MedPAC Wants Big Medicare Changes and Tells Congress

MedPAC wants Congress to give federal agencies more authority to overhaul parts of the Medicare benefit, including caps on out-of-pocket expenses, changes to the deductibles for hospital and physician services, additional charges for supplemental Medigap coverage and replacing coinsurance with co-payments.  This is according to MedPAC’s formal report sent to Congress Friday.  The House Ways and Means Committee will take a deeper dive into the report in a hearing Tuesday.  Click here for a 4-page summary.  Click here for the 259-page report.

MedPAC also called for a range of changes to both the PACE and special needs programs, so payments are more accurate and the quality of care given to “dual eligibles” is tracked and improved. MedPAC estimates that the recommendations could cut about 0.5 percentage points from overall Medicare spending per year.


New Innovation Center Awards Announced

HHS late last week announced the recipients of 81 new Health Care Innovation Awards. The awards will support innovative projects nationwide designed to deliver high-quality medical care, enhance the health care workforce, and save money.  The agency received more than 3,000 applications. Combined with the awards announced last month, HHS has awarded 107 projects.  About $900 million is provided to fund the projects.  Click here to see list and brief description of the 81 projects.


Advance Payment ACOs Get New Application Deadline

CMMI has announced that it will begin accepting new applicants for its Advance Payment Accountable Care Organization model beginning August 1. The program, which will start January 1, provides upfront and monthly payments of expected shared savings to rural and physician-based ACOs seeking to participate in the Medicare Shared Savings Program.  Click here for additional information.  Click here to see Strategic Health Care CMMI application services.


Strong Start Applications Deadline Extended

In another Innovation Center change last week, the agency said it will extend the deadline for hospitals and others to submit applications for up to $43.2 million in grants to test new approaches to prenatal care for Medicaid enrollees at risk for pre-term births. Letters of intent for the program were due May 11 and applications were due June 13.  However, interested applicants may continue to submit letters of intent. CMS will announce revised deadlines soon.  Strategic Health Care has substantial experience in developing these applications, contact Gwen Mathews at gwen.mathews@shcare.net for information.


Supreme Court Decision Today or Next Week; Moody’s Says Any Decision Bad for Hospitals

The Supreme Court has announced that it will release opinions on Thursday, June 21, in addition to planned opinion days on June 18 and 25. The court typically adds days toward the end of its term. It is unknown which opinions will be released on each day.  Moody’s rating agency says that no matter what the court does it’s not good news for hospitals.  Click here for the Moody’s release.  The ruling could have an enormous impact on Medicaid, according to a story last week in the New York Times.  Click here.  Meantime, Republicans are saying they won’t move quickly to replace health care provisions, if they are struck by the court.  Click here for the Washington Post story.  GOP presidential candidate Mitt Romney last week outlined how he would replace the health care law.  Click here.


Nation’s 221 ACOs Reviewed in New Report

There are about 221 ACOs in the US today, according to a report out last week.  Of those, 148 are single provider ACOs (67%), 43 are multiple-provider ACOs (19%), 17 are insurer ACOs (8%) and 13 are insurer-provider ACOs (6%). Multiple variations exist. Some entities are involved in the federally-backed Medicare ACO programs with formal legal structures. Others are involved in private ACO programs, either sponsored by providers (such as hospital systems or independent practice associations (IPAs) or insurance companies seeking to strengthen their involvement in providing population-level care. Additionally, a handful of entities are pursuing the aims of ACOs, but don’t use that name.  Click here for the 20-page report.


Government Says It Is Still Actively “Protecting” Health Care Competition

The federal government – through the FTC and DOJ — initiated actions in federal court in three matters seeking to preserve competition among health care providers that would otherwise have been lost as a result of acquisitions.  This is according to the 2011 year-end report issued last week by the two agencies.  Click here for the 46-page report.


