WEEKLY E-BULLETIN


New Rules Impacting Hospitals, Other Providers, Will Save $5 Billion, CMS Says

CMS last week published two final rules aimed at reducing procedural burdens on providers. CMS estimates that the reforms will save nearly $1.1 billion across the healthcare system within a year and over $5 billion over five years. The first rule revises the Conditions of Participation that hospitals and critical access hospitals must meet to be eligible to participate in the Medicare and Medicaid programs. CMS estimates that total hospital savings as a result of this rule will be approximately $940 million in the first year, and the agency attributes the cost savings directly to reduced regulatory burdens rather than to reimbursement reductions. Click here for an excellent summary of the rules prepared by the SHC policy team.

House GOP Passes Sequester Replacement with More Health Care Cuts

House Republicans moved ahead last week with their plan to replace the January 1, 2013 budget cuts “sequester” with a heavier round of health care cuts to spare the defense industry. The reconciliation bill passed the House on a 218-199 vote, with 16 Republicans opposing it and one Republican voting “present.” No Democrats supported it.
The bill would defund parts of the Affordable Care Act, impose more stringent eligibility reviews for Medicaid enrollees, and cap damages on medical malpractice awards. Senate Democrats and the White House oppose it.  Click here for a very good detailed summary of its impact on health care.

Medicaid Payment Boost for Primary Care Docs Announced

Primary care physicians would see their Medicaid payments rise under a proposed rule announced last week by HHS. Click here for details. The increase would bring Medicaid primary care service fees in line with those paid by Medicare. The boost would be in effect for calendar years (CY) 2013 and 2014. CMS said OB-GYNs were excluded from the CMS rule because they were not included in the Affordable Care Act’s definition of primary care — which could cause a fight before the rule is finalized.

$122 Million for 26 Innovation Challenge Awards

CMS’ Innovation Center announced last week 26 winners in the agency’s Innovation Challenge program.  Awardees will receive a total of $122 million to implement their demonstration projects. The next round of winners are expected to be announced in early June. The Innovation Center has allocated $1 billion total to award to innovative demonstrations. Click here for a list and description of each of the winning programs.

Detailed Accounting of CMS Innovation Center Released

In response to a request from a U.S. Senator, CMS has issued its most comprehensive report yet detailing the Innovation Center, where all the money has been spent to date, all the new demonstration and pilot programs and just about anything else you could imagine. Click here for the report.

DOJ:  Omnicare to Pay $50 Million

In the largest controlled substance settlement in history, the Justice Department has reached a settlement with Omnicare, Inc. in which the company will pay a $50 million civil penalty to resolve claims its various pharmacy facilities improperly dispensed controlled substances to patients at long-term care facilities across the country, according to the DEA and a U.S. Attorney from Ohio. Click here for more.

Young Adult Women Have Highest Rate of Indoor Tanning, Increasing Cancer Risk: CDC

Young adults are increasing their risk for developing skin cancer, according to two studies out last week by the CDC and the National Cancer Institute. One study found that indoor tanning is common among young adults, with the highest rates of indoor tanning among white women aged 18-21 years (32 percent) and 22-25 years (30 percent). Click here for details.

OIG Report:  Some Pharmacies Have Questionable Billing

According to a new OIG report last week, retail pharmacies each billed Part D an average of nearly $1 million for prescriptions in 2009. Over 2,600 of these pharmacies had questionable billing. The Miami, Los Angeles, and Detroit areas were the most likely to have pharmacies with questionable billing. The Inspector General is urging CMS to beef-up enforcement. Click here for a copy of the report.

ED Overcrowding Still a Serious Problem: Survey

According to a new survey of hospital leaders out last week, 46% described their emergency departments as overcrowded. Of that group, 93% expressed concern about patient safety as a result of the overcrowding. That represents about 43% of all respondents expressing patient safety concerns as a result of overcrowding in the ED. Click here for the survey.

Health Spending Slow Down Continues

The nation’s slow health care spending growth held steady for another month, according to the latest data from the Altarum Institute. Overall spending held at 4 percent, slower than usual, but still faster than the gross domestic product. Prices grew by only 2 percent compared to last March. Click here for details.

FDA Advisors Recommend New Weight Loss Drug – First in a Decade

Advisers to the FDA last week recommended that they approve sales of what would be the first new prescription weight-loss drug in the U.S. in more than a decade, despite concerns over cardiac risks. Click here for the story.

CDC Awards Six for Obesity Programs

Six organizations and one person were recognized last week in D.C. with the Pioneering Innovation Award for their work in advancing policies and environmental strategies to prevent and control obesity. The awards were given at the CDC’s Weight of the Nation Conference. Click here to see the award winners.

Stroke Hospitalizations Decrease

The rate of hospitalization for stroke (cerebrovascular disease) per 10,000 population increased from 32.4 in 1989 to 34.9 in 1999, and then decreased to 31.8 in 2009, according to a new report published last week from the CDC.  Click here.

FDA Tackles Radiation Exposure to Kids

In its drive to reduce pediatric radiation dosage, the FDA last week, launched a new program that will require manufacturers to consider the safety of children when designing new x-ray imaging devices. Devices that do not comply with the program may have to carry warning labels advising against their use in children. Click here for details. Meanwhile, researchers from six children’s hospitals are collaborating to build the first pediatric CT dose index registry. Click here.

CMS Extends Graduate Nurse Demo Applications Deadline

CMS has extended the deadline for a call for applications for the Graduate Nurse Education (GNE) Demonstration to Friday, May 25th at 5 p.m. Under the GNE Demonstration, CMS will provide hospitals working with nursing schools to train advanced practice registered nurses (APRNs) with payments to cover the costs of APRNs’ clinical training. Click here for details. For help with your application, contact our own Gwen Mathews at gwen.mathews@shcare.net.

Fraud and Abuse Compliance Webinar Series Introduced

We hear a lot of concerns about employee email, Facebook and related new media. Now there are some solutions for healthcare organizations. Squire Sanders law firm has a new webinar series on the most worrisome compliance and fraud challenges. “How to Handle the Bad Email or Social Media Post”, is set for Thursday, May 24th at Noon EDT. Click here to register for the no-cost program.

Looking for Federal Funds?  New Podcast Provides Answers

The Federal Government has committed more than $10 billion in funding CMS’ Innovation Center, including pilot programs, demonstration projects and cooperative agreements in which healthcare providers can apply to participate. The Feds will issue another $80 billion this year in health care grants. Two consultants working to help
secure these programs for providers outline their insights in this informative “Finding Revenues” podcast. Click here.


Dialysis Funding Changes May Be Negatively Impacting Outcomes

Even though Medicare spends more than $30 billion a year on the treatment of end-stage kidney disease, including about $2 billion for anti-anemia drugs, a change in the way the government reimburses for the care may be having severe unintended consequences. Click here for the NY Times story.


Psychiatrists Making Far Reaching Changes to Definition of Addiction, Other Mental Illnesses

Psychiatrists revising the Diagnostic and Statistical Manual of Mental Disorders, or D.S.M., would expand the list of recognized symptoms for drug and alcohol addiction, while also reducing the number of symptoms required for a diagnosis, according to the American Psychiatric Association, which produces the book. Click here for more.