Happy New Year!

Congress Reconvenes:  Obamacare, Health Care Reforms on the Agenda

GOP leaders, who now control the House and Senate, are biding their time for votes to repeal the Affordable Care Act but have moved rapidly to repeal portions of it – the 30 hour work week and the medical device tax. 
  • The House passed legislation last week changing the Affordable Care Act’s definition of a full-time work week from 30 to 40 hours. The vote was 252-172, with a dozen Democrats crossing party lines.  The White House has threatened a veto of the bill, which was sponsored by Indiana Republican Todd Young. For the ACA’s employer mandate, the law defines a full-time worker as one who works 30 hours, and Republicans argue the provision has resulted in many workers having their hours cut. The Senate is likely to take action on the bill soon.  The Congressional Budget Office said the House bill adds $53.2 billion to the deficit between 2015 and 2025.  Click here for the WSJ report.  Click here for the CBO report. 
  • Lawmakers took the first stab in the new Congress to repeal a tax on medical devices last week.  The proposal revived by Reps. Ron Kind (D-Wis.) and Erik Paulsen (R-Minn.) would repeal the tax and refund tax payments device manufacturers made since it took effect in January 2013. The bill has more than 250 sponsors from both parties in the House and support in the Senate but no set path to a vote in either chamber.  The cost of repeal is $29 billion over 10 years and there is no agreement on how to offset those losses to the government.  Click here for more.

Treasury Issues Final Not-for-Profit Hospital Regs on Community Benefit and Financial Aid 

Treasury Department has released final regulations regarding the requirements for not-for-profit hospitals to maintain their tax-exempt status. The regulations require, among many other things, hospitals to widely publicize their financial assistance policy and to conduct a community health needs assessment every three years. The regulations ban hospitals from charging financial aid patients more for emergency and medically necessary care than private and government insurance beneficiaries. Click here for the full regulation.

JAMA: Medicare’s HAC Policy Appears to Reduce Avoidable Events

Medicare’s policy not to pay for treating hospital-acquired conditions appears to be most effective in reducing avoidable events for which standardized prevention evidence is available, according to a study out last week.  Unit-level rates of central-line associated bloodstream infections and catheter-associated urinary tract infections decreased significantly since the 2008 implementation of the Medicare initiative.  Click here for the complete JAMA study.

New Physician Ratings Issued by Consumer Reports

Consumer Reports is out with a new physician ratings guide for primary care and some specialty groups in California, Massachusetts, Minnesota and Wisconsin (no fee required). They are also publishing ratings on heart bypass surgeons across the country (fee required).  Click here to see the reports.

Bipartisan House Members Push New CAH and Rural Health Bills

Reps. Adrian Smith (R-NE), Greg Walden (R-OR), David Loebsack (D-IA) and Todd Young (R-IN) last week introduced the Critical Access Hospital Relief Act (H.R. 169), a bill that would remove the 96-hour physician certification requirement as a condition of payment for CAHs. Medicare requires physicians to certify that patients admitted to a CAH will be discharged or transferred to another hospital within 96 hours for the CAH to receive payment for the patient’s services under Medicare Part A.  Click here for details.  Rep. Smith also introduced H.R. 170, the Rural Health Care Provider Relief Act would delay physician supervision requirements at critical access hospitals for at least a year until the impact of the rules is studied. Click here for details on that bill.

CDC: Flu Hospitalizations Could Reach new High

The CDC on Friday sent a new alert to doctors, advising prompt use of Tamiflu and other antivirals for hospitalized flu patients and those at higher risk for complications like pneumonia.  CDC officials say a nasty strain of flu, H3N2, is going around that is more dangerous to elderly people and very young children. Last week, flu-related hospitalizations of those over 65 jumped to 92 per 100,000 from 52 the week before. Two years ago, when H3N2 was also predominant, hospitalizations reached 183 per 100,000 and the CDC said the number could climb that high this season.  Click here for the CDC’s most recent weekly report.  Click here to see the national map.  Click here for a detailed report from the LA Times.

New Antibiotic May Be First Breakthrough in Quarter Century

An antibiotic isolated from New England dirt has successfully treated mice infected with drug-resistant staphylococci bacteria, which typically leads to death in 90% of the animals that contract it, according to a study in Nature. Teixobactin might be the first major antibiotics breakthrough in more than 25 years, according to researchers, though it has yet to be tested on humans.  Click here for the report.

CMS Okays Creative Medicaid Waivers

CMS has approved some states’ requests for Medicaid waivers, including one that allows Arkansas to require cost-sharing of Medicaid beneficiaries in so-called private-option plans and another that allows Iowa to decline coverage of non-emergency transportation.  Click here for the CMS letter to Arkansas detailing their plan.  Click here for the CMS letter to Iowa officials.

