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HHS brings back Medicare program that caught $8B in wasteful payments
The Hill
August 8, 2014
http://thehill.com/regulation/214296-hhs-brings-back-medicare-program-that-caught-8b-in-wasteful-payments
The Centers for Medicare and Medicaid Services (CMS) plans to bring back a Medicare oversight program that has spotted more than $8 billion in wasteful, fraudulent and abusive payments to healthcare providers since 2009, but was canceled two months ago.  The Recovery Audit Contractor (RAC) program finds instances where healthcare providers have improperly overbilled Medicare and requires them to return the money.  But the CMS contract for its Medicare recovery program expired on June 1, leaving healthcare providers free to overbill the system without penalty. In emails to congressional offices, CMS said it will restore the program this month on a limited basis.  RAC will be allowed to review a limited number of claims under the new contract, including those for spinal fusions, outpatient therapy services, durable medical equipment, prosthetics, orthotics and supplies, and cosmetic procedures.  However, RAC will not review claims short inpatient stays, which account for 91 percent of the money the program has recovered for Medicare in the past, according to Becky Reeves, spokeswoman for the American Coalition for Healthcare Claims Integrity, who said this is a step in the right direction but more needs to be done to reform the system.
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Still Down? Tech Glitch Hobbles Pharma Payment Disclosure System
The Wall Street Journal
August 8, 2014
http://blogs.wsj.com/pharmalot/2014/08/08/still-down-tech-glitch-hobbles-pharma-payment-disclosure-system/?KEYWORDS=medicare
Call it a mid-summer dimming of the sunshine.  U.S. doctors and teaching hospitals remain unable to review an online federal government database of payments they have received from drug and device makers, after a government agency shut it down to investigate a data mix-up.  The Centers for Medicare and Medicaid Services took the so-called “Open Payments” system offline Sunday night and doesn’t have an estimate of when it will be working again, a CMS spokesman said Thursday. The data mix-up involved at least one doctor being able to see the payment data for another doctor whose records were erroneously linked.  The “Sunshine Act” provision of the 2010 Affordable Care Act requires drug and device makers to report to CMS detailed information about most payments and transfers of value they make to U.S. doctors and teaching hospitals, for items ranging from meals to speaking fees.
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Doctors' 'conflict of interest' database gets delayed
The Hill
August 7, 2014
http://thehill.com/policy/healthcare/214652-doctors-conflict-of-interest-database-gets-delayed
The Centers for Medicare and Medicaid Services (CMS) will delay publicly launching a new database intended to disclose potential conflicts of interest among physicians.  The agency’s Open Payments System lists payments from drug and medical device makers to doctors. It was supposed to have gone public on Sept. 30, after doctors had been given a chance to dispute any information on it by Aug. 27.  However, the agency released a statement Thursday noting that the database “has been taken offline temporarily to investigate a reported issue” and physicians won’t be able to review their data on the site until it is fixed.  The CMS says it will adjust its deadlines after completing the investigation, but it did not disclose what the investigation is about nor how long the delay would be.  The delay will affect the date on which the information becomes publicly available, not just the deadline for doctors to dispute the details pertaining to them.
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Study: Only 6 Percent of Hospitals Meet Electronic Records Requirements
US News & World Report
August 7, 2014
http://health.usnews.com/health-news/hospital-of-tomorrow/articles/2014/08/07/study-only-6-percent-of-hospitals-meet-electronic-records-requirements
A broad swath of American hospitals have failed to meet new national standards for electronic record keeping, a recent study finds.   While more than half of the hospitals in the U.S. do use some kind of electronic health system, and most meet "many" of the 16 elevated requirements set down by federal regulators, the study said, fewer than 6 percent of meet all the mandates, which span automatic tracking of medications to online messaging systems for communicating with patients.  Hospitals that fail to meet the deadlines may be docked a portion of their Medicare reimbursements.  Small and rural medical centers, often faced with tight staffing and financial restrictions, have been especially burdened by the requirements, which follow a tight time frame that many experts have .  “We should be concerned about that group, and in particular think about whether there are more customized policies that are needed to help support them,” says co-lead author Julia Adler-Milstein, an assistant in the School of Information and the School of Public Health at the University of Michigan. “Are there not systems out there to meet their needs? Do they not have access to IT support? We don’t exactly know what the challenges are there.” 
