Moody’s Downgrades Record Amount of Not-For-Profit Healthcare Debt

Moody’s Investors Service downgraded a record $20 billion in US not-for-profit healthcare debt in 2012. This is an increase of 213% from the $6.4 billion downgraded in 2011, and the highest amount of downgraded debt in one year in the sector since the rating agency began tracking the metric in 1995. Three large health systems were responsible for the majority of the downgraded debt as downward revisions in ratings for Catholic Health Initiatives in Colorado, Dignity Health in California, and New York’s Memorial Sloan-Kettering Cancer Center comprised nearly $13 billion of the $20 billion, according to Moody’s. Click here for the Moody’s report.

Half the States Want Feds to Run Health Exchanges

It now looks like half the states have opted to let the federal government run their health exchanges. Friday’s deadline for states to announce their final intentions saw New Jersey, North Carolina, Tennessee, Ohio, Virginia and Mississippi opt against operating their own.  26 states will let the feds run their state exchanges, which is ironic considering some of the most conservative state governments will let federal agencies set the rules in their states. Click here for the USA Today story. Click here for a better Wall Street Journal story, but it may require a fee. For a very good update on exchanges, the government official who oversees the implementation testified before Congress on Thursday, his testimony is here.

Dems, GOP Produce Budget Sequestration Plans

It’s a two week countdown to budget sequestration, which takes effect March 1. It contains about $85 billion in cuts this year and just over $1 trillion in cuts over 10 years. Congress is on recess this week. Senate Democrats announced last week that they have plans to implement some cuts and tax increases, rather than go through sequestration this year (click here to review their plan.) The House GOP sequestration plan isn’t given much of a chance (click here to review.) House Democrats tried turning up the heat on the GOP, they sent a letter to a committee chairman asking for a public hearing on the impact of sequestration (click here.) Most observers in Washington now believe sequestration will happen (click here for a Washington Post summary of the impact.)

340B Drug Discount Program Attacked by Pharma Report

The drug discount program for hospitals (340B) was under attack last week by big pharma. A group of pharma organizations issued a report calling into question hospital eligibility criteria, the “uncertain” safety net status of some hospitals, and the definition of “patient” for 340B use. The 26-page report made a series of recommendations for changes to the program. Click here for a copy of the report. Here’s how the 340B provider coalition responded, click here.

Fed’s Pre-Existing Condition Insurance Plan to Stop Enrollment

The federal government’s Pre-Existing Condition Insurance Plan, the presently covers more than 100,000 persons, is now out of money, according to government officials late last week. That means new enrollments will be stopped, as early as today in some states. Those currently enrolled will not be impacted. Click here for the story.

Hospital Readmit Progress Slow: Robert Wood Johnson Foundation

A report out last week from the Robert Wood Johnson Foundation shows that hospitals and their community allies made little progress from 2008 to 2010 reducing hospital readmissions for elderly patients. The report also chronicles a series of in-depth interviews with patients and providers that shed light on why patients end up back in the hospital and what hospitals, doctors, nurses, and others are doing to limit avoidable readmissions. Click here for the report.

New Proposed Regs Outline Individual Mandate Requirements, Enforcement

The HHS and IRS have released two proposed rules outlining specifics on the shared responsibility provision of the Affordable Care Act that requires individuals to either purchase basic health coverage, qualify for an exemption, or make a shared responsibility payment on their federal tax return. Starting in 2015, individuals filing a tax return must report which members of their family (including themselves) are exempt from the shared responsibility provision. The proposed rules describe the process for applying for exemptions and identify specific eligibility standards, such as unaffordability of coverage, limited periods of non-coverage, and the religious conscience exemption. Our policy team has prepared an excellent three-page summary. Click here.

CMS Proposes Changes to Medicare Advantage Program

Since the Affordable Care Act was passed in 2010, Medicare Advantage premiums have fallen by 10% and enrollment is expected to increase by an estimated 28% through this year, according to a CMS announcement Friday. Additionally, costs of the defined standard Part D plan will be lower in 2014 than they are in 2013. The standard Part D deductible will be $310, down from $325 in 2013, and cost-sharing amounts will also be lower. CMS issued an updated notice and draft Call Letter to Medicare Advantage plans with numerous changes they say will increase beneficiary protections. Click here for the detailed CMS announcement.

Physician Sunshine Regs Out; New Summary Available

HHS has issued a final rule requiring physicians and teaching hospitals to submit annual reports to the Secretary detailing certain payments and gifts they receive from pharmaceutical and medical companies. The rule details which entities are subject to reporting, what must be included in these reports, and under what circumstances payments and transfers of value must be reported. An excellent four-page summary from our policy team can be read here.

