WEEKLY E-BULLETIN


Another Congressional ICD-10 Extension?

Rank-and-file members of Congress have been advising doctors in their districts to write the leadership in Congress begging for another delay of ICD-10 implementation.  Some physicians are asking for a 2-year delay – beyond the 1-year delay that pushed implementation to October 2015.  Our sources on key committees are saying that it is unlikely another extension would be granted; however, it is a Lame Duck session and anything can happen.  Click here for the letter from Texas physicians; click here for the New York letter; click here for the Alabama letter.

Moody’s Issues Negative Outlook for Non-Profit Healthcare

Moody’s has issued a negative outlook for the US not-for-profit healthcare sector in 2015 saying it reflects their belief that the fundamental business, financial and economic conditions in the sector will remain weak over the next 12-18 months.  After falling each year, from a recent high of 7% in 2009, operating cash flow growth is expected to be low, but relatively stable over the next two years, ranging from -0.5% to +1.5%.  Click here for the complete report.

National Health Spending Slows To Historic Low

U.S. spending on health care grew 3.6% in 2013, down from 4.1% in 2012 and the fifth straight year of historically low growth, CMS reported last week. Medicare spending grew 3.4%, down from 4.0% in 2012, primarily due to slower growth in enrollment, net impacts of the Affordable Care Act and the federal budget sequestration. Overall spending for hospital care grew 4.3%, 1.4 percentage points less than in 2012, in part due to decreased use of inpatient services and slower price growth. Click here for a very good CMS summary.

Hospitals Making Progress on Acquired Infections

Hospitals have reported 1.3 million fewer hospital-acquired infections from 2011 to 2013 compared to the rate of mistakes in 2010, according to a new report from HHS, which estimates that hospital safety efforts have resulted in about 50,000 fewer avoidable patient deaths in the past three years.  Click here for the report.

CMS Proposes Medicare ACO Changes

CMS has issued an update to the rules governing ACOs and are seeking comments from interested parties.  Among the changes:  Providing more flexibility to ACOs wanting to renew their participation; Encouraging ACOs to take on greater performance-based risk and reward; Emphasis on primary care; Alternative methodologies for benchmarks; and Streamlining data sharing and reducing overhead.  Click here for details from CMS.

New Law Delays Enforcement of Direct Supervision in Rural Areas

The president last week signed a bill delaying Medicare’s enforcement of inflexible direct supervision rules for outpatient therapy services at critical access hospitals and other small, rural hospitals. H.R. 4067 was offered by Rep. Lynn Jenkins and Sen. Jerry Moran, both from Kansas.  Click here for a copy of the 1-page final act.  It will undoubtedly be re-addressed next year.

New Pharma Study Is Another Attack on 340B

A new white paper funded by the pharmaceutical industry projects that sales through the discount drug program 340B will jump from about $7 billion in 2013 to $16 billion in 2019. The report said the increase will be driven by greater 340B enrollment among Disproportionate Share Hospitals and the hospitals’ acquisition of satellite clinics, which then are included in the program. Obamacare also encourages the growth of 340B, the report said.  Click here for the report.

AMA Pushes RAC Changes

The AMA sent a letter to CMS last week saying the RACs that review Medicare and Medicaid claims should face financial penalties when they reject claims that are successfully appealed. In 2013, the letter notes, more than 60 percent of appealed RAC rulings on physician payments were overturned. The AMA asks the agency to provide doctors with an optional appeals settlement process, similar to one provided for short-term hospital care, and says RAC reviews should be performed by physicians in the same specialty as the physician submitting the claim. Click here to read their letter.

CHIP Program Reauthorization In Question

In the waning days of the lame-duck Congress, it is still not clear when or whether funding for the federal-state, low-income children’s health plan known as CHIP will be authorized beyond September. 30, 2015 when it is set to expire.  The Children’s Health Insurance Program got a big boost under the Affordable Care Act, which called for an increase in federal funding for the program and required states to maintain 2010 enrollment levels through 2019.  Click here for the update.

