A Brave New World of Transparency Reporting: CMS Launches Open Payments Website
The National Law Review
October 1, 2014
September 30th marked the launch of transparency reports under the Sunshine Act through a new Open Payments website hosted by the Centers for Medicare & Medicaid Services (CMS). Mandated by the Affordable Care Act, the Sunshine Act creates a regulatory scheme requiring drug and device manufacturers and group purchasing organizations (GPOs) to report a variety of information about payments and other transfers of value to physicians and academic medical centers. The first data reporting period was for August 2013 through December 2013, and this data is now available on the Open Payments website. Unlike last year’s launch of the federal health insurance exchange website, the Open Payemnts website appears to be working smoothly. CMS reported that the payment information includes over 4.4 million payments valued at nearly $3.5 billion. More than 26,000 physicians and 400 teaching hospitals registered through the Open Payments data system.
Judge rules against White House on Affordable Care Act
September 30, 2014
A federal judge in Oklahoma has ruled that Obamacare subsidies cannot go to residents of states that are not running their own insurance exchanges, a second blow to the Obama administration on an issue that threatens a key element of the health law’s coverage expansion. Judge Ronald A. White said that the administration’s decision to allow subsidies to go through either a state-run health insurance exchange or the federal exchange is an improper and invalid reading of the Affordable Care Act and must be struck. White’s ruling marks the second judgment against the government on the subsidy question and comes as the Supreme Court could decide whether to weigh in.
Anyone Really 'HIPAA Compliant' In Healthcare?
September 28, 2014
The short answer is yes ‒ many health related organizations adhere faithfully to both the letter and spirit of the healthcare legislation known as HIPAA. The challenging answer is no ‒ many health related organizations who claim to be “HIPAA Compliant” simply aren’t. The confusing answer is that many organizations that claim to be “HIPAA Compliant” have no such legal obligation. Passed in 1996, HIPAA stands for Health Insurance Portability and Accountability Act and there are two “rules” that apply to healthcare entities that handle Protected Health Information (PHI). The first is the Privacy Rule ‒ and the second is the Security Rule. These two rules work together to outline what Health and Human Services (HHS) requires as policies and procedures for handling PHI in all its forms (paper, electronic, images etc…). The Office of Civil Rights (OCR) under HHS is chartered with enforcing HIPAA and can leverage criminal and civil penalties for violations that occur with either “covered entities” or their partners as “business associates” ‒ both of which are defined legal terms.
Use of antipsychotic drugs cut in nursing homes
September 26, 2014
Georgia has reduced its use of antipsychotic medications on nursing home residents by 26 percent, one of the largest drops in the nation. The decrease, occurring from the end of 2011 to the end of 2013, was powered in part by a pilot program targeting the Georgia nursing homes that had the highest use of antipsychotics. Nationally, the prevalence of these drugs in long-stay nursing home patients dropped by 15 percent over that period, federal officials announced last week. The federal Centers for Medicare and Medicaid Services has pushed for a decrease in the use of antipsychotics in managing dementia patients in nursing homes. The medications increase the risk of death, falls with fractures, hospitalizations and other complications for nursing home residents, leading to high medical high costs, experts say.
Burwell Touts Obamacare Gains Heading to Next Enrollment
September 25, 2014
President Barack Obama’s new health secretary said Obamacare is expanding U.S. insurance coverage and lowering consumers’ health-care costs. She declined to predict how well the program’s enrollment system will work in November, when consumers begin a new year of sign-ups. Taking questions yesterday from reporters for the first time at a White House news conference, HHS Secretary Sylvia Mathews Burwell said insurance programs created by the Patient Protection and Affordable Care Act have reduced the nation’s uninsured population by 26 percent. She called the reduction “the most important number” to measure the law’s success. “For those of you covering the private sector, any market that grows at that rate in its first year, those results would be considered pretty extraordinary,” she said.
