WEEKLY E-BULLETIN


Hospitals Urge Congress to Improve VA Health Care Contracting with Private Sector

Nearly 200 hospitals sent a letter to Congress last week urging lawmakers to reform the VA private sector contracting system to allow greater ease of contracting between private hospitals and the VA. Private hospitals have been largely excluded from providing services to the VA, even to veterans who are required to travel great distances to access the VA’s health system. Click here for the letter.

Bill Would Allow More Vets to Seek Care Outside VA System

Legislation is being crafted in the Senate that would allow veterans to access local hospitals, physicians, FQHCs and community health centers if they are on the VA’s waiting list for more than 30 days or have to travel more than 40 miles. However, some senators are pushing to have the wait times and distances reduced. The details of this legislation are still being developed. The outline of the legislation can be viewed in this summary. Click here.

Assault Continues on 340B Rx Discount Program

The attack on the 340B drug discount program continues with the latest salvo coming last week from the Biotechnology Industry Organization. They released an analysis conducted by Berkeley Research Group that focuses on hospital acquisitions of oncology practices. According to the report, within about six months, the hospital is using 340B discounts to buy drugs for the acquired outpatient oncology sites; the sites quickly account for about 40% of the hospital’s total 340B chargebacks; almost half such hospitals pocket the 340B savings. Click here for the detailed analysis.

Medicare Will Cover Hep C Screens

Medicare will cover the cost of screening for hepatitis C, a decision that may further open the government’s wallet for Gilead Sciences’ $84,000 cure for the disease. Adults at high risk for infection, including those who inject illegal drugs or had a blood transfusion before 1992, are eligible, as is anyone in Medicare ages 49 to 69, the agency said in a memo. Click here for the CMS decision memo.

Report: Medicare Advantage Misspending Billions of Dollars Every Year

Medicare Advantage now covers nearly 16 million Americans at a cost expected to top $150 billion this year; however, billions of tax dollars are misspent every year through billing errors linked to a payment tool called a “risk score,” which is supposed to pay Medicare Advantage plans higher rates for sicker patients and less for those in good health, according to an investigative analysis released last week by Public Integrity. Click here for the report.

Study: Physicians’ Politics Shifting From Red to Blue

Doctors are generally considered Republican supporters, but they’ve actually been shifting their campaign donations toward Democrats over the last two decades, says a study published last week in JAMA Internal Medicine. The change apparently has been driven primarily by the entry of more women into medicine and the diminishing number of solo and small practices. In the 1994 election cycle, 69 percent of physicians’ political donations went to Republicans. By 2010 that share had dropped to 53 percent. Click here for more.

One In Five Americans on Medicaid

More than 1 million people signed up for Medicaid in April, bringing the total growth since September to about 6 million, according to a new HHS report. In 47 states and the District of Columbia, overall Medicaid enrollment reached 65 million last month. Enrollment for those same states back in September totaled 59 million. States that expanded Medicaid saw an enrollment increase of 15.3 percent, compared to the average enrollment from July through September 2013, while non-expansion states saw a 3.3 percent increase. Click here for the HHS report, which includes a state-by-state breakdown. Click here for another analysis that includes some very good graphs.

Medicaid Enrollment Hits Snag for 3 Million

Roughly 2.9 million people have signed up for Medicaid coverage but haven’t been enrolled because the program hasn’t processed their applications yet, according to a survey released last week. The delays primarily have been caused by technical issues related to the health insurance exchange websites, combined with a surge in Medicaid applications. Three states–California, Illinois and North Carolina–have the longest backlogs. Almost 1.5 million people in those states still are waiting for their Medicaid applications to be processed. Click here for more.

Health Care Bills for Uninsured Reach $85 Billion

America spent $84.9 billion covering bills for the uninsured in 2013, according to new analysis from the Kaiser Family Foundation. A large portion of that came from federal and state governments, who paid $53.3 billion to help offset the costs of people who showed up for care without coverage. Health care providers end up eating the rest. And Patients pay a significant amount, too: not included in the $84.9 billion figure is the $25.8 billion paid out of pocket by the uninsured themselves. Click here for a very good story. Click here for the Kaiser analysis.

Debate Continues on Medicaid Managed Care’s Effectiveness

There are still serious questions about whether Medicaid managed care companies can provide quality care and cost savings, reported Kaiser Health News and the St. Louis Dispatch last week. On one side of the debate, St. Louis-based Centene Corporation cites its contract to manage healthcare for 30,000 foster children in Texas. Within a year, the state budget for foster children dropped along with the number of psychotropic drug prescriptions. However, health policy experts still have doubts about expanding Medicaid managed care to achieve significant cost savings. Click here for the report.

ACO Report Identifies 6 Types of Organizations

If you have seen one Accountable Care Organization, you have only one type of ACO and there are as many as six types, according to a new report from Levitt Partners. The analysis identifies the characteristics of all these ACOs and describes their unique challenges and opportunities. Click here for the report.

Apple, Epic Deal May Dominate Health IT

Apple will partner with Epic Systems, the country’s largest electronic health records company, a deal that has the potential to revolutionize how patients access their medical history. An estimated 40 percent of Americans already have medical information digitally stored on an Epic Systems health record. And Apple’s new HealthKit will integrate with those millions of patient records, the company announced last week. Click here for the announcement.

Investors Flocking to Health Sector

Investors continue to flock to the health-care sector, partly because they expect the Affordable Care Act to spur more business to medical-device, pharmaceutical and other health-care companies, according to a report last week in the Wall Street Journal. The health-care law is just one reason financial advisers and other professional investors expect to propel some health-care companies’ stocks upward in coming years. Aging baby boomers and growing affluence in some emerging-market economies also are expected to help lift the shares. Click here for their report.

