WEEKLY E-BULLETIN


Moody’s: 2-Midnight Rule Will Cost Hospitals $$$

CMS’ 2-midnight rule for inpatient admissions will put considerable financial pressure on the nation’s hospitals in the coming months, according to a report by Moody’s Investors Service. According to Moody’s, the rule could cost hospitals as much as $3,000 to $4,000 revenue per case, as well as prompt more patients to be held for observation care, where reimbursements are a fraction of what they are for a full admission. The cost of caring for such patients is similar to that of full admission to the hospital. Click here for a summary report. Three more House members have signed on the to the 2-midnight repeal bill, bringing the total to 125. Click here to see the list. There are now 5 on the Senate version. Click here.

5 Years Until Congress Tackles Major PAC Reforms? New PAC Data Bill Proposed

It would likely be five years before Congress makes major reforms to post-acute care payments, such as site-neutral and bundled pay, according to a draft bipartisan bill issued last week by the House Ways & Means and Senate Finance committees. The legislation would standardize data so policymakers can compare patient outcomes across the four post-acute care settings. Click here for a 4-page summary. Click here for a copy of the proposed bill.

Hospice + Other Medicare Services: CMS Proposes New Option

CMS plans to test whether more beneficiaries would choose hospice services if they could also continue with other treatments, and announced last week it is seeking applications from hospice providers to participate in an Affordable Care Act initiative to give beneficiaries the option to use both hospice and other Medicare services. Medicare beneficiaries currently are required to stop receiving curative care if they wish to receive palliative care services through hospice. Click here for the details from CMS.

Medicare Physician-Specific Data Now Available

For the first time, beginning last week, Medicare began accepting requests from the public under the Freedom of Information Act for doctors’ personally identifiable payment information. The release of Medicare payment data to doctors is intended to tell the public how many patients an individual doctor treats, and what the government paid for the care—information that could shed light on physicians’ competence in certain procedures as well as show patterns of fraud and overuse. Click here for the official government notice.

FTC Cautions States Against Limiting APRN Practices

Federal Trade Commission staff has issued a policy paper suggesting that state legislators should be cautious when evaluating proposals to limit the scope of practice of Advanced Practice Registered Nurses. By limiting the range of services APRNs may provide and the extent to which they can practice independently, such proposals may reduce competition that benefits consumers, the paper states. Click here for the report from the FTC.

Senate Poised to Pass SGR Fix Opposed By House

The Senate is expected to pass a permanent doc payment fix this week and pay for it with Overseas Contingency Operations (OCO) funds. Click here for that report. Click here to see a CBO summary of the cost of the senate bill, which comes in at $180 billion. Most Republicans are opposed to using these funds and House leadership said this approach is a non-starter. The House has already passed a permanent doc payment fix by using funds from delaying the individual mandate for five years. Here’s a one-page summary of the permanent fix that both sides have agreed to.

Short Term Doc Payment “Patch” Likely

If Congress can’t agree on a permanent solution now, it is increasingly likely it will pass a 9-month patch and cut other provider programs to pay for it. The patch is expected to cost about $15 billion. The Senate Finance Committee released a potential list of cuts several weeks ago (click here) but no one is saying what a final list of cuts will look like.

Senior Lawmaker Attacks RACs

Should the government impose financial penalties on RACs if an audit they performed on a hospital is overturned on appeal? That’s a proposal being put forth by the most senior member of the House Ways and Means Health Subcommittee, Rep. Jim McDermott (D-WA). He urge HHS to reduce the mounting backlog of RAC-related appeals at the Office of Medicare Hearings and Appeals. Read his compelling letter here.

Docs Urge Congress to Keep Patient Self-Referrals

More than 30 doctor groups are urging Congress to reject calls to eliminate exceptions to a law intended to prohibit doctors from making referrals to a facility in which they have a financial interest. In a letter that includes the support of the American College of Surgeons, the American Medical Association, the Medical Group Management Association, and the Large Urology Group Practice Association, said Congress should preserve an exception to the law that allows doctors to refer patients for advanced imaging, radiation therapy, anatomic pathology and physical therapy. Click here to read their letter.

