CMS Proposes Reduction in MA Plan Rates

CMS on Friday proposed a 0.9 percent cut to private Medicare Advantage plans for 2016. The 0.9 percent proposed cut includes policy changes in the rate notice as well as payment reductions included already by law. However, if historical trends with “coding intensity” hold true, then plans would ultimately see a 1.05 percent increase in revenue per patient, the agency estimates. Final rates are due April 6. Click here for the 172-page CMS notice. Click here for the summary from the Wall Street Journal. Meantime, Humana is facing new scrutiny from the Justice Department on allegations that it overcharged the government for Medicare Advantage plans, the Center for Public Integrity reports. Click here.


LTCHs Focus of Wall Street Journal Report on Payment Incentives

A Wall Street Journal analysis last week found that many long-term-hospital (LTCH) companies discharge a disproportionate share of patients during that window when hospitals stand to make the most, a sign that financial incentives in the Medicare system may shape patient care. Click here for the story, which includes a review of every LTCH in the country.


Feds Adjust Nursing Home Quality Standards, Star Ratings Fall

The star ratings of nearly a third of the nation’s nursing homes were lowered on Friday, as federal officials readjusted quality standards in the face of criticism that the ratings were inaccurate and artificially inflated. Federal officials said they hoped the changes would make it easier for consumers to differentiate between facilities, as well as spur nursing homes to make improvements. Click here for details. Click here for the Nursing Home Compare website from HHS.


$194 Million in New Ebola Funding Announced

HHS last week released a new funding opportunity announcement: the Hospital Preparedness Program Ebola Preparedness and Response Activities. This funding will award $194,500,000 to states and other grantees for Ebola health care system preparedness and response and the development of a regional Ebola treatment strategy. This funding, in addition to the Ebola emergency funds that will soon be awarded through the Public Health Emergency Preparedness program, provides a total investment of $339,500,000 to enhance state, local and health care system preparedness for Ebola through the emergency appropriations passed by Congress n December. Click here for the HHS details, including a state-by-state list of available funds.


Report: Ebola Can Be Transmitted Through Air

Last year we heard time and time again that Ebola is not spread through the air, food, water or indirect contact with an ill person. Now a group of prominent microbiologists has a new message. “It is very likely that at least some degree of Ebola virus transmission currently occurs via infectious aerosols,” they wrote in an article published in mBio, a journal of the American Society of Microbiology. Translation: when infected people sneeze, cough or exhale, they release tiny droplets of body fluid containing the virus that healthy people could inhale. Click here for the study.


EHR Vendor Market Ranked

A new report released last week ranks EHR vendor market share for physician practices as of January. While the report also broke market share down by practice size, the EHR vendors with the greatest overall market share were led by Epic, with 11.6%, followed by eClinicalWorks with 10.2%. Allscripts ranked third with 8.7%, while Practice Fusion was fourth with 6.7%. Click here for the complete report.


HIPAA Breach Deadline March 1

Has your organization had a breach of protected health information during the past year? March 1 is the deadline for reporting breaches that occurred in 2014 to the HHS Office for Civil Rights, which enforces the HIPAA breach notification rule. Breaches affecting 500 or more individuals require notification to affected individuals and HHS within 60 days of discovery. Covered entities with breaches affecting less than 500 individuals during 2014 must submit notice to HHS within 60 days of the end of the calendar year–March 1, 2015. Click here for more from HHS.


Hospital Prices Falling

New federal data shows that the price of hospital care in the United States fell between this January and a year prior — the first time the government has seen a year-over-year drop since it started keeping track in 1998. The price of hospital care fell 0.1 percent between January 2014 and January 2015. Click here for the story.


Basic Health Program Regs Released

CMS last week issued a final notice establishing the methodology for determining federal funding for the Basic Health Program in program year 2016. This voluntary program enables states to create a health benefits program for residents with incomes that are too high to qualify for Medicaid through Medicaid expansion in the Affordable Care Act, but are in the lower income bracket to be eligible to purchase coverage through the exchange. Click here for the CMS notice.


Obamacare Not Impacting Corporate Profits: Survey

The biggest entitlement legislation in a generation is causing barely a ripple in corporate America, according to a Blomberg news report last week. The Affordable Care Act is putting such a small dent in the profits of U.S. companies that many refer to its impact as “not material” or “not significant,” according to a Bloomberg review of conference-call transcripts and interviews with major U.S. employers. Click here for the story.


ICD-10 Focus of CMS Call and Videos

CMS will discuss ICD-10 implementation issues and testing opportunities during a National Provider Call this Thursday, February 26 at 1:30 p.m. EST. For details on the call or to register, click here. CMS has released two animated videos that explain key ICD-10 concepts. Each video is less than 4 minutes. “Introduction to ICD-10 Coding” (click here) gives an overview of ICD-10’s features and explains the benefits of the new code set to patients and to the health care community. “ICD-10 Coding and Diabetes” (click here) uses diabetes as an example to show how the code set captures important clinical details.


