Congress May Make Major Medicare Cuts This Year

A private congressional memo surfaced last week that outlined specific cuts — $96 to $173 Billion — that could be made to Medicare programs as financial off-sets to eliminate budget sequestration later this year. The list includes cuts to nursing homes, hospitals and pharmaceutical companies. Many are modified versions of proposals from the Obama Administration’s budget, or ideas considered to cover the cost of repealing the Medicare sustainable growth rate that have been on the table for several years. Sequestration was imposed in 2011 and automatic cuts started in discretionary programs in 2013. Medicare cuts were capped at 2 percent. It is unclear who created the memo, but some of the trade press picked it up last week. Click here to read the 2-page memo.


Leapfrog Says 40% of Hospitals Fail Nursing Workforce Standards

The Leapfrog Group last week released a report that found many hospitals also fail to adequately support their nurses. Leapfrog found that 40 percent of participants in its annual hospital survey failed to meet the group’s national nursing workforce standard, which is composed of 21 nursing workforce safe practices that Leapfrog developed based on National Quality Forum standards. The good news is that the percentage of hospitals meeting the standards continues to grow. Click here for the report.


CMS Has More ICD-10 Advice; New Bill Would Delay Implementation

CMS has released another fact sheet on preparing for ICD-10. This latest message offers suggestions for providers whose information systems may not be ready in time for the October 1, 2015 transition deadline. The facts sheet also attempts to dispel some myths and issues a warning. Click here. For those of you concerned about Congress passing a last-minute ICD-10 delay, congressional leaders continue to say that is very, very unlikely to happen – despite the fact that a least one bill has been introduced to delay implementation and it has seven cosponsors. Click here for details.


Full House Committee To Vote on Cures Act This Week

The House Energy and Commerce plans to vote this week on the latest draft of its 21st Century Cures Act. While committee members say the bipartisan legislation is the product of more than a year of listening to healthcare stakeholders across the country, the bill has detractors who feel that members of Congress have not been paying attention to their concerns. Click here for that story.


Cures Act Would Publicly Compare HOPD and ASC Payment Rates

One provision in the 21st Century Cures Act getting the attention of hospitals would require CMS to compare ambulatory surgery center and hospital outpatient department rates for the same procedures. The rate comparison would be posted on the CMS website. It is promoted as a transparency measure, but opponents say it is comparing apples with oranges as HOPDs and ASCs have different missions and see different types of patients with different levels of severity. Click here for the actual bill language and go to page 278 – it is brief and very clear.


Study: 9.8 Million in 20 States Would Lose Insurance If Court Rules Against Obamacare Next Month

20 states stand to lose $721 billion in federal funding if the Supreme Court rules against the administration in King v. Burwell next month, according to a new study from the Urban Institute and Robert Wood Johnson Foundation. These are the states that decided not to expand Medicaid (ceding $483 billion for their programs) or run their own exchanges (thus losing $238 billion in tax credits and cost-sharing reductions in the case of a King victory). The study finds that 9.8 million people in the 20 states would go without health insurance in 2016. Click here for the 8-page study.


Number of $100,000-a-year Drug Patients Exploding

The number of patients taking at least $100,000 worth of prescription drugs in a year tripled from 2013 to 2014, according to new research by pharmacy-benefit manager Express Scripts. Nearly 600,000 Americans have annual medication costs above $50,000. High-cost medications for hepatitis C and cancer were the biggest drivers. Click here for the study.


More Than 1 in 4 Adults with High-Deductible Individual Plans Skipped Care: Study

More than a quarter of adults who bought health coverage on the individual market skipped care because they couldn’t afford it, according to a Families USA report released last week. The report blames high-deductible health plans. More than half of the adults surveyed had deductibles of at least $1,500. About one in three low- and middle-income adults (earning up to 250 percent of the federal poverty level) skipped care, the report found. Click here for the report.


Businesses, Consumers Turning To Non-Traditional Help To Reduce Health Care Bills

ELAP, a Pennsylvania-based benefits consulting firm is working with employer groups to figure out what they should actually pay hospitals, according to a report last week. ELAP figures out what a hospital should be paid by analyzing its own financial filings to Medicare, and then adding a small cushion for a profit. In one case, ELAP cut a $600,000 bill for a spinal fusion surgery to $28,900 — the hospital did not object. Click here for the report. Individuals who pay cash can actually get doctors to bid on their need for services. Appears to be a growing trend. Click here for the LA Times story.


