CMS “Pauses” RAC Process; Pressure for Reform Building

In what appears to be a response to the outpouring of opposition from hospitals, Congress, Medicare rights advocates and others, CMS last week announced a “pause” in RAC audits. CMS says it’s in the procurement process for the next round of RAC contracts, so:

  • February 21 was the last day a Recovery Auditor may send a postpayment Additional Documentation Request (ADR);
  • February 28 is the last day a MAC may send prepayment ADRs for the Recovery Auditor Prepayment Review Demonstration; and
  • June 1 is the last day a Recovery Auditor may send improper payment files to the MACs for adjustment. Click here for CMS’ brief announcement. Click here for a very good overall summary.

Additionally, CMS said it was making 5 improvements to the RAC process. Click here for a one-page summary.

RAC Reform Legislation Gaining Steam

Legislation to reform the RAC process appears to be gaining steam. There is now reason to believe that Congress intends to pass reform legislation as part of its physician Medicare payment fix that must be addressed by April 1. 185 House members have now cosponsored the hospital industry-backed bill. However, there are also indications that Congress may be leaning in favor of passing legislation that is not as comprehensive. Our policy team put together a 2-page side-by-side of the 2 RAC bills under consideration. Click here.

CMS Hits Medicare Advantage With Cuts, Other Changes

CMS says it will strengthen Medicare Advantage; health plans say it will hurt seniors. I’m talking about the newly proposed regs – released late Friday afternoon – from CMS. Depending on the source, proposed cuts to 2015 Medicare Advantage payments ranges from 1.9% to 8%. Comments on CMS’ Advance Notice and draft Call Letter are due by March 7. CMS will release final regs on April 7. Click here to read a good media summary. Click here for the Wall Street Journal Summary. Click here for the summary from CMS. Click here for the 148 page CMS draft Call Letter. 40 US Senators and more than 100 House members urged CMS not to cut MA rates. The health insurance industry spent millions of dollars advertising messages against any more payment reductions.

2-Midnight Rules Study Confirms Anecdotal Info

So, what’s the impact of CMS’ 2-midnight rule? In announcing the new regulation, CMS said the rule would decrease the number of observation patients and increase the number of inpatients. However, according to a new study, it seems the opposite is more likely. Click here for the study from the University of Wisconsin researchers. Click here for a summary from a Medicare patients’ rights group.

2-Midnight Repeal Legislation Gains More Supporters

The number of House cosponsors to repeal the 2-Midnight rule continues to grow and now stands at 104. The legislation, introduced by Rep. Gerlach, a Republican from Pennsylvania, could become part of a package of legislation that moves through Congress in late March as part of the physician Medicare payment fix. Click here to see all the cosponsors. Another 8 were added Friday. New York, Illinois and Pennsylvania have the largest number of cosponsors, with New York representatives almost a quarter of the total. Click here for a summary of the bill.

Innovation Center Announces More Bundled Payment Opportunities

CMS’ Innovation Center announced an open period for additional organizations to be considered for participation in Models 2-4 of the Bundled Payments for Care Improvement initiative. In addition, CMS will consider the addition of both episodes and/or Episode Initiators to current participants in Bundled Payments for Care Improvement Models 2, 3, and 4. Click here for the details. Email me at paul.lee@shcare.net if you are interested in getting the help of our policy team in setting up your bundled payment and filing your application.

First Time: CMS Adds Quality Measures to Physician Compare

CMS last week announced that for the first time, quality measures have been added to Physician Compare, a website that helps consumers search for information about hundreds of thousands of physicians and other health care professionals. The site helps consumers make informed choices about their care. Click here for information on the changes. Click here for the physician compare website.

Obama Pitches Healthcare.gov Enrollment; WSJ Reviews Obamacare Impact

President Obama is pitching the working Obamacare enrollment website in a new White House video aimed at getting people to sign up before the March 31 deadline. The pace of enrollment has picked up this winter, after the dismal start last October. But the administration is still hoping for a surge of sign-ups in the final five weeks. Obama said nearly six in 10 uninsured Americans can get coverage for less than $100 a month. Click here to see the minute-long video. How will the Affordable Care Act impact America? That’s the subject of a new series from the Wall Street Journal. Click here for their first installment.

Study: Medical Device Makers Feel Impact of ACA

One area of impact of the ACA is on medical device makers. The medical device-makers’ trade group estimates that Obamacare’s 2.3 percent medical device tax has cost the industry 33,000 jobs so far. Based on a survey of its members, AdvaMed reports that companies have seen employment reductions of 14,000 people and have chosen not to hire 19,000 workers because of the tax that took effect last year. Click here for the report.

GAO: Medicaid Spends Most on a Few

The GAO was out with a new report last week showing that in fiscal year 2009, states spent nearly a third (31.6 percent) of all Medicaid expenditures on the most expensive Medicaid-only beneficiaries, who were only 4.3 percent of total Medicaid beneficiaries. Click here for the graph and the GAO report.

