Hospitals, Government Spar Over Upcoding Accusations

HHS and DOJ sent a letter to five major hospital groups last week warning them not to use electronic health records to “game the system” and boost their revenues. The scathing letter (click here) came just days after a New York Times story analyzing Medicare data suggested hospitals and physicians were using EHRs to pad federal reimbursement by exaggerating the scope of services they provided. Hospital groups shot back, saying they have not received the agency guidance and clarifications they have been requesting for several years. Click here for the AHA letter to HHS and DOJ.  Click here for the letter from Association of Academic Health Centers. Click here for the original NY Times story.

Number of Knee Replacements Skyrocket

The number of total knee replacement surgeries has soared 161.5% among Medicare participants over the past 20 years, a $5 billion annual tab that will continue to grow as the USA’s 77 million baby boomers age, according to a large study out last week. Click here for the study in the Journal of the American Medical Association (no cost for the full report.) Click here for the story in USA Today.

More Trauma Centers Opening

More than 200 trauma centers have opened since 2009 in more than 20 states, and another 75 hospitals are seeking approvals, according to data collected by Kaiser Health News from state health agencies. States with the greatest number of new centers include Texas, Alabama, Arizona and California. The growth reverses more than a decade of closures in the 1990s and early 2000s. But is it worth the cost? Click here for the story.

VBP, Readmissions Programs Take Effect Today

Two major federal quality programs take effect today: Value-Based Purchasing (VBP) and Hospital Readmission. Both programs penalize hospitals for less than average performance. Under VBP, the government will withhold 1% of Medicare payments to about 3,000 acute care hospitals over the next year — totaling $850 million — and redistributing that pot of money to the best-performing hospitals. That number will rise to 2%  by 2016. The Hospital Readmissions program will shave up to 1% off of Medicare payments to hospitals with high readmission rates. Questions are already being raised about whether the rewards and penalties are big enough to spur hospitals to action. And the poorly understood contribution of socioeconomic factors to health overall, and readmissions in particular, raise worries that the readmissions program may unfairly penalize hospitals located challenging environments. This is an issue MedPAC raised in its public analysis a few weeks ago. Click here for the MedPAC presentation on this issue.

CMS Proposes Reducing Supervision Requirements for Certain Outpatient Services

CMS has proposed reducing the supervision level for 15 outpatient services from direct to general supervision, including certain vaccine administrations, blood collection, bladder catheter insertion and intravenous hydration services. Click here for the 2-page CMS proposal. If finalized, the CMS recommendation would allow the services to be performed under the overall direction of a physician or non-physician practitioner without requiring their presence. The panel also recommended reducing the supervision level for 13 other outpatient therapeutic services, including hospital observation, IV drug infusions, drug injections, and bladder irrigation services. CMS will accept comments on its preliminary decision via e-mail through October 24.

Health Care Spending Ticks Up

Health care spending for employer-sponsored insurance increased 4.6% from 2010 to 2011, even as prescription drug costs remained relatively flat, according to a Health Care Cost Institute report released last week. The increase was larger than expected and was driven primarily by higher prices in four major areas of care: hospital stays, outpatient care, procedures and prescriptions. Brand name drug prices rose 17.7% , to an average of $268 per prescription while the use of brand name medications fell 13%. The price of generics dropped 7.2%, to an average of $33 per prescription — and their use was up 3.4%.  Click here for the report.

Highmark, West Penn Deal Off

Highmark Inc. representatives said the company wanted to restructure through bankruptcy, leading West Penn Allegheny Health System to cancel the $475 million deal under which the insurer planned to acquire the health system. The system’s board chairman said in a written statement that he considers bankruptcy a poor option for the health system’s employees and customers. The system is actively looking for new partners and is willing to consider all types of companies; another insurer, nonprofit, and  for-profit.  Senior management will remain in place, according to the system. Click here for the full story. Highmark disagrees with the system’s interpretation of events. Click here for their statement.

DMC CEO Exploring Detroit Mayoral Bid

The chief executive of Detroit Medical Center and former Wayne County Prosecutor Mike Duggan may run for mayor of Detroit. He said last week he will take the next 90 days to gauge the community’s interest in his potential bid for mayor. He told the Detroit News his goal is to seek a commitment of $5 million in fundraising. He plans to hold various small “coffee groups” in the homes of 25 to 30 supporters over the next 90 days to meet and greet residents intrigued by his candidacy. Click here for the story.

