WEEKLY E-BULLETIN


Hospital Outpatient, ASCs to Get Payment Increase from Medicare

Hospital outpatient payments from Medicare would increase 1.8 percent in calendar year 2014, under proposed regs released last week by CMS.  Ambulatory Surgery Center rates would increase 0.9 percent.

One of the more significant changes involves payments for emergency department and clinic visits.  Currently, there are five levels of codes for clinic visits and for each of the ED visits (24 hour and non-24 hour).  CMS proposes to replace these levels with three new Level II HCPCS (Healthcare Common Procedure Coding System) codes. The proposal creates a single HCPCS visit level for each unique type of outpatient visit—one for clinic, one Type A ED visit, and one Type B ED visit—and decreases the number of codes from 20 to 3. CMS believes by removing the five visit levels, it will reduce the administrative burden, create incentives to use resources more efficiently, and discourage overuse and up charging. Click here for our team’s excellent executive summary of the regs.

CMS Proposes Numerous Changes to Physician Payment Rules

CMS is proposing numerous changes to the physician payment rules in the next two years through proposed regulations it released last week.  For example, In last year’s final rule, CMS emphasized primary care by paying separately for care management services provided during the transition of a patient from the treating physician in the hospital to the primary physician in the community. For CY2015, CMS has increased its efforts and has proposed to separate payment for non-face-to-face care management services and face-to-face evaluation and management visits for beneficiaries with multiple chronic conditions. CMS has defined the proposed scope and standards for the complex chronic care management services that would be eligible for separate payments, and has also created proposed G-codes that would be used to bill for the services.  Click here for a comprehensive 3-page summary from our SHC policy team.

CMS Details Chronic Care Coordination Payments to Physicians

For CY 2015, CMS is proposing to pay separately for complex chronic care coordination services furnished to patients with multiple complex chronic conditions. This proposal is in response to the physician community which has told CMS that the care coordination included in many of the evaluation and management services, such as office visits, does not adequately describe the typical non-face-to-face care management work involved with these types of beneficiaries. This is further detailed in congressional testimony last week by CMS’ top Medicare administrator.  Click here if you want an excellent explanation of where CMS is headed with physician payments (16-pages).

Clinical Labs Critical of Proposed Cuts in Rule

One group, the American Clinical Laboratory Association, is sharply criticizing the proposed physician payment rule because it would significantly reduce payments for pathology codes when services are provided by independent laboratories.  These cuts to payment – 25 percent in the aggregate according to the proposed rule – come on the heels of a series of cuts experienced by clinical laboratories in last year’s regulations.  Click here for their statement.

Final Patient Navigator Regs Released

CMS released a final regulation late Friday that calls for 30 hours of training for “navigators,” the people who will be providing expert advice on a wide range of issues to those signing up for insurance coverage under the health law.  The rule also outlines standards for certified application counselors, who will also help people with their questions about how to get coverage. Navigators and certified application counselors will be providing help in the 33 states that will be served by the federal insurance exchange or that will be partnering with that exchange. The remaining 17 states are setting up their own such marketplaces and will provide help, at least initially, through what are known as “in-person assisters.”  Click here for a four-page CMS summary.  Click here for a copy of the regs (146 pages.)

CMS Says It Will Verify Eligibility for Insurance Subsidies

CMS Administrator Marilyn Tavenner is denying assertions that insurance exchanges won’t attempt to verify individual eligibility for insurance subsidies under the health care law following a delay in the employer mandate.  Whether a state exchange or the federal marketplace is operating in a state, “the Marketplace will always check the income information submitted by individuals against electronic income data sources such as tax filings, Social Security data, and current wage information,” Tavenner said in a blog posting on the Health and Human Services website.  Click here for her blog.

GOP Senators Raise Cost Concerns Over Exchange Subsidies

Citing concerns over the cost of health care premium subsidies, six Senate Finance Committee Republicans demanded an in-depth analysis on how the Administration will prevent the new health insurance exchanges from becoming a burden on the federal budget and ensure exchange operations are self-sustaining, as required by law, in a letter sent last week to Treasury Secretary Jack Lew and Health and Human Services Secretary Kathleen Sebelius. Click here to read the letter.

340B Drug Discount Supporters Issue New Report

Supporters of the government’s 340B drug discount program are distributing a new report to rebut criticisms of the program from some members of Congress and the pharmaceutical industry.  There have been a number of reports in the past year about program abuses, which have gotten the attention of Congress.  Click here for the 27-page report.

UnitedHealth Expects to Double Accountable Care Contracts by 2017

UnitedHealth Group Inc. last week said it expects its accountable care contracts to double to $50 billion by 2017, reimbursing far more doctors and patients according to how well and how economically medical care is delivered.  Click here for the story.  The Wall Street Journal last week published a very good story about how hospitals are changing how doctors practice by monitoring their progress toward goals, such as giving recommended mammograms. All with more sophisticated data systems.  It isn’t always an easy sell.  Click here for the story.

