WEEKLY E-BULLETIN


Healthgrades Releases 100 Best Hospitals List for 2015

Healthgrades has released its annual America’s Best Hospital list for 2015. It is based on clinical quality outcomes and it rewards excellence over a multi-year time period. America’s 50 Best Hospitals list are in the top 1% of hospitals for providing overall clinical excellence across a broad spectrum of conditions and procedures consistently for at least six consecutive years. America’s 100 Best Hospitals are in the top 2% of hospitals for exhibiting clinical excellence for at least three consecutive years. Click here to just to see the complete hospital list by state. Click here for Healthgrades’ complete report.

 

Physician Medicaid Coverage Dropping

As Medicaid enrollment continues to rise–it now covers as many as 1 in 5 Americans–the number of primary care physicians accepting Medicaid is dropping. Just 34 percent of PCPs now accept Medicaid, which is a 9-point drop from two years ago, according to a new HealthPocket report. Click here.

 

Site-Neutral Payment Proposals Short Sided: Study

The American Hospital Association is out with a new study showing that patients in hospital outpatient departments are more likely to be low income and minorities and to have more severe chronic conditions than those seen in physicians’ offices. That’s why Congress can’t justify reimbursing hospitals and physicians at the same level. Click here for the excellent AHA summary.

 

New Health Care Cost Info Tool Announced

A new tool called Guroo aims to provide consumers with free national, state and local cost information for common health conditions and services — using claims from multiple insurers for more than 40 million individuals. The Health Care Cost Institute is behind Guroo. It’s limited for now but will add quite a bit more information — potentially through partner relationships. Currently, Aetna, Assurant Health, Humana and UnitedHealthcare are involved in the initiative. Click here to see it. Click here for a good Washington Post summary.

 

GOP Leaders Offer CHIP Alternative

Three GOP leaders were out last week with their own plan to extend the Children’s Health Insurance Program (CHIP). A Senator and two House members introduced a discussion draft that would eliminate several provisions of the ACA related to states’ obligations to provide insurance to certain children plus provisions for increased federal dollars for the program. The proposed plan would also reduce funding for families earning more than 250 percent of poverty. Click here for the 8-page draft. Click here for a 1-page summary.

 

Gallup Report Details State-by-State Uninsured Numbers

A Gallup report released last week showed that of the top 10 states with the biggest decreases in the number of uninsured residents between 2013 and 2014, all but one had both expanded Medicaid and created state-based or partnership exchanges. The exception was Montana, which did neither. Click here for a state-by-state look.

 

FDA Wants Answers on Duodenoscope Disinfection Methods

The FDA never reviewed data from manufacturers regarding the procedures needed to clean the complex medical devices, duodenoscopes, that recently infected seven patients with drug-resistant bacteria, an agency official acknowledged last week, according to the New York Times. Now the FDA has asked manufacturers to provide evidence that their recommended disinfection methods work. Click here for the story

 

Most Obamacare Enrollees Have To Pay Back Hundreds

Fifty-two percent of Obamacare enrollees overestimated their incomes and now have to pay back an average of about $530 for subsidies they received last year, according to a study out last week from H&R Block. Most of those people are still getting big refunds, but the reconciliation process is cutting them by about 17 percent. In addition, the firm found that the average penalty for not having coverage is $172 (almost twice the $95 minimum fine). Click here for their 12-page report.

 

CMS Cuts MA Payments But Proposes Other Helpful Reforms

CMS is out with its proposal to reduce payments to Medicare Advantage plans by about .95 percent, but believes insurers will actually be able to make more than 1% because of other modifications in the rules. In fact, one report last week identifies several ways CMS is proposing to change the MA rules that further change plan designs in an effort to reduce the cost of care. CMS now believes providers can and should use in-home assessments to plan and coordinate patient care, and to come up with ways to help people stay out of nursing homes. Click here for the story.

 

Supreme Court Hears Obamacare Arguments This Week

The U.S. Supreme Court hears oral arguments this week about a case that could through a major wrench into Obamacare. Does the federal government have the right to provide subsidies to health exchange beneficiaries in states that did not create their own exchanges but relied on the federal exchange? 34 states could be impacted by the decision. Click here for a good report on how a decision against the Affordable Care Act would impact states. Now, a number of GOP governors are revisiting their positions on these exchanges because so many of their citizens could be left without affordable coverage. Click here for the story. A court decision is expected in June. Meantime, Senate Finance Committee Chairman Orrin Hatch (R-UT) is asking CMS to explain the details of the “opt out” provision in 2015 insurance contracts that allows insurers to end a contract if subsidies are eliminated by a Supreme Court ruling against subsidies. Click here for the Hatch letter.

 

Millions Could Face Cost Increases in Supreme Court Decision

Nearly 7.5 million Americans could face a premium increase in 2015 if the Supreme Court finds that consumers in states with a federally operated exchange are not eligible for subsidies under the Affordable Care Act. A new analysis finds that individuals receiving subsidies in affected states could see an average increase of 255 percent in their required premium contributions. Click here for the study with state-by-state numbers.

