WEEKLY E-BULLETIN


U.S. News Releases Top Hospitals List

U.S. News recognizes more than 700 hospitals as Best Regional Hospitals, indicating they are highly proficient in serving the needs of the majority of patients in at least one specialty, and they rank more than 700 hospitals by state, region and metro area. These Best Regional Hospitals are highly proficient in serving the needs of the majority of patients in at least one specialty, according to the report.  Just five metropolitan areas have more than one Honor Roll hospital. New York City and Boston achieved this feat last year as well, and were joined this year by Los Angeles, Philadelphia and Cleveland, due to the additions of Cedars-Sinai Medical Center, Thomas Jefferson University Hospital, and University Hospitals Case Medical Center respectively. Click here for all the details.

CMS Considering a Star Rating for Hospitals

Medicare is considering assigning stars or some other easily understood symbol to hospitals so patients can more easily compare the quality of care at various institutions. The ratings would appear on Medicare’s Hospital Compare website and be based on many of the 100 quality measures the agency already publishes.  Click here for the Kaiser Health News report.

Investigation of Physician Payment System Reveals “Exaggerations”

A new Washington Post investigation says the “secretive” AMA committee that meets confidentially every year to come up with values for most of the services a doctor performs are often overblown.  Those values are required under federal law to be based on the time and intensity of the procedures. The values determine what Medicare and most private insurers pay doctors. But the AMA’s estimates of the time involved in many procedures are exaggerated, sometimes by as much as 100 percent, according to an analysis of doctors’ time, as well as interviews and reviews of medical journals. Click here for the report.

Key Committee Releases New Doc Payment Fix Legislation

We are a big step closer to finalizing legislation that would repeal and replace Medicare’s physician payment formula.  The Energy & Commerce Committee, which has been working closely with the House Ways & Means Committee, released its latest draft legislation late last week.  Many top Democrats have joined Republicans in supporting the new bill.  The House hopes to pass it by early August.  Yet to be determined is where they will find the roughly $140 billion to pay for it.  Click here for an excellent three-page summary.  Click here for the actual text of the bill.  The American College of Physicians sent a support letter to House leaders and provides additional analysis here. Other physician specialty reaction is here.

GAO Says Some Doctors Ordering More When They Benefit Financially

Medicare doctors ordered far more anatomic pathology tests and procedures when they benefit financially, according to a GAO report released last week by Senators Max Baucus (D-MT) and Chuck Grassley (R-IA) and Reps. Sandy Levin (D-MI) and Henry Waxman (D-CA). The GAO report estimated that Medicare in 2010 paid $69 million for 918,000 extra treatments by self-referring providers. Three provider specialties — dermatology, gastroenterology and urology — accounted for 90 percent of self-referrals, the report found. The lawmakers said the GAO’s findings bolster the case for paying providers by quality of care, not just quantity. Click here for the report.

Medicaid to Start Payment Primary Care Docs; More Soon

CMS said last week that 48 states now have approval to implement a physician pay increase for those primary care doctors caring for Medicaid patients. Every state but California and Alaska is expected to implement the pay raise this summer. Under the law, Medicaid fees for primary care would be increased for two years to the same amount paid under Medicare. The change means an average 73 percent pay increase nationally, according to a 2012 study by the Kaiser Family Foundation.  Click here for the story.

Key House Committee Releases New Health Reform Bill for Comment

House Ways and Means Committee Republicans last week released a discussion draft on three ways to reform Medicare. The proposals include increasing premiums for wealthier seniors, increasing the Part B deductible and establishing a home health co-pay. President Obama included all three provisions in his 2014 budget. Public comments on the proposals are due by August 16. Click here for the 6-page legislative draft.

$12 Million Awarded for 300 Primary Care Residencies

HHS announced last week that it has awarded $12 million in grants to train more than 300 primary care residents next year, more than double the year before. The funds come from the Affordable Care Act’s Teaching Health Center Graduate Medical Education Payment Program. The awards will increase the number of Teaching Health Centers from 14 to 21. The expansion of insurance through the exchanges and Medicaid next year is expected to put pressure on an already strained primary care workforce. Click here to see who got the money.

