WEEKLY E-BULLETIN


New Leapfrog Hospital Safety Scores Released

The Leapfrog Group last week released updated and enhanced data for the Hospital Safety Score, which assigns grades to U.S. hospitals based on their ability to prevent errors, injuries, accidents, and infections. For the first time, the website allows users to view a hospital’s current score alongside its previous scores over the past three years. Of the 2,523 hospitals scored, 782 earned an A, 719 earned a B, 859 earned a C, 143 earned a D and 20 earned an F. Click here to see how your hospital scored. To see their 2014 list of top hospitals, click here.

  • 142 hospitals appear on two patient safety lists: The Leapfrog Group’s Spring 2015 list of ‘A’ hospitals and Healthgrades list of 2015 Excellence in Patient Safety hospitals. Click here to see that list, by state.

 

CMS Makes Changes to Hospice Program

CMS has proposed a change in how hospices are paid for long-stay patients as part of a proposed rule for 2016 hospice rates. The agency is also going to require hospices to report all of a patient’s diagnoses, even those unrelated to the terminal disease. The rule proposed last week has two payment rates for routine home care — with the rates higher for the first 60 days and then dropping on the 61st day. Click here for a CMS summary. Click here for the rule.

 

New Bill Would Kill RAC’s Contingency Fees, Make Major Reforms

Reps. Sam Graves (R-MO) and Adam Schiff (D-CA) last week introduced legislation to reform CMS’ policies surrounding Recovery Auditors. This comes on the heels of a new American Hospital Association report released last week, detailing its allegations that RAC practices are harming hospitals. Click here for the AHA report.

  • The latest bill would eliminate the RACs’ contingency fee structure, a policy not included in the author’s 2013 version of the legislation. Also included in the latest version are policies to lower RAC payments for poor performance due to high rates of incorrect denials, and to establish a transparent method to calculate a RAC’s appeals overturn rate. The bill also requires RACs to make inpatient claims review decisions using the same information doctors had when treating the patient. Click here for more.

 

CMS: Medicare Spent More than $100 Billion on Rx; Internal Medicine Prescribes Most

Medicare spent more than $103 billion on Part D prescriptions in 2013, according to a comprehensive data set released by CMS last week. Ten name-brand drugs alone account for nearly $19 billion in spending. The specialty with the most Part D prescribers in 2013 was internal medicine — with more than 130,000 physicians — but dentists came in a close second at 124,000. A few other key facts:

  • Spending on four medications–heartburn drug Nexium, asthma treatment Advair, cholesterol drug Crestor and the antipsychotic Abilify–topped $2 billion each. Click here for the detailed CMS fact sheet.
  • Physicians prescribed the generic heartburn drug omeprazole 6.4 million times, more than four times as often as Nexium, for a total cost that was less than one-fourth the $2.5 billion Part D spent on Nexium. Click here for a review of the impact of brand name vs. generic prescribing.
  • The Wall Street Journal reported that two single cancer treatments–Celgene’s Revlimid, for blood cancer, and Teva’s multiple sclerosis drug Copaxone–accounted for 26 percent of Part D drug spending in 2013. Click here for their analysis that includes a searchable Rx database.
  • Click here for the brief AMA guide on this data.

5 Biggest Insurers Make Big $$$ in First Quarter

The five biggest insurers in the country are heading into a more stable future after their first quarter earnings reports show that they are in good financial health in the post-reform market. Aetna, Anthem, Cigna, Humana and UnitedHealth now understand the Affordable Care Act’s impact on the market, benefit from Medicare Advantage and see overall business growth. Click here for the NY Times report.

  • Aetna reported it made $777 million in net profit and $15.09 billion in revenue, an 8 percent increase from last year. Click here for a summary of their financial report.
  • Anthem achieved a better-than-expected first quarter profit of about $865 million. The second-largest insurer’s revenue also rose about 7 percent to almost $19 billion. Click here for more.
  • Cigna’s revenues reached $9.5 billion, an increase of 11 percent from the same time last year. Click here for Cigna’s report.
  • Humana said its revenue rose 18 percent to $13.8 billion, but its earning report noted there was an unexpected increase in hospital admissions in March and April. Click here.
  • UnitedHealth posted revenue of $36 billion and net income of $1.41 billion in the first quarter, amounting a 13 percent year-over-year growth. Click here.

Some Insurers Not Meeting Women’s Health Requirements: Report

Some insurers are dodging women’s health coverage requirements in the 2010 health care law, according to a new report, but advocates stopped short of calling for new laws to bring those health plans into compliance. The National Women’s Law Center last week said it found almost half of the plans it studied were in some way violating a provision in the health care overhaul requiring insurers to cover women’s preventive services without cost sharing. Click here for the report.

 

Malpractice Suits Targeting EHR Errors

Medical errors that can be traced to the automation of the U.S. health care system are increasingly an issue in medical malpractice lawsuits, according to new report. Some of the doctors, attorneys and health IT experts involved in the litigation fear that safety and data integrity problems could undercut the benefits of electronic health records unless HHS and Congress address them aggressively. The pace of these cases doubled from 2013 to early 2014. Click here for details.

