Health Care Reform Memo Library
Monday memo: A health policy newsletter
The Monday memos are issued on a weekly basis, highlighting news from the previous week’s activities in the administration, and implications for the C-suite and various stakeholder groups. The purpose of these memos is to:
- Provide current news on various health care reform efforts
- Tease out how changes affect various stakeholder groups, including health plans, providers, life sciences companies, federal and state government, large employers, and most importantly, consumers.
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Explore our library of memos
- My take
- Implementation update
- IRS releases final rule on excise tanning tax: fitness facilities not assessed tax
- Chairman and vice-chairman appointed to the Long-Term Care Commission
- Report: MA enrollment increases
- CMS issues proposed rule on HIX, SHOP, premium stabilization and consumer protections
- Legislative update
- MedPAC recommends changes in Medicare payment policies
- FDA concerns about food safety
- CO-OP loan program gets attention from House committee; 5 of 24 considered at risk of non-performance
- Senators urge vote on compounding pharmacy bill
- Congress asks CMS to delay the Competitive Bidding Program for DMEPOS
- FDA issues cybersecurity warnings for medical devices
- Lawmakers call for an integrated EHR for Defense and Veterans Affairs by October 2016
- Senators question HHS on HIX navigators
- Medical, dental, nursing schools warned against hepatitis B discrimination
- State update
- Small-business exchanges not attracting plans
- State round-up: Medicaid
- State round-up: HIX
- State round-up
- Industry news
- Supreme Court: genes cannot be patented
- MGMA study: docs not prepared for ICD-10
- Physician compensation up in 2012; gap between specialist and primary care income significant
- Hospital ownership status linked to performance
- Research snapshots
- Quotable
- Fact file
- My take
- Implementation update
- HIX enrollment support through navigators and health centers: update
- House committee hearing about solicitation of funding for ACA enrollment
- Employers challenged to provide pregnancy benefits
- HHS launches call center to promote public awareness of ACA
- Senator Hatch seeks information about funding request for premium subsidies
- Legislative update
- White House hosts mental health conference
- Report: nearly 30% of uninsured adults eligible for Medicaid expansion in 2014 have a mental illness
- SGR repeal update: issues remain about funding, replacement for physician payments
- House passes track and trace bill
- CMS, ONC releases data promoting transparency
- State update
- State round-up: Medicaid expansion
- State round-up: HIX
- State round-up
- Industry news
- Report: premiums reduced as result of ACA
- Health care employment continued to trend up May: Bureau of Labor Statistics
- ACO risk sharing with commercial insurers, Medicare
- Medical spas: medical treatments and beauty treatments?
- Medical oncologist survey: Cancer drug shortage
- Immunotherapy strategy gets attention at national meeting
- Research snapshots
- Quotable
- Fact file
- My take
- Major elements of ACA wherein “evidence-based medicine” is a central feature
- Implementation update
- Final rule released on employer worksite wellness programs
- Small business coverage final rule released
- HIX update
- Legislative update
- Trustee report: Medicare trust fund solvent through 2026, Social Security through 2033
- This week: Congress in session, White House hosts mental health conference
- GOP Senators seek clarity around HHS fundraising for enrollment campaign
- CMS to make provider, consumer fraud data available for analytics by health plans
- SGR repeal framework to be discussed this week
- Hospital readmission rate drops
- Immigrants made 14.7% of Medicare contributions and account for 7.9% of its expenditures
- State update
- State round-up: Medicaid
- State round-up: HIX
- State round-up
- Industry news
- Physician data to be released after 33-year protection
- FDA official challenges drug class safety
- HIT spending
- Research snapshots
- Quotable
- Fact file
- My take
- Implementation update
- CMS: states to receive additional funding for Medicaid expansion
- States drop ACA duals program
- Hobby Lobby challenge to ACA heard in federal court
- Legislative update
- HHS: 50 percent of eligible physicians, 80 percent of hospitals have adopted EHRs
- Think tanks propose Medicare enrollees share in savings
- State fraud units can use federal funds for Medicaid data mining
- SGR status
- Lawmakers propose alternative for calculating medical practice cost differences
- Legislation to allow FDA to access user fees explored
- Compounding pharmacy, track and trace legislation advance in Senate
- Senator proposes blocking ICD-10 implementation
- Health care-related legislation introduced last week
- State update
- State round-up: HIX
- Medicaid expansion update
- State round-up
- Industry news
- Insurers announce exchange participation on state-by-state basis
- @Regulatory update: The cloud in life sciences—a regulatory perspective
- New coalition promoting medication adherence
- HIT oversight challenging to medical device manufacturers
- American Benefits Council seeks clarity on ACA employer reporting requirement
- Certified medical home experts recognized by NCQA
- Psychiatric manual controversial
- Actavis to acquire Warner Chilcott in $8.5 billion transaction
- Quotable
- Fact file
- My take
- Implementation update
- CBO updates ACA impact on coverage, costs
- CMS seeks Bundled Payments applicants
- New funds for innovation available
- 4th Circuit hears ACA challenge
- PCIP guidance released as program winds down
- CMS proposed rule would separate DSH payments from Medicaid expansion temporarily
- IRS, HHS release MLR guidance for certain organizations, Medicare Part C and Part D plans
- Legislative update
- Physician ban on hospital ownership challenged
- Tavenner confirmed
- House passes legislation to repeal ACA for 37th time
- Report: increases in premium prices due to ACA
- Track and trace legislation advances in Congress with bipartisan support
- Health care related legislation introduced last week
- State update
- State round-up: HIX
- Medicaid expansion update
- State round-up
- Industry news
- AMA membership up, revenues down
- Stem cell cloning promising as Oregon researchers
- SEC investigating political intelligence activity
- Jolie preventive mastectomy puts spotlight on genetic testing for cancer risk
- IOM: salt intake precautions not warranted; American Heart Association disagrees
- Immunotherapy market might be $20 billion annually
- Research snapshots
- Recent health spending trend might persist to produce longer-term savings
- Quotable
- Fact file
- My take
- Implementation update
- Three stages for the adoption of MU over five years
- Clinical effectiveness researchers receive $86.6 million in federal funding
- HHS releases funding to support health insurance enrollment in 2014
- GOP rejects IPAB
- FDA proposes reclassification of tanning beds
- Legislative update
- Medicare hospital pricing data released
- Mobile device legislation proposed; increased scrutiny of regulators
- Acting Director of CMS likely to be confirmed this week
- Appropriations bills expected in the House among controversy over spending caps
- Senate to hold hearing on NIH FY2014 budget request
- Capitol Hill briefing: patient centered medical home effectiveness not yet known
- GOP senators working to reinforce restrictions to accessing federal health programs for immigrants
- Recently introduced health care legislation
- Report: combining Medicare hospital, physician and prescription drug programs proposed
- Report: federal government could generate $264 billion by capping employer tax exemption
- State update
- State round-up: HIX
- Medicaid expansion update
- State round-up
- Industry news
- Study: gap between MU adopters, non adopters widening
- Study: slowdown in health costs might be long term trend
- Drug spending down 3.5 percent last year
- Home care industry rebasing harmful to sector
- HHS to partner with Archimedes in open source clinical analytics partnership
- Restaurant, retail trade groups challenge auto enrollment requirement
- Prostate diagnostic test promising
- Mesothelioma lawsuits gets media attention
- Research file
- ROI for EHR use is primarily driven by increased physician income, reduction in transcription costs
- Quotable
- Fact file
- My take
- Implementation update
- Upcoming implementation deadlines
- IRS releases rule on minimum value requirement in employer coverage, tax credits
- Roles of agents and brokers in HIX outlined by CMS
- Briefings with states implementing federally-run or federal partnership exchanges underway
- HHS releases shorter HIX enrollment application form, takes 7 minutes to enroll
- USPSTF adds HIV screening to preventive health guidelines
- States ask for more time before caps on state run high risk pools implemented
- Legislative update
- Medicare spending slowed in 2013; IPAB trigger not likely
- Hospices will see increase in payments in FY2014
- State update
- State round-up: HIX
- Medicaid expansion update
- Industry news
- Physician income up; steady decline in overall satisfaction
- Research file
- The Search for a Meaningful ROI for Patient Centered Medical Homes Continues
- Quotable
- My take
- Implementation update
- CMS announces outreach timeline for HIXs
- Democratic Senators voice concerns about ACA implementation
- Insurers indicate interest in federal exchange participation
- Biologics and biosimilars in the ACA
- PCORI plans national CER network
- CMS will use real-time data to evaluate ACO program
- New Part D, DSH regulations expected
- Additional 2,000 IRS employees needed for ACA implementation
- CMS releases measures and evaluation process for acute and LTCHs
- Senator questions Massachusetts waiver for insurance rating requirements
- Vote on bill to fund PCIP postponed
- Legislative update
- Security and privacy audit results reported; many problems unknown to organizations who are unaware of regulations
- Medicare DME competitive bidding program gets attention
- CMS proposes bigger rewards for Medicare fraud tips, denial of providers for violations
- FDA sequester cuts compromise food safety
- Fake medicine focus of FDA effort
- National drug strategy: continue pain pill addiction efforts, refocus on heroin
- Health care-related legislation introduced last week
- State update
- State round-up: HIX
- Medicaid expansion update
- State round-up
- Industry news
- Supreme Court hears oral arguments on patenting genes
- Myriad Genetics court ruling puts spotlight on patents
- Biotech manufacturers cautious about biosimilar drug market entry
- Naming for biosimilars point of tension
- Study: declines in U.S. biomedical and health R&D funding threaten global competition
- Autism risk diagnostic test
- Quotable
- Fact file: spotlight on drugs
- My take
- Implementation update
- Study: 25.7 million eligible for Affordable Care Act insurance subsidies
- ACA Prevention and Public Health Fund targeted to support HIX enrollment
- Analysis: 3.1 million newly covered under ACA adult-dependent mandate, 0.2 percent cost increase for employers
- CMS issued a notice on Early Retiree Reinsurance Program
- Major ACA provisions impacting acute hospitals
- Legislative update
- Senators propose national drug tracking program
- BPC proposes plan for $560 billion health spending cost-containment
- Final mental health parity regulations to be released in 2013
- GOP senators challenge health IT implementation efforts
- Health IT workgroup to recommend innovation and regulatory efficiency improvements
- Highlights: new health care legislation introduced last week
- State update
- State round-up: HIX
- Medicaid expansion update
- Industry news
- Diagnostics and therapeutics
- Health plans and coverage
- Delivery system (hospitals, post-acute, physicians, ancillaries, retail health)
- Public health and disease surveillance
- Research file
- Costs or profitability of hospital complications vary by payer
- Outcomes improve when physicians understand patient perspective
- Tests ordered in hospitals less when costs known to clinician
- Quotable
- Fact file
- My take
- Implementation update
- Final guidance for health insurance plans offering coverage through federal and federal partnership HIX
- Out-of-pocket expenses for health care may exceed $6,250 annually for some consumers
- Most (90 percent) consumers are unaware of the start date for HIX open enrollment
- Navigator program gets funding from CMS
- House Health Subcommittee recommends amendments to ACA
- Legislative update
- White House releases budget for FY2014
- HHS to extend safe harbors for EHR donations
- Tavenner testifies before Senate Finance Committee
- State update
- State round-up: HIX
- Medicaid expansion update
- State round-up
- Industry news
- Employer sponsored insurance decreased 10.1 percent between 1999 and 2011
- ACA implementation: 90 percent of employers have “moved beyond wait-and-see mode” but understanding is low
- Big data: insurer and health system team up to analyze implantable devices
- Employers challenge unhealthy employees’ health with sticks and carrots
- Survey: small business execs expect higher health costs, but most will keep coverage rather than pay a penalty
- Survey: industry preparedness for ICD-10 lagging
- Moody’s: sequestration impact on not-for-profit hospitals
- Study: sedentary lifestyle costly to employers
- Physicians urged to be cautious in using social media
- Quotable
- Fact file
- My take
- Implementation update
- Key ACA provisions impacting the medical device and biopharma industries
- Report: number of self-insured plans decreased but participant enrollment increased
- OIG report: information about health insurance plans for consumers on Healthcare.gov website inadequate
- HHS proposes new guidelines for HIX Navigator Program, does not allow insurance companies to provide Navigator services
- Legislative update
- President to release budget Wednesday
- SGR fix proposed in House committee
- Senate Finance Committee schedules hearing on Tavenner
- Meaningful use update: bill to exempt solo practices and physicians nearing retirement; request for safe harbor guidance
- District court rules in favor of emergency contraception coverage without age restriction
- State update
- State HIX update
- Medicaid expansion update
- State round-up
- Industry news
