WEEKLY E-BULLETIN


Truven’s Top 100 Hospitals Announced

Truven Health Analytics annual 100 Top Hospitals® were announced last week, just a week after Healthgrades announced its winners. Truven says its study uses objective research and independent public data to recognize the best hospitals in the nation…and “hospitals do not apply, and winners do not pay to market this honor”. Click here to see the list of Truven winners. To see the Healthgrades winners, click here (they are listed starting on page 9.)

Bill Would Reform Hospital Readmissions Penalty Program

Legislation is expected to be introduced this week that would change the type of patients that could be counted against hospital readmission penalties. U.S. Rep. James Renacci (R-OH), a member of the Ways and Means Committee and long-time health care provider executive, is sponsoring a bill that would remove transplants, end state renal disease, burns, trauma, psychosis or substance abuse from the readmission penalty section of the law. The bill also directs the HHS Secretary to re-evaluate each hospitals’ share of dual eligible patients and make recommendations on whether additional readmission penalties should be adjusted or removed. Click here for a copy of the 4-page bill. Click here for a 1-page executive summary. Urge your Representative to contact Rep. Renacci’s office today to cosponsor the legislation. Renacci’s health staffer can be reached at Alyssa.Palisi@mail.house.gov.

New Senate Bill Would Reform 2-Midnight Rule

Legislation was introduced in the Senate last week aimed at forcing Medicare and hospitals to agree on criteria for an appropriate hospital stay. The bill is a response to the 2-Midnight Rule. Legislation from Robert Menendez (D-NJ), and Deb Fischer (R-NE), would maintain the current RAC enforcement delay through October 1. If the development of criteria for medically necessary stays is not implemented by then, the enforcement delay would be extended a year, through October 1, 2015. Also, hospitals have up to one year to revise an initial determination on how patients in their care were classified. After that, if an audit contractor successfully challenges an inpatient admission, the hospital can no longer try to resubmit a claim for payment for outpatient services through Medicare Part B. Click here for a copy of the bill.

2-Midnight Rule, RAC Reform, CAH 96-Hour Repeal Bills Gaining Steam

There is an effort underway to have a 2-Midnight Rule bill, a RAC reform bill and a Critical Access Hospital 96-Hour Rule bill included in legislation to fix the physician Medicare payment formula later this month. Members of Congress are hearing more and more from their hospitals and other providers about the need to reform all these CMS regulations.

  • 10 more House members have cosponsored the RAC reform bill (HR 1250) within the last two weeks. Bringing the total to 198. (Click here to see the Representatives on the bill.) No new senators are on the Senate’s version of RAC reform. There are a total of 11 senators. Click here to see the list.
  • 11 more House members have signed on to the 2-Midnight Rule repeal bill, HR 3698, – click here to see the list – bringing the total to 116. The Senate’s 2-Midnight Rule bill was just introduced (see story above.)
  • There are now 33 House members on the CAH 96-hour requirement repeal bill (HR 3991). Click here to see the list. The bill would repeal the 96-hour physician certification requirement for inpatient CAH services under which a physician must certify that a patient may reasonably be expected to be discharged or transferred to a hospital within 96 hours after admission to the critical access hospital. There are now 17 senators on the Senate version. Click here to see the list.

Hospital RAC Appeals Skyrocketing

Hospitals now appeal about half of all RAC payment denials, which cause long delays associated with the process, according to the latest survey from the American Hospital Association released last week. Nearly all the 1,805 hospitals that participated in portions of the survey through the fourth quarter of 2013 –93 percent– say they experienced some form of RAC activity, although rural facilities and hospitals under 200 beds reported less activity overall. Click here to review the survey results.

