CMS’ Bundled Payment Demo Includes 500 Organizations

CMS announced last week the 500 health care organizations selected to participate in the Bundled Payments for Care Improvement initiative. Click here for a state-by-state breakdown of participants. Under the Bundled Payments program, organizations will enter into payment arrangements that include financial and performance accountability for episodes of care. The program includes 32 organizations that will begin testing bundled payments for acute care hospital stays as early as April 2013 under Model 1 of the program. It also includes participants for Phase 1 of Models 2, 3, and 4, which will run through July 2013. Phase 1 organizations will receive new data from CMS on care patterns and engage in shared learning in how to improve care. They generally are expected to participate in Phase 2, in which approved participants opt to take on financial risk for episodes of care starting in July 2013. CMS plans to announce a second opportunity for providers to participate in Model 1, with an anticipated start date of early 2014. Click here to see the list of approved bundles of care and a definition of each model.


New Regs Clarify Exemptions from ACA’s Individual Mandate

HHS and IRS last week issued regulations that exempt people who can’t purchase insurance for less than 9% of their yearly pay from the Affordable Care Act’s individual mandate. Certain people in states that forgo Medicaid expansion will be exempt as well, HHS said. Proposals from HHS and IRS “include rules that will ease implementation and help to ensure that the payment applies only to the limited group of taxpayers who choose to spend a substantial period of time without coverage despite having ready access to affordable coverage,” according to CMS. Click here for a summary report. Click here for the 80 pages of regs.


Most States Aren’t Ready With Insurance Market Reforms: Analysis

Most states aren’t ready for the health care law’s insurance market reforms going into place next year, according to a new report released late last week by the Commonwealth Fund. Just 11 states and D.C. have taken action to prepare for seven key insurance market reforms that will go into place next year, including guaranteed issue, bans on waiting periods for eligibility, bans on denying coverage to those with pre-existing conditions and limits on out-of-pocket costs. Connecticut and California have addressed seven and six of the reforms, respectively. Arkansas, Maine, Maryland, New York, Oregon, Rhode Island, Utah, Vermont, Washington and the District of Columbia have each addressed at least one. But 39 states have done nothing. Click here for the 14-page report.


Insurers Slam Docs Over Out-of-Network Charges

A report out last week from the nation’s largest health insurance association slammed physicians who treat patients out-of-network and charge exorbitant fees. Click here for the report. Click here for the corresponding story in the NY Times.


New Regs: Drug, Device Makers Must Now Disclose Financial Ties to Docs

CMS released a final rule late last week for the implementation of a law requiring drug and device-makers to disclose their financial relationships with doctors. The Physician Payment Sunshine Act will require companies to begin collecting the information in August and start reporting it to HHS by the end of March next year. The final rule also requires manufacturers and group purchasing organizations (GPOs) to disclose to CMS physician ownership or investment interests. Click here for a CMS summary. Click here for the 287-pages of rules.


New Regs: Exemptions for Birth Control Coverage Includes Some Hospitals

The Obama Administration proposed new regulations about health plans being required to provide free contraceptives. The proposal could expand the number of groups that do not need to pay directly for birth control coverage, encompassing not only churches and other religious organizations, but also some religiously affiliated hospitals, universities and social service agencies. Health insurance companies would pay for the coverage. Click here for the 80 pages of rules. Click here for the NY Times story.


Senators Tackle Medicare, Medicaid Waste, Fraud and Abuse

Six current and former members of the Senate Finance Committee, led by Ranking Member Orrin Hatch (R-Utah) and Chairman Max Baucus (D-Montana), released a comprehensive report outlining recommendations from more than 160 stakeholders in the health care community on ways to improve federal efforts to combat waste, fraud and abuse in the Medicare and Medicaid programs. Joining Hatch and Baucus on the report are Senators Tom Coburn (R-Okla.), Ron Wyden (D-Ore.), Chuck Grassley (R-Iowa), and Tom Carper (D-Del.). Click here for the informative 12-page report.


Kaiser Foundation Proposes Major Medicare Reforms

Those looking for more options to reform the Medicare program should review the latest comprehensive recommendations released last week from Kaiser Family Foundation. The 232-page report covers all aspects the government program. There are too many proposals-all well thought out and supported with documentation-to list here. Click here for the report.


New Recommendations Designed to Improve Americans’ Health

Trust for America’s Health last week released a report that provides high-impact recommendations to prioritize prevention and improve the health of Americans. The Healthier America recommendations outline top policy approaches to respond to studies that show 1) more than half of Americans are living with one or more serious, chronic diseases, a majority of which could have been prevented, and 2) that today’s children could be on track to be the first in U.S. history to live shorter, less healthy lives than their parents. Click here.


Northeast Ohio Program Reduces Hospitalizations

Stepped-up access to primary care doctors reduced nearly 3,000 hospitalizations in northeast Ohio, according to a new analysis, which found the region saved $20.1 million from 2009 to 2011 by preventing unnecessary hospitalizations for common heart conditions. According to the study, patients at risk of heart conditions avoided an estimated 650 hospitalizations in 2009, 990 in 2010, and 1,214 in 2011. The Better Health Greater Cleveland report suggests that fewer hospitalizations for diabetes, high blood pressure, heart failure and angina are an indicator of the strength of the primary care networks in a region. Click here for the 20-page report.