 

CMS Obamacare Enrollment Numbers Released

CMS last week provided its first breakdown of new enrollments versus renewals, which showed that 1.96 million Americans were automatically re-enrolled in coverage for 2015. A total of 8.8 million enrolled. Click here for their complete report.

 

NAIC Outline Anthem Investigation

Seven members of the National Association of Insurance Commissioners will lead the multi-state examination of Anthem Insurance Companies, Inc. and its affiliates — triggered after Anthem reported being a victim of a cybercrime exposing as many as 80 million Anthem customers to identity theft. Click here for details from the NAIC.

 

Bipartisan House Members Push Medicare Anti-Fraud Bill

Ways and Means Health Subcommittee Chairman Kevin Brady (R-TX) and Ranking Member Jim McDermott (D-WA) last week introduced the Protecting the Integrity of Medicare Act (PIMA) of 2015. The bill would prevent fraud in Medicare by making a number of reforms such as removing Social Security numbers from Medicare cards and eliminating unnecessary paperwork for employers. There is much bipartisan support for this bill. Click here for a summary.

 

Study: Medical Identity Theft Growing

A study by the Ponemon Institute revealed the incidence of medical identity theft in the U.S. grew 21.7% between 2013 and 2014. Data also showed nearly 50% of consumers said they would consider switching health care providers if their medical data were stolen, while almost all respondents said that clinicians should reimburse consumers who experienced theft. To get the complete report, click here.

 

Policies to Thwart Unnecessary ED Use May Not Work

Nearly half the states use higher copayments to keep Medicaid recipients from unnecessary visits to emergency rooms. These states require patients to make the payments, which are as high as $30 per visit in Oklahoma, when it is later determined that they did not experience a true medical emergency. But at least one multistate study has found that charging higher copayments does not reduce emergency department use by Medicaid recipients. Click here for the story.

 

Aetna CEO Unconventionally Leading Company’s Transformation

Aetna is the insurer on the move, in part because of its CEO, according to a story in the New York Times. Anumber of significant personal moves have transformed a stodgy insurance company into one of the most progressive actors in corporate America. Most health insurance companies are thriving, largely because of increased enrollment. Aetna’s stock has increased threefold since Mr. Bertolini took over as chief executive in 2010, and recently hit a record high. Click here for the story.

 

Appeal Made on Behalf of Home Health Workers

Advocates for home health workers asked a Washington, D.C. appeals court last week to reverse a judge’s decision that essentially vacated the Labor Department’s overtime and minimum wage rules for home health aides. The groups, which include the National Employment Law Project and National Jobs with Justice, said home health work has undergone a dramatic transformation from an informal line of work to a full-fledged occupation since 1974. Click here to read the brief.

 

ACOs Need Reform: Study

It’s time to fix Medicare’s Accountable Care Organizations, according to a report out last week from the Campaign to Fix the Debt in Washington, D.C. Their goal is to reduce government spending and they believe moving more of Medicare beneficiaries into the ACO model will help accomplish that. Among their recommendations: improve the financial model and increase patient engagement. Click here for their report.

 

Recommendations Made To Speed Move from Fee-For-Service to Value

HHS took a major step last month by setting a goal for 50 percent of fee-for-service Medicare payments to be made through alternative payments models by 2018. How do we get there? The Center for American Progress has put out a plan to meet that target, offering several policy actions to accelerate payment reform. Click here for their compelling recommendations.

 

HHS: Seniors Save Billions on Rx Under ACA

9.4 million seniors and people with disabilities have saved over $15 billion on prescription drugs, an average of $1,598 per beneficiary since the ACA was created in 2010, according to HHS last week. In 2014 alone, nearly 5.1 million seniors and people with disabilities saved $4.8 billion or an average of $941 per beneficiary. These figures are higher than in 2013, when 4.3 million saved $3.9 billion, for an average of $911 per beneficiary. Click here for more from HHS.

 

C. Difficile Bacteria Study Details Scope of Impact on Patients

The toll taken by the highly dangerous bacteria C. Difficile is assessed in a study released last week from the CDC. With nearly a half-million infections caused by Clostridium difficile in 2011, researchers found that about 29,000 patients died within 30 days of the initial diagnosis. They also found that about two-thirds of infections were associated with a stay in a hospital or nursing home. Seniors accounted for one in every three infections. Click here for more from the CDC.

 

Bioethics Commission Issues Ebola Report

West Africa’s Ebola epidemic has shown that the U.S. government has “both a prudential and moral responsibility” to respond to global health emergencies, but it must do so far more effectively by strengthening infrastructure and capacity both at home and abroad, says the Presidential Commission for the Study of Bioethics. Click here for their report released last week.