WEEKLY E-BULLETIN


Supreme Court Health Care Decision Expected Soon

The U.S. Supreme Court could announce as early as today (10 a.m. EDT) – but certainly before the end of its session this month – its decision on the constitutionality of the Affordable Care Act, in whole or in part.  Nobody in Washington, outside the court itself, knows how the justices will decide – don’t let anyone tell you otherwise.  There hasn’t been a Supreme Court news leak in more than 30 years and there is not likely to be one now.  Two good stories, USA Today (click here) and the NY Times (click here), discuss the potential consequences of the court’s decision.  The latest NY Times/CBS News poll shows most Americans want all or part of the law thrown out.  Click here to see the poll data.

Primary Care Practices Would Get Financial Boost Under New CMS Program

45 commercial, federal and state insurers in seven markets are now working with CMS to give more Americans access to quality health care at a lower cost. Under the Comprehensive Primary Care initiative, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services.  Insurers in Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley Region, Ohio’s and Kentucky’s Cincinnati-Dayton Region, and greater Tulsa, Oklahoma signed agreements with CMS to participate.  Approximately 75 primary care practices will be selected to participate in the Comprehensive Primary Care initiative in each designated market.  Primary care practices have until July 20 to apply.  Click here for more.

17 States (Red & Blue) Working Together on Insurance Exchanges

It may be hard to believe, but for more than a year now a bipartisan group of 17 states has been quietly collaborating with the Obama administration to help build a foundation for the health care reform law’s success. They are backed by $3 million in funding from eight nonprofit organizations that hope to see the Affordable Care Act succeed. Click here for the story in the Washington Post.  They have developed a new tool to help consumers navigate health insurance exchanges.  Click here for that.

Leapfrog Report Ranks Hospitals on Patient Safety

A new report card from health care watchdog The Leapfrog Group ranks hospitals for patient safety – A through F. Infections, medication and medical error and injuries are still rampant, according to Leapfrog’s survey. Massachusetts hospitals ranked high. Those the nation’s capitol had the lowest average scores. Click here to find what grade your hospital received.  The American Hospital Association and other hospital groups raised serious questions about the validity of the scoring process used.

More Consumer Assistance Funds Made Available

CMS announced last week more grants to states to provide consumer assistance for health care coverage; more than $30 million has been made available. State agencies and local nonprofits under contract with a state are eligible for the grants.  To see whether your state has applied and what it is doing with the money, click here.  For information about the program, click here.  USA Today also has a story on the program, click here.

52 Distance Learning; Telemedicine Grants Announced

The USDA last week announced funding for 52 distance learning and telemedicine projects that will increase access to health care and enhance educational opportunities in 29 states.  The projects total $14 million and include 19 distance learning projects, 32 telemedicine projects and one combined project.  All will benefit rural counties. Nearly half of the total funding – 45 percent – will go to counties where the minority population is greater than 30 percent. Another 18 percent of this funding will benefit areas where the Native American population exceeds 30 percent.  Click here for a detailed, state-by-state list of funded projects.

IOM: Hospital Execs Recommend Strategies for Transformational Success

CEOs from 11 well known health systems across the nation last week issued a 72-page discussion paper recommending 10 strategies to help hospital leaders promote high-quality care and reduce costs.  The report was issued under the government’s Institute of Medicine Roundtable on Value and Science-Driven Health Care.  Click here for a copy of the report.

Health Care Prices Continue Their Moderation

Health care prices in April 2012 were 1.9% higher than in April 2011, bringing growth barely above its February 2012, 14-year low of 1.8% — according to the health economics group Altarum.  The 12-month moving average at 2.1% (fractionally below March 2012) is the lowest since December 1998.  Year after year, hospital prices rose by 2.2% (up from 1.9% in March), and home health and nursing home care show moderate price growth of 0.5% and 0.3%, respectively. Prescription drug prices moderated to 3.7% growth from 4.2% in March.  Click here for additional details.

CBO Says Federal Health Care Spending Continues Growth 

The Congressional Budget Office has projected that under current law, spending on major federal health care programs alone would rise from almost 5 percent of GDP today to nearly 10 percent in 2037 — and would keep rising. The rising cost of health care would cause spending on the major health care programs and Social Security to grow from more than 10 percent of GDP today to almost 16 percent of GDP 25 years from now.  The 7-page CBO summary is here.

