WEEKLY E-BULLETIN


100 Top Hospitals for 2016 Named by Truven

Truven Health Analytics last week released its annual study identifying the 100 top U.S. hospitals based on their overall organizational performance. The study found that the top performing hospitals in the country were able to improve outcomes while reducing overall expense per patient. This was the first time in the study’s 23-year history that a notable trend toward reduced expense per patient was observed among the majority of top-performing hospitals.  Overall, the study found that these hospitals had lower 30-day mortality and readmission rates, fewer complications and higher survival rates, while maintaining three percent lower inpatient costs per beneficiary than non-winning peer group hospitals.  To see the list of 100, click here.  Click here for the complete report.

CMS Hits 30% APM Goal 1-Year Early

CMS has met its goal of tying 30 percent of Medicare payments to alternative payment models — nearly a full year ahead of schedule. Medicare is projected to pay more than $117 billion to accountable care organizations, bundled payment programs and other alternatives to fee-for-service medicine in 2016 according to CMS. The agency seeks to tie half of Medicare payments to alternative payment models by 2018. Click here to read a summary of what CMS says are its alternative payment models.

  • A new survey of hospital orthopedic programs nationwide finds that more than half of them feel unprepared for the new Medicare bundle payment model that goes into effect in 68 metro areas April 1.  Click here for details.

 CMS Announces Next Generation ACO Application

CMS’ Innovation Center has announced the second and final round of applications for the Next Generation Accountable Care Organization Model. This program will begin its second performance year on January 1, 2017. Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program, the Next Generation ACO Model offers a new opportunity in accountable care—one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care. Click here for all the details.

  • A small software company, Innovaccer, has come up with a Medicare ACO comparison website where you can see how your ACO compares with others across the nation.  Click here.
  • Next Generation Medicare ACOs include a waiver allowing providers to use telehealth services in rural and urban areas and in the patient’s homes.  Click here for last week’s MedPAC summary of the use of telehealth today.

 MedPAC Moving Closer to Proposal for Mandatory Post Acute Bundling

The Medicare Payment Advisory Commission last week discussed its pending report to Congress on a prototype payment system that could replace the current payment systems for home health, skilled nursing, inpatient rehabilitation and long-term care hospital services. The prototype includes separate payment tiers for “institutional” and “home-based” post-acute care; sets payments based on a patient’s pre-PAC clinical profile; and includes high-cost and short-stay outlier components. According to MedPAC, the prototype would produce less variation in PAC margins, decrease average payments for physical rehabilitation, and increase payments for medical and medically-complex services.  Click here to review MedPAC’s detailed slide presentation.

Congressional Leaders Raise Serious Concerns with Proposed Medicare Advantage Rules

A bipartisan group of House Ways and Means Committee leaders are raising concerns about the Obama administration’s proposed Medicare Advantage payment policies for 2017. The eight legislators wrote to CMS lat week to express concerns about three areas of the payment policies proposed last month. In particular, the legislators raise questions about a change to the funding formula for employer-based MA plans that’s expected to reduce payments by 2 to 4 percent. They also raise questions about changes to the risk adjustment formula for determining how much plans are paid. Click here to read their letter.

  • Spending on employer-based Medicare Advantage plans will decrease by roughly $250 per enrollee – or 2.5 to 2.8 percent – under the 2017 payment proposal released by CMS, according to a new study Milliman. That works out to a spending reduction of between $750 million and $870 million for the roughly 3.3 million Medicare beneficiaries in employer-sponsored plans. Click here for the study.

State and Federal Governments Calling for Limits on Opioids

In the throes of the deadliest drug epidemic in U.S. history, governors, presidential candidates and major health care organizations — from insurance companies to physician associations — are calling for limits on the number and strength of opioid pills prescribed. The CDC is close to taking the unprecedented step of issuing national guidelines to curb liberal opioid prescribing practices widely blamed as the cause of the epidemic.  Click here for more.

HHS: 20 Million Americans Gain Health Coverage Since 2010

A new report released last week finds that the provisions of the Affordable Care Act have resulted in an estimated 20 million people gaining health insurance coverage between the passage of the law in 2010 and early 2016. Those provisions include Medicaid expansion, Health Insurance Marketplace coverage, and changes in private insurance that allow young adults to stay on their parent’s health insurance plans and require plans to cover people with pre-existing health conditions.  Click here for the HHS report.

Home Health Adopting Patient Data Analytics Solutions

A growing number of home health agencies are using data analytics to improve the health of their patients and stop unnecessary hospital visits.  There may be few studies confirming the technology accurately predicts problems, prevents hospitalizations or saves money. Still, the business has attracted venture capital investments and may lead to more health care applications for consumers. Click here for details.

The Costs of Long-Term Healthcare Are Growing Substantially

A House committee last week held a hearing to examine the cost and delivery of long term care services. The Committee is looking at options for addressing the growing cost of providing long-term care for the elderly, including financial aid for caregivers and using insurer-run Medicare Advantage plans to coordinate care. In 2014, $340 billion was spent on long-term care, representing more than 13 percent of the almost $2.6 trillion spent on personal health expenditures. To watch the video of the hearing or to read the written testimony, click here.

