CMS Increases 2013 OPPS Payment Rates

CMS released a final rule for the Outpatient Prospective Payment System last week. The rule increases OPPS payment rates by 1.8% in CY 2013. This is a result of the hospital inpatient market basket increase of 2.6, the multifactor productivity adjustment of a 0.7% decrease and a legislated percentage point adjustment of a 0.1% decrease. Click here for an excellent 5-page summary.


CMS Cuts Home Health Payments in 2013 Update

CMS announced last week it will reduce payments to home health agencies by approximately $10 million in CY 2013 (about 0.01%). The payment update for home health agencies next year is 1.3%. And that is combined with a reduction of 1.32% in CY 2013 to account for growth in aggregate case-mix that is unrelated to changes in patients’ health status. Meaning there is a net decrease of 0.02%. Click here for more information.


Final Regs Increase Primary Care Doc Payments

HHS announced late last week the final rule implementing the part of the health care law that delivers higher payments to primary care physicians serving Medicaid beneficiaries.  The new rule raises rates to ensure doctors are paid the same for treating Medicare and Medicaid patients and does not raise costs for states. This payment increase goes into effect in January of 2013. Click here for a summary of the final rule.


Dialysis Payments to Increase: CMS

Payment rates for outpatient maintenance dialysis treatments will increase by 2.3% in CY 2013, according to a CMS announcement last week. This reflects the ESRD bundled market basket increase of 2.9% reduced by a productivity adjustment of 0.6%, as required by statute. CMS estimates that Medicare payments to the 5,726 ESRD facilities in CY 2013 will total $8.4 billion. Click here for details.


AHA, Hospital Systems File Suit Against HHS Over RAC Audits

The American Hospital Association, Trinity Health Corporation, Lancaster General Hospital, Munson Medical Center and Missouri Baptist Sullivan Hospital have filed suit in federal court against HHS over decisions to pursue inpatient treatment that they say is being second-guessed by recovery audit contractors. The suit says the Obama administration is refusing to reimburse hospitals for “reasonable and necessary care” when government auditors determine that the care could have been provided at an outpatient facility. Hospitals are asking the U.S. District Court in the District of Columbia to overturn the policy. Click here for a copy of the 28-page suit, which is a very good read.


MedPAC Makes Recommendations to Congress on Various Payment Rates

MedPAC last week made several proposals to Congress regarding payments for ambulance services, home health and therapy caps. They also continued their considerations of other payment changes. Congress will reconvene later this month and consider their recommendations for year-end action. Click here for a very good summary.


GAO Identifies $100 Million in Annual Unnecessary Imaging

A new report from the U.S. Government Accountability Office (GAO) takes a hard line on physician self-referral of imaging services, detailing more than $100 million in annual unnecessary spending in CT and MRI alone. The report found self-referred MRI services, in which the referring physician either provides the testing service or has a financial interest, increased more than 80% from 2004 through 2010, while non-self-referred imaging increased only 12%. The report recommends steps to curb the practice, including a pay cut for self-referred imaging studies. Click here for the story. Click here for the GAO report.


New Federal Grants of $100 Million Available

Nearly $100 million in new federal grants has been announced in the last week from several federal agencies. Strategic Health Care’s grants team is working with organizations across the country that are applying for these and other federal funds. Click here for grant details.


More Docs Likely to be Elected to Congress

The 113th Congress is poised to elect 30 physicians, up from 20 in the current Congress and 16 in the 111th Congress. Currently, 18 members are Republicans, two are Democrats, and two are women physicians, one from each party. Click here to review the list by state and for information on physician PAC contributions.


Drug Shortages, New Legislation from Meningitis Outbreak

The recall of all drugs from a Massachusetts manufacturer, in the latest response to the meningitis outbreak, will likely exacerbate a critical shortage of at least six drugs that were already in short supply. Click here for the list of those drugs and the FDA response.  Hundreds of products were recalled last week by Ameridose, a company associated with the New England Compounding Center that is at the center of the FDA’s investigation into the fungal meningitis outbreak that has killed 29 and sickened more than 400. Click here for an updated FDA list of all facilities that received products from this facility. Click here for a new one-page summary of legislation from Rep. Ed Markey (D-MA) to increase regulation of compounding pharmacies.


Government Directs States on Meningitis Response

Meantime, the Center for Medicaid and CHIP Services is directing states to be prepared to fill prescriptions for voriconazole, the anti-fungal drug CDC recommends be used to treat the infections caused by the contaminated steroid injections from New England Compounding Center. Click here from the bulletin.


Small Businesses Dropping Health Insurance: Study

The number of workers with health insurance in small businesses is shrinking, according to a report out last week from the Commonwealth Fund. According to Commonwealth, only 33% of workers in small businesses with fewer than 50 workers received health benefits through their employers in 2010, down from 42% in 2003. Fifty-five percent of workers in companies with 50 to 99 employees were enrolled in their companies’ insurance plans in 2010, and 71% of workers in companies with 100 or more people had insurance through their job. Click here for the report.


Medicare Bundling Focus of New Report from AHA, AAMC

In order to promote Medicare payment bundling as a more comprehensive population-based model, policymakers will need to design a complete framework that carefully considers the ways to define and price the bundles, with adequate safeguards to protect the quality of patient care and the financial stability of providers, according to a new report out last week from the AHA and the Association of American Medical Colleges. Click here for a copy of the 8-page report.


Dual Eligible Savings Elusive: Study

A new study that examines available pilot programs aimed at coordinating care for “dual eligibles” found that wringing budget savings out of the duals may be harder than it looks. Overall, the study failed to find significant Medicare savings, even in programs that reduced the rate of hospitalization for patients. Click here for the 24-page report from the Kaiser Family Foundation.


Adult, Pediatric Trauma Centers Have Same Outcomes for Kids: Report

Data from the 2007-2008 National Trauma Database showed no significant difference in outcomes for children treated at pediatric trauma centers compared with those treated at adult centers. Both in-hospital mortality and intensive care unit admission rates were higher at adult centers than pediatric centers, researchers reported last week. Click here for the story.


Wide Variations in Care Found at Major Academic Medical Centers

The type and amount of care provided at the top 23 academic medical centers to Medicare patients varies significantly, according to a new Dartmouth Atlas Project study released last week. The report used Dartmouth Atlas of Health Care data to analyze the differences in services that Medicare patients received at teaching hospitals, including academic medical centers rated by U.S. News and World Report as the best hospitals for clinical excellence in 2012-13. The hospitals are responsible for about 17% of all primary residency slots in 2012. Click here for the 24-page report.


Blue Shield of California to Return $50 Million

Health insurer Blue Shield of California said it would return $50 million to customers by year-end as part of its pledge to limit its annual profit to 2% of revenue, according to an announcement last week. The San Francisco company said most customers would receive credit on their December bills. It said the average credit would be about $25 for an individual customer and roughly $75 for a family of four, depending on their premiums. Click here.