Elections Have Consequences: What Will Happen to Health Care?

With the 2014 midterm elections behind us, will Obamacare now be repealed? What about further cuts to hospitals? Will there finally be a permanent SGR fix? Click here for Strategic Health Care’s summary of how the elections will impact health care policy in the year ahead.

Supreme Court Takes On Obamacare Subsidies

In what was considered a surprise last week, the Supreme Court agreed to hear a new challenge to the Affordable Care Act — a case that threatens subsidies that help millions of low- and middle-income people afford their health insurance premiums. The justices said they will review a federal appeals court ruling that upheld IRS regulations that allow health-insurance tax credits under the ACA for consumers in all 50 states. Opponents argue that most of the subsidies are illegal. A decision would is expected until June. Click here for details. Click here for a NYTimes report on what this could all mean.

11 States’ Suit Weigh In On Health Care Subsidies

Arkansas, Delaware, Illinois, Iowa, Maine, Mississippi, New Hampshire, New Mexico, North Carolina, Pennsylvania and Virginia—last week filed a court brief in a separate appeal on the ACA subsidies saying they assumed there wouldn’t be a problem with the tax credits when they opted not to run their own exchanges. Click here for the report.

Open Enrollment Starts This Week and There Is Much on the Line

Open enrollment for Affordable Care Act insurance coverage through the exchanges begins this Wednesday, November 15. Polls show most Americans hold an unfavorable view of the law despite the fact that millions gained benefits from it this year. HealthCare.gov may have to withstand almost twice as many users as last year. And back-end parts of the site still remain unbuilt, though they aren’t immediately crucial for consumers. Click here for a good Wall Street Journal story on the person responsible for Healthcare.gov and the challenges facing him now.

HHS: Insurance Coverage Grew by 10 Million Under ACA

10.3 million nonelderly adults (ages 18-64) gained health insurance coverage since the start of the Affordable Care Act initial open enrollment period in October 2013, according to a report released by HHS last week. The uninsured rate among nonelderly adults fell by more than a quarter (26 percent), from 20.3 percent to 15.1 percent. African Americans and Latinos saw particularly large drops in their uninsured rates. Click here for the HHS summary.

MedPAC Uncertain About Fixing 340B

Medicare’s Payment Advisory Commission last week reviewed the growth of the 340B Drug pricing program and its implications on Medicare spending. The commission is not close to making policy recommendations, as many members are still trying to more clearly understand the program and determine the adequate metrics to use for measuring success. Due to the lack of transparency surrounding drug prices, MedPAC staff had difficulty quantifying costs and determining any savings reforms would bring. The commissioners expressed some skepticism that the current Disproportionate Share Hospital (DSH) threshold is the right metric to determinate provider eligibility. Click here for MedPAC’s slide presentation.

MedPAC Tackles Short-Stay, 2-Midnight Changes

The Medicare Payment Advisory Commission was split on a recommendation to eliminate payment differences between outpatient observation stays and inpatient stays. The proposal under consideration would create a DRG for all observation and inpatient 1-night stays to eliminate the need for the two-midnight rule. Another proposal to focus RAC audits on hospitals with the highest rates of short stay admissions was well received by commissioners. They also agreed that the requirement for a 3-day inpatient stay to be eligible for SNF benefits is outdated. They liked the proposal to allow observational stays count toward the 3-day requirement. MedPAC will make formal recommendations to Congress next year. Click here to review the detailed MedPAC slide presentation.

Patients, Hospitals Expected to Take Hit on New HHS COPD Readmissions Policy

Lung disease experts say Medicare’s new policy to penalize excessive hospital readmissions for chronic obstructive pulmonary disease (COPD) will do more harm than good–hurting a vulnerable patient population and also the hospitals that care for them. CMS has added COPD to its list of conditions subject to penalties for readmitting patients too often within 30 days of discharge. Under the program, the agency will likely penalize more than 2,600 hospitals this fiscal year for readmissions of patients due to different ailments, including acute myocardial infarction, heart failure and pneumonia. Click here for the report.

Growing Cybersecurity Threats Getting Attention from Health Care Execs

Health care executives are beginning to spend more time on developing strategies to thwart cybersecurity threats, according to reports last week. A September global state of information security report from PricewaterhouseCoopers LLP found that detected incidents reported by health-care providers and payers in a two month period in 2014 were 60% higher than for a similar period in 2013. Financial losses increased 282% over 2013. Click here for the story.

Readiness Review: U.S. Health Care Not Ready for Ebola

The U.S. health care apparatus is so unprepared and short on resources to deal with the deadly Ebola virus that even small clusters of cases could overwhelm parts of the system, according to an Associated Press review of readiness at hospitals and other components of the emergency medical network. Click here for the report.

