Hospitals in 75 Metro Areas Targeted for New Medicare Mandatory Bundling

CMS late last week released a proposed rule that would bundle payments for knee and hip replacements for 75 metro areas. The Comprehensive Care for Joint Replacement (CCJR) Model for Acute Care Hospitals would bundle all related care for a 90-day episode. Among other provisions, under certain circumstances the 3-day stay skilled nursing facility rule can be waived in this model. It is a five year test beginning January 1, 2016. “We believe that by requiring the participation of a large number of hospitals with diverse characteristics, the proposed model would result in a robust data set for evaluation of this bundled payment approach, and would stimulate the rapid development of new evidence-based knowledge,” CMS said in its proposed rule. Comments on the proposed rule are due by September 8, 2015. Click here for our health policy team’s three-page overview and for the list of 75 selected MSAs. Click here for the CMS fact sheet.

  • A new study out last week says the bundled payment for inpatient and post acute care services in Medicare would modestly reduce geographic variation in spending, but neither accountable care organizations nor pay-for-performance appear to have an impact. Click here for the AJMC study.


Newest Leapfrog Report Includes 1,500 Hospitals; New Data Included

Last year, just over 1,500 U.S. hospitals voluntarily completed the Leapfrog Hospital Survey, the highest recorded participation to date, according to an announcement last week. The report contains newly released information on hospital-acquired conditions, ICU staffing, safe practices, and never events. Rates of certain hospital-acquired conditions remain a problem. One in six hospitals have higher infection rates than expected for central line infections (CLABSIs) and one in ten perform poorly in preventing catheter-associated urinary tract infections (CAUTIs). Click here for the comprehensive 51-page report. Click here to see how your hospital compares with others.


CMS Proposes 2016 OPPS Regs, Modifies 2-Midnight Rule

CMS has proposed changing several aspects of the 2-midnight rule, which might take some of the steam out of Congress’ interest in repealing the rule altogether. The proposal also contains changes to the Chronic Care Management payment program that started in January. Click here for our team’s excellent 4-page summary. Click here for CMS’ comprehensive summary.


Home Health Regs Cuts Payments, Increase Reporting, Create Value Based Payment Model in 9 States

CMS last week released the proposed rule for the home health prospective payment system for calendar year 2016, which would reduce home health payments by 1.8% from 2015 payment levels. Additionally, CMS has randomly selected nine states — Arizona, Florida, Iowa, Maryland, Massachusetts, Nebraska, North Carolina, Tennessee, and Washington — in which to start a new value based payment model for home health. CMS is also requiring the reporting of new data as part of the IMPACT requirements passed last year. Click here for our policy team’s two-page summary. Click here for the CMS fact sheet.


CMS’ New Doc Payment Regs Make Numerous Changes, Move Toward New Payment System

CMS last week released is proposed physician payment regulation containing substantial changes. It is the first proposed rule since the passage of the law that eliminated the SGR physician payment formula and replaced it with a new plan to pay physicians. Some of those new plans are included in this proposed rule that takes effect January 1. Click here for a detailed CMS summary of its proposal. Click here for CMS’ summary of its effort to replace the SGR.

  • The federal government is proposing to pay health-care providers for talking to Medicare beneficiaries about end-of-life care after mounting calls for a better approach to conversations about dying that can both save costs and improve patient care. The rule would reimburse doctors, nurse practitioners and some others in the health industry for discussions about end-of-life care, which was championed last year in a report by the Institute of Medicine. Click here for the Wall Street Journal story.


Aetna, Humana Deal Prompts More Scrutiny; Hospitals Said To Be Well Prepared for Deal

The Aetna Humana merger plan is likely to receive intense scrutiny from the Federal Trade Commission and Department of Justice, according to a variety of interests closely following the developments. Click here for a 24/7 Wall Street report. Some of the deal points in the Aetna Humana merger have been set. Click here. Senate Majority Leader Mitch McConnell who represents Humana’s home state, Kentucky, is keeping his eyes on the deal. Click here. Click here for more on the GOP response. What is the “prize” in the deal for Aetna? Humana’s extensive Medicare Advantage enrollment. Click here.

