WEEKLY E-BULLETIN


Government Report Recommends Eliminating 846 Critical Access Hospitals

Critical Access Hospital designation for 846 hospitals across the United States would be taken away under recommendations made last week by the HHS Inspector General. The report said these hospitals received their designations even though they are less than 35 miles from another hospital. The law allowed states to designate those hospitals as Necessary Providers and waive the federal mileage requirement until January 1, 2006.  The OIG says the proposal would save about $8 billion a year. Click here for the 38-page report.

Hospital Merger Wave Highest Since ’90s

Hospitals across the nation are being swept up in the biggest wave of mergers since the 1990s, a development that is creating giant hospital systems that could one day dominate American health care and drive up costs, according to a report last week in the New York Times. So far this year, there have been 46 hospital mergers and acquisitions, 105 last year. Click here for the story.

Merger Wave Prompts Congressional Action

Concerns about “unintended consequences” have prompted U.S. Rep. Jim McDermott (D-WA) to request a study from the GAO about the hospital consolidation wave. McDermott asserts that the trend may result in less competition and higher prices. Click here for McDermott’s 2-page letter to the GAO.

CMS Answers More Questions on Its New Two-Midnight Inpatient Admission Rule 

CMS held a national conference call last week to clarify issues raised by hospitals on its two-midnight inpatient admission regulation. CMS is encouraging anyone with questions to contact them directly. It appears CMS plans to issue additional clarifications. Click here for our policy team’s 2-page summary of the call.

Nurse Practitioners Fighting to Treat Without Physician Oversight

Nurse practitioners in California, Pennsylvania, Michigan, Massachusetts and New Jersey are fighting for the right to treat patients without oversight from doctors, according to a new report. In 17 states and the District of Columbia, NPs can set up practices and treat patients autonomously. Twelve states require them to be supervised, to varying degrees, by a physician or other health authority. Click here for a state-by-state map of the status of NPs. Click here for the Wall Street Journal story (fee may be required.)

Administration Delays Consumer Protection Provision in Affordable Care Act

The Obama administration has delayed until 2015 a significant consumer protection in the law that limits how much people may have to spend on their own health care. The limit on out-of-pocket costs, including deductibles and co-payments, was not supposed to exceed $6,350 for an individual and $12,700 for a family. But federal officials have granted a one-year grace period to some insurers, allowing them to set higher limits, or no limit at all on some costs, in 2014. Click here for the NY Times story. Click here for the Administration’s announcement.

Health Exchange Subsidies Will Be Available to Almost Half: Study

Nearly half of those who are now buying health coverage individually will be eligible for subsidies on the new health insurance exchanges, according to a report last week from the Kaiser Family Foundation finds. The analysis estimated that 48 percent of those who are currently buying insurance on the individual market will be able to collect tax credits if they enroll on the exchanges. Eligible families would receive an average subsidy of $5,548, lowering their costs for a mid-level silver plan by 66 percent. Click here for the report.

Risky Strategy Outlined for Uninsured in States Not Expanding Medicaid

In states not expanding Medicaid, there may still be a way for some uninsured to get insurance coverage. Experts say the key is for them to project their 2014 income to at least the federal poverty level, about $11,500 per person or $23,500 for a family of four. Click here for the report.

$67 Million Announced in Navigator Grants

The Obama administration announced last week that 105 groups will split $67 million to serve as navigators in states with federal-run and partnership exchanges. That’s $13 million more than originally announced for the program, but still short of what advocates say is necessary. Click here to see a state-by-state list of recipients, which includes a number of hospital systems.

13 State AGs Worried Exchanges Won’t Protect Privacy

Thirteen state attorneys general wrote to the HHS Secretary last week to say they’re worried that the agency isn’t adequately protecting the privacy of those shopping in the insurance exchanges. Among their worries: that navigators and other assisters aren’t being trained well enough to protect personal data. Click here to see their letter.

Treasury Regs Detail Hospital Penalty for Community Health Needs Assessment 

The Affordable Care Act requires hospitals to conduct a Community Health Needs Assessment at least once every three years and adopt an implementation strategy. The requirements are effective for taxable years beginning after March 23, 2012. Failing to meet the mandate results in a $50,000 tax or fine for each year of non-compliance. The Treasury Department issued regulations last week on how it plans to implement the penalty. Click here for the 8-pages.

North Carolina Family Subject of New ObamaCare Ad

A pro-ObamaCare group, Organizing for Action, has started running its third TV ad. It tells the story of a North Carolina family that said it’s saving money because of the health law. After receiving a renewal notice that their insurance premium would go up by “about $110 a month,” the family says Obamacare delivered a $350 health insurance rebate from its insurer and brought down the premium by about $60 a month. Click here to see the 30-second ad.

