WEEKLY E-BULLETIN


DOJ Sends Heart Device “Resolution Model” to Hospitals


Hospitals across the country received emails from the US Department of Justice last week containing a proposed “Resolution Model” that will allow the hospitals to begin to settle the long-standing DOJ investigation into improper Medicare billing for Implantable Cardioverter Defibrillators (ICDs). Hospitals are being asked to perform audits on their cases and to estimate damages, “with the severity of penalties based on whether the hospital had medical reasons to violate CMS rules; if patient harm resulted; if the hospital had prior knowledge or a statistical pattern of non-guideline implants; and if a hospital compliance program was in place.” Click here to read the 15-page DOJ document (as first reported by Modern Healthcare).  Click here for the American Heart Association response (DOJ reportedly consulted with the AHA before issuing its Resolution Model.) Click here for a good explanatory article.

An “Epidemic” of Overtreatment Costs System $210 Billion

An epidemic of overtreatment — too many scans, too many blood tests, too many procedures — is costing the nation’s health care system at least $210 billion a year, according to the Institute of Medicine, and taking a human toll in pain, emotional suffering, severe complications and even death, according to an article last week in the NY Times. Click here.

Physician Shortage Could Swell to 130,000

The physician shortage could swell to 130,000, according to a report out last week. One of the primary reasons is the residency programs to train new doctors are largely paid for by the federal government, and the number of students accepted into such programs has been capped at the same level for 15 years. Medical schools are holding back on further expansion because the number of applicants for residencies already exceeds the available positions, according to the National Resident Matching Program, a 60-year-old Washington-based nonprofit that oversees the program. Click here for the story.

Insurer Consolidations Could Spur Anti-Trust Action

Aetna is buying Coventry and Wellpoint is buying AmeriGroup and both deals could be the target of federal anti-trust action; at least that’s what’s being called for in an article last week in the Washington Post. Click here for a good story providing an overview of the health market consolidation already well underway. Meantime, WellPoint’s chief executive, Angela F. Braly, abruptly resigned last Tuesday as a result of mounting pressure from shareholders, according to a story in the NY Times. Click here.

More Health Systems Starting Health Plans

A growing number of health systems are taking a closer look at starting health insurance companies, according to a report out last week. Several dozen health systems already sponsor plans. Driving the change is the transition from fee-for-service payment schemes to one that pays providers a lump sum per person per year. This will shift more of the financial risk of medical care from insurers to providers. Click here for the story.

Should Hippocratic Oath Include “Do No Financial Harm?”

There is a small but growing movement of doctors and medical students who are trying to add “do no financial harm” to the Hippocratic oath taken by doctors and other medical personnel, according to a story last week in the Chicago Tribune. One medical school dean is creating a series of training videos for medical schools to help make students mindful not only of the cost to society of the care they will order but also of the cost to the patient. Click here for the very interesting story.

New Community Benefit Services Created Because of New IRS Requirements for Hospitals

The Affordable Care Act added new requirements that hospital organizations must satisfy in order to be described in section 501(c)(3) as a not-for-profit organizations. Among the new requirements, under Section 501(r), hospitals will have to conduct a community health needs assessment (CHNA) at least once every three years. This CHNA requirement is effective for tax years beginning after March 23, 2012. Hospitals will be required to pay an excise tax for failure to meet the CHNA requirement. Strategic Health Care is offering a new Community Benefit Innovation designed to transform your community benefit program into an evidence-based, outcomes-focused system for serving your community. It also provides a strong foundation for increasing your grant funding opportunities. Click here for details.

KPMG: Health Care Execs Uncertain About Current Business Model

Healthcare and pharmaceutical executives are clearly uncertain whether or not existing business models are sustainable over the next five years, according to the findings from a survey by KPMG and released last week.  KPMG found that the largest percentage of respondents – 40%, 53%, and 43% of systems, plans and pharmaceuticals, respectively – said that their current business model was somewhat sustainable over the next five years, while 20 to 27% of respondents in each group said current business models were either not very or not at all sustainable over the next five years. Click here for details.

