CMS Awards First 5-Star Ratings for Nation’s Hospitals

Medicare has awarded its first star ratings to hospitals based on patient satisfaction. Many of the nation’s best known hospitals received average ratings, while comparatively unknown and local hospitals and others that specialized in lucrative surgeries often received the most stars. Evaluating hospitals is becoming increasingly important as more insurance plans offer patients limited choices. Only 7 percent of hospitals received 5 stars.

  • Click here to see the list of ALL hospital scores, by state by hospital.
  • Click here to compare hospitals by state – with Maine, South Dakota and Wisconsin leading the way.
  • Hospital Compare is based on 11 facets of patient experience. Click here for an excellent summary on HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems).
  • Healthgrades issued its awards two weeks ago for patient satisfaction based on HCAHPS. Click here to see their results that gave 452 hospitals their highest mark.
  • Click here for a summary of the new hospital star rating program from CMS.

Limited and Ultra-Limited Networks Are Significant on Exchanges

Consumers are being offered few choices in limited networks, according to new data from the McKinsey Center for Health System Reform. Consumers seem increasingly comfortable trading a greater choice of hospitals or doctors for a health plan that costs significantly less money. Click here for the McKinsey report. Click here for the NY Times story. CMS is now proposing more restrictive changes to how it calculates these payments in its new payment rules released late Friday (see below.)


WSJ: Government Over-Paying for Hospital Outlier Patients

List prices charged by hospitals aren’t supposed to matter to Medicare because the government doesn’t pay them. The federal program almost always pays fixed amounts based mostly on patients’ conditions. However, this apparently isn’t the case for treating “outlier patients.” Medicare allows hospitals to collect for such patients based on the actual costs of treating them. But because hospitals don’t provide cost data until many months after patients are treated, the government has to estimate costs using a formula that relies heavily on list prices. A new Wall Street Journal story suggests that the government is overpaying for these services. Click here.


CMS Proposes Major Changes for Hospitals, LTCHs

CMS late Friday issued its hospital inpatient prospective payment system proposed rule for FY16. The rule would increase rates by 1.1% beginning October 1, 2015, after accounting for inflation and other adjustments required by law. CMS projects that total Medicare spending on inpatient hospital services will increase by about $120 million in FY 2016. There are also additional Medicare DSH payment reductions, as required by the ACA.


CMS projects that LTCH PPS payments would decrease by 4.6 percent, or approximately $250 million, based on the proposed payment rates for FY16. This estimated decrease is primarily attributable to the statutory decrease in the payment rates for site neutral LTCH PPS cases that do not meet the clinical criteria to qualify for the higher standard LTCH PPS payment rates. Cases that do qualify for the higher standard LTCH PPS payment rate will see an increase in that payment rate of 1.9 percent.


CMS also plans to make changes to many reporting requirements, including Value Based Purchasing, Hospital Acquired Conditions (CMS estimates that 644 hospitals would be subject to the 1 percent payment reduction in 2016), Hospital Readmissions program (CMS estimates that 2,655 hospitals will have their base operating DRG payments reduced based on their proxy FY16 hospital-specific readmissions adjustment) and Hospital Inpatient Quality Reporting measures.


Click here for a good CMS summary. Click here for the 1,500 pages of proposed rules.


CMS To Grant $201 Million for Navigators

Eligible individuals and entities, including health care providers, may apply until June 15 for a portion of $201 million in grants to support navigators in federally-facilitated and state partnership marketplaces over three years, CMS announced last week. Letters of intent to apply are due June 3. The grants will be awarded in 12-month increments, with at least $600,000 available for the first 12-month period in each state with a federally facilitated or state partnership marketplace. Click here for details.


Physicians See New Medicare Payment Program as Mixed Blessing

President Obama signed the new physician Medicare payment system into law last week. Physicians will see an average 0.5 percent increase in payments this year and in each of the next four years. Then, significant changes will be implemented requiring a new physician-specific quality reporting system that will provide additional increases or cuts to docs treating Medicare patients. Physicians see the new law as a mixed blessing, according to a New York Times story. Click here. Click here for a very good detailed summary of the changes that will be implemented.


More States Paying Docs To Care for Medicaid Patients

15 states are paying physicians more to take care of Medicaid patients, according to a report out last week. States are using a variety of funding sources including taking from their general funds, increasing tobacco taxes and a tax on hospitals. Click here for the Pew report summary. Click here for the more detailed and most recent MACPAC report on the status of Medicaid and CHIP across the nation.


FDA OKs Chronic Heart Failure Drug that Could Reduce Hospital Admissions

The FDA last week approved a drug to treat chronic heart failure that may help keep patients out of the hospital. The drug, which Amgen will sell under the name Corlanor, works by slowing the heart rate, which helps relieve stress on the organ. Click here for the FDA announcement. To add perspective, click here for the news report.


First Generic MS Drug Could Bring Prices Down

The FDA last week approved the first generic substitute for Copaxone, a widely used drug for multiple sclerosis and the biggest-selling product for Teva Pharmaceutical Industries. The approval of the generic could bring some price competition to the market for multiple sclerosis drugs. Prices for those drugs have tripled in the last several years, to over $60,000 a year, even as more products have come to market. Click here for the story. Click here for the FDA announcement.


