(NOTE: Because of today’s holiday, this report will also be emailed Tuesday morning)
Hospitals Should Get 3.25% Medicare Payment Increase in 2016: MedPAC
The Medicare Payment Advisory Commission (MedPAC) last week recommended that Congress increase Medicare payment rates for the hospital inpatient and outpatient prospective payment systems by 3.25% in 2016. MedPAC also recommended that Congress reduce or eliminate payment differences between hospital outpatient departments and physician offices for selected procedures; pay long-term care hospitals the same rates as general acute-care hospitals for cases involving patients who are not considered “chronically critically ill; freeze Medicare payments to physicians in 2016 in place of the SGR formula; and make several other important payment changes. Click here for an excellent summary with links to each MedPAC powerpoint presentation.
CMS Innovation Center Success Falling Short
The national hospital readmissions rate continues to drop, but not necessarily because of efforts by the CMS Innovation Center. Only a small number of community groups receiving federal reimbursement to reduce hospital readmissions produced significant results — compared with others that were not part of the $300 million program, according to partial, early results. An independent analysis conducted last year but released only two weeks ago, showed that innovation center projects were not reducing readmissions as much as had been hoped. Click here for the analysis. Click here for the news report.
Progress Made on Eliminating Hospital Infections: CDC
Progress has been made in the effort to eliminate infections that commonly threaten hospital patients, including a 46 percent decrease in central line-associated bloodstream infections (CLABSI) between 2008 and 2013, according to a report released last week by the CDC. CDC’s Healthcare-Associated Infections (HAI) progress report is a snapshot of how each state and the country are doing in eliminating six infection types that hospitals are required to report to CDC. Click here for the CDC report.
California Hospitals Improving Performance: Leapfrog
A detailed look at performance data shows many California hospitals continue to struggle with medical errors and injuries to patients — despite industrywide efforts to remedy those problems. according to an LA Times report late last week. Since 2012, Leapfrog has been analyzing information it collects as well as data reported to Medicare to issue hospital scores in California and nationwide. The percentage of A-rated hospitals in California reached 43% late last year — the seventh-highest rate among states nationwide. That was up from 40% two years ago. Click here for the story. Click here for an inter-active California map of hospitals.
Data Analytics Helping Improvements in Patient Satisfaction, Outcomes
Data is driving the patient experience at many leading hospital systems, according to a report last week in U.S. News. Patient satisfaction scores at the Cleveland Clinic have seen significant improvement over the past few years, in part because physicians now have access to an array of data to help decision-making. Click here for the story.
Kaiser Nursing Strike Settlement Reached
Kaiser Permanente will hire hundreds of RNs as part of the deal with the California Nurses Association announced yesterday. The CNA said the strike against Kaiser is canceled even though the pact must still be ratified. The CNA says hiring more nurses should substantially improve the quality of care for hospitalized patients. Click here for other details in the agreement.
Changes Made in New Contracts with RACs
CMS is signaling its intent to change RAC practices with the latest contract it approved with a national RAC covering home health, hospice and DME. The contract, dated December 30, 2014, is the first one issued since Recovery Audit contracts were halted last summer. The new contract incorporates changes addressing provider concerns with prior RAC arrangements, and these changes will apply to all future contracts with RACs, according to CMS. Other contracts have been delayed because of contract protest litigation. Click here for a good CMS summary of the changes.
OIG Recommends Anti-Fraud Measures for Hospice
The Office of the Inspector General urged CMS to develop new anti-fraud measures targeting hospices that make few visits to patients, according to an OIG report released last week. The OIG recommended that CMS make five specific changes, including payment reforms and CMS agreed with all the recommendations. Click here for the OIG report that raised numerous questions about billing practices in certain settings.
Most Companies Unprepared for Employer Mandate: Survey
Most companies are not prepared for the Affordable Care Act’s employer mandate, and nearly two-thirds of large employers are increasing workers’ share of their health care costs, according to a survey released last week by ADP. The survey of about 800 human resource managers and executives also found that about two out of five employers either have limited or are planning to limit some employees’ hours because of the law’s requirement that coverage be offered to individuals working more than 30 hours weekly. Click here for a summary.
Congressional Hearing This Week on Effort to Fix Doc Payment Formula
The current formula Medicare uses to set physicians’ payment rate – call the Sustainable Growth Rate (SGR) – expires March 31. If left unchanged, Medicare would cut physician payments by about 25%. Fixing it this year would cost about $150 billion over ten years, according to the Congressional Budget Office. The House Energy & Commerce Committee focuses two days of hearings on this issue this week. Click here for the Committee announcement. One publication is even speculating that Congress might consider another delay in ICD-10 implementation as part of the SGR fix. Click here for that. Click here to watch the hearings live – first hearing is Wednesday at 10:15 a.m. EST.
CMS Administrator Announces Departure
CMS will have a new chief in February because the current Administrator Marilyn Tavenner announced her departure on Friday. Click here for her 5-page memo to her staff, which also lists CMS accomplishments during her tenure. Principal Deputy Administrator Andy Slavitt will become acting administrator. Click here for the NY Times story.
New Bill Would Change Meaningful Use Reporting Period
Rep. Renee Ellmers, R-N.C., has reintroduced legislation that would establish a three-month meaningful use reporting period in 2015 if approved. Final HHS rules require a year of reporting. A number of medical and health IT groups lauded the reintroduction of the Flex-IT Act. Click here for the story. Click here for the current list of House cosponsors.
