WEEKLY E-BULLETIN


Healthgrades Makes Hospital “Excellence Awards” for Women’s Health

Healthgrades last week issued awards to hospitals for excellence in maternity (116 recipients), gynecologic surgery (122 recipients) and women’s health (176 recipients). The analysis also provides insights about how women make decisions about required healthcare services throughout their lifetime. It also features the results of a national online survey that asked 1,116 women of different ages and demographic groups what mattered to them in making healthcare decisions. Click here for the Healthgrades’ report.

U.S. News Announces Best Children’s Hospitals

U.S. News is out with its 2014-15 rankings for the best children’s hospitals. The news organization surveyed 183 pediatric centers to obtain clinical data in 10 specialties and asked 150 pediatric specialists in each specialty where they would send the sickest children. 89 hospitals ranked in at least one specialty. 10 hospitals were named to the Honor Roll for high scores in at least three specialties. Click here for the rankings.

Hospitals Fault 2-Midnight Probe-and-Educate Audits

As Congress continues its work on legislation that will address problems with the two-midnight rule, CMS’ probe-and-educate audits are causing a fair amount of frustration in the healthcare industry, according to a report last week. Many hospitals say that they are being “failed” on charts that quite clearly satisfy the two-midnight rule, and other hospitals are reporting that they are being considered to represent “moderate to significant concerns” because the Medicare Administrative Contractor (MAC) chose a sample of claims that was too small. Click here for more.

New Bill Would Reform Hospital Readmissions Penalty Program

U.S. Senators Joe Manchin (D-WV), Roger Wicker (R-MS), Mark Kirk (R-IL) and Bill Nelson (D-FL) late last week introduced the Hospital Readmission Accuracy and Accountability Act to ensure that hospitals serving low-income populations are evaluated and reimbursed fairly under the Hospital Readmissions Reduction Program. This budget-neutral legislation requires CMS to account for patient socio-economic status when calculating risk-adjusted readmissions penalties. Click here for a summary. Click here for the bill. Similar legislation was introduced in the House a few months ago.

Legislation Would Limit Dropping Docs from Networks

As health plans continue to narrow their provider networks, at least one federal lawmaker believes there needs to be a legislative solution. Rep. Rosa DeLauro (D-CT) last week announced she will introduce the Medicare Advantage Participant Bill of Rights Act. The legislation was developed as a result of UnitedHealth Group’s dropping of doctors from their Medicare Advantage networks, including the entire Yale-New Haven Hospital network. Click here for more.

Hospital Health Plans Jumping Into Exchanges

More hospital-based health plans are jumping into state health exchanges across the country, according to a report out last week. While much of the attention has been focused on larger, national plans like United Healthcare and Aetna, at least 31 new plans are entering 12 exchanges. Click here for the report.

HHS Report Says Most Exchange Plan Premiums Under $100 a Month

A new report released last week by HHS finds that people who selected silver plans, the most popular plan type in the federal health exchanges, with tax credits paid an average premium of $69 per month. 69 percent of enrollees who selected federal exchange plans with tax credits had premiums of $100 a month or less, and 46 percent of $50 a month or less after tax credits. Click here for the HHS report.

New Study Says Monthly Silver Exchange Plans Will Increase $26 Next Year

A new report released last week analyzed proposed rate increases in nine states and predicts the average monthly silver plan premium will rise from $324 in 2014 to $350 in 2015. Consumers are also likely to see more premium diversity: the difference between the highest and lowest-priced proposed silver premiums in each state is higher than the 2014 differences. That variation may be driven by new entrants in those states markets. Click here for the study.

Report Says Exchange Enrollment Exceeded Health Plan Expectations

Data gathered this spring by House Republicans show enrollment in a sample of ACA exchanges exceeded what insurance companies expected by 4 percent. Democrats touted the numbers in a fact sheet released last week. Click here.