Physicians Struggle With Medical Devices They Question; Major Court Case Underway  

A court case underway in Los Angeles highlights some of the difficulties physicians have in changing or stopping the use of medical devices they question, according to a report last week in the New York Times. The case centers around a specific hip replacement technology that was eventually recalled. More than 10,000 patient lawsuits are pending. Click here.

MACPAC Recommends Two Policy Changes to Congress

The Medicaid and CHIP payment commission to Congress, MACPAC, met last week and voted unanimously on two recommendations to Congress in its March report. The first recommendation urges Congress to provide statutory authority for 12-month continuous eligibility for children enrolled in CHIP and adults enrolled in Medicaid. The second recommendation asks that Congress permanently fund current transitional medical assistance for Medicaid enrollees. Under this recommendation, states would have the option to opt-out of TMA if they expand coverage to new Medicaid-eligible adults. Click here to see the MACPAC hearing agenda. They meet again in April.

SGR Fix Focus of House Hearing

A lot of activity last week surrounded the effort to fix the Sustainable Growth Rate formula used to calculate physician payments for Medicare. The Energy & Commerce Committee held its first formal hearing vowing to repeal it this year. Click here for their three-page proposal. Still no solution to cover the $138 billion cost. Click here if you want to read a good summary on why this continues to be such a difficult problem to solve. Click here for the GOP’s one-page summary of the hearing.

Study: More Beds Mean More Use and Higher Costs

A new Michigan State University study finds more hospital beds lead to more utilization and likely higher costs, reinforcing support for certificate-of-need programs to regulate new hospital facilities. Researchers looked at more than 1 million admissions at nearly 170 hospitals in 2010 in Michigan, a state that requires new hospitals to acquire certificate-of-need approval, the controversial regulation designed to avoid duplicate services in one area. Click here for more.

Hospital Infections Down: CDC

Hospitals appear to be making meaningful progress on reducing certain healthcare associated infections, according to an updated report out last week from the CDC. This includes a 41% reduction in CLABI and 17% decrease in surgical site infections. Click here for the update.

More Managing Diabetes Better: Study

More people are meeting recommended goals in the three key markers of diabetes control, according to a study conducted and funded by the NIH and CDC. The report, published online Friday in Diabetes Care, shows that, from 1988 to 2010, the number of people with diabetes able to meet or exceed all three of the measures that demonstrate good diabetes management rose from about 2% to about 19%. Each measure also showed substantial improvement, with over half of people meeting each individual goal in 2010. Click here for the NIH report.

Nurses Union Joins Bigger Union

The National Federation of Nurses (NFN) is joining the American Federation of Teachers (AFT), according to their announcement last week. AFT will add the nurses union’s 34,000 members to its ranks. It already has 48,000 nurses among its membership. The union currently has 1.5 million members, including physicians, medical researchers, psychologists and other health care workers. The NFN is active in Montana, Ohio, Oregon and Washington state. Click here for the NFN release.

Obama Wants Drug Companies to Negotiate Prices with Medicare

The Obama Administration has a plan that would require drug companies to provide Medicare with discounts like those they now give to Medicaid. Specifically, the proposal would reduce federal payments for drugs used by low-income Medicare beneficiaries, including nine million people who are eligible for both Medicaid and Medicare. According to a report last week in the NY Times, the initiative has significant opposition and chances of passage are slim. Click here. The Institute of Medicine is out with a report detailing the problems with falsified and substandard drugs. Click here.

Medicare Fraud Enforcement Nets Huge Return: DOJ, HHS

For every dollar spent investigating Medicare fraud and abuse in the last three years the federal government recovered $7.90. That return on investment is the highest three-year average in the 16-year history of the Health Care Fraud and Abuse Program, federal officials announced last week. A joint initiative of the Department of Justice and HHS said that the government recovered $4.2 billion in fiscal 2012 and $4.1 billion in fiscal 2011. A total of 826 defendants were convicted of health care fraud-related crimes during the year.  Click here to see the 99-page report.

Group Purchasing Report Praises GPOs

The Healthcare Group Purchasing Industry Initiative last week released its seventh annual Report to the Public, which found that group purchasing organizations consistently maintain high ethical standards and business practices that promote innovation, transparency in the bidding process and compliance. Three former members of Congress oversaw the review process and presented the findings to Capitol Hill staff. Click here for the 63-page report.

Flu Waning: CDC

The flu level across the country appears to be waning, according to the CDC. Click here for a very good interactive map that shows flu levels state-by-state.