Exchange Grants Awarded to Six States and DC

HHS last week awarded a new round of Insurance Exchange Establishment Grants to Arkansas, Colorado, Kentucky, Massachusetts, Minnesota, and the District of Columbia. These awards will give states the resources needed to create Exchanges. All the states received awards for Level One Exchange Establishment Grants, one-year grants awarded to states to build Exchanges. The District of Columbia received a Level Two Exchange Establishment Grant today, a multi-year grant awarded to states further along in building their Exchanges. States may apply for grants through the end of 2014 and may use funds through the initial start-up year. Click here for an interactive state map showing the status of their exchanges.

Exchange Funding Draws Congressional Fire

Federal funding for the creation of Health Exchanges continues to draw fire from key members of Congress. Last week, Senator Charles Grassley (R-IA) and Rep. Fred Upton (R-MI), chairman of the Energy & Commerce Committee, fired off a letter to the HHS Secretary looking for more answers.  Click here to see their letter. The Republican Governor’s Association is also pressing for more information on exchanges. Click here for their letter.

PA Wants Answers on Essential Health Benefits

Speaking of the need for clarification, Pennsylvania Insurance Commissioner Michael Consedine, who’s co-chairing a new NAIC panel on federal exchanges, is asking HHS for more clarity on states’ deadline to submit an essential health benefits benchmark plan. Click here for his letter to HHS.

Seven Receive Grants for Effort to Reduce Hospitalizations

CMS has announced cooperative agreement awards for seven organizations that will be partnering with 145 nursing facilities to implement the Initiative to Reduce Avoidable Hospitalizations among Nursing Facility Residents. The participating organizations are: Alabama Quality Assurance Foundation, Alegant Health (Nebraska), HealthInsight of Nevada, Indiana University, The Curators of the University of Missouri, The Greater New York Hospital Foundation, Inc., and UMPC Community Provider Services (Pennsylvania). Click here for details.

810 Community Health Centers Granted $44.5 Million

HHS has announced new grants totaling about $44.5 million that will improve the quality of care at community health centers and ensure more women are screened for cervical cancer. The grants will help 810 community health centers become patient-centered medical homes and increase their rates of cervical cancer screening. Click here to see the list of facilities receiving the funds.

NIH Gives $11 Million for Health System Research

Funds totaling approximately $11.3 million, will support the first year of the Health Care Systems Research Collaboratory, which will engage health care systems as research partners in conducting large-scale clinical studies. The funds are managed through the Common Fund at the National Institutes of Health. Health care systems, which include health maintenance organizations and other large integrated care settings, see large populations of patients. By partnering with these entities, NIH will be able to conduct large-scale and more cost-effective clinical research within the settings where patients are already receiving their care. Click here for more.

$10 Million Given to Boost Social Workers, Psychologists

HHS announced last week a new program that will boost the number of social workers and psychologists who work with Americans in rural areas, military personnel, veterans, and their families. Through the Mental and Behavioral Health Education and Training grant program, $9.8 million is being awarded to 24 graduate social work and psychology schools and programs for three-year grants. Click here for details.

HR Leaders Want FTE Clarifications

For those of you who have been wondering about the lack of clarity in some sections of the Affordable Care Act, you’re not alone. A national human resources association is telling the IRS that the final “full-time employee” rules need to be clear on when employers can enroll employees under the health law’s shared-responsibility provisions. Click here for WorldatWork’s letter to the IRS.

GAO Says Pay Attention to Implantable Device Security

Some House members want the FDA to pay more attention to the risk that computer hackers might pose to implantable medical devices, like pacemakers. A GAO report released last week recommended greater focus on information security risks in general. The FDA said no malevolent instances of hacking were known to have occurred, but researchers have demonstrated that it is possible to hack into an insulin pump and a cardiac defibrillator. More than 25 million Americans rely on implantable medical devices, and the number is expected to grow rapidly, according to a House staff report. Click here for the GAO report.

Radiology’s Success Causing Backlash

Radiology is experiencing a backlash among policymakers and other physicians that could threaten its future; a backlash that’s based in large part on its own success, according to Dr. Bruce Hillman who is a professor of radiology at the University of Virginia. Click here for the story.

IOM Report Out on Improving Health of Children

Improving the health and fitness of children is the focus of a report out last week from the Institute of Medicine. A committee convened by the IOM undertook a comprehensive review of the science and found that it supports the use of specific ways to measure three of these components: cardiorespiratory endurance, body composition, and musculoskeletal fitness in young people. These measurements should be used in national youth fitness surveys and school-based fitness tests, says the committee’s report. Click here for a summary.

FDA Tackles Illegal Online Pharmacies

The FDA is tackling the problem of illegal pharmacies with a new website.  BeSafeRx includes links to state agencies that will allow consumers to check whether an online pharmacy is properly licensed. About 25% of internet consumers have bought prescription drugs online, according to a new FDA survey, and 30% said they didn’t know how to determine whether an online pharmacy was safe. Click here to see the site.