WEEKLY E-BULLETIN


Two Websites Launch That Evaluate, Compare Surgeons

Two new sites launched last week will allow consumers to evaluate and compare surgeons based on never-before-available information on complications rates and patient outcomes.

  • The first, released by the nonprofit consumer’s group, only lists surgeons that have had better-than-average outcomes based on an analysis of more than four million surgeries conducted by 50,000 surgeons on hospital inpatients. It uses a 5-star rating system. Click here.
  • The second, created by ProPublica, does include surgeons that have higher-than-average complications based on infections, clots or infections that call for post-operative care. The non-profit news outlet calculated death and complication rates for surgeons who perform one of eight elective procedures in Medicare, including gall bladder removal and hip replacements, adjusting for differences in patient health, age and hospital quality. Click here.

 

CMS Posts First Home Health Star Ratings

CMS last week posted the first star ratings to Home Health Compare, which are based on nine of 29 quality measures publicly reported by home health agencies for calendar year 2014. Medicare-certified agencies that reported data for at least five of the nine measures during the 12-month reporting period received a star rating. CMS plans to introduce additional star ratings in January based on publicly reported measures from the home health patient experience of care survey. Click here for a detailed summary from CMS. Most HHAs scored 2.5 – 3.5 stars. Click here to see how your area’s home health agencies score.

 

Key Senator Calls for 340B Hearing

U.S. Senator Chuck Grassley (R-IA) late last week asked the leaders of the Finance Committee to hold a hearing on the 340B prescription drug pricing program in light of a report from the GAO showing there is a financial incentive at participating hospitals to maximize revenue through the difference between the cost of the drug and Medicare’s reimbursement by prescribing either more drugs or more expensive drugs to beneficiaries. Click here for the Grassley letter. Click here for the GAO report.

 

Primary Care Driving Health Care Revenues; Psychiatrist Demand at All Time High

Specialists are no longer the key to generating healthcare revenues. Now the drivers are team-based healthcare and the chronic care model. Population health and managing chronic illness are fueling continued strong demand for primary care providers, a new report from physician recruiters Merritt Hawkins shows. Demand for psychiatrists is at an all time high. Of the 10 most-recruited positions, six were in primary care, including family physicians, internists, hospitalists, nurse practitioners, OB/GYN, and pediatrics. Click here for details. Click here for a Merritt Hawkins infographic with more information.

 

ICD-10 Roll Out on Target; New Bill Calls for Flexibility

ICD-10 is still on track to begin October 1, but that isn’t stopping some members of Congress from expressing their displeasure with that. A bill proposed last week in the House of Representatives by two top Republicans calls for use of ICD-9 and ICD-10 codes for the first six months after the ICD-10 transition date, Oct. 1. The Code-FLEX Act also calls for HHS to update Congress on how patients, providers and other stakeholders have been affected 90 days after the transition. Click here for more.

 

Report: Veterans Continue to Die While Waiting for Care; VA Hospitals May Close

More than 238,650 of the 847,882 veterans listed as pending for enrollment in the Department of Veterans Affairs health care system as of April died before receiving care, according to a leaked report from the VA Health Eligibility Center and the VA Office of Informatics and Analytics. Click here for the story. And a NY Times story discusses the possibility that the VA may have to close some hospitals because of budget woes. Click here.

 

New Hampshire, Colorado, Maine, Vermont, Virginia Best States on Price Transparency: Analysis

When it comes to requiring healthcare prices to be made public, only five states adequately make the information transparent to consumers, according to a new report released last week. The third annual report from the Health Care Incentives Improvement Institute and Catalyst for Payment Reform shows little progress is being made despite what seems to be more activity in state legislatures discussing the need for price information. 45 of 50 states fail when it comes to disclosing healthcare price information to the public, the report says. Click here for the Forbes report. Click here for the state-by-state analysis.

 

Algorithms Save Medicare $820 Million

Medicare has saved nearly $820 million by using algorithms to fight fraud, a CMS report issued last week shows. The program to date has a nearly 10-to-1 return on investment. It has also shown accelerating gains: The first year showed savings of $115.4 million; the second, $250.1 million; and the most recent, ending last December, $454 million. Plus it has shown expanded capacity to automatically deny claims without human intervention. Click here for details.