- Cuts to Medicare Advantage plans set aside; Part D rates announced
- Medical testing labs see growth but margin erosion; Medicare cost-sharing accelerates sector pressure
- Small business survey: ACA the major concern
- Generic drug makers challenge abuse deterrent requirements as anti-competitive
- IOM analysis: Medicare spending variation influenced largely by long-term care utilization
- India Supreme Court strikes down cancer drug patent
- Study: dementia costs $215 billion
- Research snapshots
- Mortality rates for Medicare beneficiaries in critical access hospitals higher than in non CAH settings
- Coverage expansion for children and impact on pediatrician workload
- Quotable
- Fact file
- My take
- Implementation update
- Medicare milestones
- Key ACA programs related to Medicare
- Deadline for Pioneer ACO participation extended
- Legislative update
- Congress on recess
- White House to release budget next week
- GOP wants HHS to restrict HIX implementation grants
- State update
- BHP Program guidance expected this year for states
- CMS issues final rule on Medicaid FMAP methodology
- CMS issues guidance about expansion using private plans, exchanges
- Medicaid expansion update
- HIX update
- State round-up
- Industry news
- MA FY 2014 payment adjustment expected today
- Report: incentives for value-based performance by providers missing in most health plans
- Commonwealth study: 84 percent of premiums to medical care, 1 percent of premiums for quality improvement
- FDA drug approvals: breakthrough designation for cancer drug, third drug for MS
- “Pay-to-delay” oral arguments in Supreme Court—ruling expected in June 2013
- Independent drug stores pursue challenge to PBM transparency
- EHR meaningful use dominated by big players
- Appeals court reverses decision regarding DSH payments for duals
- IOM: payment reform should target decision makers, not geographic variation
- Research snapshots
- ACA will cause medical claims costs to increase 32 percent for insurers; non-group individual market to grow 115 percent
- Quotable
- Fact file
-
- My take
- Implementation update
- Pioneer ACOs push for changes
- Survey: 78 percent unfamiliar with Medicaid expansion; 48 percent unaware of HIX
- HHS to direct insurance reforms in four states
- ACA elements directly impacting physicians and health professionals
- Legislative update
- Congress approves continuing resolution to fund federal operations through September
- Medical device tax repeal gets Senate approval; will not apply to smartphones
- Dental care added to Medicaid
- State update
- States focus on medical liability reform
- Health plan enrollees interested in HIXs if given choice to participate
- Report: 17 percent of uninsured are illegal or recently arrived immigrants not eligible for Medicaid expansion
- Moody’s: DSH cuts complicate Medicaid expansion decisions in states
- Report: transparency on hospital prices inadequate in states
- Medicaid expansion update
- Health exchange update
- Industry news
- Xeijanz case raises question of ROI for basic research funded by taxpayers
- @Regulatory update: compliance with Euro pharmacovigilance guidance
- Drug costs down 1 percent in 2012
- Pre-existing condition provision funded by $63 fee on privately insured
- FDA pre-emption doctrine in spotlight: Mutual Pharmaceuticals vs. Bartlett arguments heard in U.S. Supreme Court case
- QUEST quality improvement project projects $9 billion savings
- Gene therapy promising in cancer treatment
- FDA changes approval threshold for Alzheimer’s disease drugs
- Study: preventable hospital admission rates linked to community health status
- Lawsuit filed against IRS for HIPAA violation
- Research snapshots
- Physicians concerned about the future of the profession
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- My take
- Implementation update
- Status of implementation: ACA
- White House Economic Report: ACA slowing health care spending growth
- Expatriate health plans don’t have to comply with ACA until 2016
- White House, Democratic leaders make appointments to Commission on Long-Term Care
- Legislative update
- Congressional leaders introduce FY 2014 budget proposals: vast differences
- Senate introduces legislation to avoid government shutdown
- CMS amends Medicare Part B billing policies to allow hospitals to recover funds denied by RAC audits for inpatient services
- MedPAC submits biannual report to Congress
- State update
- Study: states that don’t expand Medicaid may increase employer health costs
- Medicaid expansion update
- State round-up: HIX
- State round-up
- Industry news
- Physicians not satisfied with EHRs
- Study: 80 percent of physicians would prescribe cheaper drugs if they had access to patients’ formularies and co-pay information
- Report: U.S. drug manufacturers shift patents to lower tax rate countries
- Report: medical student debt climbs to $170,000
- AHA: provider payment cuts will not curb health care spending
- CDC: “Nightmare bacteria” increasing in hospitals
- Tele-ICU: new guidelines from AACN
- Brand and generic drug manufacturers challenge FTC pay to delay position
- Research snapshots
- ROI for EHR use is primarily driven by increased physician income, reduction in transcription costs
- My take
- Implementation update
- Transparency in key ACA provisions
- Tavenner: enrollment push this summer
- CMS issues guidance on health plan certification requirements for HIXs
- Legislative update
- CMS releases 2013 HIT goals
- GAO report: MA plans received $3.2-$5.1 billion in overpayments
- FDA issues new plan to analyze risks and benefits of new drugs
- Report: VA transmitted sensitive personal data on unsecured networks
- House Republicans pass bill to avoid government shutdown
- Senators request report on prescription drug abuse prevention
- Congress asks FDA for mobile medical device apps guidance
- Medical disaster bill pending signature by President
- Dental therapists to address shortage of dental care
- Think tank proposes option for extending eligibility age for Medicare
- New health care bills introduced last week
- State update
- State round-up: HIX
- Medicaid expansion update
- State round-up
- Industry news
- Recap: HIMSS13 in New Orleans
- Study: MA cuts could result in 11 percent decrease in enrollment
- Chamber of Commerce encourages members to oppose tax on insurance plans
- AHIP study: Medicaid managed care plans provides higher quality care, better value for taxpayers
- Coalition proposes tax on sugary drinks
- Study: hospitals feel brunt of state Medicaid cost containment efforts
- FDA rejects hot flash medications
- Pfizer gets extension of patent for Celebrex
- FDA initiates surprise inspections of compounding pharmacies
- Physician payment reform recommendations released
- Research snapshots
- Study shows price transparency an issue for hospitals
- EHR alerts to physicians often overlooked, information overload cited
- My take
- Implementation update
- HHS issues proposed rule on enrollment for small businesses purchasing coverage through HIXs; significant for plans selling health insurance
- HHS issues final rule for benefit and payment parameters
- OPM issues final rule on multi-state plan HIXs
- IRS issues notice on annual fees to be imposed on health insurers per ACA
- CCIIO releases HIX implementation timeline
- HHS report: rate increase requests from insurance plans slowing
- Legislative update
- GAO analysis: health care costs will grow faster than overall economy for 75 years; ACA cost containment provisions helpful but not enough to reduce shortfall
- State update
- OIG survey: one in four states says it’s not likely to be ready to confirm eligibility and enroll individuals and small businesses in exchanges
- State round-up: HIX
- Medicaid expansion update
- State round-up
- Industry news
- AHIP: proposed cuts by CMS will increase Medicare Part C premiums for seniors by $50-90 per month
- AMA and McKesson announce collaboration to track molecular diagnostic tests
- Excise tax on medical devices
- Biotech manufacturers cautious about biosimilar drug market entry
- Study: mental health service utilization, costs increasing
- Research snapshots
- Nurse practitioners role in reducing primary care shortage
- Psychiatric disorders linked genetically
- My take
- Implementation update
- Health plans in exchanges get final rules on essential health benefits, actuarial value, and accreditation
- CMS issues final rule on insurance market rate review
- Mandatory participation in individual and small group market opposed by industry groups
- Legislative update
- Poll: public not well informed about sequestration update
- Simpson-Bowles 2.0
- New health care bills introduced
- GAO: Potential for fraud in Medicare, Medicaid, FDA high
- State update
- HHS announces grants to test new models of care delivery
- State round-up: HIX
- Medicaid expansion update
- State round-up
- Industry news
- HIMSS preview
- Hospital community benefits unrelated to profitability
- Consortium promotes limitations on unnecessary care in “Choosing Wisely” campaign
- FDA designates “breakthrough” status to novel cancer treatment
- Administration announces Brain Activity Map
- Video games to treat schizophrenia
- Global markets: Sanofi India Ltd. focuses on OTC products
- Analytics acquisitions
- GPOs to focus on technology
- Research snapshots
- Hysterectomies: robotic technology increases costs but does not improve outcomes
- Medicare costs for breast cancer screening above $1 billion, high regional variation
- My take
- Implementation update
- HIX readiness focus of Congressional hearing
- Final rule on EHBs actuarial calculations expected soon
- CMS issues guidance on MA, Part D MLR requirements
- Website launched to connect government databases
- Part D drug benefit guidance provided
- SOTU: President supportive of “modest reforms” to Medicare
- DOD: health care benefits not extended to same sex partners
- Fraud pursuits net 8 to 1 return: DOJ, HHS
- Legislative/regulatory update
- Sequester approaching: HHS, Senate scramble to come up with alternatives
- E&C Committee asks for clarification on HIPAA rules, mental health
- GOP congressional leaders seek details on 340B audits, recertification process
- Health legislation introduced last week
- State update
- Poll: majority favor Medicaid expansion
- State round up: HIX
- Medicaid expansion update
- State round-up
- Industry update
- Study: 1 in 3 health plans will fail ACA standards
- Report: few health IT security breaches, providers should prepare for new challenges
- BPC offers framework for health IT patient safety
- National nurses union partners with teacher union
- Research snapshots
- Bundled pricing transparency problematic for hospitals, consumers
- HIE lack standard quality and return on investment metrics
- CDC: hospitals report fewer health care-associated infections
- My take
- Implementation update
- CBO budget and economic outlook—new health care projections: spending, coverage assumptions, and cost of ACA
- Report: IRS did not receive adequate funding to implement ACA
- Commission on long-term care appointed
- Costs of ACA calculated
- Basic health plan implementation delayed to 2015
- Rate review rule in final review at OMB
- Legislative/regulatory update
- Permanent SGR fix proposed
- CMS proposes rule to reduce regulatory burdens for providers
- Tavenner nominated to top CMS post
- CMMI announces bundled payment program for kidney dialysis
- State update
- CMS guidance to states: Medicaid cost sharing for newly eligible
- State round-up: HIX
- Medicaid expansion update
- State round-up
- Industry update
- Survey: ACA’s major impact on how larger employers handle part-time employees
- Three updates on information-driven health care
- VA and DOD will not use a single EHR system
- AHRQ, CMS launch EHR for pediatrics
- Survey: implementation deadlines, infrastructure major challenges for CIOs
- FDA releases guidance on Alzheimer’s trial designs
- Research snapshots
- Alzheimer’s projected to triple in U.S. by 2050
- Death rates in acute care decreasing
- My take
- Implementation update
- CMS releases final rule on physician payments: increased restrictions, transparency required
- HHS, IRS issue proposed rules for minimum essential coverage, individual mandate exemptions
- HHS proposes expansion of contraception exemption for religious organizations
- IRS clarifies eligibility for HIX subsidies for those whose employer-sponsored coverage is not affordable
- GAO: ACA provides less generous tax credits for certain unemployed workers
- CMS announces bundled payment participants
- Legislative update
- Immigration reform takes center stage
- Debt ceiling suspended until May
- Senate Finance Committee compiles recommendations to reduce waste, fraud, and abuse
- House Democrats seek protections against employer discrimination in wellness program due to pre-existing conditions
- State update
- Survey: most states need to take legislative action to comply with ACA health insurance market reforms
- Health exchange update
- Medicaid expansion update
- State round-up
- Industry news
- HHS launches new web site for employers
- AMGA membership increases
- CMS: meaningful use payments $10.7 billion
- Applications for multi-state HIX plans being accepted
- Career Builder: health care to hire more but skilled talent a challenge
- Compounding oversight records sought
- Research snapshots
- Unlocking value in health plan M&A Sometimes the deals don’t deliver
- Comparing ACA and state level reporting requirements for charitable hospitals
- Cost-conscious behavior may not result in a larger savings for HSAs and HRAs
- My take
- Implementation update
- Deadline for notification of employees about HIX options extended
- NAIC wants states to maintain primary oversight role in HIXs
- Legislative update
- House passes debt ceiling suspension
- FDA panel votes to recommend painkillers move to more restrictive classification
- Fiscal cliff concession for kidney dialysis drugs revisited
- Hatch proposes changes to sustain Medicare
- DEA: marijuana a dangerous drug
- Study: VA overpayments for veterans’ disabilities
- Medicare overpayments
- Comparative effectiveness limitations sought in bill
- State update
- State priority poll: HIX, health insurance costs top list of public concerns
- HIX update
- Medicaid expansion update
- State round-up
- Industry news
- MedPAC: reinsurance premium increases examined
- Moody’s: outlook remains negative for not-for-profit hospitals
- Deals and consolidation
- Research snapshots (NEW!)
