WEEKLY E-BULLETIN


“Drive-By” Doctoring Raises Concerns of Cost, Transparency

In operating rooms and on hospital wards across the country, physicians and other health providers typically help one another in patient care. But in an increasingly common practice that some medical experts call drive-by doctoring, assistants, consultants and other hospital employees are charging patients or their insurers hefty fees. They may be called in when the need for them is questionable. And patients usually do not realize they have been involved or are charging until the bill arrives. Click here for the NY Times report.

Big Changes Coming to Post Acute Care

A measure to create a standardized assessment tool for Medicare’s system for handling post-acute care is headed to the White House for the President’s signature. The House and Senate cleared last week a bill, HR 4994, that would require Medicare’s post-acute care providers to submit standardized data on its services. It also would require HHS and MedPAC to provide Congress with new models for post-acute care payments, such as using bundled or site-neutral payments. Click here for a copy of the bill and a summary.

FTC: Consumers May Be Victimized by Mergers

With the number of hospital mergers continuing to grow, the Federal Trade Commission is rattling its powerful sabre suggesting that consumers may be victimized by this merger mania. The NY Times reports that the FTC is touting the number of its successes against hospital mergers and now physician practice acquisitions. Click here.

RAC Appeals Deal Called Into Question

Hospitals have until October 31 to take CMS’ deal on RAC appeals. CMS will pay 68 percent of the net payable value of a denied eligible claim in exchange for a hospital’s acceptance of the administrative agreement as the full and final administrative and legal resolution of the claim. Click here for an excellent summary of the issue. The chairman of the Ways and Means Health Subcommittee tried to throw cold water on the CMS “deal” last week saying CMS didn’t have the authority to offer such a deal. Click here for his letter to CMS.

CMS Raises Concerns with Adjusting Hospital Readmissions for Socioeconomic Reasons

Serious discussions between Congress and CMS concerning the hospital readmissions penalty program are continuing and last week CMS sent a letter to one of the leading congressional advocates for changing the current program. CMS said it is continuing to make adjustments to the program but it has concerns about adjustments for the socioeconomic status of patients. Click here for the letter from the CMS Administrator to U.S. Rep. James Renacci (R-OH). Click here for Renacci’s letter to CMS.

“Super-Utilizers” of Health Care Are Targeted

Efforts are underway to better manage the nation’s “super-utilizers,” the 1% of the population who account for 22% of health care spending, according to CMS. In the states’ Medicaid programs — which increased by at least 3 million people in 2014 because of the Affordable Care Act — 5% of users account for 54% of spending. Most have three or more chronic conditions, such as diabetes, heart disease or HIV. Many are also fighting substance abuse, homelessness and mental health issues, creating a mix of hard-to-reach and hard-to-treat patients. Click here for the report.

Baby-Friendly Hospital Certifications Increasing

The number of U.S. hospitals applying for the baby-friendly certification has gained momentum since 2010, when the HHS incorporated the practices into federal goals. And the hospital measures are in keeping with the latest research about the significant health benefits of breast-feeding. So far, 197 U.S. hospitals, of more than 3,000, have been certified as baby-friendly, according to Baby-Friendly USA, the accrediting body. Click here for the story. Click here for Baby-Friendly.

Consumers Saved $1 Billion in 2013 on Insurance Rates

Insurance regulators cut $1 billion off consumers’ 2013 health premiums by negotiating lower rates than carriers initially proposed, according to a report released late last week by HHS. Premium rate reviews, which occurred in many states before Obamacare, are now mandatory for proposed increases of 10 percent or more. Regulators around the country are negotiating with insurers over their proposed 2015 rates. Click here for the 7-page HHS report.

Are Insurance Companies Needed?

Do we really need insurance companies? That’s the question addressed by one of the country’s best known insurance watchdogs, Wendell Potter, in an interesting commentary written last week. Click here.

Insurers May Be Requiring Patients to Pay More for Rx

Health insurance companies are no longer allowed to turn away patients because of their pre-existing conditions or charge them more because of those conditions. But some health policy experts say insurers may be doing so in a more subtle way: by forcing people with a variety of illnesses — including Parkinson’s disease, diabetes and epilepsy — to pay more for their drugs. Click here for the NY Times report.