3-Day Preadmission Payment Rule Costing Government Millions: OIG

According to an HHS report out last week, Medicare contractors made approximately $6.4 million in overpayments to hospital outpatient providers during calendar years 2008 and 2009 for services provided to beneficiaries within 3 days prior to the date of admission for, on the date of admission for, or during (excluding date of discharge) inpatient prospective payment system stays. These overpayments occurred because provider controls failed to prevent or detect incorrect billing, providers were unaware that beneficiaries were inpatients at other facilities, and providers were unaware of or did not understand Medicare requirements.  Click here for the OIG report.


“Churning” Patients Focus of New Study

An estimated 29.4 million people—equal to nearly a third of the 96 million people who will qualify for either Medicaid or exchange subsidies—will change eligibility from one year to the next, according to a new report from the Robert Wood Johnson Foundation.  Two-thirds of churning will happen when people move between Medicaid and ineligibility for all subsidies because of income above Medicaid levels and access to employer-sponsored insurance.  What to do about the “churn?”  Click here for recommendation in the 12-page study.


New Data: Health Spending Slow Through 2013, Then It Accelerates

For 2011–13, US health spending is projected to grow at 4.0 percent, on average—slightly above the historically low growth rate of 3.8 percent in 2009, according to a study in Health Affairs based on data from CMS.  Preliminary data suggest that growth in consumers’ use of health services remained slow in 2011, and this pattern is expected to continue this year and next. In 2014, health spending growth is expected to accelerate to 7.4 percent as the major coverage expansions from the Affordable Care Act begin.  Click here for more.  Republicans were quick to pounce on the report’s claim that health spending would rise under the ACA.  Click here for that report.


CDC Issues Report on Utilization of Preventative Services

In a baseline data report on preventative services, the CDC reported last week that tens of millions of people in the United States have not been benefiting from key preventive clinical services, and that there are large disparities by demographics, geography, and health care coverage and access in the provision of these services.  For example, slightly less than half of patients with diagnosed ischemic cardiovascular disease were prescribed aspirin or other antiplatelet agents; despite improvements in hypertension treatment and control over the past 10 years; slightly less than half of persons in the US with high blood pressure had it under control; and only two thirds of adults (68%) had their cholesterol levels checked during the preceding 5 years.  Click here for the report.


Medicare Patients Get More Preventative Services Today:  HHS

However, said last week the Affordable Care Act helped 14.3 million people with Medicare get at least one preventive service at no cost to them during the first five months of 2012.  This includes 1.1 million who have taken advantage of the Annual Wellness Visit provided by the Affordable Care Act.  In 2011, 32.5 million people in Medicare received one or more preventive benefits free of charge.  Click here for more.


National Prevention Strategy Announced

The National Prevention Council last week released an action plan for implementing its National Prevention Strategy. The Affordable Care Act established the council to coordinate federal efforts to prevent disease and promote wellness.  Click here for a summary.


Telepsychiatry for Kids Works, According to Study

A pilot telepsychiatry program for children significantly improved symptoms and cut emergency department visits in half, based on data from more than 8,000 patients over 2 years, according to a report out last week. Click


Number of Cancer Survivors Growing Swiftly

A first-ever report released last week by the American Cancer Society – in collaboration with the National Cancer Institute – estimates there are 13.7 million cancer survivors alive in the US today, and that number will grow to almost 18 million by 2022.  The 3 most common cancers among male survivors are prostate cancer (43%), colon and rectal cancer (9%), and melanoma skin cancer (7%). The 3 most common cancers among female survivors are breast cancer (41%), uterine cancer (8%), and colon and rectal cancer (8%).  Click here for more.


Report Ranks States on Services Available for Ovarian Cancer

California ranks highest and Wyoming lowest of all the states when it comes to quality care for women with ovarian cancer, according to a report released lat week by the Ovarian Cancer National Alliance. Click here for more.


States Looking to Ban Tanning Beds for Those Under 18

California and Vermont have already passed legislation and now Delaware and 14 other states are considering legislation to do the same:  ban anyone under 18 from using a tanning bed.  Click here for the story.