 

House Pushing Rx, Device FDA Fast Track Bill

One House initiative gaining momentum is the 21st Century Cures bill, designed in part to speed up FDA drug and medical device approvals. The newest discussion draft was released last week. Click here for a good, detailed summary. Click here and here for short NY Times stories on the effort.

 

States Taking Advantage of Medicaid Expansion Budget Boost

Medicaid expansion has given a budget boost to participating states, mostly by allowing them to use federal money instead of state dollars to care for pregnant women, inmates, and people with mental illness, disabilities, HIV/AIDS, and breast and cervical cancer, according to two new reports. Click here.

 

New Rule Downgrades Safety of Hand Sanitizers, Surgical Scrubs

The FDA last last week issued a proposed rule that would downgrade the safety status of virtually all antiseptic products used by healthcare workers, such as hand-sanitizing gels and surgical scrubs. It says more evidence is needed to prove they aren’t unsafe. There is concern about the safety of alcohol, iodine, and other ingredients used to make hand washes, rubs, surgical scrubs, and patient preoperative skin preparations, including pre-injection preparations used in hospitals and other clinical settings. Antibacterial soaps and hand sanitizer rubs sold as consumer products are not part of the proposed rule. Click here to read the proposed rule.

 

GOP-Led Budget Cuts Hundreds of Billions from Medicare, Medicaid

The Senate takes up the GOP-developed FY16 federal budget deal this week. The House passed it 226-197 Thursday. It would balance the budget in a decade without raising taxes and would pave the way for an Obamacare repeal, which the president said he would vote. Hundred of billions of dollars in cuts to Medicare and Medicaid are included, but not specified. Click here for a summary news report.

 

Most Think ICD-10 Still On Track for October: Survey

Although ICD-10 has been delayed two times already, and many critics gamble that ICD-10 implementation will be deferred yet again, 83 percent of respondents speculated that the current Oct. 1, 2015 deadline will indeed be the “go-live” date for the transition. This is according to a survey that included over 150 upper-level healthcare industry professionals, mostly in IT positions throughout the organizations and conducted by a software testing company. Click here for the survey results.

 

Medical Schools Anticipating 30% Enrollment Increase in 4 Years

The nation’s medical schools are on track to reach targeted enrollment increases of nearly 30% within four years, the Association of American Medical Colleges reported last week. The AAMC’s annual Medical School Enrollment Survey shows that first-year medical school enrollment in 2019–20 will reach 21,304—a 29.2% increase over the baseline enrollment level in 2002–03 and only 130 slots shy of the 30% target. The AAMC says the United States facing a shortage of up to 90,000 physicians by 2025. Click here for the report.

 

New Bill Would Increase Medicare Supported Residencies by 15,000

Legislation introduced last week in the House and Senate would increase the number of Medicare-supported hospital residency positions by 15,000 (3,000 slots per year, over five years), bringing the total number of slots available to approximately 102,000. The legislation also places an emphasis on expanding residency slots in primary care and other specialties necessary to meet the needs of a growing civilian and veteran population. Click here for details.

 

GAO Slams VA Health Care

The GAO placed the Veterans Affairs Department’s healthcare system on a list of high-risk programs for 2015, saying at an April 29 Senate Veterans’ Affairs Committee hearing that the agency needs to address inadequate oversight and ambiguous policies. Click here for the report.

 

What Happens If Supreme Court Nixes Exchange Subsidies?

We are moving closer to an expected Supreme Court decision on the Affordable Care Act that could disallow subsidies to beneficiaries getting their health insurance on federally-run exchanges. The decision is expected next month. Should the court rule against subsidies, the GOP-controlled Congress has no agreed-to solution to help the 7 to 10 million Americans who would be affected. Click here for a brief summary of the options now under consideration.

 

Report: Individual Insurance Market Booming

A new analysis from the Kaiser Family Foundation finds that the nation’s individual insurance market grew 46 percent to 15.5 million people in the first year plans could be purchased through the Affordable Care Act’s marketplaces, which offer premium assistance to low- and moderate-income people. California, Florida, Texas and Georgia accounted for almost half of the enrollment growth. In six states, the number of people covered in the individual market increased by more than 75 percent: Arkansas, Florida, Georgia, Maine, New York and Rhode Island. Click here for the Kaiser report.

 

OIG Says State Exchanges May Be Using Grants Illegally

The HHS Inspector General warned CMS last week that state-based exchanges might be using federal grants to cover operational expenses this year, which is prohibited by the ACA. CMS should issue more guidance on what constitutes operational costs to minimize the improper use of grants, OIG said in an alert to CMS. Click here for that.

 

FDA OKs Generic Abilify

The FDA last week approved the first generic versions of Abilify (aripiprazole). Generic aripiprazole is an atypical antipsychotic drug approved to treat schizophrenia and bipolar disorder. Click here for the FDA announcement.

 

NIH Issues Recommendations on Alzheimer’s

The National Institutes of Health released recommendations last week that provide a framework for a new Alzheimer’s disease research agenda. Developed at February’s Alzheimer’s Disease Research Summit 2015, the highly anticipated recommendations provide the wider Alzheimer’s research community with a strategy for speeding the development of effective interventions for Alzheimer’s and related dementias. Click here for the recommendations.