WEEKLY E-BULLETIN


CMS Softens the Blow of the 2-Midnight Rule

CMS didn’t delay the 2-Midnight inpatient rule, but the agency did try to soften the blow. In about a 24-hour period, 109 House members signed a letter to CMS urging a six month delay. Click here to see who signed the letter. Agency officials held a national conference call Thursday afternoon and said they were going to give hospitals some time to figure out how to make it work before starting serious enforcement. Click here for our team’s one-page summary of the announcement. Click here for a pretty good CMS updated Q&A.

Exchanges Online Tomorrow, But There Are A Few Glitches

If you want an excellent primer on state exchanges – what they could mean to you and your family, click here for the New York Times summary. Small businesses getting ready to buy on SHOP have to wait at least another month, according to an HHS announcement last week. Click here for that report. Information technology problems are delaying implementation in the District of Columbia and other problems are plaguing various aspects of exchanges in a number of other states. Click here for that report.

HHS Releases Health Plan Costs on Federal Exchanges – State Specific Data Available

Individuals and families may be able to choose between 6 and 169 qualified health plans in 2014 in the 36 states with a federally supported health insurance exchanges, HHS announced last week. On average, eight different health insurance companies are expected to participate in each federally facilitated exchange, with premiums generally lower in states with more insurers participating. In 48 states, monthly premiums for the second-lowest-cost silver plan average 16% below previous government projections of $392. The agency estimates that 56% of uninsured Americans may qualify for premiums of less than $100 per month after tax credits. Click here for the detailed data on rates – state by state. Click here for the NY Times summary. Click here for the White House blog on the report, which includes an interactive state map.

Out-Of-Pocket Costs Could Be High for Exchange Enrollees: Report

Initial data suggest that exchange plans will include high out-of-pocket costs for enrollees—including deductibles and cost-sharing for medical services and prescription drugs—before consumers reach their out-of-pocket maximum – according to a new report from Avalere Health. For a single individual enrolled in a Silver plan, the average annual deductible before any plan coverage begins will be $2,550, which is more than twice the average deductible in employer-sponsored coverage. Click here for their 2-page report.

Tax Preparers and On-Line Insurers Team Up on Federal Exchanges

Jackson Hewitt, the tax preparation firm, last week announced a partnership with Getinsured.com to enroll people in new Obamacare coverage. Getinsured is one of several online Web brokers that have signed an agreement with CMS to sell ACA plans in states with federal-run exchanges, and it’s also providing technology for state-run exchanges in California and New Mexico. The partnership mirrors a similar one recently announced by H&R Block and GoHealth to enroll people in ACA coverage. Click here for more.

RACs Recoup More than $800 Million in 3rd Quarter

The latest CMS data out indicates that RACs recouped approximately $2.4 billion in overpayments made to hospitals and other providers in the first nine months of fiscal year 2013. It also reports that providers received $101.9 million back after RAC reviews revealed they were underpaid. During the third quarter, which ended June 30, RACs recovered $855.3 million in overpayments and gave back $36.3 million in underpayments. Click here for the 3rd quarter report released last week.

IG Says IRS Needs to Better Track Its Obamacare Spending

The IRS needs to do a better job tracking how it’s spending money on the health care law, according to a Treasury Inspector General report issued last week. For example, the agency didn’t track all ACA-related costs that didn’t come out of Obamacare’s Health Insurance Reform Implementation Fund, the report said. Between fiscal years 2010-2012, the agency didn’t track or attempt to quantify about $67 million of indirect ACA costs, which includes IT support. Click here for the IG report.

75 House Members Push for Face-to-Face Home Health Change

A bipartisan group of 75 House lawmakers last week sent a letter asking CMS to consider modifying the physician face-to-face documentation requirements for Medicare home health services to allow for the mandate to be met through the collection of a modified 485 form. The lawmakers and home health community say the requirement is a duplicative and costly burden. Click here for a copy of the letter.

Congress Wants More Info on Navigators

Navigator groups are still not out from under congressional scrutiny. House Energy and Commerce Committee Republicans last week asked CMS to answer more questions about the navigator groups. “The questions and concerns that emerged from our review appear to be a direct result of the rushed implementation of the navigator program by HHS and the limited time available for training navigator grant recipient organizations and their staff,” the letter said. Click here to read the GOP letter.

Obama, Clinton Have Public Discussion on Affordable Care Act

In a renewed effort to change public opinion on the Affordable Care Act, President Obama and former President Bill Clinton spent an hour discussing the health care law in a New York City forum that was widely covered by media.  The two presidents are introduced by Hillary Rodham Clinton. Click here for a 6-minute video summary of the highlights of the discussion.

Government Shutdown? What Happens Next…

So what happens if the government shuts down. Click here for a good summary of what would occur within each of the government’s agencies. Since 1976, the government has shut down 17 separate times, lasting a cumulative 110 days. Here’s why each happened and how they ended.

