Moody’s Outlines A Success Pathway for Hospital Systems

Hospital systems that are focusing investment dollars on information technology, outpatient services and improved efficiencies will be best prepared to mitigate the negative impacts of declining inpatient utilization, shifting payer models and increased competition from nontraditional participants in the healthcare industry, according to a new report from Moody’s on not-for-profit hospitals. Click here for their report.

Hospital Systems Scaling Back on Charity Care for Uninsured

Hospital systems are scaling back on charity care for uninsured patients, hoping to convince them to obtain insurance via Medicaid or the health insurance exchanges, the New York Times reported last week. Among the providers to change their charity care policies are Barnes-Jewish Hospital in St. Louis, which now charges the uninsured co-payments, ranging from $50 for an office visit to $100 for a trip to the emergency room. Fletcher Allen Health Care in Vermont and Southern New Hampshire Medical Center also scaled back charity care for patients who are above the federal poverty line. Click here for the story.

IRS Blocks Employer Dumping of Employees onto Exchanges

The IRS has moved to block any wholesale move by employers to dump employees into state health exchanges. Many employers had thought they could shift health costs to the government by sending their employees to a health insurance exchange with a tax-free contribution of cash to help pay premiums. Such arrangements do not satisfy the health care law, the administration said, and employers may be subject to a tax penalty of $100 a day — or $36,500 a year — for each employee who goes into the individual marketplace. Click here for the story. Click here for the IRS guidance.

Rx: The Next Front In The War On Health Care Prices

The insurance industry is picking a fight with pharmaceutical companies over the rising cost of specialty drugs. Insurers say the high prices are raising healthcare costs for insurance companies and everyone else, threatening the sustainability of the U.S. healthcare system. Click here for the unfolding story.

Hep C Drug Focuses Debate on Skyrocketing Rx Costs

It’s been about six months since the FDA approved an $84,000 breakthrough drug to treat Hepatitis C. One record-breaking sales quarter later for Gilead Sciences’ Sovaldi, and the health-care industry isn’t much closer to figuring out how to deal with the drug’s hefty price tag as it warns of a larger problem ahead. Click here for the story.

Oncologists Developing Cost-Effectiveness Methodology for Cancer Drugs

With new cancer drugs priced as high as $10,000 a month and more, and insurers tightening payment rules, patients who thought they were well covered increasingly find themselves having to make life-altering decisions about what they can afford. As a result, cancer doctors trained to weigh side effects and efficacy are being regularly pulled into delicate discussions on cost, an issue that will be explored at the American Society of Clinical Oncology meeting in Chicago through June 3. The group is working on an algorithm to rate the cost-effectiveness of oncology drugs to help doctors with those conversations. Click here for the story.

OIG: Physicians Are Overpaid E/M Payments by $6.7 Billion

The assault on Evaluation and Management payments continued last week with a new report from the HHS OIG saying that Medicare overpaid physicians $6.7 billion in 2010 E/M payments. Click here for the OIG report. E/M payment cuts continue be the target of MedPAC and Congress as they consider ways to “pay for” future fixes to Medicare’s physician payment formula, known as the SGR.

RAC Review: 57% of Payments to Hospitals Did Not Contain an Overpayment

The American Hospital Association is out with its latest hospital data on RACs. 57% of medical records reviewed by RACs did not contain an overpayment, according to the RAC. 59% of hospitals indicated they experienced short-stay medical necessity denials. 59% of hospitals also received denials for inpatient coding, an increase of 8% from Q4 2013. 66% of short-stay denials for medical necessity were because the care was provided in the wrong setting, not because the care was medically unnecessary. Hospitals reported appealing 50% of all RAC denials, with a 66% success rate in the appeals process. Click here for the complete report.

CMS Planning New ACO Reg for Spring

CMS plans to propose this spring a regulation for the second round of the accountable care organization program, according to the government’s latest regulatory agenda released last week (click here). This is the first official word from the agency that a regulation is forthcoming. “This proposed rule would address changes to the Medicare Shared Savings Program and contains provisions relating to Medicare payments to providers of services and suppliers participating in Accountable Care Organizations (ACOs) under the Medicare Shared Savings Program,” according to the agenda. “These changes would apply to existing ACOs and approved ACO applicants participating in the program beginning January 1, 2016.” The regulatory agenda provides no specifics.

