“Doc Fix” Deal Has Provider Cuts, CHIP Extension, New Doc Payment System

Senate Democrats seem to be digging in their heals over the House legislation permanently fixing the Medicare physician payment formula (Sustainable Growth Rate – SGR). Leading Democrats say the House package isn’t balanced. They are pushing for a four year extension of CHIP. The House bill has only two years. The current payment fix expires April 1. Senate GOP leaders are preparing a “very short term” extension, anticipating that the deal may not be completed until after the Easter recess in mid-April. Click here to read more about the status of the deal.

  • Cuts to providers in the package were limited. Click here for the 1-page summary of the House deal.
  • The most significant changes are how physicians would be paid by Medicare. Click here for an excellent summary.
  • The GOP developed detailed talking points supporting increasing beneficiary costs. Click here.


CMS Releases Stage 3 Meaningful Use Proposed Rule – All Must Comply by 2018

CMS late Friday released the proposed Stage 3 “Meaningful Use” rule for the Medicare Electronic Health Records Incentive Program. The Stage 3 rule proposes to make Stage 3 optional in 2017. Beginning in 2018, however, all eligible hospitals, critical access hospitals and eligible professionals would be required to report on the same eight objectives of meaningful use that incorporate 21 specific measures, many with higher thresholds than in Stage 2. All providers, even those new to the program, would have to meet Stage 3 beginning in 2018. Click here for the proposed 300-page rule. Click here for the HHS press release.

  • At the same time, the Office of the National Coordinator released a companion rule that proposes certification criteria, standards and implementation specifications for EHR technology. Click here for the 430-page rule. Click here for more details from HHS.
  • Meanwhile, members of Congress are urging HHS to fix current problems with Meaningful Use requirements – and there are many. Click here for their letter.
  • CMS last week did explained how eligible professionals can report on clinical quality measures (CQMs) just once to meet CMS requirements for its physician quality reporting system (PQRS), meaningful use electronic health records (EHR) incentive program, and value-based modifier (VM) program. Click here for details.

Senators Say Meaningful Use Not Working; EPIC Testifies

At a Senate health committee hearing on health IT last week, Chairman Lamar Alexander (R-TN) said the government has been too quick to penalize physicians and hospitals for not meeting the goals of the meaningful use. Sen. Sheldon Whitehouse (D-RI) said it’s time for a reboot of the meaningful use program, and said any reboot should include behavioral health homes and nursing homes. A representative from EPIC testified – click here for their interesting report. Click here for the concerns raised by the Family Physician association.


Record Number of Medical School Seniors Match; Big Gains in Primary Care

A record 16,932 U.S. medical school seniors were matched to first-year residency positions Friday through the National Resident Matching Program, 533 more than last year. A total of 30,212 first- and second-year positions were offered, including more than 600 new first-year positions, half of which were in primary care specialties. Internal Medicine programs offered 6,770 positions, 246 more than in 2014; 98.9 percent of positions filled; Family Medicine programs offered 3,195 positions, 86 more than in 2014; 95.1 percent of positions filled; Pediatrics programs offered 2,668 positions, 28 more than in 2014; 99.5 percent of positions filled. Click here for all the details. (My daughter-in-law matched with Vanderbilt in Anesthesiology!)


2016 GOP Budgets Are Tough on Health Care

While working to find a passable deal on replacing the SGR, Congressional Republicans released their budget proposals for FY16 and the budget committees in both chambers passed their plans. Full House and Senate votes are expected this week. Then they will work to reconcile their two plans into one. Neither plan gives much detail in terms of where Medicare, Medicaid and other health care reductions would be made, but their targets are substantial. Details won’t be available until later this year as Congress works to pass spending bills through September.

  • The House FY16 budget plan would reduce Medicare spending by $148 billion and Medicaid and other health care spending by $913 billion over 10 years; repeal the Affordable Care Act; create a block grant program giving states flexibility to tailor the Medicaid program to their communities; and unify the Medicaid and the State Children’s Health Insurance Program into a single program. Click here to see their plan. Click here for the NYT’s take.
  • The Senate budget plan would adopt the president’s overall Medicare reductions, directing congressional committees to achieve the nearly $431 billion in savings over 10 years; repeal the ACA and provide “reserve funds” to replace it with legislation that “strengthens the doctor-patient relationship, expands choice and lowers health care costs”; and increase state flexibility in Medicaid benefits and administration. Both chambers are expected to consider the plans next week. Click here to see their plan. Click here for the good WSJ comparison of the House and Senate plans.

New Study Details Impact of Changing Payment Models on Physicians

Physician practices are engaging in new health care payment models intended to improve quality and reduce costs, but need help managing increasing amounts of data and responding to the diversity of programs and quality metrics from different payers, according to a study released last week by the RAND Corporation and American Medical Association. Among other findings, physician practices reported making significant investments in their data management capabilities to track and improve performance in alternative payment models. Click here for the study.


