Obama, GOP Could Be Close to Agreement on Major Medicare Changes

President Obama has reportedly told House Republicans that he is open to combining Medicare’s coverage for hospitals and doctor services, Part A and part B, according to a NY Times report late last week. That would create a single deductible that could increase out-of-pocket costs for many future beneficiaries, but also could pay for a cap on their total expenses and reduce the need to buy Medigap supplementary insurance. However, the same problem against moving forward continues, the Administration won’t agree to fundamental Medicare changes until the GOP agrees to higher taxes on the wealthy and some corporations. Click here for the story.


White House FY14 Budget Could Have Entitlement Cuts

The White House plans to release its FY14 budget proposal next week, April 10. The budget is about two months late, and it may contain some major proposals including entitlement cuts, reductions and changes in Medicare, Medicaid and Social Security, according to published reports. Click here for a summary from the Washington Post.


Medicare Advantage Payment Cuts (Or Not) Could Be Announced Today

CMS is expected to announce as early as today whether it will cut payments to Medicare Advantage plans 2.3% as it had proposed last month. A large bipartisan group of lawmakers has written to the agency opposing the cuts. And late last week the Congressional Research Service issued a report that adds weight to the claim that the formula used to calculate the cut was flawed. Click here for the story.


Government’s Hospital Readmission Penalty Program Raising Questions

Hospitals and health policy experts are beginning to raise questions about the federal government’s readmission penalty policies, according to a NY Times report over the weekend. Some believe there are too many unanswered questions about what actually works best and whether there should be a focus on other ways to improve care. Click here.


OIG Warns About Physician Owned Distributorships

The HHS Office of the Inspector General last week issued a special fraud alert saying physician owned distributorships (PODs) are prone to violating anti-kickback law. OIG is worried about the rapid growth of PODs, and the alert states that some PODs might be corrupting medical judgment, causing unfair competition and overusing services. Click here for the four-page OIG report.


Medicare Spending Driving Federal Deficit: Heritage Foundation

The Medicare shortfall is the difference between the money the program brings in and the money it spends on health care benefits. Even assuming that unrealistic cost containment policies in current law are sustained by 2040, Medicare’s shortfall will account for 81% of the federal deficit. According to a Heritage Foundation report last week, addressing runaway federal deficits requires targeting Medicare. Click here for an excellent slide summary on the depth of the problem.


CMS Issues Guidance to States on the Use of Medicaid Expansion Dollars

First Arkansas, and now Tennessee and perhaps a number of other states are negotiating with CMS about using Medicaid dollars from the expansion to pay for private coverage for the poor. CMS on Friday issued two-pages of guidance to states on the issue. Click here to see the guidance. CMS has said it is willing to talk about it with states, but there’s a limit to what can be done with Medicaid, according to federal officials. Click here for the news report.


CMS Issues Final Rule on Medicaid Expansion

On Friday, CMS published a final rule establishing that the federal government will pay 100% of the cost of newly eligible beneficiaries under Medicaid expansion until 2016. Then it will begin phasing down to a permanent matching rate of 90% by 2020. The rule also explains the matching rate for populations in states that expanded Medicaid already. Click here for a copy of the 100-page rule. Click here for the CMS announcement. We will provide a summary to our clients later this week.


Xerox Report Outlines Eight Reforms for Medicaid

Speaking of major corporations’ involvement in health care reform, Xerox is out with a plan to states outlining eight key reforms to reign in Medicaid. Click here.


Rules for Federal Basic Health Plan Option to be Released This Year

HHS plans to release proposed rules for the federal Basic Health Plan Option this year and will issue final rules in the first quarter of 2014, HHS Secretary Sebelius wrote in a letter to Sen. Maria Cantwell (D-WA), who has vocally backed the program for more than a year.  Click here for a copy of the letter.


Move From Volume to Value Based Payment Structure Slow: New Report

Major corporations have been tracking the status of the private sector’s progress from volume to value based payment on a national and regional perspective. In a report out last week, they say only about 11% of payments to doctors and hospitals are value based. Click here for their report. Click here for a graphic two-page scorecard with good info. And how did all this get started? Click here for General Electric’s story.


Biggest U.S. Health Care Problem Now? Higher Prices

An analysis of health care prices from across developed countries by an international health plan association has noted health care economics expert Uwe Rheinhardt writing that it is the price we pay for health care as Americans, combined with lower utilization, that is one of the biggest problems we face. This is a compelling article, with graphs. Click here. For the complete health plan analysis on 2012 comparative pricing, click here.


