500 Primary Care Practices Selected for Major CMS Demo

500 primary care practices in seven regions were selected by CMS last week to participate in a new partnership between payers from CMS, state Medicaid agencies, commercial health plans, self-insured businesses, and primary care providers. Under the Comprehensive Primary Care Initiative, CMS will pay primary care practices a care management fee, initially set at an average of $20 per beneficiary per month, to support enhanced, coordinated services on behalf of Medicare fee-for-service beneficiaries.  Public and private health plans in Arkansas, Colorado, New Jersey, Oregon, New York’s Capital District-Hudson Valley region, Ohio and Kentucky’s Cincinnati-Dayton region, and the Greater Tulsa region of Oklahoma signed letters of intent with CMS to participate in this initiative. Click here for an interactive map that identifies all the practices.

Medicare Spending Slowing: New CBO Report

Amid its severe projections for the economy overall, the Congressional Budget Office last week said that Medicare spending growth is slowing, although the program will take up a larger share of the economy in a decade than it does now. In an update to its January report, CBO said that outlays for Medicare will total 3.7 % of the gross domestic product in 2013, rising to 4.3% of GDP in 2022, as enrollment in the program increases. But the report also noted that for the third year in a row, CBO expects the growth in Medicare spending in 2012 to be “substantially slower” than anticipated earlier in the year. Click here to see the CBO report.


Stage 2 Meaningful Use Rules Issued

CMS has published the final rule outlining the requirements for Stage 2 of the Meaningful Use incentive program, adopting many, but not all of the provisions they proposed in March. The 672-page rule delays the Stage 2 requirements until 2014, giving providers more time to meet the Stage 2 criteria. No provider will have to follow the Stage 2 requirements before then. Stage 2 originally was slated to begin next year.  The program is divided into three stages:

  • Stage 1 sets the basic functionalities electronic health records must include such as capturing data electronically and providing patients with electronic copies of health information.
  • Stage 2 increases health information exchange between providers and promotes patient engagement by giving patients secure online access to their health information.
  • Stage 3 will continue to expand meaningful use objectives to improve health care outcomes. Click here for a copy of the rules. For an excellent summary, click here.


Study Says Meaningful Use is Working

For anyone who doubted whether the Meaningful Use incentive program has influenced the adoption of electronic health records, there is proof, according to a study published last week in the Journal of the American Medical Informatics Association. Their study analyzed a cohort of 3,447 hospitals from 2006-2010. Click here for an abstract of the study.


ICD-10 Formally Delayed a Year

CMS last week issued a final rule that official pushed back ICD-10 adoption 1 year – to October 1, 2014.  The rule also adopts the standard for a national unique health plan identifier (HPID) and establishes requirements for the implementation of the HPID. The rule also specifies the circumstances under which an organization covered health care provider must require certain noncovered individual health care providers who are prescribers to obtain and disclose a National Provider Identifier (NPI). The effective date of the new regs is November 5, 2012. Click here for a copy of the 208-pages of regulations. CMS says the rule will save $6 billion over 10 years.  Click here for the CMS announcement.


State Innovations Demo Delayed a Week; Webinar Set for Tuesday

CMS has extended the deadline to September 24  for states to apply for $275 million in grants to design and test improvements to health care delivery and payment for people enrolled in Medicare, Medicaid and the Children’s Health Insurance Program. It’s a one week extension. The State Innovations Models initiative will award up to $225 million to help up to five states implement existing models, and the rest to help up to 25 states plan and design proposals in partnership with health care providers and others.  CMS is hosting a webinar this Tuesday, August 28 at 3 p.m. EDT on the program. Click here to sign up.

New Summary of Major National Health Associations Activities

Strategic Health Care is bringing you a new service: a regular summary of the major public announcements from the nation’s most important health care associations. From the major physician specialty groups and hospital associations to major business groups, the summary will summarize then guide you to their public releases. Click here for the August summary.

CMS Teleconferences on Health Exchanges Announced

CMS announced that it will host a series of 10 regional teleconferences September 6-14 on the latest information regarding implementation of health insurance exchanges. For details on the two-hour calls and how to register, click here. Registration is required.


8 States Get New Exchange Grants

Eight more HHS grants were awarded last week to help states establish health insurance exchanges beginning in 2014. California, Hawaii, Iowa and New York received one-year grants while Connecticut, Maryland, Nevada and Vermont received multi-year grants available to states further ahead in the process. To date, 34 states and DC have received the Exchange Establishment grants, which will be awarded through 2014. Click here for an interactive national map to see where your state is on funding.

ACO Participation Rapidly Increasing: New Survey

Participation in accountable care initiatives has more than doubled in the last 12 months, according to 200 healthcare companies who completed the second annual Healthcare Intelligence Network survey on Accountable Care Organizations. Almost a third of this year’s respondents — 31% — participate in an ACO, up from 14% of respondents in 2011. And two-thirds of respondents said ACOs would have survived a challenge by the U.S. Supreme Court. Click here for a 5-page summary of the survey.


