Long-Term Physician Medicare Payment Reform May Not Happen This Year

House Republicans are working on legislation that would replace the Medicare physician payment formula (Sustainable Growth Rate, SGR) with a plan that would move to a pay-for-quality model. The difficulty is not with identifying new methodologies, but finding the right combination that will get enough votes to pass. Committee insiders are telling SHC they put the odds at less than 50% for this year. The current formula expires at year’s end, likely creating another short term fix scenario, as has been the case for many years now. Click here for an excellent 5-page SHC summary, including links to expert testimony and positions from committee members.

RAC Audits Up: AHA

Hospitals are facing an increase in Medicare recovery auditor (RAC) activity, including upswings in denials and medical record requests, according to an American Hospital Association survey. 91% of hospitals participating in the AHA’s RACTrac survey experienced RAC activity during the first quarter of 2013, slightly up from 90% in the prior quarter. Click here to see the survey.

OB/GYNs Tell Government to Stop Dictating Patient Conversations

OB/GYNs have apparently reached their limit on government officials telling them how to treat their patients. ACOG issued a policy statement last week against laws that require physicians to tell their patients certain things or perform certain procedures. This includes a ban on providers from talking to their patients about guns and gun safety; laws that tell doctors what to say to women about breast density and cancer risk; those that require outdated abortion treatment protocols; and those that require women to have ultrasounds and view the images before an abortion. Click here to see their one-page statement.

CMS Releases Detailed Hospital Outpatient Data

CMS last week released a new round of data last week showing a wide range in pricing between hospitals for the same outpatient procedures. The data highlights the gap between what hospitals charge and what Medicare actually pays. In total Medicare was charged $1.2 billion, but ended up paying $397 million. Click here for the CMS report.  Click here for a county-by-county file (it’s large.)

GOP Leader Pushes Funding for Pediatric Research

Legislation that would end federal financing of presidential campaigns and conventions and put the money ($13 million) into pediatric research for 10 years might make it to the House floor for a vote this week, according to reports. The second highest ranking House Republican is looking for ways for the government to finance additional medical research, but he could be at odds with many conservatives in his own party. Click here for the story.

Study: You Don’t Always Need Specialists to Increase Access, Quality

A new study by the Center for Studying Health System Change for the Commonwealth Fund evaluated efforts to increase access to specialty care among patients and found using telemedicine or physician assistants and primary care providers to deliver specialty care instead of specialists seems to give patients broader access to the services without compromising quality. The analysis included those enrolled in Medicaid in Connecticut, Illinois, Minnesota, New Mexico, Oregon and Tennessee. Each model showed the potential to be used in other states. Click here for the study.

House Moves Anti-Counterfeit Rx Bill

In an effort to control counterfeit pharmaceuticals, the House passed legislation last week that would establish new supply chain security measures. The Senate is moving similar legislation, but will not likely pass the same House bill. Click here for an excellent SHC one-page summary of the legislation.

Survey Says Many Cancer Docs Delaying Treatments Because of Shortages

According to a report out last week, shortages of medicines for some of the most common cancers have caused nearly half of doctors to delay treatment and forced about a third to choose between patients needing a particular drug. The findings from a survey of 250 cancer doctors highlight the anxious situation some of their patients have faced during the past year as manufacturing lapses and changes in the generic-drug industry have cut off supply of key medicines. Click here for the story. Meanwhile, CMS is telling cancer docs it has no authority to reverse the budget sequestration cuts that are reducing payments for cancer care. Click here.

RAND: 3 Million Won’t Be Covered Under Medicaid

More than 3 million Americans will miss out on health coverage if 14 states threatening to forgo Medicaid expansion follow through, according to a RAND Corp. analysis released last week. Those states will miss out on $8.4 billion a year in federal support. Click here for a RAND summary.