New Bill Eliminates 3-Day Inpatient Stay for SNF Services
Rep. Jim Renacci (R-OH), a member of the House Ways and Means Committee, last week introduced H.R. 290, the Creating Access to Rehabilitation for Every Senior (CARES) Act, which eliminates the three-day inpatient hospital stay requirement for Medicare beneficiaries who are in need of skilled nursing facility (SNF) services. Click here for a copy of the 5-page bill.
Physician Recommends Changes to Force Down High Drug Costs
A physician at Memorial Sloan Kettering is out with a very good article in the NY Times about the high cost of drugs and the negative impact they have on the health care system. He’s recommending that the government, insurers and provider just say “no” and watch the prices fall. Click here.
Medicare Advantage Growth Coming from Traditional Medicare Beneficiaries
The majority of people who signed up for Medicare Advantage plans in recent years were switching out of the traditional Medicare program, according to a new study. The findings contradict the popular belief that growth in Medicare Advantage has been fueled primarily by people who choose it when they first become eligible for Medicare. Click here for details.
Federal Exchange Enrollment at 6.8 Million
HHS reported last week that 6.8 million people have enrolled in Obamacare coverage through the federal exchange since open enrollment began Nov. 15. The latest weekly snapshot shows a slight increase in the relatively slow rate of enrollment over the holidays — about 163,000 last week, up from about 100,000 in each of the two weeks before. Click here for details with state specific summaries.
Fewer Americans Skipping Needed Health Care: Study
The Commonwealth Fund released a report last week finding that 66 million Americans skipped health care because of cost in 2014 — down from 80 million in 2012. And fewer were struggling to pay their medical bills or pay off their medical debt — 64 million in 2014 compared to 75 million two years earlier. The study’s lead author says the findings suggest that the ACA is helping people afford the care they need. Click here for the report.
FDA Issues Warning on IV Saline Solution
The FDA said last week that more than 40 patients had received infusions of intravenous simulated saline from bags made by Wallcur LLC that wasn’t sterile or intended for human use, with some patients hospitalized and at least one death linked with using the products. Click here for the latest from the FDA. Click here for the news report.
Number of Stage 2 Meaningful Use Hospitals Increase
CMS last week reported that 77% of 2,115 eligible hospitals have attested to stage 2 meaningful use as of Tuesday. Among other findings, 65% of stage 2-qualified hospitals used 2014-certified EHR technology to attest to stage 1, while 23% used 2011-certified EHR platforms. Click here for the story.
FDA Says It Won’t Regulate General Wellness IT Products
The FDA does not intend to regulate general wellness IT products that “are designed to maintain or encourage a general state of health,” the agency said in draft guidance released last week. Click here. The FDA will, however, place a degree of regulatory scrutiny on accessories that work in tandem with a classified medical device, it said in a separate guidance. Click here. The agency defines an accessory as “a device that is intended to support, supplement, and/or augment the performance” of a larger device.
Report Says Medical Device Tax Not the Burden Critics Say
A tax on medical devices, imposed by the Affordable Care Act, has become a prime target for Republicans, some Democrats and a small army of lobbyists for the industry. But a new report from the Congressional Research Service challenges economic arguments that are being made to justify repealing the tax. Critics of the tax say it is destroying jobs and encouraging manufacturers to move operations overseas. Repealing it is a priority for Republicans on Capitol Hill. Click here for the story.
IOM Urges Quicker Release of Clinical Trial Data
An Institute of Medicine report issued last week urges researchers and others involved in clinical trials to release data from the studies as quickly as possible while taking into account protection of privacy and intellectual property, and recognition of academic work. Analytic data sets supporting results should be shared no later than six months after publication of a trial’s results, while full analyzable data sets should be released within 18 months of study completion or a month after regulatory approval if a new drug or device is being tested, the IOM panel found. Click here for the report.
Most Adults Think They Won’t Need Long Term Care Services
About 60 percent of adults between 40 and 65 years old don’t think they’ll need need long-term care services, according to a new study published last week in Health Affairs. That’s much less than the 70 percent of people at least 65 years old who will need long-term care services at some point either in their home or at a facility, according to a widely cited earlier study from the Georgetown University Long-Term Care Financing Project. That includes 20 percent who will need between two to five years of long-term care and 20 percent who’ll need more than five years. Click here for the story.
96 Years Old Is the Most Expensive Age for Medicare Spending
Being 96 years old is the most expensive age for Medicare spending, according to a Kaiser Family Foundation review released last week. The analysis found that seniors who were 80 or older in 2011 made up just under a quarter of traditional Medicare enrollees but accounted for a third of the program’s spending. Medicare spent 2½ times as much on 85-year-olds and three times as much on 95-year-olds than the $5,600 spent on the average 66-year-old. But 96-year-olds were the priciest, costing $16,145. Click here for the report.
Twin Births Hit Record High in U.S.
A CDC report revealed the rate of twin births in the U.S. reached a record high at 33.7 twin births per 1,000 deliveries in 2013, a 2% increase from a previous all-time high in 2012. Researchers also noted lower rates of cesarean births. Utah had the highest birthrate, 17.6 percent. New Hampshire had the lowest rate at 9.4 percent. Click here for the new report.
Walk-In Medical Clinics Growing in Shopping Malls
As retailers struggle to keep up with changing shopping trends, mall operators across the U.S. are looking to fill spaces left empty by the likes of Sears and RadioShack. One promising new group of tenants: walk-in medical clinics, staffed by doctors who can treat common ailments such as pink eye and minor injuries like sprains and burns. Click here for the story.