WEEKLY E-BULLETIN


Home Health Payments Take Medicare Hit

CMS late Friday cut Medicare home health payments by $200 million or 1.05 percent for Calendar Year 2014. The decrease reflects a 2.3 percent increase in the home health payment update percentage ($440 million); a 2.7 percent decrease due to rebasing adjustments mandated by the Affordable Care Act (-$520 million); and a 0.6 percent decrease due to the effects of HH PPS Grouper refinements (-$120 million). This final rule also updates the home health wage index for CY 2014. Click here for details from CMS.  Click here to read the 221-page rule.

CMS Holds Dialysis Payments Steady

Also late Friday, CMS issued a final rule that updates Medicare policies and payment rates for 2014 for dialysis facilities. Overall payments for 2014 will see a zero percent change. The rule also finalized a 50 percent increase to the home dialysis training add-on payment adjustment that is made for both peritoneal dialysis and home hemodialysis training treatments. Click here for the CMS summary. Click here for the 347-page rule.

Hospital Outpatient Rule Expected Next Week

CMS last week sent the Hospital outpatient and Medicare Physician Fee Schedule pay rule to the Office of Management and Budget for review. The deadline for publishing these rules is the end of the month and normally would have been at the beginning of the month, but the government shutdown delayed them. We expect the final rules to be published this Wednesday.

RAC Audits Up Again: AHA

Hospitals continue to experience rapid growth in recovery audit contractor (RAC) reviews, according to the AHA. The new report shows cumulative medical record requests have increased by 13% since the first quarter of 2013 while the number of cumulative complex audit denials reported by respondents increased by 28% during that six-month period. Click here to see the 72-page AHA report.

OIG: Nursing Homes Transferring Increasing Number of Patients to Hospitals

In FY 2011, nursing homes transferred one quarter of their Medicare residents to hospitals for inpatient admissions, and Medicare spent $14.3 billion on these hospitalizations, according to a new OIG study. Nursing home residents went to hospitals for a wide range of conditions, with septicemia the most common. Annual rates of Medicare resident hospitalizations varied widely across nursing homes. Nursing homes in Arkansas, Louisiana, Mississippi, or Oklahoma as well as homes with one, two, or three stars in the CMS Five-Star Quality Rating System, had the highest annual rates. Click here for the report.

White House: Health Spending Growth Slowest on Record

Health care spending growth is the slowest on record, according to a new White House report. The administration says the report reflects changes under the Affordable Care Act. Click here to review the 29-page report.

Health Insurers Respond to Government Cuts

Given the growing attention to provider networks in Medicare Advantage plans, the nation’s largest health insurance association, AHIP, sent a letter to CMS raising concerns about the impact the ACA’s Medicare Advantage payment cuts are having on seniors. The letter also highlighted what health plans are doing to preserve benefits and improve value for beneficiaries in the program. Click here to read the two-page letter.

ObamaCare Summary for the Week:

  • The Obama administration said late last week it would give people eight more days, until December 23, to sign up for health insurance coverage that takes effect January 1 under the new health care law. For the 2015 sign up, there was a one month extension.  Click here for the NY Times report.
  • Four U.S. senators — Susan Collins, Republican of Maine; Lisa Murkowski, Republican of Alaska; Joe Donnelly, Democrat of Indiana; and Joe Manchin, Democrat of West Virginia — have taken aim at the definition of “full time” in the health care law, which is set at 30 hours per week. Their legislation, the Forty Hours is Full Time Act, would change the threshold to 40 hours. Their concern, they say, is that employers may be increasingly motivated to avoid the mandate by cutting workers’ hours. Click here for the story.
  • How have states responded to the Obama Administration’s call on insurance commissioners to extend the dates people can hold on to existing health plans? Click here for a very nice, updated map. Click here for an excellent Q&A on the insurance cancellation issue.
  • Nearly three-quarters of those potentially losing current health plans will actually benefit through Medicaid expansion or tax credits to offset their costs, according to a new analysis. The final number of people at risk of being without their desired plan or financial help is just 0.6 percent of the non-elderly population, or 1.5 million people, a new report by Families USA finds. Click here.
  • Many of New York City’s financially strapped hospitals are scrambling to sign up people for health coverage through New York state’s exchange or through Medicaid as they prepare for Disproportionate Share program cuts, according to a report in the Wall Street Journal. Click here.
  • One of the key Democratic criticisms of Republicans is that they haven’t offered a meaningful alternative to the Affordable Care Act. Is there a “conservative” plan?  Noted health care economist Uwe Reinhardt seems to think one has emerged. Click here.
  • One of the ObamaCare health exchange success stories is Kentucky where the number of people signing up is greater than expected. Click here for a look at the impact in a very rural part of the state.
  • California’s exchange announced last week it is signing up 10,000 a day. Click here for details.
  • The House Republicans’ response to the Affordable Care Act is increasingly organized and orchestrated, including collections of stories about people who say they were harmed by the health care law. The GOP has produced an 18-page “playbook” instructing their conference members. Click here to see it.
  • How much can ObamaCare be despised politically? Check out the U.S. Senate campaign in Georgia where there are three male House members and a woman running. The GOP primary may answer that question. Click here.
  • “Redistribution.” These days the word is particularly toxic at the White House, where it has been hidden away to make the Affordable Care Act more palatable to the public and less a target for Republicans, who have long accused Democrats of seeking “socialized medicine.” Click here for the story.

