Not-for-Profit, Church-Owned Hospitals Perform Better: Truven

Not-for-profit, church-owned hospitals perform better than publicly and privately held institutions on quality, efficient return to daily life and patient satisfaction, all related to their religious mission, according to study results released last week by Truven Health Analytics. Click here for the study. Truven also conducted a study to determine whether the size and teaching status of a hospital had an impact on quality, they found some very interesting answers. Click here for that study.


U.S. News Names Best Children’s Hospitals

Children’s hospitals in Philadelphia, Boston, Cincinnati, Houston, LA, St. Louis, Aurora, Chicago, Baltimore and Pittsburgh were identified last week by U.S. News as the best in the publication’s 2013-2014 Honor Roll of children’s hospitals. Click here for the complete rundown.


Doc Pay Fairly Flat; Cardiologist Make the Most: MGMA

The 2013 Medical Group Management Physician Compensation and Production Survey Report showed physician pay increases were largely flat, rising about 3% for primary care doctors – family doctors, internists and pediatricians — to $220,942 in 2012 compared to $212,840. Meanwhile, compensation for specialists rose 3% to $396,233 from $384,467 in 2011. Pay ranged from $532,269 for cardiologists to $301,000 for obstetricians, according to MGMA’s list of selected specialties. Click here for more.


ACOs Getting High Marks

Accountable Care Organizations are receiving high marks from at least one news analysis out last week. A Bloomberg report says ACOs are saving millions of dollars and improving care all over the country. Click here to read the story.


MedPAC Report Recommends More Tough Medicine for Providers

The Medicare Payment Advisory Commission (MedPAC), which advises Congress on Medicare policy, is doling out some tough medicine in its June report to Congress released Friday. MedPAC outlines numerous policy changes that would reduce Medicare payments to hospitals and other providers. While MedPAC’s recommendations that require a change in the law can’t be implemented without Congress acting, some of its proposals could be adopted by CMS changing its regulations. We believe some of these recommendations are likely to be addressed by Congress later this year as it begins to look for funds to pay for the physician’s Medicare payment fix that expires at the end of the year. MedPAC is reporting that physicians face a 24.4% payment reduction in Medicare January 1 should Congress not address the formula.

Here’s a brief summary of the most consequential issues and links to those chapters in the report (a fairly easy read.):

Site neutral payment changes: MedPAC continued to refine its proposals to pay the same amount for services regardless whether it is a hospital, ambulatory surgery center or physician’s office. For example, in 2013 Medicare pays 140% more for a level II echocardiogram in a hospital outpatient department compared with a freestanding physician’s office. Click here. Click here for the NY Times story on this issue.

Redesigning post acute care services:  MedPAC continued to refine ways in which post acute providers could be required to better coordinate services, increasing quality and reducing costs. CMS already has several bundled payment demos underway, which are examined in the report. This section is very instructive for those of you engaged and considering your own bundled payment programs. Click here.

Adjustments to the hospital readmission reduction program:  Although readmissions have declined a small, but statistically significant amount since Medicare’s readmissions program started in 2011, MedPAC tells Congress that further program changes might reduce readmissions even more. Click here.

Click here for the complete 303-page report.


Key House Committee Focuses on Post Acute Care

The House Ways and Means Committee last week turned its focus to post acute care in a hearing Friday. Click here for a 2-page summary from our team. Click here to read the testimony from CMS’ Deputy Administrator, which is a 17-page summary of CMS’ post acute care initiatives. Click here to read the testimony from MedPAC’s executive director, which is a 16-page analysis of the agency’s perspective on post acute care.


Senate Health Reform Leader Says Focus Should be on Chronically Ill

U.S. Senator Ron Wyden (D-OR) outlined a series of major Medicare reform recommendations last week that would put greater focus on the chronically ill. This would include changes to the rules government ACOs and higher Medicare payments in areas where there are larger numbers of chronically ill. Click here for details.