HHS: Health law will lead to big drop in free hospital care
September 24, 2014
The Affordable Care Act will lead to $5.7 billion in savings in uncompensated hospital care costs this year, the Obama administration said Wednesday, reducing one of the biggest financial challenges hospitals face. The states that expanded Medicaid so all low-income residents would have medical coverage will reap about 74% of the savings nationally, Department of Health and Human Services Secretary Sylvia Burwell said. Nearly 8 million additional individuals are now enrolled in Medicaid and the Children's Health Insurance Program (CHIP), compared with the number before open enrollment in the ACA Marketplace began in October 2013. Pennsylvania and New Hampshire recently joined the 25 states and the District of Columbia to expand coverage.
Burwell Steers Clear of Specific Pledges on HealthCare.Gov
The Wall Street Journal
September 24, 2014
Health and Human Services Secretary Sylvia Mathews Burwell told reporters Wednesday that officials are “continuing, step by step” in their effort to get HealthCare.gov ready to open for its second year of business in 50 days’ time but steered clear of specific commitments that have haunted officials who preceded her. In her first on-the-record question session with reporters since taking the top job at HHS, Ms. Burwell got several inquiries about whether the department’s preparations to fix and revamp the site were on schedule, and answered all of them without making the kinds of comments that people could hold against her later.
Administration Says Hospitals Will Save $5.7B From Unpaid Bills Due To Health Law
Kaiser Health News
September 24, 2014
Hospitals are projected to save $5.7 billion this year as previously uninsured patients gain coverage through the 2010 health care law, the Department of Health and Human Services said Wednesday. States that have expanded their Medicaid programs will see about 74 percent of those savings, an HHS report said. While 27 states and Washington, D.C. have expanded the federal-state insurance program for the poor to date, the survey was done when 25 states and D.C. had done so. “This is one of the reasons that we see hospitals and others supporting the expansion of Medicaid,” HHS Secretary Sylvia Burwell said at a briefing with reporters. While the health law required states to expand Medicaid, the Supreme Court made that optional.
"Critical" flaw found in HealthCare.gov security
September 23, 2014
The government's own watchdogs tried to hack into HealthCare.gov earlier this year and found what they termed a critical vulnerability - but also came away with respect for some of the health insurance site's security features. Those are among the conclusions of a report being released Tuesday by the Health and Human Services Department inspector general, who focuses on health care fraud. The report amounts to a mixed review for the federal website that serves as the portal to taxpayer-subsidized health plans for millions of Americans. Open enrollment season starts Nov. 15. So-called "white hat" or ethical hackers from the inspector general's office found a weakness, but when they attempted to exploit it like a malicious hacker would, they were blocked by the system's defenses.
Insurers’ bigger role suggests confidence in Obamacare
September 23, 2014
The insurance industry believes Obamacare is here to stay no matter who wins control of the Senate this fall. A lot more insurers plan on taking part in Obamacare next year — a 25 percent increase, HHS Secretary Sylvia Mathews Burwell announced Tuesday. She called it a sign that the administration is “making historic progress” in covering the uninsured. “When you consider the law through the lens of affordability, access and quality, the evidence points to a clear conclusion: The Affordable Care Act is working,” Burwell said at the Brookings Institution in one of her first major speeches as secretary. “And families, businesses and taxpayers are a better off as a result.”
Burwell: ObamaCare is working
September 23, 2014
Health and Human Services (HHS) Secretary Sylvia Burwell on Tuesday declared that ObamaCare is working in a major address aimed at changing the public debate about the reform law. Speaking at the Brookings Institution in Washington, Burwell said the Affordable Care Act has lowered the number of uninsured adults by 25 percent and lent security to families who might otherwise struggle with medical debt. "When you consider the law through the lens of affordability, access and quality, the evidence points to a clear conclusion. The Affordable Care Act is working — and families, businesses, and taxpayers are better off as a result," she told the audience. Burwell announced that the number of insurers in the marketplaces will increase by 25 percent next year, which she said is a sign of the system's health. The speech marked the second time in roughly two weeks that Burwell has argued publicly for "turning down the volume" in debates over the healthcare law. While the reform law remains unpopular, it is increasingly entrenched four years after its enactment.
