Number of Medicare ACOs Almost Double

There are now 252 official Medicare ACOs, after CMS announced another 106 last week. The new ACOs include a diverse cross-section of physician practices across the country. Roughly half of all ACOs are physician-led organizations that serve fewer than 10,000 beneficiaries. Approximately 20% of ACOs include community health centers, rural health centers and critical access hospitals that serve low-income and rural communities. Click here to see the list. Click here for the lists of other ACOs. The next application period to participate in the ACO program beginning in January 2014 is summer 2013. If you are interested expert help in making application, click here. Strategic Health Care has successfully assisted more than a dozen organizations.  


Medicare Spending Slows; Report Says ACA Is Having A Spending Impact

HHS issued a new report last week showing Affordable Care Act provisions are already having a substantial effect on reducing the growth rate of Medicare spending. Growth in Medicare spending per beneficiary hit historic lows during the 2010 to 2012 period, according to the report. Projections by both the Office of the Actuary at CMS and by the Congressional Budget Office estimate that Medicare spending per beneficiary will grow at approximately the rate of growth of the economy for the next decade, breaking a decades-old pattern of spending growth outstripping economic growth. Click here for the easy-to-read report.


MedPAC Recommends 1% Medicare Increase for Hospitals

MedPAC commissioners voted unanimously last week to recommend a 1% Medicare payment increase to hospitals – FY14 inpatient and CY14 for outpatient. The recommendation is 0.80% less than the statutory update for inpatient services, to allow HHS to recoup past overpayments to hospitals based on documentation and coding adjustments. Click here for a very good slide summary of the hospital market from MedPAC’s view.


Other Providers Should Get No Increase: MedPAC

While the 1% hospital recommendation might seem paltry, it was significantly more than the updates recommended for ASCs, home health, and hospice. Commissioners in December were leaning in favor of recommending a 0.5% increase to ASCs; however, during last week’s meeting commissioners heard staff reports showing ASCs continue to grow indicating current adequate reimbursement. Click here to see MedPAC’s ASC report.

MedPAC also recommended last week a 0% marketbasket update for inpatient rehabilitation facilities, long-term care hospitals and home health providers in 2014. The commissioners restated their prior recommendation for a two-year rebasing of the home health payment system starting in 2013. Commissioners repeatedly noted the potential future benefit of bundling hospital and post-acute payments.

Click here for MedPAC’s report on LTCHs, which says LTCH use is only favorable when the right type of medically complex patients are treated. 

Click here for MedPAC’s report on home health, which says Medicare has consistently overpaid for services.


Senators Say Government Should Try Harder to Find Medicare Fraud and Abuse

A bi-partisan group of U.S. Senators – Coburn (R-OK), Carper (D-DE), Baucus (D-MT), Hatch (R-UT) - is calling into question a new HHS report on Medicare (Parts C and D) that says they couldn’t find much waste and fraud in the two programs. This is a pretty wonky report (click here), but a press release from the senators, here, provides a good summary of the issues raised.


Senators Fighting HHS Proposal to Change Definition of “Frontier”

Montana’s U.S. Senators are challenging HHS over a change in the definition of ‘frontier’ status. Regulations currently define a community with fewer than six people per square mile as ‘frontier.’ But HHS is considering changing the definition of ‘frontier’ from population density to a community’s distance from a major population center. This could negatively impact hospitals and other providers reimbursements from government programs. Click here to see their letter to HHS.


High Number of Children on Psychotropic Meds: GAO

Nearly 20% of children in foster care are taking psychotropic medications, according to a GAO report released last week. Outside the foster care system, about 6% of children in Medicaid and 5% of kids with private insurance were on psychotropic medications, according to data from 2007 through 2009. The report, requested by Senator Tom Harkin (D-IA), Rep. Rosa DeLauro (D-CT.) and Rep. Lucille Roybal-Allard (D-CA), also showed 30% of children in the foster care system who might have needed mental health services didn’t get them in the past year. Click here for the report.