New Medicare ACO Applications Due Soon

CMS will review the 2016 application process for the Medicare Shared Savings Program (Medicare ACO) during an April 7 National Provider Call. Click here for the current application process. For more information or to register, click here.

  • CMS last week reviewed its new Next Generation ACO in a national webinar. Click here to see the 47-slide presentation.

Study: ACA Ignited Fundamental Health Care Shifts

The Affordable Care Act has energized five fundamental shifts in health care over the past five years, according to a new report by the PwC Health Research Institute. They are a shift in risk away from traditional insurers and onto providers; a renewed emphasis on primary care; an influx of companies to a new health economy focused on innovation; a shift from wholesale to retail health insurance; and an increased role for states in shaping the health care landscape. Click here for the report.


HHS: More than 14 Million Insured Under ACA

A new report from HHS found that 14.1 million uninsured adults got insurance since October 2013, when the first open enrollment period for the exchanges began. Another 2.3 million young adults got covered between 2010 and October 2013 by staying on their parents’ insurance plan until age 26, one of the law’s most popular benefits. Click here for the specifics from HHS.


CMS Changes Home Health Star Ratings; Schedules Webinar

In response to the comments received and further analysis, CMS has made a number of changes to the Home Health Compare Star Ratings methodology. The finalized methodology is being posted on the Home Health Star Ratings web page – click here. CMS is sponsoring a webinar to review the format of the report and the process for requesting review of the HHC Star Ratings on Thursday, March 26, 2015 at 1pm EDT. To register for this webinar, click here.

  • Face-to-Face encounter requirements for home health agencies are again under fire for contradiction, according to an analysis released last week. Click here.

More MA Plans Have 4+ Stars: Report

The share of Medicare Advantage enrollees in plans with four or more stars climbed significantly over the past year — from 38 percent in 2014 to 60 percent this year, according to an analysis out last week. The percentage in plans with 3.5 or fewer stars dropped from 60 to 39 percent in that year. Plans that rank high on these quality measures get paid more by CMS, so they can offer additional benefits such as reduced cost sharing, an enhanced Part D drug benefit or lower premiums. Click here for the report.


5 More Common Tests, Practices Targeted as Unnecessary

Indwelling urinary catheters, end-of-life breast and prostate cancer screenings and C. difficile toxin tests are common — but often unnecessary, says the Society for Post-Acute and Long-Term Care Medicine in a report out last week. It’s part of the ABIM Foundation’s Choosing Wisely campaign to list practices and tests that are common, but which aren’t supported as effective or necessary by scientific evidence. The first five came out in September 2013. Click here for the latest.

  • Another study in the NEJM says that early scans for back pain in seniors may be a waste of time and money. Click here.

Most Don’t Go To Closest ED To Home: Study

Fewer than half of emergency department visits are to the patient’s local emergency room, according to a new data brief from the CDC. After analyzing data on ED visits between 2009 and 2010, the analysis found the average visit involved an ED that was located 6.8 miles from the patient’s home even though the nearest ED was on average only 3.9 miles away. Overall, only 43.8 percent of visits were to the ED closest to the patient’s home. Click here for more from the CDC.


Another Cyber Attack Against Major Insurer

A cyber attack against information technology systems at health insurer Premera Blue Cross may have given attackers unauthorized access to information on members and others who have done business with the organization since 2002, including names, birth dates, Social Security numbers, claims and clinical information, as well as email addresses and bank account information. Click here for an updated announcement from Premera. Senator Patty Murray (D-WA) criticized Premera last week for its response to the attack. Click here.


Medicare: $3.3 Billion Recovered in Anti-Fraud Efforts Last Year

More than $27.8 billion has been returned to the Medicare Trust Fund over the life of the Health Care Fraud and Abuse Control Program, Attorney General Eric Holder and HHS Secretary Sylvia Burwell announced last week. The government’s health care fraud prevention and enforcement efforts recovered $3.3 billion in taxpayer dollars in FY14. Click here for details.


Are Humana, WellCare, Centene Take Over Targets?

These insurers’ rapid growth in Medicare and Medicaid enrollees may be capturing the attention of larger insurers, according to reports last week. Click here for more. Meantime, authorities have revoked the tax-exempt status of nonprofit Blue Shield of California, potentially putting it on the hook for tens of millions of dollars in state taxes each year. Click here.


Report Looks At Impact Court Decision Could Have on Hospitals

The Supreme Court is likely to rule in June on the constitutionality of the federal government providing subsidies to enrollees in health exchanges run by the federal government. A report out last week looked the devastating impact the decision could have on hospitals in 34 states. Click here.