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Affordable Care Act (ACA)

The Hill: CMS Suggests More Glitches to Come with Obamacare
Testifying before a subcommittee, CMS Deputy Administrator Andy Slavitt said that the agency expects more bumps in the second year of Obamacare implementation and healthcare.gov. Also, Bloomberg
Vox: Kentucky's Uninsured Rate Falls After ACA Implementation
This article includes a county-by-county breakdown of the percent of people without insurance before and after the ACA. It's clear the law dramatically reduced the number of people without insurance.
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Employer Sponsored Insurance

Georgetown HPI: Data Suggest Children Use ED When They Have No Other Source of Care
This post summarizes a study finding uninsured children or with Medicaid coverage are much more likely than those privately insured to use the emergency room because they have no other source of care.
KFF: California, the State with the Highest Uninsured Rate, Sees Huge Growth in Coverage
Roughly 58% of CA's uninsured residents last fall now have insurance coverage through Medicaid, employer-sponsored insurance or qualified health plans purchased via Covered California. Also Vox, KHN,
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Doctors

House Small Business: At Hearing, Witnesses Cite Promise of Telemedicine, Point to Licensure, Reimbursement Barriers
The House Committee on Small Business’ Subcommittee on Health and Technology hosted a hearing about the uses and possibilities of telemedicine. Moderated by Subcommittee Chairman Chris Collins (R-NY), the hearing featured testimonies from four witnesses, who focused on telemedicine applications for small practices. These speakers included:
  • Karen Rheuban, senior associate dean for CME and external affairs director at UVA (testimony)
  • Megan McHugh, research assistant professor at the Feinberg School of Medicine at Northwestern University (testimony)
  • Maggie Basgall, community development specialist at Nex-Tech (testimony)
  • Brenda Dintiman, a dermatologist at Fair Oaks Skin Care Center (testimony)
Themes of the discussion included the efficacy of telemedicine applications, medical care accessibility through small practices and major barriers to incorporating telemedicine, such as licensure regulations and a pronounced lack of reimbursement options. Both Members and witnesses agreed that telemedicine is a promising field, but one that is currently hindered by insufficient support.
CMS: Fact Sheet: Internet-based Provider Enrollment, Chain and Ownership System for Providers, Suppliers
In an updated fact sheet, CMS addresses the "Basics of Internet-based Provider Enrollment, Chain and Ownership System (PECOS) for Provider and Supplier Organizations," including submitting and updating Medicare enrollment information.
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Prescription Drugs

WSJ: Drug Firms Bid Over FDA Voucher to Speed Drug Views
A $67.5M voucher gives the holder prioritized FDA drug reviews which can shorten the process from ten to six months. It is intended to encourage the development of drugs for rare pediatric diseases.
CBO: Report: Medicare Part D Costs Far Less than Initial MMA Projections
In a newly released report assessing competition and costs of the Medicare Part D prescription drug program, the CBO concluded that federal spending for Part D program is far less, roughly 50% lower, than what the independent budget and economic analysis arm initially projected when the authorizing MMA legislation was first enacted in 2003. The CBO’s analysis attributes a “combination of broader trends in the prescription drug market and lower-than expected enrollment in Part D” to the lower than anticipated spending.
  • Broader Trends in the Prescription Drug Market: The report states that, for example, that while “[m]any health care analysts, including those at CBO, expected in 2003 that growth in national drug spending would slow from the rapid rates observed in the late 1990s and early 2000s,…the magnitude of the slowdown that occurred surprised many observers.” Specifically, the CBO indicated that “[d]rug spending per person for the country as a whole [as well as per person in Part D] increased by only 2 percent per year, on average, between 2007 and 2010, compared with average growth of 13 percent per year between 1999 and 2003, the five-year period before enactment of the MMA.” The agency states that “[t]he greater-than expected slowdown that began after 2003 caused national drug spending in 2012 to be about 40 percent less than the amount predicted by analysts at the CMS in 2003.” The CBO goes on to attribute the slowdown in the growth of national drug spending per person to two main developments, namely that: (1) “[m]any existing brand-name drugs lost their patent protection and faced new competition from generic substitutes;” and (2) “new brand-name drugs…were introduced at a slower rate than in the late 1990s.”
  • Part D Enrollment Trends: The report also indicates that “enrollment in Part D has been smaller than CBO initially projected – by about 12 percent in 2012.” The CBO surmises that a possible explanation to lower beneficiary take-up is due to the fact “that beneficiaries need to make an active effort to enroll in Part D – unlike Part B, in which beneficiaries are usually enrolled by default and must take steps to opt out.”
The report also goes into further detail regarding the effects of competition between plan sponsors on Part D spending, as well as provides some comparative data regarding Medicare Part D and Medicaid fee-for-service (FFS) drug spending, including estimates regarding the application of Medicaid’s statutory rebates to drugs purchased by low-income Part D beneficiaries. Concurrent to the fuller Part D cost analysis, the CBO also released a “working paper,” the first of its kind to “examine the relationship between the number of competing plan sponsors and the cost of Part D during the program’s first five years.” According to the working document, the CBO estimated that, “among stand-alone plans that were not eligible to be assigned low-income beneficiaries, …each additional plan sponsor entering an 18-firm market was associated with a reduction in bids for a month of basic coverage to a beneficiary of average health of 0.4 percent—or $0.33 for a plan that bid $85…Because bids are used to directly determine government spending, [the CBO] estimate[s] that an additional plan sponsor nationwide was associated with a reduction in government spending of $7 million to $17 million each year.” Also, Sen. Hatch statement, Modern Healthcare ($)
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Medicaid – General

