WEEKLY E-BULLETIN


Home Health Regs Cut Payments Less for Hospital-Based Agencies

CMS on Friday issued a proposed rule that would reduce home health payments by 1.5% ($290 million) in calendar year 2014, although hospital-based agencies would receive a smaller reduction of 1.1%. The total reduction is based on a 2.4% market basket increase, minus 3.4% for proposed rebasing adjustments and 0.5% for coding changes related to the transition to ICD-10.  The Affordable Care Act requires CMS to rebase the HH PPS over four years beginning in 2014. The rule proposes a cumulative 14% payment cut as a result of this proposed rebasing process, which is intended to adjust for changes in the mix, intensity and cost of services in the HH 60-day episode since the HH PPS was implemented in 2000. The proposed rule also would establish quality reporting requirements for rehospitalization and emergency department use during the first 30 days of a HH stay.  Click here for all CMS supporting documents. Click here for CMS’ fact sheet.

Key Committee Updates Legislation to Fix Physician Payment Formula, Seeks Comments

A key House committee is moving closer to finalizing legislation that would replace Medicare’s physician payment formula, known as SGR – the Sustainable Growth Rate.  The Energy & Commerce Committee Friday released an updated legislative draft (click here) and a request for comments by July 9 (click here for the list of the committee’s key questions.)  Click here for the committee’s press release.

Hospitals Urged to Preview Their Readmimssions Data Before Final Report

Hospitals can preview their hospital-specific reports for the fiscal year 2014 Hospital Readmissions Reduction Program through July 12 by downloading the reports at My QualityNet. Hospitals should notify CMS of any suspected errors in their Excess Readmission Ratio calculations or discharge-level data by sending an e-mail to CMS by July 12. The ratios are based on CMS fee-for-service claims from July 1, 2009 through June 30, 2012. The ratios will be publicly reported on the Hospital Compare website in October. Click here for details.

Hospital Fair Pricing Law Not Being Enforced: Report

Lax enforcement and lack of clarity of the “fair pricing” provision of the Affordable Care Act are undermining the intended goal of preventing hospital bills from bankrupting uninsured patients, according to an Associated Press report.  The ACA requires that nonprofit hospitals charge uninsured patients the lower rates that insurance companies negotiate for their members. Click here for the report.

New Bill Would Change Doctor Fees Panel Composition

A bill introduced last week by Rep. Jim McDermott (D-Wash.) would change how Medicare sets its doctor fees by lessening the influence of an advisory panel criticized as secretive and weighted toward medical specialists.  Click here for details.

RACs Smacked at Senate Finance Committee

Recovery Audit Contractors (RACs) were the target of the Senate Finance Committee in hearings last week.  Overly aggressive practices of contractors charged with recovering inappropriate Medicare payments are causing headaches for hospitals and patients, according to hospital executive testimony.  Click here for details.

Clear Definition of Essential Community Providers Sought

One of the many issues concerning providers with the health insurance exchanges is the provision in the health reform law requiring insurers on the exchanges to make sure they are contracted with a sufficient number of “essential community providers.”  House GOP leaders are pressuring HHS to detail how the agency will assure compliance with this provision and precisely what constitutes an essential community provider.  Click here for the letter to HHS.  Meantime, Oregonians who buy their own insurance from the state’s exchange have the first clear indication of what 2014 premiums will look like after state regulators Tuesday slashed carriers’ rate requests by as much as 35 percent. Click here for the story.

The Selling of Obamacare Begins

The selling of Obamacare begins in earnest with about 90 days to go before the health exchanges open to the public and a number of other health care provisions start.  The White House is recruiting public officials in some states that have been openly opposed to the Affordable Care Act.  Click here for the NY Times story.  Public awareness of Obamacare is pretty high, according to the latest Gallup Poll; however, awareness among the uninsured – for whom the health care law is specifically targeting – is much lower.  Click here to see the polling data.

GOP Keeps Up Obamacare Attack

The GOP continues its assault against the law. Click here to see Senator Pat Roberts’ (R-KS) weekly public address to hear the Republican arguments. Twenty-eight Republican senators have sent a letter to HHS Secretary Kathleen Sebelius asking her to “immediately stop” fundraising for Enroll America until she has answered more questions about it. Click here for the letter.  Rep. Steve Scalise (R-LA) is asking the NBA and NFL for details about the Administration’s requests for help to promote Obamacare.  Click here for his letter.

