WEEKLY E-BULLETIN


Number of “Straight A” Hospitals Increase in Latest Leapfrog Scores

Hospital Safety Scores, released last week by The Leapfrog Group, shows key shifts among many hospitals on the letter grades rating them on errors, injuries, accidents, and infections. Of the 28 measures used to calculate the A, B, C, D or F grades, on average, hospital performance improved on eight measures, but average performance declined on six measures. Click here for the summary.

  • Of the 2,530 hospitals issued a score, 773 earned an A, 724 earned a B, 866 earned a C, 133 earned a D and 34 earned an F. Additionally, 133 hospitals earned the “Straight A” designation, these are hospitals that have received an A grade for safety since the safety score launched in 2012. Click here to see your hospital’s score.
  • For the fourth time in a row, Maine claimed the top spot for the state with the highest percentage of A hospitals, with nearly 69 percent of its hospitals receiving an A. Click here to see how your state ranks.

Final Budget Deal Impacts HOPD Provider-Based Billing

The Bipartisan Budget Act of 2015, a budget revision and a debt limit increase plan, passed both Houses of Congress and headed to the President’s desk on Friday. The measure offers relief from a planned increase in Medicare premiums and resolves debt ceiling and budget issues into 2017 – onto the plates of the next Congress and new President.

  • Sec. 603 of the legislation would codify the CMS definition of provider-based (PBD) off-campus hospital outpatient departments (HOPDs) and states that any PBD HOPD executing a provider agreement after the date of enactment would not be eligible for reimbursements from CMS’ Outpatient Prospective Payment System (PPS). New PBD HOPDs would be eligible for reimbursements from either the Ambulatory Surgical Center or the Medicare Physician Fee Schedule. Off-campus HOPDs that were billing prior to the President signing the bill into law are grandfathered. Click here for legislative language. Click here for an executive summary of the bill. To see the CBO cost estimate of the bill, click here.

CMS Releases OPPS Final Rule with a Bigger Cut to Hospital Payments

The final outpatient PPS rule — release by CMS late Friday — will reduce payment rates under the hospital outpatient PPS by -0.3 percent in CY16, a larger decrease than the -0.1 percent CMS proposed in July. This reduction is based on the projected hospital market basket increase of 2.4 percent (down from 2.7 percent in the proposed rule) for services paid under the hospital inpatient PPS minus a 0.5 percentage point adjustment. There is an additional proposed 2.0 percentage point negative adjustment to the payment update to account for excess packaged payment for laboratory tests. CMS says it overestimated the shift in CY14 spending for newly packaged labs into the outpatient PPS payment rates and finalized the proposal to reduce the CY16 conversion factor by 2.0 percent to account for the roughly $1 billion inflation in outpatient PPS payments. Click here for a detailed summary of the regs from CMS. Click here for the 1,358-page regulation.

  • CMS has finalized changes to the two-midnight rule to modify “rare and unusual” exceptions and revise the medical review strategy. Under the final rule, a “rare and unusual” exception could be determined on a case-by-case basis by the admitting physician, subject to medical review. Click here for the CMS Fact Sheet.

CMS Releases Final Physician Fee Schedule; OKs Advanced Planning Discussion Payment

Also Friday, CMS released the final rule that revises payment polices under the Medicare Physician Fee Schedule and makes other policy changes related to Medicare Part B payment. Among the finalized policies was the inclusion of reimbursement for physician discussions on advanced care planning with patients and their families. Advance care planning includes the explanation and discussion of advance directives such as standard forms by the physician or other qualified health care professional; first 30 minutes, face-to-face with the patient, family member(s), and/or surrogate. Click here for a CMS summary. The 1358-page final rule can be found here.

  • CMS has also made changes starting in 2016 to the Physician Quality Reporting System. Click here for details.

1.4% Cut in Home Health Payments in New CMS Rule; VBP and Quality Reporting Begin

CMS last week released a final rule that updates the Home Health rates and wage index for CY16. CMS estimates that the net impact of the payment provisions will result in a decrease of 1.4 percent ($260 million) in Medicare payments to home health agencies. Additionally, the rule implements the 3rd year of the 4-year phase-in of the rebasing adjustments. The rule also implements a home health value-based purchasing model, beginning January 1, 2016, in which all Medicare-certified HHAs in selected states will be required to participate. Finally, the rule finalizes changes to the home health quality reporting program. Click here for an executive summary. Click here to read the 297-page rule.

CMS Proposes Revisions to Discharge Planning Rules

CMS last week released a proposed rule that would require hospitals and other facilities to develop a written discharge plan for every inpatient and many outpatients. This proposed rule would revise the requirements that hospitals, including LTCHs, IRFs, Critical Access Hospitals, and home health agencies must meet in order to participate in the Medicare and Medicaid programs. The proposed rule also implements the discharge planning requirements of the Improving Medicare Post-Acute Care Transformation Act of 2014 (IMPACT Act). Click here for a CMS summary. Click here for the 125-page rule.

 

457 Hospitals Involved in Justice Department Settlements

The U.S. Department of Justice has reached 70 settlements involving 457 hospitals in 43 states for more than $250 million, with the agreements related to cardiac devices implanted in Medicare patients in violation of Medicare coverage requirements, officials announced last week. An implantable cardiac defibrillator, or ICD, is an electronic device that is implanted near and connected to the heart. Only patients with certain clinical characteristics and risk factors qualify for an ICD covered by Medicare. Click here for the DOJ notice that includes the list of hospitals.

