Ebola Update – The Provider Perspective

  • Texas Health Presbyterian Hospital Invests in Campaign to Rehab Reputation — Click here to read the story from the Dallas News.
  • The Ebola Crisis Is Testing Presbyterian Hospital – Moody’s Issues Credit Change — Click here for the report.
  • Texas Health Resources (THR) CEO Places Full-Page Ad in Texas Newspapers — Click here for the letter.
  • THR’s Chief Clinical Officer Testified Before a House Committee Last Week — Click here for his testimony.
  • U.S. Hospitals Aren’t Ready for Ebola – Click here for the story from the Atlantic.
  • The CDC Says Hospitals ARE Ready for Ebola – Click here for the CDC report.
  • Colorado Officials Designate 3 Hospitals as Ebola-Ready — Click here for the story.
  • CDC will Issue New Guidelines to Protect Health Workers — Click here.
  • The federal government has already spent $311 million responding to Ebola — Click here for details.

CMS Announces $114 Million ACO “Investment” Model for Rural Health

CMS has released another ACO model designed with rural health care in mind. Under the ACO Investment Model, ACOs that will begin participating January 1, 2016 will receive three types of payments: an upfront, fixed payment; an upfront, variable payment and a monthly payment of varying amount depending on the size of the ACO. Click here for details from CMS.

Waivers from Fraud and Abuse Extended for Medicare ACOs

CMS and the HHS OIG have extended the effectiveness of an interim final rule related to waivers from fraud and abuse rules for Medicare ACOs. In November 2011, CMS and OIG issued an interim final rule with comment period establishing waivers of the application of the physician self-referral, federal anti-kickback statute and certain civil monetary penalty law provisions to specified arrangements involving ACOs participating in the MSSP. Click herefor details.

HHS To Hold Second Public Conference Call on RAC Appeals Status

HHS’ Office of Medicare Hearings & Appeals on Wednesday, October 29 will host its second forum on the backlog of Medicare RAC and other appeals. During the hearing, representatives from OMHA will provide information about initiatives it has undertaken to address the appeals backlog at the OMHA-level and streamline the adjudication of appeals. Officials will also provide updates on actions they are taking to address appeals. Click here for information on how to participate.

Feds: Medicare Advantage Plans See Increase in Deficiencies

Federal agencies are stepping up their scrutiny of Medicare Advantage plans and finding an increasing number of deficiencies, according to a NY Times analysis, and they are taking action. Federal officials told Capital BlueCross in a letter, this year that it could not enroll any more Medicare beneficiaries and should stop marketing its Medicare plans. About 16 million people, accounting for 30 percent of the 54 million beneficiaries, are in private Medicare Advantage plans. Click here for the story. Click here for the Center for Public Integrity Report.

MedPAC: Hospitals Should Have More Flexibility in Placing Medicare Patients in Post Acute Sites

MedPAC is working on proposals that would give hospitals more flexibility in steering fee-for-service Medicare beneficiaries to preferred high-quality post-acute care sites, after raising concerns with private insurers’ initiatives to manage post-acute care. MedPAC rejected private insurer models used in Medicare Advantage, such as post-acute care benefits managers or beneficiary incentives for using preferred networks, because of concerns these initiatives wouldn’t work within the fee-for-service framework. Click here for MedPAC’s slide deck on this issue.

Private Health Exchanges Growing in Popularity

In 2014, about 2.5 million people across companies of all sizes will be enrolled in health insurance through so-called private exchanges, according to analysts. These are similar to Obamacare’s state and federal-based health insurance exchanges but are run by private consultancies like Aon Hewitt or Mercer. While these platforms generally offer a similar “e-commerce” approach to purchasing health insurance – either with a single carrier or multiple carriers offering plans – as the public exchanges do, there remain key differences. Click here for the Forbes report.

MedPAC Focuses on Site Neutral and RAC Reforms as Methods to Reduce Hospital Payments

The Medicare Payment Advisory Commission continued its review of hospital costs during its last meeting and they paid particular attention to administrative costs, particularly as they compare with hospitals in other nations. MedPAC suggested, again, site neutral payments and improvements to the RAC program as ways of reducing the amounts paid to hospitals by Medicare. Click here for MedPAC’s interesting slide deck.

High Deductibles Keeping Patients from Doctor

Not meeting your deductibles often means you won’t be seeing your doctor, according to a new report. Deductibles for the most popular health plans sold through the new marketplaces are higher than those commonly found in employer-sponsored health plans. A survey by the Kaiser Family Foundation found that the average deductible for individual coverage in employer-sponsored plans was $1,217 this year. In comparison, the average deductible for a bronze plan on the exchange was $5,081 for an individual and $10,386 for a family. Click here for more.

Medical Groups Urge HHS to Take Different Approach on Health IT

The American Academy of Family Physicians, the American Medical Association, the Medical Group Management Association, the National Rural Health Association, Premier and several large health systems submitted a letter to HHS Secretary Burwell, expressing serious concerns about current Meaningful Use standards and the need for greater HIT interoperability. In the letter, the groups request a different approach to improve the MU program and HIT. Click here to read the letter.

Medicaid Enrollment Growth Continues

Nearly 8.7 million people enrolled in Medicaid or the Children’s Health Insurance Program between Oct. 1 and Aug. 31, increasing total enrollment in the programs by an estimated 14.9%, according to a report released by CMS. Medicaid enrollments will likely rise 13.2 percent in the coming year, according to state Medicaid directors. States that expanded Medicaid under the ACA should see an average enrollment increase of 18 percent, while states that have declined to expand Medicaid will still see their rolls increase 5.2 percent. That’s up considerably from a year ago, when enrollments in those states rose 12.2 percent and 2.8 percent. Click here for details.

Study Says Link Between Current SNF Rules and Hospital Readmissions Is Lacking

A new study in JAMA has found little association between available performance measures for skilled nursing facilities and the risk of hospital readmission. Although SNF performance measurement plays an important role in promoting transparency and accountability in the U.S. health care system, the findings suggest that in their current form they are unlikely to serve as a sole basis for large-scale reductions in readmissions unless accompanied by other strategies. Click here for more.

CDC: Enterovirus D68 Continues Spread Across Country

The CDC warned that a newly developed, faster test for enterovirus D68 will boost the number of people confirmed to have it coming days — but that the increase will cover a backlog of samples and not indicate a rash of new infections. Of more than 1,160 samples from 45 states tested so far, CDC says about half have been positive for the enterovirus. The new test will allow the agency to process 180 samples per day, up from 40, that have been received since mid-September. Click here for more on the spread of the virus across the country.