WEEKLY E-BULLETIN


Medicare Cut $11.6 Billion in Budget Sequestration January 1: White House Report

The Obama Administration on Friday released a report detailing the specific financial impact the budget sequestration law would have, if it is implemented as scheduled January 1, 2013.  According to the report, the sequestration would result in a 9.4% reduction in non-exempt defense discretionary funding and an 8.2% reduction in non-exempt nondefense discretionary funding. Click here for a copy of the 398-page report. Click here for a good, brief overview of sequestration.

Sequestration would also impose cuts of 2% to Medicare (this is an across-the-board cut to programs within Medicare), 7.6% to other non-exempt nondefense mandatory programs, and 10% to non-exempt defense mandatory programs. “The percentage cuts in this report, and the identification of exempt and non-exempt accounts, reflect the requirements of the laws that the Administration is applying. With the single exception of military personnel accounts, the Administration cannot choose which programs to exempt, or what percentage cuts to apply. These matters are dictated by a detailed statutory scheme.” (Quote from the report.)

Specific Health Care Cuts from CMS:
Medicare — Supplementary Medical Insurance Trust Fund: $5.2 billion; Hospital Insurance Trust Fund: $5.8 billion; Prescription Drug Account, Supplementary Insurance Trust Fund: $591 million

Prevention and Public Health Fund: $76 million
Affordable Insurance Exchange Grants: $66 million
Public Health and Social Services Emergency Fund: $47 million
Health Care Fraud and Abuse Control Account: $78 million
General Departmental Management: $39 million

Nearly 500,000 jobs could be lost in the health care sector in 2013 should sequestration go through, according to a report released Friday by the AHA, AMA and ANA. Click here for the study.

Investigation Says Medicare Upcoding May Cost More Than $11 Billion

According to an investigation reported yesterday in the Washington Post, thousands of doctors and other medical professionals have billed Medicare for increasingly complicated and costly treatments over the past decade, adding $11 billion or more to their fees — and signaling a possible rise in medical billing abuse. The Center for Public Integrity released its investigative report over the weekend. The report includes a list of the top 20 U.S. counties in which doctors billed the highest percentage of the two most expensive Medicare codes for established patients in 2008. Click here to read the CPI report. Click here for the Washington Post story.

Transform Your Hospital’s Community Benefit Program: Free Webinar

The need to transform your hospital’s community benefit program into an evidence-based, outcomes-focused system for serving your community has never been greater. Strategic Health Care is offering a new, comprehensive service – backed by years of proven experience – to align ongoing strategic initiatives, clinician champions, and patient needs with your new community benefits program. Our program increases your capacity and community engagement, while exceeding best practices to meet patient needs and IRS compliance. Our service also creates a community benefits program to give your hospital a strong foundation to increase grant funding opportunities. Click here to sign up for the free webinar.

GAO: Most Hospitals Using Nuclear Material Don’t Have Recommended Safeguards

A report released last week by the GAO has found that only one out of every five hospitals that use high-risk nuclear isotopes for diagnosis and treatment have the recommended safeguards needed to secure the materials. Over 1,500 hospitals in the U.S. use radiological sources that could be turned into dirty bombs, according to the National Nuclear Security Administration (NNSA), which shares purview over nuclear technologies with the Nuclear Regulatory Commission. NNSA has spent $105 million to upgrade security at 321 hospitals, but the agency warns it will take until 2025 to upgrade all of the hospitals on their list. Click here for the 56-page GAO report. Click here to read the story from the Center for Public Integrity.

Health Insurance Exchanges: California May Be Leading the Way

13 states and the District of Columbia have told the Obama administration they intend to set up the insurance exchanges that are supposed to provide a marketplace for people to buy health plans. Perhaps the state furthest along in this effort is California. The California Health Benefit Exchange has already hired 50 employees and is ready to hire 50 more. Already underway is construction of the state’s Web portal through which some three million people are expected to buy insurance by 2019, and through which many others will likely enroll in Medicaid. Click here for the detailed account in the New York Times.

AHRQ Issues Final Report on Bundling

The Agency for Healthcare Research and Quality is out with its final report on bundling as part of its Closing the Quality Gap: Revisiting the State of the Science series. Entitled “Bundled Payment: Effects on Health Care Spending and Quality,” the 155-page report endeavors to provide an understanding of the current evidence about the effects of bundled payment on healthcare spending and quality as well as developing key design features of bundled payment programs. Click here for the report. Click here for the 16-page executive summary.

