WEEKLY E-BULLETIN


CMS Proposes 1.35% Rate Increase for Medicare Advantage; Part D Targets Opioid Abuse

CMS has proposed to increase 2017 Medicare Advantage rates by 1.35 percent, according to guidance issued by the agency late last week. CMS also would add a “coding trend” to account for discrepancies with the traditional fee-for-service program. CMS estimates that when that is factored in, the actual increase in payments to plans will be 3.55 percent. Additionally, the proposal would put in place a new risk adjustment system for 2017 to more accurately compensate plans. In particular, CMS hopes to provide more precise payments to plans that attract beneficiaries who are disproportionately sick and expensive. Click here for details from CMS.

  • CMS is targeting high drug costs and the opioid overdose epidemic in its proposed requirements for next year’s Medicare Part D plans. CMS also won’t approve benefit designs that are overly restrictive of medication-assisted treatment for opioid addiction or that require high cost-sharing for it. CMS is also calling on plans to include checks on over-utilization of opioids at the point of sale. Details are included in the link above.

Study: Cardiac Imaging Costs Much Higher In HOPD than Physician Office

Medicare reimbursement for cardiac imaging is significantly higher at a hospital outpatient departments compared to physician offices, according to a Physicians Advocacy Institute-funded analysis released last week. Payments for cardiac imaging at a hospital outpatient department were more than triple, or $2,100 vs. $655 for reimbursement to physician offices. Researchers also looked at Medicare’s payments for an entire episode of care—the full 22-day period encompassing preparatory and follow-up care for a given procedure. Under this measurement, Medicare’s payments for echocardiograms averaged $5,148 when provided in hospital outpatient department instead, but were $2,862 when provided in a physician’s office. Click here for the report.

Critical Access Hospital Bill Would Restore Lost Funding

A bi-partisan group of U.S. Representatives have come together to introduce legislation that would pay critical access hospitals their costs for many services provided to patients that have been unpaid or underpaid for years. The Critical Access and Rural Equity (CARE) Act of 2016 (H.R. 4553) is sponsored by Rep. Greg harper (R-MS), and cosponsored by Rep. Loebsack (D-IA), Rep. Peterson (D-MN), Rep. Palazzo (R-MS), Rep. Kelly (R-MS) and Rep. Thompson (D-MS). The legislation would add specific definitions to “allowable costs” that are to be reimbursed at 101 percent of costs at critical access hospitals. Click here for a one-page summary.

Providers Driving Up Hospice Costs: Wall Street Journal

The Wall Street Journal is pointing the finger at hospice providers for driving up Medicare’s hospice costs – in a new report published last week. The investigative report says providers are sometimes canvassing nursing homes and other facilities for Medicare patients to persuade to enroll in hospice programs, according to hospice workers and regulators. Patients, their families and sometimes their doctors have ample reason to agree. For many, it entitles them to care that wouldn’t otherwise be covered by the federal government. The shift has fueled a steady increase in Medicare hospice spending, which roughly doubled over the nine years examined by the Journal, to about $15 billion in 2013. Click here for the WSJ story.

Intermountain Health System and Health Plan Seek To Save Billions

With its new insurance plan, Utah-based health system Intermountain Healthcare plans to limit the rising costs consumers face by holding yearly rate increases at set amounts–a move that if successful could lead other plans to follow suit, according to the New York Times. SelectHealth Share is looking to help keep its rate increases to one-third to one-half less than the typical employer sees. Intermountain says it will save $2 billion over the next five years. Click here for the NYTimes report.

CMS and Insurance Industry Agree on Quality Measures

CMS, the America’s Health Insurance Plans, and other provider groups announced last week a new set of quality measurements meant to make reporting requirements for doctors and other health care providers more consistent and efficient. Currently, individual payers utilize their own measurements, this agreement would assign core measures in seven areas. The new measures would ease the reporting complexity for clinicians, insurers are also hoping to bring down costs. To read the agreement, click here.

