WEEKLY E-BULLETIN


IOM Calls for Major Overhaul of Graduate Medical Education

The Institute of Medicine called for a major overhaul of the United States’ graduate medical education system in a report released last week. The federal government spends about $15 billion a year on funding for GME, with the bulk of that–nearly two-thirds–coming from Medicare. Although the report calls for the government to maintain current levels of public funding, it also recommends it change the way Medicare funds physician training over the next 10 years. Click here for the report brief. Click here for the IOM’s 6 recommendations.

340B Congressional Support a Concern

Supporters of the 340B drug discount program circulated sign-on letters in the House and Senate over the past two weeks to demonstrate a show of congressional support for the program. 31 Senators, but only 4 Republicans, signed the Senate letter to the Committee with jurisdiction over the issue. 77 Representatives, or only 18 percent of the House, also signed on. There were 24 Republicans and 53 Democrats on the House letter. HRSA is expected to released proposed regulations governing the 340B program any day now. Click here for the final Senate letter. Click here for the House letter.

VA Reform Bill Passes, Impact on Providers Assessed

Congress late last week passed the VA reform legislation. The President is expected to sign it. The $17 billion plan is designed to decrease the waiting times of veterans to receive care as billions of dollars will be spent for the VA to hire more physician and clinicians and build new facilities. There are also provisions that would allow more veterans to receive their care from private providers, outside the VA system. Click here for a summary from Strategic Health Care on what those provisions may mean for you. Click here for a complete summary from the CBO.

Hospital Mergers Accelerate; Medical Arms Race Continues; Physician Acquisition Practices Questioned

Strategic alliances between hospitals are now more popular than mergers, according to a report last week. Healthcare merger and acquisition activity has sharply increased since the Affordable Care Act’s passage, with more than twice as many deals in 2012 as 2009. There are numerous possible reasons for this, including the ACA’s incentives to provide more efficient, high-quality care and a desire for security as the economy continues to slowly recover from the recession. Click here for the story. According to studies out last week, the medical arms race between hospitals continues. Click here for the Washington Post report. As hospitals continue to buy physician practices and clinics, regulators are taking a closer look at the impact on prices. Click here for the BloombergBusinessweek report.

5 Million Americans Treated for Skin Cancer

A U.S. Surgeon General report released last week showed that almost 5 million Americans are treated for skin cancer annually. Acting U.S. Surgeon General Boris Lushniak said excessive exposure to indoor and outdoor ultraviolet light is a main reason that skin cancer is a “major public health problem.” People are not prohibited from enjoying the outdoors, but it is necessary to “take steps to protect your skin,” Lushniak said. Click here for the report.

GAO: Hospital Bed Taxes, Other Revenue Supporting Medicaid Program

Hospital bed taxes have become more popular in recent years for states to help fund their portion of the Medicaid program, with the states using the fees to then leverage matching Medicaid funds, according to a new GAO report. One such tax in California was recently extended and will likely raise more than $10 billion over the next couple of years. The states financed 26 percent of their Medicaid obligations, or $46 billion, from healthcare providers and local governments in fiscal year 2012, according to the report. Click here for the report.

Reports: Some Clinical Trials Run by Questionable Docs; Social Media Impacting Trials

A new investigative report out last week details how some organizations are hiring physicians to conduct clinical trial programs who have had disciplinary action taken against them. Sometimes the sanctions imposed have been severe. Click here for the report. Social media may be jeopardizing some clinical trials, according to a report last week in the Wall Street Journal. Click here.

Hospitals Pay for Use of U.S. News Best Hospital Ranking

Hospital staff and administration work hard to earn a place in the U.S. News and World Report ‘s Best Hospital rankings each year, but those same hospitals then pay the publication if they want to use the “Best Hospitals” logo in advertising, according to reports last week. Children’s Mercy Hospitals and Clinics in Kansas City pays $42,000 a year to use the logo, according to news reports. Click here for the story.
– Click here for the 2014-15 U.S. News Best Hospital results from 3 weeks ago.
– Click here for the Leapfrog Hospital Safety Survey released 2 weeks ago.

