WEEKLY E-BULLETIN


CMS To Release Physician-Specific Payment Info This Week

The Obama administration will open its records this week on what the government pays doctors through Medicare, a first-of-its kind data release. CMS plans to provide a detailed account of $77 billion in payments made to more than 880,000 physicians in 2012. It will list procedures performed by individual doctors, how much they charged for them and how much they were reimbursed by the program — a total of 10 million lines of data. The action will be similar to last year’s release of payment information on hospitals. That revealed wide variation by facility and procedure, sometimes among hospitals with comparable quality rankings in the same community. Click here for the announcement from CMS. Click here for CMS letter sent to the AMA.

Government Decision on Medicare Advantage Payments Expected Today

The federal government is expected to announce a major decision today that could have significant consequences for Medicare Advantage health plans and the seniors they serve. Hundreds of Republicans and Democrats in Congress have been urging the Administration to avoid cutting Medicare Advantage payments in FY15. A preliminary announcement from HHS last month indicated cumulative cuts of 2 to 6 percent. Click here for more. Click here to see a state-by-state impact report. More than 15 million people participate in a Medicare Advantage plan.

One-Year SGR Law Has Several Surprises

Signed into law on April 1, the physician Medicare payment fix (SGR) contains several surprises for health care providers. It instructs Medicare officials to review the value of some physician medical procedures and sets a target for reductions of misvalued codes of hundreds of millions of dollars. The law also orders the Government Accountability Office to study the AMA process for setting the value of procedures. The real target is what the government believes is overprices medical procedures. Click here for the report.

New SGR Law Has Affordable Care Act Change for Small Businesses

A relatively obscure provision in physician Medicare payment fix legislation passed last week is actually a major victory for the business community and Republican supporters. It is a change in the Affordable Care Act that eliminates a cap on deductibles for small group policies offered inside the law’s health care exchanges as well as outside; the cap was set at $2,000 for individuals and $4,000 for families. Republicans said they sought it so small businesses can offer high-deductible plans that could be purchased by individuals who also have health savings accounts. Click here for the story.

It’s Official: ICD-10 Delayed Another Year

From H.R. 4302, signed into law April 1:
“The Secretary of Health and Human Services may not, prior to October 1, 2015, adopt ICD–10 code sets as the standard for code sets under section 1173(c) of the Social Security Act (42 U.S.C. 1320d–2(c)) and section 162.1002 of title 45, Code of Federal Regulations.”

CMS has estimated that another one-year delay of ICD-10 would likely cost the industry an additional $1 billion to $6.6 billion on top of the costs already incurred from the previous one-year delay. The delay of ICD-10 impacts much more than just coded medical bills, but also quality, population health, and other programs that expected to start using ICD-10 codes in October. The extent of the logistical challenges and costs associated with “dialing back” to ICD-9-CM are not yet fully understood but are expected to be extensive. Click here for more on the impact from the Health Information Management Association.

The delay is widely believed to be a concession to the AMA, which continued to complain about its implementation costs. Congress did not pass the permanent fix to the physician Medicare payment formula (SGR) as the AMA and most others had hoped, but instead passed a one-year patch that include the coding delay. Click here for the AMA’s statement. Click here for a good 5-page summary of the legislation.

FY15 GOP Budget Plan Would Slash Medicare, Medicaid; Balance Budget in 10 Years

The House Budget Committee last week passed a sweeping new FY15 budget proposal that has ignited the debate over the future of federal spending and taxes. It includes hundreds of billions of dollars in cuts to Medicare and Medicaid over the next 10 years. And an increase in defense spending of several hundred billion dollars. Click here for the press report. Click here for a copy of the GOP budget plan. Click here to see President Obama one-minute video calling the budget a “stinkburger.”

SEIU Targets UPMC In New Organizing Drive

The Service Employees International Union is seeking to organize more than 10,000 of University of Pittsburgh Medical Center’s service workers, and demanding that the hospital system be a leader, much like U.S. Steel once was, in raising wages. The union staged a traffic-clogging protest outside UPMC’s headquarters and helped create community groups that accuse UPMC of paying poverty-level wages. Click here for the report.

Health Care Sector a Now Leader on the Stock Market

Long embraced by investors seeking to weather market downturns and recessions, the group—comprising drug companies, hospitals and health insurers, among others—has emerged as one of the healthiest gainers in a resilient U.S. stock market. Click here for the Wall Street Journal report.

JAMA Article Raises Issues with Pharma Payments to Medical Center Leaders

Academic medical center leaders who serve on pharmaceutical company boards could create a conflict of interest or foster competition between institutional oversight responsibilities, and individual clinical and research practices, according to an article published last week in the Journal of the American Medical Association. The article contains specific hospital compensation information. Click here.

Millions Added to Medicaid Rolls – State-by-State Numbers

Oregon, West Virginia, Vermont, Colorado, Washington are the states that have seen the greatest enrollment increases in Medicaid and CHIP of all the states that have expanded the programs under the Affordable Care Act, according to a CMS report out late last week. In states that didn’t expand their programs, Florida, Montana, Idaho, Kansas and Oklahoma saw modest increases. Seven states have seen actual declines in enrollment. A total of 61 million people were enrolled in Medicaid or CHIP as of February 28, with Medicaid expansion states showing an average 8.3% increase and non-expansion states showing a 1.6% increase. Click here for the report.

