Nearly $1 Billion in Grants for Health Reform Initiatives

HHS last week announced a nearly $1 billion initiative that will fund awards and evaluations to build on the Obama administration’s work to transform the health care system by delivering better care and lowering costs. HHS estimates that 100 awards will be granted ranging from $1 million to $30 million. Strategic Health Care and Innovation Funding Partners are working together to help interested organizations apply, with seasoned grant writers providing an array of services. Click here for funding details. For more information from CMS, click here. If you have an interest in learning more about our services, email me at Paul.Lee@shcare.net and will will schedule a call to discuss.

CMS Wants More Hospital Bundled Payment Applicants

CMS has also reopened its invitation for hospitals to apply to its Model 1 of the Bundled Payment for Care Improvement initiative. The invitation said testing on Model 1 started in April, about 18 months after CMS first asked for applications. CMS is accepting intake forms until August. Click here for the brief announcement.

CMS Issues DSH Payment Cut Regs

CMS last week issued proposed regs to implement the disproportionate share payment reductions required as part of the Affordable Care Act. CMS did not “punish” states that have not yet expanded their Medicaid programs. The law requires a $500 million reduction. Arkansas has the highest reduction at 7.14% and Delaware loses the least at just 0.5%. Click here to see how your state is impacted. Click here for the regs.

House Votes to Repeal ObamaCare…Again

For the 37th time the House voted last week to repeal, in whole or in part, the Affordable Care Act. Click here to read about why it matters. Interestingly, the Congressional Budget Office was not able to complete a cost estimate for the House bill to repeal the health law. But CBO Director Douglas Elmendorf said he expects the last estimate, that repeal would increase budget deficits by $109 billion over 10 years, “is about right.”

Exchanges May Reduce Insurance Rates

It’s still too early to tell for sure, but state health insurance exchanges (marketplaces) may actually push down insurance rates, based on what’s already happening in Oregon.  On Thursday, a comparison of proposed 2014 health premiums became public online, causing two insurers to request do overs to lower their rates even before the state determines whether they’re justified. Click here for the report.

House GOP Wants More Answers on Exchange Navigators

Two senior Republicans on the House Ways and Means Committee wrote to HHS last week asking several questions about how new health insurance navigators will be trained and whether they’ll adequately protect private health information. Reps. Kevin Brady (R-TX) and Charles Boustany (R-LA) asked HHS to detail how the agency will make sure the enrollment form complies with the HIPAA and how it will safeguard insurance information on federal and state-run exchanges. Click here for a copy of the letter.

20% of Americans Will Be Excluded from Medicaid for 10 Years: CBO

CBO estimates that one in five Americans who would be eligible for Medicaid expansion based on income will be excluded, because they live in states that aren’t expected to support expansion within the next 10 years. By contrast, about 70% of newly eligible Medicaid beneficiaries will live in states that fully embrace expansion and another 10% will live in states that partially expand Medicaid, according to CBO. Click here for the CBO report.

New Jersey Hospital Has Highest Medicare Charges

Based on bills submitted to Medicare, the most expensive hospital in the country is in New Jersey just a few miles from New York City, this is according to a report last week in the New York Times. Click here to read the story and see the list of the 10 hospitals that charged the most.

There Are Many Reasons Why a Hospital Charges Medicare So Much

There are reasons why hospitals charge so much to Medicare and they are complicated, according to a Washington Post report last week. The amount of charity care provided by a hospital is just one reason. Click here.

CMS Releases Final MLR Rule

CMS last week released a final rule detailing how it will implement regulations requiring Medicare Advantage and Part D plans to spend at least 85% of revenue on patient care.  The medical loss ratio provisions were included in the federal health care law. The agency modeled the Medicare MLR policy after the rules governing the MLR of commercial plans. If an MA organization or Part D sponsor fails to meet MLR requirements for more than three consecutive years, they will also be subject to enrollment sanctions and, after five consecutive years, to contract termination. Click here for the 118-page final rule.

MedPAC Chief Says Doc Payment Formula Must Be Repealed ASAP

MedPAC’s executive director Mark Miller told the Senate Finance Committee last week that the physician Medicare payment formula is in desperate need of repeal. Click here for his very informative testimony. He said rates paid to primary care physicians must be increased, and the current formula has failed to restrain volume growth and may have exacerbated it. The CBO last week said the cost of repeal is about $139 billion. The House Ways and Means Committee holds a hearing Tuesday on ways to reform Medicare.

