Supreme Court Decision on Federal Insurance Subsidies Could Be This Week

The U.S. Supreme Court could rule as early as today on the King v. Burwell case. If the government loses, as many as 10 million Americans could be without insurance subsidies. Click here for a good report on the possible political consequences of the ruling.


Anthem Pursuing Cigna; Aetna Wants Humana

Intensifying a five-way merger frenzy, Anthem went public on Saturday with a sweetened $47.5 billion takeover offer for Cigna Corp. , while Aetna in recent days made a takeover proposal for Humana. Anthem said in a written statement that it has offered $184 a share for Cigna. That equates to about $47.5 billion for all the company’s stock that was recently outstanding. Click here for the latest story on the health insurance merger mania from the Wall Street Journal.

  • Hospitals and physicians are bracing for mergers that will create even larger health plans. Click here for the story from Forbes.

Hospital Creates Cancer Drug Cost Calculator

Memorial Sloan Kettering Cancer Center in New York has created an interactive calculator that compares the cost of more than 50 cancer drugs with what the prices would be if they were tied to factors such as the side effects the drugs produce, and the amount of extra life they give patients. In many cases, the website calculates a price that is lower than the drug’s market price. The project is the latest salvo from doctors and others against the escalating costs of cancer drugs, which increasingly carry price tags of $100,000 or more per patient for a year or a course of treatment. Click here for the WSJ story.


Oncologists Find New Way to Tackle Late Stage Cancers

An international research team led by Mayo Clinic oncologists has found a new way to identify and potentially stop the progression of many late-stage cancers, according to media reports last week. The new approach can turn off genes that prevent cancer from growing. Late-stage bladder, blood, bone, brain, lung and kidney cancers are examples that oncologists say could be stopped in their tracks. Click here for the USA Today story.


HHS Medicare Fraud Strike Force Announces Biggest Ever Enforcement Action

HHS announced last week a nationwide sweep led by the Medicare Fraud Strike Force in 17 districts, resulted in charges against 243 individuals, including 46 doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes involving approximately $712 million in false billings. In addition, CMS also suspended a number of providers using its suspension authority as provided in the Affordable Care Act. This coordinated takedown is the largest in Strike Force history, both in terms of the number of defendants charged and loss amount. Click here for details from HHS.


MedPAC Makes 5 Hospital Recommendations in Latest Report

The Medicare Payment Advisory Commission (MedPAC) last week issued its annual June report to Congress. MedPAC made five recommendations directly impacting hospitals. MedPAC said the HHS Secretary should:

  • direct recovery audit contractors (RACs) to focus reviews of short inpatient stays on hospitals with the highest rates of this type of stay,
  • modify each RAC’s contingency fees to be based, in part, on its claim denial overturn rate,
  • ensure that the RAC look-back period is shorter than the Medicare rebilling period for short inpatient stays, and
  • withdraw the “two-midnight” rule.
  • The Secretary should evaluate establishing a penalty for hospitals with excess rates of short inpatient stays to substitute, in whole or in part, for RAC review of short inpatient stays.

Click here for the 5-page summary. Click here for the complete report.


AAMC Joins MedPAC In Call Against 2-Midnight Rule

Both the American Association of Medical Colleges and the Medicare Payment Advisory Commission last week called on CMS to remove the 2-Midnight Rule. The AAMC wrote in comments to CMS “This policy and the physician order and certification requirements finalized with it have caused substantial provider and beneficiary confusion, inadequate payment for medically necessary services, and countless operational challenges.” Click here for the AAMC comment letter.


CBO Says Obamacare Repeal Would Cost $353 Billion

Repealing Obamacare would increase the federal deficit by $353 billion over a decade, the CBO determined and released in a report last week, delivering a blow to congressional Republicans bent on scrapping the law. That amount is more than three times what CBO estimated repeal would add to the deficit three years ago. While getting rid of the health care law would save money by eliminating subsidies and Medicaid expansion, those savings would be more than offset by jettisoning the law’s Medicare cuts and tax increases. Click here for the CBO’s report. Click here for the Washington Post story.


