WEEKLY E-BULLETIN


Best Children’s Hospitals Named by U.S. News

Boston Children’s, CHOP and Cincinnati Children’s top the list of Best Children’s hospitals issued last week by U.S. News. 83 rank among the best. Whether a hospital was ranked, and if so how high, depended on its performance in three areas: clinical outcomes, such as cancer survival and rates of various infections; efficiency and coordination of the process of care delivery, which included reputational survey results, compliance with “best practices” and steps to control infection; and care-related resources such as adequate nursing staff and availability of programs tailored to particular illnesses and conditions. Click here to see the rankings.

  • The CEO of Healthgrades was interviewed last week about the evolving nature of health care ratings systems. Click here.

Supreme Court Ruling – Maybe this Week – Won’t Likely Hurt Hospitals: JP Morgan

The U.S. Supreme Court could rule as early as this week on the legitimacy of federal subsidies to subscribers of health insurance from federally run exchanges. Investors don’t anticipate major financial damage to hospitals even if the Supreme Court’s King decision strikes subsidies in nearly three dozen states — although the anonymous survey of 75 investors by JPMorgan also found that 81 percent expect the Obama administration to prevail in the case. Should the plaintiffs triumph, nearly 90 percent of those surveyed anticipate that the justices would allow subsidies to continue at least through the end of the year. Click here for the survey.

 

OIG Issues Fraud Alert on Doc Deals

The HHS OIG last week issued a one-page fraud alert warning physicians against certain types of compensation arrangements. The OIG placed particular emphasis on the medical directorships and office staff arrangements. Press reports indicated stepped up enforcement efforts are underway. Click here for the fraud alert.

 

CMS Settles $1.3 Billion of Pending Claims; Congress Moving RAC Reform Bills

CMS says it is moving as quickly as it can to settle inpatient claims that have been languishing through the government’s review process. In a notice last week CMS said it had processed the equivalent of 300,000 claims for more than 1,900 hospitals and paid out about $1.3 billion. Click here to see the updated CMS report. This continues as Congress works to move legislation that would dramatically reform the RAC program. The industry-supported bill (H.R. 2156) would eliminate the RACs’ contingency fee structure. 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. Click here to see if your Representative is on the bill — if not, please make a call!

 

Class Action Suit Filed Against CMS for Claims Backlog

In a related development, The Center for Medicare Advocacy, Inc. last week announced the certification of a nationwide class-action suit filed on behalf of Medicare beneficiaries who are challenging “Medicare’s program failure to render decisions at the administrative law judge level within the 90 days required by law.” Click here for the story.

 

Study Identifies Hospitals with Highest Markups

North Okaloosa Medical Center in Florida, along with New Jersey’s Carepoint Health-Bayonne Hospital, tops the list of the U.S. hospitals with the highest markups for their services, according to a new study in Health Affairs. The study found that, on average, the 50 hospitals with the highest markups charged people 10 times more than what it cost them to provide the treatments in 2012. Click here for the report in The Atlantic. Click here for the Health Affairs study. A Bloomberg editorial says it is not the fault of hospitals. Click here.

 

FDA Panel OKs 2 New, Expensive Cholesterol Drugs

An FDA advisory committee last week approved a second very expensive cholesterol-lowering drug. The panel voted in favor of approval of Amgen’s Repatha, following its earlier approval of the Sanofi-Regeron product Praulent. As biologics, both drugs are complicated to manufacture and expected to be priced around $10,000 to $12,000 per patient annually, which could add significantly to the nation’s health spending given the millions of patients here who could be eligible for treatment. Click here for the story.

 

Battle over 340B Drug Discount Program Heats Up

Pharma is stepping up its attacks on the 340B pharmaceutical discount program. A new analysis released last week from a Pharma supported group found hospitals participating in the 340B Drug Pricing Program were more likely to acquire independent physician practices than non-340B hospitals. Click here for the report. Last week the drug industry released a new educational video on-line that says hospitals are abusing the program. “While clinics that receive government grants largely use the program to improve access to medicines for needy patients, not all 340B hospitals are good stewards of the program,” Pharma says. Click here for the Pharma video. Click here to see the American Hospital Association’s response. Another study recently released says hospitals are doing a good job of management the program. Click here. New HRSA regulations governing the 340B program are expected to be released any day.

 

Analysis Reveal Explosion in Medicare Funding of Popular Tranquilizers

In 2012 Medicare didn’t spend a dime on popular tranquilizers such as Xanax and Valium. The following year it paid $377 million to cover prescriptions for nearly 40 million beneficiaries, according to a report last week from ProPublica. Click here.

 

More Consumers Facing Unexpected Health Care Bills

Many consumers with health coverage through the Affordable Care Act are facing unexpected medical bills that in some cases greatly exceed the law’s caps on out-of-pocket expenses. According to a Wall Street Journal report last week, the law’s limits don’t apply to charges from out-of-network providers, and many insurance plans sold on ACA exchanges have limited networks—amplifying the risk of surprise bills. Click here. A national survey released last month by Consumers Union found that 30 percent of respondents reported receiving a surprise medical bill in the last two years. Click here for the survey.