New Proposal Would Reduce Need for Defensive Medicine

In an effort to reduce the negative impacts of defensive medicine, a new report out last week recommends implementing a “safe harbor” solution. Under a safe harbor plan, physicians are protected from medical-malpractice litigation if they: document adherence to evidence-based clinical-practice guidelines, use qualified health information-technology systems and use clinical decision-support systems that incorporate guidelines to assist physicians with patient diagnoses and treatment options. Click here for the Center for American Progress report.


End-of-Life Care Improvements Made

A new Dartmouth Atlas report shows Medicare patients have experienced improvements in end-of-life care, with chronically ill beneficiaries in their last six months of life spending fewer days in the hospital and receiving more hospice services in 2010 than in 2007. Looking at more than 1 million Medicare claims for patients who died in 2010, researchers found that in only three years, hospital days per patient dropped 9.5% while deaths occurring in the hospital fell 11%.  Hospice enrollment increased by 13.3% and the average number of hospice days rose by 15%. Click here for the 4-page report. Click here for an LA Times story on how LA spends the most on end-of-life care.


CMS Clarifies Billing Issues for Dual-Eligibles

CMS is going after states that are not reimbursing providers for services provided to dual-eligible patients. In a very pointed letter to states, CMS last week said it has been receiving reports of providers not having their claims processed by the state as required by law. CMS also reminded providers that they cannot balance bill those patients. Click here for the 4-page letter from CMS.


Retail Health Clinics to Boom: Report

The number of U.S. retail health clinics is projected to double in the next three years due to the increasing demand of newly insured patients under healthcare reform, according to a new report released last week by Accenture. Click here for the report.


Medicaid Births Growing; Emergency Medicaid Available to Undocumented

About half of all births last year were paid for by Medicaid or CHIP, according to MACPAC’s June report to Congress, also released Friday. 31% were Cesarean, about the same for all non-Medicaid births. The report tracks all things Medicaid and is an excellent resource. Click here for a copy of the 244-page report. On the Medicaid front, a report last week in the Washington Post detailed the fact that some illegal immigrants in the United States are eligible for emergency Medicaid. Health care benefits is proving to be a difficult issue for Congress as it develops an immigration reform bill. Click here.


Government Insurance Coverage Growing

In 2012, more than 17.7 million people received comprehensive health insurance through fully-insured small group policies, compared to nearly 40.1 million people who received similar coverage through fully-insured large group policies, according to a report out last week. Enrollment in health insurance plans for small and large businesses declined 3.2% and 3.9%, respectively, between 2011 and 2012, while enrollment was up 5.5% for products offered through government entities. Click here for the report.


New Exchange Rules Released; Smaller Insurers Lead the Way on Exchanges

CMS issued a new rule for state exchanges last week that would require all qualified health plans to accept a wide variety of payments for premiums, including money orders, cashier’s checks and prepaid debit cards. The proposed rule is a response to the fact that a substantial percentage of the uninsured don’t have credit cards or bank accounts, and may not be able to sign up if restrictive payment policies are in place. Click here for a summary. The proposed regs are 253 pages, click here. A dozen states with their own exchanges have now announced the level of interest from insurers on offering products. Click here for an updated summary. And another report showing how smaller insurers seem to be leading the way on those state exchanges. Click here.


Majority in House Sharply Critical of DME Competitive Bidding Plans 

227 House members (a majority) last week sent a letter to CMS urging the agency to delay Round 2 implementation of the Durable Medical Equipment competitive bidding program. This has been an ongoing fight between the DME industry and CMS since the program started a few years ago. Click here for a copy of the congressional letter to CMS.


More Anti-Fraud Legislation Introduced

Rep. Peter Roskam (R-Ill.), Rep. John Carney (D-Del.), Sen. Tom Carper (D-Del.) and Sen. Tom Coburn (R-Okla). introduced legislation last week to curb waste and fraud in Medicare and Medicaid. The “Preventing and Reducing Improper Medicare and Medicaid Expenditures (PRIME) Act of 2013,” focuses on a number of oversight issues, toughens penalties for criminals, attempts to phase out so-called “pay and chase” practices used by anti-fraud contractors and encourages more data sharing among federal agencies to detect and prevent fraud. Click here for a summary.