Pharma Defends Rise in Rx Costs

Just a few days after reports showed a 13.1 percent spike in prescription drug spending, PHARMA is out with a new video that tries to put it in perspective. “Since 2000, biopharmaceutical companies have brought more than 500 new medicines to U.S. patients, resulting in significant progress against some of the most costly and challenging diseases,” PhRMA says in the video. Click here to see the 2-minute video.


CMS Releases Proposals To Change Skilled Nursing Payments, Reporting Requirements

CMS last week released a proposed rule updating Medicare fee-for-service payments for the skilled-nursing facility prospective payment system for FY16. The rule would increase aggregate payments by 1.4%, or $500 million, after accounting for inflation and other adjustments required by law. The rule also would require the submission of staffing information based on payroll data. CMS also proposes to adopt an all-cause readmission measure for use in the SNF value-based purchasing program, which will begin in FY 2019. Click here for a good CMS summary. Click here for the 150-page rule.


Insurers Call for More Restrictions on Medical Devices

The health-insurance industry is calling for tougher rules for approving and tracking medical devices, citing regulatory gaps exposed last year when a tool used for decades in hysterectomies was found to spread cancer. America’s Health Insurance Plans said in a letter to Senator Bob Casey (D-PA) last week that the dangers of the laparoscopic power morcellator reveal weaknesses in how devices are cleared for use and monitored once they are on the market. Click here for the WSJ article.


E-Cigarette Use Skyrocketing Among Youth: Report

Current e-cigarette use among middle and high school students tripled from 2013 to 2014, according to data published by the CDC and FDA. Findings show that current e-cigarette use (use on at least 1 day in the past 30 days) among high school students increased from 4.5 percent in 2013 to 13.4 percent in 2014, rising from approximately 660,000 to 2 million students. Among middle school students, current e-cigarette use more than tripled from 1.1 percent in 2013 to 3.9 percent in 2014—an increase from approximately 120,000 to 450,000 students. Click here for the report.


New Analysis Shows Dramatic Slowing of Health Care Spending Growth

The United States is in the midst of a remarkable slowdown in health-care spending growth. Health care costs grew, on average, 2 percent faster than the economy between 1990 and 2008. However, since 2008, things have been different. New federal data released in December shows health care costs grew at 3.6 percent — the slowest rate the government has recorded ever, since it began keeping track of health-cost growth in 1960. Click here for a very good and creative visual analysis of the slowing of health care spending.


Nearly 1 in 10 Workers Have Substance Abuse Disorder: SAMHSA

A new report by the Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that 9.5 percent of full-time workers (ages 18 to 64) experienced a substance use disorder in the past year. The report shows that an average of 8.7 percent of full-time workers used alcohol heavily in the past month. Heavy drinking is defined as consuming five or more drinks on the same occasion on five or more days in the 30 days. The report also indicates that 8.6 percent of full-time workers used illicit drugs in the past month. Click here for the report.


CMS Says Most Home Health Claims Are Wrong; New Guidance Released on Doc Home Health Requirements

CMS is hoping to improve the accuracy of provider claims submissions for Medicare home health by implementing clinical templates for provider use. They have been under development for some time. CMS says in FY14, 51.4 percent of the home health claims were paid improperly. CMS is hosting its final national conference call on the development of the clinical templates Tuesday, April 28 at 1:30 p.m. EDT. Click here for details. CMS last week released an update to its sub-regulatory guidance for physician home health certification requirements. Click here for a good summary.


ACA Provision Will Allow States to Redesign Their Healthcare Programs in 2017

The next president will have the chance to remake the nation’s health care overhaul without fighting Congress. The Affordable Care Act includes a waiver that, starting in 2017, would let states take federal dollars now invested in the overhaul and use them to redesign their own health care systems. States could not repeal some things, such as the requirement that insurance companies cover people with health problems. But they could replace the law’s unpopular mandate that virtually everyone in the country has health insurance, provided the alternative worked reasonably well. Click here for the story.


Survey Says: Number of Uninsured At New Low

A new Urban Institute survey finds that the number of uninsured working-age Americans has fallen by 15 million people since Obamacare enrollment began in late 2013. That’s a 7.5 percentage point drop through last month, although it still leaves one in 10 adults aged 18 to 64 without health coverage. The survey found that the uninsured rate fell more sharply in states that expanded Medicaid. Click here for details.


Florida, Feds Fighting Over Medicaid Expansion

The Obama Administration and Florida’s Governor are escalating the fight over the state’s Medicaid program. Last week, Gov. Rick Scott, a Republican, said he planned to sue the Obama administration for using what he called “coercion tactics” to try to pressure the state expanding Medicaid, a centerpiece of the Affordable Care Act. The federal government made clear that unless the Republican-controlled state legislature moved forward with Medicaid expansion, it could lose as much as $2.1 billion in federal dollars to help hospitals care for the uninsured. The federal aid is scheduled to expire June 30. Click here for the story. Click here for a report on how other states are also dealing with their Medicaid expansion efforts.