WSJ: Medicare Paid Florida Cancer Group $128 Million to Administer One Drug

Medicare paid U.S. oncologists $128 million in 2012 to administer Procrit, federal data show. Today, use of this class of drug is sharply restricted. One-sixth of that money went to oncologists in the group, Florida Cancer Specialists, based in Fort Myers. Of the 20 oncologists whom Medicare paid most for Procrit, 11 belonged to the Florida group. Florida Cancer Specialists also used Procrit at higher rates than is typical, a Wall Street Journal analysis of 2012 Medicare billing data shows. Click here for the WSJ report.

Only Half of Vets Received Recommended PTSD Therapy Last Year

Only about half of the veterans diagnosed with PTSD last year after serving in Iraq and Afghanistan received the recommended therapy despite efforts by the Department of Veterans Affairs to beef up its mental health staffing, the Institute of Medicine said in a report released last week. About 53 percent of the veterans whose primary diagnosis was PTSD got at least eight psychotherapy sessions within a 14-week period in 2013. But that is significantly short of the department’s target of 67 percent, according to the report. Click here for the report (purchase required). Click here for the LA Times report.

Third State Requiring Patient Observation Status Notification

Connecticut has joined New York and Maryland in requiring hospitals to notify patients that they have been placed on observation status. Connecticut requires oral and written notice when observation status if for 24 hours or more. Click here for more from the Center for Medicare Advocacy.

Community Health Center Capacity Could Plummet

The capacity of the nation’s community health centers — which will serve an estimated 25.6 million people this year — could decline by more than a quarter if about half the states continue to decline Medicaid expansion and federal funding remains stagnant, according to new research from George Washington University. Click here for the study.

ASC Deal Will Create 100-Facility Company

Chicago-based Surgery Partners plans to acquire Symbion for $792 million, a move that will add to consolidation in the physician surgery center market. The combined company will own and operate about 100 ambulatory surgery centers and surgical hospitals with physician partners in 27 states. Click here for more.

Prosecutors Investigating Congressional Health Care Leaks

Prosecutors are digging around for more details about whether Congressional aides leaked information about a sensitive change in Medicare policy before it was public, The Wall Street Journal reported last week. Federal law enforcement officials issued the first subpoenas to Congress in an insider trading investigation in a decade, according to the report. Click here for the WSJ article.

Survey: Value Based Contracts Will Hurt Bottom Lines

Healthcare providers expect the industry shift to value-based contracts will negatively impact their organizations’ bottom lines, according to a new survey by KPMG, LLP. Nearly one-third of the 240 representatives from hospitals, physician practices, health plans and pharmaceutical companies polled said they expect value-based contracts to hurt profits. More than 12 percent said operating income will likely fall 10 percent or more due to these agreements. Click here for the survey.

Congressional Committee Seeking Input on 21st Century Cures

The House Energy and Commerce Committee is seeking public comment on a white paper released last week regarding potential digital and personalized healthcare technologies intended to enable 21st Century cures. The aim of the committee is to accelerate the discovery, development, and delivery cycle to get promising new treatments and cures to patients more quickly. Click here for the white paper.

Study: Readmissions Could Fall With Aid of Community Pharmacists

Readmissions could drop as much as 20 percent if community pharmacists work with high-risk patients after discharge on counseling and medication management, according to a study released last week. Researchers from the University of Cincinnati said hospitals were less likely to readmit patients who saw a pharmacist after discharge than those who didn’t. Click here for details.

40 Percent Having Trouble Paying Premiums

About four in 10 people who bought ACA-compliant plans told Kaiser Family Foundation pollsters that they’re having difficulty paying their monthly premiums, and more than six in 10 fear the premiums will become unaffordable in the future. Almost half said they are not confident they would be able to pay for a major illness or injury. Click here for the survey.

Gallup: Strong Majority Favor Physician-Supported Euthanasia

A strong majority of Americans support allowing physicians to legally end a patient’s life “by some painless means if the patient and his or her family request it,” according to a Gallup poll released last week. Since 1990, the percentage of people answering yes has been 64 percent or higher. Click here for the poll.