98 Top Hospitals Announced by Leapfrog

The Leapfrog Group last week announced its 2015 Top Hospitals.  More than 1600 hospitals report on quality and safety standards through the annual Leapfrog Hospital Survey and the results are publicly reported. This year, 98 Top Hospitals are receiving recognition. Of those, 12 were recognized as Top Children’s Hospitals, up from nine honored last year. They are joined by 24 Top Rural Hospitals, one of the few distinctions made available for rural and critical access hospitals, and 62 Top Urban Hospitals. California, Massachusetts and Maine continue to boast high numbers of Top Hospitals. 41 hospitals became Top Hospitals for the first time this year and 36 hospitals are achieving the honor for the second consecutive year.  Click here for the list.

  • 87,000 fewer patients died in hospitals and nearly $20 billion in health care costs were saved as a result of a reduction in hospital-acquired conditions from 2010 to 2014, according to a HHS report released last week. Preliminary estimates show that hospital patients experienced 2.1 million fewer hospital-acquired conditions from 2010 to 2014, a 17 percent decline over that period. Click here for the details.


In Response to Mass Shootings, Congress Moves Emergency Psych Bill

Congress last week sent the President a bill that would improve access to emergency psychiatric care for adult Medicaid beneficiaries.  The bi-partisan Improving Access to Emergency Psychiatric Care Act of 2015 will extend the Medicaid emergency psychiatric demonstration project which reimburses private psychiatric hospitals for certain psychiatric services that previously were not reimbursed through Medicaid.  Additionally, the bill allows the HHS secretary discretion to expand the demonstration across the country.  Click here for a summary of the bill from the Senate Finance Committee.

Hospital Financials Get Stable Forecast for 2016 from Moody’s and Fitch

Both financial rating services companies say next year will be relatively stable – but several positive factors may not be sustainable.

  • Fitch has also maintained its overall negative sector outlook, observing that it “will be increasingly challenged by growing consumerism, meager rate increases and a shifting of risk from payers (particularly Medicare) to providers through the expansion of value-based/risk-based contracting. The slower than anticipated impacts of ACA have not diminished sector risks, only deferred them.” Click here for the report.


  • “Hospital cash flow growth is strong following years of lower trending although we expect it to moderate to historical levels of 3%-4%. Some of the recent drivers, such as gains in insurance coverage and volume increases, will not be sustained over the next 12-18 months,” says Daniel Steingart, a Moody’s VP.  Click here for the Moody’s report.


340B Is Now Half of Hospital Medicare Outpatient Drug Spending

Medicare spent $3.5 billion on discounted drugs purchased by covered entities in 2013, representing nearly one-fifth of the $19 billion that Part B spent that year, according to a new HHS OIG analysis.  340B expenditures were concentrated among hospital outpatient settings rather than associated physicians’ offices and DME suppliers. In total, payments for 340B-purchased drugs accounted for almost half ($3.2 billion) of Part B hospital outpatient drug expenditures.  Click here for the complete report.

Docs Call On All Clinicians To Prescribe Generics Whenever Possible

The American College of Physicians is making the case that all clinicians should prescribe generic medications whenever possible as a way to improve adherence to therapy and clinical outcomes while containing costs.  A new study found that doctors are still prescribing brand name medications when equally effective generics are available. As many as 45 percent of prescriptions written for Medicare patients with diabetes are for branded drugs with an identical generic alternative and the study estimates that Medicare could save $1.4 billion just on diabetes if generics were substituted.  Click here for the study.

Fight Brewing Over CDC Opioid Prescribing Guidelines

A panel set up to coordinate pain research across the federal government is blasting a CDC proposal to rein in opioid prescribing set for release next month.  Members of the NIH’s Interagency Pain Research Coordinating Committee, which was created by Obamacare and includes the FDA, AHRQ and the Department of Veterans Affairs, announced at a meeting last week they plan to file a formal objection to the CDC prescribing guidelines. Those guidelines are a key piece of the administration’s effort to combat the prescription overdose epidemic that claims more than 16,000 lives a year.  CDC has not released a draft but an early version was circulated.  Click here for the draft guidelines.  Click here for a report from the Pain News Network.

  • Opioid use may be on the decline, according to the NIH, but heroin use is on the rise.  Click here for the NIH report.


