WEEKLY E-BULLETIN


Hospital Inpatient, LTCH Regs Propose Big Changes

CMS last week issued its hospital inpatient prospective payment system and long-term care hospital proposed rule for fiscal year 2013.  CMS’ proposals would increase inpatient PPS hospital payments by 0.9% in FY13. Value Based Purchasing penalties were detailed and start with a 1% Medicare payment cut in FY13.  Hospital readmission penalties and processes are also outlined. The agency said total Medicare operating payments to acute care hospitals would rise by a total of about $904 million in fiscal 2013. However, because of expiring statutory provisions providing special temporary increases in payments, plus other proposed changes, CMS said “total Medicare spending on inpatient hospital services will increase by about $175 million in FY 2013.”
Click here for an excellent Strategic Health Care summary of the IPPS regulations.
Click here for a summary of the Inpatient Quality Reporting program.
Click here for a summary of the Value-Based Purchasing and Readmissions proposals.
Click here for a summary of the Long Term Care Hospital (LTCH) changes.
Click here for your own copy of the 1300-page rule.

Hospital, Health Care M&A Activity Up

Merger and acquisition activity in the health care industry posted strong gains during the first quarter of 2012 over the prior quarter and year-ago quarters, according to a new report. There were 23 hospital deals in the first quarter – two more than in the last quarter of 2011. There were 153 health care facility and managed care deals in the first quarter. Click here for details.

Hospital Debt Collection Practices by Company Causes Congressional Investigation

Congress is about to examine the practices of debt collector company Accretive Health whose practices in hospitals have generated stories in the NY Times, ignited the wrath of the Minnesota attorney general and now members of Congress. Click here for the Times’ story that started the scrutiny. Click here to see how Congress is responding.

Ophthalmology Sees Biggest Income Increase, General Surgery Biggest Decline: New Survey

Radiologists, on average, are paid the most; pediatricians are paid the least – according to the latest annual survey from Medscape/WebMD. Click here to see the survey.

First Independence at Home Programs Named by CMS

The first 16 organizations that will participate in the new Independence at Home Demonstration were announced by CMS last week. They will test whether delivering primary care services in the home can improve the quality of care and reduce costs for patients living with chronic illnesses. Click here for the list.

Final Rules Would Boost Medicaid Rates to Certain States

CMS released a final rule last week on the Community First Choice Option that provides states choosing to participate a six percentage point increase in federal Medicaid matching funds for providing community-based attendant services and supports to beneficiaries who would otherwise be confined to a nursing home or other institution. Click here for details. Click here for a copy of the 304-page rule.


Rules Attacking Medicare Fraud, Abuse Outlined by Government

CMS announced another final rule last week that prevents fraud in Medicare and is estimated to save taxpayers nearly $1.6 billion over 10 years. The rule ensures that only qualified, identifiable providers and suppliers can order or certify certain medical services, equipment and supplies for people with Medicare. The rule also helps ensure beneficiaries receive quality care because CMS will verify the credentials of a provider who is ordering or certifying equipment and supplies. Click here for more.

VA Health Services Funds Protected from Sequestration

Funding for veterans’ health care programs is not subject to sequestration, the White House budget office announced last week, ending months of speculation about how across-the-board budget cuts could be applied early next year if Congress cannot find a way to avoid fiscal disaster. Click here for the story.

IG Report Slams VA on Mental Health Services

The VA has greatly overstated how quickly it provides mental-health care for veterans, according to an inspector general report released last week. (click here for the report.)  Contrary to VA claims that 95 percent of first-time patients seeking mental-health care in 2011 received an evaluation within the department’s goal of 14 days, just under half were seen in that time frame, the report found. A majority waited about 50 days on average for a full evaluation. Click here for the story in the Washington Post.