Under Affordable Care Act, 25 Percent Increase in Health Insurers Is Predicted
The New York Times
September 23, 2014
Consumers in much of the country will have a broader selection of health insurance plans next year, the Obama administration said Tuesday, as it predicted an increase of about 25 percent in the number of insurers that are expected to compete in federal and state marketplaces. More competition will help hold down premiums, federal health officials said. The administration released preliminary data on insurers that have indicated they want to participate next year in the insurance exchanges, where the federal government subsidizes premiums for millions of people. So far, it said, the number of insurers, also known as issuers, is up to 315 next year, from 252 this year. For the 36 states served by the federal marketplace, it said, the number is up almost 30 percent, to 248 next year, from 191 this year.
U.S. government health agency sees 25 percent increase in Obamacare insurers
September 23, 2014
The number of insurers offering individual health plans on the Obamacare exchanges will increase about 25 percent in 2015 and that should keep down prices, the U.S. Department of Health and Human Services said on Tuesday in a report. More than 7 million people signed up for health insurance through the exchanges in 2014, which were created under President Barack Obama's national healthcare reform law and offer income-based subsidies. Next year, there will be 63 additional issuers in the 44 states for which it has data, the agency said in a report. Some insurers left the market, it said. Healthcare.gov, which sells insurance in 36 states, will have 248 issuers in 2015, an increase of 30 percent from 2014, it said. "We're seeing it as evidence that these are attractive marketplaces, and just from our casual review of investor communications by the firms, these are being seen as growth opportunities," an HHS official said.
Number of Obamacare insurers to rise by 25% in 2015
September 23, 2014
Obamacare's store is going to be a bit more crowded this year. The number of insurers set to sell health plans on Obamacare exchanges in the upcoming open-enrollment period is 25 percent higher than for 2014, as 77 issuers jump into that market, federal officials revealed Tuesday. Health and Human Services Secretary Sylvia Burwell said the boost in insurers willing to sell the new form of health insurance starting Nov. 15 is "a real sign that the Affordable Care Act is working." "When consumers have more choices, we all benefit," said Burwell, who announced the expansion in the number of insurers selling Obamacare plans during a speech at the Brookings Institution in Washington, D.C. HHS noted that prior estimates have shown a correlation between greater numbers of insurers and lower costs.
Antipsychotic use drops in Connecticut nursing homes, new data show
New Haven Register
September 19, 2014
Connecticut still ranks high among states in the use of antipsychotic drugs for elderly nursing home residents, but its rate of use has dropped 21.6 percent since 2011 – more than the national average -- new government data show. The data, released Friday by the Centers for Medicare & Medicaid Services, show that nursing home residents in Connecticut – many with dementia -- are still more likely to be given antipsychotics than their counterparts in 33 other states. But the state’s usage rate has declined more than the national average drop of 17.1 percent. “While quality improvement in the area of reducing off-label antipsychotic drug usage needs to be an ongoing effort, Connecticut’s skilled nursing facilities have achieved very positive change,” said Matt Barrett, executive vice president of the Connecticut Association of Health Care Facilities, which represents nursing homes. He said the state’s homes are making ongoing changes in “behavioral and health care practice” to further reduce reliance on antipsychotics.
Va. legislators approve budget deal, reject Medicaid expansion
The Washington Post
September 18, 2014
State legislators united across party lines Thursday to plug a $2.4 billion hole in the state budget but quickly reverted to bitter partisanship as they debated Medicaid expansion, with House Republicans ultimately killing a bill to expand the health-care program without giving it a formal vote. The House and Senate voted overwhelmingly to fix a projected shortfall in the two-year, $96 billion state budget by tapping the rainy-day fund and trimming spending at most state agencies and public universities. The votes came days after Gov. Terry McAuliffe (D) and House Speaker William J. Howell (R-Stafford) teamed up to announce a plan to bring state spending in line with a projected shrinkage of revenue, which Virginia leaders blamed on federal defense cuts. The bipartisan spirit did not extend to the rest of the special session, whose primary purpose was to debate McAuliffe’s top legislative priority: extending Medicaid to 400,000 uninsured Virginians.
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