WEEKLY E-BULLETIN


Doc Payment Fix Deadline Looming; Congress Remains At Odds

The House and Senate remain at an impasse about permanently fixing the Medicare payment formula for physicians.  Actually, they are fairly close to agreeing on all the major policy provisions – they just don’t know how to pay the roughly $130 billion cost.  The House passed a reform bill Friday that would pay for reform by putting off for 5 years Obamacare’s individual insurance mandate.  Senate Democrats said “no,” and the White House issued a veto threat.  Click here for further details on the fight.  The current formula expires April 1.  It is likely there will be another short term fix…there have already been 16 temporary patches.

  • The Committee for a Responsible Federal Budget released a report last week saying most of the congressional plans offered to pay for the physician Medicare payment fix would increase the federal debt.  Click here for their brief.

CMS Issues More 2-Midnight Guidance

CMS will instruct Medicare Administrative Contractors to use its general two-midnight policy when conducting prepayment reviews of claims in which a surgical procedure was canceled, according to an update posted last week.  “If the physician reasonably expects the beneficiary to require a hospital stay for 2 or more midnights at the time of the inpatient order and formal admission, and this expectation is documented in the medical record, the inpatient admission is generally appropriate for Medicare Part A payment. Click here for the update.  It is highlighted in red at the end of the 7 page document.

  • CMS also reiterated that hospitals with claims denied before January 30, under its Probe & Educate prepayment review process, have until September 30 to file a request for redetermination.  Click here for this CMS update.
  • 121 House members have now signed on to legislation to repeal the 2-midnight policy.  Click here for the list. 202 Representatives are now on the RAC reform bill.  Click here for that list.

Medicare Payment Advisory Commission Issues 2014 Report to Congress

The report released Friday includes payment policy recommendations for ten of the health care provider sectors in fee-for-service Medicare. MedPAC also reviews the status of Medicare Advantage plans and makes recommendations regarding the Medicare Advantage program, as well as reviewing the status of prescription drug plans.  Click here for the four page summary.  For the hospital inpatient and outpatient chapter (which contains the recommendations and a wealth of information) click here.  For the complete 439-page MedPAC report, click here.

GOP Warns Obama on Medicare Advantage Cuts

Republicans are warning President Obama not to create “hundreds of thousands of broken promises” by going forward with cuts to Medicare Advantage.  In Saturday’s GOP address, Rep. Bill Johnson (R-Ohio) said the proposed cuts would conflict with Obama’s message that he does not want to get between people and their doctors.  Click here for the story.

Congress Adds Weight on Cuts to Medicare Advantage

The Obama Administration is expected to announce a final decision on cuts to Medicare Advantage plans April 7 and members of Congress are weighing in.  200 House members signed a letter to CMS urging that MA payment rates be kept flat.  Click here for that letter.  Four leading House Democrats signed a letter supporting the cuts, click here.  Other Democrats on the House Energy and Commerce Committee detailed their views for the payment reductions, click here.

FTC Targeting Hospital-Doc Deals; Hosts Public Workshop

The Federal Trade Commission appears to be focusing on the mergers and/or acquisitions between hospitals and physician groups, according to recent comments from the director of the FTC’s Bureau of Competition.  Click here for that report.  The FTC is holding a a public workshop, “Examining Health Care Competition,” on March 20-21, to study certain activities and trends that may affect competition in the health care industry. The workshop will explore current developments related to: professional regulation of health care providers; innovations in health care delivery; advancements in health care technology; measuring and assessing health care quality; and price transparency of health care services.  To sign up for the event, click here.

