WEEKLY E-BULLETIN


Truven Names Top 50 Cardiovascular Hospitals

Truven Health Analytics last week released its top 50 cardiovascular hospitals, including 34 that are member of health systems. The annual list is based on public data sources, including CMS’s Hospital Compare initiative and the Medicare Provider Analysis and Review (MEDPAR) file. The 50 hospitals had 20 to 33 percent higher inpatient survival, 8 to 11 percent fewer patients with complications, 0.6 percent to 0.7 percent higher 30-day survival rates for acute MI and heart failure and 1.05 percent lower readmissions rates for acute MI and heart failure. Click here for the list. Click here for the complete report.

 

Geisinger To Launch Money Back Guarantee

Geisinger Health System will launch a quasi “money back guarantee” for its patients. Geisinger CEO David Feinberg, M.D., said the hospital system has introduced a new smartphone app called the Geisinger ProvenExperience. The app allows patients to rate the service that has been provided. If they are unhappy, the patients can ask for a refund of up to $2,000, depending on the medical service and the cost. Click here for the news report.

 

Hip and Knee Replacements Up Sharply for Seniors, Readmissions Down Substantially: AARP

AARP’s Public Policy Institute last week released a study that showed rates of unplanned hospital readmissions following elective hip and knee replacement procedures fell markedly among the 50- to 84-year-old population between 2009 and 2013. These results were primarily driven by substantial reductions in readmissions among the 65- to 84-year-old population. Overall, the rapid reductions in hospital readmission rates among the 65- to 84-year-old age group resulted in rates that are now much more comparable to those found in the 50-to 64-year-old age group. Seventy-three percent more Americans got hip replacements and 46 percent more got knee replacements, but readmission rates dropped by 20 percent between 2009 and 2013. Click here for the 8-page AARP report.

 

CMS Issues New Crack Down on RACs

CMS is beefing up its requirements for RACs (Recovery Audit Contractors), according to an updated Recovery Auditors’ Statement of Work, which should provide additional relief to providers. New CMS proposed requirements state that RACs will not be paid until after provider appeals are denied at the second level when providers appeal payment denials. Additionally, CMS is decreasing the number of documents the Recovery Auditors can request from some providers. Click here to read CMS’s 2-page list of requirements on RACs – current and proposed.

 

OIG To Target Hospital Salaries, Provider-Based Status, other Hospital Issues in 2016

The HHS Office of the Inspector General last week said it will review data from Medicare cost reports and hospitals to identify salary amounts included in operating costs reported to and reimbursed by Medicare, as part of its investigative plan for 2016. Employee compensation may be included in allowable provider costs only to the extent that it represents reasonable remuneration for managerial, administrative, professional, and other services related to the operation of the facility and furnished in connection with patient care, according to the OIG. The OIG will also determine the number of provider-based facilities that hospitals own and the extent to which CMS has methods to oversee provider-based billing. Click here for the OIG’s work plan.

 

Medicaid Managed Care Booming: New Report

A dozen Medicaid managed care insurers each have more than 1 million enrollees, increasing consolidation in that industry, according to a PwC report released last week. The report, done for the Medicaid Health Plans of America, says 70 percent of all Medicaid beneficiaries receive health benefits from a private insurer, an increase of 7.8 million people over the past year. There are 194 Medicaid plans, but the largest 12 plans have more than half of total membership. New Mexico has the highest enrollment percentage and Utah the lowest. Click here for the PwC report.

 

AMA Tells Justice To Prohibit Mega Insurance Mergers

The American Medical Association is calling on the Attorney General to prohibit Aetna’s proposed $37 billion purchase of Humana, and Anthem’s $54 billion takeover bid for Cigna. In a letter to the DOJ, AMA President James Madara said “the proposed mergers are occurring in markets where there has already been a near collapse of competition.” Click here for the AMA’s detailed 17-page letter. The American Hospital Association also has concerns with the megamergers and has called for tough regulatory scrutiny, though it stopped short of calling outright for the deals to be blocked. Aetna and Anthem officials have said that they expect to close the deals by the end of next year. America’s Health Insurance Plans brushed off AMA’s request. Click here for the news report.

