262 Hospitals Recognized by Heathgrades

Healthgrades, an online resource that helps consumers search, evaluate, compare and connect with physician and hospitals, last week announced the top 5% of U.S. hospitals for clinical outcomes, as determined by an evaluation of data on clinical measures in its new report, Hospital Quality Clinical Excellence Report 2013. The 262 recognized hospitals, out of more than 4,500 evaluated, have have a 30.9% lower risk-adjusted in-hospital mortality rate across 18 conditions and procedures as compared to all other U.S. hospitals evaluated. Click here for the list of hospitals (scroll to page 5). Click here for Healthgrades’ state-by-state hospital comparison.


Compare Your Hospital’s Value Based Purchasing Bonuses or Penalties

Medicare is revising payments to hospitals starting this month based on its Value Based Purchasing program. Almost $1 billion is being shifted impacting 3,000 hospitals. In what amounts to a nationwide competition, Medicare compared hospitals on how faithfully they followed rudimentary standards of care and how patients rated their experiences. In many regions, the hospitals that did the best are regional and community hospitals, according to government records. In all, Medicare is rewarding 1,557 hospitals with more money and reducing payments to 1,427 others, according to a Kaiser Health News analysis. Click here to see the penalties or bonuses your hospital and all other hospitals received.


CMS Issues Core Quality Measures for Medicaid Health Homes

The Center for Medicaid has released guidance on the core quality measures that will be used in Medicaid Health Homes. Final regulations are pending, but the following CMS quality benchmarks should be adopted as soon as possible: 1. Adult Body Mass Index (BMI) Assessment 2. Ambulatory Care: Sensitive Condition Admission 3. Care Transition: Transition Record Transmitted to Health Care Professional 4. Follow-up After Hospitalization for Mental Illness 5. Plan: All Cause Readmission 6. Screening for Clinical Depression and Follow-up Plan 7. Initiation and Engagement of Alcohol and Other Drug Dependence Treatment 8. Controlling High Blood Pressure. Click here for the letter to states from CMS.


Annual Medical Checkup May Not Be Necessary: Study

The annual medical checkup may be mostly a waste of time and money, according to a study out last week. Two doctors in Colorado scanned through 14 randomized, controlled studies involving 182,000 patients. The articles spanned from 1963 to 1999. The doctors looked at whether those who had regular check-ups had higher mortality rates than their counterparts who dodged such visits. They could not find a difference. Click here for the JAMA study. Click here for the Washington Post report.


Physician Rank Insurers on Satisfaction, Innovation, Transparency

Medicare Part B got the best scores from physician practice professionals when ranked against some of the nation’s largest health insurance plans, according to a new analysis from the Medical Group Management Association (MGMA). Of the private insurance plans, Cigna ranked highest on satisfaction, United Healthcare ranked highest on innovation and Anthem ranked highest on transparency. Click here for the MGMA’s complete report.


This Flu Season May Be “Worst in 30 Years”

This flu season is shaping up to be bad, particularly for seniors, according to Tom Frieden who runs the CDC. Click here for the latest CDC flu report. Nationally, influenza-like illness is down slightly this week from last, from 4.8% to 4.3%, but some parts of the country, particularly in the West, are showing increases. Thirty states and New York City are now reporting high levels of influenza-like illness activity. Last week it was 24 states. Forty-eight states report widespread geographic flu activity. Last week, hospitalization rates increased sharply in people 65 and over and this week hospitalization rates for people 65 and older increased sharply again. Going up to a rate of 82 per 100,000, which is really quite a high rate. A Mayo Clinic expert says it could be the worst in 30 years.  Click here for more. Click here for an HHS report on a new flu vaccine that uses new technology and approved by the FDA last week.


No Physician Shortage? New Study Details

There may not be a physician shortage after all, even in primary care, according to a new study out last week. Why? Most forecasts of doctor shortages assume that a primary care physician can handle a set amount of patients in a practice, usually about 2,500. Under this scenario, there are likely too few; however, the study says the health care system is rapidly changing. First, doctors are increasingly joining up into big practices. They’re able to share support staff and office space, which can make it easier to take on a bigger patient population. Second, the health care workforce is changing, as physician assistants and nurse practitioners take on larger roles. Click here for the Health Affairs study (requires a fee). Click here for the Washington Post story.


Governors Support Scope of Practice Changes

Even the National Governors Association is promoting changes to scope of practice laws to expand primary care delivery across the states. The NGA issued a report. Click here to review.


Nurse Loan Repayment Program Seeking Applicants

The Health Research and Services Administration’s NURSE Corps Loan Repayment Program, is accepting 2013 applications through Feb. 28. The program helps registered nurses, advance practice nurses and nurse faculty repay their educational loans in exchange for a two-year commitment to work at a hospital or other facility with a critical shortage of nurses or at an accredited nursing school. The program is reserving up to half of the funding for these advance practice nurses. Click here for more.


Sweeping HIPAA Reg Changes Released

HHS last week released new regulations containing sweeping changes to the Health Insurance Portability and Accountability Act of 1996 (HIPAA). The final omnibus rule greatly enhances a patient’s privacy protections, provides individuals new rights to their health information, and strengthens the government’s ability to enforce the law. Click here for details. Click here for the 563 pages of regulations.


Obama’s Gun Violence Plans Include Providers

President Obama referenced HIPAA regulations and several other health care provisions last week when the White House released its plans for executive action to combat gun violence. Click here to review the President’s 23 executive actions, with at least eight of them having a direct impact on health care providers.


