WEEKLY E-BULLETIN


CMS Launches Major Primary Care Program

CMS unveiled a massive primary care initiative last week that it predicts will save an estimated $2 billion. The Comprehensive Primary Care Plus (CPC+) is a five-year initiative, beginning January 2017, that could be implemented in up to 20 regions and involve up to 5,000 primary care practices, potentially affecting 25 million people. CPC+ will contain two tracks that can each accommodate up to 2,500 practices. In the first track, CMS will pay practices a monthly fee of $15 per patient as well as fee-for-service payments. In the second track, CMS will pay practices a monthly fee of $28 per patient as well as a hybrid of reduced Medicare fee-for-service payments and up-front comprehensive primary care payments. CMS estimates CPC+ Track 2 will result in $2 billion in savings over five years, depending on how many doctors participate. Click here for a good CMS fact sheet. Click here for CMS’ CPC+ website.

  • Click here for a new, good story on CMS’ Innovation Center and how it is working to re-invent Medicare.
  • Health Care Transformation Task Force members say they saw a major surge in use of bundled payments, global budgets and other alternate payment models in the past year. According to task force members — which include some of the nation’s largest health systems and insurers — 41 percent of their business was in value-based arrangements in 2015, versus 30 percent in 2014. Click here for their report.

Medicare ACO Cost Savings Best for First Year Participants

Providers who joined CMS’ Medicare Shared Savings Program (MSSP) accountable care organizations (ACO) in its first year created considerably higher savings than those who joined just a year later. According to a new study published in the New England Journal of Medicine, significant differences in savings were achieved by different types of organizations within the ACO program. Compared to spending on participants in traditional Medicare, researchers found that MSSP entrants in 2012 had savings of $144 per beneficiary but entrants in 2013 only had savings of $3 per beneficiary. To read the study, click here.

Number of Provider-based Health Plans Growing

The number of provider-based health plans continues to grow, according to a new McKinsey report out last week.  Among the findings: 106 providers offered health plans in 2014, up from 94 providers in 2010; Total enrollment rose about 3 million in three years. Provider-led health plans covered 15.3 million people in 2014, up from 12.4 million in 2010. Nearly all of the total growth was in managed Medicaid, with 8.8 million covered lives in 2014, up from 6.1 million lives in 2010; and more than 45 percent of provider-led health plans lost money. Click herefor the report.

CMS Says Risk Adjustments for Health Plans Are Working as Intended; Blues Are Blue; ACA In Trouble?

The Affordable Care Act’s risk adjustment program for health plans is working as it was designed, according to a report from CMS released last week. Plans that pay out a higher percentage of premiums for medical claims are typically benefiting from the program, while those with lower medical loss ratios are more likely to pay into the fund. The risk adjustment program shifted $4.6 billion in payments among insurers competing in the individual and small group markets in 2014. The paper also found that small plans showed greater variability in how much they received or paid into the risk adjustment program, potentially creating financial volatility. Click here for the report.

  • Profits for Blue Cross Blue Shield plans plummeted by 75.3 percent between 2013 and 2015, according to a new report by A.M. Best Company. The 54 plans scrutinized had net income of $1.2 billion last year, but roughly a third of the plans lost money in 2015. Pennsylvania’s Highmark was deepest in the red with more than $400 million in losses.  Click here for more.
  • Though warnings of a “death spiral” on the Affordable Care Act’s health exchanges are hardly new, health insurers’ continued struggles in the individual market are reigniting questions about that worst-case possibility, according to a report last week.  Click here.

More Americans Approve of the Affordable Care Act; Over-Utilization Falling

More Americans say that they are seeing and appreciating the impact of the Affordable Care Act however, support for the law remains split largely due to a “toxic political environment,” according to a new report. Click here for the Health Affairs report. The New York Times also explored this issue in a discussion posted here.

