Major Change: CMS Will Allow Medicare ACOs To Participate in CPC+ Program

CMS announced late Friday that some Medicare ACOs would be allowed to participate in its new primary care pilot, addressing a major concern from some provider groups.  Providers participating in existing MSSPs may also join the Comprehensive Primary Care Plus program, a pilot announced last month intended to reward better coordinated care. CMS says it will still set some limits; of the 5,000 total CPC+ primary care practices, no more than 1,500 may also be in ACOs.  The agency last month had prohibited dual participation in the programs.  CMS considers CPC+ an Advanced Alternative Payment Program in the new physician payment system.  Click herefor CMS’ 18-page updated program guidance — the key update is on pages 17 and 18.

Medicare ACOs Have Uncertain Future:  Survey

43 percent of ACOs surveyed by the national association of ACOs say they will definitely or likely quit their Medicare Shared Savings ACO Track 1 if it is not recognized by CMS as an Advanced Alternative Payment Model in the newly proposed physician payment system.  (NOTE: The new payment system is referred to by CMS as QPP – Quality Payment Program-, which was part of MACRA.)  Survey respondents also said the average cost of participating in an MSSP was about $1.6 million.  Click herefor the complete survey.

CMS Moves To Reduce Hospital Readmissions Further, Decrease Patient Harm

CMS announced last week it is expanding hospital quality efforts with new programs to reduce patient harm and keep bringing down the hospital readmission rate.  A blog post by CMS’s Patrick Conway said the agency is releasing a request for proposal for hospital improvement and innovation networks, which will work with existing Quality Improvement Organizations and related hospital safety and engagement programs. The goal is to have the networks through 2019 pursue “bold new national aims” that includes a 20 percent decrease in overall patient harm and a 12 percent reduction in 30-day hospital readmissions from the 2014 baseline. Click here for details.

  • Initiatives to reduce medical errors, the nation’s third-leading cause of death, have made progress, according to research published by AHRQ.  Researchers analyzed medical malpractice payment reports, one of the primary mechanisms for identifying errors, and found they dropped 28 percent between 2004 and 2014. Furthermore, they noted a year-over-year downward trend every year but 2013 when it ticked up slightly. Click here for the annual Chartbook AHRQ report.

 Key House Committee Passes Pro-Hospital Bill

Following a lively debate, the House Ways and Means Committee unanimously passed the hospital package and sent it to the Full House, which is likely to pass it. The legislation would extend from Nov. 2, 2015, to Dec. 31, 2016, the “grandfathering” date for off campus hospital outpatient departments, under certain circumstances. Under the “site-neutral” payment provision of budget bill from 2015, new outpatient facilities will get lower payments, but the grandfathering language will allow for those that were being built to operate under the old rules. The legislation also changes the hospital readmission program to account for socioeconomic status. The bill’s fate in the Senate is uncertain.  Click here for the legislation, herefor a summary.

Majority of House Urge CMS To Be Flexible Implementing HOPD Law

A bipartisan group of 235 members of the U.S. House of Representatives last week urged CMS to provide flexibility in implementation of the Medicare payment reductions for new off-campus hospital outpatient departments under a more restrictive law that passed late last year. Specifically, they said the “site-neutral” payment reductions under Section 603 of the Act should not affect existing off-campus HOPDs that relocate, rebuild, change ownership or types of services, and should not affect services provided by a dedicated emergency department. Click hereto read the letter and see if your House member signed on.

Another CO-OP Bites the Dust

Ohio’s co-op health plan will become the 13th Obamacare startup to collapse, leaving roughly 22,000 customers to find new coverage in the next 60 days. InHealth Mutual lost roughly $80 million last year. Only Land of Lincoln in Illinois had a bigger loss among the remaining co-ops. Only 10 co-ops remain in business.  Click here for the story.

Missouri Becomes First State To Oppose the Aetna-Humana Merger

Missouri has become the first state to oppose the Aetna-Humana merger deal, which has gotten a green light from several other state regulators as it continues to undergo a federal review.  Among other things, should the merger go through, the company and its subsidiaries must “cease and desist” from doing business throughout the state in the comprehensive individual, comprehensive small-group and group Medicare Advantage markets. In the individual MA market, Aetna-Humana would have to stop doing business in certain counties in Missouri that the state has determined would be adversely affected by competition.  Click herefor the preliminary order from the Missouri Department of Insurance.

FDA OKs Opioid Implant Delivery System

Braeburn Pharmaceuticals’ Probuphine is designed to deliver a moderate dose of buprenorphine for six months through rods inserted under the skin of a patient’s arm, removing the need for daily treatment. It’s the first implantable version of a medication to treat opioid addiction.  Probuphine is designed to provide a constant, low-level dose of buprenorphine for six months in patients who are already stable on low-to-moderate doses of other forms of buprenorphine, as part of a complete treatment program.  Click herefor the FDA announcement.

New E. Coli Strain Found in U.S. that Resists All Antibiotics

Defense Department researchers last week said that a strain of E. coli that resists all antibiotics was found last month in the urine of a Pennsylvania woman. The discovery “heralds the emergence of a truly pan-drug resistant bacteria” in the United States, the researchers write; the bacteria has already been discovered in patients in China, South America and elsewhere.  To read the study, click here.