Senators Moving New Compounding Bill

A bipartisan group of senators on the HELP Committee last week introduced a bill to increase FDA regulation of compounding pharmacies. The Pharmaceutical Quality and Accountability Act, based on a draft proposal released last month, creates a new category of drugmaker called a compounding manufacturer, that will be regulated by the FDA according to new standards to be developed by the agency. The bill also identifies categories of drugs that are unsafe to compound and prohibits the wholesale distribution of compounded drugs. Click here for a copy of the bill.

Docs, Nurses Don’t Agree on Roles: NEJM

Physicians and nurse practitioners don’t agree about their respective roles in the delivery of primary care, according to a new study in the New England Journal of Medicine. Physicians reported working longer hours, seeing more patients, and earning higher incomes than did nurse practitioners. Nurse practitioners were more likely than physicians to believe that they should lead medical homes, be allowed hospital admitting privileges, and be paid equally for the same clinical services. Click here for the abstract.  Click here for the Kaiser News summary.

89 Busted for Medicare Fraud

Attorney General Eric Holder and HHS Secretary Kathleen Sebelius announced last week that federal authorities have charged 89 people, including doctors and nurses, in eight cities (Miami, Baton Rouge, Chicago, Houston, Brooklyn, Los Angeles, Detroit and Tampa) for participating in Medicare fraud schemes totaling about $223 million. It marks the sixth Medicare fraud “takedown” for the Medicare Fraud Strike Force. Its operations since 2007 have resulted in charges against more than 1,500 people for schemes of more than $5 billion in fraud. Click here for the Justice Department announcement.

Lower Income Smokers May Not Be Able to Get Coverage

Although the Affordable Care Act is supposed to make it easier for lower income Americans to get health coverage, a new report says that low income smokers could make coverage unaffordable. Under the health care law and federal rules, premiums for health plans sold directly to individuals and small businesses can cost up to 50% more for a person who has used tobacco an average of four or more times per week within the past six months. Click here for the report from Families USA.

Senate GOP Wants More Answers on HHS Solicitations

Following reports saying HHS Secretary Kathleen Sebelius solicited funds from health care executives to assist with the implementation of the Affordable Care Act, Senate Finance Committee Republicans sent a letter asking for a review of the Department’s decision to move forward with the initiative. It has raised a variety of legal questions under federal regulations that prohibit the augmentation of congressional appropriations. Click here to read the letter.

Tavenner Confirmed as CMS Chief

The U.S. Senate last week voted 91-7 to install Marilyn Tavenner as the first confirmed CMS administrator since 2006. Tavenner is a former health system leader and nurse and was secretary of health and human resources in Virginia. She has served as the acting administrator since December 2011. Click here for more.

ICU Admissions from ED Rose Sharply

Intensive care admissions from the emergency department rose by nearly 50%, from 2.79 million in 2002-2003 to 4.14 million in 2008-2009, according to a study out last week. Of all the ED patients, those aged 85 and older had the highest increase in the rate of ICU admissions. Click here for a summary of the study in the journal Academic Emergency Medicine.

Dental Issues Causing More ED Visits

Nearly one in five (18%) lower-income adults have reported that they or a household member has sought treatment for dental pain in an emergency room at some point in their lives, compared to only 7% of middle- and higher-income adults. This is according to a new report from the American Dental Association. Only 6% of those low-income adults who went to the emergency room reported that the problem was solved. Click here for the report.

Retiree Medical Costs Down: Fidelity

According to a report out last week from Fidelity Investments, an annual update of retirees’ medical costs, its estimate of those expenses for a 65-year-old couple has dropped by about $20,000. Click here for the report.

CDC: More Kids Having Mental Disorders

According to a new study out last week from the CDC, as many as one in five children experience a mental disorder each year. In the CDC’s first-ever study on the issue, mental health issues in children cost about $247 billion a year, and recent research shows an uptick in mental health and substance abuse admissions among children. Boys have higher rates of suicide while girls are more prone to alcohol abuse and depression. Click here for more from the CDC.

More TBIs Increase Suicide Risk

A new JAMA Psychiatry study finds that suffering more traumatic brain injuries increases the risk of suicide. TBI is common in members of the military stationed in Afghanistan and Iraq. The study found that members of the military with multiple TBIs have more severe symptoms of depression and post-traumatic stress syndrome. And the more TBIs a member of the military sustains, the more they may be in danger of committing suicide. Click here for the abstract.

More Pregnant Teen Girls Have Substance Abuse Issues

A new government report shows that among the approximately 57,000 teenage females (ages 12 to 19) suffering substance abuse treatment admissions each year, about 2,000 (4%) involve pregnant teens. The Substance Abuse and Mental Health Services Administration’s report finds that these pregnant teen admissions tend to face greater challenges than other female teen admissions in a number of key areas such as financial and educational status. Click here for the SAMHSA report.