WEEKLY E-BULLETIN


Health Care to Play Prominent Role in Federal Budget Discussions

Health care payment reform (read: reductions) are likely to be part of the discussions as a House-Senate Conference Committee began meeting last week as part of the deal to re-open the federal government. Although the government re-opened last week, it could close again in mid-January with another potential default pending the first week of February 2014. The special committee, which was created by last week’s congressional deal, is required to produce a report to Congress by mid-December. It may be a bit confusing, so click here for our 1-page summary, including the key players, along with several supporting documents.

Insurers, Others Seek Relief in Upcoming Budget Deal

Many organizations are seeing the congressional budget conference as an opportunity to push industry-specific issues. For example, the association representing most of the nation’s health plans, AHIP, said late last week it intends to seek a two year delay in the tax on insurers that takes effect in January. Click here for that report. Click here to read how other groups are readying for the fight.

2 “Nightmare” Rule Enters Third Week

We are now into week three of CMS’ 2-Nightmare…I mean, Midnight…Rule. It seems to have become more of a challenge for implementation than was anticipated by the agency. This article examines the three most important areas physicians will need to pay particular attention to when addressing the regulation. Click here.

Obama Tackles HealthCare.gov Technology Glitches

President Obama will “directly address the technical problems with HealthCare.gov” at an event today in the Rose Garden where he also plans to underscore the benefits his health law will provide Americans, the White House said late yesterday. “Unfortunately, the experience on HealthCare.gov has been frustrating for many Americans.” That’s according to an unusual confession in an HHS blog posted yesterday on the government’s site. The 600-word post discusses what happened to the federal health exchange and what the agency is doing to fix it. Click here to read the blog. For more details on the HHS effort, click here for the Washington Post story.

Nearly 500,000 File ObamaCare Applications

According to data released to the Associated Press on Saturday, Obama administration officials say about 476,000 health insurance applications have been filed through federal and state exchanges. However, the officials continue to refuse to say how many people have actually enrolled in the insurance markets. Click here for the report. More than 20 million people have visited the website. Click here for some further analysis from the Washington Post on this issue.

State-Run Exchanges Fairing Better Than Federal System

State-run exchanges are reporting their sign up numbers.

  • Minnesota’s state-run health insurance exchange reported Wednesday that 5,569 households had completed applications for coverage in the first two weeks of operation, representing 11,684 people. Click here for details.
  • Washington State’s enrollment seems to be running well – click here that report.
  • In Maryland, about 2,400 have signed up. Click here for more.
  • Connecticut’s exchange appears to be attracting older persons. Click here for the story.
  • ObamaCare has just cut Oregon’s uninsured rate by 10 percent, according to state officials who say that 56,000 have signed up under the Medicaid expansion. Click here for details.
  • To see a state-by-state breakdown – with only 13 states reporting – click here.
  • States that run their own exchanges appear to be fairing better on their rollouts, according to published reports. A Fox Business story on this issue has some explanation as to why this may be. Click here.

Some States Don’t Have Enough Insurance Offerings

So few insurers offer plans on some of the new government health insurance exchanges that consumers in those states may pay too much or face large rate increases later, insurance experts say. An average of eight insurers compete for business in 36 states that had exchanges run or supported by the federal government last month, according to HHS officials. Click herefor the story.

Some in GOP Call for Sebelius’ Resignation; House Investigation Begins

The Washington “blame game” over the troubled launch of the federal health exchange has begun in earnest with some GOP leaders calling for HHS Secretary Kathleen Sebelius to resign. So far, the secretary is standing firm, although she could testify before congressional committees on the issue. Click here for the report. A House committee has launched an investigation and will hold hearings later this week where they will likely grill the companies that put the federal site together. Click here for the story.

The Politics Surrounding ObamaCare Heats Up

The AP is reporting that the GOP is intent on making the health law an uncomfortable anchor around the neck of four Democratic senators seeking re-election in GOP-leaning states, weighing them down as they try to unseat them. Click here for the story. Some in the GOP are focused on a state-by-state political strategy to undo ObamaCare. Click here to read about their tactics. Speaking of politics, the government reopened last week and I would be remiss not to mention the drama around that event — complete with a Washington Post story detailing the blow-by-blow. Click here.

New Poll Says Most Uninsured Not Familiar with Exchanges

Although federal and state health insurance exchanges opened on Oct. 1, 71% of Americans who lack health insurance — the primary target group for the exchanges — say they are “not too familiar” or “not familiar at all” with them, little changed from last month. Click here to see the Gallop survey results.

Senators Propose Change In “Indian” Definition Under ObamaCare

Five Senate Democrats have introduced legislation to clarify who qualifies as an “Indian” under the Affordable Care Act. The law contains several different definitions of Native American, leading to conflicting interpretations of eligibility for benefits and requirements for coverage. Without legislation, thousands of Alaska Natives and American Indians could be prohibited from receiving health benefits they’re eligible for, said Senators Mark Begich of Alaska, Max Baucus of Montana, Tom Udall of New Mexico, Brian Schatz of Hawaii and Al Franken of Minnesota. Click here for details.

