WEEKLY E-BULLETIN


Best Places To Work in Health Care – New Fortune List

What are the 20 best places to work in health care? Fortune has its new list including some hospital systems, physician groups and technology companies. Click here.

 

New Provider Rating System Announced

Yelp and ProPublica have teamed up to create a new provider rating system. Their partnership will allow information from ProPublica’s interactive health databases to begin appearing on Yelp’s health provider pages. In addition to reading about consumers’ experiences with hospitals, nursing homes and doctors, Yelp users will see objective data about how the providers’ practice patterns compare to their peers. Many consumer critiques are already available. Click here for details.

 

Most Hospitals To Be Penalized for Hospital Readmissions

Nearly 2,600 hospitals will be penalized for missing readmission targets under Medicare. They will face an average Medicare payment reduction of 0.61% per patient stay. The reductions are based on readmissions of patients initially hospitalized for heart attack, heart failure, pneumonia, chronic lung problems, or hip or knee replacements, and penalties total $420 million. Most hospitals that escaped penalties this year were exempt because they are specialty or critical-access hospitals or otherwise not subject to the penalties. Click here for the complete list of hospitals. Click here for a state-by-state comparison.

 

AHA Launches Salvo Against Major Insurance Mergers

The American Hospital Association has launched its first salvo against the mergers of Anthem with Cigna and Aetna with Humana. In a letter to the Justice Department last week the AHA said it would first address the Anthem/Cigna merger. A 13-page letter detailing its opposition can be read here. A second letter opposing the Aetna/Humana merger would be sent soon. “While some are comparing these acquisitions to those in the hospital sector, we submit that the antitrust issues for these transactions are fundamentally different. The size, scope and enduring impact of the announced deals far surpass any hospital merger. These transactions will combine four of the five national health insurance companies, with effectively no possibility that existing firms could replicate their size and scope,” the AHA wrote. The AHA has also asked to testify before Congress on these mergers. The Senate Judiciary Committee’s Antitrust, Competition Policy and Consumer Rights Subcommittee has scheduled a hearing for September 22. The CEOs of Aetna, Anthem, Cigna and Humana have been invited to testify.

 

OIG: Terminated Medicaid Providers Get Work in Other States

More than 1 in 10 Medicaid providers who were terminated from one state’s program in 2011 continued to participate in other states despite new ACA rules cracking down on fraud, a new HHS Inspector General report finds. The ACA requires that if a provider is terminated from one state’s Medicaid program for reasons related to fraud, abuse or quality, it can’t continue to participate in Medicaid in other states. But today’s report said state agencies reported that 295 of 2,539 providers “terminated for cause” in one state were still participating in other states’ Medicaid programs as of January 2012. Click here for the OIG report.

 

Most Preventive Health Care Costs More than It Saves: Report

There’s strong evidence from a variety of sources that people who have health insurance spend more on medical care than people who don’t, according to a NY Times story last week. It also turns out that almost all preventive health care costs more than it saves. Those facts don’t mean that giving people health insurance is a waste of money, since those dollars spent may improve their health and financial security. But there are only a few situations in which giving someone more health care will actually end up saving money. Click here.

 

Survey: Less Than 50% of Practices Ready for ICD-10

The latest ICD-10 readiness survey from the Workgroup for Electronic Data Interchange found that fewer than 50% of medical practices say they are prepared for the new codes. WEDI sent a letter to HHS recommending steps to ease the transition. Click here for more.

 

Senators’ Bill Tackles Prescription Drug Abuse

A bipartisan group of Senators introduced a bill last week to help cut back on prescription drug abuse and improve care for at-risk patients. The Stopping Medication Abuse and Protecting Seniors Act, sponsored by Senators Pat Toomey (R-PA), Sherrod Brown (D-OH), Rob Portman (R-OH) and Tim Kaine (D-VA), identifies patients with histories of drug abuse in Medicare Part D and Medicare Advantage and locks them into one prescriber and one pharmacy in order to reduce “doctor and pharmacy shopping.” Click here for details.

 

Lack of Dental Care Causing ED Stress

A lack of dental care for low-income American’s stresses hospital emergency rooms and expanding dental care under Medicaid isn’t enough to solve the problem, the Washington Post reports. Click here.

 

Quality Measures Needed But Current System Not Quite Right: FAHS CEO

The head of the nation’s for-profit hospital association says that quality measures are certainly needed to improve patient care, but that some of the current initiatives lack both the appropriate focus and financial incentives. Writing in the most current edition of the journal Health Affairs, Charles “Chip” Kahn, executive director of the Federation of American Hospital Systems, critiqued the programs developed under the Affordable Care Act as sometimes redundant and costly to deploy. Click here.

 

Insurer Wants Big Rate Hike; Actuaries Say Drug Costs Contributing to Premium Growth; Obama Wants Premium Cuts

Blue Cross Blue Shield of North Carolina, the state’s dominant insurer, explains why the company is increasing its requested rate hike from 25.7 percent to 34.6 percent. Click here for the BCBS explanation and here for the news report. Meantime, premium increases for 2016 Obamacare plans will be driven by the phasing out of programs designed to shield insurers from risk, more in-depth knowledge about the fledgling customers base and the growing cost of prescription drugs, according to a report issued last week by the American Academy of Actuaries. Click here for the report. And, hoping to avoid another political uproar over the Affordable Care Act, the Obama administration is trying to persuade states to cut back big rate increases requested by many health insurance companies for 2016. Click here.

