WEEKLY E-BULLETIN


Leapfrog Defends Hospital Scoring

The Leapfrog Group’s CEO was out with a statement last week defending its scoring of 2,600 hospitals where more than 1,200 earned a C or below. The AHA claimed that the scoring questionnaire is largely inaccurate, biased and uses unreliable scoring methods. The AHA further alleged that Leapfrog may have “manipulated” data for hospital safety scores. Click here to see why Leapfrog disagrees. Click here to see your hospital’s score updated last month compared with other hospitals in your state. Leapfrog also announced last week it partnered with Johns Hopkins’ Armstrong Institute for Patient Safety and Quality on its scoring methodology. Click here for the announcement.

House Democrats: Don’t Raise Medicare Eligibility Age

83 House Democrats sent a letter to President Obama last week arguing against raising the Medicare retirement age as part of the ‘fiscal cliff’ negotiations. Click here for the report. The Center for American Progress released a report that warned 435,000 seniors could become uninsured in a single year if the proposal became law. Click here for that study.

Most States Tell Feds to Operate Insurance Exchanges

Friday was the deadline for states to tell the federal government whether they would run their own health insurance exchanges, operate in partnership with the federal government, or leave it up entirely to the federal government to run. Just 18 states and the District say they plan to operate their own exchanges, which are slated to begin enrollment in October. 32 states exchanges will be run either by the federal government or a federal-state partnership. Click here to see a status map of the state-by-state exchanges. Most GOP governors opted to have the feds run their exchanges, much to the chagrin of other GOP health experts. Click here for a good report from the Washington Post.

No Funding for Partially Expanded Medicaid Programs

The health care law does not allow states to partly expand their Medicaid programs, administration officials announced last week in a letter to governors. The news was not well received by several governors, particularly Republicans, who had hoped they would be able to expand their programs beyond the eligibility level of people who are covered now, but not as much as 138% of poverty (or about $31,810 for a family of four), as the law outlines. Click here for the 17-page document that provides a lot of very good and updated detail about the Medicaid expansion and state exchanges. Two leading congressional Republicans (Sen. Orrin Hatch, Rep. Fred Upton) sent a terse letter to HHS in response. Click here to read the letter.

More Employers Likely to Keep Coverage: New Survey

When exchanges come online in 2014, 85.1% of employers say they definitely plan to or are very likely to keep offering coverage, according to a new survey from the International Foundation of Employee Benefit Plans. That’s up from 77% in the aftermath of the Supreme Court decision, the group said. Click here.

New CMS Fraud System Appears to be Working: CMS

CMS’s program integrity chief delivered a report to lawmakers Friday detailing significant returns from a new fraud detection method, called the Fraud Prevention System. The method works like credit card companies that flag suspicious activity. According to the report, CMS has identified $115.4 million in suspicious payments and returned $3 for every $1 invested in the new system. Of the $115.4 million in estimated savings, about two-thirds have yet to be realized — including $68.2 million that’s based on the value of cases referred to law enforcement, $6.6 million from payments that would have gone out to providers under the old system, and $4.4 million estimated from a change in providers’ behavior. Click here for a copy of the 82-page report.

Hospitals Push Suit Against HHS Payment Policy

What happens when Medicare refuses to pay a hospital for providing care to a patient when a Medicare recovery auditor says the care should have been provided on an outpatient basis? It’s happening all over the country and the American Hospital Association is pushing its lawsuit against this HHS policy. Last week, AHA filed a motion for a summary judgment against HHS (the original lawsuit was filed November 1) and also petitioned the court to expedite its lawsuit. Click here to read the 2-page summary judgment request. Click here for the 6-page expedited review request.

Hospital Foundations Could Be Hurt by Fiscal Cliff Deal

In a move with significant implications for hospitals and their non-profit foundations, federal lawmakers are considering an across-the-board limit on tax deductions, much like what was proposed by GOP presidential candidate Mitt Romney, which would hit charitable contributions particularly hard, according to numerous experts. Click here for a good NY Times summary.

Neurologists Urged to Negotiate New Deals with Insurers

Starting January 1, neurologists must negotiate with private payers for all new and revised Current Procedural Terminology (CPT) codes, as old nerve conduction study and H-reflex codes (95900, 95903, 95904, 95934, and 95936) will no longer exist. Several new and revised CPT codes were created for neurologists as well. Click here for a report from the American Association of Neurologists. For a comprehensive news summary from the major health care trade associations, click here.