More than 800 Comment Letters Submitted on 340B Proposed Mega Guidance

The comment period for the 340B Mega Guidance has closed with over 800 comments received. Hospitals, patient advocacy groups, pharmacists and pharmacies voiced concerns over the patient definitions, contract pharmacy arrangements and audit procedures, to name a few. Pharmaceutical companies also weighed in, while supportive overall, they also voiced concerns that the guidance did not go far enough to cut down on abuses. To view the docket folder for the rule on regulations.gov, click here.

 

Independent Physicians Pushing Back on Hospital Systems’ Use of EHRs

Independent medical groups are accusing big hospital-based networks of using their electronic health records as a tool to coerce practices to join them while punishing those who remain out of network. These accusations led Connecticut in June to become the first state to make it illegal to use EHRs to block the flow of medical information. Click here for the Connecticut law. The state attorney general has reportedly opened investigations into Epic Systems and hospital networks in Connecticut, while HHS’ inspector general has issued a warning about unfair EHR-related practices (click here for the IG’s warning). The Senate HELP committee this month drafted a bill that prohibits data blocking. Connecticut’s law took effect October 1.

11th CO-OP Bites the Dust

Arizona’s Meritus became the 11th not-for-profit health insurance co-op to fold on Friday when state regulators placed the plan under supervision and removed its policies from HealthCare.gov just two days before the start of the health law’s third open enrollment season. Meritus had roughly 55,000 members at the end of June. It lost more than $11 million during the first six months of this year, according to financial filings. Meritus officials didn’t agree with the state order requiring it to cease operations, according to the Arizona Department of Insurance. Click here for more.

  • Two key House Committees have scheduled hearings this week on the failed co-op plans and what happened to the $2.4 billion in federal loans provided to 23 nonprofit startup insurers. With a total of 11 now shut down, the House Ways and Means Committee has scheduled a hearing for tomorrow and the House Energy and Commerce Committee hearing on Thursday. To see the Ways and Means notice, click here. For the Energy and Commerce notice, click here.

More Hospitals will Receive Increases under CMS’ VBP Program this Year

More of the hospitals participating in CMS’s Hospital Value-Based Purchasing program will see payments increase slightly than decrease, according to data from the agency. Of the approximately 3,500 hospitals participating, over 1,800 will see their base operating payments rise and about 1,200 will see go down. For the CMS summary, click here. For the program results, click here.

 

New Rules Finalize Fraud and Abuse Waivers for ACOs

CMS and the OIG last week finalized waivers from fraud and abuse rules for Accountable Care Organizations participating in the Medicare Shared Savings Program. The final rule maintains key provisions of the 2011 interim final rule, which waived the application of the physician self-referral, federal anti-kickback statute and certain civil monetary penalty law provisions to specified arrangements involving ACOs in the program. The rule no longer waives the application of the CMP law provision relating to “gainsharing” arrangements, citing recent legislation clarifying that the prohibition only applies to medically unnecessary services. Click here for the rule.

 

CMS Reg Strengthens Medicaid Access to Services

CMS last week finalized a regulation ensuring that Medicaid beneficiaries have adequate access to covered services, more than four years after the initial version was proposed. States will be required to develop access review plans that outline how they will ensure that Medicaid beneficiaries have adequate access to mandatory and optional health care services, and to examine how cuts to provider payments affect the care that beneficiaries receive, the agency said. Click here for a summary. Click here for the 124-page rule.

 

CMS Issues New ESRD Regs with Payment Reduction

CMS late last week finalized the End-Stage Renal Disease regulations for CY16 and included a base rate reduction. The new ESRD PPS base rate is $230.39, which is a reduction of $9.04 from CY15. Click here for details from CMS.

Open Enrollment Started Yesterday; Uninsured Identified by County

The annual open enrollment for Healthcare.gov yesterday. Consumers have been able to review plans for about a week prior to the open enrollment on HealthCare.gov. Officials have cautioned consumers to check out premium prices because in many places they may be higher. Deadline to sign up for health insurance for 2016 is December 15, 2015. According to various reports, this third enrollment period is expected to be the toughest. Click here for details.

  • So, after two full years of Obamacare, who is still uninsured? Click here for a very good county-by-county interactive map that takes a closer look.

Mental Health Groups Weigh In on Insurance Mega Mergers

Joining the chorus of providers raising serious issues, mental health groups are now requesting close regulator scrutiny of the two major insurance mergers – Aetna’s acquisition of Humana and Anthem’s purchase of Cigna. They say the consolidation will leave a gaping hole in the ability for patients to access mental health and substance abuse care. Click here for the story in the Washington Post.

 

According to WHO Red Meat Can Cause Cancer

The World Health Organization last week released a new finding that states that eating red and processed meats increases the likelihood of getting colorectal, pancreatic and prostate cancers. While this has very low risk for people, they concluded that processed meats, like bacon, ham and hot dogs, are a cause of colon cancer and conceivably of stomach cancer, because processing the meat by curing, smoking, fermentation or other methods generates chemicals that are carcinogens or suspected carcinogens. To read more from the WHO, click here.

 

Be Prepared to Laugh – New Look at Dem, GOP Debates

As you know by now, this weekly report is non-partisan. In that spirit – and please take no offense — the presidential debates, both Republican and Democratic, have been the subject of much discussion. So, even if you don’t care about presidential politics, you should take a few minutes and see the productions from our friends at Bad Lip-Reading as they see those debates in their own hysterical way. Click here for the Democratic debate. Click here for the GOP debate. Be prepared to laugh!