WEEKLY E-BULLETIN


New Study Names Hospitals With Highest “Excess” Costs to Medicare

A report out last week identified, by name, those hospitals it says have excess Medicare costs to CMS and inpatients of $5.3 billion above the average across all hospitals by procedure. The study in the Harvard Business Review said the “excesses” are highly concentrated in just a small number of hospitals. 32 hospitals — less than 1% of the hospitals in the CMS data — accounted for about 25% of the excess accepted charges. For example, the study said for major joint replacement (procedure 470) the cheapest hospital received $9,000 per treatment on average while the most expensive received $39,000; for septicemia (procedure 871), total accepted charges ranged from $7,500 per treatment on average in the lowest-cost hospital to about $44,000 in the highest-cost one. The study’s authors emphasize that their analysis is based on actual payments, not hospital charges. Click here for the HBR report.

OIG Report Says 158 Hospitals Have Very High Medicare Outlier Payments

In a separate report, the HHS OIG found 158 hospitals — these were NOT specifically named — received Medicare outlier payments “beyond a statistically determined threshold of 8 percent of their total Medicare IPPS payments.” These high-outlier hospitals received an average 12.8 percent of their IPPS payments from outlier payments, while all other hospitals received an average of 2.2 percent. Click here for the OIG report.

More Than Half of Hospitals Get Payment Cuts Under VBP Program

CMS last week announced its second round of penalties and bonuses to hospitals under the Value-Based Purchasing Program. (Click here for the CMS summary.) Medicare reduced payment rates for 1,451 hospitals and increased rates for 1,231 based on 24 quality measures. It also incorporated death rates into the assessment for the first time. (Click here for a 1-page summary of all the quality measures used.) The best hospital scores were found in Massachusetts, Wisconsin, New Hampshire, Maine, Nebraska, Utah and Maine, where 60 percent of hospitals saw payment increases. 17 other states saw reduced reimbursement rates in at least two thirds of hospitals, including New York, New Mexico, Washington, North Dakota, Nevada and Connecticut. (Click here to see your hospital’s scores – this is an excellent interactive site.)

CBO Identifies Significant Health Care Changes to Cut Deficit

The Congressional Budget Office issued an updated report last week to Congress on ways to reduced the federal budget deficit. The CBO identified 16 major health care reforms and reminded Congress of previous proposals including eliminating Critical Access, Medicare Dependent and Sole Community Provider programs. Other options included a major bundled payment program – both inpatient only and inpatient plus 90-day post acute — and imposing caps on Medicaid spending. Click here for the complete report. The health care section begins on page 181.

Study: Health Care Price Increases Due to Pricing NOT Aging Population

Researchers reporting last week in the Journal of the American Medical Association noted that 91% of the increase in national health care spending was attributed to annual increases in the prices of drugs, devices and hospital care, not a growing population of elderly patients. Data from the study also showed that chronic conditions in patients younger than 65 were responsible for two-thirds of total U.S. health care spending. Click here for details.

AMA Details Changes It Wants to Doc Payment Formula

The AMA last week released a detailed list of recommendations to the House and Senate committees working to reform the physician Medicare payment formula (SGR – Sustainable Growth Rate). The AMA supports scrapping the current methodology. Congressional leaders say they want to vote on a comprehensive reform plan this year – but have not yet said how they would finance the $150 billion to $180 billion price tag. Click here for the AMA’s 12-page recommendation.

UnitedHealth Dropping Thousands of Network Physicians

The nation’s largest provider of privately managed Medicare Advantage plans, UnitedHealth Group, has dropped thousands of doctors from its networks in recent weeks—spurring protest from lawmakers and physician groups and leaving many elderly patients unsure about whether they need to switch plans to keep seeing their doctors.  Doctors in at least 10 states have received termination letters. Click here for the Wall Street Journal report. (subscription required.)

Medicaid Enrollment Soaring

While enrollment on Healthcare.Gov is lagging, Medicaid signup is soaring in states that have expanded the program, according to a new report. The biggest reason for the initial jump in Medicaid enrollment is that hundreds of thousands of people in the expansion states have been pre-qualified for expanded Medicaid because they are already enrolled in low-income state health care. Illinois, for example, will roll over 100,000 Cook County residents who have received expanded Medicaid benefits since 2011. Click here for details.

House OKs Major Change to Obamacare

The House of Representatives, with the support of 39 Democrats, Friday approved legislation that would allow insurance companies to renew individual health insurance policies and sell similar ones to new customers next year even if the coverage does not provide all the benefits and consumer protections required by the new health care law. Click here for the story. Click here for a copy of the 3-page, House passed bill.

Colorado Exchange Ads Stir Controversy, Get Attention

A new round of advertisements unveiled by supporters of Colorado’s health insurance exchange has ignited controversy that rippled through social media last week and launched debate over their portrayal of women. In one of the most discussed “Got insurance?” ads, produced by the liberal ProgressNow Colorado and the Colorado Consumer Health Initiative, a young woman holds a packet of birth-control pills and stands next to a young man, his hand wrapped around her waist. Click here to see all the ads. Click here to read the story.