MedPAC Focuses on IRFs vs. SNFs

Inpatient Rehab Facilities were the focus of MedPAC during the congressional advisory panel’s March meeting last week in Washington. Patient stays at IRFs are often more costly than at skilled nursing facilities. SNFs are the most commonly used sites post-acute care after hospitalization or events such as a stroke. MedPAC staff presented research about how expenses vary in the two settings. It cost about $20,864 to treat a stroke patient at an IRF, but $15,873 at an SNF. The trend was reversed for people recovering from hip and femur procedures. Treatment cost about $17,646 at a skilled nursing facility, and $17,406 at an IRF. No formal recommendations were made. Click here for MedPAC’s detailed 20-slide presentation.

MedPAC Chief Says Medicare Programs Could Be Streamlined

MedPAC’s executive director also said his agency is beginning to review ways in which all the government’s Medicare programs could be streamlined. Of particular note is the Commission’s interest in ACOs and their competition with Medicare Advantage plans. Click here for the story.

House GOP Action Likely Scuttles Permanent Doc Payment Fix This Month

The chance that a permanent physician Medicare payment formula fix will happen any time soon quickly evaporated last week when House Republicans announced they would vote this week on a provision that would pay for the “doc fix” with the repeal of Obamacare’s individual mandate. Senate Democrats will oppose it; President Obama would veto it. Click here for details. The current fix expires April 1. It is likely Congress will pass another short term extension. Click here for the latest AMA-led letter to Congress urging passage of a permanent SGR fix – it is signed by 624 mostly physician organizations.

OIG: Too Many Medicare Patients Have Preventable Adverse Events in SNFs

A third of Medicare beneficiaries in skilled nursing facilities experienced “adverse events” or “temporary harm” during their stays — the bulk of which were preventable, according to a report issued by the HHS inspector general last week. Those incidents equated to $208 million in costs to Medicare and an estimated $2.8 billion in spending overall. Click here for the report.

Hospital Drug Cost Increases Higher This Year

Hospital drug costs will likely rise between 3 and 5 percent this year, according to data from the American Journal of Health-System Pharmacy. The report projects drug expenditures in the healthcare settings will also increase 3 to 5 percent. That compares with a decrease of 0.7 percent in the prior year ending last Sept. 30. The report cites a variety of factors for the projected increase in 2014, including the expiration of patents on existing products and new products. Expenditures for influenza-related drugs will also rise, while expenditures for powerful–and highly addictive–painkillers, such as oxycodone, will likely experience a fairly steep decline. Click here for the very interesting 18-page report.

States Stepping Up Medicaid Anti-Fraud Efforts

States are stepping up efforts to combat health care fraud and overpayments that cost them billions of dollars a year, with a special focus on Medicaid. States are assigning special investigators, sharing information with each other and using new ways of looking at data to track improper coding and identify suspicious health care providers. Click here for the story.

FY15 Federal Budget Plan Has Hundreds of Millions in Medicare Cuts

The Obama Administration last week released its FY15 budget plan. It will likely not pass in its present form; however, it does offer up hundreds of billions in dollars of cuts to health programs. Some of those cuts could be used by Congress to offset the costs for fixing the physician Medicare payment formula. Click here for the list of health care cuts proposed by the Administration.

CMS Releases Basic Health Program Rules

CMS last week released a final rule and payment notice for the Basic Health Program. The program is a bridge between Medicaid and exchange coverage. It would give states the ability to set up a Medicaid-like option for people with incomes too high for the Medicaid expansion but in the lowest income bracket of those on the exchanges. The program could reduce the “churning” of those individuals between Medicaid and exchange coverage. Click here for the 154-page rule. Click here for the 71-page payment notice.

About 20 Major Changes to Obamacare Programs Outlined

The Basic Health Program was supposed to be implemented last year, but the Obama Administration postponed the role out as it worked to refine the implementing regulations. There have been nearly 20 major changes to the Affordable Care Act implementation time line. Click here for a good Washington Post summary of those changes that started last year.

75 House Reps Urge HHS to Change Healthcare.gov to Help Brokers

75 U.S. Representative asked HHS last week to make three upgrades to HealthCare.gov that health insurance brokers have been pushing for months: a dedicated call line to help them resolve problems, a function that lets them edit applications without starting over, and a function that would allow consumers to add the names of any assisters to their applications at any point in the process. Click here for a copy of the congressional letter.