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Rising rates of hospice discharge in U.S. raise questions about quality of care
The Washington Post
August 6, 2014
http://www.washingtonpost.com/business/economy/leaving-hospice-care-alive-rising-rates-of-live-discharge-in-the-us-raise-questions-about-quality-of-care/2014/08/06/13a4e7a0-175e-11e4-9e3b-7f2f110c6265_story.html
At hundreds of U.S. hospices, more than one in three patients are dropping the service before dying, new research shows, a sign of trouble in an industry supposed to care for patients until death.  When that many patients are leaving a hospice alive, experts said, the agencies are likely to be either driving them away with inadequate care or enrolling patients who aren’t really dying in order to pad their profits.  It is normal for a hospice to release a small portion of patients before death — about 15 percent has been typical, often because a patient’s health unexpectedly improves.  But researchers found that at some hospices, and particularly at new, for-profit companies, the rate of patients leaving hospice care alive is double that level or more.  The number of “hospice survivors” was especially high in two states: in Mississippi, where 41 percent of hospice patients were discharged alive, and Alabama, where 35 percent were.  “When you have a live discharge rate that is as high as 30 percent, you have to wonder whether a hospice program is living up to the vision and morality of the founders of hospice,” said Joan Teno, a Brown University hospice doctor and researcher and the lead author of the article published in the Journal of Palliative Medicine. “One part of the reason is some of the new hospice providers may not have the same values — they may be more concerned with profit margins than compassionate care.”
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Docs Urge CMS to Postpone Deadline for ‘Sunshine’ Data Disclosures
The Wall Street Journal Blog
August 6, 2014
http://blogs.wsj.com/pharmalot/2014/08/06/docs-urge-cms-to-postpone-deadline-for-sunshine-data-disclosures/
More than 100 medical societies are urging the federal government to delay the launch of a widely anticipated database that will show payments from drug and device makers to physicians.  In a letter sent to the Centers for Medicare and Medicaid Services, the American Medical Association and dozens of other groups argue that more time is needed to allow doctors to register and review payment data or “inaccurate, misleading and false information” may be posted.  The online, searchable database was required in the Sunshine Act provision of the Affordable Care Act and was initiated over concerns that financial ties between doctors and industry may unduly influence medical practice and research.  The law requires most companies to report detailed information to CMS about payments and gifts to doctors and teaching hospitals in the U.S. The disclosures are being made in stages, but next month marks the debut of when payments will appear publicly.
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First Look At Medicare Quality Incentive Program Finds Little Benefit
The Washington Post
August 6, 2014
http://www.washingtonpost.com/national/health-science/first-look-at-medicare-quality-incentive-program-finds-little-benefit/2014/08/06/20343f74-1da4-11e4-9b6c-12e30cbe86a3_story.html
One of Medicare’s attempts to improve medical quality –by rewarding or penalizing hospitals — did not lead to improvements in the first nine months of the program, a study has found.  The quality program, known as Hospital Value-Based Purchasing, is a pillar of the federal health law’s campaign to use the government’s financial muscle to improve patient care. Since late 2012, Medicare has been giving small increases or decreases in payments to nearly 3,000 hospitals based on how patients rated their experiences and how faithfully hospitals followed a dozen basic standards of care, such as taking blood cultures of pneumonia patients before administering antibiotics. As much as 1 percent of their Medicare payments were at stake in the first year and 1.25 percent this year, though most hospitals gained or lost a fraction of that. Hospitals were judged both on how they compare to others and how much they are improving.  The program is one of several payment initiatives instituted by the health law. Others include penalties for hospitals that have high rates of Medicare patients readmitted within 30 days and penalties that will go into effect this fall for hospitals with high rates of patient injuries or infections.
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Controversial Medicare recovery audits make limited return
Modern Healthcare
August 5, 2014
http://www.modernhealthcare.com/article/20140805/NEWS/308059962/controversial-medicare-recovery-audits-make-limited-return
The CMS is restarting audits of Medicare fee-for-service claims on a limited basis. The program has been dormant since June 1 when current audit contracts expired.  Lauren Aronson, director of CMS' Office of Legislation, sent an e-mail to congressional staffers Monday announcing the resumption of the recovery audit contractor program.  “Current recovery auditors will conduct a limited number of automated reviews and a small number of complex reviews on certain claims including, but not limited to: spinal fusions, outpatient therapy services, durable medical equipment, prosthetics, orthotics and supplies, and cosmetic procedures,” Aronson wrote. “The recovery auditors will not conduct any inpatient hospital patient status reviews Since the audit program began in 2009, roughly $8 billion in improper Medicare payments have been identified and returned to the federal government. But hospitals have complained that the program has tied up crucial funds in endless appeals.