Hep C Drug Price Set with Politics in Mind: Senate Investigation

Gilead’s pricing strategy for its revolutionary hepatitis C treatment, called Sovaldi, was focused on maximizing revenue, even as the company’s own analysis showed a lower price would allow more patients to be treated, according to an 18-month Congressional investigation into the costly new drug. Gilead spent eight months determining the price of the drug, according to the Senate report. Among the factors it considered were what price it could set without risking public outrage, media attention and congressional inquiries that could harm the drug’s reputation or revenue potential. Click here for the congressional report.

  • The Wall Street Journal has an interesting report on why the U.S. pays more for drugs than any other country.  Click here.


Agency Wants Rural Hospitals To Report Performance Measurements

A new National Quality Forum report recommends that CMS make performance measurement mandatory for rural healthcare providers. The report, which summarizes the recommendations of a multistakeholder Rural Health Committee convened by NQF, notes the urgency for integrating rural providers into Medicare quality improvement programs in light of recent Congressional legislative actions and efforts by HHS to accelerate a timeframe for paying providers based on quality and cost.  Click here for the report.

Observation Status To Be Subject to New Outpatient Bundles

In the 2016 Outpatient Prospective Payment System Final Rule, CMS adopted a new comprehensive ambulatory payment classification (C-APC) to encompass observation services.  This is a first and essentially means providers will do more for less for observation patients. First adopted in 2015, the C-APC can be viewed as the outpatient version of the diagnosis-related group (DRG) payment system, with one payment to cover all services provided during an outpatient encounter.  And CMS continues to advance these bundles.  Click here for a very good analysis on the observation bundle.

  • Unplanned hospital readmission numbers are declining, but the Wall Street Journal says it may be because of the way hospitals are changing their billing practices.  Click here.


Cities Now Ranked for Pre-Term Birth Rates

Portland, Oregon has the best preterm birth rate of the top 100 cities with the most births nationwide, while Shreveport, Louisiana has the worst, according to the new 2015 March of Dimes Premature Birth Report Card, which for the first time graded cities and counties around the nation and revealed persistent racial, ethnic and geographic disparities within states.  The only other cities receiving “As” were Oxnard, CA; St. Paul; and Seattle.  Click here for the top 100 cities.

Family Docs Say Stage 3 MU Will Impede Accountable Care

Stage 3 of the electronic health records Meaningful Use program will impede rather than aid physicians in moving toward value-based accountable care, the American Academy of Family Physicians has told CMS and Congress in a letter released last week.  Regarding Stage 3 regulations, which were finalized in October but with a comment period that could result in modifications, AAFP noted it agreed with moving toward a three-part goal of improving health and improving medical treatment while at the same time lowering costs. “However, we still have significant concern that this final rule does not allow for continued successful transformation toward the three-part aim, but rather places further obstacles in the path to this goal.” Click here to read the very informative AAFP letter.

States Urged To Update Nursing Scope of Practice Law: IOM

Five years have passed since the Institute of Medicine issued a report calling for significant regulatory changes for the field of nursing. Most notably, the 2010 “Future of Nursing” report – which the IOM updated last week – called on states to change their laws so that nurses can practice medicine at the full range of their training. It argued that emerging payment models that rely on coordinated care make it crucial for nurses to fully participate in treatment. In 2010, 13 states were deemed to have full practice authority. Since then, eight more states – CT, MD, MN, NE, NV, ND, RI and VT – have changed their laws to allow nurses to perform all suitable tasks. In addition, several states – NY, TX, KY, UT – have loosened their rules, but still aren’t allowing nurses to perform all care for which they’re trained. Click here for the complete report.

CBO Says Medicare Costs Shifting to Post Acute

The decline in inpatient hospital care is leading to slower spending growth for younger Medicare beneficiaries, however there is faster growth in spending for nursing home and hospice, used more widely by older beneficiaries, contributes to more spending per older beneficiary.  The new CBO report projects that aging will account for about two-fifths of the projected growth in federal spending for the major health care programs as a share of Gross Domestic Product between 2015 and 2040.  Click here for the CBO report.