New Ambulances, Home Health Agencies Ban Continued

CMS last week announced it will extend its current enrollment moratoria on new ground ambulances in the Houston and Philadelphia metropolitan areas and new home health agencies in the metropolitan areas of Chicago, Fort Lauderdale, Detroit, Dallas, Houston, and Miami. CMS said the extension is necessary because the significant potential for fraud, waste and abuse continues in these areas. Click here for a full list of impacted counties.

CMS Announces IRF, Psych, SNF Payment Increases

CMS announced last week that next year Medicare will pay inpatient psychiatric facilities 2.5 percent more, nursing homes reimbursement will increase 2 percent and pay for inpatient rehabilitation facilities will increase 2.4 percent. CMS also officially delayed ICD-10 until Oct. 1, 2015. CMS also said Medicare drug premiums will remain stable next year, despite predictions that the hepatitis C drug Sovaldi would have a major impact on the Part D program. The average Medicare Part D premium will be $32 per month, compared to between $30 and $31 over the past four years, according to CMS. Click here for details from CMS on the Part D drug program.

  • IRFs-CMS estimates that aggregate payments to IRFs will increase in FY 2015 by $180 million, or 2.4 percent, relative to payments in FY 2014. This estimated increase is attributed to a 2.2 percent payment update, which includes a 2.9 percent market basket increase factor, reduced by a 0.5 percentage point multi-factor productivity adjustment and an additional 0.2 percentage point reduction as required by law. Click here for details.
  • Inpatient Psych-The IPF PPS applies to inpatient psychiatric facilities across the United States, including both freestanding psychiatric hospitals and psychiatric units of acute care hospitals or critical access hospitals. The updated rates would generally be effective for discharges occurring on or after October 1, 2014. Under the final rule, payments to IPFs are estimated to increase by 2.5 percent compared to FY 2014. Click here.
  • SNFs-On February 28, 2013, the Office of Management and Budget issued OMB Bulletin No. 13-01, which contained a number of significant changes related to the delineation of Metropolitan Statistical Areas, Micropolitan Statistical Areas, and Combined Statistical Areas, and guidance on uses of the delineation of these areas. To align with these changes, CMS is revising the wage index based on the newest OMB delineations for the FY 2015 SNF PPS wage index. Click here.

Medicare Bundled Payment Program Booming

The increasing number of healthcare providers joining a trial run of bundled Medicare payments signals widespread interest to explore risk-based reimbursement models. About 4,100 providers will join 2,400 hospitals, nursing homes and medical groups as candidates for Medicare’s Bundled Payment for Care Improvement initiative, the CMS Innovation Center said last week. At this stage, providers vet their performance under the possible bundled payments to see how much risk they can tolerate. Not all of the candidates will agree to actually enter into bundled-payment contracts. In the first crop, 86 did not and 236 went ahead. Click here for CMS’ updated bundled payments fact sheet.

$55 Million Awarded to 221 Health Centers

HHS announced last week $54.6 million to support 221 health centers in 47 states and Puerto Rico to establish or expand behavioral health services for over 450,000 people nationwide. Health centers will use these new funds for efforts such as hiring new mental health professionals, adding mental health and substance use disorder health services, and employing integrated models of primary care. Click here for the list of recipients.

FDA To Strengthen Diagnostic Regs

The FDA last week took steps to ensure that certain tests used by health care professionals to help diagnose and treat patients provide accurate, consistent and reliable results. The FDA is issuing a final guidance on the development, review and approval or clearance of companion diagnostics, which are tests used to identify patients who will benefit from or be harmed by treatment with a certain drug. The agency is also taking other actions. Click here for the details.

Colorado Website Compares Hospital Prices

The non-profit Center for Improving Value in Health Care has launched a website that allows residents of Colorado to compare hospital prices statewide, according to reports last week. The data was derived from the state-mandated All Payer Claims Database. Currently, prices are only available for three major inpatient services: Joint replacement (knee and hip), vaginal birth and cesarean sections. There are wide price disparities among hospitals for the services provided. A knee replacement ranges from $25,000 to $50,000; a joint replacement varies from around $25,000 to $36,000; vaginal births range from $5,500 to $11,000; while are priced between $10,000 and $18,000. Click here to go to the website.

