WEEKLY E-BULLETIN


House Members Circulating Letter to Save Critical Access Hospitals

With the recent HHS OIG report calling for the elimination of Critical Access Hospitals under consideration as a source of further federal budget cuts, U.S. Representatives Ron Kind (D-WI) and David McKinley (R-WV) are circulating a sign-on letter opposing the report and cuts to CAHs. By the OIG’s own “conservative estimate,” 64 percent of CAHs could lose their status if the recommendations go into effect. The sponsors are asking their colleagues to sign-on by tomorrow. Click here to see of copy of the sign-on letter.

Hospitals in Medicaid Expansion States Faring Better in Bond Market

Health systems that issue bonds in states that are expanding Medicaid are getting better terms than those in states that don’t, Bloomberg reported last week. Muni bonds sold by hospital systems in the past three months in no-expansion states have been the biggest losers in the market. “States that aren’t expanding Medicaid are still going to have a high percentage of the uninsured,” said a senior analyst at Wells Capital Management that oversees $31 billion in bonds. “The hospitals are going to lose a lot of money.” Click here for the report.

Final Medicaid DSH Regs Released by CMS

CMS on Friday issued the final rule gradually reducing Disproportionate Share Hospital payments to facilities that serve a high concentration of low-income patients. The reg adopts a proposal to ignore states’ decisions on the now-optional Medicaid expansion over the next two years when calculating DSH reductions. The cuts total $1.1 billion. “State decisions to expand Medicaid will not affect the amount of reduction in DSH allotments,” according to CMS. Click here for the fact sheet. Click here for the 84-page rule.

Government Panel Recommends Scrapping Hospital 3-Day Stay Requirement

Eliminating Medicare’s three-day hospital stay requirement for skilled nursing coverage is one of many recommendations made last week by the Federal Commission on Long-Term Care. The recommendations also include site neutral payment policies for post-acute services and reconsidering the Medicare requirement that individuals receiving home health services be “homebound.” Click here for the complete list of recommendations.

Hospitals Leading Efforts on Exchange Sign-Up

Two weeks until the federal health exchanges open for business and there continues to be significant political posturing in Washington over whether the governments – state and federal – will be ready. Among the groups making meaningful preparations to sign up exchange beneficiaries are hospitals – both the for-and not-for-profit. Click here for the story on this emerging exchange sales force.

CMS Hosting Exchange Teleconference Thursday

CMS is hosting a Thursday, September 19, teleconference on the health insurance exchanges, which will highlight health coverage strategies from Arkansas, Connecticut, Kentucky and Minnesota. To participate, from 1-2 p.m. EDT, register by clicking here.

Bill Fixing Doc Payment Formula Costs $175 Billion: CBO

It’s official, the Energy and Commerce Committee bill to repeal and replace the Sustainable Growth Rate (physician Medicare payment) formula costs $175 billion over 10 years, the Congressional Budget Office said in a report released Friday. The bill was passed unanimously by the full committee in July. The CBO said last spring that repealing the SGR would cost $140 billion. Click here for the 9-page CBO analysis.

Health Experts Recommend Reform Alternatives to Pay For SGR

How to pay for the physician payment fix needed by year’s end?  A group of prominent health care experts has released a set of recommendations – none of them new to those of you who have been following this weekly report – that they say will lower the cost of care and improve quality without further payment cuts. The recommendations call for rewarding value, improving care coordination and increasing competition among certain services as the path to long-term sustainability. Click here for their summary and complete report.

Hunger Is Focus of Health Care Symposium in D.C.

The House Cannon Caucus Room on Capitol Hill is the sight of an upcoming national program October 10 where the focus is on hunger as a major factor in health care. Former U.S. Rep. Tony Hall, who now chairs the Alliance to End Hunger and ProMedica, a health system in Ohio, are teaming up for the symposium. Click here for details. Click here to sign up for the event.

House Passes Subsidy Verification Bill

The House passed legislation last week aimed at preventing people from receiving health insurance subsidies under the Affordable Care Act until a better system is put in place to verify who is eligible for those subsidies. Members passed the No Subsidies Without Verification Act, H.R. 2775, in a 235-191 vote that saw support from five Democrats. It is unlikely the legislation will be passed by the Senate. Click here for the story.