CMS Sponsoring Hospice Reform Webinar Wednesday

CMS plans to test whether more beneficiaries would choose hospice services if they could also continue with other treatments, and announced it will sponsor a webinar this Wednesday, April 9 from 2:30 to 3:30 p.m. EDT to review the new opportunity. CMS 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 to sign up for the CMS webinar.

MedPAC Says Home Health Profits Are Continuing; Some Cuts Won’t Impact Care

The Medicare Payment Advisory Commission (MedPAC) reported last week that home health agencies had average Medicare payment margins of 14.4% in 2012, about 30% of agencies currently have a negative Medicare margin, and the growth of for-profit agencies is increasing and the number of not-for-profit agencies continues to decline. Because of these and other factors, MedPAC says the impact of continuing small annual payment reductions to HHAs will have little impact. Click here to review MedPAC’s slide presentation with all the facts.

“Hospital-Dependent” Patients Create New Delivery Challenges

A growing percentage of our population is becoming “hospital-dependent,” according to some health policy experts writing in the New York Times last week. Despite hospitals’ best efforts to find appropriate post-acute care, some patients continue their trips back to the hospital – often within 30-days of discharge and negative financial consequences for hospitals. Click here for this interesting story. 44 House members have now cosponsored a bill introduced last month that would change the hospital readmissions penalty program. Click here for a one-page summary. Click here to see the list of cosponsors by state.

State Officials On Defense Over Health Exchanges

Officials from five states — Hawaii, Maryland, Massachusetts, Minnesota and Oregon — were on the defensive at a congressional hearing last week saying their health insurance exchanges had been hobbled by technology problems like those that crippled the federal exchange. However, they said their states were recovering. Click here for the NY Times report. States are plotting on how to improve the process for next year. Click here for this Pew Report.

House OKs Obamacare Change; Senate Could Agree

18 Democrats joined 230 Republicans to pass a bill last Thursday that would change the workweek to 40 hours. Under current law, companies with more than 50 full-time employees must provide health-care coverage for employees working 30 or more hours a week or face penalties starting at $2,000 a worker, beginning in 2015. There is growing interest among Democrat in the House and Senate to pass this law. Click here for report from the Wall Street Journal.

More Young Workers Turning Down Employer Coverage

Young workers across the country signed up for employer-sponsored health plans at a lower rate than last year, a surprising result that helped keep overall workplace enrollment rates flat, according to a report out last week. Companies had been bracing for a big bump in the number of workers signing up for workplace plans because of the new government mandate that most American adults buy health insurance or pay a penalty. Click here for the story.

7.1 Million Sign Up By March 31 Deadline

President Obama declared victory last week as 7.1 million persons signed up for insurance under state and federal exchanges by the March 31 deadline. Click here for the story. People who started signing up for private health coverage before the deadline will have until April 15 to finish their applications. A growing number of enrollees are young, which is a must for the program to succeed. Click here for that report. At least 5.4 million uninsured adults have gained coverage since the Affordable Care Act started signing up customers in October, according to an analysis released last week by the Robert Wood Johnson Foundation. Click here.

Chance to Switch Plans or Sign Up May Be Over for the Year

Americans thinking about buying health insurance on their own later this year, or maybe switching to a different insurer, are probably out of luck. The policies are going off the market as a little-noticed consequence of President Barack Obama’s health care overhaul. With limited exceptions, insurance companies have stopped selling until next year the sorts of individual plans that used to be available year-round. Click here for the story.

Report: More Price Transparency Needed, Recommendations Made

Each year, our nation spends more than $8,000 per person on health care, but patients have little to no idea how much each procedure, medication, or hospital stay actually costs. And unlike many other goods and services, higher health care prices do not necessarily reflect higher quality. More than 30 states now require disclosure of at least some minimal level of health care price information, and last year, CMS released large amounts of Medicare claims data for the first time. Click here to see recommendations from the Center for American Progress on how to increase price transparency.

CDC: Poisonings Caused by E-Cigarette Liquids Soaring

Poisonings caused by e-cigarette liquids have soared over the past several years, according to a study out last week from the CDC. Between September 2010 and February 2014, calls to poison centers related to e-cigarette fluids spiked from one per month to 215 per month. More than half of those calls involved children 5 or younger, who typically had ingested or inhaled the fluid. In some cases, the poison was absorbed through skin or eyes. Click here for the report.

New Draft Report Outlines Federal Regulation of HIT

HHS last week released a long-awaited draft report on the regulation of health information technology. Among other things, it recommends that the FDA not expand its authority to oversee the use of electronic health records, mobile health apps and similar features. The report says the FDA should continue regulating medical devices, including computer-aided detection and diagnostic software. Click here for a copy of the report.

New Survey Updates Most, Least Obese Communities

Boulder, Colorado, continues to have the lowest obesity rate (12.4%) in 2012 and 2013 out of 189 metro areas, according to a new survey. Residents of Huntington-Ashland, W.Va.-Ky.-Ohio, were the most likely to be obese, at 39.5%. Click here.

Survey: Illinois Residents Trust Their State Government Least; North Dakotans Most

Residents in Illinois have the least and North Dakotans have the most – trust in their state governments, according to a new Gallup Poll that for the first time measured trust on a state-by-state basis. Rounding out the least-trusted are Rhode Island, Maine, Pennsylvania and Louisiana. The most-trusted include Wyoming, Utah, South Dakota and Nebraska. Click here to see how your state ranks.