 

GAO: Healthcare.gov Has Fraud, Abuse Potential

A watchdog report on fictitious people signing up for ObamaCare has put renewed attention on the potential for fraud and abuse in the system. Congressional Republicans, who have long warned about a lack of safeguards in ObamaCare, pounced last week as the nonpartisan Government Accountability Office (GAO) released the results of an investigation that found 11 of 12 fabricated people were able to enroll in coverage through the federal marketplace. Click here for the GAO report. Democrats blasted the report saying the fictitious people didn’t go through the entire process, which could have caught them at a later point. Click here. Click here for the WSJ story.

 

More Exchange Plans Are “Skinny”

The average ACA exchange plan has 34 percent fewer providers than the average plan offered in individual and group markets outside the exchanges, according to a new Avalere Health analysis. It found 42 percent fewer oncology and cardiology specialists, as well as 24 percent fewer hospitals. The analysis looked at the largest rating regions in California, Florida, Georgia, Texas and North Carolina. Click here for details.

 

S&P: Insurers See Mixed Bag in Risk Adjustment, Reinsurance Programs

Nearly all insurers participating in the ACA’s reinsurance program will get payments that on average are 20 percent higher than expected, according to a new Standard and Poor’s analysis. HHS announced earlier that 437 insurers are splitting $7.9 billion because they had individual customers who exceeded $45,000 in claims in 2014. Meanwhile, more than half of insurers received less money than expected through the law’s risk adjustment program, which redistributes industry funds to insurers that ended up with disproportionately expensive customers. Click here for Standard and Poors report.

  • Government audits just released as the result of a lawsuit detail widespread billing errors in private Medicare Advantage health plans going back years, including overpayments of thousands of dollars a year for some patients – this is according to a report last week from the Center for Public Integrity. Click here.

 

Moody’s: Insurance Consolidation Will Pressure Docs, Cancer Drugs

As the nation’s biggest health insurers jockey for supremacy (Aetna buying Humana, Anthem pursuing Cigna), drug makers should brace for added pressure because doctors are likely to face stingier reimbursement over the next few years. And cancer treatments, in particular, are expected to be targeted, according to a report from Moody’s Investor Service. Click here for the story.

 

Former CMS Chief Tapped To Lead Insurance Lobby

Marilyn B. Tavenner, the former Obama CMS administrator in charge of the rollout of HealthCare.gov, was chosen last week to be the top executive/lobbyist for the nation’s largest health insurance association (AHIP) in Washington, D.C. Click here for the NYTimes story.

 

New Bill Creates Nurse Staffing Requirements

Legislation has been reintroduced, H.R. 2083, that would require each hospital – in consultation with the nursing staff – to implement a staffing system that ensures an appropriate proportion of registered nurses on each shift and in each unit of the hospital. The sponsors say it provides flexibility to tailor nurse staffing to the specific needs of each unit, based on factors including how sick the patient is, the experience of the nursing staff, available technology, and the support services available to the nurses. Click here for to read the bill and see a summary. There are 16 cosponsors – click here for the list.

 

CMS Overhauls Nursing Homes Regulations

CMS is out with a new proposed rule overhauling requirements for nursing homes that participate in Medicare and Medicaid. The regulation addresses training staff requirements, adds behavioral health requirements and changes the discharge process to make sure patients understand follow-up care. HHS said the proposal is the first rewrite of long-term-care conditions of participation since 1991. Click here for the rules. Click here for a CMS summary. The projected cost of the proposed nursing home rule is $729,495,614 in the first year, which works out to about $46,491 per facility. By far the most expensive provision: new infection-control standards that take into account the specialized role and typically frail population of nursing homes.

 

Senators Want Investigation of Assisted Living Facilities

U.S. Senator Elizabeth Warren (D-MA) is joining Finance Committee Chairman Orrin Hatch (R-UT), as well as Senate Aging Committee leaders Susan Collins (R-ME) and Claire McCaskill (D-MO), in calling on the GAO to report on the quality of care for Medicaid enrollees in assisted living facilities. For the most part, states are responsible for overseeing those facilities — with “standards that vary dramatically,” the senators note in a statement. Click here to read their letter.

