WEEKLY E-BULLETIN


Bipartisan, Bicameral Physician Medicare Payment Formula Fix Proposed

Physicians are facing a 10-year freeze in Medicare payments under a newly released proposal to fix the Sustainable Growth Rate formula. The Senate Finance Committee and the House Ways and Means Committee issued a joint proposal. The leaders of the House Energy and Commerce Committee, that had already approved a plan, also endorsed the proposal. Click here for the 1-page summary. Click here for the full 8-page proposal. Keep in mind, none of the committees has yet to formally propose a way to pay for this fix, so its passage is still in doubt. The current formula expires January 1 when physicians will see an average 24.4 percent Medicare payment cut.

Joint Commission Issues New Hospital Report Card

Thirty-three percent of all Joint Commission-accredited hospitals that reported accountability measure data to The Joint Commission in 2012 are recognized as Top Performer hospitals. These 1,099 hospitals represent a 77 percent increase in Top Performer organizations from last year. The report was released last week. A state-by-state list of individual hospitals begins on page 40 (out of 60). Click here to see how your hospital (and your competing hospitals) performed.

Medicare Advantage Plans Grades Issued by US News and CMS

We’re in the middle of Medicare open enrollment and millions of Medicare-eligible seniors will opt to buy a Medicare Advantage plan from a private insurer instead of participating in the federal Medicare program. US News has published its list of best MA plans, by state. They have also detailed their grading methodology. Click here for the list. This year, CMS awarded five-star quality ratings to 14 Medicare Advantage plans covering about 5.6 million enrollees. Among the significant perks of being a five-star plan: the ability to enroll members throughout the year rather than only during the seven-week Medicare open enrollment period. The 2014 Medicare 5-star plans are:

  • Kaiser Foundation Health Plans; CA, CO, GA, HI, OR, WA and the Mid-Atlantic states
  • KS Plan Administrators; TX
  • Group Health Cooperative; WA
  • Gunderson Health Plan; IA, WI
  • HealthSpring of Florida
  • Providence Health Plan; OR and WA
  • Medical Associates Health Plan; IA, IL
  • Dean Health Plan; WI

HHS Letter Clarifies Whether Hospitals Can Subsidize Indigent Patients on Exchanges

Hospitals and other healthcare providers wanting to assist indigent patients by subsidizing their premiums on health exchange — even if they receive a tax subsidy — may be able to do so, according to an HHS letter sent last week to U.S. Representative Jim McDermott (D-WA). The letter states that providers that assist patients with paying their premiums for qualified health plans (QHPs) purchased on the exchanges are not subject to the anti-kickback statute. HHS stated that QHPs and other federal and state health insurance marketplace-associated programs are not considered to be “federal healthcare programs,” and thus the anti-kickback statute is not applicable. Click here for a copy of the letter.

Hospital, SNF, Home Health Medicare Deductibles to Increase

The Medicare Part A deductible – for inpatient hospital, skilled nursing facility and home health services – will increase by $32 in calendar year 2014, to $1,216, CMS announced last week. The daily coinsurance amounts will be $304 for days 61-90 of hospitalization in a benefit period; $608 for lifetime reserve days; and $152 for days 21-100 of extended care services in a skilled nursing facility in a benefit period. Click here for the details from CMS. Click here for the changes in Part B.

Rural Provider Payments Come Under Fire in New Study

A study released last week in Health Affairs is drawing new conclusions about the need for providing additional Medicare payments to providers in rural areas. According to the new study, “Medicare payment policies for rural health care providers are influenced by the assumption that the limited supply of physicians in rural areas causes rural Medicare beneficiaries to receive fewer health care services than their urban counterparts do. This assumption has contributed to the growth in special payments to rural providers. As a result, Medicare pays rural providers $3 billion more each year in special payments than they would receive under traditional payment rates.” Click here for the report.

Small, Non-Profit Hospitals Will Likely Weaken Further: S&P

Lower revenues and increased competition are taking a toll on small non-profit hospitals, and the financial profiles of those with lower credit ratings will likely continue to weaken, according to a report last week from Standard & Poor’s Ratings Services. While some hospitals appeared to successfully adapt to smaller revenues, the report states that others had trouble coping with decreased volume, the expense of electronic health records and physician turnover. Click here for the report (fee required by S&P).