Medicaid Provider Taxes Increasing Costs – Study

A new study from George Mason’s Mercatus Center argues that Medicaid Provider Taxes – which 49 states use to partially fund Medicaid – are driving up health costs. The study suggests that “states’ use of accounting schemes to inflate federal Medicaid reimbursements” raise overall spending by lowering the relative price of Medicaid expenditures to states. Click here to read the study.

Two Illinois Hospitals Ordered To Pay Property Taxes

Two non-profit hospitals in Illinois have been ordered by a regulatory board to pay property taxes as a result of the state’s law governing the matter being put in legal limbo, according to news reports last week. Carle Health System and Presence Covenant Medical Center in Urbana were both ordered by the Champaign County Board of Review to pay property taxes of about $10 million combined annually. Click here for the story.

Health Coalition Pushes 6 Changes They Say Will Immediately Improve Health System

A coalition made up of health care providers, drug companies and insurers have released a set of recommendations in a report by Healthcare Leadership Council and NORC to improve the nation’s healthcare system. The recommendations include setting a deadline for achieving nationwide healthcare record interoperability by the end of 2018, making changes to the FDA’s medical product approval process, and steps for the CMS to improve the distribution and use of medication through better management by doctors and promoting health literacy among patients. To read the report, click here.

Breadth and Depth of Autism Coverage Uneven At Best

Since 2001, 44 states have begun requiring some insurance plans to cover children diagnosed with autism spectrum disorder. But the rules are all different, making for uneven coverage across states. Autism Speaks, a national nonprofit, estimates that 36 percent of Americans have access to autism coverage. Some states only require coverage up to a set dollar amount per year or a set number of hours of treatment per week, or only require the coverage until a child reaches a certain age, ranging from 8 to 21. Click here for more.

Hospital Pays $17,000 in Ransom to Hackers to Unfreeze EHRs

A Southern California hospital has paid a $17,000 ransom in bitcoins – significantly lower the the original reported request of $3 million – to hackers who infiltrated and disabled its network to have it’s computer system restored. The FBI is investigating the attack, often called ransomware, where hackers encrypt a computer network’s data to hold it hostage, and offer to provide a digital decryption key to unlock it for a price. For more on this story from USA Today, click here.

Genetically Modify Mosquitos to Reduce Zika and Other Diseases?

WHO is considering a different ways to control the mosquitoes that are spreading Zika (and dengue and chikungunya) – including genetic modification, sterilization with low doses of radiation, and infecting male mosquitoes with a bacteria that hampers breeding. On February 17th, WHO released information from an advisory group that has recommended field trials and risk assessment for genetically modified mosquitoes This comes after trials in the Cayman Islands showed significant reductions in the relevant mosquito populations. The WHO continues to state that bug repellent and the elimination of mosquito breeding sites, which can include small amounts of water in bottle caps or pet bowls, is important. For more from the WHO, click here.

  • The FDA has also issued guidelines recommending that individuals at risk of Zika infection avoid donating blood for four weeks. Click here to read the guidelines from FDA.

1 in 5 Adults Visited ED in 2014

About 18 percent of adults age 18 to 64 visited the emergency department in 2014, staying with a 10-year trend, according to a new study from CDC’s National Center for Health Statistics. Most patients state that their visit to the ED was because they were facing an urgent medical problem, however about one in five respondents said it was an access-related issue – either their doctor’s office wasn’t open, or they lacked access to other providers. To read the study, click here.

Pharmacists Can Now Write Birth Control Prescriptions in 2 States, More Coming

California and Oregon are now allowing pharmacists to write prescriptions for hormonal birth control without a doctor’s approval. The practice, designed to improve access to contraceptives and curtail unplanned pregnancies, is being considered by several states. Lawmakers in Hawaii, Missouri, South Carolina, Tennessee and Washington are considering legislation that would give pharmacists the power to prescribe contraceptives. Click here for the report.

Big Surprise – Americans Don’t Get Enough Sleep

One of every three Americans do not get enough sleep on a regular basis, a new study from CDC says. About 35 percent of U.S. adults are sleeping less than seven hours a night, increasing their risk of a wide variety of health problems – increased risk of obesity, type 2 diabetes, high blood pressure, heart disease, stroke, frequent mental distress, and death, the study authors said. To read the study, click here.