House Members Pushing Doc-Owned Hospital Bill

32 House members have now cosponsored legislation that would loosen the restrictions on the construction of physician-owned hospitals. Following a D.C. “fly-in” last week, the Physician Hospitals of America announced that five more Representatives signed on to the bill they are pushing for passage by year’s end. Click here for the list of cosponsors. Click here for a summary of the bill.

Ped Research Bill Could Move in House Soon

The House may be ready to take up a modified version of a pediatric research measure advocated by Majority Leader Eric Cantor, according to published reports last week. The so-called Kids First research measure (HR 2019), as introduced, would end taxpayer financing for presidential campaigns and conventions and instead shift funding toward pediatric research at the National Institutes of Health, authorizing $130 million over 10 years. Click here for a copy of the legislation, which has 152 House cosponsors.

Key Senate Committee Sets Doc Payment Bill Hearing Date

December 12 is the date chosen by the U.S. Senate Finance Committee to consider legislation, click here to see the 8-page draft bill, to repeal the Sustainable Growth Rate formula and replace the Medicare payment system for physicians. Click here to see the committee notice. The committee will also plans to discuss how it will deal with the extension of certain Medicare payment programs, like Medicare Dependent hospitals, that are or have already expired. Still undetermined:  how to pay for all of it.

State Mental Health Budgets Increasing

After years of state spending cuts, mental health budgets increased in 37 states this year, according to a new report by the National Alliance on Mental Illness. Click here for the 63-page report.

CDC Report Released on Mortality, Disease Risk Determinants

The CDC last week issued a report highlighting differences in mortality and disease risk related to behaviors, access to health care, and social determinants of health. Click here for the 189-page report that is chock-full of updated  information.

Hospitalizations Increasing for Irregular Heartbeat: Study

Between 1998 and 2010, hospitalizations for atrial fibrillation almost doubled, with nearly 4.7 million individuals receiving hospital treatment for the heart rhythm disorder, according to an analysis presented at the annual meeting of the American Heart Association. By 2020, hospitalizations due to the condition could be 28% more common compared with rates in 2010, while cases will cost more than $40,000 each. Click here for more.

Rx Spending Slowing Dramatically

Growth in global prescription drug spending will slow to the lowest rate in decades as low-cost generic drugs continue replacing former blockbusters in the U.S. and Europe, where governments face new pressure to reduce health care spending, according to a new forecast. Click here.

New Depression Treatment Involves Insomnia Therapy

An insomnia therapy that scientists just reported could double the effectiveness of depression treatment is not widely available nor particularly well understood by psychiatrists or the public, according to newly published reports. The American Board of Sleep Medicine has certified just 400 practitioners in the United States to administer it, and they are sparse, even in big cities. Click here for the story.

ADHD Diagnosis Numbers Increase

Two million more children in the United States have been diagnosed with attention-deficit/hyperactivity disorder (ADHD) and one million more U.S. children were taking medication for ADHD over an 8 year period (2003-2004 to 2011-2012), according to a new study led by CDC. Click here for the CDC report.

Insurer Makes Light of Health Exchange Problems with Humorous Ads

One insurance company is trying to make light of the ObamaCare federal exchange rollout problems. Click here for a couple of humorous ads from Wellmark.