- Physician likelihood to prescribe brand-name drugs at consumer request
- Usefulness of electronic health records in quality measurement
- IPOs result in lower impact of innovation due to brain drain
- My take
- Implementation update
- Medicaid, HIX, and essential benefits coordination: HHS seeks to streamline and simplify
- CMS: quality measures for Medicaid medical homes announced
- MACPAC likely to propose 12-month continuous eligibility for CHIP and Medicaid beneficiaries to reduce churning
- CO-OPs ask for funds to be restored
- Legislative update
- Security and privacy rule increases penalties, risk for providers and their business associates; new rule take effect September 21, 2013
- Sequester means 6.4 percent cut to NIH funding
- Gun control executive orders issued by the White House
- FDA: bare metal hip implants devices face increased regulatory scrutiny
- House Dems propose public option through HIXs
- Meaningful use for critical access hospitals and physicians
- State update
- Update: health insurance exchanges
- Update: Medicaid expansion
- State round-up
- Industry news
- Hospitals seek elimination of Section 3141 of the ACA
- Industry groups reactions to Stage 3 meaningful use guidance
- Study: Mobile apps in skin cancer detection have high degree of error due to image resolution
- My take
- Implementation update
- 106 new ACOs, CMS announces
- Update: leadership changes important to ACA implementation
- Legislative update
- Senators challenge Medicare Part C (MA) and D (prescription drug discount) fraud prevention efforts
- DEA seeks tighter control over pain medications
- FDA issues draft guidance on tamper resistant drugs
- MedPAC: Congress should increase hospital payments
- CMS management of meaningful use funding gets attention
- CDC: flu reaches epidemic levels in some states
- SCOTUS will not hear case disputing federal funding for stem cell research
- FCC: $400 million for rural health tele medicine
- Health legislation introduced as the 113th Congress convenes
- State update
- NGA: Medicaid spending up 10 percent last year; health care states’ number one cost problem
- EHB plans in states
- State round-up: Medicaid expansion
- State round-up
- Industry news
- U.S. health care spending increased 3.9 percent in 2011 – third consecutive year in 2011
- Report: U.S. fares worse than peer countries in health outcome
- NY hospitals to link physicians pay to performance
- Study: spending on alternative health increased 6 percent
- RAND commentary: health IT results disappointing
- Study: GME redistribution fails to increase primary and rural health care providers
- Report: malpractice system inefficient—physician spend years with open, unresolved claims
- Hospital staffing up 1.1 percent in 2011
- UK: private sector contracting with National Health Service draws attention
- Nurse unions announce formal affiliation
- Myriad Genetics court ruling puts spotlight on patents
- My take
- Implementation update
- ONC seeks public comment on HIT Patient Safety Plan
- CCIIO: guidance on state-partnership exchange model, new deadline for declaration of intent to transition from partnership to state-based model
- IRS provides guidance on employer shared responsibility
- Update: court challenges—Hobby Lobby will not cover contraception services
- Key agencies with ACA implementation responsibility in 2013
- CMS: cancer, kidney specialists might run their own ACOs
- Legislative update
- Congress passes American Taxpayer Relief Act to avoid fiscal cliff: sequestration, debt ceiling ahead
- Medicare in the spotlight in 113th Congress
- Congress responds to Newtown, final rule on MHPAEA requested
- Study: Medicare, Medicaid should incorporate physician payment incentives used by private plans
- State update
- CMS releases guidance on conversion to MAGI calculations for Medicaid expansion eligibility
- Abortion legislation
- Study: states spend 2 percent of tobacco settlement funds on smoking cessation
- State round-up: health insurance exchanges
- State round-up: Medicaid expansion
- Industry news
- Value-based purchasing: year one results for hospitals
- Meaningful use update: majority of hospitals, one-third of medical practices registered
- HHS: first HIPAA breach involving fewer than 500 records
- Study: MA use rates lower than FFS
- Study: hospice operator survey
- Study: pill coloring linked to medication non-adherence
- Study: access to psychiatric patient records in hospitals
- My take
- Implementation update
- ACA implementation calendar: 2013
- Contraceptive coverage rule legal challenges: update
- PCORI releases funds for CER research
- School-based health centers receive $80 million in federal funding
- Patient advocacy groups encourage broader drug coverage in EHBs
- ACA premium tax credits challenged; Congressmen believe they can only be accessed through state-based health exchanges
- Legislative update
- Update: fiscal cliff negotiations
- House GOP introduces Spending Reduction Act of 2012; White House vows veto
- Social security cuts on table using “chained CPI”
- Specialists seek permanent fix for SGR as part of deficit reduction, fiscal cliff negotiation
- FDA seeks to coordinate oversight of compounding pharmacies with states
- Defense bill expands abortion coverage for military women
- GAO report: CMS and CMS Innovation Center services overlap
- State update
- Twenty-three states receive CHIPRA bonuses
- Medicaid 24 percent of average state budget; ten states in the red
- State round-up
- Health exchange update
- Medicaid update
- Industry news
- Hospital systems starting their own insurance plans
- Study: repeat testing common among Medicare beneficiaries
- Study: length of stay drop in VA hospitals
- Study: ‘never events’ frequent
- Study: obesity, stress, and exercise top employer concerns
- Study: employer premiums increases passed through to employees
- My take
- Implementation update
- 18 states and DC to run state-based exchanges
- Private and public exchanges
- Recent guidance to states
- Legislative update
- Fiscal cliff update: economists estimate impact of fiscal cliff to Joint Economic Committee
- Think tanks issue fiscal cliff recommendations
- State update
- Fiscal health of states improving but lag pre-recession revenues: NGA
- State legislative make-up: blue or red, not purple in most
- Medicaid expansion update
- HHS gives HIX conditional approvals
- Industry news
- Study: ACA insurance requirements increase premiums 1.9-2.3 percent
- Study: insurance costs 20 percent or more of household income for 80 percent of population
- Study: access barriers to primary care increase ER visits
- Information-driven healthcare: BPC report spotlights adoption gap, HHS cautions about mHealth privacy and security
- CRS: federal funding for health-related R&D 21.5 percent of total R&D budget
- Nurse practitioner groups merge
- GAO report: payments for dialysis care in 2011 higher than necessary due to drug costs
- Meaningful use update
- My take
- Implementation update
- IRS releases final rule on medical device tax, PCORI funding; proposed rule on Medicare tax for higher income individuals and employers
- HHS: donut hole savings $677 per beneficiary in 2012
- CMS CIO: ACA data requires major expansion of storage capacity, consolidation of data centers
- DOL reports to Congress on self-insured plans
- CMS releases interim final rule on EHR incentive program
- Legislative update
- Fiscal cliff negotiations, grand bargain center stage in DC; opening proposals reflect spending cuts in health programs
- Related: upcoming deadlines in budget negotiations
- Medical groups oppose cuts to primary care to pay for one year SGR fix
- Compounding pharmacy law introduced
- State update
- State round-up: health insurance exchanges
- State round-up: Medicaid expansion
- State round-up
- Industry news
- Study: high deductible insurance users delay care due to out of pocket costs
- Supreme Court to hear case on “pay for delay”
- Survey: employers pursue wellness strategies
- Mental-disorder diagnosis criteria updated
- Survey: nearly 40 percent of physicians using EHRs
- OIG files lawsuit against SNF for overbilling
- MedPaC recommends 1 percent payment increase for hospitals
- FDA labeling requirement for tobacco manufacturers deemed a first amendment violation in appeals court
- Study: administrative costs (overhead) in individual insurance market down; up slightly in group market
- Study: consumer protections in Medicare Advantage dual-eligible programs vary widely across states
- Mobile health used widely by clinicians
- My take
- Implementation update
- CMS requests input on quality measurements for health plans in health exchanges
- New proposed rules released for multistate plans, ACA benefit and payment parameters, effective 2014
- CBO analysis: increased access to medications via Part D reduces utilization and costs
- Update: court challenges to religious freedom arguments against ACA
- Legislative update
- ONC sets sights on stage 3 meaningful use
- Related: e-prescribing accelerating
- Related: CMS announces EHR meaningful use extension for hospitals hit by Hurricane Sandy
- Upton appoints clinicians to leadership roles in key health oversight committee
- GOP physicians pursue repeal of ACA
- State update
- Report: Medicaid expansion costs to states
- State round-up: health exchanges
- State round-up: Medicaid expansion
- Industry news
- AMA study: health plans control anticompetitive markets
- Study: 70,000 cases of breast cancer over diagnosed in 2008, 1.3 million over 30 years
- USPSTF updates recommendations for Hepatitis C screening
- Extending prescription drug expiration dates as a cost-saving strategy
- Leapfrog analysis: hospital safety improving gradually
- Report: 25 to 31 million receiving care through accountable care arrangements
- Study: health insurance plans smoking cessation efforts challenging
- Study: medical homes ROI inconclusive
- District court ruling: tobacco companies ordered to admit deception
- Energy drinks: FDA takes closer look
- Compounding pharmacy update
- My take
- Implementation update
- HHS provides guidance on EHB, premium pricing, and wellness programs
- PCORI board adopts methodology strategy for CER
- Court challenge to contraception requirement denied
- Legislative update
- HHS priorities in 2013
- Senate committee requests information from state pharmacy boards
- HIV screening recommended for all Americans
- SGR temporary fix to cost $25.2 billion, $7 billion above prior estimate
- State update
- Survey: state health departments modernizing IT systems
- Industry news
- Hospital EHR deadline this Friday
- Meaningful use loans available
- Medicare claims data released
- Study: use of allied health professionals in primary care increases efficiency, panel size
- Study: e-visits associated with fewer diagnostic tests, more prescriptions
- Study: portal use associated with higher utilization of services
- My take
- Implementation update
- HHS extends health insurance exchange deadline
- Forthcoming federal guidance on the ACA
- Bible-publishing company legal challenge to contraceptive requirement to be heard
- PQRI: physicians face quality reporting penalty
- Legislative update
- GAO report: CMS fraud prevention system behind schedule, key to replacing “pay and chase” strategy
- CMS updates Medicare payment rules
- House GOP leaders introduce plan to streamline House oversight of health care legislation
- Health IT safety for consumers focus of attention
- Congressional hearings on meningitis outbreak, intensified attention to compounding center regulatory oversight
- State update
- State round-up
- Industry news
- Channel choking strategy extends to shippers
- Study: pay for performance linked to reduced mortality
- Medical device industry pushes for excise tax repeal
- AARP asks Congress to override scheduled SGR cuts while replacing the SGR
- OIG: upcoding prevalent in skilled nursing
- Report: primary care physician workforce needs 2010-2025
- WellStar acquires Center for Health Transformation
- Drug distribution group urges Congress to pass track and trace legislation
- Report: deficit reduction plans should protect seniors
- Organ donation regulators want hospitals to do more to protect kidney donors
- HHS announces first external innovation fellows
- Gene discovered that predicts Alzheimer’s
- FDA publishes data about energy drink risks
- Life after Lipitor: research focuses on protein
- My take
- Implementation update
- Health insurance exchange deadline extended
- DOJ defends the ACA in DC District Court
- Legislative update
- Fiscal cliff negotiations begin
- Lame duck session agenda
- Sequestration and the ACA: what might change?