CDC: Four More States Seeing Cases of Rare Respiratory Illness

The rare respiratory illness that cropped up in multiple states recently has been confirmed in four new states, public health officials said last week. Cases have been confirmed in Connecticut, Montana, Nebraska and Virginia, according to the CDC, which means that 16 states now have confirmed cases of the virus. The others are: Alabama, Colorado, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Missouri, Oklahoma, Pennsylvania and New York. Click here for more from the CDC.

HHS Says Obamacare Sign-Up Is 7.3 Million

7.3 million. That’s the number of Americans the Obama Administration says bought private health insurance under the Affordable Care Act, paid their premiums and are still enrolled. More than 85 percent of people with marketplace coverage are receiving subsidies in the form of tax credits that lower their premiums. Click here for the NY Times story.

New Medicaid Beneficiaries Like Their New Coverage

Millions of other Americans have successfully signed up for Medicaid, particularly in states that expanded the program under the Affordable Care Act. So, what do they think about their new coverage? Click here for the results of numerous focus groups reported by the Washington Post.

The Number of Uninsured Drop…But By How Much?

So, how many Americans are uninsured today? There were new reports last week that tried to put a number to the question. The Census Bureau said the nation’s uninsured rate was 13.4% – BUT that was before Medicaid expansion. A new Gallup survey and another government agency are also trying to come up with a number. Click here for the story.

Medicare Advantage Rates Stable, Enrollment Increasing

CMS last week announced that for the fifth straight year Medicare Advantage enrollment is projected to increase to a new all-time high, while premiums remain affordable. The average MA premium submitted by health plans for 2015 would increase by $2.94 next year, to $33.90 per month. However, CMS estimates the actual 2015 MA average premium will increase by only $1.30, as more beneficiaries elect to enroll in lower cost plans. 61 percent of beneficiaries will not see any premium increase at all. Open enrollment is October 15 to December 7. Click here for a state-by-state CMS summary…you will need to scroll down to find your state.

ACOs: Medicare’s Salvation or Just So-So?

CMS last week issued quality and financial performance results showing that Medicare Accountable Care Organizations (ACOs) have successfully improved the quality of care for Medicare beneficiaries. ACOs in the Pioneer ACO Model and Medicare Shared Shavings Program also generated over $372 million in total program savings for Medicare ACOs. At the same time, ACOs qualified for shared savings payments of $445 million. Click here for the CMS report. Of course, not everyone agrees there has been universal success. Click here for the response from the national ACO association.

Affordable Care Act Is a Mixed Success Story

Is Obamacare working? Click here for a brief and balanced summary from the Economist.

Leading CEOs Say Health Care Innovation Is the Way and Issue Challenge

CEOs of some of the nation’s top companies are challenging the business community to take the lead on improving health care in the U.S. through innovation. The top executives of Coca-Cola, Bank of America, Aetna and others unveiled a new initiative in Washington last week. Click here for the report. Click here for the news story.

Government Announces New Antibiotic Resistance Initiative

The Obama administration last week announced measures to tackle the growing threat of antibiotic resistance, outlining a national strategy that includes incentives for the development of new drugs, tighter stewardship of existing ones, and improvements in tracking the use of antibiotics and the microbes that are resistant to them. Antibiotic resistance takes 23,000 lives in America each year. Click here for the NY Times report.

Congress Set to Pass Sun Screen Legislation

The House and Senate have both approved their version of legislation that is designed to speed up FDA approval of sunscreen ingredients. Once the bills are reconciled, which could happen before the end of the year, the FDA will be required to clear up its backlog of ingredients under review. Click here for the story.

IOM Report: Prepare Patients for End of Life

A new report from independent experts at the Institute of Medicine may revive the conversation about preparing patients for the end of life and resurrect the “Death Panel” debate. Attitudes on end-of-life care are naturally deeply personal. But the truth is many people don’t have much say in the matter because they don’t appropriately plan for it. IOM says insurers should pay docs to discuss it with patients. Click here for the news story. To see a summary of the IOM book click here.

Bariatric Surgery Rates Vary Across U.S.

