Government Cracking Down on Questionable Medical Procedures

Questionable cardiac procedures are at the center of a Justice Department investigation into HCA Holdings, the nation’s largest for-profit hospital chain, according to a story last week in the Washington Post.  In an unusual move, HCA revealed the probe ahead of publication of a New York Times story revealing that cardiologists in some of its hospitals, mainly in Florida, were unable to justify many procedures performed between 2002 and 2010.  Click here for the story. Click here for the related New York Times story. In a related story, USA Today says the Affordable Care Act gives Medicare and Medicaid more authority to track and reject payments for medical procedures believed to be overused. Click here for this story.

Study: CCTA Use Declines with Appropriate Education, Incentives

A quality improvement effort that combines physician education with reimbursement funds successfully curbed the practice of ordering inappropriate imaging tests, according to a study published last week in the Journal of the American College of Cardiology. The study found that such measures reduced inappropriate coronary CT angiography orders by more than 60 percent. The study compared the practice patterns of roughly 5,000 doctors across 47 medical facilities in Michigan and involved more than 25,000 patients enrolled in the Advanced Cardiovascular Imaging Consortium (ACIC).  Click here for the study.

Mercer: Certain Employers Will Be Harder Hit by ACA in 2014

The major provisions of the Affordable Care Act scheduled to take effect in 2014 affect employers with large numbers of part-time and low-paid workforces, according to a report issued last week by Mercer. For example, beginning in 2014 employers will be required to extend coverage to all employees working 30+ hours per week or face possible penalties. About a fourth of all survey respondents said they will have to take action to avoid possible penalties. This ranges by industry, from just 16% of financial services employers to 46% of employers in retail and hospitality. Click here for the Mercer report. Meantime, some Democrats in Congress and advocates for low-income people say coverage may be unaffordable for millions of Americans because of a cramped reading of the law by the administration and by the Internal Revenue Service in particular. Click here for the story.

New Federal Regs Trim Paperwork, Save Billions

CMS issued interim final rules last week designed to streamline electronic funds transfers (EFT) and electronic remittance advice (ERA) that is expected to save hospitals and physician offices between $300 million and $3.3 billion over the next 10 years. CMS anticipates that the use of the new operating rules may help foster electronic payments and save an estimated 800,000 pounds of paper over ten years. The operating rules build upon industry-wide health care EFT standards adopted in January of this year. Together with the health care EFT standards, the new EFT and ERA operating rules are estimated to save between $2.7 billion and more than $9 billion in administrative costs over ten years by reducing inefficient manual administrative processes for physician practices, hospitals, and health plans. Click here for more.

Independence at Home Demo Grows

Three consortia of medical practices have been selected to participate in the CMS Innovation Center’s Independence at Home demonstration project, according to an announcement from CMS. The Innovative Primary Senior Care LLC (Skokie, Illinois), Treasure Coast Healthcare, LLC (Stuart, Florida), and Virginia Commonwealth University Health System/Medical College of Virginia Hospitals and Physicians (Richmond, Virginia) join 15 individual practices in the demo.  Click here for details.

SAMHSA Technology Grants More than $4 Million

The Substance Abuse and Mental Health Services Administration last week announced more than $4 million in new grants for Health Information Technology service for six communities across the nation. The purpose of this program is to leverage technology to enhance and/or expand the capacity of substance abuse treatment providers to serve people who traditionally have been underserved because of lack of access to treatment in their immediate community. The funds will go to organizations in TN, IA, WV, WI, PA and CA. Click here.

National Health Spending Continues Decline

National health expenditures in June 2012 grew by 3.9% relative to June 2011, down from the 4.2% growth rate observed in May, after incorporating the effects of major government updates, according to a new report from Altarum Institute.  Annual revisions in government data show growth in spending from 2010 to 2011 at 5.2% versus the previous estimate of 4.3%. Click here for their 4-page report.

