WEEKLY E-BULLETIN


Government Shutdown Continues, Healthcare Programs At Risk

It’s unclear how long the federal government shutdown will continue; however, it is already having an effect on numerous health care programs. Medicare claims payments continue, for now, because Medicare is a mandatory spending program not directly impacted by Congress’ annual “discretionary” budget process. Click here for a very good 1-pager on the shutdown’s impact on health care.

Shutdown Stops WIC Funding

Last week, the government also stopped funding the Special Supplemental Nutrition Program for Women, Infants and Children, known as WIC. Over 8.9 million moms and kids under five living near or below the poverty line rely on the program’s supplemental vouchers for healthy food, breastfeeding support, infant formula and other necessities dispensed at clinics nationwide. Click here for the story.

Obama: Don’t Give Up on Exchanges, Glitches Will Be Fixed

President Obama urged Americans late last week not to give up on signing up for health care coverage through the federal exchanges.  He said numerous glitches — caused by greater-then-expected demand — are being fixed. By Friday, there were 8.6 million unique visitors to the federal website, according to HHS officials. To put it in perspective, that’s more visits than Southwest Airlines’ website receives in a month. Click here for the report. The Obamacare exchange website was taken off-line for repairs during off-peak hours over the weekend. Click here for that story.

State Exchanges Also Had a Robust Week

16 states and D.C. have their own health exchanges. Click here for a state-by-state summary of how each of those exchanges weathered the past week.

Details on All Federal Plans Outlined by State

There are 1,923 plans being sold on federally run online marketplaces, according to a Kaiser Health News analysis. It found significant variations of price and availability. For example, Cigna is offering 50-year-olds one of its midlevel plans for $614 if they live in Flagstaff, Ariz. That same plan, contracting with different hospitals and doctors, will cost $428 in Phoenix and just $395 in Nashville. Click here for a very good complete list of all the federal exchange plans and prices, state-by-state.

Study: States With CO-OPs Have Lower Rates

States with new member-owned CO-OP health plans as have premiums that are more than 8 percent lower than states that don’t have them, according to a new study. The Consumer Operated and Oriented Plans are competing with traditional insurers on the exchanges in 22 states, introducing new competition to insurance markets. And there’s some early evidence that they may be helping to lower costs. Click here to see the 1-page analysis.

Lack of Medicaid Expansion in 26 States Hurt the Poor Significantly

The 26 states that have rejected the Medicaid expansion are home to about half of the country’s population, but about 68 percent of poor, uninsured blacks and single mothers. About 60 percent of the country’s uninsured working poor are in those states. Among those excluded are about 435,000 cashiers, 341,000 cooks and 253,000 nurses’ aides. Click here for the NY Times story.

Employee Benefit Costs to Rise 4.8 Percent Next Year: Mercer

Employers are helping to bend the health spending curve for the third year in a row, an annual survey by Mercer finds. Health benefit cost per employee will rise an average of 4.8 percent next year, according to the survey, marking another year of slow spending growth — in part because of the recession but also due to employer efforts, like consumer-directed health plans and wellness programs. But darker times are ahead under the ACA, when costs will go up for many and employers will act to minimize losses. A total of 11 percent told Mercer they would cut back hours of some workers to save on health costs. Click here for the report.

New DSH Regs Soften the Blow for Some

CMS last week issued an interim final rule that modifies the process for uncompensated care payments for hospitals eligible for Medicare disproportionate share hospital (DSH) payments for cost-reporting periods that span more than one federal fiscal year. The interim final rule clarifies operational concerns raised in the final rule released last month and also changes the data used in the uncompensated care payment calculation to ensure Indian Health Service hospitals are included in certain factors of the calculation. Click here for the 27-page rule.

Appeals of Medicare Hospital Claims Skyrocket

Appeals of Medicare Part A claims skyrocketed between 2008 and 2012, but chances for providers and beneficiaries to win an appeal on the first try have plummeted, according to a report released last week by the HHS Office of Inspector General. The report says that the first of level of the appeals system — redeterminations handled by the Medicare Administrative Contractors — has seen a 148 percent increase in Medicare Part A claims. The majority of this increase comes from inpatient stay denials, which rose over 500 percent between 2008 and 2012 driven by appeals of the Recovery Audit Contractors’ decisions. Click here for the OIG report.

2-Midnight Rule Started Last Week; New Summary Available

Although CMS is delaying full enforcement of the two-midnight rule, hospitals should begin implementing the certification and inpatient admission order documentation requirements, according to another summary of CMS’ new guidance. Also effective October 1, medical documentation for an inpatient admission must include additional elements to satisfy the physician certification requirement. Click here for the very good summary.

Doc-Owned Hospitals Asking Congress for Help

The association representing physician owned hospitals is planning a Washington, DC “fly-in” for its members November 12-13. They are asking members of Congress to sign onto HR 2027, introduced by Rep. Sam Johnson (R-TX), to provide relief for the physician-owned hospital industry. Among other things, the bill would allow existing physician-owned hospitals to add beds, operating rooms and procedure rooms. Click hereto see the list of 20 House co-sponsors.

PQRS Data Due Next Week

Physicians who do not report clinical quality performance data to the CMS by October 15 face a 1.5% reduction in Medicare reimbursement. Participation in the Physician Quality Reporting System is mandatory. Clinicians can choose from a slate of quality measures, such as percentage of 50- to 75-year-old patients who received the appropriate colorectal cancer screening. Click here for more.

Mississippi, Nevada, Alabama, Texas, Tennessee Best for Docs

If you are looking for the most physician-friendly state in the nation, look no further than Mississippi, according to the Physicians Practice 2013 Best States to Practice project, a data-driven ranking of U.S. states. In four of the six statistical categories used to compile the rankings for the 50 U.S. states and the District of Columbia, the Magnolia State ranked in the top 10.  The next four were: Nevada, Alabama, Texas, and Tennessee. Click here for more details.

ASCs Saving Medicare Billions: Study

A new analysis by researchers at the University of California-Berkeley finds that ambulatory surgery centers provide billions of dollars in savings to the Medicare program and its beneficiaries. Specifically, the researchers found that ASCs saved Medicare $7.5 billion over the four-year period from 2008 to 2011. ASCs have the potential to save the Medicare system an additional $57.6 billion over the next decade. Click here for details.