WEEKLY E-BULLETIN


U.S. News Releases Latest Hospital Rankings with New Methodology

Another major hospital scoring system – this from U.S. News – has changed its methodology and shaken up rankings from previous years. The news organization released its scorecard last week. U.S. News surveyed about 10,000 specialists and went through data from about 5,000 hospitals to rank 16 adult specialties – from cancer to urology. Only 148 hospitals were ranked in one or more specialties. Click here to see their lists.

OIG Says Most Hospital Adverse Events Going Unreported

According to reports out Friday by the HHS Inspector General, hospital “adverse events affect a significant portion of Medicare beneficiaries.” Additionally, the “OIG found that hospital staff did not report 86 percent of events to incident reporting systems. Previous explanations for low reporting levels include the following: (1) staff do not have time, (2) staff fear punitive action, and (3) staff do not believe that reports will lead to improvement. However, this report found that the low level of reporting is also due partly to hospital staffs’ lack of understanding as to what constitutes patient harm.” Click here to see those OIG reports. Click here for the USA Today story.

Hospital Coalition Fights Possible Cuts to E&M Payments

A coalition of hospitals and health systems is urging the House Ways and Means Committee to reject a March recommendation by MedPAC to dramatically reduce reimbursement for hospital evaluation and management visits by equalizing them with reimbursement for physicians. In a letter to the Committee last week, the coalition, says the E&M cuts would be a giant step backwards for care coordination and delivery system reform. Click here to read the letter.

Report: Hospital Readmissions Frequency Still a Problem

Hospitals are making little headway in reducing the frequency at which patients are readmitted despite a government campaign and the threat of financial penalties, according to Medicare data released last week. AHA says the data includes years 2009 and 2010 when hospitals were in the process of making changes that would lead to a drop in readmissions, which really began significantly in 2011. Click here for the Washington Post story.

CMS Releases Updated Medicare Data and Hospital Compare Website

The data set referenced above came from an updated CMS Hospital Compare website. Click here to check out your area hospitals. Included in the website is the updated data base that you can download and review yourself. Click here to review the available data bases.

Medicare Advantage Bonus Program Comes Under Fire

Two senior House Republicans are raising serious objections to the implementation of the Medicare Advantage quality bonus demonstration program. Ways & Means Chairman Dave Camp and Health Subcommittee Chair Wally Herger sent a letter to the HHS secretary demanding numerous documents around the creation of the program and underscored that the GAO said HHS exceeded its legal authority to create the demonstration. Click here to read the letter.

IOM Releases Phase II Report on Medicare Geographic Variation

Changing the way that Medicare payments are adjusted to account for regional variations in the cost of providing care as recommended by a previous report from the Institute of Medicine would result in payment increases for some hospitals and practitioners and decreases for others, concludes the Phase II report from the Institute of Medicine study. Geographic adjustments should be used to ensure the accuracy of payments, said the committee that wrote the report, but they are not optimal tools to tackle larger national policy goals such as improving access to care in medically underserved areas. Click here for a summary report.

Study: Safety Net Hospitals Score Lower on Patient Experience Measures

Safety-net hospitals had lower performance than non-SNHs on nearly all measures of patient experience, according to a study released last week in the Archives of Internal Medicine. The greatest differences were in overall hospital rating, where patients in SNHs were less likely to rate the hospital a 9 or 10 on a 10-point scale compared with patients in non-SNHs. Both groups of hospitals improved from 2007 through 2010, the gap between SNHs and non-SNHs increased (3.8% in 2007 vs 5.6% in 2010). Click here for the study.

Two-Thirds of Docs to be Hospital Employees by 2014: New Analysis

By 2014, two-thirds of the nation’s nearly 1 million doctors will be employed by hospitals, according to a report last week from one of the largest physician recruitment firms Merritt Hawkins. Among their findings:
– Primary care physicians remain at the top of the list for most hospitals, medical groups and other healthcare groups.
– The dearth of psychiatrists continues to represent a “silent shortage.”
– General surgeons are in high demand as the number of general surgeons per population decreases.
– Certain medical specialists, including emergency medicine physicians, orthopedic surgeons, obstetrician/gynecologists, pulmonologists, urologists, dermatologists, and hematologists/oncologists remain in strong demand, underlying the fact that physician shortages are not limited to primary care. Click here to see a summary of their report.