Essential Health Benefits Requirement Won’t Impact Plan Offerings

The Affordable Care Act’s essential health benefits requirement won’t do much to change the number of benefit plans currently offered, according to a Robert Wood Johnson Foundation study. Researchers concluded that few, if any, services currently covered by plans will be replaced by others mandated by the government. The take-away: plans won’t be majorly disrupted. Click here for the study.

House GOP Continues to Question Exchange Subsidies

House Oversight Chairman Darrell Issa (R-CA) last week urged Treasury Secretary Jack Lew to turn over 50 emails related to his agency’s decision to award insurance subsidies through federally run exchanges. Treasury has given the committee documents related to the decision, but Issa says the material provided by Treasury officials, so far, aren’t sufficiently justified. Click here for Issa’s detailed 8-page letter to the Treasury Secretary.

Tea Party Pushing GOP to Defund ObamaCare

Funding for the federal government will expire on September 30th and must be renewed to keep the government operating. Tea Party activists are pushing legislation by Senator Ted Cruz (R-TX) or Rep. Tom Graves (R-GA) that would defund the Affordable Care Act.  However, they are pushing members of Congress to vote against extending any government funding that contains any money for ObamaCare. Click here to see their list of members of Congress who have signed on to the legislation.

Former Insurance Exec Slams Coverage of ObamaCare

I don’t often include opinion pieces in this weekly summary, BUT the attached article was written by a former senior insurance executive (now fairly well known in health policy circles) who tries to set straight some of the record on the Affordable Care Act. Like or hate Obamacare, you will appreciate the research he has done. Click here for Wendell Potter’s own analysis.

RACs Target Outpatient Therapy Providers

More than 350 outpatient therapy providers are in the process of receiving letters that are not likely to be welcomed, as there is yet another CMS review contractor taking a look at outpatient therapy. Strategic Health Solutions, a CMS Supplemental Review Contractor, is requesting the targeted outpatient therapy providers to submit specified claims for post-payment review. The claims review period is from August 2012 through March 2013. Click here for details.

Joint Commission Proposes New Requirements on Imaging Services

The Joint Commission last week proposed more-stringent requirements in the ambulatory care, critical access hospital, and hospital accreditation programs for facilities that provide CT, MRI, nuclear medicine, and PET services. For example, facilities that provide CT, PET, or nuclear medicine services would be required to monitor radiation exposure levels for all staff and licensed independent practitioners who routinely work with those modalities. Click here to review all the revisions.

Government Licensing Process Blamed for Some of Doc Shortage

Foreign-trained physicians could help ease the looming doctor shortage, but are stymied by the long and cumbersome process for becoming licensed in the U.S, according to the new York Times last week. Each year about 3,000 of the 8,000 immigrant doctors who apply through the national residency match system receive a residency, or about 42 percent over the last five years. About 94 percent of seniors at mainstream U.S. medical schools win residencies through the national match system. Click here for more.

Florida Hospital Improve Outcomes Through Statewide Effort

Florida hospitals that voluntarily participated in statewide initiatives, saw lower surgical complications and readmissions, in addition to saving millions of dollars, according to a report issued last week by the Florida Hospital Association. The FHA started the quality effort in 2008. Click here for the report.

US Infertility Rates Drop

The rate of infertility among married women in the U.S. dropped from 8.5% in 1982 to 6% between 2006 and 2010, researchers from the National Center for Health Statistics said. The report found that 4.9% of unmarried women with a male partner were infertile. Click here for the 19-page report.

Olympic Committee Forms Medical Network

The US Olympic Committee last week announced the formation of a National Medical Network, which will provide medical care to elite U.S. athletes, including orthopedic medicine, physical medicine, primary care, dentistry, neurosurgery and more. This network is comprised of national and regional medical centers. Click here for the list.

University of Pennsylvania Wellness Program May Go Too Far 

Is it possible for your organization’s wellness program to go too far? Well, that may be the case at the University of Pennsylvania where more than 2,000 faculty and staff employees are protesting the University’s wellness requirements. This includes a $1,200 annual penalty for non-compliance – said to be one of the most severe employer penalties in the country. Click here for the story.

One-in-Five Deaths Related to Obesity: Report

18 percent of deaths among white and African-American people in America, ages 40 to 85, are associated with people being overweight or obese, the latest research suggests. Yet several national health experts think that may be an overestimate because of the methodology used for the analysis. Click here for the USA Today story.

Blood Test Developed to Help Diagnose Depression

A company called Ridge Diagnostics has developed a blood test that is designed to help doctors diagnose depression. Patients who take the test, which costs about $745, are assigned a score from 1 to 9. Patients who receive higher scores are more likely to be suffering from depression. Click here for the story in Forbes.