WEEKLY E-BULLETIN


IPPS Final Regs Have Many Major Changes – New Summary Available

CMS published 2,225 pages of new regulations governing the Inpatient Prospective Payment System 10 days ago and click here for a 8-page summary on all the important issues prepared by our firm’s health policy team. Included is everything from new payment rates to value based purchasing, readmissions and HAC changes and more.

CMS Sponsors “Two-Midnight” Inpatient Reg Conference Call

Final CMS regs on IPPS have never been a source of satisfaction from regulated entities and the latest rules are no exception. One of the more controversial regs involves CMS’ recent “two-midnights” time-based clarification of its inpatient admissions guidelines. Some hospitals believe the new reg will increase both Part A appeals and observation stays -  which is what the reg was designed to reduced. CMS is hosting a special conference call on this issue this Thursday, August 15. Click here for call-in information.

Study Says Malpractice Fights Aren’t the Cause of Health Cost Increases

Don’t blame malpractice litigation for increasing healthcare costs, Public Citizen argues in a new report released last week, which shows malpractice payments fell 29 percent over the past 10 years while healthcare costs rose 58 percent. Medical malpractice payments represented 0.11 percent of national healthcare costs in 2012, the lowest on record, according to the report. Medical liability insurance premiums fell to a 10-year low of 0.36 of 1 percent of healthcare costs.  Click here for the 27-page report. Meanwhile, physicians who reported a high level of malpractice concern were most likely to engage in practices that would be considered defensive when diagnosing patients who visited their offices with new complaints of chest pain, headache, or lower back pain. Click here for that study.

Healthcare CEO Turnover Rates Up

Healthcare leaders are continuing to leave their jobs in droves, according to the latest CEO turnover rate report from Challenger, Gray & Christmas Inc. The research shows that healthcare CEO’s comprised the biggest number of July’s 128 CEO departures with 34 changes, 17 of which came from hospitals and hospital systems. The report reveals that healthcare continues to lead all sectors in CEO turnover with 151, 7.8 percent more than the 140 recorded through July 2012. Click here for the report.

OIG Recommends Billing Changes for Canceled Elective Surgeries

Medicare could save more than $38 million over two years by strengthening billing requirements for canceled elective surgeries, according to a report last week from the Office of Inspector General. The OIG found most short-stay hospital inpatient claims for canceled elective surgeries were not reasonable and necessary and therefore did not meet Medicare requirements for Part A prospective payments. Click here for the OIG report.

Congressional Investigation Alleges Medicaid Fraud in New York Because of Political Connections

A key congressional investigative committee released letters last week alleging that a pharmacy and a nutrition company in New York State “got away with inappropriately billing the Medicaid program by millions of dollars” by using political connections in the Democratic Party, including former Pennsylvania governor Edward Rendell, to influence the Cuomo administration. Click here and here for the letters. Click here for the NY Times story.

New Congressional Report Details Eligibility for Health Tax Credits and Subsidies

New federal tax credits will be available to help certain individuals pay for health insurance coverage, beginning in 2014, under the Affordable Care Act. The tax credits will go toward covering premiums for health insurance offered through exchanges. ACA also establishes subsidies to reduce cost-sharing expenses. Click here for a new 35-page Congressional Research Report that describes who will be eligible for the premium tax credits and cost-sharing subsidies, and how the credit and subsidy amounts will be calculated.

Conservative Groups Pressure GOP Leaders to Delay Obamacare One Year

A coalition of 17 politically conservative organizations are pushing congressional Republicans to support at least a one-year delay of the Affordable Care Act as a condition of supporting a continuation of the FY2013 federal budget – expected to be voted on prior to October 1. Click here to read the 2-page letter from the Repeal Coalition. Democrats say the GOP is on the wrong side of the issue and back it up with a new public opinion poll that says Americans don’t want Obamacare repealed by a 40% to 36% margin. Click here.

Obama, GOP Fight Over Government Shutdown and Obamacare

The showdown between the President and many Republicans over whether the GOP will carry out its threat to shut down the government later this year unless Obamacare is defunded continue this past week. The President ridiculed Republicans for the suggestion during several speeches last last week. Click here for details.

