CMS: Family Docs to Get 7% Payment Increase; Other Major Changes Announced

CMS issued a proposed rule late Friday that would increase Medicare payments to family physicians by approximately 7 percent and other practitioners providing primary care services between 3 and 5 percent.  Also, for the first time, the agency is proposing to explicitly pay for the care required to help a patient transition back to the community following a discharge from a hospital or nursing facility. The proposals calls for CMS to make a separate payment to a patient’s community physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility stay.  You have until September 4 to comment. The rule will be finalized by November. Click here for a detailed CMS summary. Click here to read the 765 pages of proposed rules.


HOPD, ASC Payment Rates to Increase

In other proposed rules from CMS last week, there could be an increase Hospital Out-Patient Department payment rates of 2.1 percent. The increase is based on the projected hospital market basket—an inflation rate for goods and services used by hospitals—of 3 percent, less statutory reductions totaling 0.9 percent, including an adjustment for economy-wide productivity. CMS is also proposing to increase ASC payment rates by 1.3 percent–the projected rate of inflation of 2.2 percent minus an adjustment required by law for improvements in productivity of 0.9 percent.  Click here for those details. Click here for the 687 pages of rules.


Home Health Payments to be Cut

In another proposed rule, CMS would reduce Medicare payments to home health agencies in calendar year 2013 by 0.1 percent, or $20 million. Click here for details. Click here for the 186 page rule.


Bad Debt Payment Reductions for Providers Announced

CMS last week released a proposed rule implementing reductions in the amount of Medicare bad debt payments to eligible providers, including hospitals, nursing homes and Federally Qualified Health Centers. These reductions will take effect in cost reporting periods beginning in FY 2013. CMS will accept public comments on the rule until August 31, 2012, after which a final rule will be drafted and released sometime in 2013. Click here for an excellent two-page summary of the rule. Also included in the rule is a 2.5% payment update for dialysis, establishing the ESRD PPS base rate at $240.88 (for providers who have elected to forego the transition to the new PPS). Click here for details.


Medicaid Expansions by State Are New Political Battleground

The bad debt reductions are, in part, tied to relief that providers are expected to receive when states expand their Medicaid programs using mostly federal funds for the first several years. However, because of last week’s Supreme Court decision on the health care law, some states with GOP governors are saying they won’t expand their Medicaid  programs.  Governors from Florida, Louisiana, Mississippi, South Carolina and Wisconsin are already on record opposing an expansion. To find out where your state stands today, click here. The Urban Institute has published a very helpful chart that shows the impact of Medicaid expansion (or not) on each state. Click here.


House to Vote to Repeal Affordable Care Act Wednesday

Not satisfied with the Supreme Court’s decision upholding the Affordable Care Act, House Republican leadership will vote this Wednesday on legislation to repeal the health care law. It will likely pass but be blocked by the Senate. Click here for details on the new repeal effort. Most physician executives agree with the Court decision. Click here for that poll.  Americans see more bad than good in the law as it relates to the economy. Click here for the new Gallup poll.


TODAY: Webinar on the Court’s Health Care Decision

If you have an interest in learning more about what impact the Supreme Court’s health care decision could have on your organization, please sign up for a free webinar featuring Strategic Health Care and Plante Moran experts. The 1-hour program is TODAY at 1 p.m. EDT.  Click here to register. (Note to first time users: on the registration page select “New Student Registration” to create your account. You will receive an email from LearnLive Technologies confirming your registration.)


Consumer Reports Hospital Rating Guide Published

Consumer Reports was out last week with its hospitals rating guide. The guide allows you to compare hospitals based on their own patient safety score, as well as individual measures relating to patient experience, patient outcomes, and certain hospital practices. 4,000 hospitals are rated.  Unfortunately, it takes a subscription to access individual hospitals.  Click here.


Health Care Continued to Add Jobs in June

June’s anemic jobs report showed that healthcare added just 13,000 jobs, which was half of its average monthly growth rate in the past year but still comprised 16% of all new jobs in the national economy last month. Physician offices posted an overall loss of jobs, while hospitals showed a small gain. Click here for a detailed report from the Labor Department. (Look at page 30 for the health care stats.)


Employer-Based Health Care Continues Decline: Gallop

Fewer adults are getting their health care from their employers, according to a new report from Gallop. At 55.9%, the number is the lowest since 2008.  Click here to see more.


Aetna Sued by California Physicians Over Out-of-Network Referrals

The California Medical Association and more than 60 physicians have filed a lawsuit alleging that Aetna illegally threatens to deny coverage for out-of-network referrals. According to a story in the LA Times, the lawsuit also says that Aetna will terminate contracts of doctors who continue to make such referrals. Click here for the story.


FDA: Most Medical Devices Must Have Unique Device Identifier

In response to requirements in legislation that Congress passed two weeks ago, the FDA last week proposed that most medical devices distributed in the United States carry a unique device identifier, or UDI.  There is a 120 day public comment period on proposed rules. Click here for details.


HIV Over-the-Counter Test Approved

The FDA also last week approved the first over-the-counter HIV test, allowing Americans to test themselves for the virus that causes AIDS in the privacy of their homes. The test is designed to return a result within 20 to 40 minutes. Government officials estimate one-fifth, or about 240,000 people, of the 1.2 million HIV carriers in the U.S. are not aware they are infected.  Click here for the report.

United Health Care Picks Up DoD’s $20 Billion TRICARE West Program

The GAO last week approved a $20.5 billion contract between the Pentagon and United Healthcare for the insurer to run DoD’s TRICARE West program to cover 2.9 million active duty and retired service members in 21 states. TriWest Healthcare Alliance Corp., which had the contract before, appealed the Defense Department’s decision in March to switch to UHC, but the GAO came down on the giant insurer’s side. Click here for the story in the Army Times.