WEEKLY E-BULLETIN


White House: Hospitals Seeing Major Uncompensated Care Reductions

In states that have expanded Medicaid, the White House said last week, hospitals are seeing substantial reductions in “uncompensated care” as more patients have Medicaid coverage and fewer are uninsured. The Administration said the data should persuade more states to expand Medicaid. HHS projects that hospitals will save $5.7 billion in uncompensated care costs this year. Hospitals in states that have expanded Medicaid are projected to save up to $4.2 billion of the total amount. Click here for the NY Times story. Click here for the HHS announcement. Click here for a detailed analysis that includes info from for-profit hospital systems that publicly report their data.

Capitated Medicare ACO Demo Bill Introduced

Legislation was introduced last week to test capitated Medicare ACOs in a demonstration that eventually could be ramped up nationally. The pay structure of the ACOs would resemble HMOs, but patients would be allowed to visit providers out of network as they are in ACOs. The ACO Improvement Act (H.R. 5558) would give ACOs tools to keep patients in network, without requiring patients to remain in network. Click here to see the bill. Click here for a summary.

Number of Pioneer ACOs Drops by 4 to 19

4 more Pioneer ACOs — Genesys PHO in Flint, MI; Franciscan Alliance in Indiana; Renaissance Health Network in Pennsylvania and Sharp HealthCare in San Diego (announced last month) — have decided to leave this Medicare demonstration program, according to announcements last week. This leaves 19 of the original 33 in the Pioneer program. Click here for the Wall Street Journal report.

HHS Report: Medicaid Patients Having Hard Time Finding Doctor

A report to be issued this week by the inspector general at HHS, says state standards for access to care vary widely and are rarely enforced. As a result, it says, Medicaid patients often find that they must wait for months or travel long distances to see a doctor. Click here for the New York Times report.

Survey: Most Physicians “Over Extended or At Full Capacity”

81 percent of physicians describe themselves as either over-extended or at full capacity, while only 19 percent indicate they have time to see more patients, according to a new survey from Merritt Hawkins. Forty-four percent of physicians surveyed plan to take steps that would reduce patient access to their services, including cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking non-clinical jobs, leading to the potential loss of tens of thousands of FTEs. Click here for their survey.

Report: Following Care Guidelines Reduces Costs

Hospitals are cutting costs by getting doctors to stick to established guidelines, according to a report last week in the Wall Street Journal. Click here.

Some Drug Companies Getting Around 340B

It remains unclear how, or even whether, HRSA intends to move forward with its much heralded 340B regulatory framework proposal (which has yet to be released for review.) Some say HRSA is unsure about moving forward with a regulatory plan because it knows it will likely face a legal challenge, no matter what it proposes. Meanwhile, drug companies are taking new actions that will limit their 340B “exposure.” Click here for this report on Genentech’s move to specialty distributors that will impede the 340B discount to providers.

Telemedicine Groups Push Technology Solutions in Congress

Medicare only paid $12 million for telemedicine services last year. Not a lot, considering the vast investment that has been made to develop these services over the past several years. So, a group of 13 telemedicine advocates wrote the House Energy and Commerce Committee last week to offer their collective suggestions on how the committee should help technology. The organizations said Congress should allow greater use of telemedicine by accountable care organizations, federally qualified health centers and critical access hospitals. Click here for their detailed letter.

Narrow Network Debate Heats Up

The development of narrow networks that limit which providers can participate in certain health insurance programs continues to be hotly debated across the country. A South Dakota ballot initiative would create a new “any willing provider” law that would require the inclusion of a provider in any network when the provider meets their standards. Other states are looking at creating similar laws or strengthening their current any-willing-provider statutes. Click here for the report. Another report out last week from Robert Wood Johnson says there hasn’t been too much complaining from consumers about narrow networks. Click here.

Lawsuits Filed in Narrow Network Cases

More pushback against narrow networks continued in the form of legal action as a consumer group filed lawsuits against Cigna and Blue Shield of California last week. Consumer Watchdog alleged that Cigna and Blue Shield of California misled consumers with a “bait and switch” scheme. Their plans offered inadequate provider networks and incorrectly advertised which providers were in network, and when consumers learned that their doctors weren’t covered in the plans, it was too late to switch insurers. Click here for a summary and the two lawsuits.

More Insurers to Participate on Federal Exchanges

The 36 states on the federal marketplace are expected to see an increase from 191 insurers participating in the 2014 enrollment period to 248 in 2015, while the eight state-run exchanges will see the number of insurers increase from 61 to 67, according to the report from HHS. Click here for that report.

Medicaid, CHIP Enrollment Increasing

More than 7.9 million people enrolled in Medicaid or the Children’s Health Insurance Program between Oct. 1 and July 31, increasing total enrollment in the programs by an estimated 13.6%, according to a report released last week by CMS. Click here to see a state-by-state breakdown (starts on page 9).

FDA Campaign to Crackdown on Fake Drugs

Federal prosecutors have recently uncovered rogue companies distributing foreign versions of Botox, fake cancer drugs and other unapproved or contaminated medicines in the U.S. Often those operations will entice physicians by faxing “too good to be true” flyers that offer 75 percent or more off pricey injectable drugs. The FDA is fighting back with a campaign starting this week. Click here for the story. Click here for the FDA announcement.