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O-Care subsidy calculations accurate last October, audit finds
The Hill
August 5, 2014
http://thehill.com/policy/healthcare/214383-o-care-subsidy-calculations-accurate-last-october-audit-finds
The Internal Revenue Service (IRS) might have a better track record in determining ObamaCare premium subsidies than previously thought, a new audit suggests.  A government investigation released Tuesday found that the agency was 100 percent accurate in calculating the maximum monthly subsidy for all requests in the first two weeks of October.  While the report did not track activity throughout ObamaCare's first enrollment period, it hints that reports of more than 1 million incorrect subsidy determinations may overstate the problem.  The investigation was released by the Treasury Department's Inspector General for Tax Administration (TIGTA).  The report follows a separate audit by the Government Accountability Office revealing that investigators were able to procure subsidized health plans for fake applicants on the exchanges.  That finding spurred significant criticism of the IRS on Capitol Hill.
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Feds require state to talk to Native Americans for HIP 2.0 plan
Indianapolis Business Journal
August 5, 2014
http://www.ibj.com/feds-require-state-to-talk-to-native-americans-for-hip-20-plan/PARAMS/article/48915
State officials met Tuesday with members of the Pokagon Band of Potawatomi Indians in an effort to satisfy federal regulators who are considering a proposed expansion of the state’s low-income health insurance program.  In a letter dated July 17, the Centers for Medicare and Medicaid Services said the state’s application – which is a request to waive several Medicaid requirements – is considered incomplete until it consults with the tribe about the proposal.  And CMS won’t launch an official review of the application and open the proposal for public comment until it’s deemed complete, wrote Angela Garner, acting director of the agency’s waiver division.  The Indiana Family and Social Services Administration – which administers the state’s Healthy Indiana Plan – is working to address the federal concerns, said agency spokesman Jim Gavin.  Meanwhile, he said state and federal officials are continuing discussions about what the state has dubbed HIP 2.0. The plan would apply to all non-disabled adults ages 19-64, who earn between 23 percent and 138 percent of the federal poverty level. In 2014, that means a maximum income of no more than $16,105 annually for an individual and $32,913 for a family of four.
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New Hampshire receives funding to bolster home visiting program for families
Concord Monitor
August 5, 2014
http://www.concordmonitor.com/news/13015765-95/new-hampshire-receives-funding-to-bolster-home-visiting-program-for-families
New Hampshire will receive a $1 million federal grant to support programs geared toward helping to make sure that infants get off to a healthy start in their new homes, the U.S. Department of Health and Human Services announced Monday.  In total, the department said it will distribute $106.7 million to such programs across the country.  In the Granite State, money from the Maternal Infant Early Childhood Home Visiting Initiative will go toward the Healthy Families America home visiting program, department spokeswoman Kris Neilsen said in an emailed statement. This voluntary program – aimed at aiding pregnant women and their families – has helped more than 776 families in New Hampshire since its inception in 2011, Neilsen said.  According to the New Hampshire Department of Health and Human Services website, the state’s network of home visiting programs is designed to help pregnant women who are Medicaid-eligible and their families, as well as Medicaid-eligible families with children who are younger than 1. The programs are especially focused on new mothers under age 25, first-time mothers, mothers who might develop problems during pregnancy, mothers with substance abuse issues and families who might be at risk for abuse or neglect, according to the website.
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Treasury IG: IRS is reporting accurate data to Obamacare system
The Washington Times
August 5, 2014
http://www.washingtontimes.com/news/2014/aug/5/treasury-ig-irs-data-accurate-obamacare-system/
The IRS’s watchdog said Tuesday that the agency is generally reporting accurate data to Obamacare’s new insurance exchanges, suggesting at least one part of the new health care law is working as intended.  And a new poll found Obamacare is making inroads in extending coverage to residents of states that fully embraced the reforms, offering yet more good news for President Obama’s signature achievement, which has been battered by court challenges and continued GOP skepticism.  In the case of the IRS, internal auditors reviewed more than 100,000 information requests between Oct. 1 and Oct. 4, the first four days the new health exchanges were open for enrollment, and found the IRS’s responses were 99.7 percent accurate.  “In nearly all instances, the IRS correctly provided accurate information to the Health Exchanges on income and family sizes,” J. Russell George, Treasury Inspector General for Tax Administration, said in the new report. “Accurate information is essential for an Exchange to determine if an applicant is eligible to obtain insurance coverage through the Exchange.”  In 33 cases the IRS incorrectly said it had no tax information for individuals because a programming error prevented the agency from using the most recent name information on a person’s tax account.
