750 Hospitals Hit With New Medicare Penalties

Due to CMS’ Hospital-Acquired Condition Reduction Program over 750 hospitals will see their Medicare payments reduced by 1 percent this fiscal year under an ACA program that targets hospital-acquired conditions. CMS says the penalties will save Medicare $364 million. This year, hospitals did slightly worse on catheter-related infections, but better on the patient safety indicator and on central line infections. Click here for the list of penalized hospitals – listed by state. Click here for program details from CMS.

Senate Investigates High Rx Costs

Something needs to be done to curb the increasing prices of prescription drugs, according to officials from hospitals and other facets of the healthcare sector who testified last week at a U.S. Senate hearing. The hearing was prompted in part by Turing Pharmaceuticals that raised the price of the 63-year-old drug Daraprim more than 50-fold. However, many other drug manufacturers have raised the prices of their products more surreptitiously, escaping the scrutiny of lawmakers and putting providers into a bind, according to The Washington Post. Click here for the story. Click here to watch the hearing and for copies of the detailed testimony.

MedPAC Considers 340B Changes, Reviews Hospital Payment Adequacy

The Medicare Payment Advisory Commission is considering recommending changes to Medicare’s interactions with the 340B discount drug program, which, according to MedPAC has been having an unintended effect of helping spur hospitals’ acquisitions of physician practices that drive up costs for the federal health plan and its elderly and disabled participants. MedPAC’s analysis was based, in part, on a recent OIG report (click here) that suggested reductions in payments to 340B covered entities. MedPAC’s 340B discussion was part of its overall assessment of hospital payment adequacy. Click here for their very informative slide presentation.

RACs New Strategy: Recruit Important Allies

Three organizations aimed at reducing government waste have issued a letter to the Senate criticizing recent policies that have minimized the impact of the Recovery Audit Contractor (RAC) program. A coalition made up of the Council for Citizens Against Government Waste, the National Taxpayers Union and Americans for Tax Reform called on lawmakers to preserve “one of the most successful improper payment recovery programs ever enacted into law.” The letter argues that the RAC program helped drop the Medicare improper payment rate from 10.8 percent in fiscal year 2009 to 8.5 percent in 2012. In 2013, RACs collected nearly $4 billion in overpayments. Click here for the letter.

Many physicians Say they are not Ready to Care for the Sickest Patients

24 percent of U.S. primary care doctors have said that they are not well-equipped to care for patients with multiple chronic illnesses, and 84 percent said they are not well prepared to care for severely mentally ill patients according to a new survey by The Commonwealth Fund. In the 10-nation study doctors noted that coordinating care was a major challenge for these patients. Click here to read the study.

OB/GYN and Surgeons Get Sued the Most

A new survey on malpractice lawsuits by Medscape found that 85 percent of OB/GYNs and 83 percent of general surgeons say they have been sued. However, only 34 percent of oncologists state that they have been sued. Overall, 59 percent of physicians who responded said they have been named in at least one malpractice suit. Failure to diagnose and abnormal injuries were the two most common reasons physicians were sued. Click here for the survey.

Medicare Advantage Plans Could See Big Payment Shifts with New Regs

The government’s proposed changes to its risk-adjustment model for Medicare Advantage plans could result in large payment increases and decreases depending on where seniors live, according to an analysis by Avalere Health.The proposed modifications by CMS could result in large changes in payments in certain geographic areas. For example, the analysis found that seniors living in almost all of the counties in California are likely to see large payment decreases, while those living in Florida could see increases, except for those in Miami-Dade County. Click here for the report.

CMS Posts Updated Physician Quality Data; AMA Increases Criticism

CMS has published quality performance scores for individual physicians, for those who have volunteered data on Physician Compare. About 6 in 10 doctors are included in the database that CMS states will help consumers find and choose physicians and other health care professionals enrolled in Medicare so that patients can make informed choices about health care. Click here to go to the site.

  • The AMA is increasing its criticism against CMS using PQRS data that the agency has admitted it had issues gathering. CMS is now posting that info online as part of its Physician Compare website – with a disclaimer adding that the data on quality isn’t comprehensive, and that consumers shouldn’t assume problems in cases where the data doesn’t exist. Click here for the AMA statement.

Congress OKs Short-Term Fix for Direct Supervision in Critical Access Hospitals

Congress sent the President a bill that would delay a CMS’ requirement that supervising physicians be present to oversee outpatient services in critical access and small rural hospitals for 2015. The bill, S. 1461, states that CMS must require only “general supervision” for outpatient services through the end of this year. Click here to view the bill and its report.

MedPAC Gives Detailed Updates on Provider Medicare Payment Issues

  • MedPAC provided updated status reports on most major provider types in its year-end review last week. The hospital report can be found above. Here are the other reports:


  •  MedPAC says Medicare Advantage continues to grow faster than fee-for-service. Click here.
  • Most Medicare beneficiaries have no trouble finding a new doctor, says MedPAC in its physician update. Click here.
  • For the 15th consecutive year, skilled nursing facilities have been profitable on average, with for-profit SNFs having 3 times the margin as not-for-profits. Click here.
  • States with the largest decline in Medicare home health volume are Texas, Louisiana, Illinois, Tennessee and Florida. Click here for the home health update.
    Click here for all other MedPAC reports.

