WEEKLY E-BULLETIN


U.S. News Announces Its 2016-17 Best Hospitals

U.S. News released its 27th annual Best Hospitals rankings last week, comparing nearly 5,000 medical centers nationwide in 25 specialties, procedures and conditions. Here are the top 10: 1) Mayo Clinic, Rochester 2) Cleveland Clinic 3) Massachusetts General Hospital, Boston 4) John Hopkins Hospital, Baltimore 5) UCLA Medical Center 6) New York-Presbyterian University Hospital of Columbia and Cornell 7) UCSF Medical Center, San Francisco 8) Northwestern Memorial Hospital, Chicago 9) Hospitals of the University of Pennsylvania-Penn Presbyterian, Philadelphia 10) NYU Langone Medical Center, New York. U.S. News also recognized 504 Best Regional Hospitals in states and metro areas. Click here for the list.

2500 Hospitals Hit with Penalties for Excessive Readmission Rates

More than half of U.S. hospitals will be penalized for excessive 30-day readmission rates, according to a Kaiser Health News analysis.  Medicare will withhold payments starting with the new fiscal year in October.  The penalties will mean hospitals will lose more than $520 million in payments–an increase of more than $100 million from last year due to changes in how Medicare measures readmissions, according to the analysis.  Click here for a list of all penalized hospitals by state.

Hospital Payment Increases and Cuts Included in Final FY17 Inpatient Regulations

CMS has issued its final rule for the FY17 hospital inpatient prospective payment system, which will increase rates by 0.95% compared to FY 2016.  Additionally:

  • CMS finalized two adjustments to reverse the effects of the 0.2% cut it instituted when implementing the two-midnight policy in FY14. Specifically, it finalizes a permanent adjustment of approximately 0.2% to remove the cut prospectively for FY17 and onward, as well as a one-time adjustment of 0.6% to address the retroactive impacts of this cut for FYs 2014-2016.
  • The final rule includes an initial market-basket update of 2.7% for those hospitals that were meaningful users of electronic health records in FY15 and that submit data on quality measures, less a productivity cut of 0.3% and an additional market-basket cut of 0.75%.
  • CMS also finalizes a 1.5% cut to recoup what it claims is the effect of documentation and coding changes from FYs 2010-2012, which CMS says do not reflect real changes in case mix.
  • The rule also includes reductions to Medicare Disproportionate Share Hospital payments mandated by the ACA, which will reduce overall Medicare DSH payments by $400 million compared to FY16. CMS did not finalize its proposal to begin to incorporate Worksheet S-10 data into the computation of uncompensated care payments in FY18.

Click here for a complete summary from CMS.

CMS Names 14 Regions for CPC+, Solicits Primary Care Practices

CMS last week announced the 14 regions that will participate in its new Comprehensive Primary Care Plus initiative, a five-year model designed to reform primary care delivery across public programs and commercial insurance. CMS selected the regions based on payer interest and coverage. The 14 regions are: Arkansas, Colorado, Hawaii, the greater Kansas City region, Michigan, Montana, New Jersey, the North Hudson-Capital region in New York, Ohio, Oklahoma, Oregon, the greater Philadelphia region, Rhode Island and Tennessee. The CPC+ model consists of two payment tracks in which primary care practices either get a monthly fee in addition to Medicare fee-for-service payments, or a monthly fee and a hybrid of Medicare fee-for-service payments and up-front primary care payments. Primary care practices in the selected regions can apply to participate in the demonstration between now and Sept. 15. Click here for the CPC+ website.

246 Health Centers to Receive $8.6 Million for PCMH

HHS last week announced more than $8.6 million in funding for 246 health centers across the country. The awards will help to improve quality of care and patients’ and providers’ experience of care through the Patient-Centered Medical Home (PCMH) health care delivery model.  These awards will provide assistance to health centers to make the changes necessary to achieve, expand and optimize PCMH recognition.  Click here to see state-by-state which facilities will be funded.

