WEEKLY E-BULLETIN


MedPAC to Congress: More Medicare Payment Synchronization and Equalization

In a report filed late Friday, the Medicare Payment Advisory Commission told Congress:

  • It should begin synchronizing the three Medicare payments systems – Fee for Service, Medicare Advantage and Accountable Care Organizations;
  • It should equalize payments between Inpatient Rehab Facilities and Skilled Nursing Facilities;
  • It should continue bonus payments to primary care physicians but change the formula to a ‘per beneficiary’ payment. The current bonus payment expires next year; and
  • Medication adherence strategies have some questionable effects.

Click here to read a four-page summary of MedPAC’s report. Click here for the complete, 177-page June report to Congress.

Bundled Payments Are Focus of Many Hospitals

Bundled payments may be the preferred payment system of the future, according to hospitals that are pushing them. Click here for this very interesting Wall Street Journal report.

Analysis: Single Procedures Earn Docs More than $500,000 from Medicare in 2012

More than 2,300 providers earned $500,000 or more from Medicare in 2012 from a single procedure or service, according to a Wall Street Journal analysis of Medicare physician-payment data made public in April. A few of those providers collected more from the single procedures than anyone else who billed for them—by very large margins. Click here for the report. You can see the data for your own physician(s) by clicking here.

Payments Moving Swiftly to Value Based

In five years, more than two-thirds of payments for health care services are expected to be made based on value, up from one-third today, according to a survey released by McKesson last week. Already about 90 percent of payers and 80 percent of hospitals offer a mix of fee-for-service and other payment models. Technology remains the major barrier to implement the changes. Click here for the report.

VA Reform Bill Could Be Costly

Congress is moving toward an agreement on a VA reform bill allowing vets to seek private care, but the Committee for a Responsible Federal Budget says the Senate version provides a blank check to the agency and could add substantially to the national debt. If just one provision was fully phased in, it would cost $50 billion per year, more than doubling what is currently spent on VA health care, according to the group. Click here for their report.

VA Reform Bill Won’t Shift Many Vets to Private Providers

The new veteran’s reform bill doesn’t do much to allow vets to seek care from private hospitals and physicians – despite the congressional rhetoric to the contrary. A closer reading of the legislation – House and Senate versions have similar provisions – reveals that a veteran must live at least 40 miles from ANY VA medical facility, including a community based outpatient clinic, to qualify for private care. Click here for SHC’s one-page summary with links to the House and Senate bills.

VA Docs Fear Retaliation

VA doctors fear retaliation from management for complaining too much, too openly or to the wrong people, the Washington Post reports. Click here.

Premier: Number of Acquired Conditions Much Greater than CMS Considers for Payment Reductions

There are at least 86 conditions patients can acquire in hospitals, but CMS considers just one-fourth of them in adjusting payment policies, according to a hospital safety study from Premier. Many of Premier’s 86 complications occurred more frequently than CMS’s hospital acquired conditions, Premier found. Further, eight of CMS’s Healthcare Acquired Conditions affected just 50 or fewer patients out of the 5.5 million records. Some of the rarest conditions were poor glycemic control, surgical site infection after bariatric surgery for obesity and air embolism. Click here for Premier’s 13-page report.

Patients Flocking to EDs

Under the Affordable Care Act, patients are flocking to emergency departments. Why? A long-standing shortage of primary-care doctors leaves too few to handle all the newly insured patients. Some doctors won’t accept Medicaid. And poor people often can’t take time from work when most primary care offices are open, while ERs operate round-the-clock and by law must at least stabilize patients. Plus, some patients who have been uninsured for years don’t have regular doctors and are accustomed to using ERs, even though it is much more expensive. Click here for the report.

Data Shows Where Patients Pay Most, Least for Certain Services

People who live in San Francisco pay the most, on average, for a doctor’s visit ($251), and the least in Miami ($95). Indianapolis is the most expensive for a cholesterol test ($89) and Pittsburgh is the least costly ($19). Sacramento comes in highest for both CT scans of the head ($1,404) and MRIs of the lower back ($2,635). Those are the range of prices for four of the most common medical services in 30 of the most populous cities in the United States, according to an analysis by Castlight Health. Click here for a good interactive national map.

