AMA Announces New Guidelines for Physician Employment and Contracting

The American Medical Association last week adopted new guiding principles for physicians entering into employment and contractual arrangements. The principles address six potentially problematic aspects of the employer-employee relationship, including: conflicts of interest, advocacy, contracting, hospital-medical staff relations, peer review and performance evaluations, and payment agreement. Click here for the five pages of guidelines.

Report Details $385 Billion in Health Care Savings

A new report released last week details $385 billion in health care savings obtainable through other measures, such as eliminating the tax exclusion on employer plans and requiring wealthy seniors to pay more for Medicare. The Center for American Progress opposes raising Medicare’s eligibility age, transforming Medicare into a “voucher” program and cutting Medicaid to support long-term care. The report is important because its sponsor is widely influential in Democratic circles in Washington. Click herefor the report.

Chamber Urges Congress, President to Restructure Entitlement Programs

In a letter last week to President Obama and Congress, the U.S. Chamber of Commerce and 232 other organizations, said lawmakers and the President should commit to a long-term plan for restructuring the nation’s entitlement programs — including Medicare, Medicaid and Social Security — after they’ve taken quick action to avoid the fiscal cliff. “Our nation’s entitlement programs are unsustainable,” the letter states. Click herefor the letter.

Doc Fix Could Be For 1 Year; Fiscal Cliff Negotiations Start

The House GOP Doctors Caucus is pushing legislation that would “fix” the physician Medicare payment formula for a year. The legislation would reportedly be part of the year-end effort to address the “fiscal cliff”. If it is not fixed by January 1, physicians will get a 27% Medicare payment reduction. The AARP sent a letter to Congress last week urging Congress to stop the physician pay cut. Click here. A 2% across-the-board Medicare payment cut also takes effect January 1 as part of budget sequestration. The Congressional Research Service is out with a new report comparing several major proposals previously offered to change sequestration. Click here for the 13-page report. Regarding the “fiscal cliff”, negotiations between the President, House and Senate started in earnest Friday to find solutions. Click here for an excellent explanation of the “fiscal cliff”.

State Exchange Deadline Delayed One Month

HHS has pushed back last Friday’s deadline for states to declare whether they’ll build their own health exchanges. They will now have until December 14 to announce their decision. Secretary Kathleen Sebelius sent a letter to the Republican Governors Association making the announcement. Click here for the letter. The RGA had requested an extension November 14. If you want a very good refresher on exchanges and how they work, click here.

Where do the states stand on exchanges? As of Friday:

STATE-BASED – California, Colorado, Connecticut, Hawaii, Iowa, Kentucky, Maryland, Massachusetts, Minnesota, Mississippi, Nevada, New Mexico, New York, Oregon, Rhode Island, Vermont, Washington, Washington, D.C. FED/STATE PARTNERSHIP – Delaware, Illinois, North Carolina
FEDERAL OPERATED – Alabama, Alaska, Georgia, Indiana, Kansas, Louisiana, Maine, Missouri, Montana, Nebraska, New Hampshire, North Dakota, Ohio, South Carolina, South Dakota, Texas, Virginia, Wisconsin, Wyoming UNDECLARED – Arizona, Arkansas, Florida, Idaho, Michigan, New Jersey, Oklahoma, Pennsylvania, Tennessee, Utah, West Virginia

New Organ Donor Regs Could Be Tough for Hospitals

New rules released last week by federal organ donation regulators will leave many hospitals ill-prepared to handle new patient-tracking and reporting requirements. Click here for the NY Times story.

OIG Says Skilled Nursing Facilities Paid $1.5 Billion Improperly

Medicare paid $1.5 billion in improper claims for skilled nursing care in 2009, federal investigators found. The HHS inspector general reported last week that 25% of all Medicare claims submitted by skilled nursing facilities had errors and the majority of those bills were “upcoded” for ultra-high therapy that wasn’t necessary. Click here to see the report.

Preterm Birth Rate Drops Again

For the fifth year in a row, the preterm birth rate in the United States has dropped. The 2011 rate was the lowest in 10 years, the March of Dimes reported last week. However, nearly half a million babies in the United States are still born prematurely, according to the March of Dimes in its 2012 Premature Birth Report Card. Overall, the U.S. grade remains a “C” because of the continued high preterm birth rate. Click here for a state-by-state comparison.