Right-Leaning States Looking at Medicaid Expansion Alternatives

It was a year ago this month the U.S. Supreme Court issued its ruling on the Affordable Care Act, and giving states the right to accept or reject the law’s Medicaid expansion was the most significant consequence of the ruling (after agreeing the law was constitutional). Although most politically right-leaning states have rejected expansion, many are looking at alternatives. Click here for a very good Health Affairs analysis of those possibilities.

More State Exchanges Announce Insurance Plans, Rates

There’s a new announcement almost every day from the state exchanges with the focus on which insurers are in each exchange and what they are charging consumers. At least three more states last week announced what insurers would be charging how much on their state exchanges. And the news is a mixed bag for the Obama Administration, which has been touting the encouraging news from the California exchange of lower-than-expected rates. Click here for the latest from Ohio (rates higher than expected). Click here for Michigan.  Click here for D.C.

Subsidies Will Soften Rate Shock: Study

With all the talk about health insurance “rate shock,” you would think that no one will be able to afford buying insurance from a state exchange. A new analysis from the consulting firm Avalere shows that younger people will likely have access to exchange subsidies that will lower their actual out-of-pocket costs. Click here for their study. If you want a good primer or update on the exchanges and what the issues are, click here for an unbiased report from the Pew Foundation.

AHA: Hospital Mergers Helping Communities

Only 10% of community hospitals were involved in a merger or acquisition in the past six years, and those transactions have allowed hospitals to retain vital services that have clear benefits to patients and communities, according to a report released later week by the American Hospital Association. The report found that of the 551 hospitals that were involved in a merger or acquisition, the majority involved expansion into new areas or occurred in areas where there were more than five hospitals. Click here for the 12-page report.

Insurance Lobby Launches Policy Institute

America’s Health Insurance Plans are launching a new institute this week, which is designed to foster a wide-ranging public dialogue among stakeholders about various ways to improve the nation’s health care system. Called the Institute for Health Systems Solutions, the new nonprofit organization includes on its advisory board a number of prominent figures in health policy analysis and debate. Click here to go to the new website and learn more.

IOM Report Recommends New Gun Violence Research Agenda

The Institute of Medicine last week issued a new report recommending a national research agenda on gun violence that would address the issue from the same public health perspective that’s been applied to tobacco use and car accidents. The report, which will deal with mental and public health issues separately, recommends a broad research agenda for five areas characterizing gun violence, risk and protective factors, firearm violence prevention and other interventions, gun safety technology, and the influence of video games and other media. Click here for the report.

Children of Some Immigrants Have Poorer Health in U.S.: Study

An estimated 4.5 million children with at least one undocumented parent tend to have poorer health, nutrition and behavioral outcomes than children of U.S. citizens, according to a report out last week focusing on how immigration reform could benefit the health of millions of children. Click here for a summary of the study from Human Impact Partners.

Fewer People Have Trouble Paying Medical Bills

The percentage of people under age 65 in families having problems paying medical bills decreased from 21.7% in the first six months of 2011 to 20.3% in the first six months of 2012, according to a report from CDC’s National Center for Health Statistics. Click here to see the report.

CMS Urges Seniors to Help Detect Medicare Fraud

Medicare beneficiaries will soon see a redesigned statement of their claims for services and benefits that will help them better spot potential fraud, waste and abuse, according to a CMS announcement last week. CMS said it has upped fraud detection and that the number of suspect providers and suppliers thrown out of the Medicare program has more than doubled in 35 states. Click here to see how the statement will be redesigned.

CMS Webinar Wednesday for $1 Billion Grants Initiative

CMS will hold its second webinar for potential applicants for about $900 million in innovation grants. The webinar is scheduled for Wednesday, June 12, 2013 at 1:30pm – 3:00pm EDT. This webinar will focus specifically on two of the four innovation categories:  Rapidly reduce Medicare, Medicaid and/or Children’s Health Insurance Program costs in outpatient and/or post-acute settings; and improving care for populations with specialized needs. Advanced registration is required. Click here.  If you’re looking for help to prepare, edit or review your application, please contact me at Paul.Lee@shcare.net. Our team of experts is standing by.