New Analysis Says 5 Million Uninsured Hurt in States Without Medicaid Expansion

According to a Kaiser analysis released last week, 5.2 million poor uninsured adults will fall into the coverage gap in the 26 states that have opted out of Medicaid expansion under the ACA. Click here for the 9-page report.

Investigation Shows Thousands in Long Term Care Have Savings Stolen

Thousands of residents in U.S. nursing homes and other long-term care institutions for the aged and disabled have had their personal savings raided or mismanaged after relying on the facilities to safeguard the money in special trust fund accounts, a USA TODAY investigation showed last week. Click here for the story.

Miami Leads Nation In Most Medicare Rx Prescriptions

A new Dartmouth Atlas Project study released last week shows elderly Miami residents on Medicare filled more prescriptions for drugs in 2010 than seniors elsewhere in the country. They were also more than twice as likely as residents in Rochester, MN, to fill at least one prescription for medications that have been identified as high-risk for patients over age 65. In Miami, the average Medicare patient spending $4,738 on prescription drugs in 2010, more than any other region and well above the national average of $2,968. Click here for the 68-page report. Click here for press reports.

Hospitals Would Lose Billions If Muni Bond Exemptions Are Ended

Federal proposals to end or limit the tax exemption on municipal bonds would cost nonprofit hospitals and other charitable organizations between $5.8 billion and $16.6 billion in additional interest annually, according to a study released by the National Association of Health and Educational Facilities Finance Authorities. Click here for the 8-page study.

Hospital CEO Pay Basis Questioned in Study

Hospital CEO pay is based more on technology and patient satisfaction than on outcomes, processes of care and community benefit, a study published online last week in JAMA Internal Medicine found. The study found no correlation between CEO pay at private, nonprofit U.S. hospitals and hospital margins, liquidity, capitalization, mortality, readmissions, process quality performance or occupancy rates. Compensation rates did reflect the number of hospital beds, whether the hospital was a teaching facility, and location–with large, urban teaching hospitals conferring the highest compensation. Mean compensation for the 1,877 CEOs responsible for 2,681 hospitals was $595,781 in 2009. The median pay was $404,938. Click here for the abstract (there is a fee for the full study.)

Joint Commission Issues Alert on Material Left in Patient’s Bodies

There were more than 770 voluntary reports of hospitals and ambulatory centers leaving sponges, towels and instruments in patient’s bodies after surgery over the last seven years, according to The Joint Commission, which recommends hospitals report such incidents and take steps to address the problem. Click here for the Joint Commission’s Sentinel Event alert.

Hospital-Acquired Pressure Ulcers May Be Under-Reported

Hospitals that rely on claims data to measure hospital-acquired pressure ulcers are likely under-reporting the problem and creating an inaccurate comparison with competitors for the public, according to a study released last week. A far more accurate measure uses surveillance reports by trained clinicians inside the hospital. Click here for details.

PCORI Launches New Grant Program

The Patient-Centered Outcomes Research Institute (PCORI) last week launched a pilot program to help individuals and groups develop proposals for clinical comparative effectiveness research. The focus is on those not usually in the research application game. Applicants from 13 western states can apply through December 2 for the Pipeline to Proposal awards of up to $15,000 each. The states are Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington and Wyoming. PCORI expects to announce 25 recipients on December 15 and funding opportunities for other states early next year. Click here for details.

Health Centers Hurts In States Not Expanding Medicaid

Community health centers in states that have rejected Medicaid expansion under the Affordable Care Act will forgo more than half a billion dollars in new revenue in 2014, according to a new report from the George Washington University School of Public Health and Health Services. Click here for the 15-page report.

Current Flu Season “About Average”

The percentage of Americans who report being sick with the flu on any given day in the first half of October averaged 2.2%, similar to the rates found in October 2011 and October 2012. The prevalence of flu is up from 1.5% in September, representing a typical increase for this time of year. This is according to Gallop – click here to see all their numbers.

SSN#s Should Be Removed from Medicare Cards: GAO

CMS has been slow to act on data it has collected that could help it implement a technical solution for removing Social Security numbers from Medicare cards, a Government Accountability Office report concluded last week. Despite having already identified two potential approaches for removing SSNs–replacement via a new Medicare Beneficiary Identifier or masking the first five digits of SSNs displayed on Medicare cards–CMS has yet to establish a business case for an IT project to spearhead such an effort. Click here for the GAO report.

Study Says Sleep Best to Release Toxins

All you night owls, take note: sleep actually helps the body release toxins, according to a study using mice funded by the National Institutes of Health released last week. The study in which researchers observed dye flowing through the brain of a sleeping mouse, concluded that “sleep may … be the period when the brain cleanses itself of toxic molecules.” Click here for the NIH study.