HealthCare.Gov Fix: 25 Days and Counting

CMS is confident that it will meet the November 30 deadline it has imposed on itself to fix HealthCare.gov. Anticipating the website will be fixed, the GOP has already pivoted to other criticisms of the Affordable Care Act. Click here for the about the CMS deadline challenge. Federal officials said Friday that they had spent $630 million on information technology for the federal health insurance website, but they are frustrated with the complexity of the fix. Click here for an updated report on the website repair effort.

Obama Defends ACA; GOP Issues New “Playbook”

President Obama was contrite last week over the problem-plagued website, but offered a vigorous defense of the health law. Click here for the NY Times report. And so, what have we learned in ObamaCare’s first 31 days? Click here for an excellent and humorous report from the Washington Post. This report covers almost all the key rollout issues of the past week. The House GOP emailed all its members a 17-page “playbook” last week with tips on how to message on Obamacare’s effects. Members shouldn’t just fixate on the website difficulties — they should also focus on broader problems with the law, like how some Americans are losing their current health plans and some are seeing their premiums increase, the guide says. Click here for a copy of the playbook.

Many Top Hospitals Limit Exchange Insurers

One of the more interesting developments as the state/federal health exchanges are implemented across the country – many of the nation’s top hospitals (as determined by the annual U.S. News survey) are accepting a very limited number of insurers from those exchanges. Click here for the list of those hospitals and which exchange insurers they are accepting.

Insurers Offering Short-Term Plans that Side-Step Requirements

Some insurers are offering short-term medical plans that side-step the new health care law’s minimum coverage requirements and attract customers with lower sticker prices, NPR reports here.

New State-by-State Projections on PCP Needs

So, how many primary care physicians will your state need? The future need for primary care providers indicate that demographic and policy trends will only strain a workforce already struggling to meet national needs. Particularly under the expanded access created by the Affordable Care Act, the need for PCPs is significant. Click here for an excellent state-by-state projection to 2030 the increasing need for PCPs.

Study Details Impact of Individual Mandate Delay

The CBO estimates that a one-year delay of the individual mandate would decrease the number of Americans expected to gain insurance coverage in 2014 under the Affordable Care Act by approximately 85 percent. CBO’s earlier projection that 13 million Americans would gain coverage in 2014 with the mandate in place would be reduced to just 2 million persons, leaving 11 million fewer people without coverage. Click here for a new study on the consequences of a one-year delay.

HHS Report Says Exchange Prices A Good Deal for Most Young Adults

HHS says in a report released last week that that 46 percent of “single young adults who are uninsured and may be eligible for coverage in the Health Insurance Marketplace could get coverage for $50 or less per month” after the federal subsidies are factored in. In 34 states served by the federal insurance exchange, the study says, 1.3 million out of the 2.9 million single young adults ages 18 to 34 who may be eligible for coverage could buy a bronze plan for $50 a month or less after taking subsidies into account. A total of 1.9 million, or 66 percent, may be able to pay $100 or less per month for coverage in 2014, the study also found. Click here for the HHS report.

Would You Bid for Patients’ Surgeries?

A 3-year-old website says it has facilitated 1,800 surgeries, thus far. The site grants elective surgery patients who are willing to pay out of pocket the ability to choose from a range of physicians and hospitals bidding, eBay style, to provide the surgery they’re seeking. The providers get their business, and the patients get the best “deal”. Click here to go to the MediBid website. Click here for a separate story.

Premature Births Hit 15-Year Low

The United States was given an average score of ‘C’ in the new March of Dimes 2013 Premature Birth Report Card, meeting the organization’s target of 9.6 percent and hitting a 15-year low. In the annual report released late last week, the March of Dimes ranked each state individually on its pre-term birth rate. With a few exceptions, northern states tended to score higher on the report card than their southern counterparts. Click here to see how your state performed.

