Epic Systems Targeted in News Magazine Report, Says Company “Inhibits Patient Care”

A national magazine has taken aim at Epic Systems, saying the company has inhibited patient care and failed to lower national healthcare costs, a primary goal of electronic health records. Mother Jones, a liberal and widely read news magazine, published “Epic Fail” in its latest issue. Below the headline, the writer asks, “Digitizing America’s medical records was supposed to help patients and save money. Why hasn’t that happened?” The article, a 2,300-word feature, points out Epic CEO Judy Faulkner’s motto, “Do good. Have fun. Make money.” Click here to read the story.

  • Twelve major electronic health record vendors have reached consensus on an objective “interoperability metric” to measure data exchange and then report the findings on an ongoing basis, according to Orem, Utah-based research and insights firm KLAS. Click here.

17% of Patients Receive Care in a 1-Star Hospital: Healthgrades

One out of every six patients in the U.S. received care in a hospital rated 1-star, according to new research released last week by Healthgrades. Had those patients researched local doctors and hospitals to identify and select a physician practicing in a 5-star hospital for their specific procedure or condition, they would have faced a 71 percent lower risk of dying or a 65 percent lower risk of experiencing complications during their hospital stay. If all hospitals performed similarly to hospitals receiving 5-stars, 222,392 lives would have potentially been saved. Click here for the 2016 Healthgrades report.

  • The Healthgrades report also compared patient outcomes from care in one-star hospitals with three- and five-star hospitals in 50 key U.S. markets. Click here to see the scores of individual hospitals in each of the 50 markets (Regional Packet Guides). For the report, Healthgrades analyzed roughly 45 million Medicare hospitalization records for patients at nearly 4,500 short-term, acute care hospitals across the U.S. between 2012 and 2014. For one condition, Healthgrades also used 2011-2013 all-payer state data.

Key House Committee Drafting New 340B Legislation

The House Energy and Commerce Committee’s GOP majority staff is expected to draft legislation that addresses the 340B patient definition. The Committee has four primary areas of interest: new resources for HRSA; new enforcement mechanisms; new data reporting requirements for hospitals; and new charity care requirements for hospitals. The Committee’s focus for this anticipated legislation is aligned with their long-term goal to increase oversight and change the way hospitals qualify for the 340B program. This is happening as the Health Resources Services Administration is awaiting final responses to its new “mega-rule” governing 340B. Interested parties have until tomorrow, October 27, to submit comments.

  • The executive vice president and chief operating officer of Henry Ford Health System in Detroit, Robert Riney, issued an urgent plea to providers to send their comments about the new 340B proposed regulations to HRSA by tomorrow’s deadline. Click here for his op-ed in Modern Healthcare.

New PACE Innovation Act Passes Congress

The U.S. House of Representatives last week passed the PACE Innovation Act. The legislation will encourage CMS to allow providers to develop pilot programs using the PACE Model of Care to also serve individuals under 55 and those at risk of needing a nursing home The Senate passed companion legislation (S. 1362) with bipartisan support in August. It is expected to be signed into law shortly. Click here for more. Click here for a summary of the bill.


Philanthropic Giving Up at NFP Hospitals

A steadily improving economy and more sophisticated fundraising strategies have help U.S. nonprofit hospitals and health systems raise $9.6 billion in 2014, according to the Association for Healthcare Philanthropy’s annual Report on Giving. AHP says giving was up 4.5% when compared with 2013. Fundraising efficiency—measured as the cost to raise a dollar —was 25 cents, a 3-cent drop over the past year. Return on investment jumped 14% over the past year to $4.05 for every dollar spent on fundraising, a 50-cent increase over 2013. Click here for the report.


Study: Physician Acquisition by Hospitals Has Increased Outpatient Prices

As hospitals have acquired more doctor practices, prices for outpatient medical services have gone up, according to a new study that will fuel debate over the impact of the merger boom sweeping through health care. The new study, in the journal JAMA Internal Medicine, looked at what happened to the cost and volume of health-care services as physicians became more integrated into hospitals, by working for them or selling their practices to hospital systems. Overall, outlays for inpatient stays didn’t change significantly, but spending on outpatient care increased. Click here for the Wall Street Journal Story. Click here for the study.


Medical School Enrollment Hits Another All-Time High

More than 20,600 students enrolled in medical school this year, marking an all-time high, according to new data from the Association of American Medical Colleges. There was also greater interest in medical school than ever before, with applications rising 6.2 percent to 52,550. First-time applicants increased by 4.8 percent. Males accounted for approximately 52 percent of the student population in 2015, while females accounted for nearly 48 percent of enrolled students, the same as last year. Click here for details from the AAMC.


More CO-OPs Fail; Senator Demands Answers

South Carolina’s co-op will become the ninth nonprofit startup insurer established with federal loans under the Affordable Care Act to collapse. Consumers’ Choice Health Insurance Company, which captured roughly 40 percent of South Carolina’s exchange enrollment, will shut down at the end of the year, regulators said. Roughly 67,000 customers will need to shop for new plans when the next open-enrollment window begins on Nov. 1. Click here for more.

