WEEKLY E-BULLETIN


Truven Health Releases Top Cardiovascular Hospital List

Last week, Truven Health released its newest list of 50 Top Cardiovascular Hospitals.  According to Truven, these hospitals spent roughly $2,000 less per bypass surgery and about $1,000 less per heart attack patient admitted. They were also quicker to release their patients: a half day better than their peers for heart attack, heart failure, and angioplasty cases, and a full day sooner for bypass patients. Click here to see the list.

2-Midnight Rule Attacked by Hospital, Doc Groups; CMS Plans Another Conference Call

The leading hospital and physician groups last week attacked CMS’ 2-midnight rule. AHA and AMA urged CMS to postpone the rule for a year. The letter stated, “Unfortunately, CMS has made clear that, in most cases, it will no longer consider inpatient stays which are expected to last less than two midnights appropriate for payment under Medicare Part A, regardless of whether a physician determines that intensive services are required based on the patient’s complex signs and symptoms. This undermines medical judgment and disregards the level of care actually needed to safely treat a patient. Click here for their letter to the agency. CMS is planning another national conference call for tomorrow (Tuesday), 1 p.m. EST, to discuss its 2-midnight rule. Click here for details. CMS posted additional guidance about 10 days ago hoping to provide further clarification to the rule. Click here for CMS’ regulatory update.

Courts Getting Involved in Inpatient Admission Policies

Inpatient or outpatient…the choice can have significant consequences for all involved, including new law suits. In a recent court case in Connecticut, 14 plaintiffs who had been hospitalized for between three and seven days sued Kathleen Sebelius in her capacity as the head of the CMS, asserting that CMS policy on inpatient admission was unconstitutional and inconsistent with a variety of federal laws. Click here for the report.

New CMS Criteria to Meet Homebound Requirement for Home Health Could Spell Trouble

Medicare only covers home health care if, among other requirements, the beneficiary is homebound. As of November 19, 2013, CMS will require new criteria for purposes of meeting the homebound requirement, according to a new report from a Medicare patients rights group. These new requirements will leave many Medicare beneficiaries without access to the medically reasonable and necessary home care coverage to which they are legally entitled. Click here for their detailed report.

MedPAC Suggests Negative Payment Update for Hospitals Next Year

The Medicare Payment Advisory Commission (MedPAC) suggested last week that hospital inpatient rates could see an average -1.5 percent adjustment in 2015. MedPAC said because of declining inpatient volumes, hospitals will not be turning away Medicare patients even if Medicare payment rates continue to fall. Click here for our 1-page summary and MedPAC’s presentation on this issue.

Post Acute Payment Changes Reviewed by MedPAC

Reducing the variation in Medicare payments between the various post acute settings was another focus of MedPAC commissioners last week. They identified two site neutrality approaches and suggested the need for a uniform tool to assess post acute patients to determine functional status. Click here for our 1-page summary and MedPAC’s slides.

MedPAC Discusses Integrating Hospice into Medicare Advantage

Should Hospice care be integrated into Medicare Advantage plans? That was a key issue last week as MedPAC commissioners explored potential changes to MA plans. Click here for a summary and the MedPAC slides.

ACOs Could Assume More Risk Under MedPAC Proposal

The future of Accountable Care Organizations and how they should be changed was another focus last week of MedPAC commissioners. Whether ACOs should assume more risk or whether Medicare patients should know they are being assigned, are key questions under consideration. Click here for our 1-page summary and the MedPAC’s slides.

Hospital DSH Cuts Focus of NY Times Article

It’s not news that under the Affordable Care Act hospital disproportionate share payments will be cut, which was part of the deal to get hospitals more paying patients by expanding the Medicaid program. However, hospitals in states that have chosen not to expand their Medicaid programs will still get payment cuts starting in January. The NY Times published a good story on the issue this past weekend. Click here.

White House Chastises States that Refuse to Expand Medicaid

The White House continued last week to push against states that refuse to expand their Medicaid programs. White House reports said 24 states are not expanding the program leaving millions of Americans without adequate coverage. Click here for details. Medicaid enrollment in the expansion states is soaring, according to a new report. Click here to see the details.

Study Says 17 Million Eligible for Premium Tax Credits

The Kaiser Foundation issued a report last week and estimated that about 17 million people who are now uninsured or who buy insurance on their own (“nongroup purchasers”) will be eligible for premium tax credits in 2014.  Their study provides national and state estimates for tax credit eligibility for people in these groups. Click here for a state-by-state summary.

Actuaries Warn Congress on Individual Mandate

Congress got a strong warning last week from the American Academy of Actuaries about any move to delay the implementation of the individual mandate. Without the individual mandate or limited open enrollment period, premiums would likely be higher than they would be otherwise, according to the AAA. Click here to read their 2-page letter to Congress.

