WEEKLY E-BULLETIN


Joint Commission Lists Its Best Hospitals

The Joint Commission last week released its 2012 report that includes the 620 hospitals designated as Top Performers on Key Quality Measure. The program is based on data reported about evidence-based clinical processes that are shown to be the best treatments for certain conditions, including heart attack, heart failure, pneumonia, surgical care, children’s asthma, inpatient psychiatric services, stroke and venous thromboembolism. These hospitals represent 18% of the hospitals that receive Joint Commission accreditation. Click here for the annual report and hospital list.

Obama Administration Wants Patients to Report Medical Mistakes

The Obama administration wants consumers to report medical mistakes and unsafe practices by doctors, hospitals, pharmacists and others who provide treatment, according to a new report in the New York Times.  Hospitals leaders say they are receptive to the idea, despite concerns about malpractice liability and possible financial penalties for poor performance. Click here for the story.

Hospitals, Physicians Billing Billions More Because of IT Changes: Report

The NY Times has been reviewing Medicare data and reports that hospitals received $1 billion more in Medicare reimbursements in 2010 than they did five years earlier, at least in part by changing the billing codes they assign to patients in emergency rooms. Regulators say physicians have changed the way they bill for office visits similarly, increasing their payments by billions of dollars as well. The complete story is here.

Family Docs, Nurse Practitioners Fighting Over Care Models

National organizations representing family practice physicians and nurse practitioners were at odds last week over who should lead team-based care models.  The physicians say, “The rationale behind most proposals to allow nurse practitioners to practice independently is that the nation is facing a primary care physician shortage. This is true. But substituting NPs for doctors cannot be the answer.” Nurse practitioners responded that the family physicians’ “efforts to link these evolving models of care with the licensure of nurse practitioner practice are misdirected and out of step with today’s environment.” Click here for the AAFP report. Click here for the AANP response.

Study: 15 Primary Health Care Cost Drivers Identified

The Bipartisan Policy Center last week released a report that identifies 15 primary drivers of health costs. The Health Care Cost Containment Initiative plans to issue recommendations early next year to address the drivers, which include the fee-for-service reimbursement system, fragmentation of care delivery, and the tax treatment of health insurance.  Click here for the 27-page report.

Report: ACOs, Bundled Payments, PCMHs Will Lower Spending

One of the key reasons for the high level of health care spending and its rate of growth is the predominance of the fee-for-service payment system, which rewards quantity over quality, especially for high-cost, high-margin services, according to a report out last week from the Center for American Progress. But there are signs this trend is changing. The Affordable Care Act includes a variety of payment and delivery system reforms designed to control costs and improve care, especially in the Medicare program. This report examines bundled payments, ACOs and PCMHs – with some case studies. This is a very encouraging report for those of you engaged in any of these initiatives. Click here.

Agency Issues $96 Million in New Grant Opportunities

The Patient-Centered Outcomes Research Institute will accept applications through Dec. 17 for up to $96 million in funding for research to help patients and caregivers make better informed health and health care decisions. Hospitals and others must submit letters of intent to apply by Oct. 15. Click here for details. If you need some expert grants assistance, please contact Strategic Health Care’s Gwen Mathews at gwen.mathews@shcare.net.

IRS Regs Encourage Changes to Hospitals’ Community Benefit Program: Webinar

The IRS is finalizing regulations detailing how tax-exempt hospitals will be required to implement a Community Health Needs Assessment. The draft regs carry many new requirements (click here to review). Strategic Health Care is sponsoring a free webinar this Wednesday, September 26 at 1 p.m. Eastern Time about re-engineering your community benefit program to both meet – and exceed - new IRS requirements, as well as create new grant opportunities. Click here to sign up for the webinar.

Essential Health Benefits: State Driven, Under Federal Guidelines

What are essential health benefits under the Affordable Care Act? Well, the Obama administration empowered each state to devise its own list. When all Americans are required to purchase health insurance in 2014 or pay a penalty, they will find that the plans reflect the social and political priorities of wherever they live, according to a Washington Post report last week. States have guidelines: they must cover 10 broad categories, including doctor visits, maternity care and prescription drugs. They also must use an existing health-insurance policy as a template, such as a small-group plan or the package for state employees. Click here for more.

HHS Says Senior to Save Thousands Under Affordable Care Act

Because of the Affordable Care Act the average person with traditional Medicare will save $5,000 from 2010 to 2022, according to an HHS report last week. People with Medicare who have high prescription drug costs will save much more – more than $18,000 – over the same period. Click here for the report. State-by-state numbers are also available.

NCQA Releases New Health Plan Rankings

The National Committee for Quality Assurance is out with new rankings of health insurance plans, and community based and provider sponsored plans scored particularly high. NCQA evaluated over 538 private health plans and ranked 474 of those based on clinical performance, member satisfaction and NCQA Accreditation. To be eligible for rankings, health plans must authorize public release of their performance information and submit enough data for statistically valid analysis. Click here to see the list.

MA Enrollment to Increase 11% in 2013

Enrollment in the Medicare Advantage program is projected to increase by 11% in the next year and premiums will remain steady, HHS announced last week. Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 10 percent and enrollment has risen by 28 percent. Click here for details.

2 Million More Expected to Pay Health Care Fines

The Supreme Court ruling making optional a state’s Medicaid expansion combined with a sluggish national economy will mean about 6 million Americans — 2 million more than previously estimated — will face penalties for lacking health insurance. This is according to estimates issued last week by two congressional agencies.  About 6 million people will face tax penalties in 2016, raising $7 billion. Click here for a copy of the 3-page report.

Report: More Rx Drug Monitoring Programs Could Do Much More

State prescription drug monitoring programs have become prevalent but could do much more to address the national abuse of painkillers and other medications, according to a report released last week by Brandeis University. The report says prescription drug monitoring programs, which draw their data from pharmacies, have sprung up rapidly in recent years. Forty-nine states have passed legislation authorizing such programs. The report makes several recommendations. Click here.

NIH: Vaginal Deliveries Safer Earlier

Infants born to mothers attempting to deliver vaginally before the 32nd week of pregnancy are as likely to survive as those delivered by a planned cesarean, provided the fetus is in the head-first position, according to researchers at the National Institutes of Health. Click here for the report.

More Kidneys Could Be Transplanted Under Better System: Report

Last year, 4,720 people died while waiting for kidney transplants in the United States. And yet, as in each of the last five years, more than 2,600 kidneys were recovered from deceased donors and then discarded without being transplanted, government data show, according to a report last week in the New York Times. Many experts agree that a significant number of discarded kidneys — perhaps even half, some believe — could be transplanted if the system for allocating them better matched the right organ to the right recipient in the right amount of time. Click here for the complete story.

Obesity Rates Exploding in Most States

A report from the Trust for America’s Health and the Robert Wood Johnson Foundation projected that obesity rates would be at least 44% in each state and more than 60% in 13 states by 2030. Researchers also estimated as many as 7.9 million new cases of diabetes and 6.8 million new cases of chronic heart disease and stroke every year in the future. Click here for the report with an interactive map.

Power Mobility Devices Hit in OIG Report

The Senate Aging Committee last week a hearing on what might seem like an unexpected market for scam artists: powered wheelchairs and scooters for Medicare beneficiaries. But according to a HHS Inspector General’s report, 80 percent of claims for “power-mobility devices” did not meet Medicare criteria and should not have been paid. The scooters and wheelchairs are costly for Medicare, with CMS paying $606 million for the devices in 2010.  Click here for the OIG’s report.