Proposal Says Feds Could Save $542 Billion in Medicare and Medicaid

The federal government could save up to $542 billion in Medicare and Medicaid spending over the next 10 years through a proven “third strategy” for modernizing health care and improving patient outcomes, according to a new report by UnitedHealth Group. Among recommendations:

  • The federal government could save $202 billion by providing care management services to seniors enrolled in traditional fee-for-service Medicare who are not also Medicaid-eligible.
  • Expand use of coordinated care for dual-eligible Medicare and Medicaid beneficiaries: full integration of Medicare and Medicaid benefits for the dual-eligible population could yield savings of $153 billion for the federal government. Under this approach, all states would enroll their dual-eligible beneficiaries in managed health plans.
  • Provide coordinated care for all Medicaid enrollees: The federal government could save $30 billion if all states adopted comprehensive managed care for their fee-for-service Medicaid enrollees.
  • Accelerate programs to improve health, particularly diabetes initiatives: by adopting innovations that already have been proven to prevent and control pre-diabetes and type two diabetes, the federal government could save an additional $53 billion.

Click here for a copy of the report.


Another Proposal Would Save $2 Trillion over 10 Years

The Commonwealth Fund last week announced a detailed plan that would slow spending by a cumulative $2 trillion by 2023, if begun now with public and private payers acting in concert. Among many recommendations:

  • Revise Medicare physician fees and methods of updating payment to pay for value. Replace Medicare’s current system for determining physician fees by holding fees constant at their current level, while adjusting relative payment rates for services that meet specified criteria as “overpriced.”
  • Bundle hospital payments to focus on total costs and patient outcomes.
  • Strengthen primary care and support care teams for high-cost, complex patients.
  • Adopt payment reforms across markets, with public and private payers working in concert.

Click here for the report.

Study: Most Radiologists Not Meeting PQRS Requirements

More than three-quarters of radiologists are not meeting requirements of the Medicare Physician Quality Reporting System (PQRS), according to a study to be published in the February issue of the Journal of the American College of Radiology. The shortfall could expose radiologists to penalties starting in 2015. Click here for the story.


Too Many Docs Spend Years with Open Malpractice Claims: Study

The average physician will spend more than 10% of his or her career facing an open malpractice claim. Some specialists will spend upwards of 27%, according to a study published last week by the RAND Corporation. Click here.


OIG Opinion Supports Certain Physician Bonuses for Quality and Cost Efficiencies

Providing bonuses to physicians for quality and cost efficiency doesn’t warrant financial penalties under anti-kickback laws, according to a 16-page advisory opinion released last week by the Office of Inspector General. In its review of a co-management arrangement between an unnamed hospital and a cardiology group, the OIG determined that the hospital shouldn’t suffer sanctions for offering performance bonuses to the physicians for implementing patient service, quality and cost-saving measures, OIG said in an advisory opinion. Click here for the OIG advisory.


New Survey Shows Demand Up for Advanced Practice Clinicians

A survey released last week revealed a high demand for clinical professionals, as 63% of respondents reported a 17% increase in the Advanced Practice Clinician workforce over the last 12 months and 53% indicated they plan to increase the APC workforce by 15% in the next 12 months. In addition, of 135 organizations responding to APC compensation questions, nearly two-thirds (62%) reported increased salaries with an average and median increase of 3.9% and 3.0%, respectively, over the past 12 months. The survey also found that more than half of these organizations (54%) plan to provide salary increases to APCs in the next 12 months, with a projected average and median increase of 3.1% and 3.0%, respectively. Click here for details.


$32 Million Available to Enroll Kids in Health Programs

States and local governments and community-based and non-profit organizations can apply through Feb. 21 for a portion of $32 million in federal grants to find and enroll eligible children in Medicaid and the Children’s Health Insurance Program, CMS announced last week. CMS expects to award grants of up to $1 million each beginning in June. Click here for details.


New Recommendations Out On Improving Cancer Care

The American Society of Clinical Oncology last week issued recommendations to help improve the quality of care for the more than 13 million cancer survivors living in the United States. Among recommendations: promote patient-centered coordinated care through the use of shared-care models, which allow for collaboration among practitioners of different disciplines or with different skills and knowledge;  increase adoption of quality improvement programs, which help physicians monitor and improve care for all survivors. Click here for details.


Report: Americans Fare Worse Than Others in High Income Countries

On average, Americans die sooner and experience higher rates of disease and injury than people in other high-income countries, says a new report from the National Research Council and Institute of Medicine. The report finds that this health disadvantage exists at all ages from birth to age 75 and that even advantaged Americans – those who have health insurance, college educations, higher incomes, and healthy behaviors – appear to be sicker than their peers in other rich nations. Click here for the report.