Respite Centers Help Mental Health Services Crunch

Community-based mental health services are particularly vital at a time when the number of beds in state psychiatric hospitals has declined sharply. Nationwide, psychiatric hospitals shed 3,222 beds from 2009 to 2012 amid recession-related budget cuts, and the number has continued to decline even as the economy has improved. 55 percent of U.S. counties have no practicing behavioral health workers and 77 percent have reported an unmet need. Relatively rare in the U.S., respite centers cost a fraction of the price of a hospital stay, and can be far more effective at helping people avoid a psychotic break, severe mood swing or suicidal episode. Click here for the report.


A Third of Nursing Homes Have Low Government Quality Ratings

More than one third of the nation’s 15,500 nursing homes, accounting for 39 percent of all nursing home residents, received relatively low ratings of 1 or 2 stars under the federal government’s recently revamped Five-star Quality Rating System, according to an analysis released last week by the Kaiser Family Foundation. Click here for the report.


Youth Obesity Could Cost $1.1 Trillion: Study

If all 12.7 million U.S. youth with obesity become obese adults, the individual cost on average is just over $92,000, and the societal costs over their lifetimes may exceed $1.1 trillion. Those are the findings of a new study from the Brookings Institute. Click here for the presentation that includes some very good slides. Click here to watch the research panel discussion.


17 Million Could Lose Mammography Screening Coverage

If the most recent U.S. Preventive Services Task Force breast cancer screening guidelines are finalized, 17 million women between the ages of 40 and 49 could lose insurance coverage for mammography screening exams, according to a new report released last week by consulting firm Avalere Health. Click here for the report.


Health Systems Continue Push Against Hunger

Two major health systems and other organizations are continuing their push to promote hunger as a medical issue. ProMedica, The Alliance to End Hunger and Presbyterian Healthcare Services are hosting a regional summit on hunger and health on Tuesday, June 2, in Albuquerque, New Mexico. The Come to the Table summit is free of charge and will feature perspectives from an array of experts including a keynote address by Audrey Rowe, Administrator for the Food and Nutrition Service at the U.S. Department of Agriculture. Click here to learn more about the summit or to register.


137 Million Have Preventive Services Without Cost Sharing: HHS

137 million people, including 55 million women and 28 million children, have private health insurance that covers recommended preventive services without cost sharing, according to a new data from HHS. Under the Affordable Care Act, most health plans are required to provide coverage for recommended preventive health care services without copays. Click here for more information from HHS that includes state-specific numbers.


U.S. Spends Most on Cardiac, Trauma, Cancer, Asthma

The top medical conditions for overall spending have generally remained static for a decade, although the amount being spent on these ailments has risen substantially, according to data out last week from the U.S. Agency for Healthcare Research and Quality (AHRQ). Among the top conditions for spending were cardiac conditions, trauma-related injuries, cancer, and asthma. Click here for details.


Benefits of Medicaid Pay Bump for Docs Uncertain

The long-term effect of the so-called Medicaid pay bump mandated by the Affordable Care Act in 2013 and 2014 remains to be seen, according to a Health Affairs analysis released last week. The ACA required states to raise Medicaid primary care payment rates to Medicare levels in 2013 and 2014, with the federal government covering the difference. Total spending for the Medicaid pay bump program in 2013 and 2014 will likely reach $12 billion. Congress has no plans to re-instate the pay increase. Click here for the analysis.


Not Enough Black Physicians: An Op Ed

Only around 5 percent of practicing physicians are black, compared with more than 13 percent of Americans overall, according to an interesting op ed in the New York Times yesterday. Written by an African American physician, the article says that “as a general rule, black patients are more likely to feel comfortable with black doctors. Studies have shown that they are more likely to seek them out for treatment, and to report higher satisfaction with their care. In addition, more black doctors practice in high-poverty communities of color, where physicians are relatively scarce.” Click here to read.


Machine May Replace Anesthesiologists

Anesthesiology – one of the best paid medical specialties — has some new competition…a machine and it’s already in operation. Click here for the story.