Medical School Seniors Choose Residencies; Internal and Family Medicine Selections Up

The number of medical school seniors choosing to go into internal medicine was up slightly in 2014, the fifth year in a row in a field that includes primary care. However, it is still likely most will end up in specialty care. The American College of Physicians announced last week that 3,167 students chose an internal medical residency — just above the 3,135 from last year. Click here for their report. The most competitive specialties were Neurological Surgery, Orthopedic Surgery, Otolaryngology, Plastic Surgery, and Radiation-Oncology. Click here for a complete summary of matches.

Medical Device Recalls Double Over Past 10 Years

Recalls of defective medical devices nearly doubled in the decade from 2003 through 2012, according to an FDA report released last week. The total number of recalls rose to 1,190 in 2012, up from 604 in 2003. There was a sharp increase in recalls where the defective product carried a reasonable probability of death. In 2012, there were 57 of these so-called Class I recalls, up from seven in 2003. Click here for the 20-page FDA report.

CMS Releases Final Guidelines for QHPs

CMS late Friday released a final letter to insurers describing 2015 certification requirements for Qualified Health Plans in federally facilitated marketplaces or the Small Business Health Options Program. The final letter requires QHPs with provider networks to maintain a network that is sufficient in number and types of providers, including those providing mental health and substance abuse services, to assure that all services will be accessible to enrollees without unreasonable delay. Click here for the CMS letter.

Duke LifePoint Continues Expansion Outside of North Carolina

Duke LifePoint Healthcare continues its expansion outside of North Carolina and plans to acquire the three-hospital Conemaugh Health System in Pennsylvania, according to reports last week. The deal, which includes Conemaugh’s hospitals, physician practices and outpatient centers, would be the first in Pennsylvania for Duke LifePoint, which currently operates five hospitals. Click here for the story.

Georgia Governors Throws Lifeline to Rural Hospitals

Georgia Governor Nathan Deal has proposed a form of restricted “mini” or “step-down” hospitals to keep the state’s struggling rural providers in business, according to reports last week. Not included in the proposal is the state expansion of Medicaid. Deal proposed rural hospitals downsize their services in order to remove some of their financial strain. The hospitals would have functioning emergency rooms and some other services, such as obstetrics, but not much beyond that. Click here for details.

Hospitals Added No New Jobs Last Year

Hospitals added no new jobs in 2013, although the healthcare sector as a whole grew by 204,000 jobs and makes up more than 10 percent of total employment nationwide as of February, according to a labor brief from the Altarum Institute. Job growth isn’t getting any better in 2014–hospitals lost 1,200 jobs in February and nearly 10,000 total in the past three months. Meanwhile, hospital price growth fell to 1.1 percent in January, its lowest reading since September 1998. Click here for the Altarum report.

CMS Hosts New MSSP Call April 8; Sign Up Here

CMS will host a Tuesday, April 8 National Provider Call on the Medicare Shared Savings Program application process for 2015. Hospitals, physicians and other Medicare providers participate in the program’s ACOs, which share with Medicare savings from lowering the growth in health care costs while coordinating care for patients and meeting certain quality and performance standards. Click here to register for the conference call which is from 1:30-3 p.m. EDT.

Most Docs Haven’t Joined ACOs

The majority of physician practices have not joined an accountable care organization and don’t plan to anytime soon, a new study has found. These reluctant medical groups are also less likely to have the resources—electronic health records, care coordinators, formal quality improvement initiatives—to effectively manage the costs and care for chronically ill patients, the study said. Click here for the study.

ACO Growth Getting Bumpy: Aetna

As accountable care organizations multiply across the country, Aetna’s chief of ACO operations says they can continue to succeed even though they’ll hit some bumpy roads ahead. He said ACOs must manage operations while both the provider and insurance industries transition toward value-based payments when fee-for-service reimbursements remain dominant. Click here for the report.