  • Fitch Ratings is out with a new report saying hospitals are well-positioned to manage this and other insurer consolidations. Click here.
  • The combined companies, according to a Kaiser Family Foundation analysis, would account for more than 50 percent of market share in four states — Iowa, Kansas, Missouri and West Virginia. Humana alone already controls more than 50 percent of the market in Kentucky, Louisiana, Mississippi and Virginia, while Aetna’s market share tops 50 percent in Alaska. Click here for the analysis.

21st Century Cures Passes House with Big DME Payment Changes

The House last week passed the 21st Century Cures bill on an overwhelming vote of 344-77. The package is pared-down from the legislation that received a unanimous vote out of the Energy and Commerce Committee in late May. Costly parts of the Act were trimmed because leaders were unable to overcome objections to the use of several controversial offsets for the roughly $12 billion package. Durable medical equipment makers take a $2.5 billion hit in payments to help pay for the package. It mostly impacts pharma and medical device industries. The Senate is expected to move similar legislation early next year. Click here for our team’s excellent summary.


Out of Pocket Health Costs Increased Slightly Last Year: Study

Out-of-pocket healthcare costs have increased modestly over the last year, according to a new study – a sign that prices are not skyrocketing under ObamaCare as some critics had predicted. The total amount of money that a patient spent per visit increased 3.5 percent over the last year, according to data from a study published Health Affairs last week. That amounts to about $1 per visit, including copayments and deductibles. Click here for the report.


Precision Medicine Initiative Moves Forward

The Obama administration reported new commitments last week that will help advance the precision medicine initiative that was launched early this year. Among the commitments are the development of guidance materials and partnerships with federal agencies — including the ONC — to increase patients’ understanding of their right to access their own data. The private sector also announced commitments to the program. Click here for a summary.


CVS Aims To Be One-Stop Shop for Health Care

Surveys show that many of the estimated 30 million people who gained insurance coverage last year under health care reform do not have a primary health care physician or do not use one. Many, too, opted for high-deductible health plans and are expected to become picky with the dollars they spend, and less tolerant of the opaque pricing that is still the industry’s norm. And consumers in general are starting to demand more convenient, on-demand access to health care, closer to home. So, CVS dumped tobacco and is transforming to meet growing consumer health care needs. Click here for the story on CVS’ transformation.


NQF Endorses 11 New Measures Related to Cardio Conditions

The National Quality Forum Board of Directors las week endorsed 11 measures related to cardiovascular conditions. The measures focus on a variety of cardiovascular conditions, including heart failure, heart rhythm disorders and Cardiovascular Implantable Electronic Devices (CIED), acute myocardial infarctions (heart attacks), cardiac imaging, congenital heart disease, and statin medications. In all, 15 measures were evaluated against NQF’s endorsement criteria; 11 received endorsement status. Five were new measures and six were maintenance measures. Click here for the complete list.


GAO Medicaid Analysis May Fortell Congressional Reform Action

The GAO is out with a new report that identified four key issues facing the Medicaid program: access to care; transparency and oversight; program integrity; and federal financing. It may help provide some insight into the direction Congress may take the program as it discusses health care payment reforms. Click here for the GAO report.

• A Pew report out last week brings you up to date on efforts to expand Medicaid in the 19 states that have thus far refused. Click here.


Slavitt Gets Official Nod for CMS Post

Andrew Slavitt has been nominated by President Barack Obama to be the next CMS administrator. Slavitt, who is serving as acting administrator, has also held positions with Optum and Ingenix, both units of UnitedHealth Group. He would replace Marilyn Tavenner, who stepped down from the post in February. Click here for more.


Telehealth App Links Docs and Patients Globally

There’s a new telehealth app that allows patients to connect with physicians anywhere in the world…another sign of things to come. Click here for the USA Today report.