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Groups call for delay in physician transparency database
The Hill
August 5, 2014
http://thehill.com/policy/healthcare/214382-groups-call-for-delay-in-physician-transparency-database
Medical groups are asking the Centers for Medicare and Medicaid Services (CMS) to push back implementing a new database intended to disclose possible conflicts of interest.  Over 100 medical professional groups, including the American Medical Association, signed a letter to CMS Tuesday to delay launch of the Open Payment System under the Physicians Payments Sunshine Act.  The database is expected to go live Sept. 30 and would publicly list what payments medical providers have received from drug and device industries in the interest of transparency.  “There are widespread concerns that the implementation of this new system for data collection — without minimally a six month period to upload the data, process registrations, generate aggregated individualized reports, and manage the dispute communications and updates — will not be ready and will likely lead to the release of inaccurate, misleading, and false information,” the groups wrote.  The groups are asking CMS to reschedule the database launch date to March 31.  The Open Payment System has come under criticism after media reports unearthed mistakes in the database that could potentially hurt a physician’s reputation.
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Senator Ron Johnson Appealing Decision that Dismissed His Lawsuit Against President Obama
The National Review
August 4, 2014
http://www.nationalreview.com/corner/384547/senator-ron-johnson-appealing-decision-dismissed-his-lawsuit-against-president-obama
Senator Ron Johnson (R., Wis.) said he will file an appeal today regarding his lawsuit against the president that a judge dismissed last month because of Johnson’s lack of standing. Johnson’s lawsuit challenges the president’s effort to force lawmakers and their staff off of the federal employee health benefit plan and into the new Obamacare exchanges.  Writing in the Milwaukee Journal Sentinel, Johnson noted that his suit was thrown out because of a lack of standing, and asked, “If a member of Congress does not have standing in this case, who does?” Johnson questioned the court’s ability to deny him standing, saying that it threatened the rule of law if the legislative branch cannot use the courts to force the president to execute the laws. “After all, it affected my health insurance, required me to take action to designate my staff and provided special treatment that drove a wedge between me and my constituents,” Johnson wrote. “It denied me — as a member of Congress and employer of staff — the legal status that Congress thought essential for each of its members and those who work for them.”
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New grants for O-Care's home-visit parenting program
The Hill
August 4, 2014
http://thehill.com/policy/healthcare/214216-new-grants-for-o-cares-home-visit-parenting-program
Federal health officials are distributing more funds for an ObamaCare program designed to improve parenting and connect at-risk families with social services through home visits.  State-based agencies involved in the program will receive roughly $107 million in grant funding this fiscal year to expand services for pregnant women and parents with children up to age 5, the Department of Health and Human Services (HHS) announced Monday.  "These awards allow states to reach more parents and families in an effort to improve children’s health while at the same time building essential supports within their communities," said Health Resources and Services Administration (HRSA) Administrator Mary Wakefield in a statement.  A description of the Home Visiting program said it helps to prevent child abuse and neglect, encourage positive parenting and promote children's readiness for school.
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GOP senator to appeal ObamaCare lawsuit
The Hill
August 4, 2014
http://thehill.com/policy/healthcare/214206-gop-senator-to-appeal-obamacare-lawsuit
Republican Sen. Ron Johnson (Wis.) will file an appeal after a federal judge last week dismissed his lawsuit challenging an ObamaCare rule.  "To honor my solemn oath of office, I feel compelled to exhaust every legal recourse," Johnson said in an op-ed in the Milwaukee Journal Sentinel over the weekend. "I will file my appeal on Monday."  Johnson had filed suit over a rule that allows congressional staff to continue to receive federal.  A federal judge, though, dismissed his case last month, arguing the senator and a member of Johnson's staff did not have standing to challenge the rule, because they suffered no injury.  The 7th Circuit Court of Appeals has jurisdiction over the Eastern District of Wisconsin, where Johnson filed the suit.   Johnson sued the Office of Personnel Management (OPM) in January over congressional staff guidance issued in regard to ObamaCare. Last year, the OPM issued a ruling allowing members and their "official office" staff to continue to receive federal healthcare subsidies on the newly created health exchanges.
