Senate Punts Doc Fix to Mid-April; SGR Expires Wednesday

The Senate will not vote on the House-passed SGR reform bill until after Congress returns from Easter break in mid-April. The House overwhelmingly passed the doc payment reform bill March 26. Senate Majority Leader Mitch McConnell predicted the Senate would also pass it by a substantial margin when it returns April 13. The current payment formula expires April 1 when physicians face a 21 percent Medicare payment cut. However, anticipating Senate passage, CMS said it would hold Medicare claims for two weeks -avoiding the payment cut.

  • Click here to see the list of House members who voted against the SGR reform bill.
  • Click here for an excellent updated summary of the House-passed bill.
  • Click here for the NY Times report.

Passage of the SGR reform package means that Congress won’t have to “fix” the payment formula once or twice a year, as it has for the past 13 years. But it also doesn’t keep the status quo. Physicians will receive a 0.5% payment increase this year and and through 2019. However, starting in 2020 physicians meeting new quality standards will receive a larger increase than those who don’t. Click here for a detailed summary of new physician payment system.


Agency Says It Will Issue New Guidance on 340B Program

The Health Resources Services Administration told a House Health Subcommittee last week that it plans to publish proposed guidelines later this year on the “definition of a patient” and “hospital eligibility” under the 340B drug pricing program. There were no fireworks at the hearing as testimony came only from government agencies that administer and oversee the program that allows certain health care providers to substantially reduce the cost of covered outpatient drugs. HRSA says 340B saved providers $3.8 billion in 2013. Click here for the testimony from HRSA. Click here for the GAO’s testimony. Click here for the OIG’s testimony and their recommendations to change the program. Click here for the response from the 340B Coalition.


House, Senate Pass FY16 Budget with Deep Health Care Cuts

The House and Senate both passed FY2016 budget plans last week – both containing massive cuts to Medicare and Medicaid programs. Implementation of those plans won’t happen until later this year and there is no certainty that they will be implemented as designed. Lawmakers will have to make some tough votes in the Fall if these cuts are to be enacted.

  • Click here for a good summary on the House budget plan.
  • Click here for a brief summary of the Senate plan.

Report Challenges Hospitals’ Cost Shifting Arguments

A NY Times report out last week challenges the commonly held belief that when government programs like Medicare and Medicaid are cut then hospitals must charge private payors more. The article notes recent studies that suggest government payment cuts actually result in lower payments from private insurers. Click here for the story.


National Learning Network Pushes Alternative Payment Models

President Obama last week joined hundred of health care providers and other organizations at the White House to kick off the Health Care Learning Payment and Action Network. More than 2,800 payers, providers, employers, patients, and others have registered to participate. Click here if you want to sign up. The Network will accelerate the transformation of the health care delivery system by supporting the adoption of alternative payments models. Earlier this year, HHS announced the ambitious goal of tying 30 percent of payments to quality and value through alternative payment models by 2016 and 50 percent by 2018. Click here for more information from HHS. Click here for the list of organizations, including hospital systems, with specific quality payment goals.


Study: Male Nurses Make More than Female Nurses

Male nurses make $5,100 more on average per year than female colleagues in similar positions, researchers reported on last week. The new analysis, which included data on more than 290,000 registered nurses, also found that the pay gap had not narrowed within workplace settings and specialties from 1988 to 2013. Click here for the analysis. Click here for the news report.


Obama Administration Announces Plan to Fight Antibiotic Resistance

President Obama last week said doctors over-prescribing antibiotics “is a serious problem” and that his plan to combat antibiotic resistance will give doctors guidance “to make the right calls in hard situations.” Obama proposed doubling the federal investment in antibiotic resistance to $1.2 billion in his budget proposal. HHS, USDA and DoD leaders announced Friday a mutli-pronged approach. Click here for details.