Uninsured Rate Continues Rapid Drop

The U.S. rate of uninsured has dropped to 12.9 percent.  That’s the lowest rate Gallup has found since it started measuring in 2008, and the rate has been dropping steadily. It was 17.1 percent in the fourth quarter of 2013, just before the Obamacare expansion began. It was 13.4 in the third quarter of 2014 before dropping to this new low in the final months of last year. The sharpest declines have been among African-Americans and low-income Americans. Click here for the Gallup report.

Interventional Cardiologists May Get Formal CMS Recognition This Week

CMS is expected to recognize interventional cardiologists as a subspecialty sometime this week, which they say will allow more fair and accurate comparisons of physician performance.  The decision was made last May.  Click here for that announcement.  In the current fee-for-service model, the designation brings the ability to collect between $73 and $144 per consult. Duffy said he suspects that payments for consults conducted in the weeks ahead will probably be made retroactively.  Without the CMS subspecialty designation, if a general cardiologist called in an interventional cardiologist in the same medical group, they could not bill Medicare for the second doctor’s time. 

Humana Says Its ACOs Work Well

The country’s second largest Medicare Advantage provider has released a report showing that Humana’s Accountable Care Continuum has had a positive, measurable impact on the quality of care of approximately one million Humana MA members who have experienced improved care. Humana compared quality, outcomes and costs for these MA members who were treated by providers in Humana’s Accountable Care Continuum programs versus members who were treated in traditional, fee-for-service and original Medicare settings.  Click here for the findings.

Federal Court Blocks CMS’ Plan to Recoup DSH Funds from Children’s Hospitals

A federal district court of D.C. blocked CMS on December 29 from recouping Medicaid Disproportionate Share Hospital payments from two children’s hospitals that sued the agency because of changes to Medicaid DSH reimbursement rules.   The hospitals sued HHS because they allege CMS used a FAQ to change Medicaid DSH reimbursement rules to count private insurance payments made on behalf of those eligible for Medicaid against a hospital’s DSH payments.  Click here for a copy of the court decision.

Insurers Gird for MA Funding Fight

Insurers are readying efforts to fight back against another round of Medicare Advantage cuts that are expected to come from CMS soon. But the campaign to keep Medicare Advantage payments stable may be harder than last year due to the post-midterm election political environment, according to news reports.  Click here.  Meanwhile, the Obama administration has told private insurers that it will seek to lower Medicare Advantage payments to bring per-capita spending on the private program more in line with traditional Medicare.  Click here for that report from Forbes.

More Health Systems Offering Health Plans

13 percent of all US health systems offer health plans in one or more markets—commercial, Medicare Advantage, or managed Medicaid, according to a report out last week. Together, these 107 systems operate health plans covering about 18 million members, about 8 percent of all insured lives. Ten more provider-led plans will be offered on the public exchanges in 2015.  Click here for the report from McKinsey&Company on the growth of these plans and whether this model will continue to grow.

Small Businesses Snubbing SHOP Program

Some small-business owners are snubbing the new health-insurance exchanges, operating under the Small Business Health Options Program, citing limited federal tax credits and a small menu of insurance offerings in a few states, companies and health-insurance brokers said.  Click here for the Wall Street Journal story.

Social Security Disability Insurance Payments in Trouble

Federal disability insurance payments are in trouble as the fund is expected to run out of money next year, according to a new analysis.  The Social Security trust fund, which is comprised of the disability program and the Old Age and Survivors Insurance program, is prohibited from transferring funds between the two accounts without congressional approval.  Click here for the story.

FDA Panel Pushes Cheaper Cancer Drug

A government panel last week took a major step toward approving a copycat version of a blockbuster cancer drug, paving the way for a new class of cheaper medicines that could save consumers billions of dollars. An expert FDA panel unanimously recommended that the government approve the drug known as EP2006, a lower-cost imitator of a popular medicine called Neupogen, used to help cancer patients fight off infection while undergoing chemotherapy. The FDA usually accepts recommendations from advisory panels but is not required to.  Click here for the report.

15% of Middle Aged Americans Have Lung Disorder: CDC

New CDC data showed almost 15% of adults ages 40 to 79 have a lung disorder, and more than one-third have moderate or severe respiratory symptoms. The data showed men and women had similar disease severity, and rates of lung diseases such as asthma and chronic obstructive pulmonary disease increased with age. Click here for the CDC report.

Dr. Ezekiel Emanual: Annual Physical Is Basically Worthless

Around 45 million Americans are likely to have a routine physical this year — just as they have for many years running. There is only one problem: From a health perspective, the annual physical exam is basically worthless.  This is according to former Obama health care adviser and oncologist, Ezekiel Emanual.  Click here details.

1.5 Million Cancer Deaths Avoided in Past Two Decades

More Americans are surviving cancer, according to the American Cancer Society’s annual statistics report.  Cancer deaths have dropped 22 percent over the past 20 years.  This means 1.5 million cancer deaths have been averted – a result of earlier detection, better screening, improved treatments and lower rates of smoking.  Click here for the complete report.

Congress’ Return Is Fodder for Late Night Comedians

The late night comedians had their take on the new Congress.  Click here to get their take.