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UPDATE 1-Medicare raises U.S. hospital payment rates for FY2015
Reuters
August 4, 2014
http://www.reuters.com/article/2014/08/05/usa-healthcare-medicare-idUSL2N0QA2DW20140805
The U.S. government said on Monday that it will increase the operating payments that acute-care and long-term care hospitals receive from Medicare for inpatient care for the federal fiscal year that begins on Oct. 1.  The Centers for Medicare and Medicaid Services (CMS) announced a 1.4 percent rate update for 3,400 acute care hospitals and a 1.1 percent rate update for 435 long-term care hospitals for fiscal year 2015.  Under a final rule released on Monday, CMS also said it would distribute $7.65 billion in payments to hospitals for uncompensated care, a decrease from the $8.56 billion it initially proposed.  The American Hospital Association said it was disappointed in the higher-than-expected payment cuts.  "Today's rule will make it more difficult for hospitals to maintain their commitment to their communities," Linda Fishman, AHA senior vice president, said in a statement. "These payments provide vital support to hospitals that serve the most vulnerable patients."  CMS said the decrease in uncompensated care payments for Medicare Disproportionate Share Hospitals, or DSH, was due to lower projected hospital inpatient spending and revised estimates for the percentage of individuals who are uninsured. 
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Senator Johnson to appeal Obamacare lawsuit's dismissal
WBAY
August 4, 2014
http://www.wbay.com/story/26183589/senator-johnson-to-appeal-obamacare-lawsuits-dismissal
U.S. Sen. Ron Johnson says he plans to appeal the dismissal of his lawsuit challenging rules that call for congressional members and their employees to seek government-subsidized health insurance through small-business exchanges.  The Milwaukee Journal Sentinel reports the Republican from Wisconsin made the comments in an opinion piece running Sunday. He says he feels compelled "to exhaust every legal recourse" as he challenges President Barack Obama's executive actions.  U.S. District Judge William Griesbach had ruled in July that Johnson and his aide, Brooke Ericson, didn't have legal standing to bring their lawsuit because they hadn't been injured, and that the Affordable Care Act and the U.S. Constitution afforded them other recourses than using the judicial system to settle the matter.  Johnson contends the rules twist the Affordable Care Act to ensure senators, representatives and their staffers continue to receive generous health insurance subsidies and place them above the American people.
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Medicare Reduces Payments for 2015 Hospital Admissions
Bloomberg
August 4, 2014
http://www.bloomberg.com/news/2014-08-04/medicare-reduces-payments-for-2015-hospital-admissions.html
Medicare, the U.S. program for the elderly and disabled, said payments for hospital admissions would fall $756 million next year as penalties stiffen for patients who return too early.  Payments for inpatient services at about 3,400 acute-care hospitals will be cut about 0.6 percent in 2015, the Centers for Medicare and Medicaid Services said in a regulatory filing, including reductions in funding for hospitals who provide care for many low-income patients, those with too many patients who contract infections while admitted and higher penalties for readmissions within 30 days.  The Obama administration has applauded reduced Medicare spending for hospital admissions, a trend encouraged by the Patient Protection and Affordable Care Act that has added 13 years to the life of Medicare’s key trust fund. The program’s actuaries have warned the payment cuts may not be sustainable as hospitals struggle to improve their efficiency.  “Today’s policies further support our efforts to continue improving the care our Medicare beneficiaries receive while also cutting the growth of Medicare costs,” Marilyn Tavenner, the administrator of the Medicare agency, said in a statement.
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White House appeals Obamacare subsidy case
Politico
August 1, 2014
http://www.politico.com/story/2014/08/obamacare-subsidies-white-house-appeals-109646.html
The Obama administration Friday asked a federal appeals court to grant another hearing in a case challenging Obamacare subsidies, and hours later, the court gave the subsidies opponents 15 days to respond to that request.  The Justice Department filed the petition with the U.S. Court of Appeals for the D.C. Circuit in the case Halbig v. Burwell. In a blow to the Affordable Care Act, a three-judge panel ruled last month that the subsidies can’t flow through the federal exchange, HealthCare.gov, but only through state markets.  That same day, a separate three-judge panel of the Fourth Circuit in Virginia issued a contradictory ruling that the subsidies were allowed in both state and federal exchanges. The plaintiffs this week petitioned the Supreme Court on that case, King v. Burwell, rather than ask for a broader review at the appellate level.  “The majority erred by purporting to discern the plain meaning of one provision before considering all relevant provisions of the act,” the government’s petition in Halbig says. The administration had said it would appeal and filed in less than two weeks.


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