Pioneer ACOs: CMS Heralds Savings, Will Expand Program

Pioneer ACOs saved Medicare nearly $400 million over two years and is the first alternative-payment model certified to cut costs while improving health-care quality, CMS said last week.

  • Click here for the CMS actuary report.CMS now wants to expand the program.
  • Click here for the CMS announcement.
  • The Pioneer ACOs have met with mixed success by other measures. Thirteen of the original 32 participating hospital systems have dropped out or switched to other models. Click here for the WSJ report.
  • A new report says more than 40 percent of CMS payments to providers were designed to boost the value of care. Click here for the 2-page summary.

Move Underway to Fix 2 Big Obamacare Complaints

The White House is moving to address two of the most common consumer complaints about the sale of health insurance under the Affordable Care Act: that doctor directories are inaccurate, and that patients are hit with unexpected bills for costs not covered by insurance. Click here for the report.


More Rural Hospitals Close; A Crisis for Rural America

50 hospitals in the rural America have closed since 2010, and the pace has been accelerating, with more closures in the past two years than in the previous 10 years combined. That could be just the beginning of what some health care analysts fear will be a crisis. An additional 283 rural hospitals in 39 states are vulnerable to shutting down, and 35 percent of rural hospitals are operating at a loss. Click here for the AP report out last week.


$101 Million Awarded to Health Centers

HHS last week awarded about $101 million in funding to 164 new health center sites in 33 states and two U.S. Territories for the delivery of comprehensive primary health care services in communities that need them most. These new health centers are projected to increase access to health care services for nearly 650,000 patients. Click here for the state-by-state list of recipients.


Meditech, Epic, Cerner Dominate Hospital IT Market

179 health IT vendors supply certified EHR products to 4,623 hospitals participating in the CMS EHR Incentive Programs at the end of 2014, according to a health IT report out last week from the federal government. MEDITECH, Epic Systems, and Cerner comprise over 53% of the market share of primary certified EHRs for participating hospitals. Click here for more details from the Office of the National Coordinator for Health IT.


CMS Guidance Says Insurers Must Limit Out-Of-Pocket Costs

Insurers must limit each person’s out-of-pocket costs to the ACA’s individual limit even if he or she is enrolled in a family plan that has a higher out-of-pocket cost cap, CMS said in guidance last week. For 2016, the individual out-of-pocket maximum is $6,850 but the family maximum will be $13,700. CMS also clarified how health plans can be in compliance with that requirement but still offer a family high deductible health plan with a $10,000 deductible. Click here for the 1-page CMS guidance.

  • Between 2000 and 2013, Americans spent 1.7 times more out of pocket on health care, according to a report released last week. During that period, the average cost of deductibles more than doubled, the percent of premiums paid by employees increased by about 4 percent, and consumers’ prescription drug costs increased by 55 percent. Click here.

States’ Telemedicine Regulatory Patchwork Produce Mixed Results: Report

Maine, New Hampshire, New Mexico, Tennessee, Virginia and D.C. lead the nation in support of telemedicine, according to a detailed report out last week that looked every state and 13 different indicators. Rhode Island and Connecticut were graded with an “F” in the analysis conducted for the American Telemedicine Association. Click here for the detailed report.


Top 5% of Medicaid-Only Patients Are Almost Half of All Expenditures: GAO

Mississippi, Idaho, Illinois, Utah and Georgia lead the states with the highest cost Medicaid-only patients for hospital care, according to a new GAO report. In each fiscal year from 2009 through 2011, the most expensive 5 percent of Medicaid-only enrollees accounted for almost half of the expenditures for all Medicaid-only enrollees. In contrast, the least expensive 50 percent of Medicaid-only enrollees accounted for less than 8 percent of the expenditures for these enrollees. Click here for the GAO analysis with a state-by-state summary.


State Medicaid Fraud Recovery Hits $2 Billion in FY14

State Medicaid Fraud Control Units continue to see significant financial returns, according an analysis released two weeks ago. The HHS OIG 2014 fiscal year report shows total recoveries of just over $2 billion. While this total is down from the $2.5 billion collected in 2013, the total amount collected represents a return rate of $8.53 for every dollar invested. Click here for more.