 

Congress Tackles EHR Meaningful Use Program

Concerns about a $30 billion federal program meant to encourage the adoption of electronic health records are likely to be addressed in a Senate medical innovation bill later this year, according to Health Committee Chairman Lamar Alexander (R-TN). Lawmakers in both parties largely agree the government’s six-year-old Meaningful Use Program needs improvements. The CEO of Cerner testified at the hearing and said, “current health IT systems lack true interoperability, and the lack of true interoperability is failing patients.” Click here for his 4-pages of testimony.

 

Study: LTCHs Discharging Patients When They Can Make the Most Money

Long-term-care hospitals discharge a disproportionately large share of Medicare patients during a window when they stand to make the most money from reimbursements under the federal program, according to a study in the journal Health Affairs released last week. The study, which focuses on patients who were on ventilators, is similar to findings in a report by the Wall Street Journal. Click here for the story.

 

Premium Increases Likely to be Modest in 2016: Report

Insurers in 8 states want to raise 2016 premiums for the most popular Obamacare plans by an average of just 5.8 percent, according to an analysis of rate filings released last week by Avalere Health. The proposed rate hikes on silver plans range from a 12 percent increase in Oregon to a 5.3 percent decrease in Michigan. The analysis also scrutinized rate filings in Connecticut, Maryland, Oregon, Vermont, Virginia and Washington, plus the District of Columbia. Click here for the report.

 

Explosion of Digital Health Technology Underway

Attendance continued to increase at last week’s HIMSS conference as entrepreneurs showed some of the results of their innovations. As the world becomes more digitized, the health care industry is racing to keep up, sparking an explosion of new digital technology geared to improving patient care. Click here to see some of the innovations in this USA Today story.

 

Health Spending Is on the Rise, Census Bureau Says

The U.S. Census Bureau has published new estimates of health spending based on their Quarterly Services Survey. Analysis of the survey data shows that health spending was 7.3% higher in the first quarter of 2015 than in the first quarter of last year. Hospital spending increased 9.2%. Greater use of health services as well as more people covered by the ACA appear to be responsible for most of the increase. Click here for the WSJ analysis.

 

Medicare Spending Increasing for Beneficiaries with Multiple Chronic Conditions

A USA Today analysis released last week of CMS data on Medicare spending in 2012 showed that two-thirds of the nation’s nearly 27 million traditional Medicare beneficiaries have multiple chronic conditions. (The analysis does not include the more than 17 million Americans covered through Medicare Advantage plans.) Roughly 15 percent, or 4 million, have more than six chronic conditions. They alone account for more than 40 percent of Medicare Part A and B spending, which hit $324 billion in 2012. Click here for the analysis that includes a state and county-by-county interactive map.

 

Hospitals in 9 States to Receive Ebola Funding

HHS last week announced its selection of nine health departments and 11 associated partner hospitals to become special regional treatment centers for patients with Ebola or other severe, highly infectious diseases. The agency has awarded approximately $20 million through its Hospital Preparedness Program to enhance the regional treatment centers’ capabilities to care for patients with Ebola or other highly infectious diseases. The government will provide an additional $9 million to these recipients in the subsequent four years to sustain their readiness. Click here for details.

 

HHS Releases Benefits and Coverage Rule for Health Plans

HHS late last week released a final rule updating the coverage information that health plans have to provide to customers. It’s the first regulatory update to the “summary of benefits and coverage and uniform glossary” rule since 2012. Click here for the 98-page rule.

 

Bill Would Require Submission of More Medicare Data

Legislation is moving through the House that would require HHS to submit to the Congress data on enrollment in the Medicare Part A, Part B, Part C and Part D programs by zip code, congressional district, and state. The Secretary would be required to submit the data not later than May 1st of each calendar year beginning with 2016. Click here for the 1-page CBO summary of the H.R. 2505.

 

Breast Cancer Incidence Rises with Weight: Study

Overweight or obese postmenopausal women had a higher risk of invasive breast cancer than women at a healthier weight, according to research published last week in JAMA Oncology. The research found that risk was greatest for women with a BMI greater than 35, who had a 58 percent increased risk compared with women of normal weight. Obesity was also associated with markers of poor prognosis — large tumors, lymph node involvement and poorly differentiated tumors. Click here for the complete study.

 

Bill Would Pay for Voluntary Conversations about End-of-Life Care

Medicare would pay doctors and other health care providers to have voluntary conversations about end-of-life care with patients diagnosed with a serious or life-threatening illness under bipartisan legislation introduced last week by a Republican and Democratic senators. Sen. Mark Warner (D-VA), alluded to “death panel” allegations that caused a similar provision to be dropped from the Affordable Care Act and has since made it virtually impossible for lawmakers to address policy gaps around end-of-life-care. Click here for details.

 

HHS Launches Healthy Self Campaign

HHS last week announced its new “Healthy Self” campaign, an initiative to encourage people, particularly young people, to use free preventive services under the ACA. The campaign will promote health literacy and highlight the fact there’s now no cost-sharing for these services. HHS is also encouraging people to post a “#HealthySelfie” on social media while working out or going the doctor. Click here for details.