WEEKLY E-BULLETIN


New Medicare Hearings Suspended for 2 Years

Hospitals and other providers are reacting negatively to an announcement by the HHS Office of Medicare Hearings and Appeals to suspend new hearing requests for 24 months.  A memo from the Chief Administrative Law Judge, Nancy Griswald, said the OMHA backlog has grown from 92,000 claims to more than 460,000 in the past two years. Click here to read the OMHA memo. Click here for the news story with reaction from providers.

Moody’s Downgrades Outlook for Health Insurers

Moody’s changed the outlook for US health insurers to negative from stable, as implementation of the Affordable Care Act continues to create uncertainty for the industry, according to Moody’s Investors Service in its new industry outlook released last week. Click here for more.

HealthCare.gov and Medicaid Sign-Ups Soar

The number of people enrolled in private health insurance under Obamacare has soared by more than one-third in recent weeks to around 3 million, according to government data released late last week. Click here for the Reuters report. Click here for the Blog from CMS Administrator Marilyn Tavenner. Meanwhile, Medicaid enrollment is booming, according to published reports. Click here for the NY Times article.

Medicaid Expansions Good for Insurers

As state budgets have been hurt by the stagnant economy, lawmakers have turned more patients eligible for Medicaid over to privately-contracted insurance companies. Now, the health law provides a cash infusion of more than $900 billion in federal dollars from 2014 to 2022 to expand Medicaid programs for states interested in the proposition. This is good news for health insurers, according to a report in Forbes. Click here.

Certain Medicare Advantage Plans Have Higher Profit Margins: GAO

Special needs plans (SNP) reported having higher profit margins and spending a lower percentage of total revenues on medical expenses, on average, than Medicare Advantage (MA) plans available to all beneficiaries in 2011, according to a GAO report out last week. For instance, SNPs’ average profit margin was 4.0 percentage points higher than plans available to all beneficiaries–8.6 percent vs. 4.6 percent. SNPs also had a higher plan-level median profit margin compared to MA plans available to all beneficiaries–7.1 percent vs. 3.2 percent. Click here for the report.

$201 Million Awarded for State Health Exchanges

Nine states were awarded a combined $201.2 million in new federal grants last week to support state-run and partnership exchanges according to HHS. Washington State’s exchange received the most, $84.6 million, to fund a number of activities. The next largest went to New Mexico,$69.4 million, to build up the IT infrastructure supporting individual enrollment in 2015. Mississippi got $16.9 million; Arkansas received $3.6 million; Delaware got $8.3 million, Nevada $7 million, New Hampshire $2 million, Rhode Island $6.2 million and Utah $3.2 million. Click here for details. Click here to see the latest on your state.

Doc Payment Fix Costs Less But Paying For It Remains Unclear

The current physician Medicare payment fix expires March 31 and the real question is not whether there will be a replacement policy agreed to by the House and Senate. The burning issue is, “how will it be paid for?” The Senate Finance Committee’s SGR repeal bill has been scored by the CBO at $150.4 billion over 10 years. The cost of two House SGR measures, passed by the Ways and Means Committee and the Energy and Commerce Committee, was pegged by CBO last week at $121 billion and $146 billion, respectively. The Senate’s legislation includes nearly $40 billion in Medicare extenders that were not included in the House versions. Most, if not all, of the extenders are expected to be in any final bill. The committees are remaining tight lipped about where they will get the funding. Click here for the CBO’s latest 14-page analysis containing some very helpful info.

Hospitals Go To Court To Fight 2-Midnight Rule

The AHA, several hospital associations and four hospital systems last week took the first steps to bring a federal court challenge to CMS’ two-midnight inpatient admissions criteria and related policies. Banner Health (AZ), Einstein Healthcare Network (PA), Wake Forest University Baptist Medical Center (NC) and The Mount Sinai Hospital (NY) are asking the Provider Reimbursement Review Board to grant expedited judicial review for the hospitals’ claims that the rule’s 0.2% payment cut for FY14 IPPS hospitals is unlawful. Click here for more.

ObamaCare Could Be GOP Target in Debt Ceiling Debate

Despite potential political and economic costs, GOP leaders say they’ll again set conditions on raising the US debt limit in February, according to published reports last week. A top target could be the high risk corridors in the Affordable Care Act designed to reimburse insurers when fewer healthy people enroll than what was expected…acting as a financial cushion during the early years of the program. Click here for the story.

