WEEKLY E-BULLETIN


CMS to Announce Medicare Advantage Payment Update Decision This Afternoon

CMS is expected to announced its decision later today on whether to move ahead with a proposed cut to Medicare Advantage plans of 0.9 percent starting October 1. The agency is waiting to announce until after markets close. More than 300 members of Congress signed letters urging CMS not to cut payments. New polling shows that seniors love their Medicare Advantage plan. Click here to see how much better MA fares than traditional Medicare.

 

Pressure Builds on U.S. Senate to Pass SGR Deal Next Week

CMS now says it can hold physician claims through April 15. After that, physician Medicare payments are reduced by 21 percent. The Senate reconvenes April 13, providing for about a day and half to bring the House-passed SGR repeal and reform legislation to a final vote. Click here for additional information. However, the two week Easter recess is giving opponents to the deal time to foment angst with the House version. One provision attracting scrutiny would provide new lawsuit liability protection to physicians. Click here for the NY Times story. The AARP is urging its membership to urge their senators to re-open the deal and make it more “fair” for seniors. Click here for that. And another think tank says the SGR deal will force doctors to avoid the sickest patients. Click here.

 

CMS Delays 2-Midnight Enforcement Again

CMS announced last week that it is delaying enforcement of the “two midnight” rule until April 30, an additional month after the previous deadline. The delay is intended to give Congress a chance to pass the “doc fix” bill, which includes a six-month delay in the enforcement of the rule. Click here for the CMS announcement.

 

MedPAC Urges End to 2-Midnight Rule

MedPAC staff last week presented five recommendations to MedPAC commissioners regarding hospital short stay policy issues. The first two recommendations seek to reduce administrative burden currently placed on providers and improve the accountability of RACs. The last three recommendations focus on improving beneficiary protection. Click here for an excellent two page summary, including links to staff presentations.

 

Joint Commission Warns of Patient Harm from Health IT

As the adoption of health information technology continues to grow industry-wide, the potential for health IT-related harm to patients and even death will increase unless risk-reducing measures are put into place by healthcare organizations. That’s the warning of a new alert from The Joint Commission that identifies specific types of sentinel and adverse events, describes their common underlying causes, and recommends steps to reduce risk and prevent future occurrences. Click here.

 

Study: Dual Eligibles’ Health Outcomes Negatively Impacted by Socioeconomic Factors

Sociodemographic factors are a major driver of adverse health outcomes for patients who qualify for both Medicare and Medicaid, or “dual eligibles,” according to a new study from healthcare analytics firm Inovalon. Researchers analyzed member-level Medicare Advantage data from several health plans, incorporating numbers from more than 2.2 million members and 364 health plans. They found patients with significant socioeconomic disadvantages have worse overall health outcomes even after controlling for their health coverage’s service quality. Click here for the study.

 

Physician Acceptance of New Medicaid Patients Varies Widely by State: CDC

California, Florida, Louisiana, New Jersey and New York-area physicians were the least likely to accept new Medicaid patients in 2013, just as states were increasing reimbursement rates for the low-income health insurance program under the Affordable Care Act, according to a new federal report. The CDC report also found that just 38.7 percent of New Jersey physicians said they accepted new Medicaid patients that year — below the national average of nearly 69 percent. Meanwhile, among California physicians 54.2 percent accepted Medicaid patients. Florida, Louisiana and New York doctors rounded out the top five states. Click here for the CDC report.

 

Health Plans Falling Short on Covering Mental Health: Report

Health plans are failing to cover mental health as required by federal law, according to a report released last week by the National Alliance for Mental Illness. Both a 2008 “parity” law and Obamacare require that some large-group plans with mental health benefits provide them on the same terms they do other medical care. But many plans’ networks don’t have enough mental health providers. Click here for the report.

 

FDA Guidance Target Opioid Use

The FDA issued final guidance last week that it believes will lead to the development of opioid painkillers that aren’t easily abused. The document should help drug companies design and conduct studies so that they can prove their products have abuse-deterrent properties — such as being difficult to crush, break or dissolve — and can label them as such. The agency has already approved four opioids as abuse-deterrent. Click here for the FDA guidance.

 

OIG Starting EHR MU Audits of Eligible Providers

Are you ready for an OIG audit of your EHR Meaningful Use funding awards? Looks like the OIG has started auditing Eligible Providers in accordance with their 2015 workplan. Click here for the workplan. The two audits completed so far were in Massachusetts and Florida on their Medicaid MU payments. Many providers in Massachusetts were required to pay back some of their funds. Click here for the MA report. Not so in Florida. Click here for the FL report.

 

Supreme Court Rules Against Providers on Medicaid Payment Lawsuits

The Supreme Court last week punted the ball to the Obama administration to decide whether states’ Medicaid reimbursement rates are adequate for providers. In a decision with high stakes given Medicaid’s growth, the court ruled 5-4 that private parties do not have the right under the Constitution’s Supremacy Clause to sue states over low reimbursement rates. They initially must seek relief from HHS. Click here for the story.

 

NIH Names Committee to Chart Precision Medicine Initiative

The National Institutes of Health has formed a team of experts to help chart the future course for President Obama’s $215 million Precision Medicine Initiative. The Administration’s vision includes a national research cohort of 1 million or more participants who will volunteer to share their biological, environmental, lifestyle and behavioral information, as well as tissue samples with researchers. Click here for more and the list of the NIH committee members.

 

China Develops New Cancer Drug; Rx Market to Grow Substantially

China has developed a new cancer drug, according to reports last week. It was developed by former researcher with an American pharma company who left to work with a Chinese company. China’s spending on pharmaceuticals is expected to top $107 billion in 2015, up from $26 billion in 2007. It will become the world’s second-largest drug market, after the U.S., by 2020. Click here for the WSJ report.

 

White House Economic Chief Extolls Affordable Care Act

The chairman of the White House’s Council of Economic Advisers last week praised the Affordable Care Act’s role in strengthening the economy. In a speech at the Center for American Progress, Jason Furman listed three ways the health care law is improving the economy: Healthier people are better workers; Americans are not confined to their jobs for health insurance; and macroeconomic performance benefits. Click here for his speech.

 

CDC Warns of Multi-Drug Resistant Shigellosis Bacteria Spreading in U.S.

International travelers to the United States are bringing shigellosis with them and then spreading it to others, with 243 people in 32 states and Puerto Rico sickened from May to February, the CDC reported last week. Shigella sonnei bacteria caused several clusters of illness in Massachusetts, California and Pennsylvania; nearly nine in 10 cases were found to be resistant to Cipro, the first treatment choice. Click here for more from the CDC.