HHS Awards $300 Million to FQHCs

HHS will award up to $300 million in supplemental funding to the 1,300 federally qualified community health centers across the country so that they can staff up, add services and expand hours, the agency announced last week. Applications are due July 1. Click here for the HHS announcement.

CMS Creates RAC Helper for Providers

Apparently, CMS believes providers are not getting enough help when it comes to dealing with RACs. CMS last week announced the creation of a Provider Relations Coordinator to help increase program transparency and offer more efficient resolutions to providers affected by the medical review process. Now if you think your RAC is doing its job, you can contact the Coordinator. Click here for the CMS notice.

AHA Urges HHS to Stop Extrapolation Process

The American Hospital Association last week asked HHS to stop the HHS Office of Inspector General’s extrapolation reviews of hospital reimbursement and the collections that follow, complaining the audits are redundant and the extrapolated amounts that the OIG designates as improper payments are often inaccurate. Click here for the AHA letter.

GAO: Docs With PT Ownership Refer More

Physicians in family practice and internal medicine in urban areas were more likely to refer a Medicare patient to physical therapy if they had financial stakes in the services, a report from the GAO found. The average number of Medicare beneficiaries referred by self-referring family practice providers in urban areas was 43 to 87 percent higher than for their non-self-referring counterparts. Click here for the GAO report.

CBO: Majority of Uninsured Won’t Pay Penalty

The Congressional Budget Office has estimated that about 30 million nonelderly residents will be uninsured in 2016 but that the majority of them will be exempt from the financial penalty imposed on the uninsured. Those who are exempt include: unauthorized immigrants, who are prohibited from receiving almost all Medicaid benefits and all subsidies through the insurance exchanges; people with income low enough that they are not required to file an income tax return; people who have income below 138 percent of the federal poverty guidelines and are ineligible for Medicaid because the state in which they reside has not expanded eligibility by 2016 under the option provided in the ACA. Click here for the CBO summary.

Report: Pre-ACA Premiums Grew By 10 Percent Annually

Premiums grew by 10 percent or more each year during the pre-Affordable Care Act period of 2008 through 2010, according to a new report from the Commonwealth Fund. In 2008, premiums increased by 9.9 percent, followed by 10.8 percent in 2009 and 11.7 percent in 2010. Click here for their analysis.

More Insurers Entering State Exchanges

State health insurance marketplaces that offered consumers very few health plan choices in 2014 are starting to add more insurers — slowly, in most cases. But this is a sign that insurers are feeling confident about the second year of the Affordable Care Act’s coverage expansion. Click here for the story.

More Positive Analysis on PCMHs

Patient-centered medical homes already have proven to enhance quality of care, and now new research finds that quality improvement comes from the community and culture created through the program rather than the technology used. Key features of medical homes include case managers and a team-based approach to patient care. They also usually employ health information technology, including electronic health records and electronic prescribing, according to the study published last week in the Annals of Internal Medicine. Click here.

Hospital Charge Variations Continue

CMS last week updated its public databases for inpatient and outpatient payment data. The update includes data that compare the average charges for services that may be provided in connection with the 100 most common Medicare inpatient stays at more than 3,000 hospitals nationwide. The information updates data that the agency released last year. CMS also released a dataset that allows users to compare geographic variations in payments made to providers. Click here for details. Media are already reporting that charge variations for the same procedures can been thousands of dollars. Click here.

National Health IT Office Outlines 10-Year Vision

Office of the National Coordinator for Health Information Technology last week proposed a broad framework and 10-year vision for achieving an interoperable health IT infrastructure. By 2024, individuals, care providers, communities, and researchers should have an array of interoperable health IT products and services that allow the health care system to continuously learn and advance the goal of improved health care. Click here for their report.

Measuring Value Is Next Challenge for Health Plans

As technology’s role in the health insurance industry grows, payers are moving on to their next IT challenge: measuring value, according to press reports last week. The industry shift to value-based care means payers need tools to measure value to keep providers from falling back to fee-based care. Employers also need payers to rise to the challenge with calls for longitudinal data across home, work and wellness programs. Click here for the report.

FDA Could OK New One-Dose MRSA Drug Soon

A single infusion of an antibiotic can clear serious bacterial skin infections — including methicillin-resistant Staphylococcus aureus, or MRSA — just as effectively as the 10-day regimen now used to treat patients, researchers reported last week. The FDA could approve it as early as August on a fast-track process. Click here for the report.

$30 Million Study Announced on Reducing Fall-Related Injuries

The Patient-Centered Outcomes Research Institute and National Institute on Aging last week announced a five-year, $30 million study that will test the effectiveness of patient-centered strategies to reduce fall-related injuries in older adults. The study will recruit 6,000 adults age 75 and older who have one or more risk factors for falls from community-based primary care practices affiliated with 10 health care delivery systems located in rural, urban and suburban communities. Click here for the details.

“Death Panels” May Be Making a Quiet Come Back

The federal government may reimburse doctors for talking to Medicare patients and their families about “advance care planning,” including living wills and end-of-life treatment options — potentially rekindling one of the fiercest storms in the Affordable Care Act debate, according to reports last week. Click here for the story.

How You Will Likely Die May Depend on Where You Live

How will you die? Well, perhaps it depends on the state where you live, according to very interesting CDC numbers that were made into multiple state maps depicting the chief causes of death – and related information – for each state. This is worth a look! Click here.