Advanced Payment ACOs Increase by 15

There are now 20 advanced payment ACOs underway with Medicare, according the CMS when it announced last week that 15 new programs had been approved. There are three in Florida and three in Texas with the rest scattered mostly east and south. The Advance Payment Model is designed for physician-based and rural providers who will receive upfront and monthly payments to make investments in their care coordination infrastructure. Click here to see the detailed list. For expert assistance in preparing an ACO application to CMS, click here.

Big Medicaid Fraud Bust Announced in New York

Federal prosecutors last week announced charges against 48 defendants for their participation in a massive fraud scheme involving the trafficking of hundreds of millions of dollars’ worth of prescription drugs that had previously been dispensed to Medicaid recipients in the New York City area, in a national underground market. Medicaid lost more than an estimated $500 million in reimbursements for pills that were diverted into this second-hand black market. Click here for the FBI announcement. Click here for the NY Times story.

Congress Focuses on Medicare Payment Formula

Congress focused more attention last week on the physician payment formula and at least one key Republican, Rep. Michael Burgess from Texas, announced he would be introducing legislation to extend the current payment formula for one year. Unless Congress acts, physician Medicare payments are cut 27% January 1. In testimony before the House Energy & Commerce Committee, the American College of Surgeons and the American College of Physicians outlined their solutions – both testimonies are very interesting. Click here for the ACS and here for the ACP.

Health Innovation Program for States Announced by HHS; $275 Million Available

HHS has announced a new program to help states design and test improvements to their health care systems. States will work with a broad coalition – including employers, insurers, community leaders and service organizations, health care providers, consumers, tribal governments – to design or test multi-payer payment and delivery system improvements to health care systems for Medicare, Medicaid, and Children’s Health Insurance Program beneficiaries. Up to five states will be chosen for the initial round of Model Testing awards and up to 25 states will be chosen for Model Design awards. Up to $275 million is available in funding, including for $50 million for Model Design and $225 million for Model Testing. Click here for further details.

GOP Congressmen Ask for 340B Clarification of “Patient”

Congressman Joe Pitts (PA-16), Chairman of the Energy and Commerce Health Subcommittee, and Congressman Bill Cassidy, M.D. (LA-06), member of the Health Subcommittee, sent a letter to the Health Resources and Services Administration asking for an end to the confusion over the definition of a patient in the 340B drug program. “The 340B program is intended to serve the nation’s poor and uninsured who need access to critical pharmaceuticals. Last year, the Government Accountability Office found HRSA’s oversight of the 340B program inadequate in part because of an outdated definition of “patient” set in 1996.” Click here to read the letter.

More Small Companies Self-Insuring

A growing number of small companies – those with fewer than 100 employees — are either self-insuring for health benefits or at least interested in exploring that option, according to a new study from the Center for Studying Health System Change out last week. The markets for both third-party-administrative services and stop-loss insurance are becoming increasingly competitive as some carriers offer services to firms with as few as 10 workers. Click here to see the report.

Prostate Cancer Surgery Questioned

Surgery for prostate cancer was no better in saving lives than observation over a 10-year period, according to one of the first rigorous studies to compare the two approaches in American men with early-stage disease. The government-funded study assigned 731 men across the country with early prostate cancer to have the gland surgically removed or be observed without any attempt at curative treatment. Ten years later, 47 percent of men in the surgery group had died, mostly from other diseases, versus 49.9 percent who were just watched. Click here for the results published in the New England Journal of Medicine last week.

Impact of Supreme Court Ruling Continues to Reverberate

The debate continues over whether states will be expanding their Medicaid programs following the Supreme Court ruling that said the federal government could not force states to do so. The Center for American Progress is out with a report that details the health coverage gap between those who get coverage under a Medicaid expansion and those who don’t. Click here. The Washington Post had a story last week about the new Medicaid “doughnut hole” for states that don’t expand. Click here. A state budget crisis task force says many states just can’t afford a long term expansion. Click here for their 112 page report. Speaking of the court’s decision, a number of publicly traded health care companies seemed to have benefited from the ruling, according to an analysis in a USA Today report last week. Click here. More health insurance mergers and acquisitions are in the offing, according to another report last week. Click here.

New Standards for Academic Medical Center Accreditation Announced

Joint Commission International announced last week that academic medical centers accredited by JCI will be accredited under a new set of standards beginning January 1, 2013. “Not every hospital with students or conducting research is considered an academic medical center hospital under these new standards”, according to JCI. Click here for more.

For additional health policy news, click here.