Hospital Mergers May Not Mean Better Care

Do hospital mergers and physician acquisitions mean better care? Not according to two researchers who argued last week against going big. They say that the Dartmouth Atlas and other sources have shown that some of the biggest and best-known U.S. hospitals are no less guilty of subjecting patients to useless tests and marginal treatments. Click here for their Bloomberg article.

Fight Continues Over Paying For Doc Payment Fix

Congress is struggling to find the $150 billion or so it will take to replace the Sustainable Growth Rate formula, better known as the doc payment fix. Special interests are digging in over possible cuts. Click here for that story. The Wall Street Journal editorial board seemed to endorse the legislative fix that was worked out by the House and Senate a few weeks ago. Click here.

ACOs Could Harm Hospital Finances

Could ACOs damage hospital finances in the long run? According to a report last week in Businessweek, this could happen because many physician-led ACOs excluded hospitals from their groups. Physician practices lead more than half of the nation’s 367 healthcare provider ACOs and leave out hospitals, according to the article. Doctor-led ACOs keep costs down because they encourage their patients to use retail clinics or home visits for nonurgent care instead of expensive hospital visits. To combat this, some hospitals are expanding into the primary care market by buying doctors’ practices. Click here for the Businessweek report.

ACA Could Lower Personal Bankruptcies

Could the Affordable Care Act help to reduce personal bankruptcies? That’s the research performed by economists at the Federal Reserve of Chicago and the University of Notre Dame. The economists used healthcare reform in Massachusetts–which is structurally similar to the ACA–to determine its impact on personal bankruptcy filings. Their findings: personal bankruptcies dropped by 20 percent, and credit scores improved. Click here for their extensive study.

DOJ Joins Suit Against Two Hospital Companies

The Justice Department will join a whistleblower suit against Tenet Healthcare Corp. and Health Management Associates Inc. alleging the firms’ Georgia hospitals illegally paid kickbacks to obstetrics clinics for referring low-income and undocumented patients to their facilities for deliveries, the department announced last week. The suit is the latest in a wave of similar cases the Justice Department is pursuing against hospital operators, including at least eight separate cases against HMA for a range of tactics. Click here for the Wall Street Journal story.

Leading GOP Lawmakers Urge CMS to Withdraw Proposed Part D Rule

Top Republicans in the House and Senate asked the Obama administration last week to withdraw a proposed rule to overhaul the Medicare Part D prescription drug benefit. A letter from Senate Finance Committee Ranking Member Orrin Hatch, Energy and Commerce Chairman Fred Upton and Ways and Means Chairman Dave Camp wrote that they may take legislative action if the rule isn’t withdrawn. The letter follows a rule from CMS last month that limits the number of Part D plans that can be offered and changes the requirements for drugs to be covered. Click here for a copy of their letter.

Survey: Physicians Just Not Happy with EHR Options

For nearly a third of physician practices, electronic health record implementation cost more than $200,000, according to a new national survey of about 1,000 physicians. 37% of practices have spent less than $50,000. 67% are dissatisfied with system functionality. Click here to review the survey.

New Guidelines Issued to Curb C-Sections

In a bid to curb cesarean delivery rates in the U.S., the American College of Obstetricians and Gynecologists and the Society for Maternal-Fetal Medicine issued guidelines (click here) urging that more time be allowed for labor to progress for first-time mothers with low-risk pregnancies. The guidelines, which will appear in the journal Obstetrics & Gynecology, also recommend expanding access to supportive, nonmedical interventions during labor. Click here for the story.

A Record Number of In Vitro Babies Born

In 2012, a record 61,740 infants were born through in vitro fertilization, approximately 2,000 more than the previous year, according to a report released last week by the Society for Assisted Reproductive Technology. The fertility treatment accounted for more than 1.5% of about 3.9 million births. The increasing average age of first-time mothers may partly explain the rising number of IVF babies, researchers said. Click here for more.

CDC: Flu Hitting Youth Harder This Year

Sixty-one percent of influenza-related hospitalizations this season have involved patients between the ages 18 and 64, compared with 35% the past three seasons, CDC researchers said last week. Young and middle-aged adults also accounted for about 60% of flu deaths. Click here for a good summary from USA Today. Click here for the latest CDC map of the US on where flu is concentrated.

FDA Order Suspension of Sales of 4 Tobacco Products

The FDA issued orders late last week to stop the further sale and distribution of four tobacco products currently on the market. The action marks the first time the FDA has used its authority under the Family Smoking Prevention and Tobacco Control Act to order a manufacturer of currently available tobacco products to stop selling and distributing them. Click here for details from the FDA.

North Dakota Tops Well Being List

For the first time, North Dakota had the highest well-being of any state in the country, according to the Gallup-Healthways 2013 Well-Being Index released last week. With a score of 70.4 out of 100, up from 67.4 last year, North Dakota put an end to the Hawaii’s four-years at the top of the list. Click here to see where your state ranks.