CDC Creates Ebola Kits for Hospitals

The CDC has ordered $2.7 million in personal protective equipment to increase Strategic National Stockpile supplies to assist U.S. hospitals caring for Ebola patients. Products are being configured into 50 kits that can be rapidly delivered to hospitals. Each kit can provide the PPE needed by clinical teams to manage the care of one Ebola patient for up to five days. Click here for details from the CDC.

Report: Premature Birth Rates Continue To Fall

The number of babies born prematurely has significantly decreased in recent years, but the U.S. still has a lot of room for improvement, according to the March of Dimes in a report last week. In 2013, the national preterm birth rate was the lowest it has been in 17 years, falling to 11.4 percent (about 450,000 babies). That means the country has reached HHS’ Healthy People 2020 goal for preterm births seven years early. To see how your state scored on the report card, click here.

ACA Has Focus on Sickest Elderly

Several programs in the Affordable Care Act are designed to focus care in the sickest elderly patients. The Congressional Budget Office estimated that the top 5 percent of Medicare patients represented 43 percent of expenditures in 2001. On average, these patients cost the system $63,000 a year — while the median patient cost Medicare only $1,620. Click here for the story on efforts underway to care for the sickest patients.

House Calls Still a Good Patient Strategy

If you think physicians making house calls is old fashioned and not too effective, think again says one physician who believes it should be part of the answer to improve the health of our nation. Click here for the Washington Post story of Dr. Peter Boling.

New VA Chief Pushing Physician Recruitment

The new head of the Veterans Administration has spent much of his brief tenure urging medical students and young doctors and nurses at medical schools like Duke, Johns Hopkins and the University of Vermont, to join the department, offering raises, school-loan forgiveness and what he calls an improving work environment. His goal is to hire 28,000 workers to fill both long-vacant and newly appropriated clinical staff positions. The challenge facing him is great. Click here for the story.

Military’s Medical School Sees Enrollment Increases

The nation’s only medical school for the military now serves 1,200 students, including 700 medical students among nursing candidates and those studying public health and other disciplines, according to report last week. Medical students pay no tuition in exchange for a commitment to serve across the armed forces; some are already active-duty members of the military while others have no military experience. They receive a commission when they enroll. They not only learn to deliver a baby, but also to fire a rifle and defend themselves in hand-to-hand combat. Click here for the story.

Small Business Health Care Program Still Uncertain

Experts say it remains an open question whether the program, known as SHOP for Small-Business Health Options Program, will eventually work. There remains strong opposition from brokers and some insurers, who view it as a threat to their existing business, according to some analysts. Federal officials say they are committed to making the small-business marketplaces work over the next few years; five states are offering businesses early access to the online exchanges this year. Click here for more.

Insurer Sees Small Business as Prime Market Opportunity

One insurer sees the small business market as a new business opportunity for its products and services. Health Care Service Corporation is introducing a private insurance exchange for businesses with up to 50 employees. It is known as Blue Directions for Small Business and will be available for 2015 in the five states where the company offers Blue Cross and Blue Shield insurance: Illinois, Montana, New Mexico, Oklahoma and Texas. Click here for the story.

Cigna Changes Prescription Plan as Protests Mount; Other Insurers also Impacted

Facing allegations of discriminating against people with HIV and AIDS, Cigna Corp. agreed to restructure the HIV prescription drug benefits in its 2015 plans in Florida, making them less costly and burdensome for such patients, according to reports late last week. Under the Affordable Care Act, insurers can no longer refuse to cover patients with pre-existing or very costly illnesses. The complaint charged that the four insurers were instead seeking to discourage people with HIV/AIDS from selecting their plans by making them more costly. CoventryOne, Humana Inc. and Preferred Medical Plan also have complaints pending. Click here for the story.

HRSA Awards $51 Million to Health Centers

The Health Resources and Services Administration announced last week that it has awarded $51.3 million to 210 health centers in 47 states, D.C. and Puerto Rico for behavioral health services. The money can be used to hire mental health professionals and implement integrated models of primary care. Earlier this year, HHS awarded $54.5 million to 223 other health centers for the same purpose. Click here for the list of recipients by state.

CMS’ Dialysis Star Rating Program Finalized

CMS has finalized the methodology for its Dialysis Facility Compare Star Rating program and is releasing previews of ratings to individual Medicare-participating dialysis facilities. Facilities will have 15 days to review their ratings. We expect to post ratings to Dialysis Facility Compare in January 2015. Click here for details from CMS.

Rx Overdoses Create Substantial Burden on Emergency Departments: Study

Prescription drug overdoses, a dangerous side effect of the nation’s embrace of narcotic painkillers, are a “substantial” burden on hospitals and the economy, according to a new study of emergency room visits. A new analysis of 2010 data from U.S. hospitals found that prescription painkillers, known as opioids, were involved in 68 percent of overdoses treated in emergency rooms. Hospital care for those overdose victims cost an estimated $1.4 billion. Click here for the story.