WEEKLY E-BULLETIN


Medicare ACOs Saved $320 Million in First Year: CMS

Medicare ACOs saved hundreds of millions of dollars in its first full year, CMS announced last week. Almost half of the 114 Medicare ACOs that began in 2012 had lower than projected spending over 12 months. The 29 top performers will receive “shared savings” of more than $126 million, and the share of savings to the Medicare trust funds is more than $128 million, the agency reported. Click here for the CMS details.

Government Continues Down ACO Path

Will government continue down the ACO path? The answer is likely yes, according to a new Health Affairs analysis. ACOs are now located in all 50 states and DC, as determined by location of their hospitals or clinics. California leads all states with 58 ACOs followed by Florida with 55 and Texas with 44. ACOs are primarily local organizations, with 538 having facilities in only one state. At the Hospital Referral Region level (HRR), Los Angeles (26), Boston (23) and Orlando (17) have the most ACOs. Click here for the Health Affairs blog that details the growth of ACOs.

CMS Delays 2-Midnight Enforcement Another 6 Months

CMS announced late Friday it delay full enforcement of the 2-Midnight Rule for another 6 months – until October 1. The current delay was set to expire in April. Specifically, CMS is extending the Inpatient Hospital Prepayment Review “Probe & Educate” review process. This means that:

  • Medicare Administrative Contractors (MACs) will continue to select claims for review with dates of admission between March 31, 2014 and September 30, 2014. MACs will continue to review and deny claims found not in compliance with CMS-1599-F (commonly known as the “2-Midnight Rule”).
  • MACs will continue to hold educational sessions with hospitals as described below in “Selecting Hospitals for Review” through September 30, 2014.
  • Generally, Recovery Auditors and other Medicare review contractors will not conduct post-payment patient status reviews of inpatient hospital claims with dates of admission on or after October 1, 2013 through October 1, 2014.

Click here for more details from CMS. We assume CMS will still be hosting a national conference call on the 2-Midnight rule tomorrow afternoon EST. Click here for sign up details.

2-Midnight Repeal Bill Picks Up Dozens More Cosponsors

Legislation to repeal the 2-Midnight rule now has 85 House cosponsors as hospitals increase the pressure on their congressional delegations to stop the regulation altogether. Click here to see the most current list of the House members who have signed on. There is no Senate companion bill at this time.

2-Year RAC Hearing Suspension to be Explained Further Next Week: HHS

Adding insult to injury, the HHS office that conducts RAC hearings and reviews appeals says it will suspend any new hearings for 2 years because of its tremendous backlog of cases. The Office of Medicare Hearings and Appeals (OMHA) will host a forum to provide updates on the status of operations; relay information on initiatives designed to mitigate a growing backlog and provide information on measures that appellants can take to make the administrative appeals process work more efficiently. The forum is Wednesday, February 12, 2014 from 10:00 a.m. – 5:00 p.m. EST in Washington; however, you can sign up to participate remotely by click here. Click here for more details.

AARP Says Rx Companies Should Pay for SGR Fix

As providers brace for potential payment cuts to pay for the physician Medicare payment fix, pharmaceutical companies are AARP’s target for cost savings to pay for the new payment system. In a letter sent last week to the Senate Finance, House Ways and Means and Energy and Commerce committees, AARP said requiring more Part D drug rebates and several other Rx changes would pay to permanently fix the doc payment formula. Click here to read the AARP letter. Some of those suggestions were included on the first official list released from Congress on potential cuts to pay for the doc fix. Click here for that list.

CMS Imposes Another Moratorium on New Home Health, Ambulance Services

CMS last week announced new temporary moratoria on the enrollment of home health agencies in four metropolitan areas: Fort Lauderdale, Detroit, Dallas and Houston. This new action also includes the enrollment of new ground ambulance suppliers in the Greater Philadelphia area. CMS is also extending for six-months the current enrollment moratoria of home health agencies in Chicago and Miami and for Houston area ground ambulance supplier enrollments in its Medicare, Medicaid and Children’s Health Insurance Program operations. Click here for details.