Georgetown HPI: Data Suggest Children Use ED When They Have No Other Source of Care
This post summarizes a study finding uninsured children or with Medicaid coverage are much more likely than those privately insured to use the emergency room because they have no other source of care.
KHN: Six States and DC Using State Funds to Extend Medicaid Pay Raise to Primary Care Docs
Authorized initially under the ACA, the federal funds expire next year and only six states and DC plan to use their own funds to sustain the Medicaid pay raise to primary care doctors.
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Health Information Technology (HIT)

House: Agriculture Subcommittee Panel Holds Hearing on Rural America's Broadband Access
The House Agriculture Subcommittee on Livestock, Rural Development and Credit held a hearing to address ways to expand broadband in rural areas through joint programs of the USDA and the FCC. The chairman, Rep. Rick Crawford (R-AR), and Ranking Member, Rep. Jim Costa (D-CA-16), both voiced their support for rural broadband programs. The chairman said, “the financial challenges that come with building out these services for rural areas should be a focus of lawmakers in both rural and urban areas of our country. I believe that the information provided at today’s hearing will serve as a springboard to more discussions about how to increase broadband access to the area that needs it most, rural America” In testimony, John Padalino, administrator of the Rural Utilities Service at the USDA, highlighted the important rule of broadband access with respect to healthcare in rural America. In his prepared remarks, he noted, “[i]nfrastructure investments offer returns for rural America-building, deploying, and using broadband increases access to health care and education, expands markets for businesses, and increases the quality of life for rural Americans.” Other panelists, including Lang Zimmerman, testifying on behalf of the National Telecommunications Cooperative Association emphasized the role of the rural telecom industry in facilitating outreach to Rural America, noting that the “rural telecom industry has always been at the forefront of technological innovation, being the first segment of the industry to completely convert to digital switched systems, provide wireless options to their hardest to reach customers, offer distance learning and tele-health applications…”
AHRQ: Report Distills Lessons in Implementing Clinical Decision Support Technology
A report identifies lessons and barriers to EHR-based use of clinical decision support, including incorporating the guidelines into varying EHR systems and "accommodating variability in practice size and integration into larger health systems," among other issues.
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Health Insurance Exchanges

The Hill: CMS Suggests More Glitches to Come with Obamacare
Testifying before a subcommittee, CMS Deputy Administrator Andy Slavitt said that the agency expects more bumps in the second year of Obamacare implementation and healthcare.gov. Also, Bloomberg
Vox: Kentucky's Uninsured Rate Falls After ACA Implementation
This article includes a county-by-county breakdown of the percent of people without insurance before and after the ACA. It's clear the law dramatically reduced the number of people without insurance.
View More

Hospitals

House Small Business: At Hearing, Witnesses Cite Promise of Telemedicine, Point to Licensure, Reimbursement Barriers
The House Committee on Small Business’ Subcommittee on Health and Technology hosted a hearing about the uses and possibilities of telemedicine. Moderated by Subcommittee Chairman Chris Collins (R-NY), the hearing featured testimonies from four witnesses, who focused on telemedicine applications for small practices. These speakers included:
  • Karen Rheuban, senior associate dean for CME and external affairs director at UVA (testimony)
  • Megan McHugh, research assistant professor at the Feinberg School of Medicine at Northwestern University (testimony)
  • Maggie Basgall, community development specialist at Nex-Tech (testimony)
  • Brenda Dintiman, a dermatologist at Fair Oaks Skin Care Center (testimony)
Themes of the discussion included the efficacy of telemedicine applications, medical care accessibility through small practices and major barriers to incorporating telemedicine, such as licensure regulations and a pronounced lack of reimbursement options. Both Members and witnesses agreed that telemedicine is a promising field, but one that is currently hindered by insufficient support.
CMS: Mass Adjustment of OPPS Claims for and July OPPS Provider Specific Files Now Available
In its MLN Connects newsletter, CMS announced that due to a "publication error of the National Unadjusted Copayment associated with Ambulatory Payment Classification (APC) 0066, Outpatient Prospective Payment System (OPPS) claims with a payment associated with APC 0066 were not processed correctly." The problem has now been corrected for claims with dates of service on or after July 1, 2014. Additionally, the OPPS provider data for July 2014 is now available in the “Downloads” section of the OPPS Pricer Code web page under “3rd Quarter 2014 Files.”
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Quality