New AMA Study Details Least Competitive Insurance Markets

The AMA was out last week with its most comprehensive analysis on insurance competition to date. Among its findings:  The 10 states with the least competitive commercial health insurance markets were: 1. Alabama, 2. Hawaii, 3. Michigan, 4. Delaware, 5. Alaska, 6. South Carolina, 7. North Dakota, 8. Nebraska, 9. Louisiana and 10. Rhode Island. The 10 states that experienced the biggest drop in competition levels between 2010 and 2011 were: 1. Louisiana, 2. Idaho, 3. Oklahoma, 4. Iowa, 5. Texas, 6. Missouri, 7. Nebraska, 8. Kansas, 9. Ohio and 10. Arkansas. Click here for all the info.

HHS Releases Mental Health Parity Regs

HHS on Friday released the long-awaited final rules for the 2008 Mental Health Parity and Addiction Equity Act. Combined with new mental health benefits required under the Affordable Care Act, the parity rules will expand access to mental health care for more than 62 million Americans, according to administration officials said.  Click here for a copy of the rules and a summary from HHS. In the White House, the regulations are also seen as critical to President Obama’s program for curbing gun violence by addressing an issue on which there is bipartisan agreement: Making treatment more available to those with mental illness could reduce killings, including mass murders. Click here for the story.

Nurse Practitioners Seek Expanded Roles and Polls Say Public Supports It

The American Association of Nurse Practitioners last week released survey results (click here) that show widespread, national support among the general public for legislative and policy proposals that give patients access to NP care and services. The results coincided with findings (click here) last week from the nonprofit research organization the RAND Corporation, which demonstrate that much of the shortage of primary care physicians expected over the next decade could be eliminated if the nation increases use of new models of care that expand the role of NPs and other health care providers.

$150 Million Given to Community Health Centers

HHS last week awarded $150 million to community health centers to help establish 236 new full-time service delivery sites, and the department says the funding will help centers care for roughly 1.25 million more patients. The funding was awarded just two months before the benefits under the ACA’s coverage expansions begin to kick in. HHS also is relying heavily on community health centers to do educational work related to the law’s coverage expansions. Earlier this year, the department announced a separate $150 million in grants for nearly 1,200 health centers to do outreach related to the exchanges.  Click here for a state-by-state summary.

HHS Smacks J&J for Putting “Profit Ahead of Health and Safety”

Multiple investigations found Johnson & Johnson put profit ahead of the health and safety of children, the elderly and people with developmental disabilities, according to an HHS press release issued last week. The $2.2 billion resolution announced by Attorney General Eric Holder is “another example of our commitment at the Department of Health and Human Services to protect health and aggressively combat health care fraud.” Click here for more.

Obama Defends Affordable Care Act; GOP Senators Call for Sebelius’ Job

President Obama strongly defended his signature health care law last week in the largest state (Texas) that has refused to participate, as rattled Senate Democrats called for changing or delaying key parts of the new health coverage. Click here for the NY Times story.  Only a small number of people have signed up for insurance on-line in D.C. and Maryland according to officials. Click here for the report. For the latest on the HealthCare.Gov repair process, click here. 10 GOP senators last week sent a letter to the president asking him to fire HHS Secretary Sebelius. Click here to read the 2-page letter and see if one of your senators signed it.

It Can Be Challenging to Find What Doctors and Hospitals Are In What Plans

More than a month after HealthCare.gov and 15 state-based exchanges opened for business, consumers and even physicians are finding it’s isn’t easy or even possible sometimes to find out which doctors and hospitals are in the plans’ provider networks. Click here for the story.

Adjoining States Can Have Vastly Different Health Care Experiences

One major consequence of the roll out of the Affordable Care Act is that neighboring states may have major differences in implementation. For example, Minnesota is now enrolling individuals through its health-insurance exchange by the thousands and at premium rates that are among the lowest in the country. Next door in Wisconsin, the numbers of Obamacare enrollees have barely hit the hundreds and rates are between 25 and 35 percent higher than in Minnesota. Click here for the story.

Retail Clinic Use Up, But Only Slightly

The proportion of American families using a retail clinic in the previous year nearly tripled between 2007 and 2010 from 1 percent of U.S. families in 2007 to 3 percent in 2010, according to a national study released last week by the Center for Studying Health System Change. Click here for their report.

Physician Discusses What Determines a High Performing Hospital

What is the difference between the highest performing hospitals and all the others? While there is no easy answer, part of the difference is an unwavering CEO commitment to quality, according to a recent analysis. Click here for the story from a physician and health policy adviser who spends a lot of time thinking about these issues.

Hospital System Chiefs Discuss Starting a Health Plan

Should hospitals become health insurers? That was the topic of discussion last week among several hospital executives and reported by US News. Click here for this interesting story.