WEEKLY E-BULLETIN


New Oncology Bundle from CMS Continues Push Away from Fee-for Service

CMS continued its push away from fee-for-service to value-based care last week with the announcement of a new Oncology Care Model that provides performance-based payments for chemotherapy under Medicare in order to incentivize high-quality care. The NIH says cancer cost the United States an estimated $263.8 billion in medical costs and lost productivity in 2010 — majority of those diagnosed are Medicare beneficiaries. Medical practices can sign up by April 23, although letters of intent are due March 19. Click here for all the CMS details.

 

ICD-10 Delay? Not Likely

The House Energy and Commerce Committee’s hearing last week on the implementation of ICD-10 showed little enthusiasm for an additional delay. The new coding system is expected to start October 1 and all signs suggest that Congress will allow that implementation date to stand. Click here for the report.

 

Feds Change Ratings Program for Nursing Homes

The federal government last week announced that it was changing the way it rates nursing homes, essentially adjusting the curve it uses to measure homes to make it more difficult for them to earn coveted four- and five-star government ratings. Scores are likely to fall for many homes, federal officials said. Facilities saw a preview of their new scores Friday, but the information will not be made public until February 20. Click here for details.

 

CMS Wants Input on Advanced Primary Care Innovations

CMS is seeking input on initiatives to test innovations in advanced primary care, according to an announcement last week. The agency is particularly interested in mechanisms to encourage more comprehensiveness in primary care delivery; to improve the care of complex patients; to facilitate robust connections to the medical neighborhood and community-based services; and to move reimbursement from encounter-based towards value-driven, population-based care. Responses must be submitted by March 16. Click here for details.

 

ObamaCare Sign Up Exceeds Expectations; Penalties Increasing

As the deadline passed for most to sign up for insurance on the state and federal health exchanges, observers believe that more than 11 million Americans may have done so and surpassed the Administrations’ expectations. Click here for details. Part the motivation to sign up is that the tax penalty is increasing for those who remain uninsured. Every adult without insurance will be subject to a minimum penalty of $325 when filing taxes next year. The fee will rise the following year to $695 per adult, more than seven times the $95 penalty for being uninsured in 2014. Click here for details.

 

10 Counties with Highest Enrollment; Supreme Court Case in Doubt

Interestingly, the top 10 counties with the highest enrollment numbers are in states that have federal, not state, health exchanges. Click here to see those numbers. In related developments, ObamaCare supporters believe they have found a fatal flaw in the pending Supreme Court case that could make illegal the subsidies provided to enrollees in federally-run health exchanges. Click here.

 

VA Health Care Costs Booming: GAO; Veterans’ Private Sector Utilization Small

Veterans’ health care is a “high risk” budget issue that threatens to cost taxpayers tens of billions of dollars unless longstanding problems are addressed, government auditors warned last week. The GAO said health care costs at the Department of Veterans Affairs have nearly tripled since 2002 — to more than $59 billion a year — as a result of the Iraq and Afghanistan wars and the aging of Vietnam-era veterans. Click here for more. Meantime, in what was supposed to be a move to allow more veterans to use private health care service, the VA is now saying that very veterans have used their choice cards to access non-VA health care. Click here.

 

Kentucky, CVS Benefiting from Medicaid Expansion

Kentucky’s expansion of Medicaid got another boost from a new study released last week by its governor. The report said continued expansion would generate a positive fiscal impact of nearly $1 billion for the state over the next seven years — even though the state’s share of the cost will increase. Click here for more. Who else has benefited from the growth in Medicaid? CVS. Click here.

 

Push Accelerates to Extend CHIP

Senate Democrats are launching a partisan push to end the funding battle over the federal government’s child healthcare program, which is set to expire in the fall. All of the chamber’s Democrats are signed on as co-sponsors to a bill that would extend funding for the Children’s Health Insurance Program (CHIP) through 2019. Click here. An unlikely political duo has come together urging Congress to extend the program again. Democrat Hillary Clinton and Republican Bill Frist co-authored an article in last week’s NY Times saying Washington gridlock shouldn’t jeopardize renewal. Click here.