CMS Rules Would Punish Problemed Providers

CMS last week announced new rules to strengthen oversight of Medicare providers and protect taxpayer dollars from bad actors. These new safeguards are designed to prevent physicians and other providers with unpaid debt from re-entering Medicare, remove providers with patterns or practices of abusive billing, and implement other provisions to help save more than $327 million annually.  Click here for a summary of the new rules.

House Bill Would Further Strengthen Medicare Fraud and Abuse Laws

Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) and Ranking Member Jim McDermott (D-WA) have introduced the Protecting the Integrity of Medicare Act (PIMA) of 2014.  The legislation reforms Medicare’s anti-fraud programs and emphasizes preventing fraud, waste, and abuse before it happens.  It may be on the fast track in the Lame Duck session.  Click here for details.

Hospital Readmissions Penalties Impacted by Patient’s Socioeconomic Status

Medicare patients from socioeconomically disadvantaged neighborhoods are at increased risk for readmission to the hospital within 30 days of discharge, according to a study published last week. The study looked at a sample of Medicare patients hospitalized for pneumonia, heart attack or congestive heart failure, the clinical conditions used to calculate Medicare readmissions penalties.  Click here for the study from the Annals of Internal Medicine.  Congress is likely to pass legislation next year that would require HHS to reform its readmissions penalty program based on socio-economic status.

Bill Pushed to Curb FDA Health IT Regulatory Authority

U.S. Rep. Marsha Blackburn (R-TN), vice chair of the House Energy and Commerce Committee, is predicting that legislation to curb the FDA’s authority to regulate health IT will pass the Congress in early 2015. Blackburn’s bill would establish a risk-based regulatory framework for health IT divided into three broad categories of software–clinical, health and medical–with the two former software types not subject to regulation under the proposed legislation. Click here for details.

ONC Report Details Why Providers Adopt EHRs

The need to share patient information with other providers and the use of financial incentives are key drivers in why many providers adopt and use health information technology tools like electronic health records (EHRs), according a data brief released last week from the Office of the National Coordinator for Health IT.  Click here for the ONC report.

Cyber Crime Group Targeting Health Care Organizations

A cybercriminal group, FIN4, is targeting the email accounts of individuals who have access to private and valuable information, with the healthcare industry targeted most, according to a report out last week.  Instead of infecting computers with malware or a virus, this group gains access to people’s usernames and passwords. Two-thirds, or 68 percent, are public healthcare and pharmaceutical companies.  Click here for the report.

Top Health Care Issues for 2015 Released by PwC

As the post-Affordable Care Act healthcare landscape takes shape, the health care industry will shift toward digitally-enabled, consumer-focused care models. PricewaterhouseCoopers has released its list of the top issues within the healthcare industry for 2015.  It says the following trends will dominate the healthcare agenda next year: 1) more convenience for less privacy 2) innovation in response to costly patients 3) expanded scope of practice 4) transparency initiatives 5) more emphasis on positive outcomes 6) more portable home medical devices 7) do-it-yourself healthcare.  Click here for more.

Study: Employers Don’t Know How to Get Most Value When Buying Health Insurance

Most employers don’t know how to get the most bang for their buck when buying health coverage, according to a survey funded by the Robert Wood Johnson Foundation. Most companies that offer health insurance are unfamiliar with ratings of health plan quality, with just 7 percent saying they use objective quality information. 60 percent of employers said quality ratings are an important factor when choosing a plan, but most were unfamiliar with independent sources of quality data. Click here for the complete survey results.

States Tackling Super-Utilizers

Many state Medicaid agencies are trying to diminish use of medical services by super-utilizers by better managing their care. The goal is to not only reduce costs, but to achieve better health outcomes for these patients. Under the ACA, Medicaid for the first time will reimburse health care providers to coordinate the care of patients who have more than one serious chronic health condition, such as diabetes, congestive heart disease and dementia, or who have a serious mental illness or a substance abuse addiction. Click here for the Pew report.