New HHS Rules Allows HIV Infected Persons to Donate Organs

HHS issued a final rule last week allowing individuals infected with HIV to donate organs, though their organs may only be transplanted into people who already are HIV-positive and who are participating in clinical research. Supporters say that allowing the donation of HIV-positive organs to HIV-positive recipients could save 500 to 600 lives a year. Click here for a summary and the new rules.


IRS Not Ready to Enforce Coverage Requirement

The Affordable Care Act requires individuals to have basic health insurance coverage, known as Minimum Essential Coverage, or pay an additional tax. The law also requires health care exchanges, employers and insurers to give individuals information about their coverage. But the Treasury Department has delayed employer and insurer reporting until March 2016. And the IRS has not developed processes and procedures to verify compliance with the MEC requirement for the 2015 filing season. Click here for the IRS audit report.


9 in 10 Healthcare Organizations Had Data Breach in Past Two Years

40% of healthcare organizations in a recent survey have experienced more than five data breaches in the past two years, with 90% of the organizations having had at least one breach during that period, according to a new report by the Ponemon Institute. Criminal attacks, which have more than doubled in the past five years (up 125%), are now the most common cause of healthcare data breaches. Click here for the report.

  • CMS and ONC will provide an overview of the CMS Stage 3 and ONC 2015 Edition Health IT Certification Criteria proposed rules — today at 11 a.m. EDT. Information about the comment submission process will also be provided. Click here to sign up.


McAllen, Texas Medical System Sees Huge Reversal

The medical system in McAllen, Texas has seen a dramatic reversal in the past six years, according to the physician who brought national attention to it six years ago. Once the highest cost, least efficient health care city in American, Dr. Atul Gawande now says it has all changed. Click here.


Most Breast Cancer Patients Do NOT Have a Family History of the Disease

Everyone knows that hot pink stands for breast cancer. The second-leading cause of cancer death among women has given rise to perhaps the most effective anti-cancer campaign in U.S. history. But widespread public awareness hasn’t tamped down misperceptions about breast cancer and how it operates. Here are some myths you might still believe. Click here for the story. The debate also continues about breast cancer screening and whether it should be routine and at what age. Click here for another expert physician’s view.


CDC: Too Many Adults Not Screened for Cancer

Many adults in the U.S. are not getting the recommended screening tests for colorectal, breast and cervical cancers, according to data published by the CDC last week. Among adults in the age groups recommended for screening, about 1 in 5 women reported not being up-to-date with cervical cancer screening, about 1 in 4 women reported not being up-to-date with breast cancer screening, and about 2 in 5 adults reported not being up-to-date with colorectal cancer screening. Click here for more from the CDC.


To Screen or Not To Screen: CMS Says Yes to Smokers

Medicare is now paying for screening for lung cancer to patients who have smoked for years – but is screening always a good idea? The medical debate continues…although CMS’ coverage decision was based on the facts of survivability. Click here for the story.


California, New York Only States Consistently Enforcing Mental Health Coverage

Under federal law, insurance plans that cover mental health must offer benefits that are on par with medical and surgical benefits. Twenty-three states also require some level of parity. However, only California and New York consistently enforce the rules, mental health experts say. Click here for the story.


Report: America’s Deadliest Drugs Are All Legal

As the US debates drug policy reforms and marijuana legalization, there’s one aspect of the war on drugs that remains perplexingly contradictory: some of the most dangerous drugs in the US are legal. Tobacco, alcohol, and opioid-based prescription painkillers were responsible for more direct deaths in one year than any other drug. Click here for this compelling report.


Healthcare Leads the Way on New Jobs

The healthcare industry added 45,200 jobs in April, the largest monthly increase so far this year, according to the latest jobs report released last week. Hospitals accounted for more than a quarter of that total. Employment at hospitals went up by 11,800 last month,0.2% more than March and a 1.8% increase from April 2014. Click here for more details from the BLS.


Going Digital to Stay Healthy? What About All that Data You Generate?

Spearheaded by the flood of wearable devices, a movement to quantify consumers’ lifestyles is evolving into big business with immense health and privacy ramifications. Click here for the story.


Hospital Starts Email Free Fridays

Is email the bane of your existence? One hospital has implemented an “email free Friday” program. Click here for details.