Bariatric surgery has become a widely accepted, Medicare-covered treatment for obesity. But like so many aspects of U.S. medicine, some parts of the country have a far higher rate of surgery than others — and the differences aren’t based on local rates of obesity and diabetes, according to the latest Dartmouth Atlas report. Click here for their comprehensive report on obesity. Another report out last week talks about how Americans are getting fatter and older with diabetes. Click here for the USA Today story.

Hep C Cure Drug Sales Waning; New Drugs on the Way

Sales of the $84,000 Hep C cure drug appear to be slowing, according to data released by CVS Health last week. But that doesn’t mean it’s because of the high cost. The slowdown can partly be explained by the health-care industry’s anticipation of more hepatitis C treatments soon hitting the market, including another one from Gilead that could gain FDA approval any day now. Click here for the story.

Transplant Allocation Policies in the Spotlight Again

The wait for a liver transplant alone killed about 1,523 people in 2013, according to a federal agency overseeing organ transplant policy. Nearly the same amount of people were taken off the waiting list for a new liver last year because they were determined too sick to receive a transplant. Liver donations are awarded to patients with the greatest need, but geography also plays a role. There’s a growing debate over the liver allocation system. Click here for the report.

HCAHPS Preview Period Underway

As part of CMS’ Hospital Inpatient Quality Reporting Program (IQR) preview period — which runs from Sept. 15 to Oct. 14 — CMS informed hospitals last week that they will have a preview of their star ratings system based on Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS). Click here the latest HCAHPS update from CMS.

New Meaningful Use Reporting Period Bill Introduced

A one-paragraph bill introduced last week would require that HHS “shall continue through 2015 (in the case of eligible professionals) and fiscal year 2015 (in the case of eligible hospitals and critical access hospitals) to permit the use of a 3-month quarter EHR reporting period to demonstrate meaningful use for purposes of such part, without regard to the payment year or the stage of meaningful use criteria involved.” Click here for more info.

VA To Increase Physician, Dentist Pay

The Veterans Affairs Department plans to bump pay for VA doctors and dentists in an effort to recruit more top talent, according to a VA announcement last week. The VA plans to update existing pay tables to increase pay for newly hired doctors by between $20,000 and $35,000 more than current salary ranges. However, doctors in leadership and executive roles would not be included in the pay raises. The policy will take effect on Nov. 30. Click here for the notice from the VA.

IRS Rule Outlines Cap on Insurance Execs’ Deductions

The IRS last week finalized a half-million-dollar cap on deductions that the biggest insurance companies can take for executive pay. The little-known Affordable Care Act provision amounted to about $1.3 million per executive for the biggest carriers in 2013, according to a recent analysis by the Institute for Policy Studies. The tax code change saved the government about $72 million from the 10 largest insurers last year. Click here for the IRS reg. Click here for the interesting analysis.

Report: More Women Pay Less Out-of-Pocket for Contraceptives

The proportion of women who paid nothing out of pocket for oral contraceptives rose sharply after the Obamacare coverage for birth control went into effect, according to a new Guttmacher Institute study. The proportion of privately insured women who paid nothing rose from 15 percent in the fall of 2012 to 67 percent this spring — the health law requires contraception to be available without a co-pay in most health plans. Click here for the study.

HRSA Funds Health Centers for HIV Care Integration

The Health Resources and Services Administration (HRSA) announced $9.9 million in funding through the Affordable Care Act to 22 health centers in Florida, Massachusetts, Maryland and New York. The awards will support the integration of high-quality HIV services into primary care through innovative partnerships between the health centers and state health departments. Click here for a list of where the money is going.

CMS To Pay $13.8 Million for Next Generation Ventilator Development

HHS will sponsor the advanced development of a next-generation portable ventilator to help fill the need for portable, low-cost, user-friendly and flexible ventilators in a pandemic or other public health emergency. The new ventilator will be developed under a three year, $13.8 million contract with Philips Respironics of Murrysville, Pennsylvania. Click here for more from HHS.

Study: 6.4 Trillion Calories Cut By Producers

Researchers at the University of North Carolina report, in a study published in the American Journal of Preventive Medicine, that a coalition that includes 16 of the largest food and beverage companies did indeed cut 6.4 trillion calories out of their food and beverage products between 2007 and 2012. The 10 percent reduction means a decrease in consumption by Americans of 78 calories per capita per day, the researchers found. Click here.