WEEKLY E-BULLETIN


CMS To Hold Another 2-Midnight Rule Conference Call

CMS is hosting a telephone training session on the medical review criteria for the new 2-midnight rule for inpatient hospital admission and medical review on January 14 at 1:30 p.m. EST. CMS will also answer questions on the two-midnight policy. Participants may register for the call here. CMS held a 2-midnight rule conference call on December 19, click here for a one-page summary of that call.

Washington Post Investigation into Hospice Care Reveals Significant Growth in “Survivors”

A Washington Post investigation published over the holidays revealed that over the past decade, the number of “hospice survivors” in the United States has risen dramatically, in part because hospice companies earn more by recruiting patients who aren’t actually dying. Healthier patients are more profitable because they require fewer visits and stay enrolled longer. Medicare now pays about $15 billion for hospice services. Click here for the report.

Study Suggests Hospital ED Visits Will Increase Under Medicaid Expansion

Hospitals have been bracing for more emergency department visits as the number of newly insured through Medicaid increases – about half the states are expanding Medicaid under the Affordable Care Act. Now, a new study confirms that it was right to expect the ED boost. The study, published in the Journal Science, compared thousands of low-income people in the Portland area who were randomly selected in a 2008 lottery to get Medicaid coverage with people who entered the lottery but remained uninsured. Those who gained coverage made 40 percent more visits to the emergency room than their uninsured counterparts. Click here to access the study. Click here for the NY Times report. Click here for an update on the impact of the Medicaid expansion.

Survey: Hospital Execs Believe ACA Will Improve Health Care

A large majority of hospital executives believe the Affordable Care Act will improve healthcare, according to a new survey. 65 percent of the executives polled believed that healthcare in the United States will be somewhat or significantly improved by 2020, according to the survey of 74 C-Suite executives from organizations with an average of 8,520 employees and yearly revenues of $1.5 billion. An even greater amount–93 percent–said they believed their own health system’s quality of care would improve. Click here for the report.

Provider Network Narrowing Comes Under Attack

One of the issues expected to get a lot more attention as the Affordable Care Act is implemented is the narrowing of provider networks by insurers. At the center of the storm today is UnitedHealthcare’s plan to drop thousands of doctors from its Medicare Advantage network starting February 1. In Connecticut, the  insurer is expected to cut as many as 2,250 physicians: 810 primary care and 1,440 specialists across the state. But the state last week came out against the changes. Lawsuits are filed and the battle is underway. Click here for the story. The national health insurers’ lobby, AHIP, issued a statement on New Year’s Eve warning of dire consequences, click here for the statement.

Number of MA Plans Available in 2014 Holds Steady

2,014 Medicare Advantage plans will be available nationwide for general enrollment in 2014, down 60 plans from 2013, taking into account new entrants, consolidations, and departures, according to a report by the Kaiser Foundation. On average, Medicare beneficiaries will be able to choose from among 18 plans in 2014, two fewer than in 2013. As in prior years, choice will be more extensive in metro than non-metro areas (on average 20 versus 11 plans, respectively). About 526,000 of current 2013 Medicare Advantage enrollees (5%) will have to make some change because their plan is not available in 2014. Click here for the complete report.

123 New MSSP ACOs Get Underway

Providers have formed 123 new accountable care organizations to participate in the Medicare Shared Savings Program, according to CMS. They officially started January 1. More than 360 organizations have formed Medicare ACOs serving more than 5.3 million beneficiaries. More than half of the ACOs are physician-led organizations serving fewer than 10,000 beneficiaries, and about 20 percent include community health centers, rural health centers and critical access hospitals that serve low-income and rural communities, CMS said. CMS will take new MSSP applications this summer. Click here for the list of new ACOs. Click here for the CMS announcement.

$307 Million Awarded to States to Help Enroll Kids

CMS has awarded $307 million in performance bonuses to 23 states for making it easier to enroll children in Medicaid and the Children’s Health Insurance Program. To qualify, states must implement at least five out of eight specific program features aimed at streamlining enrollment, and must increase children’s enrollment in Medicaid above a baseline level for the fiscal year. Fifteen of the states increased enrollment by more than 10% above their baselines, earning a larger award. Click here for the list of states, amounts awarded to each and each state’s program features.

