New Regs Would Relieve Hospital Regulatory Burdens; Help Other Providers
HHS released a proposed rule last week that would save providers $3.5 billion over five years. Among other changes, these regs eliminate the requirement that a physician be physically present at least once in a two-week period at critical access hospitals (CAHs), rural health clinics (RHCs), and federally qualified health centers (FQHCs). HHS estimates the change will result in annual costs saving of $1.6 million for CAHs, $18.1 million for RHCs and $23.4 million for FQHCs. The rules also propose changes to hospital boards, definition of hospital medical staff, outpatient services, nuclear medicine, ASCs, transplant centers and others. Click here for an excellent 6-page summary prepared by our policy team. Click for the 114-page rule. Click here for the CMS announcement.
Budget Sequester Nears; Cuts Are Real
The White House is turning up the heat on Congress as the deadline for the budget sequester nears. About $90 billion in cuts will take effect March 1, unless Congress acts. The sequester cuts about $1.2 trillion over 10 years. In addition to a 2% across-the-board cut in Medicare, the White House said “up to 373,000 seriously mentally ill adults and seriously emotionally disturbed children could go untreated. Additionally, 7,400 HIV patients would not receive treatment and 424,000 fewer HIV tests would be conducted by the CDC.” Click here to read the WH fact sheet.
Report Details Medical Research Impact of Sequester
A United for Medical Research report out last week painted a much grimmer picture of the sequester’s impact on medical research. Click here for their state-by-state impact summary.
Dems Say Deep Health Care Cuts Already Happening
Even before the possible sequester, health funding has already sustained extensive cuts, according to a report out last week from House Democrats. NIH funding adjusted for inflation cut 8% since 2010, reducing number and size of research grants. CDC drug and vaccine stockpile and grants to prepare for epidemics cut 14% in FY2012. Click here to see the 27-page report.
House Committee to Focus on SGR Repeal This Week
The House Energy and Commerce Heath Subcommittee will devote its first hearing of the year on Thursday, Feb. 14, to fixing the Sustainable Growth Rate formula, the system used to determine Medicare payment rates for physicians. The Committee released a detailed outline for repealing and replacing the SGR. Click here for the three page report. The cost of permanently replacing the flawed Medicare physician payment formula has decreased dramatically, according to a new CBO analysis. The new cost of freezing payments for ten years is $138 billion, more than $100 billion less than the previous projection.
Key GOP Govs OK Medicaid Expansion
About 12 states have yet to make a final decision on whether to expand their Medicaid programs starting next year. Michigan and Ohio were the latest GOP-led states to agree to the expansion. Families USA is planning to spend $1 million in the undecided states to encourage an expansion decision. Six Republican governors have joined most of the Democratic governors in approving the expansion, which is big news in hyper-partisan Washington. Click here for a summary report from the Washington Post, including a good graphic on the status of health exchanges and Medicaid in each state. Click here for an insider’s report on how Ohio’s GOP governor decided to side with Obama.
Insurers Altering Plans Because of Exchanges, Other Changes
Insurance companies across the country, whether national profit-making companies like WellPoint and UnitedHealth Group or nonprofit Blue Cross plans in states like Arizona and Michigan, are undergoing radical changes as a result of health exchanges and Medicaid expansions. After years of focusing on selling plans to employers, rather than individual consumers, the insurers must alter course. Click here for the NY Times story.
Medical Device Tax Repeal Bill Has Broad Support
The medical device industry is having some success in getting a large bipartisan group of lawmakers to support the repeal of an ObamaCare provision it doesn’t like. Reps. Erik Paulsen (R-MN) and Ron Kind (D-WI) formally introduced a bill last week to repeal the health law’s 2.3% medical device tax. They have 175 co-sponsors. They say that Sens. Orrin Hatch (R-UT) and Amy Klobuchar (D-MN) are expected to introduce similar Senate legislation. Click here for the story. For a look at the industry’s state-focused policy strategy for 2013, click here.
Children’s Hospital GME Bill Attacked But Bill Passes
Not even children’s hospitals are immune from the rough and tumble budget fights going on in Congress these days. The influential conservative Heritage Foundation last week urged House members to vote against the five year reauthorization of the children’s GME reauthorization bill. Heritage Action, which is the political arm of the Foundation said the bill would increase funding and is “inconsistent with getting the nation on a path to fiscal balance.” The House passed the bill 352 to 50. Click here to review the Heritage document urging a “no” vote. Click here for the Children’s Hospital Association response to the vote.
Basic Health Plan Delayed for a Year
The Obama administration has delayed for a year a health program for low to moderate-income people who won’t qualify for the expanded Medicaid program. Some states had planned to offer government insurance to people who don’t qualify for Medicaid, but who would be hard pressed to afford the premiums and cost-sharing of plans offered in the new insurance marketplaces. Those earning up to twice the federal poverty level, or about $47,000 for a family of four, would have been eligible. Click here for a Kaiser Health New summary.
CBO: Number To Sign Up Thru Exchanges is Down
The Congressional Budget Office had a number of major predictions in its latest long term economic forecast released last week. 1) Medicare and Medicaid spending growth has slowed substantially. Click here for a news report and click here for an excellent summary. 2) The number of people expected to be covered by 2017 is down 5 million from previous projections, click here for a report. 3) The cost of Obamacare is up slightly from previous estimates, click here. 4) The 2013 budget deficit is down sharply, click here. For a copy of the 77-page CBO 10-year budget projections that cover more than healthcare, click here.
