WEEKLY E-BULLETIN


Emergency Docs Give America’s Emergency Care a D+

A new report card from the American College of Emergency Physicians is sharply critical of emergency care in the U.S., giving it a grade of D-plus overall. The overall grade was based on scores in several categories, including access to emergency care, which made up 30 percent of the total score and included access to treatment, providers and specialists, hospital capacity and financial obstacles. The report card issued a grade of D-minus for this category. Click here for a copy of the report with a state-by-state summary.

MedPAC Calls for 0% Updates for All But Hospitals; Votes for Several Significant Policy Changes

The Medicare Payment Advisory Commission late last week adopted a final recommendation to freeze payments for long-term care hospitals, inpatient rehabilitation facilities, ambulatory surgical centers, home health, hospice and dialysis providers under Medicare prospective payment systems for 2015. Commissioners also stated their opposition to the 2% sequestration imposed on Medicare. Their recommendations will be made to Congress in a formal report in March. MedPAC recommendations are not binding on Congress, but many are often adopted. Our policy staff has prepared one-page summaries for each of the detailed recommendations made by MedPAC:

  • Click here for hospital inpatient update, site neutral reform and LTCH payment reform;
  • Click here for home health and post acute care reform;
  • Click here for hospice;
  • Click here for ASCs;
  • Click here for inpatient rehab;
  • Click here for outpatient dialysis; and
  • Click here for Medicare Advantage.

Regarding LTCHs, although MedPAC continues to make significant policy recommendations, Congress took action in December as part of the federal budget deal to make LTCH payment reforms. Click here for the summary. It is unlikely Congress will adopt these further recommendations this year.

New Bill Tackles Medicare Patients with Chronic Conditions

Legislation introduced last week by the senator expected to chair the Finance Committee later this year, Ron Wyden (D-OR), would make significant changes to Medicare to address patients with chronic conditions. This proposal is open to Medicare beneficiaries regardless of income or place of residence. With a “Better Care Plan” (BCP) designation, a state-licensed and certified provider may practice at the top of his/her license, removing barriers to care that currently exist in parts of the country with provider shortages. In response to the need to move away from fee-for-service, this proposal makes BCP providers and plans fully responsible for the cost, care and outcomes of their enrolled patients, and directs CMS to determine spending based on the experience of similar patients that are not enrolled in a BCP. Click here for the details, which includes excellent graphics.

New Analysis Highlights Physician Pay Differences

Incomes of dermatologists, gastroenterologists and oncologists rose 50 percent or more between 1995 and 2012, even when adjusted for inflation, while those for primary care physicians rose only 10 percent and lag far behind, according to a report over the weekend in the New York Times. Why? In large part because a cardiac surgeon can perform only a couple of bypass operations a day, but other specialists can perform a dozen procedures in that time span. And physicians are still paid mostly on the basis of volume. Click here for the very good story.

CMS Call Attempts to Clarify 2-Midnight Rule Issues – Summary Provided

CMS continued its efforts last week to clarify its interpretation of the 2-Midnight rule with a national conference call last week. CMS made an important distinction on the call, clarifying the difference between unforeseen circumstances and exceptions to the 2-Midnight rule. Unforeseen circumstances (formerly referred to as “rare and unusual” circumstances) are events that occur that may result in a shorter beneficiary stay than the physician’s expectation that the beneficiary would require a stay spanning at least 2 midnights. Click here for our two-page summary, which also includes a link to the CMS presentation slides.

Administration Delays Another Obamacare Provision

The Obama Administration is delaying enforcement of another provision of the new health care law, one that prohibits employers from providing better health benefits to top executives than to other employees. Tax officials said they would not enforce the provision this year because they had yet to issue regulations for employers to follow. Click here for details.

Aetna CEO Says Exchange Sign Up Better Than Expected

Aetna’s CEO Mark Bertolini last week said the early health exchange demographics are actually better than expected, according to a Washington Post report. Bertolini’s take on the age-breakdown of marketplace enrollees was different from the reaction in Washington. While most journalists pointed out that the Obama Administration is falling short of its young adult enrollment target, that doesn’t really matter to Aetna. What matters to a health plan is who they expected to sign-up, and what type of age mixed they used to set their premium prices. Click here for the report.

Wellpoint CEO “Very Cautiously Optimistic” About Exchanges

The CEO of one of the country’s other very large health insurance companies, Wellpoint, said last week he is “Very cautiously optimistic” about the health exchanges. “Proportionally speaking it’s part of our business portfolio, but, for instance, our government division includes 45 percent of our revenue. Not many people appreciate that. And that’s an ever-growing part of our business. Exchanges are not included in government business.” Click here for the rest of the interview with Joe Swedish.

Exchange Subsidies to Insurers Expected to Start This Week

Subsidies to help people buy health coverage on the new insurance exchanges begin flowing to insurers this week, according to a top official at CMS in testimony before Congress last week. Gary Cohen, Director of the CMS Center for Consumer Information and Insurance Oversight, indicated that there might be a shortfall in funds collected from a 3.5 percent user fee paid by insurance companies and intended to be used to finance the operations of the federal exchange. Click here to read Cohen’s testimony.