Consumers Have Greater Choice in Exchange Health Plans

With 25 percent more issuers participating in federal exchanges in 2015, based on analysis of 35 states, more than 90 percent of consumers will be able to choose from three or more issuers—up from 74 percent in 2014. Consumers can choose from an average of 40 health plans in their county for 2015 coverage—up from 30 in 2014.  Click here for more from HHS.  The deadline for enrolling in a health plan is Feb. 15. Coverage begins on Jan. 1 for those who sign up by Dec. 15.

Health Insurance Markets Remain Concentrated: GAO

In most states, the individual, small and large group health insurance markets have remained concentrated since 2010, according to a report released last week by the GAO.  Enrollment last year in the individual, small group and large group health insurance markets was concentrated among the three largest insurers in most states.  Click here for the GAO report.

Report:  OOP Costs for Specialty Drugs Increasing on the Exchanges

Patients’ out-of-pocket costs for specialty drugs are increasing in Obamacare exchange plans next year, with more silver-level plans imposing co-insurance for those meds than in 2014, according to an Avalere analysis.  It found that in 2015, 41 percent of the silver plans — up from 27 percent this year — will have co-insurance levels of at least 30 percent. Avalere examined exchange plan data from HealthCare.gov as well as from state-based exchanges in California and New York.  Click here.

Number of Uninsured Continues to Drop

The latest report by Urban Institute researchers says the number of uninsured adults dropped by a third — an estimated 10.6 million people — from September 2013 to this past September. That lowered the nation’s percentage of uninsured to 12.4 percent, compared to 17.7 percent a year earlier. Young adults and Hispanics showed the strongest gains in coverage.  Click here for the report.

Is Obamacare Working?  New Studies Say Yes

It is certainly a matter of opinion, but “Is Obamacare Working?”  The non-partisan Brookings Institute says yes.  Click here.  Several other new studies have reached the same conclusion.  Click here for a very good and brief summary.  On a related note, not everyone agrees that America has the best health care system on the planet.  Click here for a Wendell Potter report on a new film.

Three Dozen Hospitals Get Federal Ebola Designation

Nearly three dozen hospitals nationwide are now officially identified as having the capability, preparation and resources to treat patients with Ebola, with additional facilities likely to be selected in coming weeks, CDC announced last week.  Click here for the hospital list.

CDC Issues Interim Ebola Guidance

The CDC last week issued interim guidance to help state and local health departments, acute care hospitals and other emergency care settings develop preparedness plans for patients with suspected or confirmed Ebola.  Click here for the CDC report.  The Senate passed a bill prioritizing Ebola treatments by adding filoviruses — the family of viruses that includes Ebola — to a program Congress created in 2007 to facilitate the development of new treatments for neglected tropical diseases. Now the bill goes to the House. Click here for a copy of the 2-page bill that passed.

What Is the Biggest Health Problem for Americans: New View

Is Ebola really among the biggest health problems for Americans? Not when we look at the chances of actually being infected.  So, what are the actual biggest health problems that Americans face? One way to answer this question is to look at what drugs are prescribed the most. Here are the seven top health problems based on the most-prescribed drugs in the U.S., according to data provided by IMS Health.  Click here.

Panel Okays Blood Donations from Gay Men

An outside advisory panel said last week that improved scientific testing of blood is sufficient to ensure that donated blood is safe, making the 31-year ban of blood donations from gay men — initially intended to prevent the spread of HIV — unnecessary. The FDA is expected to issue national guidelines to blood banks soon, and generally follows the advice of its advisory committees.  Click here for more.

House Passes ABLE Act, Final Approval Likely

The House passed legislation last week to create new tax-exempt savings accounts for people born with disabilities. The Achieving a Better Life Experience Act is designed to help individuals save for expenses such as transportation, education and housing.  To pay for the bill, Congress requires HHS to identify Medicare codes for overpayments starting in 2016 (saving $365 million), delay by one year the implementation of an oral-only drug policy for Medicare dialysis patients (saving $380 million) and prohibit Medicare from covering penis pumps until erectile dysfunction drugs are covered under Part D (saving $444 million).  The bill is expected to pass the Senate.  Click here for more on the legislation.