Sequester Cuts Hit Cancer Treatments Hard

Medicare sequester cuts are threatening patient access to cancer treatment, lawmakers and advocates warn as they prepare to lobby the White House to spare cancer clinics, according to reports last week. Already thousands of Medicare patients have been turned away from clinics since the cuts took effect April 1. Will Congress fix it? Click here for the report.


House GOP Has Updated Plan to Fix Physician Medicare Payments

Providers have until April 15 to comment on a revised House Republican proposal for repealing Medicare’s sustainable growth rate (SGR) physician payment formula, which has required an annual “doc fix” by Congress for the past several years. The draft plan would replace SGR with more “predictable, statutorily-defined” payments based partly on patient experience and development of quality and efficiency measures that evaluate physicians’ performance. Lawmakers don’t say how they would pay for the change. Their goal is to get legislation to the House floor by summer. Click here to read the revised plan  with details on how to send comments.


New, Big Loophole for Insurers in Obamacare?

A new fight is brewing over health insurance companies letting millions of Americans renew their current coverage for another year, and thereby avoid changes under the federal healthcare law. Some of the nation’s biggest health insurers are looking to take advantage of this delay, and Arkansas officials are encouraging companies to do this by resetting customers’ renewal dates for the end of December. There’s also concern that some insurers and agents could rush to sell more individual policies before year end so they could be extended in 2014. Click here for the LA Times story.


Federal Navigator Rules Published

CMS released a proposed rule last week outlining standards that Navigators in Federal and State Partnership exchanges must meet, and clarifying earlier guidance about the Navigator program. Navigators are organizations that will provide unbiased information to consumers about health insurance, health exchanges, qualified health plans, and public programs including Medicaid and the Children’s Health Insurance Program. Click here for the CMS press release and link to the regs.


SHOP Program Delayed One Year for Federal Exchanges

The Small Business Health Options Program is supposed to provide small employers with an insurance marketplace, or exchange, that offers multiple plan options starting in 2014. But last week HHS proposed that for the first year, businesses that use the 33 state exchanges run fully or in part by the federal government, will be able to offer only one plan to their employees, rather than pick from a range of options. The 17 states running their own exchanges under the law could choose to enact a similar delay for 2014. Click here for the NY Times story. Click here for an interesting take from the Washington Post.


New Community Health Needs Assessment Rules Released by IRS

Hospitals received some much needed and requested flexibility from the IRS in proposed regs out last week that specify the requirements for a Community Health Needs Assessment. The severest penalties appear to only hit hospitals that intentionally refuse to conduct a CHNA. Under certain parameters, hospitals are allowed to coordinate their efforts with other hospitals and community organizations and share identical components of their reports. Click here to read the 96-pages of regs.


MedPAC Suggests Significant Payment Changes for LTCHs, Chronically Critically Ill

The Medicare Payment Advisory Commission (MedPAC) last week suggested changing the payment system chronically critically ill patients, a policy change that could have a profound impact on Long Term Care Hospitals (LTCHs). While making no formal recommendations, MedPAC staff said it would continue refining various payment models and determine the impact. Recommendations could come in the fall. Click here for MedPAC’s slide presentation.


ACOs Concentrated in Major Managed Care Markets: MedPAC

MedPAC last week reviewed a staff presentation on ACOs that updated the commissioners on the number and location of Pioneer and MSSP ACOs, and highlighted their common features and differences in payment. The presentation also compared ACOs’ and Medicare Advantage plans’ comparative market advantage and strengths and weaknesses. MedPAC staff research has found that ACOs are concentrated in markets with higher potential for managed care gains. Click here for a copy of the very good powerpoint slides used by MedPAC in this presentation.


CAHs Have Higher Mortality Rates in Certain Measures: Study

The nation’s critical access hospitals have higher mortality rates on several key measures than urban and rural hospitals without the special designation, and the trend steadily worsened over the past eight years, according to a new study by Harvard researchers. Click here to go to the JAMA report.


Dementia Costs Higher Than Cancer, Heart Disease: Study

The most rigorous study to date of how much it costs to care for Americans with dementia found that the financial burden is at least as high as that of heart disease or cancer, and is probably higher. And both the costs as well as the number of people with dementia will more than double within 30 years. Click here to read the study in the New England Journal of Medicine. Click here for the NIH one-pager. Click here for the NY Times report.


Gallup: Medicaid Patients Have Worse Health Problems

A new Gallup poll details how Medicaid enrollees are much more likely to be depressed or have asthma, diabetes and higher rates of obesity and high blood pressure. The poll released last week shows adults on Medicaid have worse health problems than people with employer or union coverage. Click here for the poll.