Government Promotes Grants for Mental Health Coordination with Primary Care

SAMHSA has put out a new grant RFP to establish projects that provide coordinated and integrated services through the co-location of primary and specialty care medical services in community-based mental and behavioral health settings. The goal is to improve the physical health status of adults with serious mental illnesses who have or are at risk for co-occurring primary care conditions and chronic diseases. Only qualified community mental health programs may apply. Up to $400,000 each year for up to 4 years is available for each program selected. Strategic Health Care’s grants team has considerable experience with these programs. Contact SHC’s Gwen Mathews at gwen.mathews@shcare.net for more information.

Health Insurers May Rebate $1.3 Billion to Consumers by August

A Kaiser Foundation report last week said that consumers and businesses are expected to receive an estimated $1.3 billion by this August in rebates from health insurers who spent more on administrative expenses and profits than allowed by the Affordable Care Act. The share of consumers in the individual insurance market expected to receive rebates ranges from near zero in several states to as high as 86% in Oklahoma and 92% in Texas. Click here for the report. Responding to this, the largest health insurance lobbying group said the amount is overstated. Click here to read why.

GAO:  36 to 122 Million Have Pre-Existing Conditions

Hypertension was the most commonly reported medical condition among adults that could result in a health insurer denying coverage, requiring higher-than-average premiums, or restricting coverage, according to a report last week from the GAO.  The analysis found that about 33.2 million adults age 19-64 years old, or about 18 percent, reported hypertension in 2009.  Mental health disorders and diabetes were the second and third most commonly reported conditions among adults. Click here.


Study: Cost of Specialty Drugs Hard to Control

Health insurers and employers have few tools to control rapidly rising spending on high-cost specialty drugs—typically high-cost biologic medications to treat complex medical conditions, according to a new qualitative study from the Center for Studying Health System Change. Click here. Unlike conventional prescription drugs, where spending trends have moderated because of patent expiration, generic substitution and other factors, specialty drugs have persistently high trends—ranging from 14 percent to 20 percent annually in recent years.


McKesson to Pay $190 Million to Resolve Dispute with Government

The McKesson Corporation has agreed to pay more than $190 million to resolve claims that it reported inflated prescription drug prices, causing Medicaid to overpay, the Justice Department announced last week. McKesson admitted no guilt and states are still free to negotiate a settlement based on their share of the overpayments. Click here for the Justice Department announcement.

Health Spending Slows:  New Report

The growth of health spending has slowed substantially in the last few years, according to the latest report from Medicare, surprising experts and offering some fuel for optimism about the federal government’s long-term fiscal performance. Click here for the story.

ACO Success Metrics Discussed

What will it take for ACOs to be successful? What are the right metrics? Health system experts Elliott Fisher and Stephen Shortell outline their thoughts in a very good article in a Commonwealth Fund blog. It also contains a useful map pinpointing the location of all the government approved ACOs. Click here.

AAAHC Offers New Program Hospitals

The Accreditation Association for Ambulatory Health Care last week announced the launch of a new accreditation program for hospitals. The accreditation, which will focus on small hospitals located in rural, urban, and suburban regions in the United States, will be offered through the Accreditation Association for Hospital/Health Systems Inc. Click here for more.


House GOP Committee Says Reform Law Harms Businesses

A new report released last week by the House Energy and Commerce Oversight and Investigations Subcommittee says businesses are finding the health care reform law is harming insurance benefits in the workplace — even among members of President Barack Obama’s own jobs council. Click here to see the report. Committee Democrats attacked the report with a letter made public. Click here.

Survey: Radiology Services Will Grow; Concern About Medicare

According to a survey released last week, radiology administrators are confident that over the next six months their facilities will grow in procedure volume and as a profit center, they’re not so sure they’ll receive adequate reimbursement from Medicare for these services. Click here to see the survey results.

PCORI Issues Updated Agenda

The board of the Patient-Centered Outcomes Research Institute voted last week to slightly amend PCORI’s draft research agenda in response to 15 major themes that emerged from more than 450 public comments on its proposed agenda, released in February. The board made no changes to the agency’s National Priorities for Research. Click here for a summary of the changes made.