CMS: States Can Opt Out of Medicaid Expansion After Joining

States may choose to adopt the Patient Protection and Affordable Care Act’s Medicaid expansion and later decide to drop it, a senior CMS official told state legislators last week. Cindy Mann, CMS’ director of Medicaid and CHIP, spoke to the National Conference of State Legislators and you can view her 96 second interview on YouTube here.

Medicare Rx Premiums Stable

Average basic premiums for Medicare prescription drug plans are projected to remain constant in 2013, according to HHS last week.  The average 2013 monthly premium for basic prescription drug coverage is expected to be $30. Average premiums for 2012 were projected to be $30 and ultimately averaged $29.67. For more information click here.

Teen Tobacco Use Continues Decline

Tobacco use among American middle school and high school students showed a slow decline from 2000 to 2011, according to a report from the CDC last week. The report shows that in 2011 nearly 30% of high school males and 18% of high school females used some form of tobacco. More than 8% of middle school males and nearly 6% of middle school females used some form of tobacco in 2011. Click here for more from the CDC.

Blue Collar Workers May Suffer Worst Health: Survey

Workers who keep the country running through transportation, construction and other services may also suffer the worst health, according to recent rankings of employees’ well-being.  The survey found that blue-collar workers topped the charts when it comes to many health concerns: About 37% of transportation workers and 30.7% of manufacturing and production employees are obese; smoking was prevalent among 33% in mining and construction and 29.3% in installation and repair work.  Click here for the USA Today story.

Study on Nation’s Largest Health Systems Released

Results of a two-year study of the nation’s largest health system were published last week by the Commonwealth Center for Governance Studies in a report entitled “Governance in Large Nonprofit Health Systems”. The study examined board structures, processes, and cultures in 14 of the country’s 15 largest nonprofit, nongovernment health systems and compares them to nine well-established benchmarks and related metrics of effective governance. Douglas Hawthorne, President of Texas Health Resources, a large health system based in Dallas, states “This report is a must read for hospital and health system CEO’s and board members.”  Click here for the 124-page report.

Survey: Most Seniors Hope to Stay at Home

About 90% of seniors in a survey released last week said that they hope to stay in their homes as they age. Within this group, about 85% said they believe they can do that without making major changes to their residence. The comprehensive survey of seniors can be viewed by clicking here.

US Overspending on Epogen by the Millions: New Report

The U.S. health care system is overspending for a single anemia drug, Epogen, because Medicare overestimates its use by hundreds of millions of dollars a year, according to an analysis of federal data and reported last week in the Washington Post. The overpayment to hospitals and clinics arises because Medicare reimburses them based on estimates rather than the actual use of the drug.  Click here for the story.

House GOP Calls for Affordable Care Act Spending Report

Some House Republicans last week asked government auditors for a detailed accounting of the money being used to implement President Obama’s healthcare law.  Republicans — Reps. Camp (MI), Herger (CA) and Boustany (LA) — on the Ways and Means Committee asked the GAO to investigate how much money the Obama administration has spent implementing the law — and how much it expects to spend through 2014, when most of the major provisions take effect. Click here for more.


Pregnancy Coverage Not Likely Available for Many Under Insurance Expansion

The Affordable Care Act provides a safety net for young adult children, who can now stay on their parents’ health plans until they reach age 26. But it doesn’t guarantee that their parents’ plan will cover a common medical condition that many young women face: pregnancy. Group health plans with 15 or more workers are required to provide maternity benefits for employees and their spouses under the Pregnancy Discrimination Act of 1978. But other dependents of employees aren’t covered by the law, so companies don’t have to provide maternity coverage for them. Click here for the story.

Obesity Limiting Growing Number of Organ Donations

A growing number of potential organ donors are ineligible to donate because of their weight, according to a report last week in the New York Times.  Rising obesity has spurred a small but growing effort to pay closer attention to the health of obese donors, whose risks are still incompletely understood.  There is no binding donor weight limit, but a little more than half of transplant centers cap donor body mass index at 35. About 10 percent don’t allow donors with B.M.I.’s over 30, generally considered the cutoff for obesity, while the rest allow some heavier people to donate.  Click here for the story.