More Regs Out on Exchanges; New Funding Streams Revealed

New proposed regulations released last week revealed the government’s intent to charge insurers for selling health insurance in new exchanges being established by federal and state governments. Most of those new fees are expected to be used by the government to pay for exchanges in states that are relying on the federal government to establish them. All exchanges will start open enrollment in October 2013. Click here for a very good detailed update from CMS. Click here for the story from the NY Times. Click here for a new 5-page state-by-state summary of the status of exchanges.

IRS Regs Show Tax Increase on Wealthy to Help Pay for ObamaCare

Friday’s new rules included a 373-page HHS regulation (click here) that covers risk adjustment in the exchanges, cost-sharing limits, and user fees for the federal exchanges. And the IRS put out a 42-page rule (click here) on the Medicare payroll tax that will be charged to high-income earners to help pay for the law.

Regs Outline New Government Insurance Options

Also last week, the Office of Personnel Management issued a proposed rule outlining the Multi-State Plan Program. The Affordable Care Act directs OPM to contract with private health insurers to offer at least two multi-state plans on each state insurance exchange. Click here for an OPM summary. Click here to read the 122-page proposed rule.

Small Companies Face Big Health Benefit Decisions

As federal agencies roll out new regulations to implement the Affordable Care Act, small employers are weighing the impact on their companies, particularly those who do not provide health insurance benefits. Click here for a good story from the NY Times.

AMA: Insurance Markets Are Highly Concentrated

Most U.S. health insurance markets are highly concentrated, according to a report released last week by the American Medical Association. Examining market share and concentration levels for health maintenance organizations, preferred provider organizations and point-of-service plans in 385 metropolitan areas, the study found 70% of the markets are rated “highly concentrated” based on 2010 Horizontal Merger Guidelines issued by the U.S. Department of Justice and Federal Trade Commission. In 89% of the areas, at least one insurer held a commercial market share of 30% or more. Click here to review the report; there is a fee for non-AMA members.

Battles Underway Between Health Systems for Market Dominance in New Environment

The battle between competing hospitals and health systems for market dominance, often revealed in the acquisition of physician practices across the community, continues to heat up across the nation with growing interest from the Federal Trade Commission. This war is the focus of a detailed article from the NY Times last week as it describes the battle in Idaho between two systems. Click here.

Fiscal Cliff Negotiations – A Very Informative Update

The ‘fiscal cliff’ negotiations that now consume Washington are increasingly complicated with likely significant impact on all Americans, particularly those working in health care. Everyone wants to know what is really going on and the answer is that no one knows for sure. However, the ‘cliff’ is only 28 days away. Click here for a very good update and analysis on all the ‘cliff’ issues from the Washington Post. The very influential AARP has come out against major changes in entitlement programs, including increasing the Medicare eligibility age. A Medicare patient advocacy group says increasing the age actually costs more money. Click here for details.

Public Prefers Payment Cuts to Providers: Survey

When asked to prioritize healthcare reductions, half of survey respondents said they want budget savings to come from lower payments to doctors and hospitals, according to a post-election survey conducted by PwC’s Health Research Institute. Health information technology was the second choice for reductions. Click here for complete survey results.

Most Oppose Raising Medicare Age

Two-thirds of Americans oppose raising the Medicare age from 65 to 67, according to a Washington Post/ABC poll released last week. Only 30% of those surveyed support it, with independents (34%) more favorable than either Democrats (27%) or Republicans (30%). Click here for the story.

OIG Report Says $6.9 Billion in Health Payments Recovered in FY 2012

In its Semiannual Report to Congress, the HHS Office of Inspector General last week announced expected recoveries of about $6.9 billion from audits and investigations. The report highlights OIG accomplishments for FY 2012 in total. However, nearly have of the total comes from a settlement with a major drug company regarding marketing and promotion practices. Click here for the report.

Strategies to Curb Hospital Readmissions Are Creative 

As the federal government increases penalties on hospitals for unplanned readmissions, hospitals are trying new methods to reduce those unwanted visits – everything from sending nurses to patient homes and giving away medications. Click here for the story.

