WEEKLY E-BULLETIN


Healthgrades Announces Its Top 100 Hospitals for 2016

Healthgrades released its list of America’s 100 Best Hospitals for 2016.  Healthgrades leading hospitals had an overall 26.5% lower risk-adjusted in-hospital mortality rate across the 19 procedures and conditions where mortality is the measured outcome, compared with all other hospitals. From 2012-2014, if all hospitals, as a group, performed similarly to its top 100 hospitals, more than 170,000 lives could potentially have been saved, according to Healthgrades.  Click here for the list.

Northeastern States Rank Best In Clinical Prevention

Massachusetts, Rhode Island, New Hampshire, Connecticut, and Vermont ranked best in clinical disease prevention while Texas, Arkansas, Nevada, Alaska, and Mississippi were at the bottom of the list, according to a new America Health Ranking report.  The CDC says Americans use clinical preventive services at half the recommended rate, leading to tens of millions of individuals missing out on basic preventive care. The Institute of Medicine has also estimated that in one year, the United States spent $55 billion due to missed preventive opportunities.  Click here for the report and complete state listings.

Hospital Readmits Declining Significantly: NEJM

Fewer patients are returning to the hospital within 30 days of discharge, and it’s not because hospitals are holding patients in observation units instead of admitting them as a means of avoiding penalties, according to new federal data. Readmission rates dropped significantly for more than 3,300 U.S. hospitals between 2007 and 2015. A small increase in the number of Medicare observation claims was also seen at that time.  Click here for the study in the New England Journal of Medicine.

Highmark Plans to Cut Payments to Physicians through ACA Exchanges; BCBS Plans See Net Income Drop

Highmark, the fourth largest Blue Cross and Blue Shield-affiliated company based in Pennsylvania, will reduce payment rates through ACA exchange plans to participating physicians by 4.5 percent starting April 1st. Highmark states that the move is due to the $500 million loss last year on health insurance plans sold on the Affordable Care Act marketplace and helps ensure that the exchanges remain a viable investment. Click here for more.

  • Some Blue Cross and Blue Shield insurers have said they will cut back on sales commissions for Affordable Care Act policies, according to a report.  Click here.
  • Fitch Ratings says in a new report that it expects Blue Cross and Blue Shield companies’ earnings to decline for all of 2015.  Click here to see net income numbers in 2015′s first 3 quarters for most of the Blue Cross plans.
  • People who want to use HealthCare.gov to subscribe to a health insurance plan or change plans outside the open enrollment period must now prove that they are eligible, according to CMS. The requirement is strongly supported by insurers.  Click here for the story.
  • Click here for a summary of CMS’ new Healthcare.gov Program Integrity rule.

 Medicare Advantage Continues Strong Growth

United Health Care, Humana, Kaiser, Aetna and Anthem are the top five insurers for Medicare Advantage, according to new data released last week.  Total MA enrollment as of February 1, 2016 stood at 18,203,676, with a net gain of 927,534 members, year-over-year.  According to CMS, 33% of the 54.8 million people eligible for Medicare are enrolled in MA plans.  Click here for the complete report.

Failed CO-OP Sues Feds for $5 Billion

As the federal debate rages over how to handle the Affordable Care Act’s growing number of CO-OP failures, one CO-OP has sued the government for $5 billion for not making good on promised payments from the risk corridor program.  Health Republic Insurance of Oregon, which closed down in October, filed its suit this week in the U.S. Court of Federal Claims.  Click here for the story.

OIG Outlines Difficulty with Healthcare.gov Development

The HHS Inspector General has issued a report providing an extensive look into the missteps of the development HealthCare.gov, including organizational confusion and lack of clear leadership. According to the report, there were countless the issues associated with building the complex technologically for the federal exchange platform, a number of delays in developing policy, and problems with the main federal exchange contractor CGI. Click here to read the full report.

CMS Extends MU Hardship Exemptions Deadline

CMS has extended the deadline for hospitals, physicians and other eligible professionals to file applications for hardship exemptions from the meaningful-use requirements of the electronic health records incentive payment program. The new deadline for hospitals, critical-access hospitals, physicians and other eligible professionals is now July 1, 2016.  Click here for more from CMS.

CMS Bundled Payment Program May Be Falling Short on Savings: Kaiser Foundation

As CMS continues its drive to pay for value rather than volume, a new Kaiser Foundation study says that CMS’ bundled payment initiatives may not be saving much money.  Alternate payment models such as bundled payments are continuing to grow dramatically. A recent American Medical Association study found nearly 60 percent of medical practices were enrolled in an alternative payment model.  Click here for the Kaiser report.

