Docs Willing to Accept Payment Cuts to Force Permanent SGR Repeal

Doctors who are opposed to the proposed temporary fix to the sustainable growth rate (SGR) payment formula (which is set for a Senate vote this afternoon) have said that they would take the 24 percent cut in Medicare payments this year to force Congress to permanently repeal the formula.

The SGR, which determines how much the government pays physicians who treat Medicare patients, has been a concern to physicians since its implementation in the 1990s.

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Monday Morning Recap

The HMS Healthcare Management Solutions Monday Morning Recap reviews some of the top stories and healthcare highlights you may have missed last week.

Holding April 2014 Claims Paid Under MPFS

The 2014 Medicare Physician Fee Schedule (MPFS) final rule provided a negative update to the MPFS that was to be effective January 1, 2014. However, the reduction was “averted for three months with the passage of the Pathway for SGR Reform Act of 2013, which provided for a 0.5 percent update for services paid under the MPFS through March 31, 2014.”

CMS hopes that there will be congressional action to prevent the negative update from taking effect on April 1, 2014. CMS has also instructed Medicare Administrative Contractors to “hold claims containing services paid under the MPFS for the first 10 business days of April (i.e. through April 14, 2014). This hold would only affect MPFS claims with dates of service of April 1, 2014, and later.”

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6 Million People Have Signed Up For Insurance

Yesterday, President Obama announced that more than 6 million people have signed up for health insurance through the health law’s state and federal online marketplaces, since October 1. The CMS officials stated that the health law’s website, healthcare. gov, and the 800 number, had near record traffic Wednesday, with 1.5 million visitors and more than 430,000 phone calls. Insurance industry officials have reported that about 70 to 80 percent of the enrollees have paid their premiums.

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Report: CT Had High Hospital Infection Rate in 2012

In 2012, patients in Connecticut hospitals caught infections during treatment at rates much higher than the national average in several key areas, according to a new report released by the CDC. State officials say they are looking to “make progress from here” and urge patients to be their own advocates by talking to their doctors and nurses about infection control. In addition, patient visitors should always make sure to disinfect their hands before and after touching a patient. The Department of Public Health plans to use the new data to focus on efforts to bring infection rates down.

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New Bill Delays Reimbursement Cuts & ICD-10 For One More Year

The House of Representatives has reached a deal to delay physician Medicare reimbursement cuts under the SGR formula for one more year. According to the Congressional Budget Office, the cost to repeal the SGR with the ACA delay will total more than $180 billion.

Another bill, which Congress will vote on today, “consolidates Medicare sequester cuts scheduled for 2024, so that they all take place in fiscal year 2024, rather than dividing them between fiscal years 2024 and 2025.” The bill also contains language that would delay ICD-10 implementation until 2015.

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CMS Issues Guidance to Surveyors on Alternative Sanctions for HH Agencies

The CMS has issued guidance to State Survey Agency Directors for the implementation of new alternative sanctions for home health agencies that were finalized in the November 8, 2012 Federal Register notice. Alternative sanctions provide CMS with alternatives to program termination for agencies that are found to not be in “substantial compliance” with the conditions of the participation.

“CMS now has the authority to impose alternative sanctions of civil money penalties (CMPs), directed in-service training, directed plans of correction, suspension of payment for new admissions, and temporary management on HHAs that are found to have condition level deficiencies. The guide instructs on the implementation, basis for, and notification requirements for the individual sanctions, in addition to, the process for an informal dispute resolution (IDR), and the formal appeals process for when CMPs sanctions are imposed.”

Click here for more info from NAHC

CMS Launches “Concurrent Care” Demonstration

The CMS announced the launch of the “concurrent care” demonstration authorized by the Patient Protection and Affordable Care Act (PPACA). Under the Medicare Care Choices Model (MCCM), up to 30 Medicare-certified hospices will be selected to provide palliative support services in the form of routine home care (RHC) and in-home respite to patients with advanced cancers, chronic obstructive pulmonary disease, congestive heart failure and HIV/AIDS who meet hospice eligibility requirements.

Patients will concurrently receive services provided by their curative care providers. In addition, hospices selected for the three-year demonstration will receive $400 per beneficiary per month (PBPM) to provide the palliative care services.

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Hospital Mergers in CT May Increase Patient Costs

As of late, Connecticut has seen an unprecedented streak of hospital mergers and consolidations that claim to increase efficiencies in healthcare. More than half of the 29 acute-care hospitals in Connecticut now operate in networks with other hospitals and out-of-state partners-something experts say will reduce market competition and drive up prices. Adding to this is a proposal from a private company, which would convert four non-profit hospitals in the state into for-profit entities.

Numerous studies and data from the federal Medicare program suggest that such mergers and for-profit conversions lead to higher prices. The state also does not have a “comprehensive blueprint guiding hospital configuration” or a way to limit the number of takeovers or networks it allows. A review of Medicare pricing data shows that hospitals in the state are part of networks which charge more for common procedures than independent hospitals. In addition, for-profit hospitals bill Medicare at higher rates-up to 25 percent higher.

Between 2009 and 2013, there have been seven hospital consolidations and partnerships in Connecticut (there were only four in the entire prior decade). This month, Yale New Haven Health System partnered with the for-profit Tenet Healthcare Corporation to offer statewide clinical services. Connecticut lawmakers say that they will be reviewing the for-profit conversion to make sure that patients continue to have access to affordable care. But, experts say that lawmakers need to seriously weigh finances, patient access and services in deciding if mergers are indeed benefiting consumers.

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Should For-Profit Companies Be Allowed to Deny Contraception Coverage to Employees?

The ACA guarantees that all new health insurance plans cover FDA approved contraceptives without any co-pays and deductibles. Under the law, religious nonprofits are exempted from the requirement. But, numerous for-profit companies have started filing lawsuits against this requirement, saying that they have a right to deny coverage to their employees because of the companies’ religious beliefs. These companies believe that certain methods of birth control, such as IUDs and morning-after pills, can interfere with the creation of life once an egg is fertilized.

However, the government points to past Supreme Court cases that take the opposite view, stating that the court has never found a for-profit company to be a religious organization for purposes of federal law and that they would be “unable to function if religious beliefs could be the basis for corporations’ refusing to comply with generally applied laws.”

So, the question remains: should for-profit companies be allowed to deny coverage to their employees, based on their religious beliefs? We’d love to hear your thoughts.

The contraceptive case will go before the U.S. Supreme Court today.

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