CDC Wants Comments on Proposed Guidelines on Opioid Prescribing

After criticism from stakeholders such as pain advocates and professional associations for developing draft guidelines on opioid prescribing behind closed doors and with limited public input, the CDC announced plans to publicly post them. A notice posted provides 30 days for public comment, which means that the guidelines won’t be released in January as the agency had planned. Click here for the CDC notice.

  • New CDC data shows the overall number and rate of drug overdose deaths increased notably between 2013-2014, driven in large part by continued increases in heroin deaths and an emerging increase in deaths involving illicit synthetic opioids. Click here for the data.

Multi-State Health Plans Are Required, But Not Happening

The Affordable Care Act required that at least two multi-state plans be available to consumers in 31 states by 2014 and in all states by 2017, but it doesn’t require insurers to offer the plans and most so far have opted not to, according to a new report. Federal officials and insurance experts say it is unlikely that the 2017 goal will be met. Click here for more.

Kids Dental Care Getting Better, Declining for Adults

The percentage of Medicaid enrolled children who visited a dentist within the past year increased from 29 percent in 2000 to 48 percent in 2013, according to a new American Dental Association report. As a result, the gap in dental care use between Medicaid enrolled children and children with private dental benefits narrowed significantly over this same timeframe in the vast majority of states. The trend for adults differs dramatically from that for children. Dental visits by adults with private dental benefits are declining in most states. Click here for the ADA’s very good interactive map detailing dental health in each state.

Hospitals Lead in Health Spending Increases

Health care spending on hospitals, doctors and social services grew 5.6% year over year in the third quarter of 2015, according to new data from the Census Bureau. The figure does not include other components of the healthcare system, such as pharmaceuticals and other medical products. Hospitals are the largest portion of health services spending with their revenue increasing 5.3% in the third quarter of this year, compared with the same period last year. Spending at physicians’ offices grew by 7.4%, outpatient center expenditures went up 8.6%, and spending on nursing homes and residential-care facilities increased by 3.3%. Click here for more.

  • The insurance industry continues to blame hospital mergers for higher health care costs. Click here for the story.

Not Surprising: Healthcare Is Where the Jobs Are!

The greatest share of jobs between 2014 and 2024 will come from the health care sector, according to new data from the U.S. Bureau of Labor Statistics. Health care-related jobs are projected to account for 13.6 percent of all U.S. jobs by 2024, up from 12 percent in 2014. Additionally, the health care sector broadly is expected to become the largest employer by the middle of the next decade, greater than both state and local government and professional and business services. Click here for the report.

FDA OKs First Treatment for Chemo Overdose

The FDA late last week approved Vistogard (uridine triacetate) for the emergency treatment of adults and children who receive an overdose of the cancer treatment fluorouracil or capecitabine, or who develop certain severe or life-threatening toxicities within four days of receiving these cancer treatments. Click here for the FDA announcement.

US Pregnancy Rate Continues Precipitous Drop

The pregnancy rate in the US continues to drop to its lowest rate since 1976, the CDC reported late last week. The abortion rate is falling, too. There were just over 6 million pregnancies in the US in 2010, which led to about 4 million live births, 1 million abortions, and 1 million fetal losses. Girls under 14 saw the biggest decline in pregnancy rate. Click here for the CDC report.

C. Diff Add Significant Costs to Hospital Care

Patients with Clostridium difficile-associated diarrhea (CDAD) had higher lengths of stay, intensive care unit admission, and inpatient mortality, according to a study released last week. CDAD also conferred higher adjusted costs and all-cause readmissions. Prevention of initial and recurrent CDAD is essential to lessen the burden on hospitals. Click here for the study.

Cross-State Clinician Licensing Gaining Traction

A doctor licensed in one state who wants to practice in another still needs a license from the other state. That’s a costly and time-consuming process, especially in an era when many health plans and their employees operate across state lines and the use of telemedicine, in which patients and their providers interact from a distance, is growing. But the state licensing situation for doctors and other health care professionals — psychologists, social workers, physical and occupational therapists, and mental health counselors — is starting to change. Click here for the report.

Hawaii, Vermont, Massachusetts, Minnesota, New Hampshire Are Healthiest States

The United Health Foundation is out with its rankings of all 50 states. They take five major factors into account: behaviors, such as smoking, excessive drinking, and drug deaths; community, including violent crime, on-the-job fatalities, and infectious disease; policies, including how many people lack health insurance, and percentage of children up-to-date on immunizations; healthcare, like the number of dentists and doctors available per capita; and outcomes, including measures on diabetes, cancer deaths, heart disease deaths, and more. Click here to see where your state ranks.