WEEKLY E-BULLETIN


No Reprieve From 2-Year RAC Hearing Delay

Apparently there will be no change to HHS’ 2-year delay in new RAC hearings and appeals announced at the first of the year. The Office of Medicare Hearings and Appeals held a public forum last week to shed more light on its decision. It blamed an expanding and problematic audit system, along with increasing numbers of Medicare patients, on the need to halt all new hearings. It presently has a backlog of more than 400,000 cases. Click here for our policy team’s one-page summary of the day long meeting.

111 House Members Call for Immediate RAC Reform

The Medicare Recovery Audit Contractor (RAC) process needs immediate reform, according to a letter sent last week to HHS signed by 111 members of the U.S. House. The letter suggested that Congress and CMS consider an alternative RAC payment model. The current model pays RACs a commission of between 9 percent and 12.5 percent based on the dollar amount of claims they deny. This payment incentive encourages RACs to deny even correct claims, the letter states. Click here for a copy of the letter. The association of RACs say the system is working well. Click here for their letter to Congress.

AMA Says Stop ICD-10; New Study Details Practice Costs

The AMA last week renewed its call on CMS to stop ICD-10 implementation. A new study released last week by the AMA says that the cost of implementing ICD-10 in physician practices will be much higher than was previously expected. The cost for a small practice will range from about $56,000 to $226,000. For a medium sized practice, the cost will range from $213,000 to $824,000. The cost for a large practice will range from $2 million to $8 million. Click here to review the study. Click here to read the AMA letter sent to HHS. October 1, 2014 is the deadline to be ICD-10 operational.

How Detailed Is ICD-10? Squirrel Attacks Are Identified!

Just how complicated is ICD-10? ICD-10 has 68,000 codes (compared with 14,000 for ICD-9). There are different numbers for getting struck or bitten by a turkey (W61.42 or W61.43). There are codes for injuries caused by squirrels (W53.21) and getting hit by a motor vehicle while riding an animal (V80.919), spending too much time in a deep-freeze refrigerator (W93.2) and a large toe that has gone unexpectedly missing (Z89.419). Click here for more.

New Tool Released for PQRS Compliance

And if ICD-10 isn’t enough, CMS has launched a new tool for eligible professionals (EPs) participating in PQRS. The tool is designed to help EPs meet deadlines from 2014 through 2016. If you are an EP or group practice participating in PQRS, CMS wants to make sure you are prepared for the many program milestones that are approaching. Click here for CMS’ new milestone tool.

OIG Work Plan Targets Hospital Executive Compensation

The HHS Office of the Inspector General says it will identify hospital salaries included in operating costs reported to and reimbursed by Medicare – as part of its new 2014/2015 work plan. This is according to the OIG’s newest work plan released last week. “We will determine the potential impact on the Medicare Trust Fund if the amount of employee compensation that could be submitted to Medicare for reimbursement on future cost reports had limits,” the report said. Click here for the OIG workplan. The salary review section is on page 18.

GOP Leaders Urge Obama NOT To Cut Medicare Advantage Payments

The top GOP leadership in the House sent a letter to President Obama last week urging the Administration NOT to cut payment rates to Medicare Advantage plans – an announcement that could be made by the end of this week. Click here for a copy of the letter. However, the Center on Budget and Policy Priorities said last week not to believe all the hype around potential cuts to Medicare Advantage payments and the impact it will have on health plans and consumers. Click here for their analysis.

GOP Wants To Eliminate Health Insurer Risk Corridors Program

The GOP is taking issue with the Affordable Care Act’s Risk Corridors program – designed to pay insurers more money if a health plan falls short of covering its medical expenses by 3%. 62 House Republicans and 14 Senate Republicans have signed on to legislation to repeal this provision. Click here for a one-pager from our policy staff that outlines the issue and its prognosis.

Health Exchanges Reach 75% Sign Up Mark; More Youth Signing

More than 1.1 million people signed up for health insurance through federal and state marketplaces in January, the government announced last week, and the number of young people enrolling increased faster than that of any other group. HHS said that 25 percent of those signing up for insurance from October through January were ages 18 to 34 — the young and presumably healthy people whom insurance companies need as customers in order to keep premiums reasonable for everyone. Click here for the HHS news. Click here for the NY Times report.

1 in 5 Newly Insured Missed Their First Premium Payment

About 20 percent of people who signed up for health insurance under the new health care law failed to pay their premiums on time and therefore did not receive coverage in January, insurance companies and industry experts told the New York Times last week. Click here for the story.

Average Americans Getting Caught Up in Health Exchange Politics

In the debate over health exchanges, politicians are more frequently turning to average Americans to tell their own version of the story. Average citizens are getting caught up in the political fray – either pro and anti Obamacare – and coming under some perhaps unwanted scrutiny themselves. Click here for the story.

Want An Easy Way To Know What You Would Pay for Insurance on the Federal Exchange

The Wall Street Journal has put together a very detailed and interactive graphic that allows you to see the rates for health plans available through HealthCare.gov, the federal insurance exchange. Many consumers will also be eligible for federal subsidies to help buy coverage through the exchanges, and may pay lower rates. Plans are labeled Catastrophic, Bronze, Silver, Gold or Platinum depending on the level of coverage. Click here.