Texas Has The Fewest, West Virginia The Most: Eligible For Federal Assistance

More than 27 million uninsured Americans became eligible in January for Medicaid, the Children’s Health Insurance Program or subsidies to purchase private health insurance through marketplaces, according to a report released last week by the Robert Wood Johnson Foundation. That’s about 56% of the nation’s uninsured population. In states that have expanded Medicaid eligibility, 68% of uninsured residents became eligible for coverage assistance, compared with just 44% in states that have not expanded Medicaid. Click here for the report that includes a state-by-state breakdown.

VA Suffers Acute Physician Shortage

At the heart of the falsified data at the VA hospital in Phoenix, and possibly many other veterans hospitals, is an acute shortage of doctors, particularly primary care ones, to handle a patient population swelled both by aging veterans from the Vietnam War and younger ones who served in Iraq and Afghanistan, according to congressional officials, Veterans Affairs doctors and medical industry experts. The department says it is trying to fill 400 vacancies to add to its roster of primary care doctors, which last year numbered 5,100. Click here for the story. Click here for the 35-page OIG report on the Phoenix issues.

For a very good summary about the VA’s health care system, i.e. number of hospitals, clinic, personnel, click here.

VA Incentive Payments Got Wrong Results

VA hospital administrators received financial bonuses keeping wait times short and, according to several reports, these incentives appear to have incentivized bad behavior. The aim of those bonuses was to incentivize good behavior: If there’s money to be made in getting patients seen quickly, the reasoning goes, then hospitals will focus on reducing wait times. Instead, they gave administrators an incentive to do something easier than improving health care: falsify records to make it look like wait times were shorter, and still net bonus payments. Click here for the report.

Humana Best, Medicaid Worst Insurer: Provider Survey

Based on analysis of claims data from more than 52,000 providers across 50 states, an annual ranking of insurance companies from revenue cycle management vendor athenahealth Inc. ranks Humana as the best in overall payer performance while Medicaid performed the worst last year. Click here for the detailed report.

Measles Cases Hits 20-Year High

The number of measles cases in the United States has hit a 20-year high. The confirmed case count for 2014 is 288 as of May 23, and growing, according to the CDC. Cases have been reported in 18 states and New York City, with about half in this month alone, due to a major outbreak in unvaccinated Amish communities in Ohio. Click here for the CDC report.

CDC: Teen Birth Rate Continues Decline

The teen birth rate declined 10% in 2013 to about 27 per 1,000 women, according to a report released last week by the CDC. The birth rate for women aged 20-24 fell 2% to a record low 81 per 1,000, while the rate for women aged 35-39 rose 3% to about 50 per 1,000. The preterm birth rate (deliveries at less than 37 weeks) fell by about 0.2 percentage point to 11.38%, while the cesarean delivery rate fell by 0.1 percentage point to 32.7%. Click here for the CDC report.

Senators Press CMS for New Lung Screening Coverage

A bipartisan group of senators wants Medicare to cover a new form of lung cancer screening they say helps catch the disease way ahead of other diagnostic tools. In a letter to CMS, the 44 senators said the scans were widely available to the privately insured but not to Medicare recipients. Click here for a copy of the letter.

FDA Announces Stricter Tanning Bed Regs

The FDA last week announced stricter regulation of tanning beds that are used by millions of Americans. The agency said that it would require manufacturers to put a black-box warning on the devices stating that they should not be used by anyone under the age of 18, but stopped short of banning their use by minors. Click here for the story.

Polling on Obamacare Still Not Favorable

Republicans are three times more likely than Democrats to say they know someone who was hurt by Obamacare, according to another poll out last week. Thirty-four percent of Republicans say they personally know someone who lost health-insurance coverage, lost their job or had their hours cut because of the Affordable Care Act. Click here for the poll results. Click here to see last week’s Obamacare poll from Gallup that says few Americans say they have been helped.

GOP Candidates Retreating from Obamacare Assault in Campaigns

However, Republican candidates have begun to retreat in recent weeks from their all-out assault on the Affordable Care Act in favor of a more piecemeal approach, suggesting they would preserve some aspects of the law while jettisoning others, according to reports last week. The changing tactics signal that the health-care law — while still unpopular with voters overall — may no longer be the lone rallying cry for Republicans seeking to defeat Democrats in this year’s midterm elections. Click here for the story.

NBC News Reviews Chinese Health System; It’s Not Pretty

You think the U.S. health system is problem-plagued? Try China. NBC News has a 2-minute report on the Chinese health system that begins with a farmer sawing off his own leg because he didn’t have the money to pay doctors. Quite compelling. Click here.