WEEKLY E-BULLETIN


Obama Budget Cuts $400+ Billion from Health Care

Health care providers, drug companies and insurers are the biggest targets in President Obama’s 2016 budget proposal – more than $400 billion in payment cuts are outlined. Click here for our excellent 3-page summary (this includes a link to the actual budget plan). Although the GOP has said the budget blueprint is “dead on arrival” in Congress, individual items in the budget proposal can become attractive options to Republicans as they put together their own budget plan. Hospitals are already opposing the plan. Click here for the response from the Federal of American Hospitals.

 

Hospitals, Insurers Are Top Data Hacking Targets

The records of 80 million patients may have been compromised in the Anthem data breach disclosed last week and experts believe more attacks on medical facilities are imminent. Click here for the latest on that from the NY Times. According to a fresh report from cybersecurity experts, hospitals are hackers’ new favorite playground. That’s unsettling news for anyone who’s ever visited a hospital but it also offers a curious window into how we guard our most important data. Click here. Click here for a report on why China is suspected.

 

Report Identifies Healthiest Metro Areas, Hospitals

IVantage Health Analytics analyzed over 4,300 U.S. hospitals for wellness, cost and population management outcomes and ranked Washington, D.C., as the healthiest metropolitan area in the U.S. and followed by Minneapolis-St. Paul, Charlotte, Virginia Beach, Portland, Boston, Chicago, Philadelphia, Grand Rapids, MI, Atlanta. Click here for their announcement. Click here for a state-by-state look. Individual hospital info is only available upon request.

 

Providers Urge CMS To Make Major ACO Changes

34 major health care provider organizations sent a detailed letter to CMS last week urging major changes to the regulations governing ACOs (Medicare Shared Savings Program.) The groups were responding to proposed regulations issued in December. They said as currently designed, the MSSP program places too much risk and burden on providers with too little opportunity for reward in the form of shared savings. This is a very good letter if you have any interest in the future of Medicare ACOs. Click here.

 

Specialists Concerned with Government’s Push Toward Bundles, ACOs

Physician specialists are growing increasingly concerned with the government’s announcement it wants 50 percent of payments tied to bundled and ACO models by 2017, according to reports last week. Specialists are still largely paid on how many services they perform. Cancer doctors said they expect the government to attempt to pay them a single fee for all of the care each patient needs. Some specialists are reacting by trying to consolidate their market share. Click here for the story.

 

Doc Payment Fix in the Works; Patch May Be Best Option

The current physician Medicare payment formula expires March 31 and it appears Congress is headed for another temporary fix that would include a continuation of Medicare sequestration and a cut to bad debt payments to hospitals – a total cost of $12 billion through the end of 2015. A permanent fix would now cost about $177 billion over ten years, according to a new CBO analysis – and that is unlikely to happen this year. A NY Times report out last week suggests the temporary fix approach have done a lot of good and should be considered the approach to a permanent fix. Click here. Click here for an excellent backgrounder on the doc payment formula.

 

HCA, Aetna, Humana Report Strong Earnings

HCA Holdings Inc, the largest operator of U.S. for-profit hospitals, said last week demand for healthcare services had increased as the economy strengthened and more patients obtained insurance, but it was leveling off. Click here. Similarly, Aetna raises it outlook as earnings beat expectations. Click here. Humana revenue was up 21%, although results fell below analyst’s expectations. Click here.

 

CMS Report Outlines ICD-10 Implementation Efforts

ICD-10 is scheduled to begin October 1 and providers have identified several areas of concern about the transition and made several recommendations, which CMS has taken steps to address. For example, CMS said it has scheduled end-to-end testing with 2,550 covered entities during three weeks in 2015 (in January, April, and July) to improve awareness. Click here for the 40-page CMS readiness report.

 

FDA’s Tracking of Dangerous Rx Side Effects Flawed: Report

The main system for keeping track of the dangerous side effects of prescription drugs is deeply flawed, according to a new study, primarily because drug makers are submitting incomplete information about the problems to the FDA. Click here for the study.

 

Legislatures Responding to Vaccination Opt Out Laws

As a nationwide measles outbreak grows, state legislatures are pushing through bills that would make it harder for parents to opt out of vaccinating their children. Click here for that report. Click here for an inter-active national map showing the status of vaccine exemptions by state. Click here for the latest measles update from CDC.

 

State-by-State Vaccination Levels Revealed

One in 10 preschoolers don’t receive the measles, mumps and rubella vaccination in 17 states in the South, West and Midwest, according to an analysis, released last week by Trust for America’s Health. Nationally, the rate is 91.1 percent for children aged 19-35 months. Colorado, Ohio and West Virginia each had MMR vaccination rates of 86 percent. New Hampshire had the highest rate at 96.3 percent. Click here for details.