Study: Patient Income Affects Hospital Over-Utilization

Patients’ income affects the likelihood they will unnecessarily seek care at hospitals instead of doctor’s offices or clinics, according to a study out last week by the Rutgers Center for State Health Policy in New Jersey. Researchers discovered that for every 1 percent increase in per capita income among New Jersey residents, there was a nearly 1 percent decrease in avoidable hospital visits. The researchers analyzed 13 regions and related hospital costs and utilization throughout the Garden State to reach their conclusion. Click here for the study.

New ACA Enrollees Get Health System Education

Efforts are underway to help the 8 million Americans who bought health insurance under the Affordable Care Act learn how to use their benefits and navigate our complicated health care system. Click here for the New York Times story.

D.O.s Shedding “Second-Tier” Image: Report

With a looming shortage of M.D.s, osteopathic medicine is shedding its second-tier image. And yes, D.O.s are real doctors, says a story last week in the New York Times. Click here.

AMA Helping Docs Navigate Sunshine Law

The American Medical Association is providing help navigating CMS’ electronic registration system to physicians looking to view and dispute reports from drug and device manufacturers under sunshine law reporting requirements, as the deadline for disputing inaccurate reports is August 27 and physicians have found the process complex. Click here for details from the AMA.

ICD-10 Start Finalized for October 1, 2015

HHS issued a rule last week finalizing October 1, 2015 as the new compliance date for health care providers, health plans, and health care clearinghouses to transition to ICD-10, the tenth revision of the International Classification of Diseases. This deadline allows providers, insurance companies and others in the health care industry time to ramp up their operations to ensure their systems and business processes are ready to go. Click here for more from CMS.

Observation Status, 2-Midnight Rule Slammed At Senate Hearing

Many Senate Aging Committee members renewed their support last week for a bill to count all time spent in a hospital, whether in observation or inpatient, toward the necessary three-day stay before Medicare pays for nursing home care. Representatives from four hospital organizations testified and were critical of the impact of the two-midnight rule and other regulations that impact inpatient vs. observation status. Click here for the interesting testimony of Marna Borgstrom, CEO of Yale-New Haven Health System.

Trustees Report: Medicare Gets 4 More Years of Solvency

The Medicare Trustees in a report released last week projected that the trust fund that finances Medicare’s hospital insurance coverage will remain solvent until 2030, four years beyond what was projected in last year’s report. Due in part to cost controls implemented in the Affordable Care Act, per capita spending is projected to continue to grow slower than the overall economy for the next several years. Click here for the report.

CHIP Extension Bill Introduced

U.S. Reps. Frank Pallone (D-NJ) and Henry Waxman (D-CA) last week introduced legislation that would extend funding for the Children’s Health Insurance Program (CHIP) which is currently set to run out on September 20, 2015. It would also extend the health law’s expiring increased Medicaid payments for primary care doctors. Click here for details. Senator Rockefeller (D-WV) has introduced similar legislation.

Study Shows Impact of Not Extending CHIP

Legislation to extend the CHIP program follows the release of multiple studies showing that low-income families would face greater cost-sharing and have networks meeting fewer of children’s needs on ACA exchange plans compared to CHIP. Click here for one study that has a state-by-state breakdown of CHIP benefits.

The Election Season Is Clearly Upon Us

So, who has benefited from the Affordable Care Act? House Democratic leaders last week released a congressional district-by-district breakdown of the numbers. Click here to check out the impact on your congressional district.

Tax On Sugary Drinks Proposed

It won’t pass this year, but legislation introduced last week by U.S. Rep. Rosa DeLauro (D-CT) would levy a penny-per-teaspoon excise tax on the caloric sweeteners in beverages like Gatorade and Coca-Cola and raise as much as $10 billion a year for public health prevention initiatives. DeLauro is optimistic that, as with a 2010 menu labeling act, opposition to the Sweetened Beverages Tax (SWEET) Act will wane. Click here for more.