WEEKLY E-BULLETIN


Medicare Rights Groups Unhappy with 2-Midnight Rule

Providers aren’t the only group concerned with CMS’ new 2-midnight admissions rule that takes effect October 1. Medicare patients rights’ group are also saying the rule leaves much to be desired. The Center for Medicare Advocacy said in a report last week, “CMS expresses hope that the new final regulations…will ‘reduce the frequency of extended observation care when it may be inappropriately furnished.’ Unfortunately, the regulations and CMS’s lengthy discussion of them in a section of the preamble entitled ‘Payment Policies Related to Patient Status’ do not resolve the problem of Observation Status for Medicare beneficiaries.” Click here to read their detailed analysis.

Hospital Merger Report Outlines Reasons for Failures, Successes

With a new hospital merger wave underway across the nation, leaders are going to need new ways to make them successful, according to a study out last week from booz&co. Click here for the report and some interesting data on hospital mergers.

Hospitals Reporting RAC Audits Up Significantly

Requests for medical records from Medicare recovery auditors (RACs) are up 47 percent since 2012′s fourth quarter, according to an American Hospital Association survey of more than 12,000 hospitals released last week. In the second quarter of 2013, complex audit denials by Medicare RACs rose 58 percent, with two-thirds of hospitals reporting the most expensive RAC requests are medical necessity denials. Sixty-three percent report they spent more than $10,000 on the RAC process in the second quarter of 2013. Forty-five percent reported spending more than $25,000 on the same process while 11 percent reportedly spent more than $100,000. Click here for AHA’s detailed 72-slide review.

Health IT Spending to Increase $34.5 Billion

Health IT spending at large North American healthcare organizations is expected to increase to more than $34.5 billion as regulatory mandates demand infrastructure modernization to meet new healthcare guidelines, according to a report out last week. Technology Business Research Inc. details how this will be be spent across industry applications, business applications, productivity applications, business intelligence and analytics, database and technology, and systems management, as well as which vendors are poised to take the lion’s share of these budgets. Click here for more. (There is a fee for the complete report.)

House GOP Leaders Release Medicare Reform Proposals

Top House Republicans on the Ways and Means and Energy and Commerce committees last week issued a paper exploring ideas for reforming Medicare that have received bipartisan support in the past: combining the Part A and Part B deductibles and changing cost-sharing for Medigap plans. This is the first of several Medicare reform reports that GOP leaders plan to issue over the next few months. Click here to review their recommendations in this 10-page report.

House GOP Targeting Navigators with Info Requests

Almost half of the 105 groups participating in the navigator program received letters from Republicans on a key House Committee, according to a letter sent last week from the top Democrat on the committee, Henry Waxman (D-CA). His letter condemns the information request made by the GOP as an abuse of authority. Waxman says the request went to every navigator group in 11 states. Click here for the GOP letter. Click here for a list of organizations that received the GOP letter. Click here for Waxman’s letter.

HHS Delays Final Contracts with Federal Exchange Insurers

HHS is delaying by about two weeks its deadline to sign the final contracts with insurers on the federal exchanges amid concerns from health plans about the system’s ability to accurately present information about consumers’ options when enrollment begins in October. Click here for the report. Ohio GOP Senator Rob Portman has called on HHS to delay the exchanges open enrollment period until the infrastructure is running well. Click here for his letter.

New Final Reg Issues on Exchanges

HHS has posted a final rule covering a number of exchange provisions, including program integrity, eligibility appeals and a new option for states to SHOP exchanges. The department also posted a fact sheet on the rule. Click here for the fact sheet that explains it. Here for the 300-page rule.

Study Says Insurance Increases Overblown

Predictions of sharp increases in health-insurance premiums for people getting coverage under the U.S. Affordable Care Act have been overstated and many states will see little to no change, researchers at Rand Corp. found. Out-of-pocket premiums for most individuals who buy health plans through new insurance exchanges will decline because of federal subsidies. The researchers looked at insurance markets in 10 states to project costs. Click here for the study.

Rural Health Could Suffer Without Medicaid Expansions

At least 21 states have refused to expand their Medicaid programs under the provisions of the Affordable Care Act and an economist last week warned of the negative impact in rural areas of the country. Click here for that report.  Additionally, the government issued a report two weeks ago recommending that three-quarters of all Critical Access Hospitals lose their CAH designation. This would also devastate rural populations heavily dependent on these hospitals for their care. Click here for a story on the impact in South Dakota.

A Rural Health System that Is Finding Success with Population Health Efforts

One rural hospital system in western Maryland has apparently figured out how to make a go of it with admissions on the decline, according to a New York Times report last week. Its population health and restructuring efforts are paying off financially. Maryland’s price controls may have also had something to do with this success. Click here for an interesting story.