- Report: CBO outlines health related deficit reduction opportunities
- Tax changes scheduled January 1, 2013
- IT incentive funds through Medicare, Medicaid top $7 billion
- State update
- Key ballot initiatives last week
- Opinion: CMS will allow flexibility on Medicaid expansion
- State round-up
- Industry news
- Study: less experienced physicians account for higher health cost
- Study: non-licensed caregivers provide complex chronic care management; role needs
- Smaller primary care practices face resistance to change necessary to participate in medical home pilots
- Some employers opt for part time workers in lieu of full time to avoid ACA mandate
- Report: providers seek increased capabilities from information technology vendors
- Hearing on compounding pharmacies scheduled
- Study: multivitamins do not cut heart attack risk
- Humana acquires provider, analytics capabilities to expand in Medicare, Medicaid markets
Memo: Special edition - November 7, 2012
- My take
- My take
- Implementation update
- Department of Justice will not contest Supreme Court decision to hear Liberty University challenge
- FTC: success of ACOs, anti-trust oversight focus of agency efforts to cut health costs
- Legislative update
- HHS issues rules on Medicare, Medicaid physician pay, outpatient payments
- Public health emergency declared in New York
- GAO: Medicare Part D discount program does not increase drug prices
- AHA pursues lawsuit against HHS for denied reimbursements
- Legislation introduced to allow veterans to access FEHBP for dental and vision
- Massachusetts lawmaker introduces compounding pharmacies regulation
- HHS backs flat-rate payment arrangement
- State update
- State round-up
- Industry news
- Beaumont-Henry Ford merger
- Walmart announces carve out strategy
- BMJ: published studies must provide access to scientific documentation
- FDA examines equivalence of generics
- Gene mapping project accelerates personalized medicine opportunities
- Deloitte acquires data analytics firm Recombinant
- Report: significant geographic variation in teaching hospitals
- AHIP releases application for health care spend
- Ameridose recalls all products 'out of an abundance of caution'
- GAO: providers self-refer imaging services hurting Medicare
- AHA urges MEDPAC to reconsider “site neutral” physician payments
- Groups urge pricing transparency in health care
- My take
- Implementation update
- Study: premium rate review
- CMS: 2.3 million Medicare beneficiaries saved an average of $657 on prescription drugs
- Physicians hesitant to participate in Medicare with looming SGR fix
- Study: safety net hospitals hurt by cuts in DSH payments, lower Medicaid enrollment
- Legislative update
- Class action lawsuit settled, Medicare enrollees with long-term medical problems entitled to coverage
- Study: Medicaid block grants could cut $1.7 trillion in Medicaid
- Compounding update: compounding pharmacy license revoked, CDC finds facility contaminated
- House GOP claims HHS improperly using tax dollars in promoting ACA
- Senate HELP Committee seeks feedback on track and trace system policy change
- State update
- State employee health costs
- Massachusetts health department officials issued warnings to compounding center
- State round-up
- Industry news
- Report: decline in the number of employers offering retiree health benefits
- Updated recommendations for cervical cancer screening and hormone therapy
- Report: medical devices spending up almost 1 percent
- Study: declines in U.S. biomedical and health R&D funding threaten global competition
- My take
- Implementation update
- Study: premium support could raise premiums for most Medicare enrollees
- Study: Medicare Advantage payments will be 102 percent of traditional Medicare FFS
- Study: notable increase in Medicare Advantage, Part D ratings
- CMS update: concerns over dual eligible demonstration projects
- Employers challenging contraception requirement in courts
- Legislative update
- Deficit Reduction Commission leaders launch education effort
- Senators urge HHS to require autism treatment in health plans, create national standard in essential health benefits coverage
- Senate Finance Committee requests documentation of fraud efforts using CMS new predictive analytics program
- Senators request meeting with CMS and ONC staff to discuss Stage 2 Meaningful Use
- Physicians urge Senators to replace SGR using industry principles
- Legislation to reform RAC program introduced in the House
- State update
- State round-up
- Industry news
- Walgreens announces medication management program to reduce hospital readmissions
- Trinity Health, Catholic Health East explore consolidation
- Pediatricians encourage removal of guns at home
- Fungal meningitis outbreak prompts further investigation
- My take
- Implementation update
- Study: ACO savings limited
- Health insurers show little interest in providing coverage across state lines
- Comparative effectiveness research doesn’t always translate to better outcomes for patients
- Health reform polling roundup: public spilt on changes to Medicare
- Legislative update
- OIG: CMS not protecting Medicare enrollee personal health information optimally
- Fungal meningitis outbreak prompts legislative action toward compounding pharmacies
- MedPAC: 25 percent of Medicare admissions preventable
- GAO: Medicare, Medicaid, CHIP fraud efforts
- State update
- State round-up
- Industry news
- GOP House members seek halt to meaningful use; HIMSS opposes
- Study: ACA impact on employer sponsored coverage, costs in 2012 negligible
- PBM trade groups offers recommendations for reducing Medicare drug costs
- My take
- Implementation update
- Avoidable readmission program starts
- DOJ announces arrests for Medicare fraud
- Supreme Court may hear more cases challenging the ACA
- GAO report: DOD and VA ineffective in collaboration on health care
- Commonwealth Fund analysis of health care coverage
- Legislative update
- ICD-10 corrections released
- GOP lawmakers challenge use of funding for meaningful use
- State update
- Study: state formularies vary widely
- Study: Medicaid expansion associated with reduced mortality and improved health status
- State round-up
- Industry news
- Solicitor General’s Office asks U.S. Supreme Court to rule on pay-to-delay
- BPC survey: electronic health information sharing issues—interoperability, cost big issues, privacy or security not significant
- Report: Medicaid managed care entities are hiring ineligible providers
- Census report: use rates for doctors, nurses down
- FDA reminds generic drug facilities of requirement to self-identify
- Study: cost at end of life
- AMGA defines high-performing health system; six attributes
- Online pharmacies target of FDA global closure effort
- Compounding pharmacies get scrutiny as result of steroid injections
- My take
- Implementation update
- HHS provides funding for mental health workforce expansion targeting at-risk populations
- CMS: new initiative to study avoidable hospitalizations for nursing home residents
- Health insurance exchange update: guidance for multi-state plans
- Report: safety net providers critical for ACA’s insurance coverage provisions
- Hospitals submit comments on IRS charitable hospital rule
- Legislative update
- House bill proposes CBO expand projections for prevention and wellness programs
- FDA receives approval from Congress to collect funding from the generic drug industry
- State update
- Health insurance exchange update
- State round-up
- Industry news
- mHealth task force releases recommendations for expanded use of mobile health
- HHS, DOJ warn about fraud in hospitals
- Military leaders say junk food is a threat to national preparedness
- My take
- Implementation update
- Sequestration and the Affordable Care Act: looking ahead
- Study: unexpected cost-sharing under ACA’s prevention benefit
- PCORI: $96 million for clinical effectiveness research projects
- Senate Special Committee on Aging examines Medicare fraud in use of motorized wheelchairs
- Legislative update
- Bipartisan Policy Center: health care cost drivers
- Congress passes Continuing Resolution for FY2013
- Congressional activity on health bills in the final week before recess
- DOL grants $500 million for HIT workforce training
- HHS hiring, compensation constraints sought in House legislation
- Senators searching for middle ground on deficit reduction
- State update
- Health insurance exchange update
- Medicaid expansion update
- State round-up
- Industry news
- CMS: Medicare Advantage enrollment, premiums in 2013
- Wal-Mart and HumanaVitality partner for healthy eating initiative
- Study: upcoding costs Medicare $11 billion
- Hospitals oppose changes to non-emergency coding payment caps
- UnitedHealth joins the Dow; health care prominent
- Study: health information exchanges struggle to prove ROI
- My take
- Implementation update
- White House releases sequestration report, specifies cuts
- HHS: rate review and MLR provisions in the ACA save $2.1 billion for consumers
- CMS to states: October 2012 essential health benefits expectation
- AHRQ: improving medication adherence can lower health care cost
- Study: ACO savings in dual eligible population
- Hospital readmission formula being reconsidered to account for patient risk factors
- Legislative update
- MedPAC suggests standardization of premium support programs in Medicare
- House Energy and Commerce Subcommittee on Health legislative approvals
- House Ways and Means Oversight Subcommittee hearing: administrative burden of ACA
- House passes six month stop-gap measure for FY2013
- State update
- State round-up
- Industry update
- U.S. Census Bureau report on insurance in 2011: commercial coverage stable, household income down
- Health insurance premiums increase 4 percent in 2012
- IOM: major drivers of waste
- Trade groups: sequestration will hurt FDA effectiveness, increase industry fees
- Regulatory focus on weight loss products
- My take
- Special feature
- Implementation update
- IRS provides guidance to employers on shared responsibility requirement
- Guidance on 90-day waiting period limitation for employee health coverage issued
- ACA civil rights protections apply to individuals who are transgender
- Legislative update
- Expanded mental health services for veterans and service members authorized by Executive Order
- State update
- HHS collaborating with states in education about health exchanges
- State round-up
- Industry update
- Study: hospital-acquired urinary tract infection data inaccurate
- FDA approves new orphan drug for cancer patients
- Study: silent heart attacks common, may predict risk of death
- Study: consumer satisfaction slightly higher among enrollees with traditional plans compared to high deductible plans
- Study: wide variation across markets in quality, costs
- IOM: better use of technology needed to reduce cost
- My take
- Implementation update
- GAO studies impact of ACA on employer-sponsored insurance
- Illegal immigrants are ineligible for HIX subsidies or PCIP program
- Legislative update
- Report: U.S. could reduce drug costs if reference pricing, comparative effectiveness implemented
- CDC, HRSA fund improvements in public health programs
- State update
- GAO study: Medicaid long-term care validation highly variable in states
- Study: Medicaid match cuts might expose states to higher Medicaid obligations
- State round-up
- Industry update
- Feds notify hospitals of fraud liability for wrongly implanted heart devices
- Merck files petition for Supreme Court to rule on pay-to-delay agreements
- FDA approves HIV combination therapy, novel treatment for cancer in children
- WellPoint seeks new CEO
- My take
- Implementation update
- Medicare reforms to be in spotlight at conventions
- CMS announces participants in primary care management services for Medicare FFS beneficiaries
- Administrative simplification final rule issued re: provider identification standardization
- ICD-10 delayed to October 1, 2014, included in health plan identifier final rule
- Legislative update
- CMS releases final rule for Stage 2 meaningful use
- Related: AHA urges FCC to modify Internet program to enable meaningful use by rural hospitals
- CBO releases budget outlook update, marks down forecast for Medicare spending
- State update
- Moody’s: states’ decisions on Medicaid expansion not likely to affect credit ratings
- State Round-up
- Industry update
- Aetna to acquire Coventry in $7.3 billion deal
- Retail health: Walmart offers expanded preventive health services
- U.S. Court of Appeals halts implementation of FDA’s graphic warning labels on cigarettes as companies win freedom of speech appeal
- Survey: many Americans make poor choices when choosing health benefits
- Study: medical residents expect to practice in groups, receive signing bonus
- My take
- Implementation update
- Physician-owned hospital restrictions in ACA upheld in Texas court challenge
- Study: 65 percent of hospitals could face penalties for avoidable readmissions
- Community-based Care Transition awards
- Cohen to head CCIIO, succeeds Larsen
- House Republicans request information about CDC Prevention Fund Grants
- HHS announces collaboration with retail pharmacies to educate Medicare beneficiaries about ACA free services
- Report: being “old” ain’t what it used to be
- Legislative update
- FTC has no plans to challenge the Generic Pharmaceutical Association’s Accelerated Recovery Initiative
- Major government agencies focused on mental health
- State update
- Medicaid system modernization still required if state does not expand enrollment
- CCIIO issues “blueprint” for state health exchanges, reinforces federal flexibility
- Politico: governors’ races will impact ACA implementation
- Industry update
- Consumer advocates encourage HHS to standardize insurance plan eligibility, rate setting and enrollments to align with ACA
- Study: hospitals not inclined to pursue ACOs
- GAO: health risks of mobile devices needs attention
- Implementation update
- CMS to states: OK to drop expansion coverage after implementation; states want flexibility
- HHS releases administrative simplification rule for electronic transactions
- Legislative update
- President Obama signs Sequestration Transparency Act of 2012
- House bill challenges individual mandate as a tax
- State update
- Industry update
- FTC has no plans to challenge the Generic Pharmaceutical Association’s Accelerated Recovery Initiative
- FDA announces guidelines to expedite device reviews
- Study: enrollment increases in health savings accounts significant led by larger companies
- Study: bend in cost curve not caused by recession
- My take
- Medicare milestones
- Implementation update
- Medicare hospital payments for FY2013 tied to ACA programs: inpatient hospital to increase 2.8 percent, outpatient 2.1 percent
- MLR rebate checks sent last week; 14 percent of plans pay out $1.1 billion
- Legislative update
- Congress reaches agreement to avoid government shutdown
- DOJ: Supreme Court should not take on Medicare secondary payer case
- Fraud efforts in spotlight: Senate Finance inquiry into the CMS FPS; GAO analysis of Medicaid payments
- State update
- Massachusetts passes sweeping health reforms aimed at capping costs, changing delivery system
- Maine seeks Medicaid waiver
- States: child abuse gets attention, connecting health and human services
- Industry update
- ONC seeking mobile application developers for Million Hearts Risk Check Challenge
- ONC seeking mobile application developers for Million Hearts Risk Check Challenge
- My take
- 2012 Deloitte Survey of U.S. Employers: concern about health costs drives employer coverage decisions
- 2012 Survey of U.S. Health Care Consumers: satisfaction with the system low and anxiety about health costs high
