Legislators Introduce Bill to Limit RACs


Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.) last week introduced the Medicare Audit Improvement Act of 2012 (HR 6575), a bill that would restructure the way Medicare Recovery Auditors — formerly known as recovery audit contractors — can review providers. The bill would establish annual limits on documentation requests from RACs, impose financial penalties on RACs if they fell out of compliance with program requirements, make RAC performance evaluations publicly available and allow denied inpatient claims to be billed as outpatient claims if necessary. Click here for a copy of the bill. Click here for a story on the legislation.


AMA: Dump SGR, Make Key Changes to Physician Payment System


The American Medical Association and more than 100 state and specialty medical societies outlined to Congress a set of principles needed to transition from Medicare’s current physician payment system to a new one.  In a letter last week to the Senate Finance Committee, the groups said the first step toward a new Medicare payment system would be to repeal the sustainable growth rate formula. That should be followed by a series of changes, including delivery system reform, stable payment updates, and rewards for physicians who achieve savings in the delivery of care. Click here to read the 6-page letter.


Quality Group Recommends Quality, Safety Changes


The National Association for Healthcare Quality last week offered five practice recommendations to improve provider institution quality, safety reporting and staff protection. Working toward accountability on safety and quality, ensuring accurate, comprehensive and transparent data collection, and promoting teamwork and communication were among the recommended practices. Click here to read the 24-page report.


Meningitis Deaths Increase; Pose New Challenges


To date, 23 people have died. New cases appear every day; the count went up by 13 on Saturday. In all, 14,000 people in 23 states received injections around the spine or a joint with the anti-inflammatory drug methylprednisolone acetate from three contaminated lots distributed by a Massachusetts company. Click here for the NY Times story. Click here for the list of facilities that received the recalled drug. Here’s the latest from the FDA.


Feds Cracking Down on Painkiller Distributors


The federal government has started cracking down on pharmaceutical distributors in its effort to curb the questionable sales of prescription painkillers. The DEA and other agencies are putting pressure on distributors like Cardinal Health, which act as middlemen between drug makers and the pharmacies and doctors that dispense painkillers. In response, the distributors are scrambling to limit their liability by more closely monitoring their distribution pipelines and cutting off some customers, according to a NY Times story last week. Click here.


Manufacturing Problems Helping to Cause Drug Shortages


Pharmaceutical shortages are getting worse in part because of manufacturing problems and the FDA, according to a congressional report.  In the last three years, six of the major manufacturers of sterile injectable drugs — which are subject to rigorous inspections by the federal government, as opposed to compounding pharmacies, which are generally overseen by the states — have been warned by the FDA about serious violations of manufacturing rules. Four of them have closed factories or significantly slowed production to fix the problems. Nearly a third of the industry’s manufacturing capacity is off line because of quality issues, according to a Congressional report. Click here for the story. Click here for the 21-page congressional report.


House Committee Chair to Subpoena HHS Over Medicare Advantage


House Oversight and Government Reform Committee Chairman Darrell Issa (R-CA) sent a letter to HHS Friday saying he will subpoena files related to a controversial Medicare Advantage demonstration program. Issa says a last-minute document delivery by the Obama administration Thursday didn’t give him any useful information. In the letter, California Republican cited “continued obstruction” at HHS, which sent 1,300 pages of files to the committee after Issa issued an initial subpoena threat. Click here for the story. Click here for the 1-minute video released by the committee explaining its position on the issue.


Is MA Causing Costs to Go Up?


Does Medicare Advantage drive up the cost of health care and Medicare?  That the subject of a report last week in the NY Times. Click here.


UnitedHealth Sees Healthy Income Increase


UnitedHealth Group’s third-quarter net income jumped 23%, and the nation’s largest health insurer raised its 2012 earnings forecast for the third time this year. But company leaders also cautioned against thinking too positively about 2013. Click here for the story.


GOP Members Pressing for Med Mal Info


Three prominent Republican lawmakers last week sent letters to HHS seeking answers about the agency’s medical malpractice grant program.  The letters call attention to the fact that none of the $23.2 million awarded has gone to researching or implementing “traditional” medical malpractice reforms and that it appears that all of the research funded by the AHRQ is aimed at proving the obvious: as the number of adverse events declines, the number of malpractice lawsuits also declines. Click here for the report and the letters.


Exchanges Used for Retiree Coverage


A growing number of companies are contracting with health insurance exchanges for retiree health coverage, allowing retired workers to select the plan that works best for them. Most employers that have contracts with exchanges provide retirees with fixed monthly assistance to buy coverage or health reimbursement arrangements. Click here for the Washington Post story.


Massachusetts Launches Statewide Health Info Exchange


Massachusetts officially launched its statewide health information exchange this last week. At a kickoff event, known as the “Golden Spike,” at Massachusetts General Hospital in Boston, Gov. Deval Patrick sent his own health record between Mass General and Springfield, Mass.-based Baystate Medical Center. Click here for more.


Catholic Systems Announce Merger Effort


Trinity Health and Catholic Health East announced plans last week to merge. That would put their combined 70 hospitals in 21 states with about $13.3 billion in annual operating revenue. Click here for the story.


Walgreen’s, Hospitals Announce Partnership


The largest drugstore chain is partnering with a dozen hospitals to offer medication delivery while patients are still in the hospital, a model that Walgreen’s hopes to be rolled out nationwide. Click here for the report from Walgreen’s.


Walmart, Hospitals Announce New Program


Walmart is introducing a first-of-its-kind Centers of Excellence program that will offer its employees quality health care with no out-of-pocket cost for heart, spine, and transplant surgeries at six of the leading hospital and health systems in the U.S. The six designated health care organizations include the Cleveland Clinic in Cleveland, OH; Geisinger Medical Center in Danville, PA.; Mayo Clinic sites in Rochester, MN, Scottsdale/Phoenix, AZ, and Jacksonville, FL; Mercy Hospital Springfield in Springfield, MO; Scott & White Memorial Hospital in Temple, TX; and Virginia Mason Medical Center in Seattle, WA. Click here for the report.


CDC: CHF Cases Under Age 65 Increase


There were 1 million hospitalizations for congestive heart failure (CHF) in 2000 and in 2010. Most CHF hospitalizations were for those aged 65 and over, but the proportion under age 65 increased significantly from 23% in 2000 to 29% in 2010. Click here for the new CDC report.


CDC: Cholesterol Cases Dropping


The average levels of total blood cholesterol and low-density lipoprotein dropped among U.S. adults between 1988-1994 and 2007-2010, while high-density lipoprotein levels rose slightly, CDC researchers found. They said that the improvements can be attributed in part to improvements in diet, including a reduction of trans fat intake, according to the study in JAMA. Click here for the news report. Click here for the study.


AAP Wants Stricter Gun Laws


The American Academy of Pediatrics last week called for stricter gun laws in order prevent firearm-related deaths among children and teens. The group recommended more counseling for parents about gun safety and storage as well as the restoration of a ban on assault weapons that expired in 2004. Click here for the AAP report.


NIH: Diet, Exercise Don’t Reduce Certain Heart Problems for Type 2 Diabetes


An intensive diet and exercise program resulting in weight loss does not reduce cardiovascular events such as heart attack and stroke in people with longstanding type 2 diabetes, according to a study supported by the National Institutes of Health and released Friday. Click here for the NIH report.