89 New ACOs Underway

HHS announced last week that as of July 1, 89 new Accountable Care Organizations began serving 1.2 million people with Medicare in 40 states and Washington, D.C. ACOs are organizations formed by groups of doctors and other health care providers that have agreed to work together to coordinate care for people with Medicare. These 89 new ACOs have entered into agreements with CMS, taking responsibility for the quality of care they provide to people with Medicare in return for the opportunity to share in savings realized through high-quality, well-coordinated care. Click here for CMS’ list of the new ACOs.


ACO Briefing Call Scheduled by CMS

CMS is hosting a National Provider Call Tuesday, July 31 at 1:30 EDT to provide an overview and updates to the Shared Savings Program application and Advance Payment Model application processes for the January 1, 2013 start date. A question and answer session will follow the presentations. To receive call-in information, you must register for the call on the CMS Upcoming National Provider Calls web page (click here). Registration will close at 12 pm on the day of the call or when available space has been filled.


MedPAC, Key Senator Urges Changes to Dual Eligibles Demonstration

Congressional scrutiny of a health law demonstration program testing the use of managed care plans for the sickest Medicare patients is intensifying, with a Senate health care leader – West Virginia Senator Jay Rockefeller – urging immediate changes. In a letter to HHS, the senator called on the agency to stop the current dual eligible demonstration project and redesign it. Click here to read the very detailed letter. The Senate’s aging committee is now planning a July 18 hearing on the program’s design. MedPAC has now weighed in with its own recommendations to Congress on how to change the program. Click here for the MedPAC letter.


New Summaries of CMS’ Proposed Physician, OPPS, ASC and Home Health Rules Available

Ten days ago, CMS proposed significant payment and operational changes to physician payments, hospital outpatient prospective payment system, ambulatory surgery centers and home health agencies. Strategic Health Care’s policy team has put together excellent summaries of the rules. Click here for the 4-page physician rule summary. Click here for the 5-page OPPS and ASC rule summary. Click here to see the 4-page home health summary.


For-Profit Hospital Group Recommends Changes to Improve Medicare, Medicaid

The nation’s for-profit hospitals are speaking out on ways to reduce waste, fraud and abuse in Medicare and Medicaid. The Federation of  American Hospitals sent a detailed letter last week to the Senate Finance Committee with specific recommendations that are worth a read. Click here for the 6-page letter.


GOP, Dems Tussle Over Affordable Care Act Implementation

The Obama Administration is pushing states to move quickly to implement the Affordable Care Act, just a few weeks after the Supreme Court voted to uphold most of the law. Click here for the story. A number of Republican governors are vowing to fight the expansion of Medicaid in their states, following the Supreme Court’s ruling that gives states the option of opting out of the expansion. The NY Times has a good story of what is happening in Florida. Click here. The Times has another good story on the Medicaid expansion itself. Click here. Meantime, the Republican Governors Public Policy Committee sent President Obama a letter last week listing questions related to Medicaid and the Affordable Care Act’s health insurance exchanges “that must have answers before states can determine best how to proceed in light of the Court’s decision.” Click here to read the letter. HHS had this initial response, click here.


Health Law Stakeholders Support Reform: New Report

And how do the Affordable Care Act’s stakeholders feel about the law?  According to an article last week in Health Affairs: “stakeholders approach health reform with distinct perspectives and some disagreement. But the major professional associations are converging on the conclusion that reform is a better option than reverting to the status quo before 2010, which presents clear, known, and threatening risks.” Click here to read the report.


House Votes to Repeal Health Law Again

The House voted last week to repeal the health care law – the 33rd time it did so in whole or in part. The Senate is not likely to go along and the White House issued a veto threat. Click here for the story.


New Study: Women Having Hardest Time Getting Insurance

Twenty percent of U.S. women ages 19 to 64 were uninsured in 2010, up from 15 percent in 2000, according to a study out last week from the Commonwealth Fund. The issue brief examines the implications of poor coverage for women in the United States by comparing their experiences to those of women in 10 other industrialized nations, all of which have universal health insurance systems. Click here for the 20-page report.


Medicaid Patients NOT Clogging EDs: New Study

Contrary to conventional wisdom that Medicaid patients often use hospital emergency departments for routine care, the majority of ED visits by non-elderly Medicaid patients are for symptoms suggesting urgent or more serious medical problems, according to a new national study by the Center for Studying Health System Change. About 10 percent of non-elderly Medicaid patient ED visits are for non-urgent symptoms, compared with about 7 percent for privately insured non-elderly people. Click here for a copy of the 13-page study.


New Bill Corrects CLIA Problems

Bipartisan legislation was introduced last week designed to give CMS more discretionary authority in managing violations and potential violations of the Clinical Laboratory Improvement Amendments (CLIA). Under current law, the government says it has little choice but to close labs – even when an error caused no harm and was unintentional. The bill, HR 6118, was sponsored by Reps. Grimm, Roskam, Womack and Ross. Click here for a summary of the legislation.

State of Nation’s Youth Improving: Government Report

The infant mortality rate, the preterm birth rate, and the adolescent birth rate all continued to decline, average mathematics scores increased for 4th and 8th grade students, the violent crime victimization rate among youth fell, as did the percentage of young children living in a home where someone smoked, according to the federal government’s annual statistical report on the well-being of the nation’s children and youth. Click here to see the report.


More Seniors Getting Preventive Services: HHS

More than 16 million people with original Medicare got at least one preventive service at no cost to them during the first six months of 2012 because of the Affordable Care Act, according to an announcement from HHS last week. This includes 1.35 million who have taken advantage of the Annual Wellness Visit provided by the Affordable Care Act. Click here for additional information.


17th COOP Approved; Utah Group to Receive $85 Million

A Utah group became the 17 CO-OP funded by HHS, according to an announcement last week from CMS. The agency awarded an $85,400,303 loan to Aarches Community Health Care in Utah to launch a new Consumer Operated and Oriented Plan. CO-OP loans are only made to private, nonprofit entities that demonstrate a high probability of financial viability. Click here for more.