- Employers vs. consumers: comparison of survey results
- Implementation update
- CBO: Supreme Court ruling means 3 million fewer insured, $84 billion saved
- Hospital requirements for tax exemption focus on transparency, efforts to collect from uninsured
- Colorado District Court throws out contraception requirement for private, non-religious employer
- AIDS activists concerned about Medicaid expansion option granted states by Supreme Court
- CCIIO: exchange guidance to be released this summer
- House introduces new menu labeling legislation, changes ACA requirement
- Legislative update
- Transparency, controls on HHS salaries proposed
- Industry update
- Government, health plans collaborate to accelerate fraud detection efforts
- NFIB, AHIP express concern over excise tax, provisions of ACA
- GAO: $2.3B in “meaningful use” Medicare payments in 2011; 16 percent of hospitals received funding as of 2011
- My take
- Special Report: 2012 Deloitte Survey of U.S. Employers to be released Tuesday
- Implementation update
- House committee passes bill to cut HHS, CMS funding, restrict implementation of ACA
- GOP members introduce resolution challenging constitutionality of ACA as an unlawful tax
- House E&C committee seeks clarity on 340B drugs, updated definition of “patient”
- HHS releases final rule on essential health benefits for qualified health plans
- House Dems propose expanded drug coverage in essential health benefits
- House Republicans challenge tax credits if federal government runs state HIXs
- Legislative update
- Federal reserve chair issues dire outlook for economic recovery
- Telemedicine bill would allow physicians treating veterans to practice across state lines
- State update
- HHS announces regional forums in states
- Report: state fiscal crisis acute
- Massachusetts attempts alignment of state and ACA reform legislation
- HHS announces funding for multi-payer innovation in states
- Federal judge dismisses state’s challenge to contraceptives case on grounds that states do not have standing to bring the case
- CMS will limit dual eligible pilot program to two million, one-third lower than state requests
- Multi-state Medicaid crackdown on drug fraud
- Industry update
- IOM report: changes in Medicare cost index could change provider payments 5 percent, rural providers hit hardest
- Meaningful use stage two guidelines: final rule pending release
- IOM report: PTSD programs reach half of service members diagnosed
- CMS updates Hospital Compare and Nursing Home Compare websites
- Hospital trade group requests streamlined auditing for hospital errors
- U.S. Postal Service in danger of defaulting on retiree health benefits payment
- Naming for biosimilars point of tension
- FDA drug approvals: obesity, HIV
- AMA alliance aims to standardize payer-provided physician data transparency
- My take
- Implementation update
- HHS to states: Medicaid expansion optional but most expected to participate
- HHS announces 89 ACOs, total now 154
- USPSTF revises obesity guidelines
- Legislative update
- Rockefeller: dual eligible demonstrations too big, costly
- CMS releases proposed annual Medicare payment update
- House votes to repeal ACA
- President signs PDUFA into law
- House Veterans’ panel focus on transparency efforts
- State update
- CMS awards new CO-OP grant
- Health exchange update
- State round-up
- Industry update
- Study: health system CEOs concerned about cost pressures, uncertainty about health reform
- OIG report to CMS: inadequate conflict of interest surveillance for contractors found
- Physicians no longer in demand for independent private practices
- WellPoint, AmeriGroup deal announced
- Trade group asks Congress to revise observational stay regulations
- Physicians to Congress: SGR replacement will take years to develop
- Hospital trade groups seek avoidance of Medicare cuts from sequester
- My take
- Implementation update
- Court decision re: optional Medicaid expansion raises questions for states
- Business groups seek clarity on ACA implementation issues
- Retailers want changes to definition of full-time employee
- Taxing authority, funding for ACA in Ways and Means, finance committees this week
- Legislative update
- House Budget Committee approves “Sequestration Transparency Act”
- HHS announces $971 million for public health emergency preparedness
- Portable devices bill introduced
- State update
- Republican Governors balk at Medicaid expansion option
- Intentions re: HIXs: breaking news from last week
- Industry update
- FDA: Senate approves PDUFA reauthorization, device identifier system announced
- AHIP recommends increased focus on fraud
- Meaningful Use update
- CMS proposes increases in end-stage renal payments, encourages bundled payments
- AHA: Medicare and Medicaid payment rules complex and duplicative
- My take
- Implementation update
- States get exchange funding
- OIG asks for increased documentation for IRS staffing increases
- ACA implementation timeline: July 2012 through January 1, 2013
- Legislative update
- Supreme Court to hear hospital case against HHS DSH rate miscalculation
- Industry news
- Reactions to Supreme Court rulings from Industry trade groups
- FDA approves diet drug
Memo: Special edition - June 29, 2012
- My take
- The rulings
- Public attitudes: context
Memo: Special edition - June 28, 2012
The Supreme Court handed down its rulings on the four legal challenges to the Affordable Care Act (ACA) finding in favor of defendants, Sebelius et al., in the case of National Federation of Independent Business et al. v. Sebelius et al. on the central issue of the individual mandate and upholding the balance of the law with the exception of federal power to terminate states’ Medicaid funding.
- My take
- Implementation update
- CMS to monitor consumer satisfaction with QHPs, HIX
- Catholics, student groups launch advocacy campaigns around contraception coverage
- CMS announces third round of ACO applications
- HHS awards funding to expand community health centers
- PCORI awards funding to study consumer engagement
- AHA expresses concerns over Hospital Readmissions Reduction Program proposed rules
- Challenge to 12-year bio-similar protection initiated
- Legislative update
- Illegal immigrant law signed by President
- CMS reconsiders hospital governing board rules that require physician representation
- ONC update: meaningful use EHR adoption
- MedPAC report to Congress: limits on Medicare out-of-pocket payments, improved expansion of dual-eligible highlights
- GAO: HRSA management of health centers inadequate
- House approves bipartisan FDA user fee bill
- Long-term care legislation introduced
- State update
- Bill to increase Medicaid FMAP to 74 percent introduced
- ONC pilots prescription drug abuse programs in Ohio, Indiana
- State round-up: health exchanges
- Personhood efforts update
- State round-up: Medicaid, CHIP
- State round-up: employee insurance coverage
- Industry news
- Supreme Court rules pharma sales reps ineligible for overtime
- AMA House of Delegates
- AMA: insurance company error rates down to 9.5 percent, denial rates up 69 percent
- FDA panel supports cancer treatment drug
- Study: more hospitals using LGBT nondiscrimination policies
- Study: ED visits grew 60 percent faster than population growth over eight years
- Study: demand for health care workers to outpace overall job growth for next decade
- Study: child consumption of sweetened beverages no more at risk for obesity than others
- My take
- Implementation update
- Director Larsen leaving CCIIO
- Study: $1 trillion at stake in Supreme Court decision
- Hospitality, restaurant industry coalition seeks delay in employer penalties
- Actuaries’ study: potential implications of risk mitigation programs in ACA
- CMMI announces new ACO funding grants, House Committee inquires
- ACO update: 65 operating today, anticipated growth
- Senate Committee rejects amendment to disallow use of Preventive Health Fund for advertising benefits of ACA
- CMS: 14 million Medicare beneficiaries receive preventive services
- Legislative update
- Health spending growth projected to average 5.7 percent annually through 2021
- Senate Appropriations Committee approves 20 percent increase in CMS operating budget for implementation of ACA
- House committee requests information on health IT safety
- GOP senator challenges administration for advising against cancer test
- State update
- CMS grants $300 million for Medicaid long-term care program enhancements in four states
- Study: state Medicaid spending to increase 3.9 percent in 2013
- State actions on insurance, health insurance exchanges
- State oversight of health markets
- Industry news
- Three national insurers announce plans to maintain ACA provisions regardless of Supreme Court outcome
- Study: employer wellness investments modest
- Medicare Advantage enrollment up, premiums down
- CalPERS to raise health care premiums 9.6 percent
- FDA delays decision on HIV-prevention drug
- AMA House of Delegates this week
- Genetic mapping completed
- Study: DSH payment reductions put safety net hospitals at risk
- Drug companies seek revisions to PDUFA to protect, generic manufacturers resist
- Committee report: increase oversight of drug supply chain
- Study: use of imaging tests doubles, concern for radiation exposure increasing
- Hospitals ask CMS to retract inclusion of medical staff on governing board
- My take
- Implementation update
- House votes to repeal medical device tax, White House will veto
- HHS announces additional funding for Consumer Assistance Programs to assist in access, complaint resolution with insurance companies
- PCORI releases draft methodology report
- ACA causes colleges to raise premiums, drop options
- Legislative update
- CBO sees health spending doubling as share of GDP in 25 years
- CMS creates new office to manage health data, facilitate transition to value-based purchasing
- GOP proposes Medicaid provider tax reductions to offset increased federal revenue from student loan interest rate increase
- June issue of Health Affairs special focus: dual eligibles
- Bill to expand Medicare Advantage, Medigap eligibility introduced
- Representatives propose expansion of dental services to Medicare, Medicaid, VA beneficiaries to be paid by Wall Street fees on trading
- Physician reentry bill proposed to bring back docs from retirement in primary care
- Scrutiny of “rouge” online pharmacies sought
- State update
- Study: Supreme Court decision impacts 14 states that have made investments already
- Obesity efforts in Michigan, New York City
- CMS encourages collaborative audits of Medicaid, seeks to improve coordination and increase collection of overpayments
- CMS announces 45 insurers to sign up for Comprehensive Primary Care initiative
- State round-up
- Industry news
- OIG: FDA should do better job resolving disputes about medical device approvals
- Pharmacy groups fight against amendment to FDA user fee bill that would classify pain meds as controlled substances
- CMS: EHR incentive program registrations down, MU payments exceed $5 billion
- Bipartisan Policy Center releases recommendations on health and obesity
- White House blog: insurers to issue rebates this summer
- WellPoint bids to acquire contact lens retailer
- My take
- Implementation update
- HHS releases proposed rule on essential health benefits, requires reporting from three largest plans in each state
- CCIIO releases reinsurance bulletin
- HHS, VA announce funding for aging and disability programs in states
- Medical device excise tax repeal passes in House Ways & Means Committee; committee considers changes to flex and health savings accounts
- Legislative update
- Senator urges indefinite delay of ICD-10 implementation
- Taskforce releases national plan to reduce childhood asthma disparities
- GOP leaders recommend funding for extension of student loan program—cuts to Prevention fund no longer part of funding
- Physician organizations respond to Ways and Means inquiry about meaningful use
- State update
- Medicaid directors concerned about infrastructure, costs for program overhaul
- State round-up
- Industry news
- House passes prescription drug user fee bill
- GOP report: PhRMA support for ACA based on deal to prevent drug importation
- AHIP: HSA enrollment increased 18 percent last year
- CMS announces Partnership to Improve Dementia Care, cites over-use of antipsychotic drugs in nursing homes
- VA-DOD facility planning urged as prototype for other federal agencies per GAO recommendation
- HHS expects to recover $1.2 billion from Medicaid, Medicare fraud investigations
- Specialist physicians want delay dual eligible demonstration programs
- Study: consumer-directed health plans could save $57 billion annually
- My take
- Implementation update
- GAO: small businesses not using premium tax credit per ACA
- Study: majority of individual health plans do not meet ACA standards
- Study: 88 percent of uninsured veterans eligible to access subsidized coverage through exchanges, Medicaid expansion in 2014
- Catholics sue over contraceptive mandate
- PCORI funds studies to integrate evidence in practice
- HHS awards $4.9 million for family-to-family health centers
- Medicaid seeks collaboration with CMMI to innovate in service delivery; states seeking flexibility
- GAO appoints five new members to MedPAC
- Report: Summary of Benefits should help enrollees and applicants understand their coverage
- Ways and Means Committee questions cost of ACA public relations effort
- Legislative update
- FDA user fee bill passed in Senate; includes expanded oversight
- CBO: sequester, Bush tax cuts reduce deficit $560 billion between FY2012 – FY2013
- State update
- Health exchange update: CCIIO urges states to apply for federal partnership as Plan B
- State round-up
- Industry news
- Pharmacists, health insurance plans encourage biosimilar naming, interchangeability
- CMS seeks software to screen for “bad actors”
- Physician groups seek continuation of ACA provisions for accountable care
- Study: health care costs caused by higher unit prices, not overuse
- Study: employer-sponsored coverage slips to 56 percent due to costs
- Preventive Services Task Force discourages PSA test for prostate cancer screening
- FCC opens spectrum to facilitate wireless patient monitoring systems
- My take
- Implementation update
- “Open market” model proposed for federally-facilitated HIXs
- CO-OP funds awarded in Nevada, Michigan
- IRS releases final premium tax credit rules for individuals, married couples
- Chamber of Commerce encourages HHS to protect access to coverage through exchanges for small business
- HHS provides details about risk adjustment methodology
- Legislative update
- CMS actuary estimates Medicare Part B costs will be 12 percent higher if physician SGR cuts set aside
- GAO solicits nominations for health IT policy board; May 25 deadline
- State update
- Industry news
- OIG report: questionable billing at retail pharmacies prevalent
- AHA survey: ICD-10 delay helps hospitals, smaller hospitals face implementation challenges
- White House releases final Alzheimer’s national plan
- Senators propose amendment to FDA user fee
- ONC reorganizes, creates CMO office
- VA seeks comments on VLER system to increase interoperability in military, veterans’ health; privacy central issue
- Study: EHR use did not improve quality of care for diabetes patients
- AHA revises billing and collecting practice guidance
- House committee considers industry consolidation and competition
- My take
- Implementation update
- CMS proposes two-year primary care payment increases
- White House: ACA tripled NHSC, adds nurses
