WEEKLY E-BULLETIN


September 9, 2013

2-Midnight Rule Update: CMS Issues New Admission and Medical Review Guidance

In its ongoing effort to clarify its 2-midnight regulation, CMS late Friday issued guidance interpreting its new requirements for admission and medical review criteria for hospital inpatient services under Medicare Part A. The five-page document clarifies the types of practitioners who may provide orders for inpatient services and the types of information that must be included in those orders. CMS indicates that the order may be documented by an individual who is not a physician – such as physician assistants, residents or registered nurses – provided the documentation is consistent with state law, hospital policies, and medical staff bylaws and rules.  Click here for the CMS document.

Berwick Says CMS Should Eliminate the 3-Day Payment Rule

Former CMS Administrator and now gubernatorial candidate Don Berwick weighed in on the observation status issue last week.  Berwick told the press he considered eliminating Medicare’s three-day payment rule for hospitals. “The patient ends up holding the bag, and that’s not fair or appropriate,” he told the Boston Globe, adding that “Medicare should get rid of that rule.”  8 percent of Medicare patients had observation stays lasting longer than 48 hours in 2011, up from 3 percent in 2006, according to the article.  Click here.

Bundled Payment Initiatives Growing at Hospitals

A large and growing number of health systems are working on bundled payment initiatives, according to a report out last week from Booz & Company.  About 30 percent of hospitals are pursuing the model and another 51 percent are exploring it.  The bigger the system, the more likely bundled payments are part of its strategy.  Click here for the very informative report.

Individual Premium Prices Lower Than Expected: Analysis

The Kaiser Family Foundation released a report last week that found individual premium prices under the Affordable Care Act lower than previously expected. The study surveys premiums in the 17 states and the District of Columbia where premium data under the ACA is currently available, and is the broadest look yet at premium prices for consumers once the health care law takes full effect in 2014.  Click here for the report.

Minnesota Claims Its Rates Are the Lowest

The State of Minnesota says the individual insurance rates it released on Friday are the lower than those in the 17 other states that have so far publicly released information for 2014, according to media reports.  A 25-year-old nonsmoker who lives in the Twin Cities will pay as little as $90.50 per month. The highest-cost plan is $407.51 a month for a 60-year-old in a “platinum” plan.  Five insurers will sell a combined 141 plans on the exchange, and residents in 85 percent of the state’s counties will have three or more choices. Click here for more details.

States’ Expansion Decisions Have Real Impact on Poor

Here’s another report about what may already be so obvious.  The decision of some states not to expand Medicaid means that the nation’s poorest — those the Affordable Care Act would have helped the most — may not receive any help at all. Click here for the USA Today story. Click here for the detailed Commonwealth Fund study.

Study: Privately Insured Pay Much More than Medicare Patients

Across 13 selected U.S. metropolitan areas, hospital prices for privately insured patients—especially for outpatient care—are much higher than Medicare and vary widely within and across communities, according to a new study by the Center for Studying Health System Change. The study found that average hospital prices for privately insured patients in the 13 communities with large concentrations of autoworkers are about one-and-a-half times Medicare rates for inpatient care and two times what Medicare pays for outpatient services. Click here for the study.

New IRS Regs Detail Minimum Essential Coverage and Large Employer Coverage

In a move impacting almost all hospitals, the IRS last week issued proposed rules implementing the Affordable Care Act’s information reporting requirements for minimum essential coverage and for large employers coverage subject to the law’s shared responsibility provisions (recently delayed until 2015). The ACA requires insurers, self-insuring employers and others that provide health coverage to provide a list of covered individuals and the months they were covered. It also requires employers with more than 50 full-time workers to provide information about the coverage offered to each, by month, including the cost of self-only coverage. The agency said it will encourage covered entities to voluntarily implement information reporting in 2014, when reporting will be optional, to enable testing of reporting systems before the provisions are fully implemented in 2015.  Click here for the minimal essential coverage rules (42-pages).  Click here for the large employer coverage rules (72-pages).

IBM to Put Retires onto Exchanges

In what may presage an ObamaCare trend in the coming weeks, IBM will move American retirees off of its company-sponsored health insurance and onto a private insurance marketplace similar to those created by ObamaCare. Click here for the story.

CBO Says Insurance Mandate Delays Would Save Billions

Although it will likely not happen this year, the House still hopes to get the Senate to agree to legislation it passed in July to delay for a year the application of the individual health insurance mandate and the employer health insurance mandate.  Last week the Congressional Budget Office said those delays would save about $35 billion over the next 10 years.  Click here for the CBO report.

OIG Slams CMS (Again) for Improper Claims Oversight

The OIG issued another report last week claiming CMS may not be catching all overpaid claims and allowing large amounts of improper payments to persist. The report found problems with CMS’ action–or inaction–regarding improper payment vulnerabilities and referrals for potential fraud, as well as with RAC performance evaluations.  Click here to read the 31-page OIG report.