Federal PCMH Initiative Falling Short: Analysis

Federal efforts to reform primary care practices through enhanced primary care medical homes have not fared well, according to a new analysis of CMS’ Multi-Payer Advanced Primary Care Practice Demo released last week.  “Overall, Year Two of the MAPCP Demonstration found state initiatives still attempting to hit their stride. States were still implementing new components and encountering and finding solutions to new challenges,” according to the report. “Our quantitative analysis supported this contention by finding very few consistent, favorable changes associated with the MAPCP Demonstration across the eight states. At the end of Year Two, only three of the eight initiatives were associated with slower rates of growth of total Medicare expenditures.” Click here for the complete analysis.

AAFP Says ACO Experience Prepares FPs for New Payment Models

Family physicians who have experience with accountable care organizations are well prepared to tackle new payment models, according to an analysis from the American Academy of Family Physicians. Physicians in ACOs already have dealt with infrastructure challenges and learned to collect and report data. Physicians without ACO experience can begin learning skills they’ll need to participate in new payment models by choosing a few clinical goals for their practice and figuring out how to measure them. Click here for more.

National Summit Will Address Health Care’s Roll in Social Determinants

The Root Cause Coalition will be joined by healthcare leadership, including AHA President Rick Pollack, at the First Annual Summit on the Social Determinants of Health in Chicago, IL on December 5-6th. The Summit will focus on methods to address food insecurity, transportation, housing, education, isolation, and economic insecurity. More importantly, the Summit will serve as an opportunity to learn how to implement programs, develop effective partnerships, and achieve measurable results for your community. Discounted Summit Registration ends August 15th. To learn more and to register, click here.

Rural Hospital Demo Announced

CMS has announced a new demo project with ten critical access hospitals in Montana, Nevada and North Dakota designed to increase access to care for Medicare beneficiaries in rural areas of the country. The Frontier Community Health Integration Project Demonstration will test ways of offering care over the next three years in some of the least populated areas and will give the hospitals financial incentives to coordinate care in order to reduce unnecessary admissions and readmissions. To read more on the demo, click here.

Rural Health Care Improvement Solutions Outlined by Robert Wood Johnson

The Robert Wood Johnson Foundation issued a follow-up to their 2016 County Health Rankings – What Works for Health – that outlines specific policies and programs rural communities can implement to improve health and wellbeing.??Within the report, RWJF provides details about finding and choosing the right solution for communities; what’s working to prepare and strengthen local workforces; and a discussion of the many factors that influence health. Strategies that have been studied and deployed in rural communities are emphasized throughout the report. Click here for the report.

CMS’ Nixes “Bay State Boondoggle” for FY2017

CMS last week said it won’t let a Nantucket hospital resubmit certain paperwork that, if it had been filed correctly, would have led to higher reimbursements for Massachusetts hospitals – and slightly lower payments for the rest of the country. The policy, which was part of Obamacare, has been derided by Republicans and hospitals in other parts of the country as a special benefit for Massachusetts that helped get the health law passed. But for one year at least, the “Bay State Boondoggle” is no more. To see the issue outlined by CMS, click here and scroll to page 659 – from CMS’ FY17 final hospital inpatient regulation.

Outpatient Spending Causing Premium Increases in 2017

Outpatient spending accounts for 29.9 percent of rate increases and represents about 27.4 percent of spending in plans for 2017, according to a new report released last week. This finding is similar to 2016 premium trends. It is also about 10-15 percent lower than prescription drug costs that represent about 14.3 percent of premium growth. Click here for the study.

Are Most Meniscus Surgeries Unnecessary?

Numerous studies show the ineffectiveness of certain types of surgeries, so why do these procedures continue and at an increasing rate?  The latest controversy — and the operation that arguably has been studied the most in randomized clinical trials — is surgery for a torn meniscus, a sliver of cartilage that acts as a shock absorber in the knee. About 400,000 middle-aged and older Americans a year have meniscus surgery.  Orthopedists wondered if the operation made sense because they realized there was not even a clear relationship between knee pain and meniscus tears.  Click here for the NYTimes story.

