WEEKLY E-BULLETIN


$181 Million Awarded to Six States for Insurance Exchanges

Illinois, Nevada, Oregon, South Dakota, Tennessee and Washington will receive more than $181 million in grants to help implement the new health care law, according to an announcement last week from CMS. The grants will help states establish Affordable Insurance Exchanges. Click here for details.

November 16:  Deadline for State’s Exchange Decisions

Insurers will know by November 16 how states in which they operate will choose to run their health insurance exchanges–either establish their own exchange, defer to the federal exchange or choose to only perform some services, according to new guidance from HHS.  If a state decides not to operate an Exchange for its residents, HHS will operate a Federally-facilitated Exchange (FFE).  Click here for the 19-page report.

New Exchange Blueprint Outlines How Exchanges Work

HHS also released last week a draft Exchange Blueprint that states may use to demonstrate how their Affordable Insurance Exchange will work to offer a wide range of competitively priced private health insurance options. The Blueprint also describes the application process for states seeking to enter into a Partnership Exchange. Click here for the 45-page Blueprint.

State Disciplinary Action Against Physicians Increasing:  New Report

Physician state licensing boards have continued to increase their disciplinary actions against doctors, according to a report last week from the Federation of State Medical Boards.  The total number of revocations, suspensions or loss of privileges increased in 2011 to 1,905 from 1,815 the year before.  Click here to see the summary for your state.  The watchdog group Public Citizen disagrees that medical boards are protecting patients.  Click here for their report.

National Plan to Fight Alzheimer’s Announced

HHS last week released an ambitious national plan to fight Alzheimer’s disease. The plan has five goals, including the development of effective prevention and treatment approaches for Alzheimer’s disease and related dementias by 2025.  Click here for details.

$137 Million Awarded to New CO-OPs

HHS last week announced funding for two new Consumer Oriented and Operated Plans: $65.9 million to Hospitality Health CO-OP in Nevada and $71.5 million to Michigan Consumer’s Healthcare CO-OP in Michigan. This brings the total number of funded CO-OPs to 12, in 12 different states.  Click here for additional information.

ACOs Impacted by Geographic Variations, Researchers Say

Not all Accountable Care Organizations are alike, according to a study last week in the New England Journal of Medicine.  Because of geographic variation in spending growth, Medicare’s use of national growth factors to set targets could cause ACOs in any hospital referral region to gain or lose financially without altering their delivery of care. Using national growth rates to set ACO spending targets could discourage participation by organizations in high-spending regions with traditionally high spending growth — arguably the most important targets for payment reforms — according to the study.  Click here for the study.

ACO’s Examined by Congress for Market Impact

And what is Congress learning about ACOs and the transformation underway, brought about in part by the Affordable Care Act?  The House Judiciary Committee held an interesting hearing last week to explore whether the reform law would spur or hinder competition.  The most balanced analysis came from Thomas Greaney, the director of health law studies at the Saint Louis University School of Law.  He said ACOs and other government-pushed innovations are not causing market consolidations, but encouraging integration which is good for competition.  Click here for his testimony.  Testimony from two conservative Washington think tanks said the opposite.  Click here for the Heritage Foundation.  Click here for the American Enterprise Institute.

Next Round of Innovation Center ACOs Have June 15 Deadline

The deadline for filing a letter of intent is June 15 for organizations interested in creating a Medicare Shared Savings Program ACO with CMS’ Innovation Center.  The final application is not due until August 30 and approved applications would start no earlier than January 1, 2013.  Strategic Health Care has provided guidance for numerous MSSP applicants.  For additional information about the application process and our firm’s services, click here.

New Outcomes Measurements Proposed for Medical Homes

How do you measure the success of medical homes?  New research released last week by the Commonwealth Fund describes the process and recommendations of more than 75 researchers who came together to identify a core set of standardized measures to evaluate the patient-centered medical home. It focuses on two domains of medical home outcomes: cost/utilization and clinical quality.  Click here for the study.

All Baby Boomers Should Get Hep C Test: CDC

The CDC is issuing draft guidelines proposing that all U.S. baby boomers get a one-time test for the hepatitis C virus. One in 30 born from 1945 through 1965 has been infected with hepatitis C, and most don’t know it, says the CDC.  Hepatitis C causes serious liver diseases including liver cancer, which is the fastest-rising cause of cancer-related deaths, and the leading cause of liver transplants in the United States.  Click here for more.

Asthma Incidence Increasing

An estimated 29.1 million adults have been diagnosed with asthma in their lifetimes, and 18.7 million still had asthma, according to 2010 data from the Centers for Disease Control and Prevention. The report, Asthma’s Impact on the Nation, is the first state-by-state data set.  Click here for details.

Want to Avoid Email and New Media Issues with Your Employees?

How are you managing difficult issues involving employee email, Facebook and related new media? Now there are 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 this Thursday, May 24th at Noon EDT. Click here to register for the no-cost program.

New CMS Actuary Report Issues Dire Medicare Outlook

CMS’ Office of the Actuary has released an “alternative projection” of cost growth in Medicare. Unlike the 2012 Medicare trustees report, the alternative does not assume current law, including SGR cuts and productivity adjustments, remains in place. It finds that Medicare spending would climb to nearly 10 percent of gross domestic product by 2080. The 2012 trustees report projects it would be 6.7 percent — a difference of nearly 50 percent. Click here for the 21-page analysis.

Medicare Advantage Star Rating Program Criticized

The Medicare Advantage star ratings program is taking some new hits from a conservative group in Washington.  A report from the American Action Forum takes a look at the health care reform law’s system of linking payment to programs with high star ratings and finds it lacking.  The study says that the ratings system — which awards bonuses or rebates to Medicare Advantage plans that receive four- or five-star quality ratings — won’t encourage quality performance. Click here for their report.

New Web Tool Tracks Health System Performance

HHS last week announced the launch of a new web-based tool that will make it easier to monitor and measure how the nation’s health care system is performing.  The web-based tool, known as the Health System Measurement Project, will allow policymakers, providers, and the public to develop consistent data-driven views of changes in critical U.S. health system indicators.  Click here to go to the site.