Exchange Subsidies Are Legal: Federal Judge Rules

A federal judge on Wednesday upheld the legality of subsidies at the core of the federal health-care law, turning aside one of the principal remaining court challenges to the law. The decision hands a victory to the Obama Administration, which has been fighting in court to defend the Affordable Care Act since it passed in March 2010. Click here for the Wall Street Journal story.

Affordable Care Act Still Unaffordable for Some?

Anti-poverty agencies across the country fear that even with the federal financial assistance available under the law, health insurance will remain unaffordable for significant numbers of low-income Americans. Click here for the report.

Largest Health Insurer Opposes Medicare Advantage Cuts

UnitedHealth Group Inc., the biggest U.S. health insurer, said government cuts to Medicare may make it harder to increase earnings in 2015, sending shares down the most in three months. Rate cuts that may reach 7 percent, following a similar reduction for this year, could be “extraordinarily disruptive” to the program, Chief Executive Officer Stephen Hemsley told analysts last week. Medicare Advantage has been a key source of growth for the industry and provided about a fifth of UnitedHealth’s profit last year. Click here for details.

Insurance Industry Fighting Expected Cuts

The insurance industry is already fighting the possibility of potential Medicare Advantage payment reductions with a new ad campaign. The campaign will include TV, print and digital promotions, as well as grass-roots mobilization of the Coalition for Medicare Choices, an advocacy group that AHIP says includes 1.5 million seniors. Click here to see the 30-second spot.

Surgeon General Report Says Millions of Children Will Die Prematurely Due to Smoking

Approximately 5.6 million American children alive today – or one out of every 13 children under age 18 – will die prematurely from smoking-related diseases unless current smoking rates drop, according to a new Surgeon General’s report released last week. Over the last 50 years, more than 20 million Americans have died from smoking. The new report concludes that cigarette smoking kills nearly half a million Americans a year, with an additional 16 million suffering from smoking-related conditions. It puts the price tag of smoking in this country at more than $289 billion a year in direct medical care and other economic costs. Click here for the report.

Physician EHR Use On the Rise

About 80 percent of office-based doctors used an electronic health records system, a sign that the Obama Administration’s incentives are encouraging the adoption of new recordkeeping technology, according to HHS’s top health IT officials last week. Officials said 13 percent of doctors described having advanced systems that would qualify for further “meaningful use” incentives when the administration begins considering them in October. Click here for a summary. Click here for a detailed CDC report on EHR adoption by physicians – state-by-state.

Seniors’ Groups Seek Therapy Cap Repeal

Some seniors’ advocacy groups last week called on Congress to repeal certain Medicare therapy payment caps. Medicare-covered outpatient physical, speech and occupational therapy services are subject to an annual dollar-amount payment cap. Many beneficiaries have their therapy terminate prematurely when they reach the cap. While there is an exceptions process in place that allows beneficiaries to receive therapy in excess of the caps, it is set to expire on March 31, 2014. Click here to see more from the Center for Medicare Advocacy.

Boehner Says GOP Will Have Obamacare Replacement

Speaker John Boehner (R-OH) last week predicted that House Republicans would unveil — and possibly vote on — a plan to replace the Affordable Care Act in 2014, fulfilling a long-delayed promise to voters. An alternative to ObamaCare will be “one of the big issues” the House GOP will discuss at its annual policy retreat at the end of the month, Boehner said. Click here for the story.

Basketball Heroes In Ads To Encourage Youth to Sign Up for Obamacare

Basketball  greats Magic Johnson and Alonzo Mourning are appearing in  television ads to encourage young people to sign up for Obamacare, the Obama Administration announced last week. The 30-second ads will appear ESPN, ABC, TNTN and NBAtv during NBA games. The players are appearing for free in the ads that will run through the end of the open enrollment season March 31. Click here to see Johnson’s ad. Click here for Mourning’s ad.

Latino Group Attacking Congressman for Obamacare

In another twist on the Affordable Care Act debate, a conservative Hispanic advocacy group launched a new round of ads last week targeting a vulnerable House Democrat over Obamacare — an effort that highlights the problems that it says Latinos have faced with the health care law. The ad from the LIBRE Initiative goes after Rep. Joe Garcia (D-FL) and stars a Latina doctor in southern Florida who cites a handful of concerns she has about the Affordable Care Act. Click here to see the 30-second ad.

Public Hospitals See Exchanges As Widening Customer Base

Around the country, a number of public health systems and charity hospitals serving large numbers of poor patients see the health exchanges, created by the states under the act, as a way to widen their customer base. Click here for the New York Times story.

High Risk Pools Extended Two Months

The Affordable Care Act’s high-risk insurance pools will remain open for an additional two months, HHS announced last week. The extension means that seriously ill patients who are using these pools won’t lose their health coverage until March 31. The pools were originally slated to close Jan. 1 but that date was moved to the end of January. Click here for details.

New Report: Medical Homes Work

A patient-centered medical home (PCMH) model resulted in reduced costs of care, unnecessary emergency room (ER) and hospital visits, and improved population health, according to a research report by the Patient-Centered Primary Care Collaborative released last week. The report focused on studies released between August 2012 and December 2013 and revealed common metrics, including: 61 percent of peer-reviewed studies and 57 percent of industry reports noted drops in per member, per month costs, return on investment and total cost of care. Click here for the report.