WEEKLY E-BULLETIN


Key House Committee Pushing Hospital “Improvements” Bill

The House Ways & Means Committee introduced the Helping Hospitals Improve Patient Care Act on last week and plans to vote on it this week. The legislation includes a narrow exemption for off-campus hospital outpatient departments that were under development when Congress passed a bill last year to cut pay to those facilities. Among the other provisions are bills previously supported by the committee, including:

  • Establishing Beneficiary Equity in the Hospital Readmission Program Act (H.R.1343), which accounts for the poor health of low-income beneficiaries for whom hospitals care when determining how many readmissions hospitals are allowed before Medicare penalizes them.
  • Seniors’ Health Care Plan Protection Act (H.R. 2506), which requires CMS to revise the Medicare Advantage risk adjustment system to account for beneficiaries’ chronic conditions. It also would require CMS to evaluate other potential changes to the risk adjustment system.
  • The Rural Community Hospital Demonstration Extension Act (S. 607), which would extend that demo from 5 years to 10 years.
  • Electronic Health Fairness Act of 2015 (H.R. 887), which calls for exempting ambulatory surgical centers from electronic health record meaningful use penalties.

The bill has a good chance of House passage, but Senate passage is uncertain. Click here for a summary and here for the text.

Final Overtime Payment Rule Impacts Millions of Hourly Workers
The Labor Department last week released the text of its final overtime rule that will take effect December 1st and will raise the salary threshold to $47,476 under which hourly workers are guaranteed time-and-a-half pay when they work more than 40 hours a week. The Labor Department also issued a non-enforcement policy for certain health care providers that are primarily Medicaid-funded, which will last until March 2019. Click here for the final rule, here for the non-enforcement policy, and here for the summary from the Department.

Not-for-Profit Hospitals Adjusting To Attract Investors

Some nonprofit hospitals are creating investor-relations teams and hosting investor calls, hoping to attract the best rates when they borrow. Nonprofit bondholders are happy with the shift, but some say they want more openness.  Other investors want more disclosure of nonprofit hospitals’ increasing reliance on loans from private banks, the terms of which aren’t public but could trigger defaults for municipal bonds. Click here for the Wall Street Journal report.

Surgeries At CAHs At Least As Good As At Any Other Hospital: JAMA Study

Medicare patients admitted to critical access hospitals for common surgical procedures are no more likely to die within 30 days than similar patients at other hospitals and have lower complication rates and expenditures, according to a study published last week. The study compared Medicare admissions for four common surgical procedures: appendectomy, gall bladder removal, removal of all or part of the colon, and hernia repair. Patients undergoing surgery at CAHs were less likely to have chronic medical problems and serious complications (6% vs 14%). Click here for the study in the Journal of the American Medical Association.

ER Doctors Sue HHS Over Out-of-Network Services; Docs Push Against State Medicaid Cuts

The American College of Emergency Physicians (ACEP) has filed suit against HHS to try to halt implementation of final ACA regulations on emergency services in out-of-network hospitals. The suit alleges that the regulations fail to ensure that emergency physicians are fairly compensated. ACEP alleges that the rule does not meet the standards required by the Affordable Care Act for transparency of data and fair insurance coverage for emergency patients who are “out of network” because of a medical emergency. ACEP said in its statement that they have met with CMS numerous times to establish a way to verify UCR amounts in the years following the proposed rule, but without success. Click here to read more from ACEP and to see the lawsuit.

  • Four major physician groups have asked federal health officials to take action to keep states from making cuts to Medicaid rates now in anticipation of the implementation of a final Equal Access rule.  In a letter to CMS, the physician groups cited “the disturbing trend” of states cutting Medicaid payment rates in anticipation of the agency’s October 1 start date for a new rule that will require states to assess how payments impact access to care. Click here for the letter.

Highmark Sues Government over Risk Corridor Shortfalls

Highmark Health, a division of Blue Cross Blue Shield, is suing the federal government to recover nearly $200 million it says it’s owed from the risk corridors program that is designed to protect insurers from big losses in the ACA exchanges. Congress required the program to be budget neutral so the Administration announced in September that it only had enough money to initially make good on 12.6 percent of anticipated payments. In Highmark’s case, that meant it has only received $27.3 million of $223 million in anticipated payment for 2014. Click here for all the details.

Growth in Specialty Drug Costs Skyrocketing

Spending per patient on specialty drugs increased 26 percent between 2013 and 2014, according to a study released last week by the Blue Cross Blue Shield Association. The study found higher prices and higher utilization were driving the increase.  Estimates suggest that the $87 billion spent in 2012 on specialty drugs could quadruple by 2020, reaching approximately $350 billion.  Included in the report are 15 of the most common or expensive specialty drug categories, which account for more than 80 percent of the total cost of specialty pharmacy. Click here for the report.

