WEEKLY E-BULLETIN


Healthgrades Announces Top 50/Top 100 Hospitals for 2014

Healthgrades has announced its annual list of “America’s 50 Best Hospitals™” and “America’s 100 Best Hospitals™.” These facilities represent Healthgrades’ top 1% in the nation and top 2% in the nation in providing better-than-expected outcomes in the majority of the most common procedures for four or more consecutive years. Click here for the full 12-page report (the hospital list starts on page 9).

CMS Updates (Again) 2-Midnight Rule Guidance

CMS last week issued another update to previous guidance regarding its 2-Midnight Inpatient Rule. CMS is requesting that the Medicare Administrative Contractors (MACs) re-review all claim denials under the Probe & Educate process to ensure the claim decision and subsequent education is consistent with the most recent clarifications. To ensure that the re-review process does not affect the ability of a provider to file a timely appeal of a denied claim, CMS will waive the 120 day timeframe for filing redetermination requests received before September 30, 2014 for claim denials under the Probe & Educate process that occurred on or before January 30, 2014. Click here for a CMS summary. At least one Medicare RAC subcontractor, PRGX, is calling it quits – click here for the story.

FY2015 Federal Budget To Be Released This Week

The big health care news this week is likely to be the release of President Obama’s FY2015 federal budget blueprint. It is likely to contain numerous changes in health care. One of those changes is a proposal boosting the National Health Service Corps from 8,900 people per year to 15,000 per year over the next five years and more than $5 billion to train primary care residents. Click here for the USA Today report.

New Study Shows Regional Metro Variations in Knee and Hip Replacements

A new and detailed study out last week showed the average spending for uncomplicated inpatient knee and hip replacements across 36 hospitals in nine metro markets ranged from less than $17,500 to $37,000 when including all services during the inpatient stay and all follow-up care within 30 days of discharge. Among the lowest-spending hospitals, spending for knee and hip replacement episodes ranged from $17,000 to $20,000, dramatically lower than the highest hospitals, where spending was close to or more than $35,000. Click here for the summary. Click here for the study.

House Tax Reform Plan Hits Health Care

It won’t pass this year, but should the GOP take the Senate and hold the House in the November election, you can bet this plan will be revived next year. I’m talking about Rep. Dave Camp (R-MI), chairman of the House Ways and Means Committee, unveiling comprehensive draft legislation to overhaul the nation’s tax code. Among the health care provisions:

  • The tax exemption for interest on tax-exempt 501(c)(3) hospital bonds would be repealed and advance refundings eliminated, effective for bonds issued after 2014.
  • An individual’s charitable contributions could be deducted only to the extent they exceed 2 percent of the individual s adjusted gross income. The income-based percentage limit for certain charitable contributions to public charities and certain other organizations would be reduced from 50 percent to 40 percent.
  • Tax-exempt organizations would be subject to a 25 percent excise tax on compensation in excess of $1 million paid to any of its five highest paid employees for the tax year.
  • A tax-exempt organization would be required to calculate separately the net unrelated taxable income of each unrelated trade or business. Losses generated by one unrelated trade or business could not be used to offset income derived from another unrelated trade or business.

Click here for the 194 page summary.

House Physicians Endorse SGR Replacement Bills

The House GOP Doctors Caucus last week officially endorsed a bill to permanently repeal the sustainable growth rate formula that was introduced by one of its own members, Rep. Michael Burgess (R-TX). 18 physician Members of Congress signed on. Click here to see their signed letter to leadership.

CBO Says SGR Replacement Bills Will Cost $138 Billion

The Congressional Budget Office is out with a new analysis of the cost of the SGR replacement legislation. The CBO pegged the cost of a permanent repeal bill supported by committees in the House and Senate at $138 billion over 11 years. Click here for the CBO report. There is still no formal congressional proposal of how to pay for the SGR bill; however, it appears that cuts to outpatient Evaluation and Management payments and 66 previously identified APCs are at the top of the list, according to congressional sources.

