WEEKLY E-BULLETIN


 

Post Acute Care in Congressional Crosshairs

The leaders of the House Ways and Means Committee and the Senate Finance Committee have joined together in calling for ideas on how to improve post acute care for Medicare patients. Post acute care includes Long Term Care Hospitals, Inpatient Rehabilitation Facilities, Skilled Nursing Facilities, and Home Health Agencies. The lawmakers also called for policy proposals to improve payment accuracy, combat fraud and address variation in utilization. Click here to read the six-page letter they sent to providers last week.

Hospital Associations Urge Congress to Delay DSH Cuts

The nation’s largest hospital associations are urging Congress to delay the scheduled reductions in the Medicare and Medicaid Disproportionate Share Hospital programs. The groups argue that as states opt out of Medicaid expansion, the coverage expansion is significantly less that what had been envisioned by the health law. The groups are supporting legislation that has already been introduced to delay the cuts. Click here to read the one-page letter from the AHA, AAMC, AFH and CHA.

Quality Measures a Growing Component of Physician Compensation

Quality measures appear to be a small yet emerging component of total compensation for physicians. According to the MGMA, primary care physicians reported that 3% of their total compensation was based upon measures of quality. Specialists reported that 2% of their total compensation was based upon quality metrics. Though these percentages are small, the Association has identified this trend and expects that physician compensation will increasingly be tied to these metrics as reimbursement aligns more closely with quality and cost measures. Click here for more.

25 House Members Stand Up for Critical Access “10-Mile” Hospitals

A bipartisan group of more than two dozen House members last week sent a letter to the Ways and Means Committee opposing any effort to enact a proposal in the President’s FY14 budget to eliminate Critical Access Hospital designation when a CAH is within 10 miles of any other hospital. There are 43 such hospitals across the country and more than half of them are working together to preserve their CAH status. Click here for the letter.

Multi-Million Dollar Campaigns Underway to Sign Up the Uninsured This Fall

The race is on to sign up uninsured Americans for health care coverage this fall, with a number of large national advocacy groups launching aggressive, multi-million dollar campaigns this summer aimed at promoting President Obama’s health care law. Click here for the story.

Is Blue Cross “True Blue” for Obamacare?

It appears that Blue Cross and Blue Shield plans across the country are going to be offering their products on most of the health insurance exchanges, according to published reports.  This will likely ensure at least a minimum choice for individuals seeking subsidized coverage when the marketplaces open Oct. 1. It also makes them an undeclared Obama ally in implementing the health law. Click here for more.

GAO Says Government Not Ready for Health Exchange Rollout

A new report from the U.S. Government Accountability Office last week warns that much work remains to be done and untested health information technology along with slow consumer outreach jeopardize a “timely and smooth” roll out of all the health insurance exchanges.  Click here for the 53-page GAO report. CMS officials disputed the report in hearings last week saying they are on schedule.

$3.9 Billion in Savings, $500 Million in Rebates for Health Insurance Consumers

HHS announced last week that consumers nationwide will save $500 million in rebates, with 8.5 million enrollees due to receive an average rebate of around $100 per family.  HHS also said 77.8 million consumers saved $3.4 billion up front on their premiums. The Affordable Care Act requires insurers to spend at least 80 cents of every premium dollar on patient care and quality improvement. If they spend a higher amount on other expenses like profits and red tape, they owe rebates back to consumers. For many consumers, the report found that the law motivated their plans to lower prices or improve their coverage to meet the standard. Click here for the two-page report.

Premium Shock, Premium Joy for Health Insurance Consumers

So, just how high will premiums increase for those buying insurance once the Affordable Care Act fully kicks in later this year? Although there have been many studies, both government and private, exploring the issue, no one knows for sure. Noted health care economist Ewe Reinhardt is weighing in with an analysis that describes both the “premium shock” and the “premium joy” Americans will feel. Click here for the very good NYTimes article.

Study: Structural Reforms Driving Health Spending Slowdown

Numerous structural reforms are driving the current health care spending slowdown, according to a new study released last week. The study, sponsored by the Federation of American Hospitals concludes that the savings in Medicare could reach $2.6 trillion over the next ten years. Even when compared to the most recent 2013 Congressional Budget Office projections, the study says there could be further savings of $1 trillion over the next 10 years. Click here for the 52-page report.