Final Individual Mandate Rules Released

CMS last week released a final regulation detailing the eligibility rules for receiving an exemption from the Affordable Care Act’s individual mandate and what qualifies as “minimum essential coverage.”  Beginning in 2014, the ACA requires that individuals purchase health insurance coverage (“minimum essential coverage”), qualify for an exemption, or make a “shared responsibility payment” when filing a federal income tax return. Individuals will not have to pay the individual mandate penalty if coverage is unaffordable, if they spend less than three consecutive months without coverage, or if they qualify for an exemption based on hardship, religious beliefs, or certain other factors. Click here for the rules.

USDA Regs Ban Fatty Foods, Sugary Sodas in Public Schools

Fatty foods and sugary sodas will officially be banned from being sold in school cafeterias and vending machines nationwide under rules released by the USDA last week.  In addition to meeting calorie, fat and sodium limits, foods sold in schools will need to be rich in whole grains, contain fruits and vegetables, or meet other specific benchmarks under the new “Smart Snacks in School” standards.  Click here to read the new regulations and to get more info.

FDA Tackling Tobacco Products for First Time

The FDA announced last week that for the first time it would exercise a four-year-old power to approve or reject cigarettes for market, according to The New York Times: “The agency can reject cigarettes and other tobacco products that its scientists believe pose public health risks above and beyond comparable products already on the market, a sharp departure from past practice, when tobacco companies could change existing products and introduce new ones at will.” Click here for the story.

Bill Would Benefit Certain Rural Hospitals

U.S. Rep. Bruce Braley (D-IA) last week introduced the Rural Hospital Fairness Act (H.R. 2578), which would reinstate “hold harmless” Transitional Outpatient Payments through 2013 for certain eligible Sole Community Hospitals and rural hospitals with up to 100 beds. These payments expired last year and these hospitals are now paid an average of 75% of their Medicare costs. Click here for details on the legislation.

Bill Would Increase Access to Home Health Services

Reps. Greg Walden (R-OR) and Allyson Schwartz (D-PA) introduced a bill last week to make it easier for those on Medicare to access home health services by giving physician assistants, nurse practitioners and other caregivers the authority to order home care.  Click here for a copy of the 8-page bill.

DME Competitive Bidding Battle Continues with Court Rejecting Delay

A D.C. district court judge late last week rejected a request to delay the July 1 expansion of CMS’s Durable Medical Equipment competitive bidding program. The American Association for Homecare and a Maryland home medical equipment provider had filed for a temporary restraining order last week, citing licensing violations.  Click here to review their court request.  However, CMS did announce a delay on the new face-to-face rule effective July 1. A three-month extension moves the deadline to October 1.

Final Contraceptive Services Rule Issued

The Obama administration issued final rules last week seeking to balance the goal of providing women with coverage for recommended preventive care – including contraceptive services prescribed by a health care provider – with no cost-sharing, with the goal of respecting the concerns of non-profit religious organizations that object to contraceptive coverage.  Click here for details, including a copy of the final regulations. Click here for the NY Times story.

Health Spending Drops and New Reports Explain Why

As we have been emphasizing in previous reports to you, health care spending has been dropping since the beginning of the recession. Medical inflation has slowed from an unsustainable 11 percent in 1990 to 3.9 percent in 2011. Many analysts attribute this to the effects of the economic downturn. However, two recent studies — one by PricewaterhouseCoopers and one by the Federation of American Hospitals — suggest that the decline in spending may not be exclusively related to the effects of the Great Recession. Click here for the latest story on this issue.

Medical Homes Touted As Big Cost Saver

One way to reduce unnecessary costs is great use of medical homes, according to a report out last week by the think tank Third Way.  Click here to read the very good report.

Former Government Officials Discuss Ideas to Save Billions in Health Care Costs

Three former U.S. Senators and a Budget Director outlined their ideas for saving $560 billion over a decade.  Their article appeared last week in the New England Journal of Medicine.  Click here.

Long-Term Care Spending to Increase Unless Changes Made: CBO

Spending on long-term care services and support, now at an estimated 1.3 percent of GDP, could grow to anywhere between 1.9 percent of GDP to 3.3 percent of GDP by 2050, according to a new CBO analysis. Estimates could be affected significantly by things like changes in how the services and support are delivered, changes to family structures, future labor costs and other factors. Click here to read the CBO report.

FDA Tackles Illegal Internet Sites Selling Rx

The U.S. Food and Drug Administration, in partnership with international regulatory and law enforcement agencies, took action last week against more than 9,600 websites that illegally sell potentially dangerous, unapproved prescription medicines to consumers. These actions include the issuance of regulatory warnings, and seizure of offending websites and $41,104,386 worth of illegal medicines worldwide. Click here for the FDA’s report.