WEEKLY E-BULLETIN


Freestanding Emergency Department Growth Skyrockets:  MedPAC

There has been a rapid growth of freestanding emergency departments across the United States in the past eight years, according to a report last week from the Medicare Payment Advisory Commission (MedPAC).  From 2008 to 2016, there was a 97 percent increase in off-campus EDs affiliated with a hospital and a 100 percent increase in independent EDs.  94 percent of the independent EDs are in Texas, Colorado, Minnesota and Rhode Island and now total 203.  There are 363 hospital affiliated EDs.  MedPAC, which advises Congress on Medicare policy, said the new hospital outpatient department payment policy that exempts EDs from site neutral payments may contribute to further growth.  MedPAC may now consider recommending new policies that would reign in the growth.  Click here for MedPAC’s slide presentation.

Leapfrog Grades 844 Hospitals with an “A”

The Leapfrog Group last week announced its Fall 2016 release of the Leapfrog Hospital Safety Grade, a program which assigns letter grades to more than 2,600 U.S. hospitals bi-annually. Of the 2,633 hospitals evaluated, 844 earned an “A,” 658 earned a “B,” 954 earned a “C,” 157 earned a “D” and 20 earned an “F.”  Hawaii, Idaho, Maine, Wisconsin and North Carolina hospitals ranked highest.  Click here to see how your hospital fared.  Click here for the list of the 20 hospitals that received a failing grade.  Click here for the state rankings.

AMA Takes On 5-Star Hospital Rating System

CMS’ 5-Star rating program continues to come under fire.  When the system was introduced by CMS, hospital leaders were particularly unhappy with the scores; nearly 40 percent of hospitals received just three out of five stars, and many said that teaching facilities were being unfairly compared to community hospitals that treat lower-risk patients. Now an opinion piece in the Journal of the American Medical Association looks at that rating system, points out flaws and makes some recommendations to make it more valuable. Click here.

CMS Cuts Home Health Payments, Adds 4 New Reporting Measures

CMS cut payments to home health agencies by about 0.7 percent in 2017, according to final rules it published last week. That equates to a $130 million payment reduction for about 11,400 home health agencies. However, this is a smaller cut than CMS originally proposed rule of 1 percent, or $180 million in cuts. CMS is also completing the last year of a four-year phased adjustment to the home health payment system. Finally, the final rule adds four measures to home health’s quality reporting program that will help determine payments starting in 2018, as required by the IMPACT Act of 2014. Click here for the fact sheet and here for the final rule.

Most Hospitals to Get a VBP Payment Bump Next Year

CMS last week announced that most hospitals participating in the Hospital Value-Based Purchasing (VBP) program will see their payments go up in 2017. Roughly 1,600 of the 3,000 hospitals in the program that rewards hospitals for improving the quality and cost-effectiveness of their care will receive higher payments. CMS expects half of the hospitals will see adjustments between -0.5 percent and 0.5 percent. The top-performing facility will qualify for a net payment increase of just more than 4 percent and the worst will get hit with a 1.83 percent net reduction. Click here for the CMS fact sheet which contains links to tables on the adjustments for the hospitals in the program.

CMS Modifies HOPD Payment Policies

In the final rule released last week, CMS backed off on the policy that did not allow for service expansion within the Hospital Outpatient Department (HOPD) but went forward with rules that would not allow HOPDs to be moved from current locations except in extraordinary circumstances. The rule included a change in the patient satisfaction survey that’s intended to prevent potential pressure on doctors to prescribe opioids. Hospitals will receive a 1.6 percent increase in payments for outpatient services under the new rule and ambulatory surgical centers will see reimbursements rise by 1.9 percent. For the CMS fact sheet, click here. For the final rules, click here.

CMS Releases 2017 Physician Payment Rule

CMS last week finalized a number of coding and payment changes including separate payments for codes describing chronic care management (CCM) for patients with greater complexity and made several changes to reduce the administrative burden associated with CCM codes to allow for great ease of billing. CMS also listened to comments from providers (and Congress) and changed the data collection requirements on global surgery codes. Finally, the rule expanded the Diabetes Prevention Program model, which is the first time CMS has turned a pilot on preventive care into a permanent Medicare program. To view the CMS fact sheet, click here. To view the final rule, click here.

