WEEKLY E-BULLETIN


Medicare’s Mandatory “Demo” Bundles Are Illegal, Says 179 GOP House Members

Calling out CMS on its CJR, Part B demo and proposed cardiac bundles, a majority of House Republicans sent a letter to CMS urging the agency to cease all current and future planned mandatory demos. The letter comes amid longstanding GOP criticism of CMS’ innovation center (CMMI), which tests innovative payment and service delivery models. Additionally, the letter asks CMS to commit to ensuring future CMMI models fully comply with current law, including:

  • Limiting the size and scope of CMMI demonstrations so they represent true tests rather than wholesale changes to statute;
  • Seeking Congressional approval if expansion of test models require changes to the underlying statute; and
  • Establishing an open, transparent process that supports clear and consistent communication with physicians, patients and other relevant stakeholders in the development of new CMMI models.

Click here to read the letter and see who signed on.

MedPAC Raises Serious Questions about CMS’ Hospital Quality Star-Rating System

MedPAC is expressing serious concerns with CMS’ hospital star rating system saying it doesn’t fully account for those hospitals treating sicker patients. MedPAC, which advises Congress on Medicare payment policy, suggested adjusting the system to account for patient complexity. To read the letter, click here. To view the ratings posted to CMS’ Hospital Compare site, click here. Legislation has been introduced that would require CMS to stop the program until an independent methodology audit is conducted.  Click here to review that 4-page bill.

LTC Facilities Likely to Face More Lawsuits under New CMS Regulations

CMS’ final rule prohibits the use of pre-dispute binding arbitration agreements between facilities and their patients. The agency says the rules are intended to reduce unnecessary hospital readmissions and infections, and improve quality and safety measures. The rules require that facility staff members are properly trained to care for residents with dementia in order to prevent elder abuse and requires facilities to base staffing levels, in part, on the health of the residents. The rule also gives more responsibility to dietitians and therapy providers when state licensing laws allow, and it. CMS proposed the rule last year and received nearly 10,000 public comments. Click here for a very good NY Times report. Click here for the rule, here for the CMS fact sheet, and here for a blog outlining the agency’s plans for long-term care.

New Bi-Partisan Bill Would Delay Home Health Pre-Claim Review Demo

Reps. Tom Price (R-GA) and Jim McGovern (D-MA) have introduced legislation to delay the home health pre-claim review demonstration for a year. H.R. 6226, the Pre-Claims Undermine Seniors’ Health (PUSH) Act, would impose a one-year moratorium on the demo across all states. The PUSH Act also requires CMS to report to Congress on the impact of the demo on patients, home health agencies, physicians, and Medicare spending. CMS paused expansion of the demonstration in September beyond Illinois. Click here for more information on the bill from the sponsors, and here for the legislation.

Health Systems, Private Practices Show Revenue Loss in 2015: AMGA

A new survey shows healthcare revenues dropped last year for both private practices and healthcare systems.  Private practices showed an average loss of $13,982 per physician, according to a new survey out from the American Medical Group Association. By contrast, health systems lost $211,961 per physician.  Physician salaries represented the top expenditure for medical groups, at 41.6 percent of their net revenue. Medical groups employed more primary care physicians than any other type of provider in 2015, but those physicians’ salaries generally lagged compared to specialists. The survey found that gastroenterologists received the highest median compensation, followed by dermatologists, cardiologists and oncologists.  Click here for the AMGA’s press release about its survey.

  • Nearly half of independent physicians expect to sell their practices in the near future, but not because they want to, according to a new survey.  The survey found 73 percent of respondents said they would prefer to remain independent assuming their practices could be reliably profitable and sustainable. Click here for ProCare Systems’ complete report.

CMS Awards $347 Million to Reduce Hospital Patient Harm and Readmissions

CMS has awarded $347 million to 16 hospital associations, Quality Improvement Organizations and health systems to reduce patient harm and readmissions. Through 2019, the new members of the Hospital Improvement and Innovation Network – which includes the Carolinas Healthcare System, Premier Inc. and the hospital associations in Pennsylvania, Michigan, Minnesota, Ohio and Washington state – will commit to a 20 percent decrease in patient harm and a 12 percent reduction in 30-day hospital readmissions over their 2014 levels. Click here for the CMS fact sheet on the awards.