Do You Have an Obamacare Question for Obama?

Do you have a question for President Obama about the Affordable Care Act? WebMD will talk with the President this Friday about signing up for health insurance coverage. Obama’s first-ever interview with the website, According to WebMD, the site has more than 156 million unique visitors each month. About a third of them are in the desired age 18-34 enrollment demographic, and 38 percent of that group is also uninsured. Click here to submit your questions.

More People Signing Up for Obamacare

More people who were previously uninsured are signing up for health coverage as we near the March 31 close of open enrollment, according to an updated snapshot released last week by McKinsey & Company. About 27 percent of those who bought a new plan this year said they had not been covered in a survey fielded from Feb. 4-13. Click here for their report.

One-Quarter of Americans Says Obamacare Hurts

23 percent of Americans say the Affordable Care Act has hurt them or their families, up from 19 percent earlier this year, according to a Gallup poll released last week. That is the largest percentage of Americans who feel they’ve been harmed by the law ever since Gallup started asking the question in 2012. One on in 10 says the law has had a positive effect on them, and 63 percent said it has had no effect. Click here for the poll.

Individual Obamacare Penalty May Be Higher Than You Think

The penalty for not having health insurance in 2014 is probably much greater than the $95 minimum under the law. You can calculate your likely penalty now thanks to the Tax Policy Center. They have developed an ACA Tax Penalty Calculator that can show the penalty amount with just a few clicks. Click here for the calculator.

Firestorm Over Part D Changes Explained

A firestorm over CMS proposed rules to revamp Part D (the Medicare drug program) erupted in January when the rules were made public. Comments to the agency were due last Friday. A lot of negative reaction centered around the suggested change that would loosen mandates on covering essentially every drug offered in six different classes. The CMS proposed rule also expands medication coordination and counseling to high-cost beneficiaries with multiple chronic conditions. The pharmacy groups like it; the Part D plans and MedPAC have raised serious questions. Click here for an excellent summary from an industry expert.

Tricare Plans Would Be Reduced to One Under DoD Proposal

Three Tricare health insurance plan options for military members and families would go down to just one under the White House budget proposal for the coming fiscal year. The proposal would combine Tricare Prime with the DoD’s two other options, Tricare Standard and Tricare Extra to form a consolidated plan starting in January 2016. Out of pocket expenses would go up as a result. Active duty service members would still get free healthcare, but their families would have to pay between $10 and $50 per visit to civilian doctors within network and foot 20 percent of the bill for out of network doctors. Details start on page 58 of this document. Click here.

Midwives, Birthing Centers Being Excluded from Health Plans

The healthcare reform law requires maternity coverage and prohibits discrimination against licensed medical providers, but most health plans exclude services provided by midwives and birthing centers, according to a report last week from kaiser Health News. As births increasingly occur outside of hospitals, more people will have to pay out-of-pocket for these alternative maternity services. In fact, more than 50,000 births occurred outside of a hospital in 2012, including more than 15,000 births that took place at freestanding birth centers, according to a recent report from the CDC. Click here for the report. Click here for the story on the increase in out-of-hospital births.

Study: Deaths from Alzheimer’s Under-Reported

Deaths attributed to Alzheimer’s disease are under-reported in the U.S. and could be about six times more common than previous estimates, nearly as lethal as cancer and heart disease, according to the study in the journal Neurology. Researchers followed more than 2,500 older people who were screened yearly for dementia. Among study participants who died, death certificates significantly under-reported Alzheimer’s disease as an underlying cause, researchers found. Click here for the Washington Post story.

CDC Says Some Hospital Docs Over-Prescribing Antibiotics

CDC researchers assessed antibiotic prescription rates at more than 300 hospitals in 2010 and found that physicians in some hospitals prescribed three times as many antibiotics as those in similar roles at other hospitals. Many patients received the medications — including the crucial drug vancomycin — without undergoing proper testing, according to the Vital Signs report. Click here for details.