Obama Announces ACA Fix

President Obama announced last week that his administration will let health insurers extend existing health plans on the individual and small-group markets into 2014. (Click here for the CMS letter to state insurance commissioners.) The administrative policy change will let insurers reach out to the millions of Americans being dropped from their plans so that they can renew their insurance for another year while the market adjusts to new Obamacare regulations. Click here for the news story.

Insurers Not Happy with Fix, But They Could Benefit

Insurers are raising concerns with the Administration’s action that allows states and health plans to allow existing individual policies to continue. Click here for details. However, insurers could see bigger government payments because of a provision in the Affordable Care Act that could see a legislative repeal effort. Click here for the report. The American Academy of Actuaries sounded alarm bells over the Obama Administration’s fix for the Affordable Care Act. Click here.

Democrats Go After Insurers

While Republicans pound on Obamacare, some Democrats think insurance executives are having it both ways, by reaping big profits from new customers entering the market because of federal subsidies and mandates while simultaneously blaming ObamaCare for problems in the market. So they have turned their attention to going after insurers. Click here for the story.

Qualified Health Plans Asked for Input

CMS asked qualified health plans (QHPs) for feedback on developing a quality ratings system, in a notice posted last week. This 29-page notice describes the overall Quality Rating System (QRS) framework for rating qualified health plans offered through an Exchange. In addition, the notice solicits comments on ways to ensure the integrity of QRS ratings, and on priority areas for future QRS measure enhancement and development. Click here for the CMS notice.

Physician Reviews Hospital Revolution Underway

Hospitals are facing a defining moment when the rules of the game begin to change. In the era of health care reform, hospitals across this country are now experiencing a time of transition, according to a physician who follows these issues. The reduction in their volume, revenue and margin threatens their independence and even their existence. Over the past decade, 16 percent of hospitals have consolidated by joining a health system. That trend is accelerating in the context of the Affordable Care Act, also known as Obamacare. Click here for his report.

ACLU Intervenes In Physician, Hospital Abortion Issue in Colorado

In a complaint filed last week, ACLU of Colorado accused Mercy Regional Medical Center in Durango, in the southwest corner of the state, of illegally telling doctors and other employees that they cannot discuss abortion with patients, even if a pregnancy threatens a woman’s life. The complaint was filed with the Colorado Department of Public Health and Environment, which oversees the state’s hospitals. Click here for the story.

New Recruiting Survey Outlines What Physicians Want

Recruiting new physicians? A staffing company’s new survey of more than 2,500 doctors found that signing bonuses, once considered “icing on the cake” of most recruitment packages, are now an expectation. The firm reported that 85.27 percent of its searches that resulted in an offer last year involved a signing bonus. The average amount was $24,037, but the highest bonus was $150,000. 54 percent of new physicians (those in training at the time of the survey) indicated a preference for hospital (28 percent) or academic center (26 percent) employment. Click here for more.

President to Sign Premature Birth Research and Education Bill

The Senate passed last week and sent to the President legislation designed to reduce infant deaths and disabilities by expanding research, education, and intervention activities related to premature birth. The House passed the bill earlier in the week. Click here for details on the legislation.

E-Cigarettes and Hookahs Are Gaining Popularity Among Students: CDC

Data from the 2012 National Youth Tobacco Survey show that recent electronic cigarette use rose among middle school students from 0.6 percent in 2011 to 1.1 percent in 2012 and among high school students from 1.5 percent to 2.8 percent. Hookah use among high school students rose from 4.1 percent to 5.4 percent from 2011 to 2012. There was no appreciable decline in actual tobacco use during this same time period. Click here for the CDC report.

NIH: Older Cornea Transplants Are Healthy

Ten years after a transplant, a cornea from a 71-year-old donor is likely to remain as healthy as a cornea from a donor half that age, according to a new study funded by the NIH. Corneas from donors over age 71 perform slightly less well, but still remain healthy for the majority of transplant recipients after 10 years. Click here for the NIH report.

Diabetes Is a Growing Worldwide Problem

Diabetes is a worldwide epidemic, according to a report released last week by medical experts. The vast majority have type 2 diabetes and the epidemic is spreading as more people in the developing world adopt Western, urban lifestyles. The latest estimate from the International Diabetes Federation is equivalent to a global prevalence rate of 8.4 percent of the adult population and compares to 371 million cases in 2012. Click here for more.

CMS to Hosts 2nd eHealth Summit

Next month, CMS will host its second eHealth Summit with health care industry leaders to discuss issues related to the successful adoption of health information technology. At the December 6th event, participants will discuss topics ranging from Stage 3 of meaningful use, to the future of quality reporting, to health information exchange, and innovations happening at the state level. Click here for details and to register.

Americans Respond to Health Care Costs More than Most

Cost drives American decision making on health care choices more than in most other countries, according to a study from The Commonwealth Fund. Researchers surveyed 20,045 adults in Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, the United Kingdom and the U.S. The study also found that the U.S. spent the most per capita on health care — $8,508, way above the others. Click here.