  • While overuse of certain diagnostic procedures is still high among those who have employer-sponsored insurance, it declined consistently in recent years–according to a new study from AHIP.  The study looked at three specific diagnostic procedures–bone density scans, cancer antigen 125 blood tests and electrocardiograph–and found that the national rate of potential overuse for these services decreased between 2008 and 2013. Click here for the study.

Optometric Association Wants Online Eye Exam Pulled from the Market

The American Optometric Association (AOA) filed a claim with FDA against an online vision test marketed by Opternative Inc. that allows patients to get prescriptions for glasses and contact lenses online. The claim states that the product has not received the premarket approval necessary for a new medical device. Opternative’s product offers a patient an “online refractive exam that provides a prescription for glasses and contacts,” according to the company’s website. A patient takes the test online and then is sent a prescription from an ophthalmologist that they can use to get glasses or contacts. Click herefor more.

High Drug Prices Hinder Hep B and C Treatments

A new report released last week says high drug costs could slow efforts to eradicate hepatitis B and C. Breakthrough drugs can cure hepatitis C within eight to 12 weeks, but not all infected will be able to take advantage of the treatment due to the current high prices for the drugs. The report states that reducing new cases of both hepatitis B and C in the U.S. is more feasible in the short term. There are currently over 1.4 million Americans with chronic hepatitis B and as many as 4.7 million with chronic hepatitis C. To read the report, click here.

E-Cigarettes on the Rise Among Teens

E-cigarettes are now the most common tobacco products used by teenagers, the CDC reported last week. Of the 4.7 million teenagers in the survey who said they used tobacco products at least once in the last 30 days, an estimated 3 million used e-cigarettes, and 2.3 million used two or more tobacco products, according to surveys conducted in 2015 for the CDC. Use of e-cigarettes among high school students jumped from 1.5 percent to 16 percent from 2011 to 2015. Click here for the report.

Physicians Lack Training for End-of-Life Conversations

Physicians strongly support the new Medicare provision allowing them to bill for end-of-life conversations with patients, but many report that they lack training in having these difficult talks and sometimes struggle with what to say. Out of the survey of 736 physicians – 470 in primary care, and 266 in oncology, pulmonology and cardiology – nine out of 10 physicians said it’s very important to have conversations about advanced directives and end-of-life wishes. For the poll results and the accompanying report, click here.

Orthopedists Contribute Most To Hospital Revenue

According to a new Merritt Hawkins survey of hospital executives, the average primary care physician generates $1.4 million in revenue for a hospital, while the average specialist generates $1.6 million. The top revenue-generating specialties were Orthopedists : $2.7 million; Invasive cardiologists: $2.4 million and Neurosurgeons: $2.4 million.  Click herefor the report.

Other Significant Health Care stories:

  • Geisinger Health has started its money back guarantee program and, as you can imagine, it is being greeted with open arms by the patients they serve.  It is certainly one way to help boost customer satisfaction scores.  Click here for the story.
  • Medtronic, one of the world’s largest medical device companies, is under scrutiny for concealing studies about its products for years. The Minneapolis Star Tribune reports the story here. Medtronic’s response here.
  • A Wall Street Journal story published last week argues that Medicare’s restrictive policies on paying for aortic valve devices are hurting patients. Click here.
  • A fever might not be 100.4 degrees or higher after all, according a Wall Street Journal story on how Boston Children’s Hospital is rethinking how it should be diagnosed. Click here.
  • A new study suggests married people with cancer have better survival rates than single cancer patients. Reuters has the story here.
  • More than 40 percent of retired NFL players showed signs of traumatic brain injuries, a new study to be presented at the American Academy of Neurology conference this week found. NBC News has the story here.
  • A new study reported in JAMA shows the strongest evidence to date that income predicts life expectancy, with a nearly 15-year gap between the richest 1 percent and poorest 1 percent of male U.S. residents and a corresponding 10-year gap for the richest and poorest female U.S. residents. Click here.
  • Women live longer with more green vegetation around their homes, according to new research from the NIH. Click here.