WEEKLY E-BULLETIN


Leapfrog Releases Updated Hospital-by-Hospital Safety Report

Hospital errors are the third leading cause of death in the U.S., according to a new analysis from the The Leapfrog Group.  The organization last week released its fourth round of safety scores, showing that most hospitals made little progress in addressing preventable medical errors and injuries since the organization issued its last update in May. Launched in June 2012, the program assigns hospitals a letter grade—A, B, C, D or F—based on publicly available safety data from the CMS’ Hospital Compare, the Leapfrog Group’s annual hospital survey and the American Hospital Association. Click here to see how your hospital, and your competing hospitals, scored. Click here for their press release.

Insurers Dropping Hundreds of Thousands Before Year End

Hundreds of thousands of people across the country are receiving letters from their insurance companies stating that their current insurance coverage will end December 31 because their plan doesn’t conform to the Affordable Care Act.  Most are offered alternatives from their insure but sometimes at a higher cost.  Click here for more.

OIG: Hospitals Do More Spine Surgeries When They Buy Implants From Doc-Owned Distributors

Hospitals that buy implants for spinal fusion cases from physician-owned distributors tend to host more spine surgeries, according to a federal report issued last week. The HHS OIG report investigated Congress’s concern that the increasing presence of physician ownership in the spinal implant industry may be creating a financial conflict of interest for some surgeons that colors their clinical objectivity.  Click here for the OIG report.  Click here for the story.

State-by-State Update on Health Exchange Enrollment

Kentucky, New York and Washington State are the only real bright spots in nation’s health exchange enrollment process since October 1, according to reports over the weekend.  For a state-by-state update on enrollment, click here for a summary from the New York Times.

10 Democratic Senators Want Open Enrollment Extended for Exchanges

In what appears to be a growing political problem for the Obama Administration, ten Democratic senators last week signed a letter calling for an extension of open enrollment for the exchanges if the website remains so problematic.  Click here to read their letter and see if your senator signed on.  Going one step further, one Democratic senator, Joe Manchin from West Virginia, is joining some GOP senators in calling for a delay in the individual mandate.  Click here.

November 30: Date Federal Exchange Will Be Fixed

HealthCare.gov, built by 55 contractors, is one of the most complex pieces of software ever created for the federal government. It communicates in real time with at least 112 different computer systems across the country. In the first 10 days, it received 14.6 million unique visits, according to the Obama administration.  It’s broken and the Administration says it will be operating smoothly by November 30.  Overall management of the fix has been given to a firm owned by UnitedHealthCare.  Click here for details.

GOP Senators Want Info From Exchange Builders

The top Republicans of the Senate Finance and Judiciary committees have sent letters to 47 companies that worked on the federal exchange website, asking for copies of their contracts and related documents.  Senators Orrin Hatch (UT) and Chuck Grassley (IA) also requested project schedules, performance reports and names of contacts inside HHS, all by November 8.  Click here for a copy of their letter.

HHS Issues $146 Million in New Exchange Grants

Five states and D.C. will share an additional $146.1 million in new exchange grants awarded by CMS last week.  The awards went to: Arkansas ($10.6 million), Idaho ($48.5 million), Iowa ($17.5 million), Connecticut ($20.3 million), D.C. ($34.4 million) and Rhode Island ($15.3 million). Click here for more information on grants to all states.

State Medicaid Directors Have Their Own Exchange Problems

State Medicaid directors have experienced numerous problems since the health insurance exchanges launched on October. 1, according to a new update from the National Association of Medicaid Directors. Work between state and local officials has slowed so much that several longer-term planned state functionalities may also suffer.  However, the update also says that connectivity with the data hub is improving and that states have reported increased real-time interactions. Click here to read their memo.

Limbaugh Outlines Method to Dodge Insurance Penalties; HHS Extends Penalty Deadline

So, you don’t want to pay a penalty for not signing up for Obamacare?  Conservative commentator Rush Limbaugh says he’s discovered a way to skirt the penalties for failing to obtain health coverage next year — but there’s a catch.  The fine for failing to obtain insurance under the so-called individual mandate, which starts at $95 or 1 percent of taxable income next year, will automatically be collected by the IRS from tax refunds. But if you make sure you don’t get a refund, the agency won’t be able to collect the penalty.  Click here to read the Limbaugh transcript.  Americans will also have six more weeks to sign up for health insurance without facing a penalty.  This is a change announced late last week by the Obama Administration.  Click here for details.

Study: Exchange Premiums Lower Because of Price Competition

Intense price competition among health plans in the marketplaces for individuals has lowered premiums below projected levels, according to a new study last week by the Center for American Progress. As a result of these lower premiums, the federal government will save about $190 billion over the next 10 years, the study says.  Click here.

US Medical School Enrollment Continues Growth

Enrollment in U.S. medical schools grew 2.8% in 2013 to a record 20,055 students, the Association of American Medical Colleges announced last week. Four new medical schools welcomed their first classes this year, contributing to about half of the enrollment increase. Applications to U.S. medical schools rose by 6.1%, to 48,014.  Click here for the announcement. Click here for specific enrollment details.