$70 Million Awarded to Childhood Homes Visit

HHS last week awarded $69.7 million in grants to 13 states to expand Maternal, Infant, and Early Childhood Home Visiting Program activities funded by the Affordable Care Act. These competitive awards recognize states that have implemented a high-quality, evidence-based home visiting program as part of a comprehensive, early childhood system of care.  Click here for the list of states and amounts.

Medicaid Managed Care Revenues Jump for Health Plans

Aggregate revenues reported by U.S. health plans totaled $435.2 billion for 2012, up from $409.4 billion in 2011, or 6.3%, according to an analysis by Mark Farrah Associates of data filed with the National Association of Insurance Commissioners.  In 2012, managed Medicaid revenues represented 18% of total health plan revenues, up from only 10% in 2006. Click here for the analysis.

Apple Story Model Used to Explain ObamaCare

The Connecticut health insurance exchange is using the Apple store model to help explain the Affordable Care Act, according to a report last week in Forbes.  Click here for this interesting take.

Commercials to Promote State Exchanges Get Underway

The federal government, state health exchanges and other supporters of the Affordable Care Act will be financing new commercials to promote Obamacare’s exchanges in the coming weeks.  According to one analysis, they strive for an upbeat, and at times humorous, tone to sell healthcare reform to a skeptical and largely unaware audience.  Click here for the story.

GOP Continues Drive to Defund ObamaCare

The conservative GOP effort to defund ObamaCare continues in earnest this week as Congress reconvenes after its summer recess.  Republicans in the House and Senate will try to use the expiring federal budget and/or the debt ceiling as leverage to move defunding legislation.  Click here for the details.

Bill Would Prohibit Subsidies Without Income Verification

Another ObamaCare issue the House is planning to take up this week is a bill that would prohibit the health insurance tax subsidies from going out until the government can verify whether consumers are eligible to receive them.  The bill, H.R. 2775, sponsored by Rep. Diane Black (R-TN) is in response to concerns raised by Republicans that the Obama administration won’t be able to immediately verify the incomes of people who receive subsidies to help them buy insurance on the health care law’s exchanges.  Click here to read the 2-page bill.

40% of Docs Would Pick a Different Career

Forty percent of physicians would pick a different career if they had to do it all over again, according to the 2013 Great American Physician Survey.  The fifth annual survey asked 1,172 physicians about politics, work-life balance, and measured their career satisfaction. Although 60 percent are still content with practicing medicine, the other 40 percent expressed unhappiness with third-party interference (32 percent), lack of adequate insurance coverage for patients (37 percent) and lack of time to adequately educate patients on better health strategies (19 percent).  Click here to see the survey.

Family Physicians Top Recruitment Efforts

For the seventh straight year, family physicians top the list of the most highly recruited doctors, according to a new survey from Merritt Hawkins, a physician search firm. The survey tracks the 3,097 recruiting assignments the firm conducted from April 1, 2012 to March 31, 2013. Physicians specializing in general internal medicine were second on the list, also for the seventh year in a row. This year was also the first in which employers requested significantly more geriatricians than in past years.  Click here for more.

Hospice Care Up, But So Is ICU Utilization in Last Month of Life

A report last week from the Dartmouth Atlas Project finds that although the use of hospice care for Medicare patients with advanced cancer is increasing, many patients do not receive hospice care until they are literally on their deathbed, within three days of the end of life. Paradoxically, the updated data also find that in 2010, despite increases in the use of hospice care, more patients were also treated in intensive care units in their last month of life than in the period from 2003 to 2007. Click here for this detailed report.

E-Cigarette Use Doubles for School Kids: CDC

E-cigarette use more than doubled among U.S. middle and high school students from 2011-2012, according to a report last week from the CDC.  More than 75 percent of youth users smoke conventional cigarettes too.  The percentage of high school students who reported ever using an e-cigarette rose from 4.7 percent in 2011 to 10.0 percent in 2012. In the same time period, high school students using e-cigarettes within the past 30 days rose from 1.5 percent to 2.8 percent. Click here for more.

200,000 Heart Attack, Stroke Deaths Could Be Prevented Each Year, CDC

At least 200,000 deaths from heart attack and stroke could be prevented each year through healthier habits and living spaces, access to preventive screenings and early treatment for high blood pressure and high cholesterol, according to a report last week from the CDC.  The agency estimates that preventable deaths from heart disease, stroke and hypertensive disease declined 29% between 2001 and 2010 due to improvements in risk factors and changes in cardiac treatments. Click here for the CDC report.

URAC Starts Accreditation for Clinical Integration and Accountable Care

The independent accreditation organization URAC announced last week two new accreditation programs for Clinical Integration and Accountable Care. Clinical Integration Accreditation program focuses on the development of the organizational structure needed for clinical integration and applying evidence-based guidelines and best practices. Accountable Care Accreditation supports an advanced level of operations with a focus on total population health and improving health outcomes through care coordination of population groups. Click here for details.