GAO Questions HHS Implementation of Health Plan Reinsurance Payments

The Government Accountability Office (GAO) says HHS erred in administering a program in the Affordable Care Act intended to pay both insurers and the Treasury Department by prioritizing insurance companies first. The legal analysis, released last week, concluded that the administration acted without proper authority in distributing so-called reinsurance payments, which are designed to redistribute payments from plans that enroll healthier individuals to those that enroll sicker customers. HHS says it strongly disagrees with GAO, arguing it formulated the reinsurance policy, which has helped mitigate premiums for consumers, in a transparent and legal manner. Click here for the GAO report.

  • More regional insurers are announcing plans to leave state exchanges.  Click here for Blue Cross’ plans in Tennessee.  Click here for Indiana University Health Plans’ announcement.  Click here for Wellmark’s plans in South Dakota.

Push for Flu Vaccination by CDC Despite Failed Nasal Vaccine

Public health authorities at the CDC last week urged Americans to get flu shots for themselves and their children after withdrawing recommendations for the painless nasal vaccines that showed no protection against the disease. It will be several weeks before evidence emerges on whether this year’s vaccine is a good match for strains of the virus that will begin circulating widely within a few months. Last season’s vaccine was a poor match for the most widely circulating strains of flu. Authorities in June withdrew recommendations for the inhaled flu vaccine because it failed for four straight years. Click here for more from the CDC.

Inspector General: Medicare Paid Millions for “Unlawfully Present” Beneficiaries

Medicare paid about $9.3 million to cover health care costs for 481 unlawfully present individuals in 2013 and 2014, according to a new OIG report. The OIG’s review found CMS followed policies and procedures to prevent payment when Medicare’s data systems found that an individual was unlawfully present at the time a claim was processed, but it didn’t follow procedures for detecting and recouping payment after a claim had been processed for an unlawfully present beneficiary. To read the report, click here.

Teen Birth Rate Continues to Plunge

The teen birth rate continues to drop. It’s now down to a new historic low: 22.3 births per 1,000 females aged 15 – 19, the CDC reported last week. That’s an 8 percent year-over-year decline, and a 46 percent decline since 2007.  Click here for the report.

HHS:  Uninsured Rate Falling Generally Uniformly and Continues into 2016

The uninsured rate fell by around 40 percent for Americans in all income groups for 2010 through 2015, including individuals with incomes above 400 percent of the federal poverty level, according to a new HHS analysis.  Individuals age 26-34 and 35-54 saw similar percentage drops in uninsured rates, but since the younger group had higher pre-ACA uninsured rates, a larger fraction of them have gained coverage since its passage. Although the report looks primarily at data through 2015, in the first quarter of 2016, the national uninsured rate dropped again from 9.1 percent to 8.6 percent. Click here for the report.

President Signs Bill Keeping Government Open Until December 9

The President last week signed a Continuing Resolution (H.R. 5325) to keep the government running through December 9. The legislation included emergency funding to combat the Zika virus, to help states with recent floods, and money to fight the ongoing opioid epidemic. To read the section by section of the bill, click here, and here for H.R. 5235.

6 Health Systems Join Two Tech Winners to Redesign Medical Bills

Two California-based companies the winners of the HHS “A Bill You Can Understand” challenge, a design and innovation challenge to solicit new approaches on medical bills.  HHS received submissions from health care organizations, technology companies, and design agencies, which will be further evaluated for testing or implementation in six health care organizations across the country that are working to improve the patient billing experience. Cambia Health Solutions (Portland, OR), Geisinger Health System (Danville, PA), INTEGRIS Health (Oklahoma City, OK), The MetroHealth System (Cleveland, OH), Providence Health & Services (Seattle, WA), and University of Utah Health Care (Salt Lake City, UT) have all agreed to work with the winners on implementation. Click here for details.