  • The presidential advisory council on antibiotic resistance just announced it’ll meet in the coming weeks to discuss new treatments for bacterial infections, strategies to better monitor antibiotic-resistant bacteria, and best practices for prescribing antibiotics. The meeting will be held on June 21 and 22, but the public can submit comments for discussion starting now.  Click here for more.

More than 100 House Members Urge HHS To Kill Home Health Demo

More than 100 House representatives are asking HHS to kill a planned demonstration that would require home health agencies to receive prior authorization before treating Medicare beneficiaries. Prior authorization would require CMS to review physician ordered healthcare before a patient can receive services.  “Facing delays during the critical hospital to home transition has the potential result in adverse events, which jeopardize patient health and lead to costly hospital readmissions.” The demo plans to start in five states:  Florida, Texas, Illinois, Massachusetts and Michigan.  Click here to read the letter and see who signed on.

Ransomware: Hospitals Scrambling To Fight Cyber Attacks

American hospitals are scrambling to meet what seem like weekly ransom threats. If they don’t pay up, their files get frozen, surgeries delayed and patients are sent across town. One of these days, someone could die as a result. And no one in government has a clear plan to handle it.  Desperate hospitals have asked the feds for new financial incentives to boost their security. But Congress seems in no to come up with the necessary billions of dollars it would take. It created a task force (click here) to come up with a report on how federal agencies can establish a chain of command for health care security.  Click hereto read a good summary of the issue from the nation’s leading health IT associations in their testimony before the Senate.

House Bill Would Remove Prohibitions on Non-Cash Incentives for Organ Donations

U.S.Representative Matt Cartwright (D-PA) last week introduced the Organ Donor Clarification Act, which is intended to remove barriers to organ donation and to encourage pilots such as offering non-cash incentives to increase supply.  A bipartisan group of 8 other House members signed on as cosponsors.  Click here for the bill.  Click herefor the cosponsors’ list.

Primary Care Docs See Compensation Increase Faster than Specialists’

Primary care compensation has grown faster than specialty care compensation over time – with the median last year just over $250,000 - according to the latest survey from the Medical Group Management Association. Compensation increased by 18 percent in primary care over the past five years. Specialty care compensation grew by about 11 percent over the same period.  Primary care doctors earned the highest salaries in Alaska, Wisconsin, and Arkansas in 2015, while primary care physicians in Nevada, Maine, and Maryland earned the least.  Click here for more from MGMA.

  • Chief executives of health care companies in the S&P 500 were better compensated than their counterparts in all other industries last year, according to an analysis from the Associated Press and Equilar, an executive data firm. The median compensation for health care CEOs in 2015 was $14.5 million, up 7 percent from the previous year. Click here for the study and it’s key findings.


  • In its first detailed disclosure on executive pay, nonprofit Blue Shield of California said Chief Executive Paul Markovich made $3.5 million last year – a 40 percent increase since he took the top job in 2013.  Click here for details.  Top 10 company salaries are on page 8.

Family Health Care Costs Rise Slowest in More Than 15 Years

The average cost of health care for a family of four enrolled in a PPO plan in employer-based coverage topped $25,000 this year, according to a Milliman study. Even though costs have tripled since 2001, they rose by just 4.7 percent in 2016, the lowest increase since Milliman began tracking the data 15 years ago. Prescription drugs, the fastest growing component, are nearly 17 percent of total health care spend. Increases in costs for all other medical services, including hospital visits, were at their lowest level in the last five years. To read the study, click here.

Most Americans Satisfied with Marketplace Coverage and Medicaid

Two-thirds of Americans getting their coverage through Healthcare.gov and the state exchanges consider their coverage good, very good or excellent, according to a new survey from the Commonwealth Fund. New Medicaid enrollees have an even higher rate of approval, 77 percent reported positive experiences. More than 60 percent of those surveyed said they wouldn’t have been able to afford that care previously. For more on the survey from the Commonwealth Fund, click here.

Catastrophic Plans Could Help Patients Needing Long-Term Care

Catastrophic plans could be an important factor in saving money on long-term care services in the Medicaid program, according to a new report. The study found that providing long-term support and services through a catastrophic insurance program could potentially offset the costs for Medicaid by about 38 percent. The catastrophic plans analyzed in the study would be insurance policies that would require enrollees to initially pay for services during a waiting period before receiving long-term care benefits for as long they need. Click herefor the report.

Link Made Between Cellphone Use and Cancer…In Rats

A National Toxicology Program report has found a link between cellphone radiofrequency radiation exposure and cancer in rats. The peer-reviewed study found low incidences of two types of tumors in the brain and heart of male rats exposed throughout their lifetimes by scientists to the type of radiofrequency radiation common in U.S. wireless networks. However, female rats exposed to the same radiation did not show similar tumors. The researchers did caution against making the direct correlation with humans. Click herefor the report.

Some Clinicians Firing Back On Line To Counter Patient Complaints

Not liking some of their reviews on public comment sites, like Yelp, some providers are fighting back by posting details of patients’ medical conditions – right on line and likely in violation of HIPAA requirements.  Click here for the story.