Bundled Payment Programs Could Be Tough Sell

Bundled payments for services may be a good idea, but it can be a hard sell. Just ask Dr. Steven Schutzer, the co-director of the Connecticut Joint Replacement Institute. It took him more than two years to find an insurance company to buy into a bundled payment contractual model his organization developed that reimburses their medical providers a preset price for hip and knee replacement surgery. Click here for the story.

Arkansas Makes Major Bundled Payment Move

Bundled payment is also the story in Arkansas, in a big way. It is moving toward ending “fee-for-service” payments, in which each procedure a patient undergoes for a single medical condition is billed separately. In three to five years, Arkansas wants to have 90 to 95% of all medical expenditures off fee-for-service. Click here for the NYTimes story from Ezekiel Emanuel, M.D.

Study: Medication Adherence Is Doable and Could Save Billions of Dollars

AHRQ is also out with another report evaluating ways of addressing poor medication adherence, which adds $100 billion to $289 billion a year in direct costs to  the U.S health care system. AHRQ said about 20 to 30% of prescriptions are never filled, half of medications for chronic diseases aren’t taken properly, and there are tools to boost patient self-management and achieve significant savings. Click here for the report.

New Bill Boosts Primary Care Scholarships

A bill introduced last week by Rep. Jim McDermott, D-Wash., would give states money for medical school scholarships to address the current and growing shortage of primary-care physicians. McDermott’s bill would allow state governments to give out the funds to ensure a local supply of internists and family-practice doctors who would agree to practice in the same state for five years. States would be asked to contribute 10% of the costs. Click here for the details.

New Funds for Telemedince to Reach Veterans Through Private Hospitals, Clinics

HHS and the VA last week announced a joint effort to expand health care delivery to veterans living in rural areas. The agreement between the two agencies promotes collaboration between VA facilities and private hospitals and clinics, and is supported by $983,100 in grants to improve access and coordination of care through telehealth and health information exchanges in rural areas. Click here for details.

HHS: Affordable Care Act Saving Consumers $2.1 Billion

The Affordable Care Act has saved consumers an estimated $2.1 billion on health insurance premiums, according to a new report released last week by HHS. For the first time ever, new rate review rules in the health care law prevent insurance companies in all states from raising rates with no accountability or transparency. To date, rate review has helped save an estimated $1 billion for Americans. Additionally, the law’s Medical Loss Ratio (or 80/20) rule is helping deliver rebates worth $1.1 billion to nearly 13 million consumers. Click here for more.

West Nile Virus Infections Reach New High

As of September 11, 2012, 48 states have reported West Nile virus infections in people, birds, or mosquitoes. A total of 2,636 cases of West Nile virus disease in people, including 118 deaths, have been reported to CDC. Of these, 1,405 (53%) were classified as neuroinvasive disease (such as meningitis or encephalitis) and 1,231 (47%) were classified as non-neuroinvasive disease. Two thirds of the cases have been reported from six states (Texas, Louisiana, South Dakota, Mississippi, Michigan, and Oklahoma) and 40% of all cases have been reported from Texas. Click here for more.

Efforts Increasing To Make Human Organs for Transplant

Only a few human organs have been man-made and transplanted, and they are relatively simple, hollow ones, according to published reports. But scientists around the world are using new techniques with the goal of building more complex organs. At Wake Forest University in North Carolina, for example, where bladders were developed, researchers are also working on kidneys, livers and more. Labs in China and the Netherlands are among many working on blood vessels. Click here for a very good story from the NY Times on the progress being made on creating human organs for transplant.

New York City Bans Big Sugary Drinks

New York City passed the first U.S. ban of oversized sugary drinks on Thursday in its latest controversial step to reduce obesity and its deadly complications in a nation with a weight problem. By an 8-0 vote with one abstention, the mayoral-appointed city health board outlawed sugary drinks larger than 16 ounces nearly everywhere they are sold, except groceries and convenience stores. Violators of the ban, which does not include diet sodas, face a $200 fine. Click here for the story.

McDonald’s To List Calorie Info on Menu

Fast food giant McDonald’s has announced that starting this week, the company will list calorie information on restaurant and drive-thru menus nationwide to further inform and help customers and employees make nutrition-minded choices. In addition to menu board labeling, McDonald’s published its first-ever nutrition progress report and revealed several 2013 menu innovations in test that will include recommended food groups from the USDA’s 2010 Dietary Guidelines for Americans reflected in the messages supporting MyPlate. Click here for more.