 

HMOs Outperforming PPOs in California: Study

California’s commercial HMO plans outperformed PPO plans on five of six quality measures, according to a new study by the Integrated Healthcare Association. For example, roughly 85 percent of women enrolled in HMO plans who met clinical guidelines for breast cancer screening were tested, compared to fewer than 70 percent of their PPO counterparts. The study scrutinized 2013 data from 11 health plans with roughly 19 million enrollees. Click here for more.

 

Region 4 RAC Loses NJ Contract

HMS Holdings, the Recovery Auditor for RAC Region 4, announced that it had lost its third-party liability contract with the State of New Jersey. This is a significant loss. Estimates are that the contract contributed about $25 million in annual revenue. The winning contractor was Public Consulting Group, HMS Holding’s archrival with which it is embroiled in a lawsuit over trade secrets and poaching employees. Click here for the details.

 

PBMs Excluding More Drugs from Coverage

CVS and rival Express Scripts Holding Co. , which together dominate the U.S. market for administering drug-benefit plans for employers and insurers, are excluding more drugs from coverage if there are viable alternatives in attempts to squeeze greater price discounts from manufacturers, according to reports last week. The pharmacy-benefit managers are steering patients to other drugs they say have equivalent safety and efficacy, but at lower costs. Click here for the Wall Street Journal report.

 

Rx, Device Companies Spend Big on Docs: Report

Pharmaceutical and medical device companies funneled $311 million last year to companies that sponsor continuing education classes for physicians, according to a Boston Globe analysis last week. Click here.

 

New Drug Could Cost $1 Million

Spark Therapeutics is working on a promising gene therapy treatment for blindness, but with an expected price tag of $1 million, the company is trying to work out new payment models with payers, according to press reports last week. It would be the first drug with a seven-figure price tag. Click here for the story.

 

CDC Issues C. difficile Warning

New CDC modeling projects a 10 percent increase in drug-resistant infections and C. difficile in the next five years, compared to 2011 levels if there is not an immediate nationwide response, a report released last week finds. Coordination could prevent up to 70 percent of one type of antibiotic-resistant infections known as CRE over five years. Click here for details from the CDC. Click here for the CDC media release.

 

Nurses on List of Professions with Higher Chance of Breast Cancer

According to a new study from the Breast Cancer Fund, workers across a wide range of fields, including nursing, have a significantly higher chance of getting breast cancer than the general population because of elements they are exposed to on the job. Click here for the report.

 

Hospice Experiment Could Extend Life

An experiment starting next year will give hospice patients access to end-of-life counseling and treatments that could extend their lives in an effort to reduce Medicare costs, reports Stateline. Click here.

 

Psychologists Ban National Security Interrogations

The American Psychological Association last week approved a ban on psychologists being involved in national security interrogations — coercive or not — conducted by the U.S. government, according to the New York Times. The new ban also applies to non-coercive interrogations that are conducted by the Obama administration. Click here for the story.

 

HHS Vulnerable to Cyber Attacks: GOP Report

Hackers have repeatedly battered the Health and Human Services Department with simple cyber attacks and the department remains vulnerable, according to a report released last week by Republicans on the House Energy and Commerce Committee. As a result, HHS needs to be reorganized, they say. Click here for their report.

 

Senators Wants Obamacare Waiver Answers

U.S. Senators Tom Cotton (R-AR) and Al Franken (D-MN) are asking HHS for more specifics about how the department will evaluate Section 1332 waivers, which will give states more leeway to pursue their own health reforms. Under the health care law, a waiver can be approved only if it provides coverage that’s just as comprehensive and affordable as the ACA, insures a comparable number of residents, and doesn’t boost the federal deficit. Several states are exploring 1332 waivers. Click here for their letter.

 

CDC: Too Many Kids Start School Too Early

Fewer than 1 in 5 middle and high schools in the U.S. began the school day at the recommended 8:30 AM start time or later during the 2011-2012 school year, according to data published today in the Centers for Disease Control and Prevention’s Morbidity and Mortality Weekly Report last week by the CDC. Too-early start times can keep students from getting the sleep they need for health, safety, and academic success, according to the American Academy of Pediatrics. Click here for the CDC report.

 

Hospital Transformation Leading to Recruitment of New Type of Leaders

Since the passage of the Affordable Care Act, the pace of change has accelerated dramatically, with a new emphasis on payment reform, prevention and population health. That means rethinking everything, from the scope of services provided to the way in which they’re delivered. Hospitals seeking to bring in new patients and keep costs down are building new alliances – sometimes even with traditional competitors – and adapting new technologies, including electronic health records, to meet their institution’s evolving needs. Click here for the US News report on how hospitals are recruiting new crops of leaders for new times.