 

Michigan ACOs Saving Millions

Across Michigan, many of the state’s 15 accountable care organizations are saving millions of dollars for the Medicare program along with passing along significant financial rewards to hundreds of participating physicians, according to several local ACO executives. Click here for the report.

 

Pharma Company Launches Research to Prevent Illness

Imagine being able to identify who is likely to develop a particular disease — and then stop the disorder before it starts. That’s the goal of three research projects launched by Johnson & Johnson’s pharmaceutical research arm. The projects, announced last week, aim to prevent illnesses — particularly ones related to aging and lifestyle — including Alzheimer’s disease, cancer, heart disease and Type 1 diabetes. Click here for details.

 

Flu Rates High in 15 States; Flu Causes Insurer Earning’s Dive

15 states are still seeing high rates of flu, according to the latest from the CDC. The hospitalization rate in people 65 years and older is 217.3 per 100,000, which is the highest hospitalization rate recorded since data collection on laboratory-confirmed influenza-associated hospitalization in adults began during the 2005-2006 season. Click here for the CDC update. In a related development, Wellcare Health Plans reported a sharp drop in earnings because of the flu season. Click here for the WSJ report.

 

Anthem Customers Get Help After Data Breach

Anthem Inc. is offering several levels of free identity theft protection to current and former customers after hackers broke into a database storing information for about 80 million people. Click here for more. The LA Times reports that that data breach is also a major test for Anthem’s CEO Joe Swedish. Click here.

 

Lawmakers’ Bill Would Repeal Insurance Tax

A bipartisan pair of lawmakers has introduced a bill to repeal the Affordable Care Act tax on health plans. Rep. Charles Boustany Jr. (R-LA) says the tax “drives up costs” across the board. Boustany is joining Rep. Kyrsten Sinema (D-AZ) on the bill. Click here for more.

 

Medicare Advantage Fraud Case Has National Implications

As Medicare Advantage plans scramble to stave off proposed government funding cuts, federal prosecutors in Florida are pursuing an unusual criminal fraud case that’s likely to raise new concerns that some of the health plans for seniors may be overcharging for their services. A federal grand jury in West Palm Beach indicted the doctor on eight counts of health care fraud. He’s accused of cheating Medicare out of about $2.1 million by claiming his Humana-enrolled patients were sicker than they actually were. Click here for the report.

 

Stroke Experts Optimistic on Stents

Stroke experts are reporting a major advance: Stents similar to the ones used to open clogged heart arteries also can be used to clear a blood clot in the brain, greatly lowering the risk a patient will end up disabled. Click here for the story.

 

House Members Push Resolution on Vaccinations

In the wake a the measles outbreak across the United States, a bipartisan group of 90 House members introduced a resolution last week extolling the importance of vaccinations. Click here to see the resolution. Through February 6 there were 121 reported cases of measles. Click here for the latest from the CDC, including a state-by-state breakdown.

 

FDA Issues Guidance on Compounding Pharmacies

The FDA last week released five draft policies to help implement new regulations on compounding pharmacies included in the Drug Quality and Safety Improvement Act. The law, passed in November 2013 in the wake of the deadly fungal meningitis outbreak linked to contaminated steroid injections from the New England Compounding Center, established a new category of “outsourcing facilities” that will be subject to risk-based inspections by FDA and standard good manufacturing practices. Click here for the FDA summary and links to the guidances.

 

Noted Cardiologist Says Hospitals Headed Toward Extinction

“Hospitals, as we know them today, will eventually be extinct,” according to a new book out by noted cardiologist Eric Topol, now with Scripps Translational Science Institute. In his vision, the hospital bed of the future will be in your home, with biosensors monitoring vital signs, smartphones analyzing and transmitting data, smart pillboxes monitoring treatment adherence, and even a smart floor to monitor your gait. Click here for a NY Times review of “The Patient Will See You Now.”