Thousands of Patient Navigators Needed for State Exchanges
Those state health insurance exchanges will need patient navigators, tens of thousands of them, according to some reports. Click here for a good Washington Post story.
$10 Million Awarded for Primary Care Loan Repayments
The National Health Service Corps last week awarded more than $10 million in funding for loan repayment to 87 medical students in 29 states, the District of Columbia and Puerto Rico, who will serve as primary care doctors and help strengthen the health care workforce. Click here for more.
New Health Record Database Developed for Kids EHR
A new database developed by the Agency for Healthcare Research and Quality with support from CMS can help software developers create better Electronic Health Records for the care of children, according to last week’s announcement. Click here for details.
CMS Issues New ESRD Reform Initiative RFP
CMS last week announced a new initiative designed to identify, test, and evaluate new ways to improve care for Medicare beneficiaries with End-Stage Renal Disease (ESRD). CMS will partner with health care providers and suppliers to test the effectiveness of a new payment and service delivery model in providing these beneficiaries with patient-centered, high-quality care. Non-binding letters of intent from applicants are due March 15. Click here.
Hospice Use Growing But Not Until After Heroic Measures Taken: Study
Data showing hospice use surging over the last decade also contains some troublesome surprises, according to a JAMA report released last week. People are accessing hospice care in their final days of life, but only after multiple hospitalizations, ICU stays and complex care that hospice was built to avoid. Click here for the JAMA report.
Online Consults Saving Big $$$: Report
Online consultations for common, routine ailments can be just as effective as in-person care, cost significantly less and produce high levels of patient satisfaction, according to a study published last week. HealthPartners, an integrated delivery network and health insurer in Minneapolis, was able to reduce billing by an average of $88.03 per case and save about 2.5 hours per patient, taking into account travel time to and from a clinic, physician office or emergency department, as well as waiting time, the actual clinician encounter and check-in and check-out times, through its Virtuwell online clinic, as compared to traditional means of care. Click here for the story.
Tavenner Renominated at CMS
Marilyn Tavenner, the acting CMS administrator, has been nominated again for the same position by the White House. Whether she will get a confirmation hearing or a vote is still uncertain. Click here for details.
IRS May Not Be Able to Adequately Enforce Insurance Mandate
Starting next year all Americans will have to have health insurance coverage under the Affordable Care Act and the enforcement agency will be the IRS. However, according to documents released last week, the IRS may not have the funding or the clout to carry out this enforcement. Click here for the story. You can read the actual IRS audit report here.
New Bill Would Change Age Rating Rules
Fearing that the Affordable Care Act’s insurance provisions could shift too many costs to younger people, insurers and state insurance officials have been asking the Obama administration to phase in new “age rating” rules. Rep. Phil Gingrey (R-GA) is trying to rewrite that part of the law through a bill he introduced last week. As of now, insurers starting in 2014 can charge older people three times as much as younger ones in the individual and small group markets. Gingrey would let the states decide the age band, and as a default for states that don’t act, the rule would be a 5-1 ratio instead of the 3-to-1. Click here for more on Gingrey’s bill.
CMS Creating New LTCH Reporting Program
CMS is establishing a new system of records titled, ‘‘Long Term Care Hospitals Quality Reporting Program (LTCH QRP),’’ according to an announcement last week in the Federal Register. The new system will support a new quality reporting program for LTCHs that is required under the Affordable Care Act. The first measure collected is the “The Percent of Patient Residents with Pressure Ulcers That are New or Worsened.” Metrics surrounding catheter-associated urinary tract infections and central line-associated blood stream infections will also be collected. Starting in fiscal year 2014, all three measures will be compiled by CMS. Click here for the announcement.
House Members Create “Obamacare Burden Tracker”
Three House committees last week launched the “Obamacare Burden Tracker,” a website that compiles all the rules and regulations issued under the Affordable Care Act and notes the hours of total burden they are estimated to cause. Using the administration’s own estimates of compliance time, the tracker finds compliance would take a total 127 million hour per year. Click here to see the site.
Breastfeeding Numbers Rising: CDC
The percentage of mothers who start and continue breastfeeding is rising, according to a report released last week by the CDC. From 2000 to 2008, mothers who started breastfeeding increased more than 4 percentage points. Click here for the CDC report.
National Planning Strategy Needed on Health Workforce Issues: New Report
A national health policy group last week called for a national planning strategy to address future demand for health care workers. The Bipartisan Policy Center said “Fragmented and inconsistent data collection, variance in methodological assumptions and rigor, mistrust between professional groups, and wide differences in regulatory and educational context contribute to an incomplete understanding of workforce supply and demand.” Click here for their 59-page report.
Health Employment Up Last Month; Prices Up Slightly
New reports from Altarum Institute last week painted an interesting health care economics picture. In January, health care employment rose 23,000, just below the two-year average, driven largely by a 28,000 job gain in ambulatory care and an 8,000 job decline in nursing and residential care (click here for the 4-page jobs summary). Meanwhile, health care prices were up 1.7% in December 2012 from the same month a year earlier, the lowest year-over-year increase since 1998 (click here for the health care prices summary). And health spending in December 2012 rose 4% from December 2011, slightly below the 4.3% increase recorded for all of last year (click here).
Fast Food Obesity Strategies Paying Off: Study
Some major fast food chain restaurants are offering more lower-calorie options, and they are performing better financially than those that are not, according to a report out last week from the Hudson Institute. The report, which studied menu items, sales and foot traffic in 21 major fast food and sit down restaurants, found that from 2006 to 2011, lower-calorie items had crept up to 37.5% of servings. Click here for the 8-page report.