WEEKLY E-BULLETIN


Expanded U.S. News Hospital Ratings Released; Top 40 Listed

U.S. News & World Report last week unveiled the broadest expansion of its analysis of hospital quality since it began ranking medical centers 25 years ago. The new Best Hospitals for Common Care ratings cover nearly every hospital in the country and evaluate each one in five common surgical procedures and medical conditions that account for millions of hospitalizations a year. The first set of ratings evaluate hospital performance for traditional Medicare fee-for-service patients, in five procedures: bypass surgery without valve repair or replacement, elective hip and knee replacement, congestive heart failure and chronic obstructive pulmonary disease. Click here for the list of 40 hospitals U.S. News says were the top performers. Click here to see their updated ratings for all hospitals and how they position your hospital.

 

Analysis Critical of Low Volume Hospitals

As many as 11,000 deaths may have been prevented between 2010 and 2012 if patients who went to the lowest-volume fifth of the hospitals had gone to the highest-volume fifth, according a U.S. News report and analysis out last week. Click here for story.

 

Three Hospital Systems Urge Others To Join Low-Volume Limit Standards

Three leading academic hospital systems plan to limit low-volume surgeries and will no longer allow surgeons to perform procedures unless they have sufficient experience, according to U.S. News. Dartmouth-Hitchcock Medical Center in Lebanon, New Hampshire, the University of Michigan in Ann Arbor, and Johns Hopkins Medicine in Baltimore expect to impose the voluntary standards by the end of the year. This is the first such coordinated move to limit procedures, according to the article, as health systems typically give surgeons and hospitals autonomy to perform almost any procedure within the scope of their training. Click here for the report.

 

340B Drug Discount Reform Legislation Stopped

Major changes to the 340B prescription drug discount program were stopped cold last week as hospitals pushed back against an amendment that surfaced unexpectedly and would have made dramatic changes to the program. The amendment, proposed by Rep. Fred Upton (R-MI), who chairs the Energy & Commerce Committee, would have added significant reporting requirements, added new definitions to what constitutes an eligible “patient,” and required a new participation fee for providers. Click here to see the amendment, which will likely come up again in some form later this year. Click here for the WSJ article. Click here to see the letter with more than 500 hospital names sent to legislators.

 

Study Reveals Significant Harm Due To Medical Care in Children

240 pediatric patient harms were identified in 600 patient charts from six academic children’s hospitals, with at least one harm recognized for 23.4% of patients, according to a new study in Pediatrics. Researchers said 45% of the harms were potentially or definitely preventable. The most common pediatric patient harms were respiratory distress, pain, constipation, surgical complications, and intravenous catheter infiltrations or burns. Click here for the study.

 

GAO Issues Favorable Report on Pioneer ACOs

A new report on Medicare’s Pioneer ACOs was released late last week by the GAO that found fewer than half of the ACOs earned shared savings in 2012 and in 2013, although overall the Pioneer ACO Model produced net shared savings in each year. Specifically, 41 percent of the ACOs produced $139 million in total shared savings in 2012, and 48 percent produced $121 million in total shared savings in 2013. In 2012 and 2013 CMS paid ACOs $77 million and $68 million, respectively, for their shared savings. The Pioneer ACO Model produced net shared savings of $134 million in 2012 and $99 million in 2013. The GAO also found that ACOs that participated in both years had significantly higher quality scores in 2013 than in 2012 for 67 percent of the quality measures. Click here for the 35-page report.

 

CMS Conference Call Set on New Round of Medicare ACOs

Notices of intent to apply to participate in the Medicare Shared Savings Program beginning January 1 are due May 29. Eligible hospitals and other care providers may participate in the program by creating or participating in an accountable care organization. CMS will review the MSSP application process during a June 9 National Provider Call. Click here for details and sign up.

