WEEKLY E-BULLETIN


ACA Causing Hospital Consolidations, Physician Acquisitions While FTC Targeting Mergers

The Affordable Care Act may be good for Medicare but not necessarily everyone else, says a new New York Times report about hospital consolidation and its impact on health care prices. Some credit is given to ACOs as the reason for the growing number of hospital mergers and physician acquisition. Click here for the story. FTC commissioner Julie Brill is now saying that her agency would respond to the glut of M&A activity. She argues that while the Affordable Care Act was designed to incentivize collaboration between hospitals and providers, the FTC wouldn’t stand by and let industry giants use the law as a “free pass” for purchasing outsized influence. Click here for that report.

761 Hospitals Could Be Penalized This Year for Infection and Complication Rates

Medicare has identified 761 hospitals that are in line to be penalized for high rates of infections and complications this fall. Some of these hospitals may avoid the penalties in the fall after federal officials factor into their analysis an additional year of infections. Click here for the list of 175 hospitals Kaiser Health News says are most likely to be penalized because their preliminary scores are nine or above on a scale of 1 to 10. Click here for the complete list.

Hospitals Using Detailed Consumer Data to Target Patients BEFORE They Get Sick

Some hospitals are using detailed consumer data, compiled by data brokers from public records and credit card transactions, to create profiles on patients so they can intervene before they get sick. Patient advocates worry this use of big data will endanger privacy and harm the doctor-patient relationship. Read this interesting story here.

Studies: Hospitals Cost More for Comparable Procedures at Other Sites

There is an often significant price difference between common procedures performed at hospitals versus at a physician’s office or in outpatient surgery centers, according to two new studies out last week. One study concluded that hospitals charged nearly three times more for some basic services, such as blood panels, compared to a physician’s office. That study used insurance claims data from 590,000 retired autoworkers and their dependents. Click here for that study. In another study, ambulatory surgical centers often had lower prices for procedures compared to hospitals, particularly in states that required fee schedules for care, the Workers’ Compensation Research Institute concluded. Click here for that study.

New Bill Standardizes Patient Assessment Tools for Post Acute Care

The Senate Finance and House Ways & Means committees jointly introduced bipartisan legislation to standardize the assessment of patients among the four post-acute care settings late last week. The legislation has been a long time coming. MedPAC recommended a common patient assessment tool for post-acute care in 2005, then in 2008 Congress directed CMS to test a standardized assessment tool. Last year, the two committees asked stakeholders for post-acute care reform ideas and most of the about 70 responses they received called for a common patient assessment. Click here for a detailed, section-by-section summary.

Moody’s Supports Insurers’ Rate Hikes

Health insurers in 10 states that reported rate filings have the support of Moody’s Investors Services to go forward with double-digit rate hikes in 2015. Moody’s analysts said the rate increases reflect an increasing medical cost trend, the Affordable Care Act industry fee and regulatory changes that allow people to keep noncompliant plans for another year, according to a report released last week. Click here for the story.

White House Report Slams VA Health Care

A review ordered by President Barack Obama of the troubled Veterans Affairs health care system concluded that medical care for veterans is beset by “significant and chronic system failures,” substantially verifying problems raised by whistleblowers and internal and congressional investigators. A summary says the Veterans Health Administration must be restructured and that a “corrosive culture” has hurt morale and affected the timeliness of health care. The review also found that a 14-day standard for scheduling veterans’ medical appointments is unrealistic and has been susceptible to manipulation. Click here for details.

Respected Senator’s VA Investigation Is Startling

U.S. Senator Tom Coburn, M.D. (R-OK), last week released his own scathing investigation of the VA’s health care system. The report is based on a year-long investigation of VA hospitals around the nation that chronicled the inappropriate conduct and incompetence within the VA that led to well-documented deaths and delays. The report also exposes the inept congressional and agency oversight that allowed rampant misconduct to grow unchecked. Click here for the report.

HHS Proposes Automatic Health Plan Renewal for Exchange Customers

HHS last week proposed a new rule to automatically renew customers’ current health exchange plans unless people opt out of them. The rule would take effect in 2015. It would align federal exchange operations with the widely used market practice of automatically re-enrolling customers in existing plans every year with updated premiums and benefits. Click here for details from HHS. Click here for the proposed rule.

Study: Align Open Enrollment with Tax Season

If the federal government shifts open enrollment for health insurance exchanges to a different time of year, insurers would see many more enrollees sign up for their plans, according to a new report published in the journal Health Affairs last week. The next open enrollment period will last from Nov. 15, 2014, through Feb. 15, 2015. But the report authors say an enrollment period from Feb. 15 to April 15 would be more ideal because that’s when consumers receive income tax returns, which they could use to help pay for premiums. Click here for the Health Affairs article.

Another Analysis Demonstrates Benefits of Medicaid Expansion

States that expanded Medicaid by March 2014 had a 4 percent increase in the number of people on Medicaid, and that figure “appears strongly associated” with a 4 percent drop in the rate of uninsurance in those states, according to an analysis by the Urban Institute out last week. Researchers estimated that states that did not expand Medicaid by March 2014 experienced a much smaller drop in the uninsured rate, 1.4 percent. Click here for the study.