Actuaries Sounding Alarm on Cost Increases for Individual Market 

A projection by the country’s leading actuaries has sparked another debate about how much Obamacare will increase health spending. The figure that’s gotten the most attention in a Society of Actuaries report last week is the projection that medical bills of people in the individual market will go up by an average of 32% nationwide. But there’s a huge variation among states. The projections for medical claims in states range from an 81% increase in Ohio to a 14% drop in New York. Click here for the report.


Special Needs Plans Enrollment on the Rise: Report

As of March 1, 2013 nearly 1.668 million people were enrolled in Medicare Special Needs Plans (SNPs) nationwide, up 18% over March 1, 2012. In 2003, Congress established SNPs to serve institutionalized beneficiaries, dual-eligible beneficiaries, and/or individuals with severe or disabling chronic conditions. Of the 644 SNPs authorized in 2013, 214 were Chronic or Disabling Condition SNPs serving 261,540 and 362 dual-eligible SNPs were serving 1,357,408 beneficiaries. Sixty-eight Institutional SNPs were serving 48,765 beneficiaries. UnitedHealth Group, the largest health plan in the U.S. based on enrollment, provides coverage for 24% of the people enrolled in SNPs and is the leading organization in the Special Needs market. Click here for the complete report.


New Website Identifies Specific Hospitals’ Inspection Reports

We reported this in last week’s newsletter, but thought it was worth repeating if you missed it. The Association of Health Care Journalists has put federal hospital inspection reports online, making them easier to access, search and analyze. This site includes details about deficiencies cited during complaint inspections at acute care and critical access hospitals throughout the United States since Jan. 1, 2011. It does not include results of routine inspections or those of psychiatric hospitals or long term care hospitals. It also does not include hospital responses to deficiencies cited during inspections. Click here to check out your hospital and your competitors’.


Obamacare at Three-Years-Old Still Facing Major Challenges

Obamacare turned three-years-old last week and it still faces some major obstacles. The Washington Post has done an excellent article outlining the challenges. This also includes some excellent graphs on where the states stand on Medicaid expansion and exchanges. Click here.


U.S. Chamber Asks Businesses to Vote on Most “Maddening” Health Care Regs 

Not to be left behind during March Madness, the U.S. Chamber’s health care policy team has determined the eight most maddening health care regulations for employers, especially small businesses. Which of these regulations do you think is the most maddening of all? Click here to see their brackets.


Gun Violence Driving Up Health Care Costs: Report

Firearm related deaths cost the U.S. health care system and economy $37 billion in 2005, the most recent year for which the Centers for Disease Control and Prevention attempted an estimate. The cost of those who survive gun violence came to another $3.7 billion that year, according to the CDC. The Huffington Post has a detailed article on the health care side of the gun control debate raging across the country. Click here.


Radiology Taking Major Reform Hits; Model Changing

Once the bastion of high pay and less than grueling work, radiology has taken a big hit in recent months as hospitals, payors and others reorganize the delivery of their services, according to recent reports. New technologies, like teleradiology where charts can be read remotely, are now shaking up the profession. Click here for the story.


Lumbar Spine MRI Overuse Cited as Significant Problem: Report

Lumbar spine MRI overuse is significant problem in Canada and likely the Untied States, according to a study out last week. Such scans make up one-third of all MRI scans in some regions and add considerably to healthcare costs. A quick Internet search of lumbar MRI scans in the U.S. revealed a range of between $1,700 to $2,175 each, and that’s without use of contrast agents. Overutilization of lumbar spine MRI scans for various manifestations of pain including radiculopathy or claudication, were seen as inappropriate 28.5% of the time, and of uncertain value in 27.2% of 1,000 requests studied. Only in cases where the symptom was postoperative back or leg pain was the scan deemed appropriate, which was in 95.8% of 167 cases. Click here for the study (may require a fee.)


New Online Medicare Chronic Conditions Dashboard Announced

A new Medicare Chronic Conditions Dashboard announced last week by CMS offers researchers, physicians, public health professionals, and policymakers an easy to use tool to get current data on where multiple chronic conditions occur, which services they require, and how much Medicare spends helping beneficiaries with multiple chronic conditions. Click here.


Scooter Ads Result in $1 Billion in Medicare Spending Each Year

Those scooter ads on TV and in other media are resulting in Medicare costs of about $1 billion each year, according to a report out last week. Much of those costs may be unnecessary and in many cases spent on persons not qualified to receive the benefit. Click here for the report.