Private Health Exchanges Booming

Three million people are now getting health coverage through private exchanges, which are on course to surpass public exchange enrollment, hitting 40 million by 2018, according to a report released last week by Accenture. Accenture said that private exchange enrollment for 2014 was three times higher than forecast. Accenture estimates that one in four people using the private exchange purchase less coverage, meaning lower premiums but potentially higher out of pocket costs. Hospitals and other providers then have to collect more of their fees from the patients. Click here for their report.

Study: Some Exchanges Require Seriously Ill Patients to Pay More for Meds

A study funded by the pharmaceutical industry found that many plans sold through new health exchanges require people with serious illnesses to contribute heavily toward the purchase of their medicines, according to a release last week. In seven of 19 classes of medicines, more than 20 percent of silver-level plans require coinsurance of 40 percent or more for drugs for illnesses such as cancer, HIV infection, and bipolar disorder, the report said. Click here for the study. The insurance industry trade group AHIP shot back. Click here for its response.

Insurers Want Lower Cost Catastrophic Plans with Subsidies on Exchanges

Although it would require congressional action, the insurance industry wants Obamacare to offer a lower cost catastrophic plan to everyone on the exchanges with the same premium subsidies as the other options. America’s Health Insurance Plans released a proposal last week, which the group says could boost enrollment among the sought after younger demographic that can help balance out the exchange risk pools and restrain premium increases. Click here for report.

CMS: $60 Million in Grants for Navigators

CMS announced last week that $60 million will be available to support navigators working in states relying on the federal marketplace and in partnerships. Last year, CMS awarded $67 million. New and returning navigator applicants must apply for a new round of funding by July 10. Click here for the details from CMS.

AMA Releases Principles for Telemedicine

How should insurers cover health care delivered via phone or by video or email? The American Medical Association last week offered some suggestions, approving a list of guiding principles for covering and paying for telemedicine services. The principles aim to help foster innovation in the use of telemedicine, protect the patient-physician relationship and promoted improved care coordination and communication with medical homes. Click here.

30-Day Readmissions Still Problematic

While there has been modest improvement in the number of hospital readmissions within 30 days of discharge, analysts are trying to figure out why improvements aren’t happening faster – especially now that hospitals are fined for being an outlier versus their peers. Click here for the NY Times report that there is blame to go around, including the patient.

CO-OPs Not Meeting Expectations, House GOP Report

Many of the nonprofit health-insurance cooperatives created by the Affordable Care Act have enrolled far fewer people than they had hoped, according to figures obtained by a Republican-led House committee, calling into question their viability. Fourteen of the 23 co-ops reported to the panel that, as of April 1 or later, they had enrolled significantly fewer people than they had projected for 2014 when they obtained $2 billion in federal loans from a fund created under the health law. Click here for the report.

SHOP Programs Delayed Again in 18 States

CMS announced last week that 18 states could wait until at least 2016 to implement their Small Business Health Option Program (SHOP) exchanges. The feature is required by the ACA and the agency signed off on all 18 state requests for a delay, some of which were rather perfunctory one page letters citing concerns from insurers. Click here for CMS’ announcement with the list of states.

27 Groups Urge CMS to Act on Part D Drugs for Hospice

The AARP and 26 other health and aging groups signed on to a letter asking CMS administrator Marilyn Tavenner to address problems hospice patients are having when they need to get prior authorization before Part D kicks in for drugs not related to their terminal diagnosis. The guidance places the beneficiary at the center of potential disagreements between hospice providers and Part D plans — essentially requiring dying patients to navigate payer disputes, according to the letter. Click here for a copy of the letter.

Low Volume Payment Rules Released by CMS

CMS on Friday issued a rule setting payment adjustments for low-volume hospitals and Medicare-dependent hospitals under a law extending the temporary payments through March 31, 2015. The rule announces changes to the payment adjustments for the second half of fiscal 2014. The measures revise the criteria for low-volume hospitals, specifying that they qualify as low-volume if they’re more than 15 road miles from another hospital and have fewer than 1,600 discharges of individuals entitled to or enrolled in Medicare Part A benefits. Click here to read the rule.

