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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Vitamin D Supplements Have No Effect For Fall Risk

According to a new study, vitamin D supplementation does not reduce the risk for falls in older adults, which is contrary to guidance from the U.S. Preventive Services Task Force.

Approximately 30,000 older adults participated in 20 trials that looked at the effect of vitamin D (both with and without calcium) supplementation on the risk for fall and found that it did not reduce the incidence of fall by 15% or more. Calcium did not have an effect, either.

The authors concluded that there is little justification for using vitamin D for fall prevention.

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Report: Physician Practices Vital To Economy

According to a new report from the American Medical Association (AMA), the rise in spending on physician services has had a positive ripple effect on the economy. The report noted that every dollar applied to physician services supports an additional $1.62 in other business activity. According to the report, each physician supported an average of $2.2 million in economic output and contributed to a total of $1.6 trillion in economic output nationwide in 2012. This resulted in each physician supporting about 14 jobs in his or her state; nationally, doctors’ offices generate 9.97 million jobs. The AMA stresses the importance of the small independent physician practice model and the positive impact on on our overall economy.

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HHS Releases Security Assessment Tool

HHS has released a security assessment (SRA) tool as a resource to assist small and medium sized healthcare providers in complying with the Health Insurance Portability and Accountability ACt (HIPPA) Security Rule. The Security Rule applies to all HIPAA covered entities, which include health plans, healthcare clearinghouses, and most healthcare providers that perform functions on behalf of covered entitities involving ePHI.

Once the tool is downloaded, users will be guided through a series of questions regarding administrative, technical and physical safeguards with respect to ePHI.

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Medicare Chief Jonathan Blum Leaving Obama Administration

Jonathan Blum, the CMS Principal Deputy Administrator, is leaving the Obama administration, effective May 16. Blum was instrumental in Medicare’s recent accomplishments, which include developing ACO regulations, implementing quality framework for Medicare Advantage plans, developing many of CMS’ value-based payment strategies, and overseeing the unprecedented release of Medicare payment data for 880,000 physicians.

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CMS Rebuilding Special Focus Facilities Program For LTC Facilities

On Friday, the CMS announced that it will begin rebuilding the special focus facility program (SFF) for nursing homes with quality issues. The program, which was minimized last year due to budget cuts, focuses on identifying deficiencies in the quality of care in nursing homes and correcting them. If serious problems are not corrected, the CMS will terminate the nursing home’s participation in Medicare and Medicaid. The CMS designates a certain number of SFF slots for each state and will start rebuilding the program by gradually increasing the number of slots. States are required to fill their slots by July 1.

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