$3.7 Million Awarded for Oral Health for Pregnant Women and Kids

The Health Resources and Services Administration last week announced a total of $3.7 million in grant awards to help nine states expand their oral health workforce or to help increase statewide access to oral health care for pregnant women and infants. Click here for the details.

FDA Takes Further Steps to Prevent Drug Shortages

The FDA announced last week it is taking two actions to further enhance the agency’s ongoing efforts to prevent and resolve drug shortages, a significant public health threat that can delay, and in some cases even deny, critical care for patients. According to the FDA, the number of new shortages in 2012 was 117, down from 251 in 2011. Click here for the new actions FDA plans to take.

Community Mental Health Centers Get First CoPs

CMS last week issue its first Community Mental Health Center ‘Conditions of Participation.’ Medicare allows CMHCs to provide beneficiaries with partial hospitalization services as a narrow benefit, as well as limited telehealth services. Finalized conditions of participation include personnel qualifications; client rights and safety protections; requirements for admission, initial evaluation, and the discharge or transfer of a beneficiary; and requirements for a comprehensive assessment. Click here for details from CMS.

New State-by-State Impact of Food Stamp Cuts Detailed

Significant food stamp cuts took effect Friday – and this could definitely impact the health care of millions of Americans. Benefits are being reduced by about 5 percent beginning November 1 for all of the nearly 47.7 million Americans on the Supplemental Nutrition Assistance Program. A family of four will receive $36 less each month because of the reduction, according to the U.S. Department of Agriculture. A household of eight would see benefits reduced $65 a month. Click here for an interactive map of the impact on each state.

Obesity Rates Up in 2013

The adult obesity rate in 2013 is up one percentage point from last year to 27.2 percent, according to a Gallop survey out last week. It’s accompanied by a slight decline in the percentage of Americans who are normal weight or overweight but not obese. Click here for details.

IRS Gives New FSA Flexibility

The “use-it-or-lose-it” rule for flexible spending arrangements could now be called the ‘use-it-or-lose-some-of-it” rule. Treasury and the IRS announced last week that employers can allow FSA participants to carry up to $500 of their  balances into the next year — and it can be effective in plan year 2013. Up until now, any money remaining in the account would have been forfeited. Click here for the government’s announcement.

New Law Would Improve Emergency Epinephrine in Schools

A bill to improve access to emergency epinephrine in schools—unanimously approved by the Senate Health, Education, Labor, and Pensions Committee last week—has passed both chambers of Congress and will now go to the President’s desk to be signed into law. The new law would require the U.S. Public Health Service to give preference for asthma-care grants to states that require their public schools to allow trained employees to administer epinephrine to students experiencing a severe allergic reaction. Click here for details from the Committee.

Medication Therapy Management Pushed As Budget Saver

Some lawmakers and pharmacists are optimistic that wider use of medication therapy management could save money for the Medicare program and the National Chain Drug Store Association is pushing for MTM to be included in the latest round of fiscal and budget discussions. The Medication Therapy Management Empowerment Act of 2013, introduced in March, would extend Medicare MTM to those with one chronic condition. Senator Kay Hagan (D-NC) sponsors the Senate version; Rep. Cathy McMorris Rogers (R-WA) is the House sponsor. Click here for details on the proposal.

CDC Says Malaria in US on the Rise

1,925 malaria cases were reported in the United States in 2011, according to data published last week by the CDC. This number is the highest since 1971, and represents a 14% increase since 2010. Five people in the U.S. died from malaria or associated complications. Almost all of the malaria cases reported in the U.S. were acquired overseas. More than two-thirds (69%) of the cases were imported from Africa, and nearly two-thirds (63%) of those were acquired in West Africa. Click here for the CDC report.

Study: CRNAs Perform Well on Endoscopy Patients

Endoscopy patients sedated by CRNAs see essentially the same outcomes whether their propofol provider works supervised or unsupervised, according to a new study. Sparked by the rise of CRNA staffing and the popularity of propofol over the past decade, researchers at the Raleigh (N.C.) Endoscopy Center combed through more than 106,000 of the center’s propofol-sedated endoscopy cases between October 2008 and August 2013. Click here for the results.