Government Shutdown Threats Could Impact Health Care Funds

The biggest news in Washington over the next two weeks will be whether there will be a government shutdown with the federal budget expiring October 1 and no replacement in sight – AND whether there will be additional Medicare payment cuts as part of any budget deal, if one emerges. Some in the GOP continue to call for a shutdown unless the Affordable Care Act is defunded or delayed. Others in the House GOP, particularly in leadership, are considering working with the Democratic minority to find the necessary votes to get a budget deal done. Click here for a very good summary from the Washington Post.

MedPAC Says Per-Beneficiary Spending Will Grow Significantly

MedPAC – the agency that advises Congress on Medicare – issued a cautionary note about the growth of health care spending last week.  Their report said per-beneficiary spending is expected to grow significantly over the next decade, even though a wave of younger, healthier baby boomers are coming into Medicare. They emphasized that the recent slower growth in health care spending should not lull policymakers into complacency. Later the same day, the Congressional Budget Office reported that Congress has not done nearly enough to control spending in large federal programs such as Medicare. Click here for MedPAC’s 19-slide presentation (it’s a great resource). Click here for the CBO report.

MedPAC Seeks Ways to Improve ACOs

At last week’s MedPAC meeting, the Commission said it is working on changes that would improve Accountable Care Organizations, but timing of legislative or regulatory action is uncertain. MedPAC is considering changes to benchmarking, attribution and risk adjustment. MedPAC plans to survey current ACOs through  interviews to develop better data. There are now 220 MSSPs and 23 Pioneer ACOs. Click here for MedPAC’s excellent 17-slide summary of current ACO issues.

Hospital Outpatient Regs Focus on Facility Fee Payments

In hospital outpatient rules waiting to be finalized, CMS officials want to replace five escalating price codes hospitals can choose from in billing facility fees with one flat rate, starting next year, according to a new report in Public Integrity. Whether charged at one rate or five, the mere existence of facility fees is contentious because they come on top of physician bills and hospital charges for tests, medicines and other supplies, and have risen sharply in recent years. Hospitals counter that the fees are needed to help defray the costs of big-ticket medical technology and resources, such as operating rooms. Click here for the detailed report.

IOM Declares Cancer Care Crisis

The Institute of Medicine last week declared a cancer care crisis in the United States, due to a growing demand for cancer care, a shrinking workforce, rising healthcare costs and the increasing complexity of treatment. An IOM-convened committee of experts found U.S. cancer care is not patient-centered, many patients do not receive palliative care and decisions about care are not always based on the latest scientific evidence. Click here for the IOM report.

$67 Million Awarded for New Health Centers and Improvements to Current Centers

HHS last week awarded $19 million to establish 32 new health center sites. In addition, the agency announced $48 million to support ongoing operations and quality improvement activities at 1,200 existing health centers. Click here to see the list of new sites in 20 states and territories.

HHS Says Rate Review Requirement Saving Consumers $1.2 Billion

A new report released last week by HHS shows that 6.8 million Americans saved an estimated $1.2 billion on health insurance premiums in 2012, due to the “rate review” provision of the Affordable Care Act. Click here for the government’s report.

Gun Assault Injuries Cost Hospitals $630 Million in 2010: Study

A report from the Urban Institute last week said hospital costs to treat gun assault injuries in 2010 was $630 million – that’s for more than 36,000 emergency room visits and 25,000 hospitalizations. Men account for 91 percent of the costs, mostly males aged 15 to 34. And 80 percent of those treated in gun assaults either have public insurance (52 percent, mostly Medicaid) or are uninsured (28 percent). Just over half are from ZIP codes in the poorest 25 percent of ZIP codes by income, and 7 percent are from the top 25 percent.  Click here for the study.

FDA Panel OKs Pre-Operative Breast Cancer Drug

An FDA advisory committee cleared the way last week for the first approval of a cancer drug that would be used to treat patients before surgery to remove their tumors. The committee voted 13 to 0, with one abstention, that Perjeta, a Genentech drug approved last year for late-stage breast cancer, could also be used at the disease’s earliest stage. Click here for the story.