MedPAC Dives Into Reform Issues

MedPAC last week jumped into a wide variety of reform issues as it prepares new recommendations to Congress.  In its two day session, the agency that advises Congress on Medicare issued reports on bundling, care coordination, Medicare’s benefit design, serving rural beneficiaries and many more.

The Commission identified bundled payments as an important strategy, particularly in post-acute care (PAC) settings, for controlling spending and increasing value in fee-for-service. Due to the substantial share of Medicare program spending dedicated to post-acute care and the inconsistencies in care delivered across PAC settings, bundled payments present a considerable opportunity for improvement. Click here for the slide presentation.

Care Coordination 
The Commission reviewed recent coordinated care demonstrations in an effort to identify successful features and challenges for designing future care models. Applicability across settings, patient engagement, and retaining beneficiaries and programs were identified as significant challenges when applying care coordination models to FFS Medicare. Possible next steps include changing fee schedule codes, instituting per member per month (PMPM) payments to medical practices or external care managers, and establishing transitions payments. Click here for MedPAC’s slides.

Reforming Medicare’s Benefit Design 
MedPAC staff presented policy objectives, key design issues, a benefits package example, and a draft recommendation to the Commissioners. The draft recommendation proposed a new FFS system that would include an out-of-pocket maximum, a combined deductible for Part A and Part B services, copayments for services that would vary based on type and provider of service, Secretarial authority to alter cost sharing, no change in aggregate cost sharing liability, and a surcharge on supplemental income. Click here for the slide presentation.

Rural Medicare Beneficiaries
While access to care and payment adequacy in rural areas were found to be roughly equal to the respective measures in urban areas, quality of care in rural hospitals was found to be worse that urban hospitals (although not skilled nursing facilities, home health agencies, or outpatient dialysis facilities). MedPAC staff also summarized the various payment adjustments, and described whether the adjustments did or did not meet MedPAC fairness and access principles. Click here for the slides.

Moody’s Favorable on Hospital Consolidations

Moody’s Investor Service was out with a new report last week with a favorable view on the hospital consolidation sweeping across the country. Click here. The NYTimes followed up with a look at hospital mergers. Click here.

IPAB Repeal Will Cost $3.1 Billion: CBO

Two House committees have passed legislation that would repeal the Independent Payment Advisory Board, created in the Affordable Care Act, but a new twist emerged last week. The Congressional Budget Office said last week (clickhere for the report) that repeal would cost $3.1 billion. To offset that cost, House Republicans say that want to pass a tort reform bill.  Democrats say that would kill the bipartisan spirit around the IPAB repeal effort (a number of House Democrats support IPAB elimination.)  The House is expected to pass repeal legislation later this month.

High U.S. Doc Salaries Draw Physicians from Across the World 

“America is stealing the world’s doctors” is a NYTimes headline last week.  (Click here.)  The story discusses how higher U.S. physician salaries are luring doctors from across the planet. The median salary of a surgeon in New Jersey is about $216,000.  In the main hospital in Lusaka, Zambia a surgeon makes about $24,000 a year.   Meanwhile, medically underserved communities may get more foreign-born physicians providing care. A proposed congressional bill would allow state health departments to receive more than 30 visa waivers for foreign physicians per year to work in underserved areas. The legislation, S. 1979, is sponsored by Senator Kent Conrad (D-ND)

Surgeon General: Youth Smoking Still Serious Problem

Almost 1 in 5 high school seniors regularly smoke and nearly 90% of adult smokers said they started smoking by age 18, according to a report released last week by the U.S Surgeon General. Although rates of cigarette smoking and smokeless tobacco use dropped in the last decade, the report found that more than 600,000 middle-school students and 3 million high-school students smoke. Click here for the 11-page government PDF report. Click here for the Washington Post/AP story.

Internal White House Memo Details PR Initiative Around Supreme Court  

As the Supreme Court prepares to hear arguments for and against the Affordable Care Act, the White House is ramping up its public relations machine, according to a report last week in the New York Times. Click here to read.  Also, a detailed agenda from the White House meeting was circulating around Washington last week. Click here to get a glimpse at the behind-the-scenes politics taking shape. If you’re looking for the latest poll numbers on the health care reform law, the AP was out last week with a comprehensive survey. Click here.

Employer Sponsored Insurance Declines Over Past 10 Years

The number of persons covered by employer sponsored insurance continued a steady decline between 2000 and 2010, according to a new study by the Urban Institute and Robert Wood Johnson Foundation. The study found a coverage decline of 10 percent. Meantime, the number of persons on Medicaid continued to increase. Click here for the 18-page report.

Hospital Readmissions are for Chronic more than Acute Conditions

The readmission rate following a hospital stay for a chronic condition such as congestive heart failure or diabetes can be substantially higher than for an acute condition like pneumonia or a heart attack, according to a report the Agency for Healthcare Research and Quality released last week. Click here for the summary. Click here to see the data.

FDA Scientists Concerned About Outside Influences

Scientists at the FDA remain concerned about “persistent interference by special interests” continues to hinder the FDA’s ability to use the best science to protect the public’s health, according to a survey out last week of 997 FDA scientists. Those surveyed said the situation is getting better. Click here for the survey results.

Donations to Health Care Organizations Down

Charitable pledges to nonprofit health care organizations slowed in fiscal year 2010, jeopardizing the ability of health care systems in both countries to generate philanthropic funding necessary to meet their long-term, construction, equipment and patient needs. This according to a new report from the Association for Healthcare Philanthropy. Click here for details. New funding opportunities are now available from HRSA in telehealth (click here for details) and from other agencies. Contact SHC’s Gwen Mathews to discuss upcoming grant opportunities at Gwen.Mathews@shcare.net.

Medicaid Reform Bill Introduced by House GOP Conservatives

A group of conservative House Republicans introduced legislation last week giving states far greater control over their Medicaid programs in exchange for significant funding cuts. The bill would freeze federal Medicaid contributions to states over the next 10 years, saving the federal government $1.8 trillion, according to its sponsors. In exchange for the funding cut, states would get full control over who is eligible to enroll, what benefits are available, and how much doctors and hospitals get paid. Click here for details.

Minorities Benefit from New Health Insurance Coverage

New data released last week by HHS shows that the Affordable Care Act has extended health insurance to 1.3 million minorities nationwide. The health care reform law allows young adults to stay on their parents’ insurance plans through age 26. Click here for details.