Nurse Practitioners Gaining More Ground in Scope of Practice

Some states are trying to fill the primary care physician shortage with nurses who have advanced degrees in family medicine. That requires relaxing decades-old medical licensing restrictions, known as “scope of practice” laws that prevent these nurse practitioners from playing the lead role in providing basic health services. At least 17 states now allow them to work without a supervising physician, and lawmakers in five big states are considering similar measures.  Some physician groups vigorously oppose these changes, arguing that nurses lack the training to safely diagnose, treat, refer to specialists, admit to hospitals and prescribe medications for patients, without a doctor’s oversight.

Click here for an updated report.

Health Exchanges Lowering Insurance Costs: HHS

HHS last week released a new report that finds premiums in the Health Insurance Marketplace will be nearly 20 percent lower in 2014 than previously expected.  The Affordable Care Act requires health insurers in every state to publicly justify any premium rate increases of 10 percent or more.  Health insurance companies now generally have to spend at least 80 cents of every premium dollar on health care or improvements to care, or provide a rebate to their policy holders.  In addition, when the Health Insurance Marketplace opens for enrollment on October 1, 2013 consumers will be able to make apples to apples comparisons of quality health insurance plans.  Click here for the report.  Click here for a good Washington Post analysis.

House Votes to Delays Business, Individual Mandates

In a mostly partisan vote, the House approved bills that would delay for one year the employer insurance mandate, which has already been accomplished administratively by the Obama Administration, and another bill that would delay for a year the individual mandate.  The Senate is not expected to go along and the White House issued veto threats before the bills were voted on.  Click here for the story.

Economists Say Individual Mandate is Necessary

More than two dozen economists signed a letter, issued last week by U.S. Representative Henry Waxman (D-CA), detailing why the individual mandate is necessary.  Click here to read the letter.

CMS Issues Report Card on Pioneer ACOs; 9 Leave Program

CMS announced last week that 9 Pioneer Accountable Care Organizations are leaving the Pioneer program.  In summary, the 32 original Pioneers generated a gross savings of $87.6 million in 2012. 13 of the Pioneers actually saved enough money to share those savings with Medicare, despite having invested in the programs and staff required to better coordinate care. And two Pioneers ended up owing the Medicare program $4 million.  According to CMS, all 32 Pioneers succeeded improving quality and performed better than fee-for-service Medicare in 15 quality measures. For the 669,000 Medicare beneficiaries in the Pioneer ACOs, spending grew by only 0.3 percent, compared to 0.8 percent in conventional Medicare.  Click here for the Washington Post story.  Get more details here from CMS.

Senators Renew Call to Repeal Budget Sequestration

Four Democratic Senators joined Senate Majority Leader Harry Reid last week to revive their party’s call to end budget sequestration.  This followed a meeting with an official from the National Institutes of Health – which was struck by $1.55 billion in cuts – that Sen. Dick Durbin (D-Ill.) called “one of the most sobering half hours we’ve spent in that room since I’ve served in the Senate,” according to a report in Politico.  Click here.

Consumer Group Says Not Enough Done to Protect Health Care Workers

A scathing new report from watchdog group Public Citizen last week blasts the level of federal action to prevent injuries and illnesses among workers in the health care sector, accusing the Occupational Safety and Health Administration and congressional policy makers of neglecting the issue.  The report says there are 650,000 nurses, orderlies, aides and others injured each year.  Click here for the report.

Health Care Integration Raises Costs: Health Exec Poll

The American College of Physician Executives last week released the results of its recent poll in which it asked its members about the effect on the cost of care when a health system buys a physician practice. Of the 469 respondents, 32% said care costs increase, while only 4.7% said costs go down. Sixteen percent said costs remain the same, 12% were unsure, and 34.8% said the question was not applicable to their organization.  Click here for more from ACPE.