Telehealth Grant Announced

The Health Resources and Service Administration is seeking applications for its Telehealth Network Grant Program. The primary objective of the grant is to demonstrate how telehealth programs and networks can improve access to quality health care services in rural, frontier, and underserved communities. $2.25 million a year will be awarded to about nine organizations. Call or email Gwen Mathews at Strategic Health Care for more information. She can be reached at 202-266-2600 or Gwen.Mathews@shcare.net.

End-of-Life Care Costs Daunting

One out of every four Medicare dollars, more than $125 billion, is spent on services for the 5% of beneficiaries in their last year of life. Yet even with Medicare or private insurance, you’re likely to face a big bill: a recent Mount Sinai School of Medicine study found that out-of-pocket expenses for Medicare recipients during the five years before their death averaged about $39,000 for individuals, $51,000 for couples, and up to $66,000 for people with long-term illnesses like Alzheimer’s. Click here for the story from CNN.

Community Centers Look to Brownfields to Build

Armed with federal funds and new government financial incentives, community health centers appear to be turning to brownfield sites as locations for new facilities, according to a report last week in the NY Times. The effort is gaining traction, however, particularly in Florida, where local government officials, environmental advocates and health center developers have led an ad hoc movement. As an incentive, the state provides developers who redevelop a brownfield into a health center with tax credits of up to $500,000. Click here for story.

EHRs Getting Up to Speed; Incentive Payments Tracked

In a research report out last week, 73% of surveyed physicians said that their EHR system was capable of meeting the meaningful use program’s electronic prescribing requirement. Researchers also noted that 68% of surveyed physicians said that their EHR system could meet the meaningful use program requirement on maintaining medication allergy lists; 56% said that their EHR system could meet the meaningful use program requirement to provide patients with a copy of their clinical summary; and 50% said that their EHR system could meet the meaningful use program requirement related to clinical-decision support functionality. Click here for the 8-page report from the ONC. Click here for a new state-by-state interactive map on the EHR Incentive Payment program.

Feds Launch Mobile Security Website

A mobile security program was unveiled by the ONC with the aim of educating health care groups and providers about ways to safeguard health data on mobile devices. The initiative includes a website that offers training videos on the safe management of health information on tablets, smartphones and other mobile tools. Click here to go to the new health IT security website. More doctors are turning to EHRs, according to a report out last week from HHS. Click here.

Americans Live Longer But Many Are Sicker

Americans are living longer, with fewer deaths from heart disease and cancer, but more chronic illnesses, an annual snapshot of the USA’s health shows. The 2012 America’s Health Rankings highlight troubling levels of obesity, diabetes, high blood pressure and sedentary behavior. Medical advances are allowing more people to live with those conditions. Click here for the excellent interactive state map. Click here for the USA Today story.  According to a new AHA report, Americans on Medicare are sicker than ever before. Click here for their report.

World Population is Living Longer but with New Complications

The health of most of the planet’s population is rapidly coming to resemble that of the United States, where death in childhood is rare, too much food is a bigger problem than too little, and life is long and often darkened by disability. High blood pressure is now the leading “risk factor” for disease around the world. Alcohol use is third. Low-back pain now causes more disability than childbirth complications or anemia. That’s one of the main findings from the Global Burden of Disease Study 2010, a collaborative project led by the Institute for Health Metrics and Evaluation at the University of Washington. Click here for the report. Click here for a Washington Post summary.

More ED Visits When Patients Can’t Reach Their Primary Doctor: Study

Patients with problems reaching their primary care practice after hours are more likely to report ending up in the emergency department and going without needed medical care, according to a study by the Center for Studying Health System Change released last week. Click here.

New Life for CLASS Act?

The CLASS Act could find its way back into the national health policy discussion.  Supporters of the program “said they thought that with some adjustments, planners could fix problems like ‘adverse selection.’” Read the update from the NY Times here.

C-Sections May Result in More Obesity

An analysis in the International Journal of Obesity showed children born via cesarean section were up to 40% more likely than vaginally born children to become obese in childhood. However, researchers said that while the results do not show a causal relationship, the link between C-section births and obesity should not be neglected. Click here for the story.

Proton-Beam Therapy Not Better than Traditional Radiation: Study

Proton-beam therapy provided no long-term benefit over traditional radiation despite far higher costs, according to a study of 30,000 Medicare beneficiaries published last week in the Journal of the National Cancer Institute. Click here for the story.