Study: Health Inflation to Drop Again Next Year

A new analysis released last week by PwC’s Health Research Institute predicted that health care inflation will drop to 6.5% next year. The group’s annual report asserts that the decrease in health care spending “defies post-recession patterns” and will continue even as millions of new consumers are brought on under President Obama’s health care law. Click here for their report.

Senators’ Bill Calls for More Medicare Claims Transparency

U.S. Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR) have introduced legislation that would open up all Medicare claims to public scrutiny, noting that additional Medicare claims transparency could curb wasteful overspending. Click here for the announcement. Click here to review the four-page bill.

Improper Rx Use Costs $200 Billion a Year: Study

The U.S. spends $200 billion each year, about 8% of the nation’s health care costs, on medical care stemming from improper or unnecessary use of prescription drugs, a new report out last week says. Click here for the brief report from the IMS Institute.

Patients Paying More Out of Pocket for Physician Bills: AMA

Patients are responsible for nearly one-quarter of the medical bill, according to the findings released today from the AMA’s sixth annual check up of health insurers and their patterns for processing and paying medical claims. For the first time, the AMA examined the portion of health care expenses that patients are responsible for through copays, deductibles and coinsurance. During February and March of this year, patients paid an average 23.6% of the amount that health insurers set for paying physicians. Click here for details.

AMA Says Obesity Is a Disease

The American Medical Association has officially recognized obesity as a disease, a move that could induce physicians to pay more attention to the condition and spur more insurers to pay for treatments. Click here for the story.

New Federal Guidelines Released for Organ Transplants to Reduce Disease

HHS last week issued updated guidance for reducing unexpected disease transmission through organ transplantation. It was last updated in 1994. The new guidance recommends that donors be screened for the hepatitis B and C viruses in addition to HIV, and the use of more sensitive laboratory testing for living and deceased organ donors. It also includes a revised set of risk factors for HIV and hepatitis infection, and recommends a robust informed consent discussion between the transplant candidate and clinician.  Click here for the 97-page guideline.

Senate Passes HIV Organ Policy Equity Act

The Senate last week unanimously passed the HIV Organ Policy Equity, or Hope Act, increasing the number of organs available for use in transplants. The legislation repeals a ban on transferring organs donated by HIV-positive donors to those who need an organ transplant that also have HIV. The House is considering similar legislation currently in committee. Click here for details.

No More Delays to ICD-10 Deadline

National Health IT Coordinator Dr. Farzad Mostashari confirmed last week that the deadline for moving to ICD-10 codes, set for Oct. 1, 2014, will not be moved again. Mostashari said the initial extension from the original conversion deadline of Oct. 1, 2013, was allowed in part to facilitate integration of ICD-10 and the Systematized Nomenclature Of Medicine Clinical Terms. Click here for more.

CMMI Round Two Grants Update Application Materials

For those of you considering applying for CMS’ Round Two Innovation Awards, supplemental and required application materials were posted last week on the CMMI website. Click here. It is important to note that a revised version of the Operational Plan template was posted on June 20, 2013. Use this updated version in your application.  Completed applications will be accepted until August 15, 2013 3pm EDT.

PCORI Issues $17 Million in New Asthma Grants

The Patient Centered Outcomes Research Institute (PCORI) last week announced new grants of up to $17 million to fund comparative effectiveness research that focuses on reducing adverse outcomes due to poorly controlled asthma in African American and Hispanic/Latino individuals, populations, and subgroups. Click here for the details.

NCQA Wants Public Input on Medical Home Program Changes

The National Committee for Quality Assurance is seeking the public’s input on proposed new standards and changes to its Patient Centered Medical Home Recognition program, the nation’s largest medical home program, during a public comment period that began June 17 and ends July 22, 2013. Click here for details.

Public Hospital Association Has New Name

The National Association of Public Hospitals last week announced it is renaming itself to America’s Essential Hospitals.  With more than 200 members, the association said the new name better defines its ongoing mission. Click here for the announcement.