the patient-specific resource expenditures portion of payment using the same acuity measures with the same weights and base rates. Click here for a Strategic Health Care 2-page summary. Click here for a copy of the 41-page study.

Health Spending Slows Dramatically

New analysis shows that health care spending in the U.S. in 2011 grew at one of the slowest rates in 50 years, according to a new report from Altarum Institute. Health spending in 2011 was at $2.71 trillion. Spending was up 4.4 percent from 2010—the third slowest rate of growth since national health expenditures have been tracked. The health spending share of gross domestic product was 18.1 percent in December 2011, up from 16.4 percent at the start of the recession (December 2007), but down slightly from the all-time high of 18.2 percent in June 2011. Click here for the 4-page summary.

Medical Device Tracking System Stalls

A proposal for a standardized coding system to track medical devices has stalled in the Office of Management and Budget, where it was submitted last July by the FDA. Congress voted in 2007 to direct the FDA to create the medical device coding system using simple scanning technology, and the FDA has been coordinating with device regulators in other countries to develop a harmonized system. Until the OMB releases the proposed rule, the FDA cannot move forward. Click here for the story.

Birth, Abortion Rates Among Teens Fall Dramatically

Birth and abortion rates among U.S. teens fell to record lows in 2008, according to a new study released last week. The overall teen pregnancy rate was at its lowest level since at least 1972. Click here.

New Health IT Penalties for Docs Coming OnLine

New penalties for physicians not reporting ePrescribing or quality data to the government begin to take effect this year. The following is an excellent summary article with charts that outline the health IT challenges facing physicians. Click here.

Medicaid Directors Want Review of FQHC Affiliation Agreements

State Medicaid directors last week asked the government to review Federally Qualified Health Centers affiliation agreements with other providers, raising concerns that such agreements might be simply designed to obtain higher reimbursement levels. Click here for the letter.

10 States Planning More Medicaid Cuts: Kaiser Survey

Most states do not anticipate the need for significant mid-year Medicaid cuts, according to a recent survey by the Kaiser Commission. However, 10 states do plan to make additional Medicaid reductions, primarily benefit and provider rate restrictions, to close budget gaps: California, Colorado, Louisiana, Maine, Maryland, North Carolina, Pennsylvania, Tennessee, Washington and West Virginia. Many states are working to integrate and coordinate care for dual eligibles. Click here for the very good 136-page report.