Report: PCORI “Not Fulfilling Mission”

The Patient-Centered Outcomes Research Institute (PCORI) is taking some heat from the Center for American Progress – a left-leaning independent think tank in Washington, DC.  The Affordable Care Act created the independent and nonprofit organization to fund and disseminate Comparative Effectiveness Research (CER). But four years into its existence PCORI is not yet fulfilling its mission, according to a new report. “It has dedicated less than 40 percent of its research funding to CER and hasn’t initiated a single CER study of medical devices. Few of its studies focus on the priority areas identified by the Institute of Medicine.” Click here for the 7-page report.

IRS Further Defines Individual Mandate Exemptions

Americans with limited health coverage under Medicaid or certain military health care programs will not be subject to Obamacare’s fine for violating the individual mandate, according to an IRS notice posted late last week. People exempted from the mandate fine include those with coverage under family planning services Medicaid, tuberculosis-related services Medicaid, pregnancy-related Medicaid and emergency medical conditions Medicaid. Click here for the 4-page IRS notice.

Study: Youth May Benefit By Skipping Health Insurance This Year

America’s youth may be better off financially if they skip health insurance this year, according to new research out last week from the American Action Forum. But that calculation could change in the future, the organization concludes. AAF found that adults ages 18-35 would be better off financially in 2014 if they pay Obamacare’s relatively weak penalty and remain uninsured — as long as they remain healthy. Click here for the study.

Insured Still Unsure of Health Benefits

Fewer than 40 percent of uninsured adults expect to get health coverage in 2014, according to survey findings released last week by the Robert Wood Johnson Foundation. The survey suggested that just three in 10 uninsured people eligible for Medicaid think they’re eligible and a third of people eligible for subsidized exchange coverage are aware of it. Click here for the survey results.

Study Says Hospital Consolidations Benefit Patients and Communities

A study commissioned by the Federation of American Hospitals and released last week says that hospital consolidations have actually benefited patients and communities. Click here for the 39-page report. Other findings:

  • Enhanced access, higher value and greater efficiency;
  • Hospital realignment is driven by a mix of policy reforms and a changing economic landscape;
  • Claims of negative effects often cite outdated data not reflective of today’s market or narrow studies not representative of most transactions;
  • Government antitrust reviews underscore that the vast majority of mergers do not raise risks of a substantial lessening of competition; and
  • Fundamental realignment changes are underway within the context of a historic slowdown in the rate of healthcare spending.

2013 Could Be 5th Straight Year of Slow Health Spending Growth

National health care expenditures grew at an annual rate of 4.0% for the first 11 months of 2013, according to the latest economic indicators from Altarum Institute’s Center for Sustainable Health Spending. 2013 could be the fifth consecutive year of health spending growth below 4%, a rate that had not been seen before in the 50-plus years of national health expenditure accounting, according to Altarum. Click here to view their reports.

White House Compares Pre and Post ObamaCare World

The White House was out last week with a new info graphic that tried to put Obamacare in perspective, when compared with life before the Affordable Care Act became law. Click here for the interesting graphic.

Report: Frequency of Follow Up Doc Visits Questioned

The time has come for evidence-based guidelines for scheduling follow-up visits with doctors, a change that could trim billions from health care costs, according to the authors of a commentary published this month in The American Journal of Managed Care. The authors modeled hypertension – using the Medicare national allowable billing amount of $65.30 (CPT code 99213 visit), they said an extension of the follow-up visit from six to seven months would result in a 15 percent decrease in visits per year, saving nearly $682 million. An extension to annual visits would reduce visits by half and save $2.3 billion. Click here for more.

$3 Billion Program Benefiting Some States for Keeping Patients Home

In New Hampshire, Medicaid pays for in-home care for nearly all of its developmentally disabled residents. For frail elders, the opposite is true. Most wind up in nursing homes. So, New Hampshire is taking advantage of the health law’s funding for a program aimed at removing existing barriers to providing long-term care in people’s homes and communities. Known as the Balancing Incentive Payments Program, it is one of several Affordable Care Act provisions designed to keep as many people as possible out of costly institutions. 16 other states are also participating in the $3 billion incentive program. States receive a higher federal match for all of their spending on home and community care through September 2015, if they meet certain conditions. Click here for details.