New CO-OPs in Tennessee, Massachusetts; California Government Looking Too

CMS awarded funding last week for two new CO-OPs in Tennessee and Massachusetts. The Community Health Alliance Mutual Insurance Company in Tennessee will receive $73.3 million.  Minuteman Health, Inc. in Massachusetts will receive $88.5 million. So far, about $1.6 billion has been awarded to 20 CO-OPs in 20 states under the Affordable Care Act. The state of California is now seriously considering establishing a CO-OP rather than a Basic Health Plan, which was shelved by its state legislature. Click here for the story.

$23 Million from HRSA for Public Health Training

The Health Resources and Services Administration last week announced awards totaling $23 million to 37 Public Health Training Centers to provide training to current and future public health workers in key public health issues such as nutrition and epidemiology, and to enhance the workforce’s basic public health skills. Click here for the list of recipients in 30 states.

$25 Million from CDC for Public Health Fellowships

The CDC is providing $25 million to support fellowship programs, similar to medical residencies, and placement of fellows in state and local public health departments, as well as expanding training programs for existing public health workers, focusing on e-learning. This includes funding for 227 new fellows in contract and field positions providing necessary screening services and community education, as well as critical assistance with ongoing public health challenges. Click here for details about the CDC’s fellowship programs.

White House Orders More Mental Health Services for Vets and Active Duty

The White House last week issued an executive order expanding suicide prevention and mental health and substance abuse prevention services for service members and veterans. The order calls for additional VA staff, expanded research and improved coordination with community providers, including a number of new pilot programs with private sector providers.  Click here to read the executive order.

CMS Publishes Helpful Tipsheet for Stage 2 EHR Regs

CMS has published the final rule for Stage 2 of the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs and last week published a new on-line, easy-to-follow “tipsheet” on the program. The rule provides new criteria that eligible professionals, eligible hospitals, and critical access hospitals must meet in order to successfully participate in the EHR Incentive Programs. Click here for the tipsheet. Many of the nation’s medical specialty associations commented on Stage 2 and other issues. Click here for a summary of their recent public announcements compiled by the SHC staff.

Too Many States Failing Long Term Care Eligibility Assessments: GAO

A GAO report out last week looked at how states assess whether people are eligible for Medicaid long-term care — and found that states may not be acquiring adequate information about income and assets. The GAO looked at what documentation states require and how they verify the information — and found that 31 states aren’t requiring the 60 months of financial documentation specified by law. There is state-by-state data in the 104 page report. Click here.

Study Recommends Ways to Lower Rx Spending

The National Institute for Health Care Reform says in a report released last week that America spent $259 billion in 2010 on outpatient prescription drugs, which came to about a tenth of total health care spending. The Institute’s study recommended two key ways other countries are bringing down spending: reference pricing and comparative-effectiveness and cost-effectiveness research. Click here for a copy of the report.

US Compares Poorly on Curbing Preventable Deaths

The United States performs the worst in curbing potentially preventable deaths compared to France, Germany and the U.K., according to a report released last week from the Commonwealth Fund. Between 1999 and 2006/2007, American preventable mortality rates for men and women dropped 18.5% and 17.5% , respectively, while the U.K. saw more significant drops at 37% and 32%. Click here for the complete report.

10,000 At Yosemite May Have Been Exposed to Deadly Virus

Up to 10,000 people who were guests in certain lodging cabins at Yosemite National Park might have been exposed to a deadly mouse-borne virus, park officials confirmed last Friday. Park concessionaire Delaware North Co. sent letters and emails last week to nearly 3,000 people who reserved the insulated “Signature” cabins between June and August, warning them that they might have been exposed. Click here for the story.

West Nile Virus Update from the CDC

As of August 28, 48 states have reported West Nile virus infections in people, birds, or mosquitoes. A total of 1,590 cases of West Nile virus disease in people, including 65 deaths, have been reported to CDC. The number of cases reported thus far is the highest number of West Nile virus disease cases reported to CDC since West Nile virus was first detected in the United States in 1999. Over 70% of the cases have been reported from six states (Texas, South Dakota, Mississippi, Oklahoma, Louisiana, and Michigan) and over 45% of all cases have been reported from Texas. Click here for more information from the CDC.

FDA OKs New Prostate Cancer Drug

The FDA approved a new life-prolonging drug for men with late-stage prostate cancer last Friday. The new drug, which will be called Xtandi, was developed by Medivation, a small San Francisco pharmaceutical company, in partnership with the Japanese firm Astellas Pharma. Click here for the FDA release. Click here for the NY Times story.