- Final rule on MLR reporting requirements for insurers; required to notify enrollees of anticipated rebate
- CCIIO holds public meeting on risk adjustment methodology
- IRS final comments on medical device excise tax
- First group of Health Care Innovation Awards announced
- HHS releases ACA funding for school-based health centers construction projects
- CMS extends deadline for Graduate Nurse Education Demonstration applications
- CO-OP funding questioned
- Legislative update
- CMS issues final rules to streamline hospital participation in Medicare and Medicaid
- Bill to repeal SGR, paid for by reductions in defense spending
- House committee passes incentives for antibiotics manufacturers
- House GOP passes reconciliation bill to cut spending in lieu of military cuts; certain ACA funding provisions targeted along with others
- State update
- Study: access to primary, preventive health declining in most states
- State round-up
- Industry news
- “Must have” health care providers in networks drives higher costs due to negotiating leverage with plans
- Study: hospital readmissions linked to HAIs
- Heritage outlines three steps to Medicaid reform
- CDC, IOM focus on obesity in “Weight of the Nation” campaign
- Study: nurse aides ease burden on PCPs
- FDA advisory committee recommends new HIV prevention drug
- Study: ED wait times vary widely; penalties for poor performance being implemented by CMS
- My take
- Implementation update
- IRS releases proposed rule for subsidy verification: necessary to participate health exchange coverage
- CCIIO releases risk adjustment guidance
- CMS: Medicare beneficiaries saved $837 on prescription drugs
- HHS awards $728 million to community health centers
- Legislative update
- CMS extends deadline for collecting sunshine data
- Senator probes CDC prevention grants
- Congress returns from recess: mark up on budget bills continues
- Senate Committee on Finance to have roundtable on Medicare physician payments
- Senate Committee on Finance announces bipartisan effort to combat waste, fraud
- CMS, IRS request information on stop loss insurance
- FDA releases rule implementing flexible standards for certifying sterility of biologics
- State update
- Republican governors seek repeal of ACA medical device excise tax
- May 1: last day for states to apply for state-specific thresholds for rate reviews
- State round-up
- Industry news
- AAMC study: 30 percent increase in med school enrollment anticipated 2012-2016; inadequate to meet demand
- ONC final comments on Stage 2 meaningful use
- GOP report: employers might choose to ‘pay, not play’
- CMS posts Medicare per beneficiary spending measure on Hospital Compare website
- Family physicians oppose FDA “safe use” proposal
- NIH launches initiative to bring together industry and researchers to promote innovation
- IOM: FDA post market surveillance inadequate
- WSJ article focused on increased use of observational studies in clinical research
- My take
- Implementation update
- Medicare trustees, CMS Office of the Actuary conclude ACA extends life of Medicare funds
- GAO recommends canceling Medicare Advantage Quality Bonus Payment Demonstration; HHS Secretary says no
- Rules update: CMS releases rules for community based care programs, physician identifier requirement
- Awards for dual eligibles demonstration program announced
- Preventive health funding cut vs. student loan interest rate: focus of House legislation
- PCORI research agenda focuses on consumer engagement
- Bulletin, notice for employer premium subsidies released
- Kaiser report: $1.3 billion MLR rebates to due enrollees; AHIP estimates ACA compliance adds 2-4 percent to premiums
- CMS expects 28 states to participate in dual eligibles demo, allows states to delay implementation
- Report: overpaid subsidies for insurance coverage would save $44 billion if re-captured but increase uninsured
- Legislative update
- Last week on the hill: activities of key health care oversight committees
- Democratic Congressional primaries in PA viewed as referenda on ACA vote
- State update
- State round-up
- Industry news
- CMS recommends FY2013 payment increase of .9 percent for acute, 1.9 percent for long term care hospitals
- Analysis: tax treatment of over the counter medications as a medical expense
- AHRQ analysis: health care disparities in 2011
- ACP recommends Medicare reforms to cut federal spending
- GAO analysis: Medicare fraud detection, prevention improving
- Study: specialty drug costs increase 14-20 percent
- FDA device tagging system announced
- My take
- Implementation update
- IRS announces proposed rule to assess fees on health insurance plans to fund PCORI
- GOP report: ACA will raise taxes by $4 trillion
- CMS: DME competitive bidding program successful in reducing costs
- Physician, hospital coalition protests overpayment rule
- CCIIO cites “excessive premium increases”
- Legislative update
- Committees, Congress tackle FY 2013 budget; health care cuts targeted
- Supreme Court ruling: generics can challenge description of brand-name patents
- VA: funding for additional mental health staffing available released
- HHS combines aging, disability administration
- Senators introduce drug labeling and testing bill for pediatric medical devices
- State update
- Study: Block grants would have cost states $555 billion
- State round-up
- Industry news
- ONC: $4.5 billion outlays for EHR systems through March 2012
- Health regulations top concern for small business owners
- GAO report: military health system cost effectiveness improving
- GAO analysis: antitrust laws and collaboration among doctors, hospitals and allied providers
- FDA receives comments on draft guidance for biosimilars
- HHS seeks comments on National Action Plan to reduce infections
- CMS provides comparison tool for home health
- Tool to monitor drug shortage introduced
- Groups seek to fortify corn masa to prevent birth defects
- Survey: one fourth of adults under 65 lacked insurance in 2011
- My take
- Implementation update
- HHS announces administrative simplification rule, delay of ICD-10 deadline
- White paper: Medicare costs exceed original estimate by $340 billion
- CMS Innovation Center announces markets for primary care management pilot targeting Medicare,
- Medicaid enrollee health improvement
- House Committee requests accounting for ACA implementation funds to IRS
- Twenty-seven new ACOs announced
- AHIP seeks flexibility in calculating actuarial values for qualified health plans
- Legislative update
- CMS releases new health care quality measures for stage of two meaningful use
- IOM report calls for additional tax on medical care to transform sick care system to preventive health
- HHS asked to revise EHB prescription drug coverage standards
- State update
- State round-up
- Industry news
- Study: health costs consume wage increases for most households
- Study: avoidable readmission costs hospital 16 percent more per discharge
- Study: lung cancer screenings benefit high-risk patients
- D.C. District Court hears oral arguments on graphic tobacco warning labels
- FDA approves end-stage kidney disease program
- My take
- Implementation update
- Supreme Court judicial process: how it works
- Texas Circuit Court considers physician ownership constraint in ACA
- CMS releases 2013 payment rule for Medicare Advantage and Prescription drug plans
- Legislative update
- Senators urge quick action on physician sunshine implementation
- Senate HELP committee seeks comments about “breakthrough” treatments legislation
- Lawmakers request more oversight of Medicare from CMS on fraud and abuse
- House Republicans investigate regulations for wireless medical technology
- State update
- Report: state implementation of insurance market and coverage reforms
- HHS awards $72 million to states for child home visit programs
- State round-up
- Industry news
- Medical societies weigh in on unnecessary tests, seek to educate consumers
- Medicare pays $6.6 million for physician reporting
- NQF announces additional quality measures
- Study: paying 10 percent more for primary care could help lower Medicare costs 2 percent
- MedPAC focus on dual eligibles
- Study: prescription drug use increases for young adults; total health care spending on medicines increases
- U.S. Surgeon General seeks comment on ways to address medication overuse
- PhRMA and NGA partner to reduce prescription drug abuse
- IOM releases recommendations for integrating primary care and public health
- FDA approves new cancer orphan drug for soft tissue sarcoma
- My take
- Special report: Supreme Court arguments about the Affordable Care Act
- Implementation update
- Study: guaranteed issue, community-ratings lead to erosion of individual insurance market
- Innovation Center delays award date for Health Care Innovation Challenge
- Legislative update
- House passes FY2013 budget authored by Rep. Ryan
- Alternative budget proposals fail in the House
- Ways and Means Health Subcommittee holds hearings on employer penalty
- Senators introduce legislation to expedite FDA approval process
- Senate Health Committee holds hearing on FDA drug and device user fees
- State update
- CMS funds new CO-OPs
- State round-up
- Industry news
- CMS releases final MITA Version 3.0
- Study: no long-term benefits in pay for pay for performance programs
- Retailers support legislation to repeal ACA employer auto-enrollment provision
- GAO: FDA device review delays problematic
- Study: academic faculty compensation varies widely
- AMA sends recommendations to CMS regarding upcoming payment incentives
- My take
- Implementation update
- HHS highlights ACA results at two year anniversary
- Innovation Center seeks applicants for hospital- nursing collaboration
- Federal agencies seek comment about proposed changes to coverage for women’s preventive health services including contraception
- Legislative update
- House budget committee passes Ryan plan; spending reduced to 2008 levels key feature
- House passes IPAB repeal and medical malpractice reform
- Medicare Advantage risk adjustment, interest income targeted as offset for SGR fix
- State update
- Newly-enrolled Medicaid eligibility methodology being tested in ten states
- HHS releases health insurance rate review results
- Improved coordination of uninsured children sought
- HHS releases guidance to states on electronic health care transactions, administrative simplification
- State round-up
- Industry news
- Supreme Court ruling tightens patent laws for diagnostic testing
- Representatives focus on medical device recall oversight, cite flaws in process
- Federal appeals court upholds graphic warnings requirement on cigarette packaging
- JOBS Act passes, helps emerging companies conserve capital
- Medicare Pharmacy Transparency and Fair Auditing Act introduced, lessens PBM audit of retail pharmacies in Part D insurance plans
- Berwick joins Center for American Progress
- Study: Racial bias influences physician communication with patients
- My take
- Implementation update
- ACA implementation update
- HHS final rules for health insurance exchanges, health plan risk adjustment
- HHS releases final rule on Medicaid, CHIP expansion
- HHS releases final rule for student health plan coverage
- House committee hearing on insurance coverage slated Wednesday
- House Committee on Rules to consider repeal of IPAB
- Final briefs to Supreme Court on ACA; transcripts of oral arguments available to public
- Legislative update
- CBO updated analysis of ACA costs, coverage, FY2013 budget estimates
- CMS delays 5010 enforcement
- Medical societies challenge usefulness of transparency about physicians inducements by manufacturers; cite flaws in process of reporting
- GOP Senators propose phase out of Medicare
- Community-Based Care Transition Program expands, avoidable readmissions key focus
- State update
- MedPAC leaders express concern about managed care for dual eligible citing lack of quality measures
- CMS awards $75 million for Medicaid Emergency Psychiatric Demonstration
- State round-up
- Industry news
- Administration launches Global Health Service Partnership to address global workforce shortages
- Commonwealth Fund releases health system score card for 306 local U.S. areas; 66 million live in low performing markets
- Study: Personalized medicine for cancer care likely more costly as result of need for multiple biopsy’s
- CMS released final rule on DMEPOS Supplier Safeguards
- Medicare advantage overpayment recovery
- AdvaMed announces agenda for medical device industry
- My take
- Implementation update
- HHS: ACA lifetime limit elimination helps 105 million
- PCORI approves updated definition of patient-centered outcomes research
- DOJ files brief to Supreme Court on individual mandate
- IPAB repeal bill moves to House floor for vote week of March 19
- HHS Secretary testifies before congressional committees re: health exchange subsidies
- Retail industry leaders meet with White House to discuss ACA implementation
- Legislative update
- AHRQ analysis: 'Disappointing results' in usefulness of its health IT implementation toolkit
- Medicare fraud efforts questioned by House Ways and Means oversight subcommittee
- State update
- Dual eligible market opportunity strong and growing per analysts
- HHS releases draft guidelines for state oversight of insurance premium rate reviews
- Bipartisan Policy Center Governors’ Council recommends changes to Medicaid waivers
- State round-up
- Industry news
- CMS: ICD-10 delay
- Study: individual long-term care insurance options shrinking
- CDC: financial burden for medical care pervasive
- Study: meaningful use rates vary by state
- Court challenge to prescription drug coupon programs initiated
- Study: increased computer access to patient test results increased number of tests performed
- Medicare redesigns claims and benefits statement to improve enrollee understanding
- AHRQ testing toolkit to improve practice adaptability to literacy gaps
- Study: Medicare Hospital Compare has minimal impact on mortality rates
- FDA releases guidance on overseas clinical studies
- FDA seeks input from experts on accelerated drug review process
- President Obama names HHS Park as director of Office of Science & Technology Policy
- DOJ appeals ruling that tobacco warning labels violate First Amendment rights
- 2012 scorecard: medical school faculty conflict of interest scrutiny improving
- GAO study: price transparency in health care falls short
- New commission to release recommendations on physician payment system reform in 2013
- Pain meds problematic in veteran population
- My take
- Implementation update
- IPAB update: HHS Secretary says it may not be fully operational until 2018 or 2019; House committee votes to repeal
- PCORI stakeholder meeting report: research funding underway
- Ways and Means Chairman asks DOT about $111 billion cost for HIX subsidies
- FDA to hold public hearing on guidance for bio-similars May 11, 2012
- Legislative update
- Ways and Means hearing: MA growth questioned
- Snowe retirement means changes in Senate Commerce, Finance Committee succession
- Senate defeats the Respect for Rights of Conscience Act of 2011
- Expanding role of pharmacists: FDA consideration of behind the counter fulfillment, ACO participation as providers
- State update
- OIG to states: “pay attention to excluded providers in managed Medicaid networks”
- State round-up
- Industry update
- AMA objects to CMS assessment of physician role in overprescribing; calls for health plans to provide data
- FDA announces new label requirements for statins
- District Judge rules that new FDA tobacco warning labels violate First Amendment rights of companies
- GAO recommends CMS set up a systematic review of QIS standards in nursing homes
- Report: dental coverage in the U.S.
