Hospital Value-Based Purchasing Program Having Little Impact: GAO

Medicare’s Hospital Value-Based Purchasing Program for hospitals, which provides bonuses and penalties based on performance, has not led to demonstrated improvements in its first three years, according to a GAO report released last week. Earlier this year Medicare gave bonuses to 1,700 hospitals and reduced payments to 1,360 hospitals based on their mortality rates, patient reviews, degree of improvement and other measurements. The audit found the financial effect has been minimal. Most hospitals saw their Medicare payments increase or drop by less than half a percentage point. In the fiscal year that ended Sept. 30, 74 percent of hospitals fell within that range, with a median bonus of $39,000 and a median penalty of $56,000. Click here for the GAO report.


Most Hospitals In CMS’ Mandatory Bundled Payment Program Are Hurt by Regional Pricing Averages

A new analysis of CMS’ proposed Comprehensive Care for Joint Replacement (CCJR) bundled payment initiative finds that 65% of selected hospitals will be subject to target prices based on regional episode spending averages that are lower than hospital-specific spending averages. Specifically, the analysis finds that the average spending for an episode of care in hospitals selected for CCJR is $3,802 higher than the average of their respective census regions. Click here for this compelling report from Avalere.


Half of Oncologists Say They’ve Been Trained To Identify Prospective Donors

In an unprecedented survey of more than 400 oncologists at 40 leading cancer centers, nearly half said they had been taught to identify wealthy patients who might be prospective donors. A third had been asked to directly solicit donations — and half of them refused. Three percent had been promised payments if a patient donated. Click here for the study. Click here for the NYTimes report.


$30 Million Paid for “Mystery” Ambulance Rides: OIG

Medicare paid $30 million for ambulance rides for which no record exists that patients got medical care at their destination, the place where they were picked up or other critical information. The mystery ambulance rides are part of a bigger problem with Medicare payments for transporting patients, according to a federal audit released last week. Across the country, 1 in 5 ambulance companies had at least some questionable billings. Click here for the ABC News story. Click here for the HHS OIG rerport.


Pfizer Raised Prices on 133 Drugs This Year, And It’s Not Alone

Pfizer Inc., the nation’s biggest drugmaker, has raised prices on 133 of its brand-name products in the U.S. this year, according to research from UBS, more than three-quarters of which added up to hikes of 10 percent or more. It’s not alone. Rival Merck & Co. raised the price of 38 drugs, about a quarter of which resulted in increases of 10 percent or more. Pfizer sells more than 600 drugs globally while Merck has more than 200 worldwide, including almost 100 in the U.S. Click here for the Bloomberg report.


FDA OKs Melanoma Drug Combo with High Consumer Cost

The FDA last week approved the first combination of drugs designed to help the immune system fight inoperable skin cancer. The combination regimen of immuno-oncology drugs Opdivo and Yervoy could cost $256,000 a year. Click here for the news report.


Out-of-Network Providers Charging Patients 300% More for Certain Treatments, Procedures: Study

Out-of-network providers charged patients on average 300 percent more than the Medicare rate for certain treatments or procedures, according to the analysis of 2013 and 2014 claims data released last week by the America’s Health Insurance Plans. AHIP, which supports limiting out-of-network charges, found that some treatments were even more exorbitant — with out-of-network providers charging nearly 1,400 percent more than what is reimbursed by Medicare. Charges for an MRI of the brain, for example, cost on average $2,929 with an out-of-network provider, compared to the Medicare rate of $405. And patients who needed a one-hour chemotherapy infusion paid on average $437 while Medicare reimbursed $136. Click here for the study with a state-by-state review.


Physician Practices Making More Under Affordable Care Act

Physician practices are enjoying a windfall from the Affordable Care Act, with many of them collecting a little more revenue since the healthcare reform law went into effect, according to a new issue brief from the Robert Wood Johnson Foundation. RWJF surveyed the practices of more than 19,000 physicians. The surprise twist: Doctors practicing in states that did not expand Medicaid eligibility under the ACA saw a bigger increase in revenues than those in non-expansion states. Doctors in non-expansion states saw their revenue rise 3.3 percent between 2013 and last year, according to the survey. By comparison, those in expansion states saw their revenue rise 3 percent. Click here for the 8-page report.