New North Carolina Law Requires Public Disclosure of Hospital Prices

In what might be the start of a national trend, the North Carolina Department of Health and Human Services’ website will soon be publishing the prices of the 140 most common in-patient, surgical and imaging services performed by every hospital in the state. This is thanks to legislation signed last week by the state’s GOP governor. Click here for a summary.

Census Bureau Identifies Texas, Florida, Nevada, New Mexico, Oklahoma with Most Uninsured

More than one in four Texans under the age of 65 lacks health insurance, more than any other state in the nation. Florida is next, followed by Nevada, New Mexico and Oklahoma. Those results are from a new Census Bureau report released last week detailing health insurance rates at the state and county level. The map on the first page of the 24 page report says it all. Click here.

Dialysis Funding Cuts Demonstrate Difficulty in Curbing Spending

In a demonstration of how hard it is to curb federal spending, more than 100 of the same members of Congress who voted in January to impose big cuts to dialysis payments are now trying to push the Obama administration to reverse it or water it down. The conflicting message is due in part to the lobbying muscle of an industry dominated by two companies — DaVita Healthcare Partners and Fresenius. Click here for the NY Times report.

Hunger is Focus of Washington Provider and Advocates Summit

I don’t usually recommend conferences in Washington; there are hundreds every year.  But one coming up next month puts a new twist on population health. A large health system is partnering with the Alliance to End Hunger and focusing on hunger as a health issue. The Director for New York City’s Health Services is one of the many speakers scheduled for “Come to the Table”, an October 10 summit for healthcare executives, policy makers. You can learn more about the summit here, and can register here.

HHS Issues Nursing Home Coverage Memo for Same-Sex Marriages

HHS announced last week that access to care in the same nursing home as one’s spouse is extended to Medicare beneficiaries in same-sex marriages. The memo stated that this coverage applies equally to all seniors in private Medicare plans who are in a legally recognized marriage, regardless of where they reside. The change is a response to the recent Supreme Court ruling on the Defense of Marriage Act, and is the first rule issued by HHS that incorporates the decision. Click here for more from HHS.

Obamacare Political Fighting Heating Up

The political fight over Obamacare continues with less than a month before state health exchanges open their doors for business. Leading the fight against the Affordable Care Act is conservative Texas Senator Ted Cruz. He told a gathering last week that he will use the upcoming government funding debate to try to defund the health care law – even if it means shutting down the government. Click here for the story. Several GOP-led states are finding new ways to thwart Obamacare implementation. Click here for details.

Clinton to Defend Obamacare in Speech Tomorrow

Can “Explainer-in-Chief” former President Bill Clinton turn public opinion on the Affordable Care Act? Clinton will speak tomorrow from Arkansas in defense of Obamacare, according to a White House announcement last week. Click here for the story.

Dual Eligible Report from CMS Raises New Issues

Medicaid is subsidizing Medicare for the care of elderly dual-eligible beneficiaries who receive long-term care, an article published last week in CMS’ Medicare & Medicaid Research Review states, which is the opposite of what previous analyses found. If you are involved in managing the care for “Duals,” this CMS study provides some very informative data. Click here.

IRS Issues Final Coverage Mandate Reg for Individuals

The IRS is maintaining a policy that deems an individual compliant with the ACA’s coverage mandate for a month as long as that person has minimum essential coverage for a least one day during that month. The IRS’ final rule was released last week. The agency called it a matter of administration convenience. “Without the one-day rule, taxpayers and the IRS would need to determine the number of days each person in a shared responsibility family is covered in each month of a taxable year.”  Click here for the rule.

Report: Children’s Health Costs Rising Faster than Adults’

Children’s health care costs are increasing faster than adults’, but a few interventions, if widely adopted, could save tens of billions of dollars over the next decade, according to a report out last week by UnitedHealth Group. A white paper by the insurer crunched the numbers of millions of its clients, both in Medicaid and private insurance, and found that spending on children aged 1 to 18 grew by almost 8 percent from 2010-2011, compared with less than 4 percent on adults under 45. Click here for the 80-page report.

Hospitalizations for Oral Infections Growing

A new study shows that there are a growing number of people being hospitalized for oral infections. After reviewing national patient data from 2000 to 2008, researchers in Boston found that the people hospitalized for dental abscesses increased by more than 40 percent, to 8,141 in 2008 from 5,757 in 2000. Some 66 patients died after they were hospitalized. Click here for the report.

And This Bud’s for You – in the ED

There is a metric for just about everything in health care today. Everything is measured, evaluated and compared.  But I think the entertainment value of this study is its most promising feature. Budweiser and Colt 45 are the two most popular beers of patients showing up at hospital emergency departments. Yep. Researchers working with Johns Hopkins at its East Baltimore hospital are now reporting the news with graphs. Click here for this sobering (sorry) report.