CMS Backs Off of Proposal To Strengthen Federal Network Adequacy Standards

CMS is backing off on an earlier proposal to impose federal network adequacy standards on states that aren’t deemed to have strict enough regulations. The Obama administration had proposed creating a federal default standard for time and distance for provider networks in 2017.   Click here for a good summary of CMS’ new final rule that outlines new payment parameters and provisions related to the risk adjustment, reinsurance, and risk corridors programs; cost-sharing parameters and cost-sharing reductions; and user fees for Federally-facilitated Exchanges. It also provides additional amendments regarding the annual open enrollment period for the individual market for the 2017 and 2018 benefit years; essential health benefits; cost sharing; qualified health plans; Exchange consumer assistance programs; and numerous other provisions.  Click here for the 539-page rule.

Supreme Court Strikes Down State Health Insurance Reporting Law

The Supreme Court has ruled that federal law pre-empts state laws that require health insurance reporting for self-funded plans under the Employee Retirement Income Security Act (ERISA) of 1974. The 6-2 decision on March 1st to strike down Vermont’s reporting law has far-reaching consequences – almost 20 other states enacted statutes to mandate reporting of health insurance claims data to their all-payer claims databases that are used by policy makers to make decisions on health care. States instead will have to make decisions with incomplete databases. To read the opinions of the case, click here.

Medicare Advocacy Group Sues CMS Again Saying Patients Are Denied Coverage

 The Center for Medicare Advocacy is taking CMS back to court over the purported “improvement standard” because, even though a settlement agreement was meant to end the unofficial policy of cutting off Medicare coverage for certain treatments when beneficiaries stopped improving, the advocates say some providers and contractors still use the approach. The group says CMS hasn’t done enough to educate providers and contractors that services, such as therapy, may be covered by Medicare once patients have stopped improving. To read more on the suit and the background, click here.

Health Care Cybersecurity Task Force Created

HHS last week announced the department’s plans for forming a congressionally mandated task force on cybersecurity, requesting nominations for the new group by March 9 in advance of its inaugural meeting March 17. Click here for details. To see how to make nominations, click here.

Unanimous House Passes Medicaid Integrity Bill

The House approved legislation to improve program integrity in Medicaid and CHIP by a vote of 406-0 on March 2nd. The Ensuring Terminated Providers are Removed from Medicaid and CHIP Act would help states identify providers who were kicked out of Medicaid or CHIP in another state and comply with Obamacare requirements that they be terminated nationwide. CBO says the legislation would save $28 million over 10 years. The bill comes after an HHS inspector general report found that as many as 12 percent of terminated providers found a way to participate in another state’s Medicaid or CHIP program. To read the bill and its report, click here. Click here for the HHS IG report.

Hospital, LTC Superbugs Still a Big Threat

America is doing a better job of preventing healthcare-associated infections (HAIs), but more work is needed – especially in fighting antibiotic-resistant bacteria according to the CDC. The CDC is urging healthcare workers to use a combination of infection control recommendations to better protect patients from these infections. Many of the most urgent and serious antibiotic-resistant bacteria threaten patients while being treated in healthcare facilities for other conditions, and may lead to sepsis or death. In acute-care hospitals, one in seven HAIs stem from antibiotic-resistant bacteria; and for long-term care facilities, it’s one in four. To read the CDC report, click here.

Backlash Grows Against Hospital CEO Compensation

There some growing backlash in various parts of the country to not-for-profit hospital’s CEO salaries.  In Connecticut, legislation has been proposed making nonprofit hospitals pay municipal property taxes if they pay their leaders salaries of more than $500,000. Click here for that story.  In Ohio, an ABC5 investigation found hospital CEOs earn up to $4 million annually, and often earn bonuses of up to 40 percent of their salary. Critics in both states say these numbers are particularly concerning among non-profit hospitals, where CEOs earn more despite more inpatient care complications and higher expenses. Click here.  In Orange County, California, unionized Kaiser Permanente employees protested executive bonuses, particularly after union members were not awarded much smaller bonuses of up to $2,000 due to budget shortfalls. Click here.

Nursing Shortage Grows – Particularly in Florida

Nursing shortages have come and gone for decades. But there’s reason to believe the current one could be a prolonged problem – particularly in Florida.  Observers there are particularly troubled because the number of vacancies has increased more than 30 percent since 2013, according to a new report from the Florida Center for Nursing. Compounding the problem, another 9,947 nursing positions are expected to be created in 2016.  Click here for details.

Updated CDC Report Focuses on Nation’s Biggest Public Health Issues

The CDC has updated its Prevention Status Reports, which ranks the biggest public health issues in all 50 states and the District of Columbia. According to the reports, the 10 most important public health problems and concerns are (listed alphabetically): Alcohol-related harms, Food safety, Healthcare-associated infections, Heart disease and stroke, HIV, Motor vehicle injury, Nutrition, physical activity and obesity, Prescription drug overdose, Teen pregnancy and Tobacco use.  Click here for an excellent interactive map with results for all states.