Analysis: Providers Slowly Moving Away from Fee-for-Service Payment Model

Although the federal government has launched a plan to speed up the transition to value-based care, a new report shows that the health industry’s move away from the traditional fee-for-service model is going slower than expected and faces many challenges. Markets with multiple alternative payment efforts are making the most progress in the move to value-based payments, according to PwC’s Health Research Institute’s (HRI) new research. Analysts found that although healthcare executives publicly support the move to value-based care, they privately fret about losing the predictable stream of revenue. Click here for the analysis.


More Hospital Academics, Researchers Hold High Paid Board Positions in Healthcare Companies

Nearly 1 in 10 healthcare company board positions are held by top academics from many of the most renowned medical and research institutions in the United States, according to a study released last week. In total, 279 healthcare company directors were affiliated with 85 non-profit academic institutions. These included 19 of the top 20 National Institute of Health funded medical schools, and all 17 of the US News Honor Roll hospitals. Salaries often approached or surpassed common academic clinical earnings, and on average they each received annual payments of $193,000 as well as significant stock options. Click here for the study.


More Hospitals Providing Palliative Care Programs

The trend toward more hospitals offering palliative care programs is continuing, although it’s still less common at smaller hospitals and for-profits, according to a report from the Center to Advance Palliative Care and National Palliative Care Research Center. Among hospitals with 50 or more beds, 67 percent now have a palliative care program, and the number reaches 90 percent at hospitals with more than 300 beds. Nonprofit and public hospitals were far more likely to have palliative care than for-profits. That gap has widened since 2011. There was also a significant regional variation, with the South and central southwest far less likely to offer programs. Click here for the report.


CMS Report Compares For-Profit and Not-for-Profit PACE Programs

CMS’ Innovation Center released a report last week on the PACE program that helps elderly adults remain in their community – the report looked at access and quality of care in for-profit PACE set-ups. The report, which reviews four for-profit plans in Pennsylvania, finds evidence that nonprofit plans are better when it come to access and quality in several ways. But it also notes that satisfaction among enrollees was quite high, just as it is among nonprofit PACE enrollees. Click here for the report.


Obama Expected To Sign ACA Change that Redefines Small Business

President Obama is expected to sign a signifant change to Obamacare passed by Congress last week. Currently, the health law defines small businesses as those having up to 50 employees. That number expands on January 1 to 100. The bill approved last week would keep the small business definition at 50 workers but let states increase the number if they choose. Under current law, companies considered small businesses must offer certain required benefits. Business groups complained that increasing the number of firms classified as small businesses would increase health care costs for many employers whose benefits today are less generous. Click here for more.


Representatives Push Stage 3 Meaningful Use Delay

116 House members sent a letter to OMB last week that supports a delay in the Stage 3 Meaningful Use rulemaking. Ninety-six were Republicans. Reps. Renee Ellmers (R-NC), Tom Price (R-GA) and David Scott (D-GA) have been circulating the letter for the past couple of weeks, responding to the calls of doctors and others. Click here for the letter.


Congress Pushes CMS Against Proposed Radiation Therapy Cuts

228 lawmakers wrote to CMS last week urging the agency to drop its proposed cuts to radiation therapy. In its proposed 2016 physician fee schedule, CMS outlined an average 6 percent cut to Medicare payments for freestanding radiation therapy centers. Click here and here for the House letters and here for the Senate letter.


House, Senate Urge CMS Not To Cut Reimbursement for Colon Cancer Screening

Nearly 100 members of the House and 27 Senators of both parties wrote to CMS last week with concerns about the proposed Medicare reimbursement rates for colorectal cancer screening. CMS earlier this year proposed cuts of 10 to 20 percent for those rates. Click here to read the House letter and here to read the Senate letter and see who signed on.