CO-OPs Fighting Funding Cuts in Fiscal Cliff Law

State health CO-OPs are fighting back after Congress cut funding for new CO-OPs as part of the ‘fiscal cliff’ deal approved January 2. As many as 40 startups have been left with little recourse now that start up funds have been eliminated. Click here for the CO-OP association letter to HHS. Click here for the Washington Post story.


New CMS Proposed Reg Impacts Exchanges, Essential Health Benefits and Medicaid

CMS issued last week a 474-page proposed rule that addresses essential health benefits in alternative benefit plans, eligibility notices and the appeals process for Medicaid and exchange eligibility. Click here for a CMS summary. Click here for the rule.


States Get $1.5 Billion in Exchange Grants; Exchanges More Consumer Friendly

HHS last week awarded 11 states additional grants totaling $1.5 billion to establish health insurance exchanges, or marketplaces, under the Affordable Care Act. One-year grants went to Delaware ($8.5 million), Iowa ($6.8 million), Michigan ($30.7 million), Minnesota ($39.3 million), North Carolina ($74 million) and Vermont ($2.2 million). Multi-year grants, available to states further ahead in the process, went to California ($673.7 million), Kentucky ($182.7 million), Massachusetts ($81.3 million), New York ($185.8 million) and Oregon ($226.5 million). Click here for the announcement. Click here to see the seven actions consumers can take now to prepare for Exchanges. And USA Today reports here on the new consumer-friendly approach the government is launching around Exchanges.


$96 Million in PCORI Grants Announced

The Patient-Centered Outcomes Research Institute will accept applications through April 15 for up to $96 million in funding for research to help patients and caregivers make better informed health and health care decisions. Applicants must submit letters of intent to apply by Feb. 15. The funding will support four of the Institute’s five national research priorities: assessing prevention, diagnosis and treatment options, improving health care systems, communicating and disseminating research, and addressing disparities. Proposals must involve patients and caregivers and will be evaluated in part on their potential to help others reproduce their results. Click here to review the funding opportunities.


Major PQRS Changes Made in Fiscal Cliff Law

The legislation fixing the ‘fiscal cliff’ includes a provision that provides recognition of the value of clinical data registries in the promotion of higher quality, more efficient care.  Section 601(b) of the legislation outlines a new process through which physicians would be able to satisfy federal quality reporting requirements under the Physician Quality Reporting System (PQRS) by participating in a qualified clinical data registry starting in 2014. Click here for details.


New Health Subcommittee Chair Wants Changes

The House Ways and Means Subcommittee on Health will be chaired by U.S. Rep Kevin Brady (R-TX) in the new Congress. He told the media that he has several key agenda items, including repealing the current physician payment formula and reducing administrative overhead costs in the health care system. Click here for the brief report.


Business Leaders Issue Medicare Reform Recommendations

The Business Roundtable, an association of 200 of the largest companies in the U.S., is out with its plan to fix Medicare. Among their recommendations: raise the eligibility age to 70 and expand competitive models of care. Click here for the report summary.


35 New Participants in CCTP Announced

CMS last week announced 35 additional participants in its Community-based Care Transitions Program (CCTP). Authorized by the Affordable Care Act, the CCTP provides funds to test models for improving care transitions for high risk Medicare patients by providing services that manage these patients’ transitions effectively. With the addition of the 35 sites, the CCTP will provide care transition services to nearly 500,000 Medicare beneficiaries in 33 states in the U.S. This new group of grants brings the total number of sites to 82. Click here for information about the new sites.


Hospital DSH Payments Focus of MACPAC Upcoming Report

Payments to hospitals under the Disproportionate Share Hospital (DSH) program are scheduled to be reduced about $500 million in 2014 under current law and the Medicaid and CHIP Payment and Access Commission (MACPAC) met last week to discuss potential policy recommendations on this issue for its March 2013 report to Congress. If you don’t regularly follow MACPAC, its importance may increase as providers struggle with Medicaid payment issues caused by the Affordable Care Act. Click here for a brief summary from the AAMC. Click here to see the Commission’s meeting agenda from last week.


Stage 3 Meaningful Use Under Fire

Stage 3 of the HIT Meaningful Use program is taking some flak from providers. In comments to the government’s Health IT Policy Committee provider groups expressed concern that the program is moving too quickly and needs additional evaluation before proceeding. Physician and hospital association comments submitted last week called for a thorough evaluation of the program, especially considering many providers have yet to even achieve Stage 1 of the program. The College of Healthcare Information Management Executives recommended that ONC reconsider the speed and scale of meeting Stage 3 by 2016, noting that the proposed thresholds are “unrealistic.” Click here for comments from the AMA. Click here for AHA. Click here for CHIME.


CMS Publishes RAC Myth-Buster Report

CMS seems to have growing concerns about the pushback it is getting from providers over its recovery auditor (RAC) program and has issued a four-page “myth-buster” report to fight back. (Click here for the report.) For example:

    • Myth: Every RAC denial is overturned on appeal. While providers may wish that were true, CMS says just 2.4% of all 2010 claims have been challenged and overturned on appeal. About 5% of claims collected in fiscal year 2010 – or 8,449 – have been appealed, CMS says.
    • Myth: RACs have a contingency fee between 30% and 50%. It may seem as if RACs have that much motivation, but contingency fees in fiscal years 2009 and 2010 were between 9% and 12.5%, CMS says.
    • Myth: RACs don’t have physicians on staff. CMS says each RAC must employ at least one full-time equivalent contractor medical director and arrange for a substitute when the medical director is not available for “extended periods.” That FTE has to be a doctor of medicine or doctor of osteopathy who has “relevant work and educational experience.”