CMS: Courses on Hand Hygiene, ICD-9 Offer Continuing Education Credit
Medicare Learning Network (MLN) courses on ICD-9 coding and infection control, the latter focusing on hand hygiene practices, offer continuing education credits for medical professionals. Details on MLN's web-based courses are available here (see "web-based training courses" under "related links" at the bottom of the page).
CMS: 2015 Quality Reporting Document Architecture (QRDA) Implementation Guide
CMS announced the availability of its updated Combined 2015 CMS Quality Reporting Document Architecture (QRDA) Implementation Guide. Specifically, this guide provides technical instructions for eligible professionals, hospitals, and critical access hospitals for QRDA Category I & Category III reporting for: The draft guide was published earlier this summer and CMS made some revisions responding to feedback. Specifically, "the new guide contains two main parts, as well as appendices that annotate changes:
  • “Part A is the harmonized QRDA-I implementation guide for both eligible professionals and eligible hospitals/CAHs.
  • “Part B is the QRDA-III implementation guide for eligible professionals."
As always, please let us know if you have any questions.
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Legal

Inside Health Policy: SCOTUS Dental Hygienist Scope of Practice Case Could Impact Other Provider Groups
In Oct., the Supreme Court will hear a case on if the NC dental board can block hygienists from opening teeth whitening clinics. The case could impact scope of practice rules for other medical groups.
National Journal: House Moves Forward on Lawsuit Against Obama
The House voted, almost entirely along party lines, to proceed with lawsuit to sue the President over executive actions related to Obamacare. Also, Reuters, AP, WSJ($), Modern HC($)
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Delivery Reform

CMS: Agency Provides Update on Ongoing Bundling Demo Implementation
A new fact sheet provides a more detailed look at CMMI's ongoing Bundled Payments for Care Improvement (BPCI) initiative. Under the BPCI initiative that was first announced in early 2013 and for which there are 4 main models, organizations “enter into payment arrangements that include financial and performance accountability for episodes of care,” with the intention of improving the quality and cost of care provided to beneficiaries under these innovative models. In addition to providing an overview of the BPCI initiative, the fact sheet provides an update the agency’s recent solicitation of additional entities to participate in Models 2-4 of the BPCI initiative. CMS notes that, “recently, CMS offered an additional Winter 2014 Open Period seeking submissions from additional entities for participation in BPCI Models 2-4.  The period ended on April 18, 2014 and many new participants from this offering were welcomed into Phase 1 in late June 2014. CMS is continuing to review submissions from the Winter 2014 Open Period and may accept additional participants in Phase 1.” Furthermore, CMS states that “Phase 2 began either on October 1, 2013 or January 1, 2014 for current Awardees that entered into Model 2 Awardee Agreements with CMS, at which point Awardees began the risk-bearing phase for some or all of their episodes. The complete transition of all episodes for all Episode Initiators to Phase 2 will be completed by January 2015. During the transition period, Awardees may transition episodes and or Episode Initiators that have remained in Phase 1 to Phase 2 on a quarterly basis.”
CMS: Guidance Explains SNF Billing Policy for Bundling Model 2
In a provider education article, CMS elaborates on a code that SNFs may use if employing a waiver of the 3-day inpatient hospital stay requirement in conjunction with Model 2 of CMMI's bundling demo.
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Prevention

AP: U.S. Warns Against Travel to West African Countries With Ebola
The CDC issued a travel warning for Americans advising them against non-essential travel to Guinea, Liberia and Sierra Leone. Roughly 700 people have been killed this year. Also, Bloomberg, Vox
: Surgeon General Pushes for Action on Skin Cancer
Skin cancer is the most common cancer and the easiest to prevent. The Surgeon General issued a report urging consumers to reduce their exposure to tanning beds and suns harmful rays. Also, NYT($)
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