House to Vote This Week on Delaying Insurance Mandates

Perhaps largely symbolic, the House of Representatives plans to vote this week on a bill to delay by one year the individual health insurance mandate and the employer mandate both required by the Affordable Care Act.  The Obama Administration has already delayed to 2015 the employer mandate, but has not moved the individual mandate set to begin in 2014.  Click here for the 3-page individual mandate bill.  Click here for the 2-page employer mandate bill.  If you’re confused about the mandate issues, click here for a very good and brief Q&A from the Associated Press.

Fight Continues Over Obamacare; New Videos Released

The political debate continues to rage over Obamacare.  Both sides released internet ads last week and are instructive of where the debate is centered.  Click here for the anti-Obamacare ad.  Click here for the response.

Union Fights for MultiEmployer Health Plans

The International Brotherhood of Electrical Workers, a union that supports the health law, is lobbying the White House to protect multiemployer health plans.  The group issued a whitepaper exposing what it says are loopholes in the law that threaten the plans. Click here for their 4-pager.

HHS Awards $150 Million to Health Center to Enroll Uninsured into Obamacare

HHS last week announced $150 million in grant awards to 1,159 health centers across the nation to enroll uninsured Americans in new health coverage options made available by the Affordable Care Act.  Health centers are expected to hire an additional 2,900 outreach and eligibility assistance workers to assist millions of people nationwide with enrollment into affordable health coverage.  Click here for more.

HHS Awards $198 Million to Six States for Exchanges

The Obama administration last week awarded six states a combined $198 million to build up Obamacare’s insurance exchanges.  Colorado, Nevada, New Mexico, Vermont, Virginia and West Virginia — which had already received multimillion-dollar exchange grants — will split the new batch of funds, handed out less than three months before the exchanges are set to open.  Click here for a summary on where funding has gone to each state.

Medicaid Won’t Cover All Services Under Obamacare

11 states have Medicaid programs that do not cover any well-adult preventive care programs, according to a report last week in Health Affairs.  And Obamacare only requires an increase in services in Medicaid programs that are expanded, while existing beneficiaries receive no change in the level of services covered.  Click here for the report.

Hospitals, Insurer Urge No More Delays to ICD-10

In a joint letter to congress last week, the American Hospital Association and the Blue Cross and Blue Shield Association said they oppose any efforts to further delay the October 2014 deadline for transitioning to the ICD-10 coding system.  Click here for a copy of their joint letter.

Health Prices Slightly Up; Spending at Record Low; Health Jobs Lagging

Health care prices were up 1 percent in May from their rate a year earlier, according to the Altarum Institute’s analysis of the health care market, the slowest rate of growth since the organization began tracking in January 1990. Likewise, health spending growth for the calendar year is at 3.8 percent, another record-low. Health care employers added 20,000 new jobs in June, a tick below the 23,000-a-month average over the last two years. Job growth has slowed in hospitals, in particular this year, according to Altarum’s findings. Click here for the 4-page price summery. Click here for the 4-page spending summary. Click here for their 4-page health care employment summary.

WellPoint Pays $1.7 Million for HIPAA Issues

The managed care company WellPoint Inc. last week agreed to pay HHS $1.7 million to settle potential violations of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) Privacy and Security Rules.  Click here for details.

Urgent Care Center Growth Continues Unabated

Consumer demand for more convenient and timely access to care for illnesses and injuries is a major driver of the rapid growth of urgent care centers across the country, according to a study out last week by the Center for Studying Health System Change.  Hospitals view owning urgent care centers as a way gain patients, while health plans see opportunities to contain costs by steering patients away from costly emergency department visits.  Click here for details.

U.S Lifespan Increases, So Do Chronic Conditions

U.S. life expectancy for both sexes combined increased by three years between 1990 and 2010, to 78.2, according to a study in the Journal of the American Medical Association last week. While healthy life expectancy also increased by 2.3 years over the period, to 68.1, the overall number of years lived with disability is increasing as the U.S. population ages.  Diseases with the largest number of years lived with disability in 2010 were low back pain, major depressive disorder, other musculoskeletal disorders, neck pain and anxiety disorders. Click here for the study.

Youth Homicide Rate Reaches 30-Year Low

The homicide rate for youth aged 10 to 24 years in the United States reached a 30-year low in 2010, according to data published in the Morbidity and Mortality Weekly Report released last week by the CDC. The 30-year low in 2010 was seen across all age and racial/ethnic groups. The report also shows that the promising decline in youth homicide rates has slowed in recent years, particularly for groups at high risk for violence. Click here for more from the CDC.

IOM Wants Population Health Quality Measures

HHS should work with public health agencies, health care organizations and others to adopt quality measures for the Leading Health Indicators in Healthy People 2020, the department’s 10-year agenda for improving population health, according to a report released last week by the Institute of Medicine.  Click here for the report.

More Hospitals Only Want to Employ Non-Smokers

They may not be the first, but two hospitals in Florida are advertising that they only want to employ those who don’t smoke. The policy is aimed at reducing the hospitals’ own health care costs.  Click here for the story.