CHIP, Medicaid Enrollment Increasing Dramatically

Enrollment in Medicaid and the Children’s Health Insurance Program has increased by about 6 million people since states began expanding their programs under the Affordable Care Act, says a new report out last week from the Robert Wood Johnson Foundation. The report also found that enrollment has varied significantly by state, with new enrollment much higher in states that chose to expand their Medicaid programs and variation even among those states. Click here for the 10-page report.

CHIP Rescue Efforts Underway

Unless Congress new funds, funding for the Children’s Health Insurance Program will expire next year. Senator Jay Rockefeller, D-WV, has introduced legislation to extend funding through Sept. 30, 2019. Click here for details of that new legislative effort.

Ambulance Companies in NJ, PA and SC Draw Scrutiny

Dozens of New Jersey ambulance companies billed Medicare for unusually large numbers of non-emergency rides in 2012, according to a new report from ProPublica. CMS announced recently that it would begin requiring prior authorization for certain types of ambulance rides in New Jersey, Pennsylvania and South Carolina, states with unusually high utilization rates and costs. Click here for the ProPublica investigative report.

Number of State Exchange Insurers Continue to Expand

The number of insurers planning to participate in state health exchanges continues to increase, according to reports form states last week. The number of insurers in the New Hampshire exchange will increase from one to five in 2015; from 13 to 18 in Michigan; and from six to 10 in Illinois. Click here for more.

Health Prices Up, But Still Low

Health care prices were 1.6 percent higher in April than a year earlier, according to Altarum’s monthly economic indicators and released last week. The rate of growth was well above the March rate of 1.1 percent, but growth still remain low by historical standards. Prices grew the most for prescription drugs (2.4 percent), dental services (2.2 percent) and hospital services (2.1 percent). Click here for the Altarum report.

Employers Still Supporting Health Benefits for Employees

While the majority of single employers believe the health care law has negatively affected their company, fewer than one percent plan to stop offering health benefits, according to a report from the International Foundation of Employee Benefit Plans. Just 12 percent of those surveyed said they expect the law to decrease or keep costs the same; the rest said they expect it to raise costs anywhere from 1 percent to more than 10 percent. Yet 94 percent said they’ll definitely or very likely continue offering benefits. Click here for the report.

Some Americans Seeking Obamacare Alternatives

A small but growing group of Americans opposed to the Affordable Care Act are seeking out alternatives, choosing once-fringe methods to pay for their medical care in an effort to skirt the many requirements the law imposes on the private health insurance market. The result is a burgeoning business among brokers, clinics and insurers that are advertising themselves as a way to avoid the sweeping federal program. Click here for the story.

Senators Want Input on Benefits of Big Data

Senate Finance Committee Chair Ron Wyden (D-OR) and Senator Chuck Grassley (R-IA) sent letters to about 100 health care stakeholders with a request for input on how big data and data transparency could foster industry reforms and benefit their work. Wyden and Grassley urged recipients to think about “what the future of health care data should look like,” adding that they are trying to “pinpoint what’s standing in the way of increasing data access and transparency, while identifying ways that data can be most useful.” Click here for a copy of their letter.

FDA: Drug Reactions Vary Between Men and Women

New data released by the FDA last week on bad reactions to drugs show men and women having vastly different experiences. The most commonly reported adverse reaction to bad drugs for men is death, according to a new database of reports spanning from 2004-2013. Women had a fairly similar number of deaths, just more than 60,000, but that was only the ninth-most common reaction suffered. Click here for more.

CDC: Teen Smoking, Fighting, Sex Is Less

High school students are smoking, fighting and having sex less, according to the CDC’s 2013 National Youth Risk Behavior Survey released last week. Fewer than 16 percent of teens are smoking, meeting early the benchmarks for teen smoking laid out in HHS’ Healthy People 2020 goals. But as smoking declines, the popularity of e-cigarettes and hookah is rising. Click here for the CDC’s report.

Why Congress Is So Divided: It’s Us

For America’s most ardent liberals and conservatives, polarization begins at home. In what may seem like stereotypes come to life, a new Pew Research Center study on political polarization finds that conservatives would rather live in large houses in small towns and rural areas — ideally among people of the same religious faith — while liberals opt for smaller houses and walkable communities in cities, preferably with a mix of different races and ethnicities. And sizable minorities of both groups say they’d be dismayed if someone from the “other side” were to marry into their family. This is a fascinating look at the polarization of America. Click here.