Some Medicaid Demos Came Up Short: GAO

HHS-approved Medicaid demonstration projects didn’t always meet their budget neutrality requirements, according to a new GAO report released last week. In four of 10 Medicaid demonstrations reviewed by the government auditor, HHS used assumptions of cost growth “that were higher than its benchmark rates,” GAO wrote. Had HHS not done that, the five-year spending limits would have been about $32 billion lower than what HHS approved, GAO said. HHS disputed the findings.  Click here for the GAO report.

Life Expectancy Report: Hawaii Highest, Mississippi Lowest

Residents of the South regardless of race, and blacks throughout the United States, have lower healthy life expectancy at age 65, according to a CDC report released last week. Healthy life expectancy is a population health measure that estimates expected years of life in good health for people at a given age.  Healthy life expectancies at age 65 are the highest in Hawaii, lowest in Mississippi.  Click here to see how your state ranks.

Life Expectancy Differences Narrow Between Black and White Americans

In a related government report, the gap in life expectancy between black and white Americans is at its narrowest since the federal government started systematically tracking it in the 1930s, but a difference of nearly four years remains, and federal researchers have detailed why in a new report. They found that higher rates of death from heart disease, cancer, homicide, diabetes and infant mortality accounted for more than half the black disadvantage in 2010.  Click here for the report by the National Center for Health Statistics.

Senator Calls for Meaningful Use Suspension

U.S. Senator Orrin Hatch (R-UT) last week called for a temporary suspension of the federal government’s meaningful use initiative because he believes the government cannot allocate funds to programs that fail to give positive results. National HIT Coordinator Dr. Farzad Mostashari responded that Hatch’s suggestion would delay the progress in health IT adoption that is being sought by the government. CMS Chief Medical Officer Dr. Patrick Conway also said the final stage of MU is important because it will promote patient outcomes, health data sharing and interoperability. Click here for more.

Computerized Medical Records Now the Norm: Report

An ever-expanding amount of the nation’s medical records — millions of prescriptions, medical reports and appointment reminders — are now computerized and part of an ambitious electronic medical records program, the Obama administration reports.  Click here for the details.

CO-OPs Meeting Most Milestones: OIG

The early implementation of the CO-OP program found that CO-OPs met 90 percent of their milestones between February 2012 and September 2012, according to an OIG report released last week. The early review only took into account the first 18 CO-OPs that received funding, and the auditors didn’t look at their financial viability. As of June 2013, 19 of the 24 CO-OPs obtained licensure, though one was rejected, the OIG report notes. Click here for the 21-page OIG report.

CMS Sets National Calls on Health Exchanges

CMS has announced its next quarterly state-by-state calls with stakeholders on the new Health Insurance Marketplace, or health insurance exchanges. The regional calls will begin July 29 and provide an update on implementation of the marketplace and opportunity for feedback. Any interested party may participate.  Click here for call-in information.

Tenet in Massachusetts Could Shake Up Market

The pending return of health care giant Tenet Healthcare Corp. to Massachusetts has the potential to shake up the state’s hospitals and doctors networks, which are already rapidly consolidating.  By agreeing last month to buy for-profit Vanguard for about $1.8 billion — a deal that will bring the three Massachusetts hospitals into the Tenet fold — Dallas-based Tenet signaled that it has become more aggressive about expanding nationally at a time when more patients will be signing up for medical insurance under the new national health care law.  Click here for the Boston Globe story.

Gallup: Numbers of Uninsured Young Adults Down

According to a Gallup Poll released last week, the percentage of young adults in the U.S. who lack health insurance began to decline at the end of 2010, when the healthcare law provision allowing those up to age 25 to stay on their parents’ plans went into effect, and has remained lower since. Currently, 23.7% of 18- to 25-year-olds are uninsured.  Click here for more from Gallup.