Uninsured Rate Falls Below 10 Percent

America’s uninsured rate fell below 10 percent for the first time in history in 2015, according to survey results published last week by the CDC. The study shows some 28.6 million Americans still go without insurance, about 16.2 million less than before the Accountable Care Act. Among the insured, 9.1 million people gained private coverage through HealthCare.gov or the state-based exchanges. Click here for details from CDC.

Zika Virus Has Infected At Least 157 Pregnant Women in U.S.

Zika virus has infected at least 157 pregnant women living in the continental United States and another 122 in Puerto Rico and other U.S. territories, putting them at risk of delivering babies with microcephaly, the CDC reported Friday. The figure, based on tests of women with symptoms of the disease, probably underestimates the total number, the agency said. All of the U.S. infections occurred in women who had traveled abroad or, in rare cases, were infected by infected sexual partners who returned from areas of Zika prevalence. In Puerto Rico, the virus is being transmitted by local mosquitoes. Click here for the CDC report.

Zika Funding Clearing Congressional Hurdles

The House last week passed a $622 million funding package to address the Zika virus. The bill allocates only about one-third of the White House’s Zika request, and passed mostly along party lines and has a veto threat from the White House. The measure includes $503 million in domestic spending funneled through HHS. The CDC would receive $170 million for mosquito control, laboratory activities, public education efforts and more. Up to $50 million of the CDC allocation could be used for the Maternal and Child Health Services Block Grant Program for Zika-related patient care. Click here for the text of the bill.  The Senate last week approved a bipartisan deal of $1.1 billion to partially fund President Obama’s request to fight the Zika virus. For more on the Senate initiative, click here.

Mental Health Costs Outpace All Other Medical Conditions

The cost of caring for patients with mental health disorders topped $201 billion in 2013, more than any other medical condition, including cancer and heart disease, according to a new study. Nearly 40 percent of the total cost of caring for mental health disorders is spent on institutionalized populations, including patients in nursing homes, psychiatric hospitals and prisons. The next most expensive were heart conditions at $147 billion, trauma at $143 billion and cancer at $122 billion. Click here for the study.

Most Insurance Marketplace Customers are Happy with Current Coverage

Most marketplace customers are happy with their current coverage – about two-thirds rate their coverage as either “excellent” or “good,” according to a new survey. A slim majority of respondents said they’re satisfied with the cost of their plan’s premium, while half of respondents are satisfied with the cost of their deductible. At least 74 percent of consumers were satisfied with their choice of primary care doctors or hospitals in their networks; however, 59 percent of respondents said they were happy with their specialist options. Click here for the survey.

Major Insurer Announces Major Opioid Reduction Plan

Cigna announced last week that within three years it will reduce its customers’ use of opioids by 25 percent, to 2006 levels. The steps it has vowed to take include: sending physicians reports on how their prescribing patterns compare to the CDC guidelines and to other doctors, contacting more than 2,600 prescribers whose patients are receiving dangerously high levels of opioids and supporting efforts to expand the use of medication-assisted treatment.  Cigna previously announced it would share medical claims data in a project with the American Society of Addiction Medicine to help identify best clinical practices on opioid prescribing. Click here for more.

  • The American Society of Addiction Medicine, the American College of Emergency Physicians and several other national organizations kicked off a campaign on Capitol Hill last week to push Congress to enact the Comprehensive Addiction and Recovery Act and encourage other regulatory and legislative steps that address the opioid epidemic.  Click here for more.  Click here for a NYTimes story on how many experts believe Congress is doing far too little.
  • The Wall Street Journal is reporting that quarrels have broken out behind the scenes of  Anthem Inc. ’s $48 billion proposed acquisition of  Cigna as the health insurers seek regulatory approval for their landmark deal, according to a series of letters reviewed by news organization.  Click here for the story.

Public Pools = Health Threat: CDC

The CDC has put us on notice – nearly 80 percent of public swimming pools and hot tubs inspected in five U.S. states in 2013 had health or safety violations. Highlighting a public health threat ahead of summer, the CDC studied the five states with the most public swimming facilities: Arizona, California, Florida, New York and Texas. In one in eight pools inspected, the violations were so serious the pools were forced to close immediately and one out of five children’s wading pools inspected was immediately closed, according to the study. For more from the CDC, click here.

Very Funny! Jimmy Kimmel Asks Nurses What They Hate About Their Jobs

Comedian Jimmy Kimmel took on improving American jobs by starting with nurses and healthcare practitioners. He went online and asked the healthcare workers of this country, what don’t you like about your job? Click here to watch the video on YouTube.