HRSA Announces $22 Million in New Nurse Faculty Loans

HRSA is seeking applications for its Nurse Faculty Loan Program to increase the number of qualified nursing faculty. Participating schools of nursing make loans from the fund to assist registered nurses in completing their graduate education to become qualified nurse faculty. The program offers loan cancellation of up to 85 percent for borrowers that graduate and serve as full-time nursing faculty for the prescribed period of time. Accredited schools of nursing are eligible to apply for funding. Students may receive loans up to $35,500 per academic year for a maximum of five years to support the cost of tuition, fees, books, laboratory expenses and other reasonable education expenses. More than $22 million is being made available. For more information, click here.

$50 Million in Rural Mental Health Grants Announced

The USDA has announced $50 million in grants will be available to fund rural infrastructure needs for mental health services. The funding may be used for the construction, expansion, or equipping of rural mental health facilities and will be provided through the Community Facilities direct loan program. This program also includes grants, guaranteed loans,and other funding initiatives. Funds may be used by rural communities and organizations with populations of 20,000 or less to develop their capacity and ability to provide essential community facilities and housing, especially to low-income rural residents. Click here for details. Please email me at Paul.Lee@shcare.net, if you would like assistance from our grant writing experts.

IOM Focuses on Obesity; Webinar Is Tomorrow

Obesity solutions is the focus of tomorrow’s key Institute of Medicine workshop in Washington, DC. Panel members will describe the current obesity prevention and control landscape. The day long session hopes to increase awareness of progress and opportunities in obesity prevention and control, identify strategies with greatest impact and opportunities for cross-sector alignment and collaboration and identify gaps in programs and implementation. The workshop is available online. Click here for the agenda. Click here to watch it online.

Cancer Set to Overtake Heart Disease as Leading Cause of Death

Cancer is on the verge of overtaking heart disease as the number one cause of death, according to the latest report on the status of cancer. Death from heart disease has plunged 68 percent since 1958. Stroke is down 79 percent. Cancer is down about 10 percent. Click here for the national report. Click here for a very good NY Times article and graph.

Health Spending Slows to Historic Lows; Administration Will Take Some Credit Today

The Obama Administration is set to announce today to what extent health care spending has slowed in the United States and how much of the slow down is attributable to the Affordable Care Act. According to a new Altarum Institute report, health care prices in October 2013 rose 0.9% above October 2012, the lowest reading in the fifty-plus years.  Prices for physician services rose by a mere 0.2%, while prescription drug prices rose by 0.5%. Hospital prices rose by 1.2%, the lowest rate since November 1998, held down by very low Medicare payment rate increases. Click here for the very informative 4-page report. Check out this graph (click here) that, if true, should help change the health care spending debate.

Study: Medicare Payment Rates Cause Other Payers to Follow

Another study continues to confirm what most of us in health care already know: Medicare payments set the trend for private insurance payments. According to a report by two researchers, on average, a $1 change in Medicare’s relative payments results in a $1.30 change in private payments. The study also found that Medicare similarly moves the level of private payments when it alters fees across the board. The study, which was based on a review of physician payments, can be accessed here.

Home Health Sounds Alarm Over Pending Cuts

Home health programs are sounding the alarm over upcoming cuts to Medicare home health payments. The final payment regulation, released by CMS just before Thanksgiving, cuts Medicare home health payments by 3.5 percent annually for four years – the maximum allowable under the Affordable Care Act. In the rule,CMS said that these payment reductions will leave “approximately 40 percent” of all home health providers with negative margins by January 2017. Click here for the statement from the Partnership for Quality Home Health Care.

