Deal Close on Doc Fix, CHIP

Negotiations will continue this week on legislation to provide a permanent fix to the formula used to determine how much Medicare will pay physicians. Known as the Sustainable Growth Rate (SGR), the formula has been broken almost since the day it was created 18 years ago. Draft legislation may be available for review as early as tomorrow. The deal could include a multi-year extension of the Medicaid CHIP program. It will also likely include some hospital payment reductions, but the majority of new spending may simply be added to the deficit – not requiring additional cuts. The current SGR fix expires April 1. Click here for the latest news report on the deal.

  • ICD-10 Delay: There has been some discussion about another delay, but Congressional leadership still favors continuing with the October 1, 2015 implementation date.

MedPAC Tells Congress to Impose Site Neutral Payment Changes, Increase Hospital Payments in 2016

The Medicare Payment Advisory Commission issued its formal recommendations to Congress late last week seeking significant changes to Medicare policies starting in 2016. Among MedPAC’s recommendations:

  • Reduce or eliminate differences in payment rates between outpatient departments and physician offices for selected ambulatory services;
  • Set long-term care hospital (LTCH) base payment rates for non–chronically critically ill (CCI) cases equal to those of acute care hospitals and redistribute the savings from LTCH payments to create additional inpatient outlier payments for CCI cases in inpatient prospective payment system hospitals. The change should be phased in over a three-year period from 2016 to 2018.
  • Increase payment rates for the acute care hospital inpatient and outpatient prospective payment systems in 2016 by 3.25 percent, concurrent with the change to the outpatient payment system discussed above and with initiating the change to the long-term care hospital payment system.

Click here for a 3-page executive summary. Click here for the expanded 14-page summary. Click here for the complete 433-page report.


CMS Announces “Next Generation” ACO

CMS announced its Next Generation ACO last week, which the agency says encourages greater coordination and closer care relationships between ACO providers and beneficiaries. CMS says they expect about 20 of these ACOs to be created. Among the changes to current ACO models: rewards to beneficiaries for receiving their care from physicians and professionals participating in their ACOs, coverage of skilled nursing care without prior hospitalization, and modifications to expand the coverage of telehealth and post-discharge home services to support coordinated care at home. Click here for details from CMS. Click here for a CMS document that describes the differences between this new ACO and previous models.


New Bill Would Modify Hospital Readmissions Program

A bipartisan group of senators last week introduced a bill to adjust Obamacare’s readmission program in a way that would bump up payments to hospitals that treat primarily low-income populations. The legislation was introduced by Senators Sherrod Brown (D-OH), Joe Manchin (D-WV) and Bill Nelson (D-FL) Rob Portman (R-OH), Roger Wicker (R-MS) and Mark Kirk (R-IL). The bill would require CMS to account for a patient’s socio-economic status when calculating the risk-adjusted readmission penalties at hospitals under the ACA. Click here for a good 1-page summary.


Best Medical Schools List Released

U.S. News is out with its 2016 list of best medical schools in the United States. They have two lists: best for research, best for primary care. Top 3 for research: Harvard, Standford and Johns Hopkins. Top 3 for primary care are the Universities of Washington, North Carolina and California. Click here to see the full lists.


Leapfrog Releases Hospital High-Risk Surgeries Survival Rates

Survival rates for high-risk surgeries diverge greatly from hospital to hospital, a new report indicates, underscoring the fact that much work still needs to be done to improve patient outcomes. In the analysis, the nonprofit Leapfrog Group used 2013 data from 1,500 hospitals to determine “predicted survival” rates for abdominal aortic aneurysm repairs, aortic valve replacements, esophagectomy and pancreatectomy. Click here for their report. For specific hospital data click here, select hospital, then click on the “High-Risk Surgeries” tab. Click here for the Reuters report.


AHA Report Details Hospitals’ National Impact

The American Hospital Association is out with a new report detailing the roll hospitals play in the lives of Americans every day. For example, ED visits have increased by nearly 19 percent over the past decade. In 2013, there were more than 133 million ED visits; almost half of hospital care begins in the ED; the majority of ED patients require immediate care. Click here for the complete report.


Health Spending Shoots Up

National health spending grew by 5.7 percent in January, compared with the same month in 2014. It increased across all major categories, but prescription drug spending, up 11.6 percent, was a big factor — according to the latest Altarum Institute analysis. Yet health care prices increased by only 1.2 percent from January 2014 — much less than the 1.8 percent rise in the December year-over-year figure. Click here for the analysis.


Rx Spending Up Most in a Decade

Prescription-drug spending rose more than 12% last year in the U.S., the biggest annual increase in over a decade, according to a report by the nation’s largest pharmacy benefit manager. The increase was driven in large part by soaring demand for expensive new hepatitis C treatments and price increases for diabetes and cancer drugs. Click here for the Wall Street Journal report.


