262 Hospitals Make Healthgrades 2013 List

262 hospitals were selected by Healthgrades as the top 5% of hospitals for clinical excellence in 2013, according to an announcement last week.  Click here to see which hospitals are on their clinical excellence list.  Healthgrades also selected the top 50 and top 100 best hospitals in 2013, based on the number of years a hospital has been selected by Healthgrades.  Click here to review those lists.

ACOs Rapidly Growing Nationwide: New Report

There were 428 commercial and Medicare accountable care organizations across 49 states as of January, according to a report issued last week, and physician groups now outpace hospitals as the main supporters behind the organizations. Consulting firm Leavitt Partners predicts that if ACOs see success in the coming years, the framework could become the main care model in the U.S. The report includes a state-by-state look at the number of ACOs and a hospital referral region by ACO map.  Click here.

Final Essential Health Benefits, Actuarial Value Regs Released

HHS last week issued final rules for Essential Health Benefits.  By January 1, 2014, EHBs are required to be included in all non-grandfathered health insurance coverage sold in the individual and small group markets inside and outside the Exchanges. These health plans must also meet actuarial value (AV) levels of coverage as distinguished by bronze (60 percent), silver (70 percent), gold (80 percent), and platinum (90 percent) AV levels. AV is defined as the percentage paid by a health plan of the total allowed cost of benefits. An excellent 4-page summary prepared by our health policy team can be downloaded by clicking here.  Click here for a very good CMS summary of the consumer protection components of the rule.

Age-Band Insurance Reg Could Hit Young Hard

HHS’ final rule released last week regarding Essential Health Benefits also locked in a provision that limits the premium an older person can be charged to no more than three times what a younger person is paying for the same policy.  America’s Health Insurance Plans warned last week that the 3:1 age band will drive up costs for young people. It says the rating change will drive up premiums by 29 percent for people in their 20s, 19 percent for those in their 30s, and 4 percent for those in their 40s. HHS said it did not have the legal authority to change the requirement contained in the Affordable Care Act.  Click here for a new one-page graphic explaning the issue.

Companies With Young Employees May Opt Out

Meanwhile, federal and state officials and consumer advocates have grown worried that companies with relatively young, healthy employees may opt out of the regular health insurance market to avoid the minimum coverage requirements.  Click here for the NY Times story.

Double-Digit Insurance Rate Increases Drop Significantly 

The number of double-digit rate increases requested by health insurers has plummeted over the past four years, according to a report from the Obama administration last week.  Researchers reviewed data available from the 15 states that publicly post all requests for rate increases in the individual market.  Click here for the story.

White House Releases State-by-State Sequestration Cuts

It appears almost certain that the federal budget sequestration law will go into effect March 1.  Medicare takes a 2% cut.  Medicaid is exempt.  Defense and other programs are cut substantially more.  Overall, about $85 billion would be cut from federal spending by October 1.  The White House released a state-by-state impact last night.  Click here to see the cuts in your state.

Fewer Physicians Adopting EHR: Study

One in 6 U.S. physicians are making sufficient use of EHR systems to attest to meaningful use, according to a study in the New England Journal of Medicine released last week. Researchers said costs and productivity concerns play roles in low EHR adoption rates. There are still some physicians who haven’t started using electronic health records at all.  Click here for the story.

MLR Insurance Reg Released

CMS last week issued a proposed rule that requires a Medical Loss Ratio (MLR) of at least 85 percent for the Medicare Advantage (MA) and the Medicare Prescription Drug Benefit (Part D) programs. CMS proposes to determine the MLR by the percentage of contract revenue spent on clinical services, prescription drugs, quality improving activities, and direct benefits to beneficiaries in the form of reduced Part B premiums. If this percentage amounts to less than 85 percent of total revenue, the MA organization or Part D sponsor will remit payment to CMS. A detailed 3-page summary from our health policy team can be downloaded here.

Medicare, Medicaid Spending Growth Expected to Decline More: CBO

Medicare and Medicaid spending are expected to continue to decline by a cummulative 3.5 percent over the next ten years, according to an updated report out last week from the Congressional Budget Office. Based on a variety of factors, spending will be up slightly in 2013, then increase a small percentage each year through 2022.  To review an easy read of this issue from the CBO, click here.