Doc Payment Fix Efforts Continue; Budget Changes Detailed

Congress now has until April to come with a permanent fix for the physician Medicare payment formula or continue with a short term patch. Key House and Senate committees have already approved overhauls in the way the government would pay physicians, but they have not yet announced how they would pay for the approximately $150 billion solution. Presumably, many provider payment programs would be targeted for cuts to pay for the permanent doc fix. Congress already made a number of payment changes in the final 2014 budget deal that President Obama signed at the end of December. Click here for a summary of all the changes.

IRS Issues Regs on Community Health Needs Assessment and Collections

The IRS and Treasury Department issued two new regulations required by the Affordable Care Act. The first provides a process for charitable hospitals that fail to satisfy the requirements under section 501(r) of the Internal Revenue Code – which provides their charitable, tax-exempt designation – to follow to correct and disclose those failures. In return for following this corrections process, charitable hospitals would receive assurance that they will not face possible loss of tax-exempt status as long as their mistakes were not willful or egregious. Section 501(r) requirements include performing a Community Health Needs Assessment and instituting new patient collections policies. Click here for the details.

Data Review for Inpatient Psych Programs Underway; Webinar Announced

Inpatient psychiatric facilities have until January 29 to preview their facility-specific reports for the IPF Quality Reporting Program at My QualityNet and correct any errors before the data are added to the Hospital Compare website in April, according to CMS. This is the first time that data will be publicly reported for the program. IPFs and distinct-part psychiatric units in acute care hospitals reimbursed under the IPF prospective payment system are eligible to participate in the IPFQRP. CMS is hosting a webinar tomorrow, January 7, at 1 p.m. EST to review the program. Click here to sign up. Click here for information about reviewing your data.

DOJ Touts Success in Fighting Health Care Fraud

The Department of Justice is touting its success in fighting health care fraud in 2013, saying it recovered over $2.3 billion. DOJ specifically cited a $26 million settlement against a Florida dermatologist in an illegal kickback scheme and a $230 million judgment against a South Carolina health care system as examples of its success. Click here for the DOJ details.

Surgery to Fix Torn Meniscus Questioned

A widely-used surgical procedure worked no better than fake operations in helping people with one type of common knee problem – a torn meniscus, suggesting that thousands of people may be undergoing unnecessary surgery, a new study in The New England Journal of Medicine reports. Click here for the report.

CMS Delays Data Collection for Several New Quality Measures

CMS has delayed until April 1 the requirement to collect data for three new colonoscopy surveillance and cataract surgery quality measures that were included in the hospital outpatient and ambulatory surgical center quality reporting programs. Data collection was scheduled to start January 1 but the measure specifications were not yet available. CMS published the specifications December 31 in updates to the specifications manuals for the HOQR and ASCQR programs. The CY 2015 data reporting periods, which affect CY 2017 payment, will not change from those specified in the CY 2014 outpatient prospective payment system/ASC final rule, CMS said. Click here for the updated Hospital Outpatient Quality Reporting Specifications Manual. Click here for the updated Ambulatory Surgical Centers Quality Reporting Program.

FDA Approves 27 New Drugs in 2013, Down from 2012

The Food and Drug Administration approved 27 first-of-a-kind drugs in 2013, down from 39 new medications in 2012, which was a 15-year high. Despite the decline, FDA officials say the tally of innovative medications approved last year is in line with the historical trend. On average, the FDA has approved 28 first-of-a-kind drugs annually over the past five years. Click here for the story.

Two New Gun Control Regs Proposed

The Obama Administration on Friday proposed two new gun control regulations aimed at clarifying restrictions on gun ownership for the mentally ill and strengthening a database used for background checks before firearm purchases. Click here for the story.

ICD-10 Has Dozens of Codes Dealing with the Big Toe

ICD-10 starts October 1 and the news media is now looking at its impact. The NY Times says that under ICD-10 there are dozens of codes dealing just with the big toe — contusion of the right great toe, contusion of the left great toe, with damage to the nail or without, initial encounter or subsequent encounter, blisters, abrasions, venomous insect bites, nonvenomous insect bites, lacerations, fractures, dislocations, sprains and amputation, not to mention the vague “acquired absence of unspecified great toe.” Click here for the story.