Debt Ceiling Debate Underway Too, Health Spending Could Be Targeted

So now the congressional budget debate moves to raising the debt ceiling. Treasury Secretary Lew sent a letter on the debt limit to House Speaker Boehner last week. In the letter, Treasury estimates extraordinary measures will be exhausted October 17 and that Treasury would then have a balance then of less than $30 billion. Click here to read the letter.  House GOP members say they may seeking Medicare spending concessions as part of any deal. Click here for the NY Times report. However, a detailed summary of the House GOP’s spending cuts has not been released.

Congress Focuses on Health Care Acquired Infections

Health care acquired infections were the focus of a hearing last week in the US Senate. Senators expressed concern about the threat posed by infections patients contract while in hospitals or other health care facilities. About one in 20 hospitalized patients develops health care-associated infections, according to testimony from the CDC, and more than 1 million infections occur annually in a health care setting. CDC said the infections, in the worst cases, can lead to a dangerous condition called sepsis that can cause organ failure and death. Click here for the CDC testimony. Click here to see a recording of the hearing and all other testimony.

NIH Study Results Support Pay for Performance

A new study from NIH out last week continues to underscore the value of pay-for-performance. Pay incentives for clinician performance can improve cardiovascular care in small primary care clinics that use electronic health records, the report says. Participating clinics were grouped by size and location and randomized to incentive or control (usual care). There were an average of about 4,500 patients in the intervention group clinics and 3,000 in control group clinics. At least 10% of the patients were on Medicaid or were uninsured. Click here for the study.

Pioneer ACOs Discuss Lessons Learned

A panel of Pioneer ACO experts shared their opinions last week about lessons learned, so far, from participation in the CMS program. More than a third of Pioneer ACOs succeeded in reducing costs in Medicare in their first year, according to CMS. The program initially saved Medicare about $87 million and cut Medicare spending by 0.5 percent. Click here to see the remarks of Seton Healthcare, Montefiore and Dartmouth – a program from the Alliance for Health Reform.

Number of Medicare Advantage Plans Falling

The pay cuts to private Medicare plans under Obamacare are starting to take their toll, according to a new analysis from Avalere Health released last week. The number of plans that will be available to seniors in 2014 fell 5 percent. About 80 percent of counties in the South and Midwest will see a reduction in Medicare Advantage plans next year, and just over half of counties in the Northeast and West will see a drop. Overall, the number of MA plans is falling from 2,664 this year to 2,522 in 2014. Click here for the report.

Minority Report Released from Long Term Care Commission

The National Long Term Care Commission released its recommendations last week, but a minority of members came to some different conclusions and issued their report last week.  The minority report suggests that Long Term Support Services could be built into Medicare Part A, while a majority said such services should be financed through a Medicaid carve out program for private long term care insurance or using savings from a move to site neutral payments for tax rebates. Click here to read the minority report.

GOP Senators Want Delay in EHR Stage 2 Meaningful Use

17 Republican senators have sent a letter to HHS asking for a one-year delay in the deadline for providers to meet the EHR stage 2 meaningful use requirements. “We are concerned that the regulatory structure of the program has created significant time pressure in 2014, and progressing to Stage 2 may not be feasible for all participants,” they wrote. They also expressed concerns that an aggressive timeline may increase medical errors, stymie innovation and widen the digital gap between large provider organizations and small, rural groups. Click here to read their letter.

$3.5 Million in Pediatric Device Development Grants Announced

The FDA last week announced it has awarded seven grants totaling more than $3.5 million to various pediatric device consortia to boost the development and availability of medical devices for children. Click here to see the list of awardees.

Task Force Makes New Breast Cancer Treatment Recommendations

The U.S. Preventive Services Task Force recommended last week that women at high risk for breast cancer, but low risk for side effects from tamoxifen or raloxifene, should be offered those medicines prophylactically. The board recommended against the routine use of the drugs in women who don’t have an elevated risk. Click here to see their complete recommendations.

Deal Reached on Compounding Drug Pharmacy Legislation

Leaders from the Senate and House committees overseeing health policy last week announced that they have reached an agreement on legislation to regulate compounded drugs pharmacies. This legislation, the Drug Quality and Security Act, reflects a bipartisan, bicameral effort to improve drug safety and help prevent a future public health crisis like the 2012 meningitis outbreak tied to the New England Compounding Center. Click here for details.

Big Pharma Launches Effort Against India

Big pharma is taking on India saying the nation has made a mockery of their drug patents, according to recent reports. Their allies in Congress are pushing legislation to raise tariffs on India’s exports if the country doesn’t increase protections. U.S. drugmakers say their situation has gotten much worse of late. 12 times in the last three years, India’s government has denied or revoked pharmaceutical patents or approved generic versions of drugs before their patent terms expired. India’s laws allow such moves when its government decides a drug is exorbitantly priced. While a month’s supply of Nexavar, for example, sold for $5,000 in India, the same amount of Natco’s version goes for $160. Click here to see their new coalition website.