HSAs, HRAs Balances Increasing Again

After a slight drop during the recent recession, health savings accounts (HSAs) and health reimbursement arrangements (HRAs) are showing renewed growth, with the average account balance increasing over the past two years, according to new research by EBRI. Click here for their report.


Health Care is the Strength of American Jobs Growth: Studies

Unemployment numbers out last week did reveal the importance of health care in the economy, according to an analysis from Altarum. (Click here.) If health care jobs had just held steady, the unemployment rate would be a full point higher. If they had taken a dive with the rest of the economy, the current unemployment rate would be 10.8%. New health care jobs made up 14.6% of the total jobs added, and were among the top contributors to the overall gain in employment. The American Hospital Association put out a report last week, touting its members roles as local economic engines. Click here for that report.


House Committee Chair Wants Health Regs More Favorable to Small Businesses

The Chairman of the House Small Business Committee, Sam Graves (R-MO), last week strongly encouraged the Treasury Secretary to consider the concerns of small business owners when finalizing regulations related to health care’s employer mandate. Proposed regs were issued last month. Click here to read Graves’ six-page letter.


Clancy to Leave AHRQ

Carolyn Clancy will step down as director of the Agency for Healthcare Research and Quality after 10 years, HHS Secretary Kathleen Sebelius announced last week to employees. (Click here for her brief bio.) Clancy will stay on as director for the next few months, Sebelius said. House Republicans have targeted the agency by introducing legislation to eliminate it.


Medicare DME Services Will Cost Seniors Less Starting July: CMS

Seniors who use medical equipment like hospital beds and wheelchairs will be paying less for their devices when July rolls around because of a significant expansion of Medicare’s competitive bidding program. CMS announced a new, lower set of fees for durable medical equipment last week, lowering both the amount Medicare will reimburse providers and the out-of-pocket costs to beneficiaries. For example, to rent a hospital bed for 13 months, Medicare currently pays $1,376 on average, with seniors contributing $275 in co-insurance. Under the new fee schedule, the reimbursement will drop to $737, with a $147 beneficiary contribution. The lower rates will go into effect on July 1. Click here for more.


Senate Reports Examine Doc Shortage, Workforce Recommendations

The growing primary care physician shortage was the focus of a Senate subcommittee, with proposals offered to address it.  Nearly 57 million people in the U.S., or one in five Americans, live in areas where they do not have adequate access to primary health care due to a shortage of providers in their communities. According to the Health Resources and Services Administration, we need 16,000 primary care practitioners to meet the need that exists today. The shortage is overwhelmingly one of primary care providers, and it is expected to get worse. 52,000 primary care physicians will be needed by 2025. Click here for the Senate report. Click here for a very good summary of the issue and recommendations from health economist Uwe Reinhardt.


JAMA Survey: Post Newtown, Mental Illness Poses Serious Challenges 

Americans say they are concerned about discrimination against the mentally ill, but many still find them dangerous and the public certainly doesn’t want them anywhere near guns, according to survey published last week in the New England Journal of Medicine. Nearly half, about 46%, of Americans surveyed agreed that people with serious mental illnesses are “by far more dangerous” than the public overall. The numbers also revealed that 58% agreed discrimination against the mentally ill is a “serious problem,” but just 29% would be willing to work closely with someone with a serious mental illness and only 33% of respondents said they would be willing to have a person with a serious mental illness as a neighbor. Click here to see the survey.


Premature Birth Rate Lowest in Decade: MOD

The rate of premature births has declined to 11.7%, the lowest rate in a decade, according to the March of Dimes 2012 Premature Birth Report Card. The March of Dimes Report Card compares each state’s preterm birth rate with the goal set by the March of Dimes of lowering the rate to 9.6% of all live births by 2020. The report tracks states’ progress towards lowering their preterm birth rates and assesses contributory factors. Click here to see how your state compares.


Battle Between Name Brands and Generics Heating Up

Brand name biologic drugs are consuming a growing share of prescription drug spending, and biologics with sales totaling more than $40 billion annually will be coming off patent by the end of 2016, according to a new Grant Thornton report published last week. New versions of those drugs, called biosimilars, some of which are already on the market in other countries, could save as much as 20-25% on those costs, the report estimates. However, the FDA has to get a premarket approval pathway for them in place, according to the association representing generic drug companies. Click here for the report and click here for the association’s response. The New York Times ran a story last week on how big pharma companies are lobbying states to stop the spread of generics. Click here.


NIH Touts New CT Scanner for Significant Radiation Reduction

A new CT scanner substantially reduces potentially harmful radiation while still improving overall image quality. NIH researchers, along with engineers at Toshiba Medical Systems, worked on the scanner. An analysis of data on 107 patients undergoing heart scans found that radiation exposure was reduced by as much as 95% compared to the range of current machines, while the resulting images showed less blurriness, reduced graininess, and greater visibility of fine details. Click here for the NIH announcement.


Few Americans Switching Health Plans

Less than 2.5% of non-elderly Americans in 2010 with employer coverage-about the same proportion as in 2003-initiated a change in health plans to reduce their health insurance costs or get a better quality plan, according to a new national study by the Center for Studying Health System Change. Overall, about one in eight (12.8%) people younger than 65 with employer coverage switched health plans in 2010, down from one in six (17.2%) in 2003. Click here for details.