6 Million Facing Obamacare Tax Penalty; HHS To Reopen Exchanges

About six million people face a tax penalty this year for failing to sign up for health insurance last year. Now, many of those people will get an extra chance to enroll in coverage for this year and avoid a second penalty. HHS said late last week it will reopen exchanges in 37 states in March and April to help Americans avoid the tax. Click here for the CMS announcement. Click here for the NY Times story.


800,000 Taxpayers Got Erroneous Obamacare Info

About 800,000 taxpayers who enrolled in insurance policies through HealthCare.gov received erroneous tax information from the government and were urged last week to hold off on filing tax returns until the error could be corrected. Click here for details.


CMS Releases Health Exchange Plan for 2016

Consumers and federally-administered health exchanges continued to see reforms in the regulations governing health plans in those exchanges as CMS last week released its formal guidance for the 2016 open enrollment period. Open enrollment runs November 2015 through January 2016. Click here for a very good 5-page summary from CMS outlining all the changes.


CMMI Issues RFI for Advanced Primary Care

CMS’ Innovation Center is seeking input on initiatives to test innovations in advanced primary care, particularly 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. Comments are due by March 16. Click here for the RFI document.


$386 Million Granted for Home Visiting Program

HHS last week announced $386 million in grant awards to states, territories, and nonprofit organizations to support the Maternal, Infant, and Early Childhood Home Visiting Program (Home Visiting Program). These funds will allow states to continue to expand voluntary, evidence-based home visiting services to women during pregnancy and to parents with young children. Click here to see who got the money.


FTC, DOJ Workshop Focuses on Provider Competition

The Federal Trade Commission and Antitrust Division of the Department of Justice will host a public workshop February 24-25 in Washington, DC, to examine “recent developments related to health care provider organization and payment models, with an emphasis on how they may affect competition in the provision of health care services.” Planned topics include early observations of ACOs; alternatives to traditional fee-for-service payment models; trends in provider consolidation; trends in provider network and benefit design strategies; and early observations of health insurance exchanges. For more on the event and to access a live webcast, click here.


Home Care Workers See Wages Decline: Study

Home care workers have seen their real wages decline over the last decade, according to a new report from the Paraprofessional Healthcare Institute. The report found that while home care workers make about $9.61 an hour, their median annual income is $13,000, since the job is typically part-time. Click here for the report.


Rx Mail Order and Specialty Pharmacies Offer Big Savings: Report

A new report, released last week by the Pharmaceutical Care Management Association, projects that mail-service and specialty pharmacies offer big savings compared to “brick-and-mortar drugstores.” For those prescriptions by mail, the report estimates $5.1 billion in savings for consumers, employers and other payers in 2015 and $59.6 billion over the next decade. And the savings through specialty pharmacies will be an estimated $13.5 billion this year and $251 billion through 2024, according to the analysis. Click here for the report.


Docs Paying Closer Attention to Patient Discharge Surveys

Do physicians really listen to their patients? Many physicians are reexamining the way they deal with patient concerns as more organizations pay closer attention to patient discharge surveys. Click here for the story.


Superbug Outbreak in LA Raises Endoscope Concerns

An outbreak of “superbug” at a Los Angeles hospital has been linked to surgical scopes. Click here for the LA Times story that says it is linked to 2 deaths…and click here for the NPR story on why you shouldn’t be worried. The FDA issued updated guidance on the cleaning of these endoscopes. Click here.


High Cost Drugs, Like Sovaldi, Targeted in New Report

In a new report, amfAR, the foundation for AIDS Research, takes aim at high-cost breakthrough drugs like Sovaldi. While such drugs are a huge improvement to hepatitis C treatment, their high cost means some people can’t access them, amfAR says. The report calls for changing pricing incentives for pharmaceutical companies so that they can’t charge the big bucks. It notes that while Gilead has licensed seven companies in India to make generic formulations of Sovaldi in developing countries, middle-income countries will still be stuck. Click here for the report.


The American Diet Is Killing Us: Nutrition Report

Eat less sugar; cholesterol is ok; eat less red meat; the Mediterranean diet is the best approach. These are just some of the conclusions reached by the Dietary Guidelines Advisory Committee, which convenes every five years. They followed the lead of other major health groups like the American Heart Association that in recent years have backed away from dietary cholesterol restrictions and urged people to cut back on added sugars. Click here for the report and further details. Click here for the HHS announcement.


States Ranked for Well Being

When it comes to well being, not all states rank the same – not even close. Gallop-Healthway is out with its annual survey and finds that Alaska, Hawaii and South Dakota are the top three. Indiana, Kentucky and West Virginia rank the lowest. Click here to see where your state ranks.