- Study: advanced EMR Systems reduce cost, improve quality
- Study: medical home results inconclusive
- CMS uses text messaging to help Medicaid- and CHIP-eligible mothers manage care for their babies
- Study: MA enrollees have lower readmission rates compared to FFS enrollees
- Study: reducing price variation in employer coverage could save $36 billion annually
- AAMC approves updates to MCAT test
- PhRMA, BIO urge FDA to revise drug labeling
- My take
- Implementation update
- GAO Recommendation: Medicare beneficiary cost-sharing for preventive health services lacking evidence
- Study: elimination of individual mandate reduces coverage
- Supreme Court schedules 30 additional minutes to hear arguments on Anti-Injunction Act
- House Energy and Commerce health subcommittee to mark up IPAB repeal bill
- HHS releases bulletin re: calculations for the actuarial value for qualified health plans sold through exchanges
- PCIP program costs expected to double in 2013
- CMS releases final rule for state innovation waivers
- CMS releases final rule on Medicaid and CHIP Section 1115 waiver demonstrations
- CMS awards $638,677,300 to seven non-profits to launch CO-OPs
- HHS awards $229 million in ACA funding to ten states to establish HIXs
- Legislative update
- CMS releases Stage 2 meaningful use rule
- HIMSS Report: EHR certification rule released
- GAO: Medicare Advantage Plans overpaid $1.2-$3.1 billion in 2010
- SGR not fixed; MedPAC recommendations for funding
- State round-up
- Industry news
- California individual premiums to increase 8 percent to 14 percent this year
- CMS: Medicare Advantage growth anticipated, new audit procedures announced
- AMA, AT&T partner in physician portal
- Health care information management executives urge HHS to set consistent ICD-10 timeline
- FDA announces it’s working with manufactures to address cancer drug shortages
- PhRMA to HHS: proposed sunshine payment rule goes beyond ACA’s scope
- Study: prescription drug spending variation driven by cost of drugs prescribed, not volume
- Study: correlation between primary care access and patient outcomes
- White House FY2013 Budget Proposal eliminates disparity between inpatient rehab and SNF—part of effort to standardize reimbursement based on what is done, not where
- My take
- Implementation update
- Major provisions in the ACA re: adoption, standards, use of health IT
- CMS provides guidance for Part C, Part D plans
- ACRO: Payments Sunshine Act should not be applied to clinical research by physicians
- HHS proposed rule requiring doctors and hospitals to return overpayments
- HHS awards $9.1 million in ACA funding to strengthen primary care; technology-enabled primary care key
- Legislative update
- HHS: ICD-10 implementation deadline pushed back
- Congress approves deal on SGR payment fix; proposes $11.1 billion in cuts to ACA
- White House releases FY 2013 budget
- Republican Senators release Medicare reform plan featuring vouchers
- Senators introduce legislation to strengthen FDA drug shortage reporting
- Increased user fees for FDA in White House budget proposal
- State round-up
- Industry news
- Deloitte survey: consumer opinions about health IT
- DEA moves against major distributors
- KLAS study: EHR use improves effectiveness in medical device use
- End-of-life measures proposed: NQF
- Survey: physicians reluctant to tell patients everything
- AAMC: changes proposed in physician training
- NIST seeks manufacturers to develop EHR systems
- HHS recovers $4.1 billion in FY 2011 for fraud
- Provider prices influence regional variation in health care spending for the privately insured
- My take
- Implementation update
- HHS release final rules to help consumers understand coverage, policies
- House Dems challenge plan to give states flexibility in defining EHBs
- Constitutional challenge update: DOJ brief argues Medicaid eligibility threshold mandate within rights of federal government
- White House compromise on contraceptive coverage proposed, then rejected by Catholic bishops
- HHS awards $40 million in ACA funding for prenatal care
- Legislative update
- President’s FY2013 budget released today
- Joint Conference Committee considers options to avoid physician pay cuts
- State update
- Kaiser: most states on track with Medicaid budget
- State round-up
- Health Affairs examines health exchanges: February 2012 issue
- Industry news
- Key ACA provisions related to biotech, pharmaceutical sectors
- FDA releases guidance on biosimilar premarket approval pathway
- Medical device trade group announces legislative agenda
- CMS adds another health care-associated infection to Hospital Compare
- AHIP requests ICD-10 conversion costs be counted in the MLR
- Study: drug spending related to unit costs, not prescribing patterns
- White House funds $156 million to address Alzheimer’s disease
- My take
- Implementation update
- HHS requests U.S. Supreme Court to extend argument on Anti-Injunction Act on ACA challenge
- Update: essential health benefits guidance
- HHS: ACA saved $2.1 billion for Medicare prescription drug costs
- Bill to exclude brokers’ commissions in the medical loss ratio calculation introduced
- Representative introduces bill to repeal PCORI
- House votes to repeal CLASS Act
- Legislative update
- CBO projects $1.079 trillion deficit for FY12
- FDA improvements sought to address drug shortages
- CBO: war savings calculation, target for SGR fix proponents
- GOP physicians ask AARP for Medicare reform details
- Rubio seeks EHB exclusion for religious organizations
- Representatives introduce bill to increase health care access in rural areas
- Representatives introduce legislation to amend 510(k) drug review process
- State update
- State round-up
- Industry news
- Study: insurance fee cost Medicaid $38.4 billion
- HHS: Medicare Advantage premiums down 7 percent, enrollment up 10 percent
- GAO: prices for medical devices vary widely, not transparent
- Moody’s: rough year ahead for not-for-profit hospitals
- IRS releases proposed regulations for taxable medical devices
- FDA and device industry recommend $595 million in drug user fees
- Medical practices: ICD-10 Version 5010 conversion creating payment glitches
- National Quality Forum endorses resource use and costs quality measures
- Prior authorization of power mobility devices and recovery audit prepayment review demonstrations to start June 1, 2012
- CBO: federal worker benefits better than private employers
- FDA approves “first ever” drugs for cystic fibrosis, basal skin cell cancer
- Study: state nursing workload mandates reduce RN overtime slightly
- HHS OIG: data inconclusive about physicians opting out of Medicare
- My take
- Implementation update
- PCORI releases draft research agenda with five main priorities
- OMB reviewing final rules related to exchanges, Medicaid expansion, and state innovation waivers
- Constitutional challenge update: actuaries argue mandate exclusion would invalidate rest of ACA
- HHS provides essential health benefits guidance
- HHS releases proposed rule to increase rebates from drug manufacturers
- CLASS repeal vote expected
- Legislative update
- Joint Conference Committee begins talks; physician pay cuts, payroll tax continuation on agenda
- OMB reviewing proposed rule related to stage 2 meaningful use
- ICD-10 final rule unclear on penalties for noncompliance
- GAO: Medicare overpayments for Medicare Advantage plans
- ONC launches new health IT challenges
- State update
- State round-up
- Industry news
- Hospitals challenge Medicare funding cuts, impact on jobs
- Preventive health in primary care settings incomplete
- MLR requirement for student health plans challenged
- My take
- Implementation update
- States push for details of federal exchanges
- House Ways and Means passes CLASS Act repeal bill
- Hospital groups urge fix to Medicare formula preferential to Massachusetts
- PCORI research agenda release expected today
- HHS gives several religious employers another year to cover FDA-approved contraceptives
- Legislative update
- House votes against President’s request to raise federal debt limit
- Nursing home cuts proposed for 2014
- Campaign 2012 health platforms
- GOP Presidential candidate health platforms
- GOP primary process, delegate count
- State update
- Survey: all but two states expanded or maintained Medicaid eligibility last year
- State round-up
- Industry news
- OMB is reviewing proposed rule on stage 2 meaningful use
- CBO: disease management, value-based purchasing pilots did not reduce costs
- NCQA announces organizations that seek ACO accreditation
- Study: Medicare Advantage Plans that offer fitness options attract healthier enrollees
- My take
- Implementation update
- January 24: budget talks start again, SGR, payroll tax key agenda items
- Constitutional challenges update: briefs filed for, against ACA
- Update: health insurance exchanges
- GOP leaders challenge essential benefits notification by bulletin rather than as a proposed rule
- Study: elimination of individual mandate results in 25 percent premium increase
- CO-OP grant awards expected soon: CCIIO
- Legislative update
- Proposed change in DSH payment calculations helps hospitals offset costs for inadequately insured patients
- MedPAC recommendation for E&M codes: “pay based on what is done, not where”
- Medicare eligibility age increase to 67 would save $148 billion, would increase Medicaid costs $35 billion
- White House announces plan to streamline departments, desire to improve effectiveness and efficiency of government
- Staff changes in White House health policy team; core leadership worked together in Clinton administration
- State update
- Managed care option for dual eligibles proposed
- State waivers for insurance coverage rule out next week
- State round-up
- Industry news
- CMS: health care spending up 3.9 percent in 2010 to 17.9 percent of U.S. GDP
- Device industry-FDA negotiate user fees
- European downgrades impact industry costs of capital
- Hospital adverse events hurt 1 in 7 patients; most go unreported
- Part C Medicare Advantage payment accuracy for high-risk beneficiaries adjusted 1 percent
- Implementation update
- Briefs on ACA’s individual mandate and severability filed
- Administrative simplification rule released, plans required to implement in 2012
- Innovation advisors announced by the Innovation Center
- State update
- MLR waiver denials: Kansas, Oklahoma
- State round-up
- Industry news
- Health IT funding in 2011
- CMS publishes quality measures for Medicaid-eligible adults
- Study: hospital quality websites vary widely in content and impact
- FDA: biosimilar, biologic pathways separate
- New medication shortages: 267 drugs in 2011, 5th straight yearly increase
- AHRQ study questions value of medical homes, cites lack of evidence
- HHS releases Global Health Strategy
- American College of Physicians releases new ethic guidelines for doctors
- My take
- Implementation update
- Highlights of ACA implementation
- AHRQ studies how to engage consumers in comparative effectiveness research
- Pioneer ACO grants announced
- Independence at home guidelines released
- Early Retiree Reinsurance Program ends
- Legislative update
- Two month SGR fix included in pay roll tax legislation
- Military health IT funding approved but requires alignment with overall health IT standards
- Physician performance data from federal government restricted
- PolitiFact: health care ‘lie of the year’ designation third year in a row
- House Doctors Caucus requests two year SGR fix
- Data center consolidation announced
- ONC announced online resource to track EHR adoption, implementation
- Home care workers’ compensation focus of White House legislative effort
- State update
- States initiate chronic care coordination efforts, connecting public health and local providers
- CHIP enrollment bonuses awarded
- Massachusetts waiver
- Industry news
- FDA issues guidance on off label drug and device use, responds to consumer demand
- Health plans digesting MLR final rules
- False Claims Act ineffective in stemming off label marketing activity: study
- AHA requests simplification of conditions of participation
- My take
- Implementation update
- Congress approves appropriations bill to avert government shutdown; Senate passes payroll tax cut extension
- HHS issues essential health benefits bulletin
- HHS announces funding for new hospital patient safety program under CMMI
- CMS announces Pioneer ACOs recipients
- FDA investigates impact of drug promotion
- Legislative update
- Legislative overrides of the SGR
- Democrat coalition releases principles for innovation in the U.S. health care system
- Bill to extend stay of foreign-born physicians introduced
- State update
- State roundup
- Industry news
- Study: physicians concerned about future of medical practice, unintended results of ACA
- Report: FDA increasingly dependent on states for food inspection oversight
- Report: harm to medical research subjects requires government action
- AHRQ launches online resource to help providers with EHR implementation
- HHS recovers $2.9 billion in health care fraud in FY2011 using advanced analytics
- USDA provides $30 million funding for telehealth services in rural areas
- CMS announces results for a value-based purchasing for dialysis services; 30 percent miss targeted threshold for quality
- My take
- Implementation update
- CO-OPs final rule published; flexible approach for states encouraged
- HHS releases final rule making physician performance data publically available
- PCORI received 856 applications for its Pilot Projects Grants Program
- HHS awards $14 million in ACA funding to school-based health centers
- HHS to stop paying claims for the Early Retiree Reinsurance Program
- Sequester default means 2 percent cut to Medicare; perhaps more
- Status of key ACA provisions which impact Medicare provider payments
- Legislative update