“No More Hospital Cuts” Ads Running in DC

The Coalition to Protect America’s Health Care launched a new ad campaign in the Washington metro system last week, urging Congress not to cut hospital funding — again — to pay for the physician Medicare payment fix. The “Stop the Hospital Cuts” ads will go up for the month of March. The Coalition includes the nation’s largest hospital associations and other pro-hospital groups. Click here to see the ads.

CBO Leader Outlines Health Care Spending Issues

CBO Director Doug Elmendorf spoke last week about the main factors that are causing federal health care spending to grow much faster than the economy. He also summarized CBO’s analysis of a wide range of approaches to address that growth. Click here for a summary of his comments and a complete copy of his slide presentation here. U.S. Sen. Tom Coburn (R-OK) was also out with a historical summary of health care spending over the past four decades. Click here for a very interesting report.

Health Insurers Trying to Figure Out Who They Are Signing Up on Exchanges

Health insurers are calling, emailing and writing letters to their new enrollees who have signed up through the exchanges, urging them to divulge information about their conditions, prescriptions and even personal habits, according to a report last week in the Wall Street Journal. Much of this information is being gathered through online forms called health-risk assessments that have long been used in employer-sponsored wellness programs. Click here for the story.

At Least One Exchange Using Predictive Modeling to Fight Fraud

Using predictive modeling to fight fraud, the Massachusetts health insurance exchange recouped $2 million in six months and avoided paying hundreds of thousands of dollars inappropriately, according to technology research and assessment firm GCN. Click here for the story.

Top Services Still Not Covered by Health Plans

Long-term care, cosmetic surgery, adult dental services, weight loss programs and acupuncture are among the 10 most commonly services excluded from health insurance coverage, according to a new report from HealthPocket. 80 percent of the services on the list were also typically uncovered in pre-Obamacare plans, the report says. But plans do include two previously-uncovered services that are now required: children’s dental coverage and eyeglasses. Click here for the report.

Trade Group Details Medicare Advantage Cuts

Seniors and people with disabilities enrolled in Medicare Advantage plans would face premium increases and benefit reductions of $35-$75 per month, or $420-$900 next year, if new Medicare Advantage payment cuts recently proposed by CMS take effect next year, according to a new analysis by Oliver Wyman prepared for America’s Health Insurance Plans. Click here for the details.

CMS OKs Subsidies for Certain Persons with Non-Exchange Plans

Some people who had trouble getting health coverage through their state insurance exchanges will be able to get Obamacare subsidies, even if they bought plans outside of the exchange. It’s another change to the federal health law, although one that will apply to a relatively narrow slice of the population. Click here for the details from CMS.

HHS Details Status of Healthcare.gov

In the most detailed update on the website in weeks, HHS last week announced that it had cut the number of screens a user must complete to begin an application from five to two, and added additional “help content” to support immigrants and those with complex family situations. Consumers can now report life changes like having a baby or getting married that can affect insurance coverage. Click here for the update.

Nearly 9 Million Eligible for Medicaid and Exchange Coverage

According to a new CMS report released Friday, between October and January, more than 8.9 million individuals were determined eligible for Medicaid or CHIP through state agencies and through state-based Marketplaces. More than 2 million people were informed in January that they are eligible for Medicaid and the Children’s Health Insurance Program (CHIP); more of those individuals are in states that have chosen to expand Medicaid coverage to more of their residents. Click here for the report, which includes state-by-state numbers.

Time Magazine Details Botched Healthcare.gov Rollout

Time magazine is out with a new and very detailed report of the botched Healthcare.gov website rollout. Among other tidbits: on October 17 of last year, the President was thinking of scrapping the whole thing and starting over. Click here for the story.

Poll Shows Seniors Satisfied with Medicare, Mixed on Affordable Care Act

Seniors are highly satisfied with their traditional Medicare, Medicare Advantage, and Medicare Part D plans, but have mixed views on the Affordable Care Act’s potential impact on the quality, cost and availability of their plans, according to a poll conducted last week among registered voters 65 years of age and older. Click here for the poll, which also includes some good graphs.