$12.6 Billion Spent on Meaningful Use Health IT Incentives

The government has paid about $12.6 billion in health IT Meaningful Use incentives to providers through February, according to an updated CMS report. 234,065 Medicare and Medicaid providers received payments. The agency also found that 3,781 of the 5,011 eligible hospitals were paid from either the Medicaid or Medicare portions of the initiative, and some were paid from both. Click here for the report from CMS.


Bill Would Exempt Small Practices from Meaningful Use

A new bill, the Electronic Health Records Improvement Act, has been proposed by Rep. Diane Black, R-Tenn., with the aim of amending Meaningful Use (MU) requirements for Medicare providers. The bill would provide exemptions for small practices and doctors who are nearing retirement, and would allow some providers to participate in specialty registries instead of reporting on the nine clinical quality measures required for stage 2 MU. Click here for the text of the bill.


MA Plans Get 3.3% Increase in 2014

Medicare Advantage health plans will get a payment increase of 3.3% next year, according to a CMS announcement. It’s a reversal of a proposed 2.3% cut. CMS is making other changes to Part C and Part D. Click here for details.


Senator Investigating Leak of MA Payment Announcement

Did someone within CMS tip off Wall Street before the agency’s announcement that it was reversing a previous position and now planning to increase the payment rate to Medicare Advantage plans last week? Sen. Chuck Grassley, R-Iowa, is demanding that CMS turn over details of when it made its decision on the final Medicare Advantage rates and who knew about the decision. Grassley made the demands because of intense trading on insurance stocks before the markets closed last Monday, about 45 minutes before the regulation was announced. Click here to see Grassley’s letter to CMS.


States Spending Less on Public Health

A new report details how states are spending less and less on public health. Twenty-nine states decreased their public health budgets from the 2010 to 2011, fiscal year to FY 2011 to 2012, according to the new report from Trust for America’s Health and the Robert Wood Johnson Foundation. Per capita state spending on public health decreased from $33.71 to $27.40 between the 2008 and 2012 fiscal years, amounting to a $1.9 billion cut when adjusted for inflation. Click here for the report. For an excellent state by state interactive map, click here.


CDC Issues New Bird Flu Warning 

A deadly outbreak of a new kind of bird flu has now sickened 16 people in China and killed six, but CDC officials last Friday cautioned that there’s no cause for widespread alarm. Click here for the story. Click here to read the CDC’s media transcript with CDC Director Tom Frieden from Friday.


House GOP Bill Would Cut Political Money to Fund NIH

Looking for new funding, Reps. Tom Cole, R-Okla., and Gregg Harper, R-Miss., will introduce legislation to end federal funding of political campaigns and conventions, redirecting the money to research at the NIH, according to House Majority Leader Eric Cantor, R-Va. The proposal would add $200 million to the NIH budget, which was cut by $1.6 billion under the sequester. Click here for more.


New Rule, When Issued, Would Raise Pay for In Home Healthcare Workers

A White House review of a rule that would give in home healthcare workers the same opportunities for minimum wage and overtime as traditional workers is nearing completion. Union groups have been pushing for the equal pay standards for years, saying that in home healthcare workers are severely underpaid. Industry and disability groups counter that a wage increase would make caretaker rates unaffordable and force layoffs in a sector that thrived during the economic downturn. Click here for the story.


Hypertension on the Rise: CDC

CDC officials reported last week that patient-reported hypertension in the U.S. showed an almost 10% increase from 2005 to 2009, when more than 28% of study participants said they had the condition. Researchers reported 62% of hypertension patients in 2009 said they used medication to manage the condition. Click here for more from the CDC.


20% of Teen Births are a Repeat: CDC

A CDC report revealed that nearly 67,000 of the 365,000 15-to19-year-olds who gave birth in 2010 had at least one child before, with American Indian/Alaska Natives recording the highest rates and whites the lowest. The study found the rate of repeat teen births decreased by more than 6% between 2007 and 2010. Click here for the CDC report.


Feud Between Hospitals, RACs Continues

Tensions between hospitals and Recovery Audit Contractors are rising, according to published reports. Part of the rift is over legislation introduced in Congress to reign in RACs. Click here for the story.


Big Gamma Knife Payment Cuts Started Last Week

Users of the Gamma Knife radiation therapy system from Elekta are now being paid 58% less for procedures performed with the system, a change that began April 1. The cut is the result of legislation passed last year by Congress, which reduced Gamma Knife payments for Medicare patients from approximately $8,100 per procedure to $3,400. Click here for more.


NIH Increases Autism Funding

NIH last week awarded $5.3 million in initial one-year funding to the latest two recipients of the Autism Centers of Excellence (ACE) program, both in California. These and nine other ACE centers around the country are now being funded for up to five years. The program was created in 2007 to launch an intense and coordinated research effort aimed at identifying the causes of autism spectrum disorders and finding new treatments. Click here for more from NIH.