WEEKLY E-BULLETIN


Thousands of Health Care Providers Move into Next CMS Bundled Payment Phase

More than 2,100 health care facilities and providers have moved into the next phase of a CMS bundled payment initiative, in which they’ll earn financial penalties or rewards tied to the program’s goals. The groups — including hospitals, skilled nursing facilities, group practices and home health agencies — will receive a lump-sum payment for certain entire episodes of care. Before this transition, the groups were in a “preparatory” phase of the Bundled Payments for Care Initiative that didn’t come with financial penalties or rewards. Those groups now get some choice in how much financial risk they’ll assume. Click here for the CMS announcement. Click here to find all participating facilities and their BPCI model(s).

 

CMS Extends Two Midnight Rule Enforcement Moratorium – Again

CMS announced last week that it will be extending an enforcement moratorium for part of the “two midnights” rule that it is currently in the process of updating. Current law grants recovery audit contractors (RACs) the power to enforce the “two midnights” rule, but Congress has periodically delayed the implementation, the latest delay is set to expire September 30, 2015. This enforcement moratorium will extend through December 31, 2015 to allow for the new rule to be finalized and begin in CY 2016. Click here for details from CMS.

 

ICD-10 “Cheat Sheets” Released

CMS has released a series of ICD-10 cheat sheets to help physician practices with different specialties choose the appropriate codes for their services. The documents cover the appropriate codes for the treatments of conditions such as acute respiratory infections, chest pain, diabetes/hypoglycemia/hyperglycemia, abdominal pain or tenderness, underdosing, asthma and hypertension. Click here for the guidance packet from CMS.

 

Number of Uninsured Drop Again

The number of people without health insurance continues to decline and has dropped by 15.8 million, or one-third, since 2013, the Obama administration announced last week. In the first three months of this year, the National Center for Health Statistics said, 29 million people were uninsured. That was seven million fewer than the average for 2014, after a reduction of 8.8 million from 2013 to 2014. Click here for the NY Times report. Click here to see the government data.

 

Almost 1 Million Sign Up for Health Insurance During Special Enrollment

Nearly a million people signed up for health insurance under President Barack Obama’s law even after the official enrollment season ended, helping push the share of uninsured Americans below 10 percent and underscoring how hard it could be for Republicans to dismantle the program. Click here for the detailed CMS report. Click here for the news report.

 

National Health Spending Grows Moderately

National health spending in June grew at a rate of 5.7 percent — down from the 6.7 percent growth rates we saw in the first few months of this year, but still higher than the CMS estimate of 5.5 percent, according to the latest numbers from the Altarum Institute. Health care prices, on the other hand, are staying low — they grew at just 1.1 percent, continuing a several-month trend of similarly low growth rates. Click here for Altarum’s report.

 

ACA Isn’t Creating More Part Time Employees: Studies

Implementation of the Affordable Care Act hasn’t meant less time on the job for American workers, according to three newly published studies that challenge one of the main arguments raised by critics. One provision of the law requires businesses with more than 50 employees to offer health insurance to those working at least 30 hours a week. That mandate took effect this year…So far…researchers say employers have not changed how they hire and schedule their workers in response to the law. Click here for the full report.

  • Businesses are holding off on some changes to minimize the effect of ObamaCare’s “Cadillac tax” to see if congressional repeal efforts are successful, according to a new survey. Click here for the story.

 

HHS Awards $169 Million to 266 Health Centers

HHS announced last week $169 million in funding to 266 new health center sites in 46 states, the District of Columbia and Puerto Rico. These new health center sites are projected to increase access to health care services for over 1.2 million patients. These awards build on the $101 million awarded to 164 new health center sites in May 2015. Click here for a state-by-state list of funding sites.

 

ACOs Not Providing Enough Physician Payment Incentives: Study

A study of 632 primary care practices published in the Annals of Family Medicine suggested accountable care organizations may not provide sufficient incentives for practices to change physician compensation formulas. Data showed most physician compensation in ACOs and non-ACOs came from salary, with productivity coming in second, but just a small percentage was linked to quality or other factors regardless of whether doctors carried substantial cost risk. Click here for the study. Click here for the summary from the AAFP.