 

Millions Could Lose ACA Subsidies in Supreme Court Ruling

The war of words is heating up between supporters and opponents of the pending Supreme Court case that could result in millions of Americans losing their health exchange subsidies. According to a recent analysis, should the court rule against the government in the King vs. Burwell case, about 80% of those who could lose coverage work full- or part-time. Nearly 40% are ages 45 to 64. Southern states would be hard hit, particularly enrollees in Mississippi, Florida and Georgia. Click here for the update from USA Today.

 

13.8 Million Eligible for Health Exchange Subsidies: Study

A new study released last week by the Urban Institute says 13.8 million people will be eligible for the ACA’s cost-sharing reductions by next year if they enroll in an exchange plan. The report says that 48 percent of those eligible live in the South and 49 percent are single adults without children. Six in 10 of the individuals are white. The subsidies are separate from the health care law’s premium tax credits. They’re available for individuals with incomes up to 250 percent of the federal poverty level and help with out-of-pocket costs such as co-pays. Click here for the 4-page study.

 

Medicaid, CHIP Enrollment Growth Booming

A new CMS report shows that enrollment in Medicaid and CHIP grew much more rapidly once the Obamacare exchanges and Medicaid expansion began than in the prior year. The report found that more than 10 million Americans signed up for Medicaid and CHIP between October 2013 and November 2014. Enrollment grew 17.5 percent more than it did during the period before the ACA exchanges launched. Click here for the report.

 

CMS OKs Lung Cancer LDCT Screening

CMS last week issued a final national coverage determination that provides for Medicare coverage of screening for lung cancer with Low Dose Computed Tomography. The coverage is effective immediately. This is the first time that Medicare has covered lung cancer screening. The agency determined that enough evidence supports Medicare coverage of annual lung-cancer screening with low-dose computed tomography for people who’ve smoked, on average, a pack a day for 30 years and people ages 55 to 77 who have quit smoking within the last 15 years. Click here for more from CMS.

 

Health IT Training Grants Total $8.1 Million

The government’s top health IT agency — the Office of the National Coordinator (ONC) — is releasing $8.1 million in grants to support workforce training and innovations that promote community-level population health. Training initiatives will receive $6.4 million for programs related to value-based care, care coordination, population health and new payment and care delivery approaches. Meanwhile, initiatives based on the Beacon Communities will receive $1.7 million. Click here for more.

 

CMS Issues Final Rules Governing MA Plans

CMS has published a rule finalizing regulations on 2016 private Medicare plans and the program’s prescription drug coverage. The rule expands quality improvement and chronic care improvement requirements and includes several provisions to more efficiently deliver drugs to enrollees in long-term-care facilities. The final reg does not lift the “protected class” status on three categories of drugs: antidepressants, antipsychotics and immunosuppressants for transplant rejection. It also doesn’t require Part D plans to adopt the “any willing pharmacy” policies that were sought by community pharmacies, and it doesn’t limit the number of Part D plans that insurers may offer. Click here for the rules.

 

ACS Says Lung Cancer Exceeds Breast Cancer for Women

A report from the American Cancer Society last week revealed lung cancer has replaced breast cancer as the leading cause of cancer-related mortality among women in developed countries. Smoking among women picked up in the 1970s, and the effects are being seen in cancer diagnoses today. Meanwhile, breast cancer diagnosis and treatment has improved, experts say. Click here for the report from Time. Click here for the ACS cancer stats report released last week that contains state-specific numbers.

 

BLS: Nursing Assistants Have Most Injuries of Any Profession

Nursing assistants suffer the most injuries of any profession, according to new data from the Bureau of Labor Statistics, ahead of police, correctional officers, truckers and repair workers. In terms of injuries per 10,000 full-time employees, nursing assistants and orderlies each suffer musculoskeletal injuries at about triple the rate of construction laborers. In 2010, the healthcare industry overall reported 600,000 workplace injuries, more than any other occupation. Workplace injuries cost the healthcare system $3.1 billion in 2011. Click here for the BLS report.

 

FDA Streamlines Access to Experimental Drugs

The FDA moved last week to streamline the process by which terminally ill patients gain access to experimental drugs, releasing a draft of a new, shortened application that providers would submit on behalf of their patients. The FDA said it was responding to concerns from patients and providers that the process is too onerous. The new form would take physicians 45 minutes to complete, the agency estimates, compared to the 100 hours noted on the existing form. Click here for the FDA draft.

 

Pain and Suffering Increasing in End-of-Life Care

Despite repeated calls for improvement in end-of-life care and planning, pain and suffering has actually increased for dying patients, and significant barriers still stand in the way of effective discussions about patients’ care options, according to new research. One study found that between 1998 and 2010, rates of pain increased by almost 12 percent for patients in their last year of life, while rates of depression increased 26.6 percent and periodic confusion went up by 31.3 percent. Click here for the study. Click here for the compelling NPR report.

 

Hospitals Issuing Patient Passports

Many hospitals are now issuing “passports” to patients to bridge common doctor-patient communication gaps, according to a report last week in the Wall Street Journal. Patient passports, like travel passports, are documents that contain a patient’s essential medical information, such as current prescription drugs and medical diagnoses, as well as treatment preferences. Click here for the report.