Urban Institute: Young Adults Greatly Benefit from Medicaid Expansion

According to a recent Urban Institute study, state Medicaid expansion under the Affordable Care Act could make coverage available for an additional 7.8 million uninsured adults who are below the age of 35. Young adults have higher uninsured rates relative to other adults, thus constraining their access to acute and preventive care, including mental health care, and contributing to financial hardships associated with meeting health care. Click here to see the study, which includes state-by-state data.


Pay for Performance May Have Detrimental Effect

With insurers and Medicare hoping that they can cajole doctors and hospitals into providing better care by paying them for good performance, a pair of articles in a top medical journal is now arguing the opposite — that so-called “pay for performance” programs can have a detrimental effect, prompting some physicians to game the system in order to bring about desired results. This is an interesting article in the Pittsburgh Post Gazette that draws heavily from a British Journal of Medicine report. Click here for the story.


Aetna Buys Coventry for $5.7 Billion

Aetna is buying Coventry for $5.7 billion, according to announcements last week. For Aetna, the deal targets Coventry’s Medicare and Medicaid customers, which are expected to grow under the expanded coverage of the Affordable Care Act. It also signals that healthcare giants are already planning for drastic change in the sector, even as the new law becomes a key campaign issue and presumptive Republican Presidential candidate Mitt Romney says he would attempt to strike it down. Coventry will add nearly 4 million medical members and 1.5 million Medicare Part D members to Aetna’s membership. Click here for more information.


Specialty Docs Providing Inordinate Amount of Primary Care

41% of our primary health care needs are taken care of by higher-paid specialty doctors. This is according to Mount Sinai’s Minal Kale who led a team of researchers that combed through data on more than 20,000 doctor visits in 1999 and 2007. All of it had information on why the individual turned up at the doctor’s office, whether it was a runny nose or a heart attack. Click here for the study in the Archives of Internal Medicine. Click here for the Washington Post summary.


Massachusetts, CMS Enter First Duals Demo

Massachusetts will become the first state to partner with CMS in the Financial Alignment Demonstration to test a new capitated payment and integrated care model for patients enrolled in both Medicare and Medicaid, CMS said last week. The project will contract with “integrated care organizations” that will oversee and be accountable for the delivery of Medicare, Medicaid and other services for dual enrollees beginning in April 2013. Click here for details.


Anti-Health Care Fraud Efforts Growing

Although Medicare and Medicaid fraud continues into the billions of dollars, according to some experts, the government has new tools to fight it.  NPR has an interesting story on the anti-fraud efforts (click here) that includes information from the National Health Care Anti-Fraud Association. The NHCAA is a new organization comprised mostly of insurance companies. Click here to visit their website.


Congressman Calls for RAC Investigation

U.S. Rep. Dan Boren (D-OK) is calling for a federal investigation into the tactics and methods used by Connolly, Inc. and other CMS Recovery Audit Contractors. Boren sent letters to congressional leaders and HHS on August 15 after hearing from hospitals in Oklahoma. Click here for Boren’s statement. Click here for the story on the Oklahoma hospital that urged Boren to act.


Congressman Says IRS Illegally Implementing Subsidies for Low Income

U.S. Rep. Darrell Issa (R-CA) last week questioned whether the White House pushed the IRS to implement President Obama’s healthcare law in a way Issa believes is illegal. Issa, chairman of the House Oversight and Government Reform Committee, believes the IRS is illegally implementing one of the law’s crucial features — subsidies to help low-income people buy insurance. Click here for the story. Click here for Issa’s letter to the IRS.


Report: Health Care Industry Wasted at Least $800 Billion in 2011

The U.S. healthcare industry wasted more than $800 billion last year in unnecessary care, according to a report out last week by GBI Research. GBI traces the waste to what it refers to as “incompetent hospital management and administrations scams,” according to a statement from the firm. Click here for more.


Court Strikes Graphic Cigarette Warning Requirements

A U.S. appeals court last week struck down a law requiring cigarette makers to brand their products with graphic warnings. A three-judge panel of the Washington, D.C.-based court ruled that a 2009 law requiring new, graphic warnings on packs of cigarettes violated the free speech rights of cigarette companies. Click here for the court’s 61-page ruling.


Newer Stents Result in Fewer Adverse Events

The use of biolimus-eluting stents with biodegradable polymer results in a lower rate of major adverse cardiac events, compared with patients with bare-metal stents, at one year following primary percutaneous coronary intervention (PCI), according to a study published last week in the Journal of the American Medical Association. Click here for a summary.

New NIH Trial Investigates Impact of Common Anti-Inflammatory Drug

An international multi-site NIH trial has been launched to determine whether a common anti-inflammatory drug can reduce heart attacks, strokes, and deaths due to cardiovascular disease in people at high risk for them. This study is being supported by the National Heart, Lung, and Blood Institute, a part of the NIH. Click here for details.