Post Acute Care Giant Kindred Says Fewer Hospitals Are In Its Future

One of the leading post acute care companies in the United States says less, not more, inpatient beds are likely for its future.  Kindred Healthcare to investors last week that the company will likely have fewer inpatient facilities.  Kindred saw big increases in the last quarter in its Kindred at Home, Kindred Rehabilitation Services and Kindred’s Nursing Center Division.  Click here for more.

Senate Confirms New FDA Commissioner

The Senate voted last week, 89-4, to confirm Robert Califf to head up the Food and Drug Administration as its next Commissioner. Califf, the FDA’s deputy commissioner for medical products and tobacco, was nominated for the top FDA job in September. In the Senate, his nomination was at various times opposed by up to three Republicans and five Democrats. Before joining the FDA in February 2015, he was a cardiologist at Duke University who also ran the university’s clinical trials institute. To read more on Commissioner Califf, click here.

Fight Continues Over HOPD Site Neutral Policies

The fight over Medicare’s site neutral payment policies continues in Congress.  Responses to the House Energy & Commerce Committee request from members of the health care community on policy changes regarding site-neutral payments (click here for the E&C request letter) are — not surprisingly — showing some major differences. The American Hospital Association says the policy breaks precedent by not grandfathering off-campus facilities that were under development when the hospital outpatient department site neutral law took effect November 2, hurts beneficiaries in rural and underserved areas and undermines the move away from fee-for-service Medicare. However, the Community Oncology Alliance wants Congress to stay the course with the site-neutral payment policy, although they are open to exempting facilities under development, if they don’t include oncology practices, from lower pay rates in narrow circumstances. Click here for the AHA letter and here for the COA letter.

Utilizing Nurse Practitioners Lowers and Increases Costs: Study

According to an analysis by researchers at University of California San Francisco, five states that let nurse practitioners treat patients without physician supervision saw slightly lower prices for primary care but had higher overall health care spending. The study found that provider prices for primary care services fell between 1 to 4 percent in states with independent scope-of-practice laws, compared with states with more restrictive laws. But health care costs increased by the same amount in those states. Click here to read the study.

Mastectomies Increase 36% Since 2005

According to new data from the Agency for Healthcare Research and Quality, mastectomies have increased 36 percent between 2005 and 2013 even though breast cancer rates have remained constant. Additionally, they are increasingly taking place in outpatient settings, as 45 percent of the surgeries in 2013 were performed in hospital-based ambulatory surgery settings. The rise in double mastectomies was particularly high during the data period.  According to AHRQ, the rate more than tripled and by 2013. To read the data brief, click here.

US Obesity Rate At All Time High: CDC

A new CDC study found the US obesity rate for adults in 2015 was 30.4%, an all-time high and an increase from 29.8% in 2014. Data showed 21.1% of US adults in 2015 met physical activity guidelines for both aerobic and muscle-strengthening exercise, which was similar to the rate in 2014 but an increase from the 16% rate seen in 2006. Click here for the CDC report.

Zika Virus Reveals More Cracks in Public Health System

State health officials were encouraged when the Obama Administration asked Congress for $1.8 billion to combat the spread of the Zika virus because they fear they don’t have the resources to fight the potentially debilitating disease on their own. Budget cuts have left state and local health departments seriously understaffed and in a precariously dangerous situation if the country has to face outbreaks of two or more infectious diseases — such as Zika, new strains of flu, or the West Nile and Ebola viruses — at the same time. Click here for the story.

Dizziness and Balance are a Problem for American Kids – NIH

According to a study of data on 11,000 children ages 11- 17 by NIH’s National Institute on Deafness and Other Communication Disorders (NIDCD), More than 1 in 20 U.S. children have a dizziness or balance problem, and only one-third of them had received treatment in the previous year. Parents were asked if, in the past year, their children had been bothered by symptoms of dizziness or balance problems such as vertigo (feeling that you or your surroundings are spinning), unsteadiness upon standing, frequent falls, or other related symptoms. To read the full results of the study in the Journal of Pediatrics, click here.

Causes of Death Vary Greatly by State

An interesting analysis released last week show causes of death can vary greatly, depending on what state you live in:

  • Seven states in the South — Alabama, Arkansas, Kentucky, Louisiana, South Carolina, Tennessee, and West Virginia — had high rates of unintentional firearm deaths, between two and four times the national average.
  • Deaths involving an interaction with a police officer were noticeably higher on the West Coast. California, Oregon, Nevada, New Mexico, and Utah had rates as high as three and a half times the national average.
  • Deaths involving machinery are more common in the agricultural states of Iowa and North Dakota.
  • Suicides are more prevalent in Oregon, New York, Minnesota, Colorado, and New Hampshire.
  • Accidental deaths involving a bicycle are more common in Florida.
  • Unintentional suffocation deaths are more frequent in Connecticut

Click here for the abstract published in Injury Prevention. Click here for the news report.