21 Million Now Covered by PCMHs

The number of patient-centered medical home initiatives featuring payment reform incentives increased from 26 in 2009 to 114 in 2013 and the number of patients covered by PCMHs increased from nearly 5 million to almost 21 million, according a new study in Health Affairs.  Per-member, per-month (PMPM) payments are the most common incentive, according to the NCQA. However, only a third of the initiatives provide adequate financial support. The majority of incentives do not meet the $6-8 PMPM that research suggests is necessary to sustain transformation and reflect the true value and cost savings delivered by the model. Click here for the NCQA report.  Click here for the Health Affairs study.

Senate Votes To Gut Obamacare; President Will Veto

The Senate last week passed H.R.3762 on a 52 to 47 vote that would dismantle large swaths of the Affordable Care Act and cut off federal funding to Planned Parenthood for one year. It is expected to pass the House quickly.  The President has already said he would veto it and Senate Democrats are likely to sustain that veto.  The bill includes provisions that would eliminate Medicaid expansion in 2018, as well as subsidies to help individuals buy coverage through the insurance exchanges.  Click here for details.

Joint Replacement Registry Sees Dramatic Growth

The American Joint Replacement Registry last week released its 2014 Annual Report on Hip and Knee Arthroplasty Data.  The number of procedures in the registry grew by 164% since its first formal report last year.  The first report covered 80,227 procedures and this one covers the collection and analysis of 211,721 procedures related to hip and knee replacements. The 2014 Annual Report contains data from 236 institutions representing 45 states.  Click here for its very detailed report.

More Cosmetic Surgery Docs Want Psych Screens of Patients

A growing number of cosmetic surgeons believe there should be a psychiatric screening of their patients before any cosmetic surgery is performed, according to a report last week in STAT.  The incidence of body dysmorphic disorder apparently affects a disproportionate number of patients seeking cosmetic surgery. The condition is best managed with antidepressants and talk therapy, yet around half of all people with BDD seek appearance-enhancing treatments instead.  Symptoms typically get worse after surgery, as patients continue to dwell on operated body parts or shift their focus to other perceived flaws. Click here for the story.

Number of Uninsured Kids Drops to New Low

The uninsurance rate for children is down to a historic low of 6 percent, according to a report commissioned by the Georgetown Center for Children and Families.  The report also found that adolescents face higher rates of uninsurance compared to younger children. Researchers have consistently found that school-aged children (ages six to 17) are more likely than younger children (under age 6) to be uninsured.  Both age groups saw a decline in uninsurance in 2014, but school-aged children still account for nearly three out of four uninsured children in the nation.  Click here for the report.

Justice Department Hauls In $3.6 Billion from False Claims Enforcement

The U.S. Justice Department last week said it netted $3.6 billion in fiscal 2015 from False Claims Act enforcement, a haul that saw the plaintiffs bar recoup unprecedented sums of money without DOJ help and health care fraud return to the forefront of FCA recoveries.  This is the fourth year in a row that the department has exceeded $3.5 billion in cases under the False Claims Act, and brings total recoveries from January 2009 to the end of the fiscal year to $26.4 billion. Click here for details.

Spending Spikes for Hospitals and Physicians

National spending for hospital care increased 4.1 percent to $971.8 billion in 2014 compared to 3.5 percent growth in 2013, according to data released last week by CMS. The faster growth was influenced by a resurgence in non-price factors, such as the use and intensity of services.  Faster growth in Medicaid, private health insurance, and Medicare spending compared to 2013 was also a major factor as was ACA-related coverage expansion for both Medicaid and private health insurance. Spending on physician and clinical services increased 4.6 percent in 2014 to $603.7 billion from 2.5 percent growth in 2013 when spending was at a historical low. Click here for the complete CMS analysis.

CDC Urging Greater Use of PrEP for HIV

The CDC is putting a larger emphasis on counseling sexually active adults who are at substantial risk for HIV infection about PrEP, a daily pill for HIV prevention.  PrEP for HIV prevention was approved by the FDA in 2012; when taken daily, it can reduce the risk of sexually acquired HIV by more than 90 percent.  “PrEP isn’t reaching many people who could benefit from it, and many providers remain unaware of its promise,” said CDC Director Tom Frieden, M.D., M.P.H. Click here for more from the CDC.

Just in Time for the Holidays: ICD-10 Codes to Brighten Your Day

The holidays are upon us, so it’s time for you to brush up on some ICD-10 codes you could see come through the hospital and physician doors during this festive season.  Click here.