 

Cancer Drug Maker Pricing Targeted by Key Members of Congress

Presidential candidate Bernie Sanders(D-VT) and Rep. Elijah Cummings (D-MD) sent letters to two drug companies last week over the “escalating” prices of two heart medicines. The two are conducting a broader investigation into drug price increases in the U.S. The primary target of the recent investigation is Valeant Pharmaceuticals which increased the prices of Isuprel and Nitropress by about 525 percent and 212 percent. Click here for their letter.

 

More Employers To Use Specialty Pharmacies: Survey

The National Business Group on Health released a survey last week that found 55 percent of employers next year plan to direct employees to specialty pharmacies if they need drugs that can cost thousands of dollars for a single treatment. More companies also say they will require employees to get prior authorization before buying specialty drugs under the employer’s health plan — 53 percent vs. 29 percent a year ago. Click here for the survey.

 

SHOP Exchanges Still Not Ready for Prime Time

The Commonwealth Fund was out with a new report looking at the SHOP exchange — the small business exchanges that have gotten off to a rocky start under the ACA. The report hones in on just two states where SHOP is up and running: Colorado and California. A few key findings: everyone agrees the system has far too many operational problems, and that it needs to look a lot more like other exchanges and insurance purchasing options. Click here for the report.

 

New DME Competitive Bidding Timeline Announced by CMS

CMS last week announced the bidding timeline for the Round 1 2017 competition of the Medicare Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Competitive Bidding Program. CMS also has launched a comprehensive bidder education program. Click here for details from CMS.

 

Medicaid Costs in Expansion State Ohio Lower than Expected

Despite higher-than-expected enrollment of Ohioans newly eligible for Medicaid, overall costs of the tax-funded health-insurance program in the most-recent fiscal year were nearly $2 billion below original estimates. According to a report released last week by the state, total Medicaid spending was $23.5 billion in the fiscal year that ended June 30; that was 7.6 percent less than projected. Click here for more.

 

Conservative Group Says Medicaid Unsustainable, Offers Alternatives

Medicaid is fiscally unsustainable and at times, inaccessible — so it’s time for reform, according to a new report from the conservative American Action Forum. They identify three potential approaches, including block grants, capped allotments and per capita caps. Click here for their report.

 

Medical Scope Infections Continue to Climb

Reports of superbug outbreaks linked to a specialized type of medical scope continue to climb, but government efforts to assess the public health risk are stymied: No one knows how often the infections occur — or where. Duodenoscopes, which are run down the throat to treat intestinal problems, have been tied to scores of infections and more than a dozen deaths at hospitals. Click here for the USA Today story.

 

“Flakka” Causing New Illegal Drug Challenges

A new drug called alpha-PVP, often known as “flakka” is causing new health care problems in a growing number of states. Created in laboratories, flakka is highly addictive and can trigger delusions and aggression. It has hit Broward County in South Florida especially hard, contributing to 29 deaths in the past year, according to the county medical examiner. The potent stimulant is spreading in such states as Kentucky, Tennessee and Ohio, authorities say, hitting communities already hard-hit by prescription-drug abuse. Click here for the WSJ report.

 

NIH Study Says 40 Million Adults Have Severe Levels of Pain

A study released by the NIH last week found that an estimated 25.3 million adults (11.2 percent) had pain every day for the preceding 3 months. Nearly 40 million adults (17.6 percent) experience severe levels of pain. Those with severe pain are also likely to have worse health status. Click here for the complete NIH report.

 

Texas Survey Reveals Severe Clinician Shortage

A new survey shows just how “under-clinicianed” Texas is. 185 counties in the Lone Star State with a combined population of more than 3.1 million people, equal to or greater than 21 states, have no psychiatrist. 147 counties with a combined population of more than 1.8 million people have no obstetrician/gynecologist. 80 counties have five or fewer physicians. 35 counties have no physician. Click here for the complete report.

 

NYC Hospitals Asked to Stop Filming of Patients

The association that represents nearly all major New York City hospitals last week asked its members not to allow patients to be filmed for entertainment purposes without their consent, joining a chorus of disapproval of a practice that patients’ families have said breached their privacy during their most vulnerable moments. Click here for the NY Times story.

 

Finally, I Get To Write About Kim Kardashian…

As much of the world can’t help knowing, Kim Kardashian is pregnant and has been struggling with, as she put it, “#morningsickness.” So she enthusiastically reported to her tens of millions of social media followers that she was now feeling “a lot better” after taking Diclegis, a prescription morning-sickness medicine. The FDA issued a warning letter to the drug maker over the Kardashian post. Click here for the story.