10% of Americans in an ACO: Study

About 10% of the U.S. population is receiving its care through an ACO, according to a report out last week from consulting firm OliverWyman.  Click here for the 10-page report. Information about running successful ACOs and avoiding problems in their creation and operation continues to be published. Click here for one such guide from the Robert Wood Johnson Medical School and the University of Medicine and Dentistry of New Jersey.

OIG Recommends Health IT Changes to Safeguard Incentive Funding

HHS’ Office of the Inspector General last week released a highly critical report of CMS’ ability to oversee the Electronic Health Record incentive payment program. The 38-page report said oversight problems leave the program vulnerable to paying incentives to professionals and hospitals that do not fully meet the meaningful use requirements. Currently, CMS has not implemented strong prepayment safeguards, and its ability to safeguard incentive payments postpayment is also limited. The OIG made four specific recommendations. Click here for the report. Click here for a NY Times summary.

Changes to Psychiatric Diagnostic Guide Will Impact Millions

The now familiar term “Asperger’s disorder” is being dropped, but “dyslexia” and other learning disorders remain. These revisions are part of the first major rewrite of the diagnostic guide used by psychiatrists, approved over the weekend. It will affect millions of children and adults and guide insurers in deciding what treatments to pay for. Click here for the story.

Orthopedic Surgeons Lobby to Preserve “In-Office” Exceptions to Stark

The American Association of Orthopedic Surgeons was in Washington last week advocating for the preservation of the in-office ancillary services exception to the Stark Law. The exception, which allows physicians to provide advanced imaging and physical therapy services in their offices, has come under scrutiny from recent probes into whether the law inclines physicians to increase their utilization of those services. Click here for details and for a summary of other major health care trade association developments last week.

CBO Changes Health Care Spending Assumptions Because of Rx Use

After reviewing recent research, the Congressional Budget Office now estimates that a 1% increase in the number of prescriptions filled by beneficiaries would cause Medicare’s spending on medical services to fall by roughly one-fifth of 1%. The CBO this week said it would add a new theory to its prescription drug calculus: more prescription drug use would reduce Medicare spending on medical services. This change could have a meaningful impact on how the government calculates payments for services. Click here for the 6-page CBO report.

Chest Radiography May Not Be Needed: Study

It may be time to say goodbye to chest radiography, according to research from Norway presented last week. In a study that compared conventional chest radiography to 320-detector-row CT using advanced iterative reconstruction, the team found no advantages to chest radiography outside the realm of cost – whereas they found enormous advantages in diagnostic power with regard to CT. Click here for the report.

7-Hospital Project Reduces Colorectal Surgical Site Infections

A project to reduce colorectal surgical site infections (SSIs) saved more than $3.7 million in costs for 135 avoided SSIs. The two-and-a-half year project included seven hospitals and was directed by the Joint Commission Center for Transforming Healthcare in collaboration with the American College of Surgeons. Click here for details.

More Americans Visiting Retail Health Clinics

About one in five U.S. adults has visited a retail health clinic, up from roughly one in ten six years ago, according to research released last week.  Of 2,000 U.S. adults it surveyed online, 21.3% have gone to a retail clinic, a significant gain from polls six years ago showing that less than 10% of adults had visited a walk-in clinic in a retail setting. Click here for the report.

Thousands of New Jobs Available in Health IT

All of the heath care IT spending by providers, the government and others – along with all the new regulations establishing insurance exchanges – is creating a tremendous demand of skilled tech workers, according to new reports. Thousands of persons are retraining for these new jobs. Click here for the story.

Future of Public Hospitals May Rest on State Medicaid Expansions

A state’s decision to expand Medicaid (or not) and reduce the number of uninsured may have a large impact on the future of public hospitals in those states, according to a study out last week. Public hospitals have stayed afloat financially without abandoning their mission to care for low-income people by expanding access to primary care, attracting privately insured patients and paying closer attention to collection of patient revenues, among other strategies, the study said. Click here for details.