U.S. Lags in EMR Use: Study

An international survey of primary care physicians in 10 countries finds progress in use of electronic medical records, particularly in the United States, though the U.S. still lags several countries where EMR adoption is near-universal. Click hereto see the study from the Commonwealth Fund released last week.

Health Benefit Costs Have Lowest Increase in 15 Years

Employers were able to limit the growth of health benefit costs to 4.1% in 2012, the lowest increase in 15 years, according to a Mercer survey released last week. The survey found that a big factor was an increase in the use of high-deductible, consumer-directed health plans. Enrollment in those plans jumped from 13% to 16% of all covered employees in 2012. Click here for the complete summary.

CMS Releases Beneficiary Premium Rates for 2013

CMS last week announced beneficiary premium rates for 2013. The Part B annual deductible for 2013 is $147.00 for all beneficiaries. Click here for the inpatient hospital deductible regs for CY13. Click here for the Medicare Part B annual deductible and related regs for CY2013. Click here to read the regs for the Part A premiums for CY13 for the unisnured aged and for certain disabled persons who have exhausted all other entitlements.

GOP Members Want New Health Committee

Three House Republicans want to create a new committee that would have complete jurisdiction over health care issues. Reps. Doc Hastings of Washington, Reid Ribble of Wisconsin and Rob Woodall of Georgia call it the best opportunity for repealing the 2010 health care law. Click here for the story.

Wisconsin Lawmakers: Arrest Those Who Implement ObamaCare

It’s a novel approach to dealing with the implementation of ObamaCare: arrest those who try to implement it. That’s the position of nine state lawmakers in Wisconsin. Click here for the story.

Senate Committee Blasts Company for Meningitis Outbreak; Drug Shortage Worsening

A key senate committee released a scathing report last week against the company at the center of the meningitis outbreak that has claimed the lives of 33 and sickened 480. Click here for the 15-page report that outlines the issues. The focus on compounding firms may also be worsening the drug shortage, according to the NY Times. Click here.

Primary Care, Nursing Homes Should Participate in Emergency Preparedness

While hospitals and first responders consistently work together to prepare for natural disasters, infectious disease outbreaks and other emergencies likely to result in many injured or ill people, other important groups—primary care clinicians and nursing homes, for example—typically do not participate in local emergency-preparedness coalitions, according to a new qualitative study of 10 U.S. communities by the Center for Studying Health System Change released last week. Click herefor the study.

More Hospitals Focusing on Patient Flow Solutions

According to a new study released last week, some 31% of U.S. hospitals indicated their intentions to purchase patient flow solutions to address the current patient crowding bottleneck effect seen in hospital departments nationwide. Click here for more.

Medicaid Personal Care Services Subject of More Fraud: OIG

Medicaid costs for personal care services topped $12.7 billion last year, according to the Office of Inspector General at HHS that posted the analysis last week. The report says that fraud is a “growing concern,” with many state Medicaid fraud control units reporting an increase in the volume of fraud. Click here for the 30-page report.

More Federal Grants Announced

There were several new federal grant announcements last week. Our grants team has summarized several for your review. Click herefor the one-pager.

Gingrich Think Tank Acquired by Health System

Georgia-based WellStar Health System has acquired the rights to the trademark, trade name and website address of the Center for Health Transformation, the healthcare think tank established by former U.S. House of Representatives Speaker Newt Gingrich in 2003. Click here for additional information.

Clinton Foundation Targets U.S. Health Improvement

Former President Bill Clinton last week announced the launch of the Clinton Health Matters Initiative (CHMI), a new program of the William J. Clinton Foundation along with its supporting partners GE, Tenet Healthcare Corporation, and Verizon. CHMI is a national initiative that will work to improve the health and well-being of people across the United States by developing and implementing a variety of evidence-based individual, systems, and investment strategies. Click here for more.

Neurologists Hit by Payment Cuts

CMS has released new codes that could severely decrease payments to neurologists. The cuts would be hard on neurology practices. The ruling goes into effect in January 2013 and are detailed here. Click here for more news from the nation’s major health care trade associations.