Report: Drug Costs Increasing Under New Insurance Plans

A new study by HealthPocket, a company that ranks health plans, says that on average the 4 types of metal plans averaged a 34% increase in drug cost-sharing as compared to copayments and co-insurance fees in the pre-reform market. Bronze Plans had the highest increase in average out-of-pocket costs for drugs. Click here for their analysis.

Here’s the 10 Places Getting the Best Bargains on Their Exchanges; Also the Worst

People in much of Minnesota, northwestern Pennsylvania and Tucson, Ariz., are getting the best bargains from the health care law’s new insurance marketplaces: premiums half the price or less than what insurers in the country’s most expensive places are charging. The 10 regions with the lowest premiums in the nation also include Salt Lake City, all of Hawaii and eastern Tennessee. This ranking is based on the lowest cost of a “silver” plan, the mid-range plan most consumers are choosing. Click here for the analysis from Kaiser Health News. The Wall Street Journal had a story on those with the “worst” choices. Click here.

Moody’s Says Two ACA Proposed Changes Will Hurt Health Plans

A couple of proposed changes to Affordable Care Act are drawing the attention of the credit evaluators at Moody’s Investors Service — and not in a good way. In a note to clients last week, the ratings agency targeted two proposals: One forcing insurers that offer plans on public exchanges to expand their network of doctors and hospitals, and the other allowing individuals to retain non-compliant insurance policies through the end of 2016. Click here for more.

States Focus on Latinos to Expand Sign Up

Key to the success of the insurance exchanges is the sign up of Latinos, according to experts; however, the Latino sign up rate is falling below expectations. California and other states with a heavy Latino population are stepping up their efforts. Click here for the story.

Medicaid Expansions Will Stretch Behavioral Health Availability

As 25 states and DC expand their Medicaid programs, experts say their higher rates of mental health and substance abuse disorders will be difficult to treat due to a lack of counselors and behavioral therapists who accept Medicaid patients. Click here for the story with a very good interactive map showing the number of projected cases in each state.

GOP, Democrats Have Their Own Political Strategies on Obamacare

While the GOP appears to be targeting Democrats who support Obamacare, Democrats are apparently targeting Republicans who oppose Medicaid expansion. This dynamic is particularly acute in GOP-heavy states with Democratic senators up for re-election. Click here for this story on interesting politics.

Hospital System Getting National Attention for Focus on Hunger

Some health systems are getting national attention for their focus on issues not traditionally associated with hospitals. For example, ProMedica, based in Toledo, OH, is the center of a new US News report on how the system is addressing hunger as a health issue. Click here for the story. Health systems, legislators, and business leaders are coming together for a half-day summit to address hunger and other social determinants of health on 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 can be found at www.promedica.org/cometothetablesummit.

States Implementing Dual Eligible Programs – Merging Medicare and Medicaid

Many states are actively engaged in merging Medicare and Medicaid programs for those patients called “dual eligibles.” The first state to implement the new system is Massachusetts. Instead of carrying separate cards for Medicare and Medicaid, dual eligibles in Massachusetts who are enrolled in the state’s One Care program will get a single health plan and a case manager to coordinate their care. California will begin participating in May, and these states will join later this year and in 2015: Colorado, Connecticut, Idaho, Illinois, Iowa, Michigan, Minnesota, Missouri, New York, North Carolina, Ohio, Oklahoma, Rhode Island, South Carolina, Texas, Virginia and Washington. Click here for the story.

Study: Mammograms May Not Be Producing the Desired Results

One of the largest and most meticulous studies of mammography ever done, involving 90,000 women and lasting a quarter-century, has added powerful new doubts about the value of the screening test for women of any age. It found that the death rates from breast cancer and from all causes were the same in women who got mammograms and those who did not. Click here for the report.

GAO: Drug Shortages Remain High

The GAO released a report last week saying the number of drug shortages remains high. Although reports of new drug shortages declined in 2012, the total number of shortages active during a given year—including both new shortages reported and ongoing shortages that began in a prior year—has increased since 2007. Many shortages are of generic sterile injectable drugs. Some providers report that drug shortages may force them to ration care or rely on less effective drugs. Click here for the GAO report.

FDA Targeting India in Rx Export Probe

The second-largest exporter of over-the-counter and prescription drugs to the United States, India, is coming under increased scrutiny by American regulators – like the FDA – for safety lapses, falsified drug test results and selling fake medicines. The agency inspected 160 Indian drug plants last year, three times as many as in 2009. The increased scrutiny has led to a flood of new penalties, including half of the warning letters the agency issued last year to drug makers. Click here for the report.

Two People Arraigned for Smuggling Cancer Drugs into the US

Two individuals last week were arraigned for charges that they, among other things, smuggled adulterated and misbranded prescription cancer treatments from Turkey and other countries into the United States and conspired to defraud the United States and the U.S. Food and Drug Administration. The drugs did not meet the FDA’s standards and had not been approved for distribution in the United States. Click here for details.

Senators Urge Walmart to Stop Selling Tobacco Products

On the heels of the CVS announcement that it would stop selling tobacco products, 7 U.S. senators last week sent a letter to Walmart urging one the nation’s largest retailers to do the same. Senators Harkin (D-IA), Durbin (D-IL), Boxer (D-CA), Brown (D-OH), Whitehouse (D-RI), Blumenthal (D-CT), and Reed (D-RI) all signed on. Walmart is the top cigarette retailers in the country. Click here to read their letter.