Senate GOP To Release 2016 Budget Plan

Senate Republicans will be releasing their budget plans for 2016 as early as Tuesday and their plan is unlikely to identify what Medicare and Medicaid programs to cut, according to sources on Capitol Hill. However, it will spell out overall savings by program – just not how to get there. It is expected to propose a balanced budget in 10 years. This approach is much different than where the House budget committee is headed as it is expected to again propose specific changes in Medicare and Medicaid. Click here for the story.


CBO Details Health Care Spending Cuts, Increases in Obama Budget

The Congressional Budget Office is out with an updated analysis of the impact of the President’s budget proposal on health care programs. Although the Administration’s budget is not likely to be enacted, individual component may be used by Congress as part of its own budget plans or for other purposes. The CBO analysis is an excellent summary of all of the potential Medicare and Medicaid changes. Click here.


CBO: Obamacare Costs 11 Percent Less

The cost of Obamacare is now expected to be about 11 percent or $142 billion less than what was projected in January, according the CBO. Why? CBO says health insurance premiums are rising more slowly and fewer people are expected to sign up. Click here for the report.


FDA Issues Tightened Endoscope Guidelines

The FDA last week released stricter guidelines for manufacturers of reusable medical instruments, including specialized endoscopes used in about a half-million U.S. medical procedures each year. For the first time the FDA is asking manufacturers to submit scientific data showing that their devices can be safely disinfected. FDA officials acknowledged that previous agency guidelines from 1996 made no such request from companies. Click here for the NY Times story. Click here for the new FDA guidelines.


ACA Didn’t Cause As Many Plan Cancellations: Report

Health plan cancellations due to the Affordable Care Act weren’t as widespread last year as some reports predicted, according to a new analysis. The Urban Institute’s report found that about 2.2 percent of people who purchased coverage on the individual market — some 400,000 individuals — had their plans canceled last year because those weren’t compliant with the ACA. About 500,000 people with employer-sponsored coverage — representing 0.3 percent of the total of this group — had their plans canceled for the same reason. Click here for details.


GAO: Providers, Local Governments Finance Quarter of Medicaid

The GAO released a report last week finding that states financed 26 percent, or over $46 billion, of the nonfederal share of Medicaid expenditures with funds from health care providers and local governments in state fiscal year 2012. State funds were most of the remaining nonfederal share. The GAO says states are increasingly relying on funds from providers and local governments to finance the nonfederal share. Click here for the GAO report.


GOP Governors Seek Response to Supreme Court Decision on Health Subsidies

Republican governors are scrambling to come up with a response if the Supreme Court cripples ObamaCare, leading to a tangle of divergent views that could make it tougher for the GOP to rally around a single solution. Justices are expected to decide in June whether to allow federal subsidies to individuals who buy their insurance on federal exchanges. Click here.


CDC: 65% of Americans with Invasive Cancers Living Longer

Data released last week by the CDC show that 65 percent of Americans with invasive cancers are living at least five years after their diagnosis. Those survival rates, included for the first time in the agency’s latest incidence report on the disease, vary by type of cancer and an individual’s age at diagnosis and race. The stage of cancer at diagnosis and a person’s timeliness of follow-up, appropriateness of treatment and other health conditions also can be factors. Click here for the CDC report.


Imaging Overuse Still a Problem: JAMA Report

A new study published online last week in JAMA Oncology found that geographic regions where imaging overuse is common for prostate cancer also see high overuse rates of breast cancer imaging — a very different type of disease. The findings indicate that imaging overuse could have a regional component, a development that might complicate efforts to reduce the phenomenon. Click here for the report.


Medical Education Nutrition Funding Bill Introduced

Nutrition as a medical issue is the focus of new legislation expected to be introduced this week in Congress. Reps. Tim Ryan (D-OH) and Pat Tiberi (R-OH) are planning to reintroduce the Expanding Nutrition’s Role in Curricula and Healthcare Act (ENRICH Act), which would establish a $15 million competitive grant program with the aim of expanding nutrition and physical activity programs to at least 30 medical schools. Click here for a copy of the bill.


IOM: Raising Minimum Smoking Age Would Save Hundreds of Thousands of Lives

Raising the minimum age of legal access to tobacco products would substantially reduce the number of new smokers, cutting exposure to secondhand smoke in the short term and saving hundreds of thousands of lives in the long term, according to a report released last week by the Institute of Medicine. While federal law sets 18 as the minimum age for purchase of tobacco products, states and localities can raise it. Alabama, Alaska, New Jersey and Utah have each pushed the threshold to 19, while New York City and several other municipalities have increased it to 21. Click here for the report.


New Bill Would Allow Greater Use of Medicare Claims Data

A bill introduced by Sens. Tammy Baldwin (D-WI) and John Thune (R-SD) would allow Medicare claims data and analyses to be redistributed to qualified subscribers for a fee. Under current regulations, reuse of data obtained through Medicare’s Qualified Entity program is allowed only for the creation of public performance reports. The proposed legislation would allow organizations receiving Medicare data to analyze and redistribute it to authorized subscribers (insurers, health systems, and physicians) so they can make more informed decisions; as well as permit those entities to charge a fee to their subscribers. Click here for a 1-page summary.