One-Third of Insurance Brokers Are Health Plan Navigators

As the Affordable Care Act changes the insurance landscape, more than 35 percent of health insurance brokers now act as navigators for plans offered on the exchanges, according to a new Aflac survey of more than 300 brokers. However, the survey also found 49 percent of brokers are somewhat lost in the healthcare industry and don’t know what their role entails. Click here for the survey.

NY Times Story on LTCHs Is Bleak

Critically ill patients, sometimes unresponsive or in comas, may live in long term acute care hospitals for months, even years, sustained by respirators and feeding tubes. Some, especially those recovering from accidents, eventually will leave. Others will be here for the rest of their lives. That’s the take on LTCHs from a story last week in the NY Times. Click here.

Wharton Study: Higher MA Payments to Hospitals Don’t Benefit Patients

Higher government payments to hospitals through the Medicare Advantage program don’t trickle down to benefit consumers, according to a study released last week from professors at the Wharton School at the University of Pennsylvania. Of the 52 million people enrolled in Medicare, about 30% opt out of the traditional program. Instead, they participate in Medicare Advantage plans, where the government writes a monthly per-person check to a health insurer that coordinates and finances the recipient’s care. Click here for the study.

VCA Standards Approved by Organ Procurement Group

The Organ Procurement and Transplantation Network last week approved the first national policies and standards for transplantation of limbs, faces and other structures known collectively as Vascularized Composite Allografts. The requirements, effective for 15 months while the network seeks comments on potential improvements, include criteria for defining VCAs covered in OPTN policy; OPTN membership requirements for VCA transplant programs; initial policies for VCA allocation; and guidance for gaining specific consent for VCA donations. Click here for details.

Omnicare Agrees to $124 Million Deal for Alledged Kickback

The nation’s largest supplier of pharmacy services to nursing homes has agreed to pay $124 million to resolve allegations that it offered illegal financial incentives to keep the business of skilled nursing facilities. DOJ alleged that the company entered into contracts to supply drugs to nursing homes below cost, a violation of anti-kickback provisions. Click here for more.

Consumer Health Care Spending Much Lower than First Believed in Early 2014

The Bureau of Economic Analysis’s new estimate that GDP fell at a 2.9 percent annual rate in the first quarter of 2014 reflected in part a re-estimation of consumer spending on health care, which was substantially lower than originally reported, according to the president’s Council of Economic Advisers last week. Health care spending’s contribution was revised down 1.2 percent, and health care prices continued rising “exceptionally slowly” at an annual rate of 0.5 percent in the first quarter. Utilization fell at a 1.4 percent annual rate in the quarter. Click here for more.

Report: Health Spending Expected to Increase Next Year

Growth in health care spending is expected to tick upward next year, in part because consumers who delayed treatment during the economic downturn are now seeking care they postponed, according to a report released last week. The PwC report forecasts medical cost growth of 6.8 percent over all in 2015, compared with their estimate of 6.5 percent for this year. Click here for the report.

Web Conference to Review Hep C Drug Value

The Center for Medical Technology Policy will co-host a web conference to explore the evidence needed to demonstrate effectiveness and value of new drugs to treat chronic hepatitis C infection. The web conference will take place Monday, July 7, at 12:00 pm EDT. Recently approved medications for hepatitis C have been the focus of attention not only because of their potential effectiveness, but also because of their price tag. Click here to register for the web conference.

JAMA Study: New Test Increases Breast Cancer Detection Rate

Adding a newer test to digital mammograms can increase the detection rate for breast cancer and decrease nerve-racking false alarms, in which suspicious findings lead women to get extra scans that turn out normal, a new JAMA study found. Millions of women will get the newer test, tomosynthesis, this year. Click here for the study.

Telemedicine Is Effective Strategy to Detect Infant Eye Disease

Telemedicine is an effective strategy to screen for the potentially blinding disease known as retinopathy of prematurity (ROP), according to a study funded by the National Eye Institute and released last week. The investigators say that the approach, if adopted broadly, could help ease the strain on hospitals with limited access to ophthalmologists and lead to better care for infants in underserved areas of the country. Click here for the NIH report.

Telepsychiatry Dramatically Reduces Rural Hospital Evaluation Time

When emergency room patients are deemed “a danger to themselves or others,” every state requires hospitals to hold them until a psychiatrist conducts a face-to-face evaluation to decide whether it is safe to let them leave. In rural hospitals across the country, it can take days for a psychiatrist to show up and perform the exam. Today, thanks to a “telepsychiatry” program that allows psychiatrists to examine patients through videoconferencing, average wait times are reduced from four days to less than 10 hours. Click here for the story.

Serious Mental Illness Costs Explored in USA TODAY Series

USA TODAY is exploring the human and financial costs the country pays for not caring more about the nearly 10 million Americans with serious mental illness. The series examines how stigma and discrimination prevent people with mental illness from receiving life-changing care and services, and why so many people with mental illness become prisoners of addiction. Click here for the first two parts.

CDC: Excessive Drinking Costs 88,000 Lives Per Year

Nearly one in ten deaths of working-age adults are attributable to “excessive alcohol consumption,” from alcohol related disease, car crashes, homicides, and other causes, according to a new report from the CDC. Click here to read the report.