4.2 Million On Exchanges; Obama Says ACA Now Sustainable

Online WebMD had an extensive interview with President Obama this week about the Affordable Care Act with a particular focus on the health insurance exchanges.  Click here to see the 27 minute interview.  Of the more than 4.2 million on the exchanges through February: 55 percent are female and 45 percent are male; 31 percent are age 34 and under; 25 percent are between the ages of 18 and 34; 63 percent selected a Silver plan, while 18 percent selected a Bronze plan and 83 percent selected a plan and are eligible to receive Financial Assistance. Click here for a state-by-state summary.  Click here for more details from HHS.  How do you get young people to sign up?  Obama joined comedian Zach Galifianakis on his online comedy program “Between Two Ferns” last week hoping that America’s youth was watching.  Click here for the humorous video clip.

  • The GOP-led House Energy and Commerce Committee is going directly to insurers to get information about who is signing up through the exchanges and whether they are paying their premiums.  The committee is sending letters to every insurance company offering plans through HealthCare.gov, the portal for the federal exchange.  Click here for the letter.
  • A new analysis by consulting firm Avalere finds that exchange enrollment is on track to reach 5.4 million by the end of March when open enrollment is set to end. That number falls short of current CBO estimates that six million people will enroll in exchanges in 2014. Click here for a map showing expected enrollment state-by-state.
  • Health insurers may be getting a financial break from the Obama Administration because of the increased costs associated with the less-than-stellar roll out of the federal health exchanges.  HHS last signaled its intention to temporarily give insurers a break on the portion of premiums they must spend on medical care or return to policyholders. The change has to do with the ACA’s medical loss ratio, which requires insurers to spend at least 80 percent of the premiums collected for plans sold in the individual and small group markets on medical care or consumer rebates.  Click here to review the regs.
  • The Obama administration late Friday hit back at states restricting the work of Affordable Care Act navigators by issuing proposed rules that could override restrictive state laws if they’re determined to conflict with the health care law’s overall goal.  Among other things, the proposed rules would prohibit navigators from specified solicitation activities such as making cold calls to provide application assistance and offering cash or gifts other than those that are nominal as an inducement to apply or enroll in coverage.  Click here for a CMS summary, which includes many other provisions impacting the management of exchanges.  Click here for the proposed regs.  Here’s the Washington Post story.

Who Are the 30 Million Who Won’t Be Covered?

The CBO projects that 30 million residents, more than 10 percent of the nonelderly population, will remain uninsured after the major provisions of the ACA take full effect. Who are they?  RAND has an analysis; click here.

ICD-10 Testing Will Happen in July.  Volunteers?

CMS confirmed Friday that end-to-end ICD-10 testing for providers, announced late last month by CMS, will take place this July.  Providers wanting to participate who submit claims to Medicare Claims Administration Contractors, A/B MACs and/or Home Health and Hospices MACs must complete a volunteer form on the MAC website by March 24.   Click here for the details from CMS.

CMS Issues EHR Hardship Exemption Application

Health care professionals and hospitals may qualify for an exemption to stage 2 meaningful use rules if they have experienced vendor-related EHR certification delays, according to newguidance from the CMS. Professionals also can apply for an exemption due to unforeseen or uncontrollable circumstances, lack of control over the availability of certified EHR technology or a lack of face-to-face interaction. Professionals must submit hardship exemption applications by July 1; hospitals must do so by April 1. Click here to review the CMS hardship application.  According to the latest figures from CMS, the EHR incentive program has exceeded its total estimated payout of $22.5 billion.  Click here for the report.

PQRS Reporting Deadline Reminder

Eligible professionals and group practices participating in the Physician Quality Reporting System have until March 21 to file 2013 quality data via the Group Practice Reporting Option website, according to the CMS. Participants have until March 31 to submit 2013 PQRS data via registry reporting.  Click here for more.

Report:  Cleveland Clinic Bundling Program Drawing Patients Nationwide

The Cleveland Clinic’s decision to accept bundled payments for complex procedures not only attracts surgical patients from out of state, it’s led other providers to do the same, according to a report last week.   Large employers like hardware retail giant Lowe’s will have their employees travel from other parts of the country to undergo heart and other surgeries at the Cleveland Clinic, Lowe’s, which has more than 160,000 employees, also pays for travel expenses for patients and their families and will waive co-payments in order to encourage workers to use the Cleveland Clinic. Click here for the story.