Leapfrog: Elective Delivery Rate Falls Again

The national rate of early elective deliveries dropped for the second year, according to the Leapfrog Hospital Survey.  Early elective deliveries – performing elective inductions or cesarean procedures prior to 39 completed weeks gestation without medical necessity – have been decreasing since 2010. This year, 46% of the 773 reporting hospitals met Leapfrog’s early elective deliveries target rate of less than 5%, an increase from 39% in 2011. Click here for additional details.

Rural Teens Have Babies at Higher Rate

Teenagers in America’s rural areas are more likely to have babies than their urban peers.  A new report from the National Campaign to Prevent Teen and Unplanned Pregnancy finds that even though teenagers living in rural counties make up just 16 percent of the total population of teenagers, they account for one in every five teen births. Click here for the 6-page report.

More GOP Governors Embracing Medicaid Expansion

Now at least 8 states run by GOP governors are looking to expand Medicaid in 2014 under provisions in the Affordable Care Act, according to reports last week.  Virginia appears to be the latest, with the state legislature working on an expansion deal now – despite objections from the governor.  Click here for the national overview from the NY Times.  Click here for the Virginia story.  Click here for a state-by-state map.

Illinois to Test New Duals Model

HHS announced last week that the State of Illinois will partner with CMS to test a new model for providing Medicare-Medicaid enrollees with a more coordinated, person-centered care experience.  Under the Medicare-Medicaid Alignment Initiative, Illinois and CMS will contract with health plans to coordinate the delivery of and be accountable for all covered Medicare and Medicaid services for participating Medicare-Medicaid enrollees.  Click here for details.

List of 90 Medical “Don’ts” Released

A coaliton of physicians and consumer groups last week released an updated list of medical “don’ts” — for example, don’t use feeding tubes in patients with advanced dementia. Don’t use drugs to aggressively treat diabetes in those older than 65. Don’t automati­cally use imaging technology for minor head injuries in children and headaches in adults. And don’t give antacids to babies with reflux.  They are trying to discourage the use of tests and treatments that have become common practice but may cause harm to patients or unnecessarily drive up the cost of health care.  Click here for the list.  Click here for the Washington Post story.

$300 Million Awarded to Half the States for Delivery Model Improvements

The government will award nearly $300 million to 25 states to improve healthcare delivery, according to an announcement last week.  The awards are intended to provide flexibility and support to states to help them deliver high-quality healthcare, lower costs and improve their health system performance.  CMS said there are six Model Testing, three Model Pre-Testing, and 16 Model Design Awardees.  Click here for details, including the list of states.

FDA OKs New Late Stage Breast Cancer Drug

The FDA last week approved a new drug made by Swiss drugmaker Roche Holding AG for some patients with late-stage metastatic breast cancer who fail to respond to other therapies.  The FDA said it had approved Kadcyla, also known as ado-trastuzumab emtansine, for patients whose cancer cells contain increased amounts of a protein known as HER2. Click here for the FDA announcement.

Drug Overdose Deaths Increase 11th Straight Year

Drug overdose deaths increased for the 11th consecutive year in 2010, according to an analysis from the CDC.  Fatal drug overdoses have increased for the 11th consecutive year in the United States, new data show.  According to a research letter published Tuesday from the National Center for Health Statistics, 38,329 people died of drug overdoses in the United States in 2010, an uptick from the previous year and the latest sign of a deadly trend involving prescription painkillers. Click here for the JAMA article.

More Americans Have Government Based Insurance: Gallup

The percentage of Americans with employer-based health insurance remained unchanged in 2012, but more Americans have government-based coverage, according to a Gallup poll released Friday.  44.5 percent of Americans said they had coverage at work — unchanged from 2011, but down from 2008-10 levels.  Another 25.6 percent said they had government-based coverage, such as Medicare, Medicaid or military or veterans care. That’s up from 23.4 percent four years ago. Click here for the Gallup poll.

For additional health policy updates, including recent summaries of other CMS regs, click here.

This weekly report is a service of Strategic Health Care.