CMS Delaying Final OPPS Regs

CMS announced it is delaying issuing the final CY14 OPPS regulations until near the end of November.  These rules are usually issued by November 1.  Now providers will have only 5 weeks, over the holidays, to implement them.  CMS issued a statement (click here) saying that:  “we intend to issue the final rules on or before November 27, 2013, generally to be effective on January 1, 2014.  The impacted regulations include:

  • Medicare Program; End-Stage Renal Disease Prospective Payment System, Quality Incentive Program, and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (CMS-1526-F)
  • CY 2014 Changes to the Hospital Outpatient Prospective Payment System Ambulatory Surgical Center Payment System (CMS-1601-FC)
  • CY 2014 Home Health Prospective Payment System Final Rule (CMS-1450-F)
  •  Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2014 Final Rule with Comment Period (CMS-1600-FC)”

Hospital EHR Attestation Due by November 30

Hospitals participating in the 2013 Medicare (EHR) Incentive Program must attest that they have meaningfully used certified EHR technology by November 30 to receive payment, according to CMS. Eligible hospitals include those that are paid under the inpatient prospective payment system and critical access hospitals. Click here for more on attestation from CMS.  Nearly half of eligible hospitals (48%) were awarded Medicare incentive payments for meaningful use of electronic health records for 2012, up from 16% in 2011, according to a report released by the GAO last week.  Click here.

CBO: Raising Medicare Age Won’t Save As Much

A two-year increase in the Medicare eligibility age would only cut $19 billion off the deficit from 2016 to 2023, according to a CBO report released last week.  This is a significantly smaller reduction than a report in January that found $113 billion in savings over the next 10 years.  The agency said it revised the estimate because now it expects those between ages 65 and 67 — whose enrollment would be delayed under such a policy change — to cost Medicare less than originally anticipated. Click here for the CBO report.

HHS Final Program Integrity Regs Released

HHS last week issued its first Affordable Care Act final regulation since the government reopened about 10 days ago – rules that are designed to enhance program integrity.  The rule ties up a number of issues that have been pending for some time.  It finalizes portions of the program integrity rule proposed in June.  The regulation also finalizes interim final provisions of the 2014 HHS Notice of Benefit and Payment Parameters Rule published in March, 2011.  Click here for a good summary from Health Affairs.

CMS Tries Again on ESRD Initiative

Sometime this winter, CMS plans to reopen the Request for Applications for the Comprehensive ESRD Care Initiative to solicit additional participation and respond to stakeholder feedback, according to a CMS announcement last week. With this opening, CMS said it is particularly interested in creating opportunities for small dialysis organizations to participate and engaging with stakeholders on the quality measures and quality performance benchmarks for the initiative.  Click here for more details.

FDA:  More Restrictions on Painkillers Containing Hydrocodone

The FDA is recommending that painkillers containing the powerful hydrocodone be moved into the most restricted category of drugs that can be legally prescribed.  Vicodin and other hydrocodone-based painkillers, the most popular pharmacy drugs in the U.S., would be placed under stricter prescribing limits to curb abuse, according to the FDA.  Click here for the story. The US Pain Foundation said this announcement is not good news for millions of people suffering with pain.  Click here.  In related news, the FDA last week approved Zohydro ER (hydrocodone bitartrate extended-release capsules) for the management of pain severe enough to require daily, around-the-clock, long-term treatment and for which alternative treatment options are inadequate.  Click here for the FDA announcement. 


114 House Members Urge CMS To Drop Cancer Care Payment Cuts

A bipartisan group of 114 House lawmakers told CMS in a letter last week to drop its proposal to pay the same rates for cancer care in physicians offices and hospital outpatient departments. CMS touts the proposal as pay parity, but the lawmakers, using an industry argument, say the proposal would increase disparity in pay.  Click here for more.


Use of Drug Therapies Shows Wide Variations:  Dartmouth Atlas

A new report out last week from the Dartmouth Atlas Project shows that the use of both effective and risky drug therapies by Medicare patients varies widely across U.S. regions, offering further evidence that location is a key determinant in the quality and cost of the medical care that patients receive. Click here for details.


CDC Urges More Compound Drug Oversight

The CDC said last week that the deadly fungal meningitis outbreak that began last fall shows “the urgent need to address shortfalls in the oversight and safety of compounded drugs.” The CDC provided a review of the national situation.  Legislation to increase compound drug oversight is pending in the Senate. The Drug Quality and Safety Act, which would bolster FDA oversight of large scale compounding pharmacies which voluntarily register with the agency, passed the House last month and the Senate could take it up as early as next week. Click here for the CDC report.


For a Quick Break from These Challenging Health Care Issues…

And, just because we’re midway through college football season and need a break from all these challenging health care issues…you won’t believe this amazing video of the Ohio State marching band.  Sorry Michigan.  Click here.