CMS: No Further ICD-10 Delay

The October 1, 2014 ICD-10 deadline will not change, CMS Administrator Marilyn Tavenner said last week. Although providers and payers must be prepared to meet the deadline, CMS may give “a hardship exemption” to facilities unable to achieve Meaningful Use 2. Click here for more.

Today: CMS Webinar on Frontier Demo

The CMS Innovation Center will host a webinar today, Monday, March 3 to provide information on how to calculate budget neutrality for the four prongs in the Frontier Community Health Integration Project Demonstration. The CMS Innovation Center will also provide examples of ways that applicants can respond to the solicitation. This is an opportunity for Critical Access Hospitals that qualify. Click here to learn more about the Demo. Click here to log-in to the webinar, which is at 1:30 EST today.

CMS Looking for Feedback on New Delivery Models

CMS is considering policy options for the development of innovative payment and service delivery models for specialty practitioner services in the outpatient setting. Due to the high level of interest, CMS is extending the comment deadline through April 10, 2014. CMS is seeking input on two potential models 1) A procedural episode-based payment model and 2) A complex and chronic disease management episode-based payment model. Click here for details and to respond to the Request for Info.

CMS Posts State DSH Allotments

CMS last week posted its FY14 funding allotments for disproportionate share hospitals. Medicaid DSH funds were slated to be cut this year under the Affordable Care Act, but the cuts were delayed in December for two years. Click here for the rules that contain a state-by-state breakdown of the numbers.

Survey: Drug Shortages Costing Hospitals Millions

U.S. hospitals incurred an annual average of $229.7 million in additional costs between 2011 and 2013, as they were forced to purchase more expensive generic substitutes for shortage drugs, according to a new survey released last week by Premier. The financial impact is likely much higher since research excludes drugs purchased from off-contract distributors or with therapeutic alternatives, as well as indirect costs such as added labor. Click here to read the 9-page report with excellent graphs.

GAO: There Could be More than 36,000 Rogue Internet Pharmacies

Although the exact number of rogue Internet pharmacies is unknown, one estimate suggests that there were over 36,000 in operation as of February 2014, and these rogue sites violate a variety of federal laws, according to a new report from the GAO. Most operate from abroad, and many illegally ship prescription drugs into the United States that have not been approved by the FDA, including drugs that are counterfeit or are otherwise substandard. Click here for the report.

ED Wait Times Soaring

Wait times at emergency departments across the country are soaring, as various hospitals report wait times far above the national average, according to numerous media reports last week. Wait times at Kings County Hospital Center in New York, for example, are up to 113 minutes, four times longer than the national average, according to the New York Daily News. (Click here.) The average wait time nationwide to see a physician, nurse practitioner or physician assistant is 28 minutes, according to a report released by ProPublica. This report contains a state-by-state average ED wait time and you can plug in your zip code to see the wait times of area hospital EDs. (Click here.)

New FDA Rules Change Nutrition Standards

The FDA last week released two major proposed rules, one to overhaul the Nutrition Facts panel (click here) and another to update the Reference Amounts Customarily Consumed (click here), which are a key element in setting standard serving sizes. The proposed changes to the Nutrition Facts panel would include a much larger and bolder calorie count as well as a new requirement to list “added sugars.” The proposal would add Daily Values for Potassium and Vitamin D, while slightly reducing the Sodium Daily Value from 2400 milligrams to 2300 milligrams. Click here for a good visual on what the new serving sizes really mean.

CDC: Flu Worst in Nevada, California, New York

Adults living in Nevada (2.9%) were the most likely to report being sick with the flu on any given day in 2013, with California (2.6%) and New York (2.5%) residents trailing closely behind. Vermont, North Dakota, and South Carolina have the lowest flu rates, with each averaging .8%. Click here for the summary of states from Gallup. Click here for the latest flu update from the CDC.