AMA Provides Help on Exchange Coverage

The American Medical Association has new guidance documents to walk physician practices through the Affordable Care Act’s insurance coverage grace period before a policy is canceled for lack of payment. If individuals buy health coverage on a state insurance exchange but then don’t make payments, physicians could be out money. Click here for the AMA guidance documents.

Exchange Insurers Record Wall Street Highs

UnitedHealth Group, Humana, Aetna and Wellpoint hit all-time highs last week on the stock market following the news that Obamacare enrollment in private plans topped 5 million. Investors also appear to be shrugging off proposed cuts to Medicare Advantage plans that were smaller than expected, too, CNBC reports. “As the industry lobbies for more favorable 2015 Medicare rates,” Citi analyst Carl McDonald wrote in a note to clients, “one obstacle is the fact that the upheaval predicted by the industry a year ago after a 4 to 5 percent rate cut in 2014 really hasn’t materialized.” Click here for more.

Medicare Advantage Payment Battle Continues as Deadline Nears

April 7 is the date the Obama Administration is expected to announce its final decision on whether to make payment reductions to Medicare Advantage plans in the coming year. Claims made in a recent series of TV ads by the trade group for American insurance companies are disputed by the chief federal Medicare watchdog organization and the companies’ own corporate filings, a USA TODAY analysis shows. Click here for the story.

Insurance Competition Mixed Under ACA

The Affordable Care Act is having a mixed impact on insurance competition, according to a new analysis of seven states running their own exchanges. The insurance marketplaces in California, New York and Minnesota are slightly to significantly more competitive than they were before the Obamacare exchanges opened, while Connecticut’s and Washington’s are less competitive, according to the Kaiser Family Foundation report released last week. Click here.

The Politics of Obamacare

  • Ten states — seven of them controlled by Republicans —hold the key to whether the Obama administration succeeds at signing up 6 million people by the deadline of March 31. Those large states account for nearly 30 million uninsured — almost two-thirds of the nation’s 47 million uninsured. That’s why the Obama administration and advocates have focused so much attention on California, Texas, Florida, New York, Georgia, Illinois, North Carolina, Ohio, Pennsylvania and New Jersey. Click here for the story.
  • The Administration announced last week that enrollment was surging and had surpassed 5 million by mid-March. Click here for the HHS info. Click here for more CMS facts on the ACA.
  • On one Friday earlier this month, more than 11,000 Muslims in mosques across the country heard a sermon about the Affordable Care Act. The National Council of Jewish Women Sacramento Section hosted tables with information about health coverage. Hindu and National Baptist groups, meanwhile, posted online announcements about the White House’s “Faith and Community ACA Days of Action” this past weekend. Click here to see how some in the faith communities are working on Obamacare enrollment.
  • President Obama was on Ellen TV last week pushing Obamacare sign up. Click here to see the interview.
  • Democratic leadership is encouraging Affordable Care Act supporters to rally this week – the fourth anniversary of Obamacare. Click here for the story.
  • A Pew Research poll released last week continues to show more opposition than support for the law. Click here.
  • Ezekiel J. Emanuel, who helped devise the Affordable Care Act, has a vision for how it will eventually work. Emanuel expects the law to produce an unadvertised but fundamental shift in where most working Americans get their health insurance — specifically, a sharp drop in the number of employers who offer coverage to their workers. Click here for the story.

New CDC Guidelines Finding More Immigrant TB Cases

Updated CDC recommendations for overseas tuberculosis screening of immigrants and refugees have identified hundreds of cases that otherwise would have gone undetected until after arrival in the United States, saving taxpayers an additional $15 million in medical costs. In 2012, overseas physicians identified more than 1,100 cases of tuberculosis, including 14 cases of multidrug-resistant TB, according to a new CDC report. Click here.

NIH Scientists Make Progress On Stroke Causes

Scientists studying the genomes of nearly 5,000 people have pinpointed a genetic variant tied to an increased risk for stroke, and have also uncovered new details about an important metabolic pathway that plays a major role in several common diseases. Together, their findings may provide new clues to underlying genetic and biochemical influences in the development of stroke and cardiovascular disease, and may also help lead to new treatment strategies. Click here for the report from NIH.