  • The nonprofit startup insurer, Colorado HealthOP, filed a lawsuit in state court seeking a temporary restraining order preventing the Colorado Division of Insurance from kicking the co-op off of the state’s exchange. Click here for details.
  • U.S. Senator Ben Sasse (R-NE) says he will block approval of all HHS appointments until the department adequately explains the collapse of the CO-OPs that were seeded with ACA loans. Outstanding HHS nominees include Robert Califf for FDA commissioner, Karen DeSalvo for assistant HHS secretary and Andy Slavitt for CMS administrator. Click here for Sasse’s letter to HHS Secretary Burwell.

New Coalition Targets Hunger as a Medical Issue, Urges Health Systems To Join

The AARP Foundation and ProMedica, a health system serving northwest Ohio and southeast Michigan, last week launched a nonprofit organization focused on “hunger as a health issue and other social determinants of health.” 14.3% of U.S. households are considered food insecure, a condition that adds billions of dollars to the cost of health care every year. The Root Cause Coalition plans to become a national advocate of programs, policies and research to eradicate hunger, food insecurity and health disparities. The CDC and its Foundation are also actively engaged. For more information about The Root Cause Coalition and membership, click here.


House Passes Obamacare Repeal Measure, Senate Passage in Question

The House last week passed a budget reconciliation measure that repeals the Affordable Care Act’s individual and employer mandates, as well as the Cadillac and medical device taxes. It also would eliminate the law’s fund for prevention and public health activities and a still-unenforced requirement for large employers to automatically enroll new full-time employees in coverage. But it faces an uncertain future in the Senate, and a certain veto from President Obama if the measure makes it to his desk. Click here to view the bill.

  • The bill would cut the deficit by about $130 billion over the next decade according to the CBO. Without accounting for macroeconomic effects, the bill would reduce the deficit by about $79 billion over that time. Click here for the CBO summary of the bill.

ACS Sets New Breast Cancer Screening Guidelines; Insurance Likely Not Impacted

The American Cancer Society released new breast cancer screening guidelines last week, recommending that most women start routine mammograms later and have them less frequently. The guidelines call for women aged 45 to 54 to have annual breast cancer screening, and for mammograms every other year starting at age 55. It also says that women between age 40 and 44 have the option of screening, and women at high risk should also have more screening. Click here to view the guidelines. According to analysts, the change is unlikely to impact insurance coverage anytime soon. Click here.


MA Star Rating Increases Attributed to Improvements, Not Methodology Changes

Now that the 2016 Medicare Advantage Star Ratings are out, a new report drills deeper into the data to reveal trends among these increasingly popular plans. CMS ranks MA plans on a one-to-five-star scale each year, using the ratings to guide consumers to the best plans as well as determine its MA Quality Bonus Payments. This year’s ratings signaled good news, as about 49 percent of MA plans with Part D prescription drug coverage earned four stars or higher for their 2016 rating, up from 40 percent of MA-PDs that did so for the 2015 ratings. The main cause of these better marks is improvements in plan performance, not CMS changes to cut-points, measures or methodology, the firm McKinsey & Company found in its analysis of the star ratings data. Click here for the report.


States File Suit Against Obamacare Insurance Provider Fees

Kansas, Louisiana and Texas have filed a joint lawsuit against the Obama administration over the Affordable Care Act’s Health Insurance Providers Fee, Texas Attorney General Ken Paxton announced last week. The complaint charges that the fee is an “unconstitutional tax” forced upon states to fund the national health care law. The ACA imposes the fee on private insurers to help finance portions of the law. But the states take issue with a CMS rule requiring states to pay the fee as part of what they pay their Medicaid managed care organizations. Click here to read the actual complaint.


Phase 2 HIPAA Audits To Begin Next Year: HHS

The HHS Office for Civil Rights will begin Phase 2 of its long-awaited audit program in early 2016 to determine compliance of covered entities and business associates with HIPAA privacy, security and breach notification rules. This is according to Deven McGraw, OCR’s deputy director for health information privacy. McGraw says that in Phase 2 of its audit program covered entities will be reviewed for HIPAA compliance regardless of whether or not a complaint has been filed against them. Click here for more.


CMS Extends Physician Payment Reform Comment Period

CMS has announced an extension to the comment period for the Request for Information for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The comment period, which was originally 30 days and scheduled to close on November 2, 2015, will now close on November 17, 2015. The RFI seeks public comment on Section 101 of MACRA. Section 101 repeals the Medicare Sustainable Growth Rate (SGR) methodology for updates to the Physician Fee Schedule and implements scheduled PFS updates, including a higher update rate for “qualifying participants in Alternative Payment Models (APMs)” beginning in 2026. Click here for more from CMS.


Obama Takes Action To Fight Opioid Abuse

President Obama last week issued a memorandum advancing efforts to fight opioid abuse. The order will require nurses and doctors employed by the federal government to receive training on how to properly prescribe opioids. Federal agencies must also review their health plans to remove barriers to accessing medication-assisted treatments. More than 40 health care groups are reportedly pledging to boost treatment, as well as training, on opioid prescribing and media companies have agreed to contribute millions of dollars worth of free ad space for public service announcements on prescription drug abuse. Click here to read the memorandum and related information.


$2.2 Billion in HIV/AIDS Grants Awarded in FY15

HHS announced last week that more than $2.2 billion in Ryan White HIV/AIDS Program grants was awarded in fiscal year 2015 to cities, states and local community-based organizations. This funding supports a coordinated and comprehensive system of care to ensure that more than half a million people living with and affected by HIV in the United States continue to have access to critical HIV health care, support services, and essential medications. Click here for details.