New Government Health Care Data Program Announced

CMS has announced a new initiative that will make volumes of Medicare, Medicaid and CHIP data eventually available in the public domain for research and analysis.  The agency has already released numerous data sets.  For more information and links to data already released, click here.

Two New CO-OPs Awarded Funds

HHS announced two new CO-OP health plan awards last week.  Compass Cooperative Health Network in Arizona and HealthyCT in Connecticut were awarded CO-OP loans of $93 million and $75 million, respectively.  Click here for more.

GOP Says PhRMA, White House Collude on Affordable Care Act

House Energy and Commerce Committee staff last week released an 18-page update on their investigation of how the pharmaceutical industry worked with the Obama Administrations – prior to passage of the Affordable Care Act — to secure its passage.  As part of its agreement with the White House, the Pharmaceutical Research and Manufacturers of America (PhRMA) needed to undertake a “significant public campaign.” PhRMA was willing to spend as much as $150 million on advertising, with nearly $70 million spent on two 501(c)(4) groups that could spend unlimited corporate money with little public disclosure: Healthy Economy Now and Americans for Stable Quality Care.  Click here for the internal staff memo.  Click here for the Democrat’s response.

Health Fraud Fight Continues; OIG Outlines Problems, Efforts

The House committee charged with oversight of Medicare and Medicaid anti-fraud initiatives held a hearing last week in Washington to review current efforts to fight fraud.  CMS contracts with a number of private entities to conduct program integrity activities such as preventing, detecting, and recovering fraudulent Medicare payments.  For an overview of the scope of the problem and what initiatives are underway, click here for the 9-page testimony from HHS’ OIG.

Report: Most Health Care Execs Say VBP Is the Future

Are you surprised that only 73 percent of the executives surveyed agreed or somewhat agreed that health care providers must now begin the transition towards a Value Based Purchasing model, which emphasizes paying for value rather than volume?  A Forbes Insights study released last week talks about the rapid transition away from fee-for-service.  Click here for the report.

Hospital at Home Program Shows Favorable Results

The subject of a new June 2012 Health Affairs profile, the Hospital at Home program at Presbyterian Healthcare Services in Albuquerque, New Mexico, has achieved clinical outcomes among at-home patients similar to, or better than, patients receiving inpatient care. Shorter patients stays, reduced clinical testing and improved patient outcomes have generated significant costs savings when compared to traditional acute care settings. Click here for more information.

PCORI Issues Draft Research Standards

The Patient-Centered Outcomes Research Institute’s Methodology Committee last week released draft research standards to serve as a resource for initial PCORI funding applicants, noting that applicants will not be scored on adherence to the draft recommendations. The panel plans to open a formal comment period on the draft standards in July and issue a revised report to the PCORI Board of Governors in November.  Click here for a copy of the 206-page report.

More Young People on Parents’ Health Plans

Between November 2010 and November 2011, an estimated 13.7 million young adults ages 19–25 stayed on or joined their parents’ health plans, including 6.6 million who likely would not have been able to do so prior to the passage of the Affordable Care Act – according to new report from the Commonwealth Fund.  Click here for more.

New Bill Would Expand Medicare Advantage, Medigap Policies

U.S. Senator John Kerry (D-MA) has introduced legislation to expand access to Medicare Advantage and supplemental Medigap policies to all Medicare beneficiaries, including the disabled. Among other things, the bill would:  extend guaranteed issuance of Medigap policies to all Medicare beneficiaries rather than limiting it to those 65 years and older, significantly improving coverage options and affordability for beneficiaries with disabilities or end-stage renal disease.  Click here for details.

More than Half of Hospitals Have Palliative Care Programs

Hospitals across the country have been adding programs in palliative care — which focuses on treating pain, minimizing side effects, coordinating care among doctors and ensuring the concerns of patients and their families are addressed — at a feverish pace, according to a report out last week.  In 2000, there were 658 palliative programs in hospitals, according to the Center to Advance Palliative Care. By 2009, about 63 percent of hospitals had palliative teams, with a total of 1,568 programs recorded.  Click here for the story.