WHO Report: Antibiotic Resistant Bacteria On The Rise

According to a new World Health Organization (WHO) report, antibiotic-resistant bacteria now reach every part of the world, which could translate to more deaths from even minor infections. The WHO examined seven common bacteria that cause serious infections and found high levels of resistance all over the world. There was also significant gaps in tracking drug resistance.

Antibiotic resistance means that people can be sicker longer, with an increased risk of death, driving up the cost of healthcare.The WHO report also acknowledges the rise in deadly fungal infections.

The WHO recommends enhancing infection prevention and control at hospitals, prescribing antibiotics only when needed, and prescribing the correct antibiotics to treat illnesses.

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LTC Experts Concerned About Jimmo Implementation

According to long term care experts, skilled nursing providers remain confused about Medicare changes related to Jimmo v. Sebelius, and beneficiaries are not aware that their therapy may be eligible for coverage.

Under the Jimmo settlement, the CMS were required to distribute educational materials to skilled nursing providers. The CMS has recently posted online resources and updated the Medicare manual.

The Jimmo settlement requires Medicare to reimburse for medically necessary skilled care, even if it is only to maintain a patient’s condition. Before the settlement, Medicare only covered skilled care if it could lead to the improvement of a beneficiary’s condition.

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New Bill Gives NPs More Independence

The Connecticut state House has given final approval to a bill that would give nurse practitioners (NPs) the ability to practice independently of doctors after they work at least three years in collaboration with a physician. The Malloy administration proposed the measure and is expected to sign it.

Currently, NPs can prescribe medication, treat patients, and run their own practice-if they have a collaborative agreement with a licensed physician. Supporters of the bill believe it is a feasible way to expand access to primary care, as demand is only expected to grow. Critics argue that the bill could lower the standard of care and that physicians have more extensive training, which better equips them to treat patients with complex health needs.

Figures show that Connecticut has a high supply of primary care doctors, but also an aging physician population.

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Tiptastic Tuesday: New ICD-10 Date Coming Soon

According to CMS, providers will not have to wait much longer for the new ICD-10 implementation date. CMS is scheduled to perform limited end-to-end testing in July, but that date may change. The delay will give CMS “a more robust group of providers to test with because more providers will be ready to test.”

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Obama Administration Moving Forward With Cuts To Home Health Care Services

The Obama administration is making dramatic cuts to home health services for seniors, cutting reimbursements by 14% over the next four years. Critics argue that the cuts will shrink the health care sector and leave over a million seniors without access to health services. In addition, they argue that these deep Medicare cuts will impact home health professionals, the very people whom home health patients depend on. The administration has acknowledged that “approximately 40% of the more than 11,000 home health agencies would be losing money by 2017.” Currently, there are over 1.2 million Americans working in the home health sector, 90% of whom are women.

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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.

WA Insurers & Providers Complain About New Rule

In Washington state, health insurers and hospitals have united to fight Insurance Commissioner Mike Kreidler about his proposed new rule for insurance-provider networks. Kreidler proposed the rule after hearing complaints that consumers were not prepared for the narrower networks in insurance plans offered under the ACA. These networks excluded some of Washington’s most prominent hospitals and medical centers, limiting consumers access to providers they expected to use.

The new rule will make it easier for consumers to find which hospital and providers are in the network for a plan they are considering buying. In addition, the rule has a number of requirements to ensure that networks have sufficient numbers and types of providers and facilities so that patients can access them without any delay.

Kreidler hopes to implement the rule as soon as this week to make the May 1 deadline for insurer plans for 2015 coverage. Insurers are complaining that they do not have enough time to comply; providers believe the rule adds costs with no gain in access to quality health care.

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Study: SNFs With Poor Quality Ratings Do Not Readmit More Patients To Hospitals

Research findings in the American Journal of Medical Quality suggest low-quality and high-quality skilled nursing facilities (SNFs) readmit approximately the same number of residents to hospitals. Researchers analyzed readmissions from 17 Massachusetts SNFs that accepted patients from a nearby medical center between 2008 and 2011. The 30-day all-cause hospital readmission rate was about 22% for seven SNFs with a one star Nursing Home Compare rating, which indicates below average care quality. For those with two or more stars, the readmission rate was 18%, which researchers do not consider statistically significant. Researchers also analyzed a variety of care processes in place at the SNFs and found that none of them had a statistically significant association with lowered readmission rates. However, researchers did note that SNFs with the ability to intravenously administer furosemide, a diuretic drug given to alleviate symptoms of heart failure patients, did lower readmissions almost to the level of statistical significance.

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Report: Medicare Should Weigh Cost In Coverage Decisions

According to a new report by the RAND Corporation, the agency that oversees the Medicare program should be able to consider the cost effectiveness of drugs and medical devices when making coverage determinations. However, researchers note that this recommendation is drastically different from the current practice in which the CMS is barred from considering cost, and does not have a great chance of being implemented without Congressional action.

The report, Redirecting Innovation in U.S. Health Care, considers options to decrease spending and increase value within the healthcare system. Researchers also recommend creating a Food and Drug Administration public-interest investment fund that would support research to produce less costly drugs and devices. In addition, RAND suggests that CMS transition from the current fee-for-service model into a model that pays doctors or hospitals a set amount for each episode of care for a given time period.

RAND believes these recommendations, if implemented, would drive market forces to control costs.

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FTC Blocks Ohio Hospital Merger

This past week, the U.S. Court of Appeals for the 6th Circuit issued a major decision in the hospital sector, when it supported the Federal Trade Commission (FTC) and ordered the Toledo, Ohio based ProMedica to stop its acquisition of St. Luke’s Hospital in Maumee, Ohio.

Although ProMedica and St. Luke’s completed their merger in September 2010, the FTC challenged the deal by arguing that it would reduce competition and allow ProMedica to increase prices. A judge upheld the FTC’s decision, which gave ProMedica six months to divest St. Luke’s to an FTC-approved buyer. ProMedica appealed to the 6th Circuit. St. Luke’s credit rating was downgraded during this time, due to “large operating losses.”

In recent years, the FTC has become increasingly involved in, and winning, hospital merger challenges. It looks as though local strategic mergers will have difficulty when trying to gain approval (especially in smaller communities where they substantially raise market power). In the future, experts predict that hospital mergers may continue to face pressure by the FTC.

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