  • The CDC announced last week it has awarded a total of $22,800,000 to 24 state health departments, as well as six universities, and one American Indian tribe to increase colorectal screening. The grants, awarded in a competitive process, are designed to increase colorectal cancer screening rates among men and women aged 50 to 75 years. Click here to see where the money went.

Health Care Changes Still Center Stage in Presidential Campaigns

This is the third consecutive presidential election where health care reform is on the front burner and candidates on all sides are pushing health policy agendas that could shake up the status quo. The political left wants more of a single payor system, the right wants more free markets and the center (to the extent that there is one in national politics today) wants some changes to Obamacare. Click here for a summary of where the debate stands today.


100 Health Economists Oppose Repeal of Cadillac Tax as Political Debate Rages

Debate in Congress and with interest groups is heating up around Obamacare’s Cadillac tax as Republicans and some Democrats push for its repeal. The Cadillac tax, set to go in to effect in 2018, will mean that companies will either pay a 40 percent tax if their plans are over a certain limit (which is $10,200 for an individual and $27,500 for a family) or cut their plans and shift more of the cost of health care on to employees. Last week, more than 100 health economists released a letter publicly urging that the tax be kept. The economists argue that the tax will increase wages and other fringe benefits as employers shift away from compensating employees through overly generous insurance that spurs overuse of the health care system and drives up spending. It will bring in an estimated $91 billion to the federal government over the next decade. Click here to read the 3-page letter.


Exchange Insurers Unhappy with CMS Risk Corridor Payments

Health insurers that lost money on Obamacare exchanges in 2014 will receive only a portion of their promised safety-valve payments, according to a CMS announcement last week. But CMS expects that the $2.5 billion still owed to insurers will be covered in 2015 and 2016. Based on current data for 2014, the first year of the three-year risk corridors program, insurers will pay risk corridors charges of approximately $362 million, and insurers have requested $2.87 billion of risk corridors payments. Click here for CMS’ explanation.


HHS Awards $695 Million in Practice Transformation Grants

Universities, state health departments, health care systems and professional groups will share $685 million from HHS to increase collaborative care and better manage patients with chronic conditions. The grants will be used for education, training, and investment in health IT, quality improvement and coordination of care programs and are part of a larger initiative to transform the health care system to one that rewards outcomes. Click here for the WSJ story. Click here for the awardees’ list from HHS.


CMS Announces New Rx Therapy Management Model

CMS and the CMS Innovation Center last week announced a model to test strategies to improve medication use among Medicare beneficiaries enrolled in Part D. The Part D Enhanced Medication Therapy Management (Enhanced MTM) model will assess whether providing selected Medicare Prescription Drug Plans (PDPs) with additional incentives and flexibilities to design and implement innovative programs will better achieve the overall goals for MTM programs. The new model will being January 2017 with a 5-year performance period in 11 states. Click here for more from CMS.


Most Physician Residents Facing “Burnout”

Feelings of hopelessness appear to be fairly widespread among medical students and early-career doctors. The worrying combination of plummeting self-worth, and emotional fatigue has reached “epidemic levels,” according to a survey conducted at the University of North Carolina, Chapel Hill. Researchers found that approximately 70 percent of residents met the diagnostic criteria for burnout. Some in the medical community believe that there must be a better way to do it. Click here for this interesting story from the Atlantic.


“We Survived ICD-10, Y2K” and Now Have Lots of Crazy Codes

It turns out that the world didn’t end on day one (October 1) of the ICD-10 transition — many are calling it a repeat of Y2K at the turn of this century. In fact, according to CMS, ICD-10′s start went ok. CMS is saying that the agency and Medicare fee-for-service claims processing systems are reporting business as usual with no reports of unusual activity at this time. If you haven’t had a chance to dive into the 70,000 new codes – click here for a list of the most absurd!