Part D Premium to Rise an Average $1.50 Per Month

CMS is predicting that Medicare Part D premiums will remain relatively stable in 2017 at about $34 per month, on average. The rate is expected to go up by about $1.50 from last year’s average premium of $32.56. Officials said the stability in Medicare Part D premiums comes despite the rising cost of prescription drugs. For the CMS analysis, click here.

Aetna Contacts Physicians About Opioid Prescribing Habits

Using the vast amount of data it collects from insurance claims by pharmacies, Aetna has begun contacting doctors whose prescribing habits are far outside the norm.  “You have been identified as falling within the top 1 percent of opioid prescribers within your specialty,” Aetna wrote to 931 physicians across the country. The not-so-subtle reminder was aimed at doctors who refill opioid prescriptions at very high rates compared to their peers. Only doctors who prescribed the painkillers at least 12 times were included in the data examined, which represented more than 8.6 million claims. Click here for the story.

GAO: CMS Should Do More to Verify Drug Prices

GAO has recommended to Congress that all drug makers should be required to submit Part B price data to CMS, and the agency should periodically verify those submissions by reviewing source data. CMS agreed with the recommendations and promised to take action. Part B reimburses physicians for administering drugs by paying them 106 percent of the average sales price, although Medicare sequestration lowers that by about 2 percent. GAO also found that the six drugs that account for 36 percent of Part B expenditures are not among the most commonly administered drugs. For the GAO report, click here.

State Spending Increased by Certificate of Need Laws

A new study on state certificate of need (CON) laws, implemented in 35 states, says CON increases states’ Medicare spending by an average of 6.9 percent and total health care spending by 3.1 percent. The laws require providers to prove to state governments that new facilities or services are economically necessary. But the researchers argue the laws are actually increasing costs by restricting the supply of health care. Click here for the study.

CMS To Change the Way It Accounts for Medicaid Payments to Hospitals

In a report released on Aug. 1st, GAO states that CMS needs to improve the alignment of Medicare and Medicaid payments to hospitals to better allocate uncompensated costs and decrease the chance of overpayments. The Government Accountability Office recommended CMS account for Medicaid payments made when making Medicare uncompensated care payments to individual hospitals. CMS told GAO it agreed steps needed to be taken. To read the GAO report, click here.

Zika Vaccine Trial Begins at NIH

NIH Doctors injected the first of 80 trial subjects with a Zika vaccine in Bethesda, MD last week – a month earlier than planned. The vaccine contains small DNA pieces designed to produce Zika particles that hopefully will stimulate protection against the disease. If the vaccine is safe and works, it will be tested starting next year on 2,400-5,000 people at several sites in Latin America and the Caribbean, and possibly in the United Sates. The target group for the vaccine is women and girls of childbearing age, but not pregnant women. Click here for more from NIH.

Strategies Outlined to Keep More Seniors at Home as They Age

By 2050, one-fifth of the total U.S. population—about 88 million people—will be 65 and older. Many of them won’t have saved enough money for an assisted living or retirement community. Some low-income seniors may be able to get Medicaid to pay for nursing home costs, but states and local government budgets will have a hard time handling the crunch. These are all reasons why an increasing number of people are saying that seniors should stay at home as they age. But how?  This is the topic of a new and interesting story in the Atlantic – click here.

Major Health System Experiences Cyber Attack

Arizona-based Banner Health released a statement last week that it was contacting 3.7 million customers whose personal data may have been compromised in a major cyber attack. Hackers reportedly got past the firewall by going through the payment processing systems for food and beverage purchases. Banner Health states that they immediately launched an investigation with a forensics firm, which revealed that the attack was initiated on June 17, 2016. For more from Banner Health, click here.