260 Hospitals Receive Top Healthgrades Award

Healthgrades has announced the 260 recipients of the Distinguished Hospital for Clinical Excellence Award. These hospitals are among the top five percent of hospitals in the nation that deliver high quality care across at least 21 of 32 common inpatient conditions and procedures, as evaluated by Healthgrades.  During the 2016 study period (inpatient stays from 2012-2014), these hospitals as a group, had a 26.5% lower risk adjusted in-hospital mortality rate across 19 procedures and conditions where mortality was the clinical outcome, compared to all other hospitals. During this same period, if all other hospitals performed at the level of these hospitals across these 19 procedures and conditions, 158,858 lives could potentially have been saved. Click here for the hospital award recipients.

Cigna Banned from Medicare Advantage

Cigna revealed that it has been temporarily banned from selling Medicare Advantage or Medicare Part D plans to new customers. In a letter of enforcement, CMS stated that it found “widespread and systemic failures impacting Cigna enrollees’ ability to access medical services and prescription medications.” The suspension doesn’t affect the benefits or plans of Cigna’s current Medicare customers. For more from USA Today, click here.

  • Medicare Advantage plans are getting a new Recovery Audit Contractor, according to an RFI released by CMS just before the end of last year.  As currently envisioned, the Medicare Part C RAC will undertake two types of audits: comprehensive risk-adjusted data validation (RADV) and condition-specific RADV. It will conduct the comprehensive RADV audits for the purpose of ensuring the accuracy of risk adjustment data and conducting overpayment recovery from Medicare Advantage organizations. Click here for details.
  • United Health Care says it lost hundreds of millions of dollars more than expected participating on federal health exchanges.  Click here for the story.

With Increasing Concerns from Providers, CMS Stepping Up IMPACT Act Education

The coming year will include deadlines and measures related to the Improving Medicare Post-Acute Care Transformation (IMPACT) Act causing growing concerns over what to expect from the post-acute care industry. New measures include ways to better track frequency of care and spending in skilled-nursing facilities, home health agencies, inpatient rehabilitation facilities and long-term-care hospitals in an effort to curb rising costs. CMS has planned two conference calls in the coming weeks to review the upcoming processes to expect. The first one, Understanding the IMPACT Act Measure Alignment and IMPACT Outcomes, will be held on February 2nd, for more, click here. The second, IMPACT Act: Connecting Post-Acute Care across the Care Continuum, will be held on February 4th, for more and to register, click here.

Exchange Enrollment Surges But Reports of Sign Up Problems Plaguing System

With enrollment surging on the federal exchanges, subscribers are seeing an increase in clerical problems that are impacting their service.  Brokers and insurers in several states told The Associated Press that they’ve been inundated with complaints about these issues from customers with individual plans and those with coverage through small businesses. Insurance provider Health Care Service Corp., for instance, has been dealing with delays for about 10,000 companies, while billing errors caused bank overdrafts for 3,200 individual customers of a North Carolina insurer. Click here for the Washington Post story.  Click here for the latest enrollment report from CMS.

 FTC Investigating Drug Maker for Raising Rx Price

The U.S. Federal Trade Commission is investigating Turing Pharmaceuticals for possible antitrust violations in connection with the company’s decision to hike the price of a life-saving drug by more than 5,000 percent, a lawyer for former Chief Executive Officer Martin Shkreli wrote on Friday.  Click here for the story from Reuters.

 CMS Finalizes Medicaid Outpatient Drug Rule

CMS last week released the final rule on Medicaid covered outpatient drugs that will create a long-term framework for implementing the Medicaid drug rebate program and replace the reimbursement system for Medicaid programs and pharmacies. CMS estimates the rule will save federal and state governments $2.7 billion over five years and improve beneficiaries’ access to needed drugs. For the CMS fact sheet, click here. For the final rule, click here.

 Senators Want Advice from Stakeholders on Drug Spending

Key U.S. Senators Chuck Grassley (R-IA) and Ron Wyden (D-OR) sent letters last week seeking advice from providers and patients on ways to control drug spending – this follows their investigation into how Gilead Sciences set the price for hepatitis C medications. The Senators state that they are especially interested in price transparency measures and policies that could ease access restrictions for Medicaid beneficiaries and the poor. To read the letters sent to stakeholders, click here.

