According to recent filings with state regulators, Tenet Healthcare Corporation is ready to spend approximately $535 million to acquire and improve four Connecticut hospitals and related subsidiaries. Tenet has already purchased Waterbury Hospital for $45 million and will invest $55 million in improvements. More recent regulatory filings indicate Tenet has deals with Eastern Connecticut Health Network, Bristol Hospital, and St. Mary’s Hospital.
Medicare officials are now allowing patients at dozens of hospitals participating in pilot projects to be exempted from the requirement that limits nursing home coverage to seniors admitted to a hospital for at least three days. These new experiments are being conducted to find out whether new payment arrangements with hospitals and other providers that drop the three-day rule can reduce costs or keep them the same while improving care. The experiments are being conducted under a provision of the ACA which also created the Center for Medicare and Medicaid Innovations to develop ways of improving Medicare.
If these experiments are successful, the tests will be expanded, according to Medicare officials. If patients can receive care while spending less time in the hospital, it can free up valuable resources for sicker patients and save money for Medicare because nursing home care and home health care is much cheaper than a hospital stay. Medicare’s three-day hospital admission rule has been a burden to seniors who don’t qualify for nursing home coverage because they were in the hospital under observation care rather than being admitted.
A federal appeals court has ruled that the Obama administration cannot subsidize insurance premiums for 7 million Americans. Today, two judges with the D.C. Circuit Court of Appeals ruled that the text of the reform law “forbids income-tax subsidies to go to low-and middle-income Americans who use one of the 34 federally run insurance exchanges.” Officials from the D.C. Court of Appeals argue that the actual text of the law says that the sliding-scale tax credits are only available for coverage purchased “through an exchange established by the state” which only 16 states have done.
“Because we conclude that the ACA unambiguously restricts the section 36B subsidy to insurance purchased on Exchanges’ established by the State, we reverse the district court and vacate the IRS’s regulation,” the judges added.
CMS issued a new memorandum moderating their regulation on “Part D Payment for Drugs for Beneficiaries Enrolled in Hospice.” The new directive limits prior authorization by hospices to four classes of drugs: analgesics, anti-nauseants, laxatives and anti-anxiety drugs. In March, CMS announced that it would require prior approval for all hospice drugs under Medicare Part D prescription drug benefit. The recent change was made after a June meeting between officials and stakeholders including hospice providers, insurers and pharmacies and patient advocates “who described the operational challenges of requiring all hospice drugs to be approved before they could be dispensed.”
Yesterday, experts told a Senate panel that nursing homes and other non-hospital providers have been overlooked in efforts to improve patient safety. Experts say we need better data in these settings to understand the risks and opportunities for improvement. Panelists also recommended implementing large-scale initiatives to change infrastructure, processes and culture which they believe is crucial to improving patient safety across the board.