Conservative GOP House Members to Release Plan to Replace Obamacare

Repeal and replace has been the mantra of the GOP since the Affordable Care Act was passed in 2010. Now the Republican Study Committee, the very conservative caucus within the House, is planning as early as today to announce its replacement for Obamacare. Click here and here for more.

Another Company Signs Up to Provide Insurance on Federal Exchanges

There’s a growing interest in providing health insurance on the federal exchanges. Towers Watson is the latest online broker to announce an agreement with CMS to sell exchange plans in 36 states where the feds are running part or all of the insurance marketplaces. In a statement issued last week (click here), the firm emphasized it can help provide exchange education and enrollment services for part-time and seasonal employees, retirees and their dependents. Other Web brokers that have announced similar agreements with CMS include eHealthInsurance, Getinsured.com and HealthCompare (click here).

Agents, Brokers Shape Navigator Laws in Many States

Over the past three years, insurance agents and brokers have waged an intense but little-noticed lobbying effort to regulate navigators in the states, leading to the passage of 16 state laws over the past year and a half – this is according to a detailed news report published last week. Most of the laws contain language that closely resembles recommendations that agents and brokers have been pushing in statehouses nationwide — a push receiving crucial aid from a legislators’ group focused on insurance policy that is supported with industry funds. Click here for the story.

New Analysis Explores Premium Variations on Exchanges

Health policy researchers are out with a new analysis offering  several  reasons for the big premium  variation even among similar silver-tiered plans. Among other reasons, they say plan actuaries are “working in the dark,” as they prepare their offerings; however, the overall new is likely good for consumers. Click here for their easy-to-read study.

Conservative Idaho Builds Its Own Exchange

Very conservative Republican Idaho is pushing ahead with creating its own health exchange – a position contrary to most other more conservative, GOP-leaning states. Political leadership in Idaho is saying they would rather control it than the Feds. Click here for the story.

Largest Health Insurers Report Mixed First Quarter Results

Most of the nation’s largest health plans saw enrollment gains in the first quarter of 2013 but five of the seven of these health insurance carriers reported a slight downturn in profitability year-over-year, according to a consulting firm study released last week. Between December 2012 and March 2013 top plans saw an aggregate increase of nearly 1.1 million members, however this is down from the nearly 1.4 million gained from December 2011 to March 2012. Gains in managed Medicare and Medicaid enrollment are driving risk enrollment up. Click here for the study.

Study: Some Co-Pays May Hurt Care and Increase Costs

As Congress and the Obama Administration search for ways to reign in government health care spending, one of the ideas under serious consideration is raising co-pays and deductibles on patients. According to a new study last week, co-payments may actually have the opposite effect on the cost of care. Researchers says requiring small co-pays can act as a dis-incentive for patients to get the care they need. Not much of a surprise for those who work in health care everyday. Click here for the report.

Pittsburgh Health Care Battle Heats Up

A tense battle between Pittsburgh healthcare organizations took another turn last week when University of Pittsburgh Medical Center, the region’s largest healthcare system, sued Highmark for false advertising. In the current battle, UPMC maintains in its federal court filings that Highmark is falsely claiming UPMC facilities won’t admit patients with Highmark insurance, the Tribune-Review reports. Click here for the story.

Obesity Rates Declining Among Low Income Kids

After decades of rising rates, obesity among low-income preschoolers declined slightly in 19 states and U.S. territories from 2008 through 2011, according to the latest Vital Signs report from the CDC. The report found that Florida, Georgia, Missouri, New Jersey, South Dakota, and the U.S. Virgin Islands saw at least a one percentage point decrease in their rate of obesity. 20 states and Puerto Rico held steady at their current rate. Obesity rates increased slightly in three states. Click here for more from the CDC.

Study: Smokers Cost Employers Plenty

Researchers at the Ohio State University are out with a new report showing that a smoker costs a private employer $5,816 more than a nonsmoker per year because of higher health costs plus all the time lost to smoking breaks. Click here for the press release. Click here to access the full report.

CDC Yellow Book Released

The CDC last week released the online version of the 2014 edition of CDC Health Information for International Travel, commonly known as the “Yellow Book.” This is the ultimate guide for healthy international travel. Click here.