Study Says High Prices Hospitals Don’t Provide Higher Quality of Care

A study out last week reviewing autoworker claims found that hospitals with the highest prices tended to have the strongest reputations and tight holds on their local markets yet showed little evidence of providing better quality care. Researchers found partial justification for higher prices charged by these hospitals. They tended to treat sicker and poorer patients, often received referrals from other hospitals and were more likely to offer specialized, expensive services. Click here for the story. Click here to go to the study in Health Affairs.

CMS Proposes New Emergency Preparedness Regs for Providers

CMS has found significant gaps in emergency preparedness among its providers, and has proposed regulations that would require providers and suppliers to meet planning, training, and communication standards. The 120 pages of rules are built around four basic standards: risk assessment and planning, development of policies and procedures, establishment of a communication plan, and ongoing training and testing of staff. Some providers are already telling the government that the regs are too onerous. Click here to read the regs. Click here to read the comments that have already been submitted. Comments are due February 25.

Report: Five States Not Implementing ACA

Five states are not implementing the Affordable Care Act, according to a report out last week. Alabama, Missouri, Oklahoma, Texas and Wyoming have said they will not scrutinize insurers in their states to make sure that they comply with the law and will do nothing to implement it. Click here for the Commonwealth Fund report that has a state-by-state review.

New ACA Ads Ready To Be Aired

Federal officials say they will spend about $52 million of their $76 million open enrollment advertising budget during the last three months of the sign-up period that ends March 31. The Winter Olympics, which starts later this week, will help the government inform a younger audience that it should get covered. Three of the four ads that CMS will use are spots that were released in an online last year. (Click here and here and here to see these 30-second ads.) Another includes excerpts from a recently-released video with basketball legend Magic Johnson, click here for that ad.

Majority of Uninsured Plan to Use Exchanges

Fifty-six percent of uninsured Americans who plan to get health insurance say they will do so through a government health insurance exchange. That figure has steadily increased since Gallup began tracking uninsured Americans’ intentions in October. Click here to see the Gallup survey released last week.

GOP Turns Attention to Problemed State-Run Exchanges

Now that the federal health exchange appears to be running smoothly, Republicans have turned their focus on those states where the state-run exchanges are not doing well, according to published reports. In Hawaii, Maryland, Massachusetts, Minnesota and Oregon GOP officials are sharpening their attacks – even in these heavily Democratic leaning states. Click here.

Experts Say ACA Repeal Brings Plenty of Problems

Health care experts on both sides of the aisle are saying that repealing the Affordable Care Act would bring severe financial penalties to millions of Americans and insurance companies, so the likelihood of eliminating the law after the next election is small. In fact, Republicans in Congress have even offered legislation that contains many of the same components of Obamacare. Click here for the USA Today story.

GOP Looking for ACA Alternatives

House Majority Leader Eric Cantor (R-VA) said yesterday that “Obamacare is on borrowed time.” He told CBS News that the House GOP will be coming up with an alternative that will likely be voted later this year. Click here for details. Senate Minority Leader Mitch McConnell (R-KY) sent a letter to the GOP Governor’s Association policy chair requesting suggestions to change Obamacare. Click here for his letter.

3 US Senators Propose ACA Partial-Repeal and Replace Bill

Republican U.S. Senators Richard Burr (NC), Tom Coburn (OK), and Orrin Hatch (UT) introduced last week legislation to repeal and replace much of the Affordable Care Act and a new analysis gives it high marks. None of the provisions relating to Medicare would be repealed. Key provisions include a premium credit for all individuals earning less than 300 percent of the federal poverty limit, a cap on tax-exempt income spent on employer sponsored health insurance, and a capped allotment funding design for Medicaid, among others. Click here for a summary of the bill. Click here for the analysis from the Center for Health and Economy.

General Public Still Not Paying Close Attention to Health Care Developments

To what extent is the general public paying attention to all the news surrounding health care policy developments? Unfortunately, not as much as you might think. That’s according to the January Kaiser Foundation report on news coverage that offers some interesting information with helpful graphs. Click here.

Health System, Legislators Leading Hunger Summit in Washington

Health systems, legislators, and business leaders are coming together for a half-day summit to address hunger and other social determinants of health in a Thursday, February 27, 2014 Come to the Table: Hunger Summit on Capitol Hill. To register, please visit promedica.eventbrite.com or email rsvp@alliancetoendhunger.org. More information about the summit can be found at www.promedica.org/cometothetablesummit.