Senate Passes Bill Extending Rural Hospital Payment Demonstration

The Senate last week unanimously passed legislation extending a Medicare demonstration program that is designed to help rural hospitals stay open. S. 607, the Rural Community Hospital Demonstration Extension Act of 2015, would extend the HHS program for an additional five years. The goal of the program is to test the feasibility and advisability of cost based reimbursement for small rural hospitals that are too large to be Critical Access Hospitals.

  • Participating rural community hospitals are located in one of the 20 states with the lowest population density: Alaska, Arizona, Arkansas, Colorado, Idaho, Iowa, Kansas, Maine, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Mexico, North Dakota, Oklahoma, Oregon, South Dakota, Utah, and Wyoming. Click here for more information on the program from CMS

CMS Posts New, Easier Meaningful Use EHR Hardship Waiver Application

CMS is making it easier for providers to waive out meaningful use requirements of EHRs amid a series of proposed changes to the 6-year-old $31.8 billion EHR incentive payment program.  To comply with the law, the CMS posted a new hardship application reducing the amount of information that providers must submit to apply for an exception. Eligible professionals will have until March 15 to apply for an exemption and eligible hospitals will have until April 1.  CMS is also making it easier for whole groups of providers to waive out by allowing them to apply for a hardship exception on a single application.  Click here for the details from CMS.

CMS Chief Says 12 Remaining Co-Ops Should Not Fail This Year

Acting CMS Administrator Andy Slavitt said that he would like to “loosen up the capital rules” for co-ops and and also help them attract more investment, or find partners to merge with so they can function more like start-ups. 12 of the 23 nonprofit startups failed in the past year or so after being given $2.4 billion in loans from the Affordable Care Act  He also indicated to a congressional committee that he did not think that any of the 12 remaining ones would go under in 2016, given their financial audits. Read his prepared testimony here.

 State Medicaid Programs Still Have Difficulty Transferring Data to HealthCare.gov

According to a new survey by the Kaiser Family Foundation, twenty HealthCare.gov states are still experiencing problems transferring data about applications between their Medicaid agencies and the federal exchange. Under the strategy envisioned by the Affordable Care Act, anybody should be able to apply for coverage in a single portal, but when marketplaces came online states experienced issues with the account transfers. That often led to significant delays in enrolling people into Medicaid. Click here for the report.

 House Committees Subpoena Treasury Secretary

Two key House committees have subpoenaed Treasury Secretary Jack Lew for information on Obamacare’s cost-sharing reduction payments. The Committee Chairmen say that the administration has refused repeated requests for information and documents on the program. The committees subpoenaed three IRS officials in addition to Lew and have also threatened to subpoena HHS, which has a role in managing the cost-sharing program. For more information from the committees click here and here.

FDA Issues Guidance on Cyber Security, Says More Vigilance Needed

The increased connectivity of medical devices with hospital networks and the Internet requires manufacturers to be more vigilant against hacking, according to the FDA. The FDA has issued draft guidance outlining important steps medical device manufacturers should take to continually address cybersecurity risks to keep patients safe and better protect the public health. For more from the FDA, click here.

Senate Committee Wants to Pass 7 Medical Innovation Bills

The Senate Health, Education, Labor and Pensions Committee will mark up at least seven bills on February 9th in the first of three expected sessions aimed at advancing medical innovation legislation. The markup will address improving electronic health records, reforming FDA medical device policy, FDA regulation of duodenoscopes as well as advancing research or treatment for rare diseases, neurological disorders and medical rehabilitation. Click here for more details.

 CDC Issues Expanded Zika Virus Travel Alert

CDC is working with other public health officials to monitor for ongoing Zika virus‎ transmission and last week CDC added the following destinations to the Zika virus travel alerts:  Barbados, Bolivia, Ecuador, Guadeloupe, Saint Martin, Guyana, Cape Verde, and Samoa.  On January 15, CDC issued a travel alert for people traveling to regions and certain countries where Zika virus transmission is ongoing: the Commonwealth of Puerto Rico, a U.S. territory; Brazil; Colombia; El Salvador; French Guiana; Guatemala; Haiti; Honduras; Martinique; Mexico; Panama; Paraguay; Suriname; and Venezuela.  Click here for more from the CDC.


CDC Says More Babies Being Born with Organs Outside of Bodies

More babies are being born with organs outside their bodies, and experts have no idea why Cases of gastroschisis, a rare birth defect that causes internal organs to protrude from a hole in the belly, have jumped 30 percent in recent years, the CDC said last week.  Click here for details.