Survey: Docs Say Distrust of Payers Is Impediment to Value-Based Relationships

41 percent of primary care physicians, who are not currently in a value-based relationship, say their biggest obstacle before agreeing to enter into one is their distrust of payers – this is according to a study released last week. The study also found that only 16 percent of all physicians surveyed were willing to accept the financial risk – a key element of many value-based relationships sought by insurers. Click here for the FTI Consulting survey summary.

Interest Payments Is Focus of RAC Appeals Deal

As hospitals across the United States evaluate the recent CMS offer of an administrative agreement to resolve their pending RAC appeals in exchange for partial payment of 68 percent of the net payable amount, new attention is being focused on interest — specifically, “935 interest.” Click here for the report.

How Hospitals Are Coping with Payment Changes

U.S. New had a report last week about how hospitals are coping with the overall reduction in the growth of Medicare spending – which has also translated to slower reimbursement growth from all payors. The summary – innovate or don’t survive. Click here. Meanwhile, Bloomberg reports on how hospitals are trying to get patients to pay more up front for the services they receive. Click here.

$212 Million Awarded for Health Initiatives

The CDC last week awarded $212 million in grants to state and local government and other organizations for programs to reduce obesity, tobacco use and death and disability due to diabetes, heart disease and stroke. The 193 grants are funded in part by the Affordable Care Act. Click here to see who received funding, including a number of hospitals.

$22 Million Awarded to Rural Health Efforts

HRSA last week awarded $22.1 million in rural health grants, including $16 million to help rural health networks coordinate, expand and improve essential services; $2.3 million to support tele-emergency care; $1.5 million for the Radiation Exposure Screening and Education Program; $1 million to improve access to automated external defibrillators; and $600,000 for resource centers to help health care providers implement telehealth programs. Click here for a state-by-state summary.

New Breast Cancer Drug Showing Unprecedented Success in Prolonging Life

A drug used to treat advanced breast cancer has had what appears to be unprecedented success in prolonging lives in a clinical trial, researchers reported yesterday. Patients who received the drug (Perjeta, from the Swiss drug maker Roche) had a median survival time nearly 16 months longer than those in the control group. The lead author is with MedStar Washington Hospital Center in D.C. Click here for the story.

Pharma Companies May Lose Most in “Inversion” Efforts

It appears that pharmaceutical companies may be the big losers in the Obama Administration’s efforts to stop the practice of ‘inversion’, where companies try to avoid paying U.S. taxes by moving their headquarters outside the United States. Click here for the report.

Employer and Insurer Based Wellness Programs Questioned

Are employer and insurer-based wellness programs effective? Many may be doomed to fail based on a recent survey finding that most consumers don’t trust their insurers or employers as a source of health and wellness. Based on more than 1,000 consumers participating in a survey from health optimization company Welltok, just 8 percent rely on their health insurers as a source of health and wellness. And just 10 percent rely on employers. Click here for a summary. Here for the survey.

CMS Conference Call Scheduled on HCAHPS Rating System

CMS is sponsoring a conference call on its planned star rating system for survey data from the Hospital Consumer Assessment of Healthcare Providers and Systems. Click here for more information and to register for the call, which is Wednesday, October 8 from 1:30-3 p.m. EDT. CMS expects to begin reporting HCAHPS star ratings on Hospital Compare next April. Hospitals can preview how their data would appear in the star rating system, and provide feedback to CMS on how to improve the system, at the QualityNet portal through October 14.

House Democrats Want Funding for End of Life Planning

34 House Democrats last week asked CMS to change Medicare rules to allow providers to be reimbursed for helping patients with end-of-life care and planning, which is the policy that led former Alaska Governor and GOP Vice Presidential candidate Sarah Palin to coin the phrase “death panel” during the Obamacare debate. Click here for their letter and to see who signed on.

PACE Pushed by Senators

The PACE program is getting a U.S. Senate push. More than a dozen senators from both parties are calling on the Obama administration to broaden a Medicaid program for the nation’s frailest seniors, calling it a proven alternative to pricier nursing home care as states seek to limit long-term medical costs. In a letter released last week, the senators urged CMS to follow through on plans to loosen restrictions on the Program of All Inclusive Care for the Elderly. Click here for the letter.

Dying at Home May Be Harder Than You Think

Many geriatric experts say that if the wasteful medical spending on end of life could be redirected, it could pay for all the social supports and services actually needed by today’s fragile elders and their families. Instead, public money appears to benefit health care businesses but not necessarily patients. An example is the abuse of short-term rehabilitation in nursing homes, improper charges costing more than $1.5 billion a year, federal HHS inspectors reported in 2012. Click here for this compelling story about one woman’s battle to have her father die at home.

Wearable Health Monitoring Devices Driving Changes

Mobile applications and wearable monitoring devices will get people more involved in their own health and change how care is delivered in the U.S., according to a report from the IMS Institute for Healthcare Informatics. Mobile health technology could encourage wellness and ensure treatments are appropriate, saving $81 billion in health care costs, the report says. Improved delivery and payment models could save a further $200 billion each year in avoidable costs. This is 1 of 10 “harbingers of change” identified in their report. Click here for more.

Respiratory Illness Spreads to 40 States

An outbreak of respiratory illness first observed in the Midwest has spread to 40 states, sending children to hospitals and baffling scientists trying to understand its virulent resurgence, according to the CDC. As of Friday, the CDC had confirmed 277 cases of infection with enterovirus 68. But it is likely that many times that number have been stricken. One case involved an adult, and no deaths have been linked to the infection. Click here for more from the CDC.