 

Bill Would Make Permanent Medicare Bundled Payment Program

U.S. Representatives Diane Black (R-TN) and Richard Neal (D-MA) last week introduced the Comprehensive Care Payment Innovation Act (HR 2502), that would create a permanent, voluntary Medicare bundled payment program. The bipartisan legislation would create, as part of Medicare, a permanent program that provides bundled payments for integrated care furnished by a group of healthcare providers and suppliers during an episode of care. Click here for more.

 

CMMI Leaders make 5-Year Assessment of Agency’s Accomplishments

The leaders of CMS’s Innovation Center are out with a 5-year assessment of the Center’s accomplishments. Click here for the article in the New England Journal of Medicine (subscription required). According to a summary (click here), their priorities going forward:

  • Development of new payment models, such as the Oncology Care Model unveiled in February 2015, which is just now accepting letters of intent.
  • Partnerships with stakeholders across managed care, including commercial insurers, to promote value-based payment to providers, purchasers, and consumers.
  • Sorting out winners and losers. CMMI will begin to expand those models that are working and phase out those that aren’t.

Despite ACA Advances, Study Says 31 Million Remain “Uninsured”

There are now 31 million people who have health coverage with out-of-pocket costs or deductibles so high that they are considered “underinsured,” making them generally unable to take advantage of their health benefits, according to a new study from the Commonwealth Fund out last week. Examining about 3,000 adults ages 19 to 64, the analysis found 23 percent to be underinsured. Most were covered by an employer-sponsored plan or a privately purchased plan. Applied to the entire population, that percentage amounts to 31 million adults. Click here for the study.

 

Disproportionate Share Hospitals Feels Brunt of Uninsured, Seek Relief

Even as the number of insured Americans increases post-Affordable Care Act, the benefits aren’t trickling down to disproportionate share hospitals, which will feel the brunt of ACA-mandated cuts in the next few years, according to a report in U.S. News last week. Safety-net providers also hope to convince Congress to further delay Medicaid cuts as it has done several times in response to some states’ failure to expand the Medicaid program. Click here for the story.

 

Family Health Care Costs Near $25,000

The cost of providing healthcare for a family of four in the United States is now approaching $25,000, according to new data from the actuarial firm Milliman. The overall cost of providing care to a family with a PPO plan has reached $24,671, up 6.3 percent from 2014, among the lowest increases since Milliman began tracking cost trends. By comparison, costs rose 10 percent annually a decade ago. Click here for the very informative 16-page report.

 

Major Insurers Seeking Substantial Rate Hikes

Major insurers in some states are proposing big rate increases for plans sold under the federal health law. In New Mexico, Health Care Service Corp. is asking for an average increase of 51.6% in premiums for 2016. The biggest insurer in Tennessee, BlueCross BlueShield of Tennessee, has requested an average 36.3% increase. In Maryland, CareFirst BlueCross BlueShield wants to raise rates 30.4% across its products. Moda Health, the largest insurer on the Oregon health exchange, seeks an average boost of around 25%. Click here for the WSJ report.

 

Anthem to Acquire Humana, Cigna?

Anthem’s Chief Financial Officer old investors in New York last week that low interest rates make it an attractive candidate for a possible acquisition, according to press reports. The nation’s second-largest insurer is well-positioned to acquire smaller insurers, such as Cigna or Humana, the CFO said. Analysts have been predicting Anthem’s acquisition of either Cigna or Humana. Click here for more.

 

Bills Would Make Changes to Medicare Advantage

Members of the two House committees with health care jurisdiction introduced a number of bipartisan bills last week to make changes to Medicare Advantage plans:

  • HR 2506 from Reps. Vern Buchanan (R-FL), Charlie Rangel (D-NY) and Marsha Blackburn (R-TN) would delay the administration’s authority to terminate MA contracts for plans that didn’t achieve high enough star ratings. (Click here for details.)
  • Another, HR 2505, from Reps. Mike Kelly (R-PA), Ron Kind (D-WI) and Gus Bilirakis (R-FL) would require annual enrollment data reporting for the plans. (Click here)
  • A third, HR 2507, from Reps. Kevin Brady (R-TX), Mike Thompson (D-CA) and Joe Pitts (R-PA) would expand an annual regulatory schedule for the program’s payment rates. (Click here)
  • And HR 2488 from Brady and Reps. Keith Rothfus (R-PA), Susan Brooks (R-IN) and Kurt Schrader (D-OR) would tweak open enrollment periods for the program. (Click here)