 

Budget Law Increases Monetary Penalties on Providers

A little-publicized provision included in the Bipartisan Budget Act of 2015 would double the maximum amount civil monetary penalties for providers. Currently, the maximum CMP for healthcare providers is capped at $10,000 per day for each day a facility is out of compliance. Without that cap, which was put in place by the Nursing Home Reform Act of 1987, the maximum per day fine would rise to $20,626. Nursing home providers are crying foul and other providers have raised concerns. The law was enacted November 2. Click here for the story.

 

High Deductibles Putting Obamacare Out of Reach for Many; 543,000 Sign Up in First Week

In many states, more than half the plans offered for sale through HealthCare.gov, the federal online marketplace, have a deductible of $3,000 or more, a New York Times review has found. Those deductibles are causing concern among Democrats — and some Republican detractors of the health law, who once pushed high-deductible health plans in the belief that consumers would be more cost-conscious if they had more of a financial stake or skin in the game. Click here for the story. More than 543,000 people selected a health plan through the federally-facilitated Health Insurance Marketplace during the first week of open enrollment, according to CMS. Click here for details.

 

Single Payer System Coming to Colorado?; Maryland’s All-Payer System Touted

Next November, Colorado voters will decide whether to set up a single-payer health care system, state officials announced last week. If approved, the state would likely try to implement the system through the Affordable Care Act’s Section 1332 waivers, which allows states to waive key pieces of the health care law in favor of their own reforms. It is estimated that this would cost about $25 billion to implement. Click here for details. Meantime, a commentary in Health Affairs looks at results from the Maryland All-Payer Model, launched last year by CMS and state to modernize Maryland’s unique all-payer rate-setting system for hospital services. Click here.

 

Pay-for-Performance Comes to Rx

Amgen is taking its brand-new cholesterol drug into uncharted territory. The drug maker has negotiated a pay-for-performance deal with the health plan Harvard Pilgrim, gaining an exclusive spot on the payer’s formulary in return for an upfront discount and future rebates if Repatha doesn’t perform as outlined. As The Boston Globe reports, Repatha will be the only PCSK9 med covered for Harvard Pilgrim Health Care’s 1.2 million members. Amgen and Harvard Pilgrim agreed on specific cholesterol targets for various patient groups, and if Repatha doesn’t help patients hit those goals, the insurer can collect additional rebates. Click here for the report.

 

Medicare, Medicaid, Social Security Consume Half the Federal Budget, Defense Drops

According to a recent report by the Congressional Budget Office, Social Security, Medicare and Medicaid took up a larger share of federal spending during the past two years, accounting for almost half of the budget, while military spending continued to shrink. The three programs grew from $1.563 trillion, or 45 percent of total spending measured in fiscal 2013, to $1.77 trillion, or 48 percent in fiscal 2015. Defense spending, which is mostly discretionary, fell from $608 billion, or 18 percent of the budget in 2013, to $563 billion, or 15 percent of the budget in 2015. Click here for the CBO report.

 

Medicare Part A and B Premiums and Deductibles See Modest Changes for 2016

Following the recent enactment of the Bipartisan Budget Law that limited the increase in Part B premiums for about 30 percent of beneficiaries, CMS released the Part A and B premiums and deductibles. For a detailed CMS information sheet, click here.

  • For most beneficiaries their monthly Part B premium will hold steady at $104.90 in 2016. The standard monthly Part B premium for those not held harmless will be $121.80, including a $3 surcharge. The Part B deductible for 2016 will be $166 for all Medicare beneficiaries, up from $147.
  • For Medicare Part A, the annual inpatient hospital deductible will be $1,288 in 2016, up from $1,260. T hat deductible covers beneficiaries’ costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. For the next 30 days of hospitalization in a benefit period, the coinsurance will be $322 a day and for the lifetime reserve days the coinsurance will be $644 a day. For those in a nursing home, the daily coinsurance for days 21 through 100 in a benefit period will be $161 in 2016, up from $157.50 in 2015.