Medical Homes Producing More Results: Study

More encouraging news on the use of medical homes. According to data compiled by researchers at UCLA, low-income residents who enrolled and remained in medical homes were half as likely as those not in medical homes to use the ER for care that did not lead to a hospitalization. Altogether, there were 606 ER visits without a hospitalization per 1,000 patients when the program began, a three-year Medicaid demonstration project. By the end of three years, the rate of ER visits among those who stayed in a medical home dropped to 295 per 1,000. Click here for a copy of the study.

Serious IV Saline Solution Shortage Reported

Many hospitals and dialysis centers across the country are experiencing shortages of intravenous saline solutions since mid-January, according to the FDA. Late last year, manufacturers warned about expected delays in filling orders, and the recent spike of flu activity increased the demand for the fluids. The FDA announced last week that it is having a discussion with three manufacturers to address the saline shortage. Click here for details.

ICD-10 Testing Program for Docs Announced

CMS has announced it has scheduled 5 days of limited front-end ICD-10 testing from March 3 to 7, in advance of the deadline for physicians to implement the new code sets. Physicians must register with their Medicare Administrative Contractor to participate and will be able to submit claims using the new coding to find out if they are accepted or rejected. Click here for the details that are on page 2.

PQRS EHR Incentive Pilot Sign-Up Announced

The Physician Quality Reporting System Medicare EHR Incentive Pilot program has given eligible professionals until the last day of February to submit their data and participate. EPs must submit 12 months of clinical quality measure data by February 28 at 11:59 pm EST. EPs that don’t submit their 2013 quality data or deselect the electronic reporting option in the EHR Attestation System will not receive an EHR incentive payment. Click here for the details from CMS.

Physician Waiting Times Growing in Many Major Metro Areas

Need to see a doctor? Get in line, because it could take weeks to schedule an appointment, a new survey indicates. The survey of 1,399 medical offices tracks the average time needed to schedule a doctor appointment in 15 large metropolitan areas. Boston is experiencing the longest average doctor appointment wait times of the 15 metro markets examined in the survey: 72 days to see a dermatologist, 66 days for a family physician, 46 days for an ob/gyn, 27 days for a cardiologist, and 16 days for an orthopedic surgeon. Click here for the survey, plus a nice national map that lays it all out.

Wellpoint Benefiting from Exchanges

Healthcare utilization increased last year because when consumers received cancellation letters, many rushed to seek care and treatments before they lost their health coverage – this is according to WellPoint last week. WellPoint also said it enrolled 500,000 new members through the exchanges and expects to add 1 million new members this year despite the botched rollout of the health insurance exchanges last year. Click here.

Report Says We Are Irradiating Ourselves to Death

Are we irradiating ourselves to death? A couple of researchers think so. A single CT scan exposes a patient to the amount of radiation that epidemiologic evidence shows can be cancer-causing. The use of medical imaging with high-dose radiation — CT scans in particular — has soared in the last 20 years. Our resulting exposure to medical radiation has increased more than sixfold between the 1980s and 2006, according to the National Council on Radiation Protection & Measurements. Click here for the NY Times article.

Hundred of Thousands of Blue Cross Customers in California to See Big Premium Hikes

Thousands of Anthem Blue Cross individual customers with older insurance policies untouched by Obamacare are getting some jarring news in California: Their premiums are going up as much as 25%. These increases, 16% on average, are slated to go into effect April 1 for up to 306,000 people — unless California regulators persuade the state’s largest for-profit health insurer to back down. Click here for the LA Times report.

ACA Causing Significant Income Re-Distribution

Another result of the Affordable Care Act: Americans with incomes in the bottom fifth of the distribution will see an average increase of 6 percent because of expanded access to Medicaid and tax subsidies for private coverage, while higher taxes, lower Medicare Advantage payments and changes to the insurance market will somewhat reduce incomes for the rest of the population – this is according to a Brookings Institute study released last week. Click here for a copy of the study.

Traumatic Spinal Cord Injuries Increasing

Among adults age 65 and older, the rate of traumatic spinal cord injuries jumped from 79.4 per million in 2007 to 87.7 per million in 2009, according to a report in the Journal of Neurotrauma. Falls were the most common cause of injury at 41.5%, surpassing motor vehicle crashes. Click here for more.