Another Cyberattack Against a Major Insurer

CareFirst BlueCross BlueShield last week announced that it was the target of a cyberattack that compromised information of about 1.1 million current and former consumers, as well as individuals who conducted business with the company online. The attack was discovered last month during information technology security efforts conducted in the wake of other recent high-profile cyberattacks on fellow payers Anthem and Premera discovered earlier this year. Click here for details.

 

21st Century Cures Act Passes; No Major Provider Cuts

The House Energy and Commerce Committee last week unanimously approved the 21st Century Cures Act 51-0. The legislation will help to modernize and personalize health care, encourage greater innovation, support research, and streamline the system to deliver better, faster cures to more patients. To pay for the bill’s $13 billion cost, the committee agreed to selling 8 million barrels of oil a year for eight years from the Strategic Petroleum Reserve, which will bring in $5.2 billion. A second change modifies the timing of government payments to insurance companies under the Medicare Advantage program so that the government can keep interest earned on the funds rather than the insurer. This measure will bring in between $5 billion and $7 billion. A $2.8 billion change reduces Medicaid payments for certain medical equipment. The bill would also make $200 million by limiting payments for x-rays on film, incentivizing the switch to digital imaging. Click here for an 11-page, section-by-section summary.

 

GAO Rips Physician Payment Process by Medicare

Medicare pays out about $70 billion a year to physicians — but the way health-care services are priced is flawed, according to a GAO report out last week. The GAO said CMS is supposed to review the rates it sets for doctors’ services every five years, but it doesn’t have any records of the reviews it’s conducted. GAO also criticized CMS for a lack of transparency about which rates it plans to review and how it does so. And it took big issue with CMS’s reliance on data and input from a rate-reviewing committee that GAO found may have overvalued certain services. Click here for the GAO report.

 

CMS Hosts Conference Call for Home Health Agencies

CMS is hosting a national conference call to provide home health agencies with additional information on the new Pay-for-Reporting Performance Requirement. This session follows up on the information presented November 12, 2014, and will also include a review of the content and format of the new Quality Assessments Only Historical Performance Reports that will be distributed to HHAs by the end of June. The call is June 2 at 1:30 p.m. EDT. Participant Dial-In Number: 1-800-837-1935. Conference ID #: 6140706. Click here for some good background information.

 

Government Report Critical of Agencies’ Efforts To Coordinate Home and Community Services

The GAO is out with a report saying the federal government lacks a coherent strategy for coordinating the delivery of home and community-based services and supports. Five federal agencies within four departments fund home and community-based services and supports that older adults often require to continue living independently in their own homes and communities. The report says they are required to coordinate their efforts, but are falling far short. Click here for the report.

 

Interstate Physician Compact Moves Forward with Seventh State

The Federation of State Medical Board’s Interstate Medical Licensure Compact is ready to be formally implemented with the addition of Alabama to the roster of states supporting the legislation. Alabama became the seventh to enact the compact. The other states onboard are Idaho, Montana, Utah, South Dakota, Wyoming and West Virginia. The interstate compact will help reduce barriers for physicians looking to obtain medical licenses in multiple states and facilitate licensure portability and telemedicine. Click here for details.

 

New Bill Would Allow PAs to Care for Hospice Patients

A key GOP member of the Ways and Means Committee is pushing legislation that would allow physician assistants (PAs) to provide care to Hospice patients. HR 1202 was authored by Rep. Lynn Jenkins (R-KS) and would add PAs to the list of authorized Hospice providers in the Social Security Act. There are already 17 cosponsors on the bill. Click here to see the list.