CMS Says Independence at Home Demo a Big Success

CMS last week announced positive and promising results from the first performance year of the Independence at Home Demonstration, including both higher quality care and lower Medicare expenditures. The CMS analysis found that Independence at Home participants saved over $25 million in the demonstration’s first performance year – an average of $3,070 per participating beneficiary – while delivering high quality patient care in the home. CMS will award incentive payments of $11.7 million to nine participating practices that succeeded in reducing Medicare expenditures and met designated quality goals for the first year of the demonstration. Click here for details.


Researchers Cloud Impact of Pioneer ACOs

CMS has touted the Pioneer ACO model as a major success, saving $384 million in its first two years. The agency has doubled down on such alternative payment models, vowing to route 50 percent of Medicare payments through them by 2018. But a new paper by two noted health researchers raises serious questions about the viability of the program. They point out that 40 percent of the 32 original Pioneers have dropped out of the program and just eight of those ACOs accounted for nearly 80 percent of the savings generated — including four that exited the program. The exodus might be explained by the fact that those savings only generated bonus payments of $31.4 million for the participants. Click here for the report.


New Report Recommends Changes to Long Term Care Financing

The U.S. spends $300 billion on long-term care every year. With the number of Americans 80 and older expected to double in the next 40 years, that cost is poised to explode. A new report out last week identified some potential solutions to the looming financial crunch. Among the recommendations: creation of a risk-corridor program for long-term-care coverage to protect insurers from losses and entice more of them to offer such products. Click here for the 8-page report.


House Repeals Device Tax; Senate Likely to Follow

The House of Representatives last week voted to repeal the medical device tax, which helps finance the Affordable Care Act. The main lobbying organization representing the medical device makers industry says the industry provides over 400,000 U.S. jobs. The group, AdvaMed, says the tax eliminated 4,500 jobs last year and a projected 20,500 more jobs over the next five years. It also says the levy is forcing companies to cut research and investments. The Senate has yet it act, but is expected to also to follow the House lead. President Obama has said he would veto the bill. Click here for the story.


Poll: Docs Split on Obamacare

A new poll out last week shows that physicians are split pretty much along party lines as to whether or not they like Obamacare. Docs are divided 52 percent against and 48 for. Click here for the interesting survey.


Not-for-Profit Hospital Tax Breaks Double in Value

The value of tax breaks for nonprofit hospitals has doubled over the course of the past decade, according to research released last week, adding fuel to a long-standing debate on whether the hospitals are giving back enough to the public in return for their exemptions. In 2002, nonprofit hospitals received about $12.6 billion in exemptions at federal, state and local levels. That number jumped to $24.6 billion in 2011, the latest data available. States with the highest tax breaks for not-for-profit hospitals were Massachusetts, California, Florida, D.C. and South Carolina. Click here for the story. Click here for the Health Affairs link.


Drug Overdoses Claim Most U.S. Fatalities

Car crashes, head injuries, fires, falls — all of them combined don’t claim as many lives as drug overdoses, with 44,000 fatalities per year, according to a report released last week. In the last four years, drug overdose death rates have climbed in 26 states and D.C. Their toll is greatest in West Virginia (33.5 per 100,000 people), representing more than a third of the state’s total injury deaths. As the problem has worsened, more states have passed laws to expand access of naloxone, which reverses overdoses; 34 now have such statutes. Click here to see how your state does on injury prevention.


U.S. Birth Rate Up, First Time in Years

The birth rate among women ages 15 to 44 increased by 1%, from 62.5 births per 1,000 women in 2013 to 63 births per 1,000 women in 2014, according to the CDC last week. The birth rate for women ages 15-19 fell 9% while rising 3% for women in their 30s and 2% for women in their 40s. The rate of preterm births decreased to slightly under 10%. Click here for more.


No Stopping ICD-10; CMS Offers Advice

ICD-10 starts in just under 100 days and there are NO PLANS in Congress to stop or postpone it. CMS is saying that there is still time to prepare for ICD-10 and recommends a five-step plan. Click here.


Heart Attack Care Resulting in More Saved Lives

Heart specialists across the United States are changing the way they care for heart attack victims, particularly in the minutes after the attack. As a result, an increasing number of persons are surviving. Click here for the report.