Surgeon General Nominee May Be In Trouble Because of Gun Control

Facing a possible defeat in the Senate, the White House is considering delaying a vote on President Obama’s choice for surgeon general or withdrawing the nomination altogether, according to reports late last week.  Senate aides said Friday that as many as 10 Democrats are believed to be considering a vote against Dr. Vivek Murthy, who has voiced support for various gun control measures like an assault weapons ban, mandatory safety training and ammunition sales limits. Click here for the NY Times story.

Third PCIP Extension Announced

The Obama administration is giving sick patients on a temporary, federal health plan one additional month to find new coverage. The announcement Friday afternoon will delay the expiration of the Pre-Existing Conditional Insurance Plan (PCIP) until April 30, the plan’s third extension. The program was due to end on March 31.  Click here for more.

NCQA Overhauling Health Plan Accreditation

The National Committee for Quality Assurance wants to overhaul its health plan accreditation program to better align with market and stakeholders needs and is proposing changes impacting provider networks and transparency.   Under the NCQA’s first requirement, health plans must annually monitor member experience and the quality of practitioners and hospitals in narrow networks. The other requirement would require transparency around policies that allow consumers to access out-of-network providers for covered services.  Click here for the NCQA recommendations.  It has an open comment period through April 4.

Top 10 Best Health Care Cities Released

A new, first time, analysis of U.S metro areas has revealed the 10 cities with the best health care in the country, according to a report released last week by iVantage Health Analytics.  iVantage assessed hospital quality based on 10 equally weighted performance measures, including care quality, outcomes, patient perspective, financial stability, market size, competitive intensity and population risk.  If lower-scoring markets improve their performance, the study states, they could save up to 3,962,850 years of potential lives lost, the equivalent of an extra year of life to the entire population of Los Angeles.  Click here for the list.

Healthgrades, Truven Best Hospitals Announced

In case you missed it, two of the most followed hospital performance annual announcements for 2014 were made in the past two weeks.  Click here for Truven Health Analytics annual 100 Top Hospitals.  Click here for Healthgrades’ best hospitals report (starting on page 9.)

AAMC Issues Report on Provider Scorecards; Says New Guiding Principles Needed 

On the heels of these two public reports, the American Association of Medical Colleges last week released a list of principles it says are necessary to guide understanding when provider performance is publicly reported.  The principles are organized into three broad categories: purpose, transparency and validity.  Click here for their excellent report.

SEIU Pushing For More Provider Transparency

Organized labor’s push for healthcare price transparency expanded to South Florida, with SEIU wanting more cost data from hospitals, physicians and health plans, according to media report.  SEIU says the health care costs for county employees could rise as much as 10 percent next year, and will approach $425 million.  Click here for the story.

States Tackling Health Disparities

21 states this year are considering measures designed to reduce health disparities, according to officials who are tracking the efforts. For example:  Hawaii is considering increasing the number of interpreters available in the state’s health facilities; A bill in Indiana would require those seeking licensing in a health profession to complete cultural competency training; Iowa lawmakers may establish Health Enterprise Zones to coordinate efforts to remove health disparities in select areas; Minnesota is considering a strategy to eliminate reproductive health disparities among Somali women; and a New Mexico bill would create a one-year pilot project in Bernalillo County to reduce infant mortality and improve maternal health among African-Americans. Click here for more details.

HHS Regs Focus on Emergency Preparedness

Describing emergency preparedness as an “urgent public health issue,” a new proposal by HHS offers regulations aimed at preventing the severe disruptions to health care that followed Hurricane Katrina and Hurricane Sandy.  Click
here for the NY Times story.  Click here for the regs.

HHS Releases Strategic Plan

Last week HHS updated its strategic plan and made it available on its website.  HHS said its plan “defines its mission, goals, and the means by which it will measure its progress in addressing specific national problems over a four-year period.”  Click here for the HHS strategic plan.