Insurance Commissioners Move To Expand State Oversight and Transparency on Network Adequacy

After 18 months of debate, the National Association of Insurance Commissioners’ health insurance committee passed a new model law that will update existing requirements for the first time since 1996. It includes language on telehealth, mental health, provider directory requirements, in-network protocols and the “good faith” nondiscrimination provision of the Affordable Care Act. The model law will push responsibility back onto the states to exercise regulatory control over the information insurers include in plans and increase transparency. The full NAIC membership will consider adoption during a national meeting next week. Click here to read the proposed plan.

 

ICD-10 Has Big Productivity Impact

A new survey shows that 75% of survey respondents projected the productivity impact from ICD-10 to be at least 30%. So how does that compare to what actually happened during October? himagine solutions has been collecting data on weekly basis and comparing that information to ICD-9 AHIMA productivity standards. They found that Large Academic Facilities are seeing an average of 40% reduction in Inpatient productivity while the reduction in outpatient productivity ranges from 10-35%. Large hospitals (over 250 beds) are seeing a 30-45% reduction on the inpatient side and a 20-40% reduction on the outpatient side. When it comes to community hospitals (under 250 beds), the inpatient reductions are much lower ranging in a productivity decline of 22-33% while the outpatient is higher on average hovering around 35-40%. Click here for complete survey results.

  • In response to questions from the provider community, CMS posted a new FAQ about physician orders written before the October 1 ICD-10 compliance date. FAQ 12625 explains that CMS is not requiring the ordering provider to translate ICD-9 diagnosis codes to ICD-10 on orders written before October 1 for lab, radiology, or any other services. Click here for details.

FDA Recalls Widely-Used Scope Cleaning Device

A new FDA recall for Custom Ultrasonics scope cleaning devices indicates some deadly infections might have been prevented if the company had complied with a 2012 agency recall. The company’s scope cleaning devices, known as AERS, have been used at health care facilities to reprocess scopes linked to confirmed or possible spread of antibiotic-resistant infections, FDA said. Click here for the FDA’s recall notice.

 

Survey: Nursing Retirement Wave Coming

A wave a nursing retirements is expected within a few years, according to a new survey released last week by AMN Healthcare. 62% of RNs over age 54 said they are thinking about retirement and most said they plan to retire within 3 years. Additionally, 21% of older nurses said they plan to switch to part time. In a development that could have a profound impact on the future of nursing, 44% of nurse educators said they are thinking of retiring. 9,000 RNs participated in the survey. Click here for more.

 

Drug Companies Not Disclosing All Clinical Trial Data

According to a new BMJ Open study, drug companies are failing to report results for about one-third of clinical trials as required by federal law. Public availability of results data varied widely by company, BMJ examined trials of 15 drugs made by large pharmaceutical companies and approved by FDA in 2012. Click here for the study.

 

$10 Million Awarded for QIO Innovations

CMS’s QIO program last week awarded 16 two-year Special Innovation Projects (SIPs) to 10 regional Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs). With a combined value of just under $10 million, the SIPs are quality improvement projects that align with the goals of the CMS Quality Strategy and emphasize the power of partnerships. Click here for details.

 

Cleveland Clinic To Perform First Uterus Transplant

Within the next few months, surgeons at the Cleveland Clinic expect to become the first in the United States to transplant a uterus into a woman who lacks one, so that she can become pregnant and give birth. The recipients will be women who were born without a uterus, had it removed or have uterine damage. The transplants will be temporary: The uterus would be removed after the recipient has had one or two babies, so she can stop taking transplant anti-rejection drugs. Click here for the NY Times story.

 

Smoking Higher Among Uninsured and Medicaid Beneficiaries than Those on Private Insurance

New data from the 2014 National Health Interview Survey show that 27.9 percent of uninsured adults and 29.1 percent of Medicaid recipients currently smoke. Conversely, 12.9 percent of adults with private insurance and 12.5 percent of those on Medicare currently smoke. The study also reported that the prevalence of cigarette smoking among the entire U.S. adult population declined from 20.9 percent to 16.8 percent from 2005 to 2014. Click here for more from the CDC.