 

While Medicaid Enrollment Surges, Some States Have Budget Concerns

More than a dozen states that opted to expand Medicaid under the Affordable Care Act have seen enrollments surge way beyond projections, raising concerns that the added costs will strain their budgets when federal aid is scaled back starting in two years. Click here for the Washington Post story.

 

Hep C Drug Maker Limits Patient-Aid Programs

The company behind Sovaldi is limiting its patient-assistance programs — designed to help people afford expensive treatments — to force insurers to do a better of job of covering its blockbuster hepatitis C drugs, according to reports last week and a letter from the company outlining its position. The company had offered insurers discounts on these therapies — following a similar move by competitor AbbVie — in the hope that they would remove restrictions on coverage. Some insurers did, but others didn’t. Click here for the WSJ report.

 

Specialty Pharmacies Drawing Questions about Business Practices

As specialty pharmacies proliferate, questions are emerging about their role and business practices, according to NYTimes report last week. Interviews with patients, patient advocates and doctors suggest that specialty pharmacies do not always live up to their billing. There can be onerous refill policies that require hours on the phone, shipments that are delayed or error-ridden, and difficulty reaching a pharmacist or other representatives. Click here.

 

Arizona, Maryland, Missouri, New York, Hawaii Lead on Medicaid Services for Disabilities

The annual ranking of services for people with intellectual and developmental disabilities was released last week by United Cerebral Palsy that looks at Medicaid services offered across the 50 states and the District of Columbia. For the fourth year in a row, Arizona took first place in the listing. Other states leading the pack include Maryland, Missouri, New York, Hawaii, Colorado, Minnesota, the District of Columbia, South Carolina and Ohio. Click here for more.

 

UnitedHealth Plans “Next Generation” Pharmacy

Now that UnitedHealth’s purchase of Catamaran, the fourth-largest pharmacy-benefit manager in the country, is almost complete, company executives say that they’re planning to create a next-generation pharmacy care business that’s more integrated and member-focused. The new PBM will focus on more than just “filling prescriptions,” Larry Renfro, UnitedHealth’s vice chairman and CEO of its Optum business, said during a call discussing the insurer’s second quarter earnings. Click here to listen to the hour-long call – long but good insights into the company. You can also click here for the 10 pages of prepared remarks.

 

Medically Complex Care for Children Not Widely Available

Of the 32 million mostly healthy children Medicaid covers nationwide, only 2 million or about 6 percent, have medically complex conditions. But their care represents more than 40 percent of overall Medicaid spending for children. While a few complex care units in places like Little Rock, Milwaukee and Cleveland have cropped up, the idea has not caught on nationwide. That’s largely because Medicaid and other insurers do not fully reimburse hospitals for specialized services. Click here for the Pew report.

 

Study: Not Enough Angioplasty Centers in U.S.

A study published in the journal Health Services Research found that nearly 50 million people in the U.S., particularly rural, poor and Hispanic people, have to drive a median 81 minutes to reach an angioplasty center. Angioplasty is life-saving in patients experiencing a heart attack. The study also found that most newly opened angioplasty centers were established near existing facilities, doing little to relieve poor access. Click here for more.

 

CDC, Hospital Study Focuses on Community-Acquired Hospitalizations

When U.S. adults are hospitalized with pneumonia, viruses are more often to blame than bacteria. However, despite current diagnostic tests, neither viruses nor bacteria are detected in the majority of these patients according to a study by the CDC released last week. This two-and-a-half year study conducted by CDC, three hospitals in Chicago, and two hospitals in Nashville estimated the burden of community-acquired pneumonia hospitalizations among U.S. adults. Click here for the CDC report.

 

Racial Disparity Continues in Colon Cancer Therapies: Study

White patients with colon cancer are more likely to undergo the recommended chemotherapy after tumor removal than black patients, according to a research report released last week. The study, which appears in the Journal of Clinical Oncology, found that among ideal treatment candidates in 2010, 67% of black patients with advanced colon cancer received chemotherapy while 87% of white patients received the treatment. Click here for more.