Next Generation ACO Conference Call Focuses on Financial Methodology

In a follow-up to the March 10 announcement of the Next Generation ACO Model of payment and care delivery, CMS is hosting an open door forum tomorrow, March 31, at 4 p.mm EDT, that will focus on financial methodology. Click here to participate.


Docs NOT Overwhelmed by New Patient Volume: Study

Data from 15,000 physicians’ records indicates that doctors’ offices are not being overwhelmed by new patients receiving insurance coverage under the Affordable Care Act. A new report, prepared by cloud-based EHR and services vendor athenahealth and the Robert Wood Johnson Foundation, found primary care physicians had 22.6 percent of their visits from new patients in 2013 and 22.9 percent in 2014. Similarly, small increases were evident for pediatricians and surgeons, while the proportion of new-patient visits was flat for OB/GYNS and declined slightly for other medical specialists. Click here for the analysis.


Happy, or Not So Happy, 5th Birthday Obamacare

The Affordable Care Act is 5 years old this month and it has driven significant change in America’s health care landscape — like it or not. U.S. News found 5 takeaways on the anniversary – everything from the dramatic drop in hospital uncompensated care to the impact of Medicaid expansion, both good and back. Click here for the report. Click here to see 5 ways it may have changed your doctor visit. Click here for the HHS 1-pager on the reduction in hospital uncompensated care.


Higher Ed Getting Out of Insurance Business

Many colleges and universities are getting out of the health insurance business as the provisions of the Affordable Care Act take hold, according to reports last week. Allowing young adults to stay on their parents’ health insurance until age 26 is one of the reasons, but there are more. Click here for the story.


Study: We Get More from Investing in Health Technology than Insurance

Investing in healthcare technology innovation might do more to reduce health risks than providing more people with health insurance, according to a paper published at the National Bureau of Economic Research. They urge thinking of medical innovation as a form of insurance. Click here for this interesting report.


Younger People Now Participating in Their Own End-of-Life Discussions

A national push to have end-of-life discussions before a patient is too sick to participate has focused largely on older adults. When patients are under 18 and do not have legal decision-making authority, doctors have traditionally asked anguished parents to make advanced-care choices on their behalf. However, more recently, providers have begun approaching teenagers and young adults directly, giving them a voice in these difficult decisions, though parents retain legal authority for underage patients. Click here for this compelling NY Times report.


Nearly One-Third of Seniors in Medicare Advantage: Report

More than 17.3 million people were enrolled in Medicare Advantage plans as of March 2015, according to a new report. Year over year, total Medicare Advantage enrollment increased by more than 1.3 million as managed Medicare continues to be an attractive growth market for health insurance companies. CMS says 54.3 million are eligible for Medicare in the United States. Click here for more.


Uninsured Rate Continues to Drop: CDC

The uninsured rate among adults ages 18 to 64 dropped from 20.4 percent in 2013 to 16.7 percent in the first nine months of 2014, according to CDC data released last week. Among adults under 65, nearly two-thirds (169.5 million) had private health insurance at the time of interview in 2014, including 2.1 percent (5.6 million) who had coverage through the Obamacare exchanges. The share of people with exchange coverage increased from 1.4 percent (3.7 million) in the first quarter of the year to 2.5 percent (6.8 million) in the third quarter. Click here for the CDC report.


Study: Health Information Exchanges Not Improving Health Care

Though health information exchanges are supposed to improve the speed, quality, safety and cost of patient care, there is little evidence of these benefits in existing HIE studies. That is the conclusion of a research paper, published in this month’s issue of the journal Health Affairs, in which researchers reviewed 27 studies looking for evidence that HIEs increased efficiency, reduced healthcare costs or improved outcomes. Click here for the story.


Congressional Democrats Want New Labeling Rules for Generic Drugs

Senior Senate and House Democrats last week urged the FDA to adopt a new safety rule for labeling generic drugs. They want to ensure that generic drug manufacturers can quickly update their labeling with new safety information — something that brand name manufacturers can already do. Click here for their letter to the FDA.