Two Leading Democrats Urge FTC and DOJ to Investigate Diabetes Medication Price Hikes

U.S. Senator Bernie Sanders (D-VT) and U.S. Rep. Elijah Cummings (D-MD) called on the Justice Department and FTC to investigate potential collusion among drug companies on the rising prices of diabetes medicines. The cost of insulin more than tripled between 2002 and 2013, the lawmakers noted in a letter released last week, even though the original insulin patent expired more than 75 years ago. The letter calls out Sanofi, Novo Nordisk, Eli Lilly and Merck. Sanofi and Novo Nordisk have reportedly taken nearly identical prices hikes of their drugs within days of each other 13 times since 2009, the Democratic lawmakers say.  Click here for the letter.

If More States Expand Medicaid Next Year, 1.2 Million Could Get Access: Study

An estimated 1.2 million people living in states that haven’t expanded their Medicaid programs could gain coverage if a newly elected governor decides to expand, according to a study released last week. Missouri, North Carolina and Utah, that do not currently have Medicaid expansion, all have gubernatorial races this year. However, regardless of the outcome of the gubernatorial races, these states all have Republican-controlled state legislatures that have opposed expansion and state legislatures in Missouri and Utah have previously blocked attempts to expand. Click here for the study.

  • If you want great graphics to see how the Affordable Care Act has impacted the nation, click here for this from the NYTimes.

Health Care Adds 31,000 Jobs Last Month

The number of jobs in the health care industry grew by 31,000 last month, according to data released last week by the Bureau of Labor Statistics.  The industry has added 415,000 jobs over the past year, and added more jobs in October than it did the previous month. Within the industry, ambulatory health care services added 19,000 jobs and hospitals added 13,000 jobs. Overall, the economy added 161,000 jobs last month.  Click here for more from the BLS.

Congresswomen Ask FDA to Report on Cyber Security for Medical Devices

In a letter to the FDA last week, two members of the House Energy and Commerce Committee asked the agency to detail what it’s doing to address cybersecurity policies for medical devices. In light of recent reports of pacemakers’ vulnerability to hacking, Reps. Diana DeGette (D-CO) and Susan Brooks (R-IN) asked the agency to describe what it is doing to mitigate cybersecurity risks, alert providers and patients of issues, and coordinate with other federal agencies that deal with cybersecurity. Click here for the letter.

Drug Resistant Fungus Connected to Four Hospital Deaths

Candida auris, a deadly new drug-resistant fungus, has been linked to the deaths of four hospital patients in the U.S., according to a report released by the CDC. The fungus targets the sickest patients and can spread in hospitals. Although practitioners have been concerned about the transmission of antibiotic-resistant bugs for many years, this fungus is relatively new. The agency states in the report that the fungus has been detected in a total of 13 patients in the U.S. since May 2013. The CDC provided details on the first seven cases, which were reported in New York, Illinois, Maryland and New Jersey. For more from the CDC, click here.

President Signs Executive Order to Combat Infectious Diseases

President Barack Obama last week signed an executive order (EO) focusing on combating infectious disease threats like Zika and Ebola that builds upon the Global Health Security Agenda (GHSA). The EO directs U.S. Departments and Agencies to coordinate with other governments, financial institutions and nongovernmental stakeholders to implement international health regulations and meet the goals of the GHSA. To read the EO, click here.

Fewer Staff Injuries Linked to Safer Patient Handling

Hospitals that implement safe patient handling and moving policies may have fewer injuries among healthcare workers, according to a new study. The researchers analyzed data on 1,832 patient care providers at two U.S. hospitals – one that started a safety program and one without any in place. At the hospital that implemented safe patient handling policies, the risk of neck and shoulder injuries declined 32 percent in a year, the odds of lifting and exertion injuries dropped 27 percent and the chances of pain and inflammation decreased 22 percent. Click here for the study.