- House Republicans release temporary physician pay bill; cuts to ACA funding, hospitals proposed to offset cost
- Bill to require prompt Medicaid payments introduced
- State update
- Health exchange update
- Industry news
- FDA releases user fee program for biosimilars
- HIPAA privacy and security audits coming in 2012
- Supreme Court hears case about patent protection for medical processes
- My take
- Implementation update
- HHS releases final MLR rules; 64 percent of insurers would meet MLR requirements
- House Energy and Commerce Committee votes to repeal CLASS
- HHS announces contractor to build the federal health insurance exchange
- Medicare releases competitive bidding guidance for medical equipment and supplies
- CMS announces Medicare coverage for preventive services to reduce obesity
- Legislative update
- "SGR fix" not fixed
- State update
- Survey: state revenues below pre-recession levels; Medicaid spending growth above average
- State roundup
- Industry news
- HHS announces delay to Stage 2 meaningful use
- ONC final rule finalizes processes for consequences for EHR accreditors’ misconduct
- Medicare open enrollment ends this week
- President announces $50 million in new funding to combat AIDs
- OECD: U.S. performs well on cancer care and screenings; not on hospital readmissions
- Study: Medicare disease management pilot results suboptimal
- Study: variation in use of in-office testing and correlation to billing
- My take
- Implementation update
- Insurance commissioners urge action protect agents and brokers
- Reconciling ACA Costs after CLASS is withdrawn
- Supreme Court health reform cases
- NCQA announces ACO accreditation program
- Legislative update
- Super Committee falls short; sequester next
- Berwick resigns, Tavenner steps into CMS role
- President signs Medicaid glitch fix
- Industry news
- Update: sustainable growth rate model and physician pay; temporary fix likely
- Hospitals lose ground in sequester
- HHS rate review: Pennsylvania health insurer charging excessive premiums
- Study: retail clinic use up, popular among young urbanites
- Physician notice of National Practitioner Database inquiries suspended pending rule
- My take
- Implementation update
- Supreme Court to hear health reform constitutional challenges; four major decisions anticipated
- CLASS Act repeal passes committee vote
- House unanimously approves “fix” for ACA Medicaid eligibility calculation
- Senators introduce bill to repeal ACA’s health insurer tax
- HHS announces $1 billion for “Health Care Innovation Challenge”
- CMS announces applications deadline for ACO Advance Payment Model
- HHS expands website to help small businesses compare health insurance plans
- Legislative update
- Supercommittee fails to reach agreement on package; automatic cuts likely
- Schwartz proposal to Supercommittee: fix SGR
- State update
- MLR waivers sought by Florida, Michigan
- NGA helps states prepare for health exchanges
- Industry news
- Grace period for 5010 implementation but deadline unchanged
- AMA proposes ICD-10 delay, include physicians in state exchange governance, and to support virtual medical IDs
- ONC: 100,000 primary care providers use EHRs
- CMS seeks comment on Medicaid Information Technology Architecture
- CMS clarifies rules for physician-owned hospitals
- Study: use of EHRs improves outcomes
- FDA suspends use of Avastin for breast cancer
- National Center for Quality Assurance starts ACO accreditation
- CDC hospital antibiotic tracking system
- My take
- Implementation update
- DC Circuit upholds individual mandate
- Pioneer ACO update: CMS seeks commitments by November 28
- Final rules for new insurance industry regulations – CO-OP plans, MLR – at OMB on final review
- IRS: fewer small businesses received health coverage tax credit than expected
- Senate approves “fix” for ACA Medicaid eligibility calculation
- Legislative update
- FDA warning to retailers about sale of tobacco products to minors
- Senators introduce legislation to improve programs for seniors and caregivers
- CBO pay-to-delay by drug manufacturers would save $4.8 billion
- Medicare to cover new preventive services to reduce cardiovascular disease
- State update
- State insurance commissioners want flexibility in health exchange roles
- State roundup
- Industry news
- Survey: Medicare payment cuts to nursing homes will lead to 6 percent workforce reduction
- IOM recommends new agency to regulate health IT and patient safety
- CMS survey: 72 percent perceive Medicaid to be good, 20 percent find enrollment process hard
- NFIB study: health insurance premium tax will cut up to 249,000 jobs
- AHIP elects new chairman of the board
- My take
- Implementation update
- Justice Department asks Supreme Court to delay hearing of Virginia lawsuit
- CLASS repeal bill introduced, blocked in Senate
- GAO analysis: ACA early retiree program status and funding outlook for FY 2012
- HHS provides survey standards to capture disparities information
- Legislative update
- Super Committee update: bipartisan members of Congress and commission leaders encourage bigger cuts to spending
- State update
- Governors want flexibility in health exchange set-up operations and assistance in IT implementation
- State round-up
- Industry news
- White House Executive Order to reduce drug shortages
- CMS releases final Medicare payment rules for providers
- ONC extends temporary EHR certification program to summer 2012
- AHIP: ACA annual fees on insurers will increase premiums up to 3.7 percent by 2023
- HHS OIG analysis: states, CMS missed opportunities in hospital patient safety programs, need for state-federal collaboration
- FDA approved 35 new drugs last year
- My take
- Implementation update
- Legal challenges to ACA: U.S. Supreme Court announcement soon, trade groups weigh in
- HHS announces Advanced Primary Care Practice demonstration
- Study: elimination of mandate reduces newly insured by 7.8 million and increases premiums 12.6 percent
- Legislative update
- House votes to eliminate withholding for providers
- House approves “fix” for Medicaid modification to ACA Medicaid eligibility
- Healthy People 2010 misses targets on obesity and health disparities
- State update
- Industry news
- Medicare announces premiums, deductibles, and cost-sharing amounts for Parts A, B, C, D
- FDA prescription drug user fees recommendation to Congress January 15
- GAO recommends health care costs transparency
- FTC report: industry reached 28 pay for delay settlements in 2011
- CDC launches Preventing Infections in Cancer Patients program
- CDC committee recommends HPV vaccine for boys
- White House urges community health centers to hire veterans
- My take
- Implementation update
- ACO final rule released; reaction from providers positive
- CBO: CLASS program repeal will not impact budget
- CMS offers program Innovation Advisors
- Update: Legal challenges to ACA
- Legislative update
- CMS announces new procedures to streamline hospital regulatory compliance
- Drug importation bill rejected in Senate; trade associations weigh in on safety concerns
- Industry news
- Lawmakers encourage 12-year biologics exclusivity
- House Committee examines effectiveness of FDA medical device oversight
- My take
- Implementation update
- HHS recommends suspension of the CLASS program
- Constitutional challenge update
- HHS awards $900 million to expand primary care workforce
- ACO Pioneer program participants announcement this week
- Essential health benefits update
- PCORI seeks input for research proposals
- Legislative update
- Joint Select Committee hears budget savings suggestions from legislative leaders, key stakeholders
- State update
- Industry news
- SAMHSA awards grants to behavioral providers for health IT
- Dual-eligibles plan proposed by AHIP
- Congress approves free trade legislation
- Medicare open enrollment started Saturday
- ONC, Health 2.0 launch “popHealth Tool Development Challenge”
- Senate introduces legislation to streamline FDA oversight of medical devices
- My take
- Implementation update
- IOM releases essential health benefits guidance
- Senators urge action on Sunshine Law, manufacturer kickbacks
- OIG agenda for FY12: provider reimbursement, ACA implementation priorities
- Energy and Commerce Leader asks for actuarial analysis of CLASS Program
- HHS: Medicare enrollee use of preventive benefits
- Medicare recovery auditors corrected $92 million in improper FY 2010 payments
- CMS extends deadline for Bundled Payments applications
- Constitutional challenge: circuit court update
- Legislative update
- Physicians focus on Joint Select Committee on Deficit Reduction to fix SGR, repeal IPAB
- Dems: allow Medicare to purchase drugs directly from manufacturers
- State update
- Industry news
- GAO: enrollee “doctor shopping” costs Part D $150 million
- HIT jobs initiative announced
- Survey: HIT use by physicians improves accuracy
- CMS proposal: eliminate under-performing Part C plans; additional reporting requirements for PBMs
- MedPAC to Congress: freeze primary care payments, cut specialists 17 percent
- Deadline for first wave of meaningful use grants
- Studies: dual eligibles care fragmented, changes in oversight, quality measurement required
- FDA announces efforts to encourage personalized medicine
- Senate Finance investigates fraud in home health
- FDA and CMS launch “parallel review” pilot program
- My take
- Implementation update
- Constitutional challenge update
Health insurance exchange rule comment period extended; essential health benefits expected this week - ACA funding released for primary care, chronic, lifestyle, and workplace wellness programs
- PCORI announces grants for comparative effectiveness research
- CMS launched Medicare Plan finder website
- GAO: cost impact of ACA requirements on military health
- Constitutional challenge update
- Legislative update
- Cuts to ACA funding proposed by House GOP committee
- AHA promoting increase in Medicare eligibility age in lieu of across-the-board cuts
- HHS data collection on CHIP
- State update
- Supreme Court to hear case about enrollee challenge to Medicaid payment cuts
- CMS awards $1.5 million to State Health Insurance Assistance Programs
- State implementation efforts
- Industry news
- Medical informatics new specialty recognized by ABMS
- Meaningful use update
- Kaiser survey: employer premiums increased 8 percent to 9 percent in 2011
- CMS proposes five new measures in HCAHPS program for hospitals
- Medical device outlook mixed: domestic price pressures increasing, risk contracting with providers sought
- My take
- Implementation update
- HHS announces $224 million to support home visits for at-risk families programs
- Anti-injunction act new wrinkle in constitutionality challenge to ACA -- might delay ruling on individual mandate until 2015
- CMS announces database to collect personal information for ACO participants and providers
- HHS awards rate review
- Constitutional challenge update
- Legislative update
- President Obama $3 trillion deficit reduction proposal: $320 billion cuts to Medicare and Medicaid included
- MedPAC releases plan to pay for $200 billion SGR fix
- Dual eligibles focus of cost management efforts, managed care solutions encouraged
- Trade groups ask for continuation of automatic payment updates
- State Medicaid directors ask for flexibility to accelerate managed Medicaid programs
- House approves $300 million for pediatrician training program
- State update
- Industry news
- AHA to ONC: HIE Stage Two meaningful use standards not feasible
- Insurers pool data, plan to create not-for-profit data warehouse for public use
- Report: U.S. needs to take “serious action” to protect leadership in global biomedical industry, protect jobs
- My take
- Implementation update
- ACA primary care provisions
- Constitutional challenge update: Pennsylvania District Court rules the individual mandate unconstitutional
- CMS releases final rule implementing the Medicaid RAC Program
- GOP seeks repeal of CLASS Act in ACA
- Legislative update
- President Obama proposes America’s Job Act
- Select Committee begins work, impact on health care spending considered in first meeting
- MedPAC recommendation: eliminate SGR, freeze payments to PCPs, cut payments to others 18 percent
- Senate Democrats encourage delivery system reforms to cut cost, protect system
- HHS funds community health center upgrades
- Upcoming congressional hearings
- State update
- MLR waivers, managed Medicaid
- HRSA funds Regional Telehealth Resource Center grants
- Industry news
- CCIIO: MLR rule causing health plans to reduce premium increases
- Health IT week declared
- OIG: fraudulent billing in physician practices
- CBO: removing pay-to-delay by drug manufacturers would reduce costs
- Stage Two meaningful use improves outcomes: study
- HHS: Medicare Advantage premiums will decrease 4 percent, enrollment increases by 10 percent in 2011
- President Obama signs patent reform bill; announces NIH center to promote drug development
- HHS launches public-private sector initiative to prevent heart attacks and strokes
- My take
- Implementation update
- Fourth Circuit finds it lacks jurisdiction to hear challenges to health reform law
- Affordable Care Act year one results: Medicare enrollee use of discount drugs, preventive health services
- HHS requests input about Basic Health Program serving lower income, non-Medicaid eligible enrollees
- HHS announces funding for community health centers
- Senators ask GAO to review prevention fund awards
- Legislative update
- Joint Select Committee begins work
- Senate appropriates $50 million increase to FDA FY12 budget
- Senate committee approves funding for pediatrician training program
- State update
- Health exchange update
- State-by-state scorecard on long term care posted
- MLR waiver requests
- Industry news
- AHA study: Medicare cuts could reduce health sector jobs
- AdvaMed study: ACA device tax could reduce jobs
- Senate passes major patent reform bill
- Medicare fraud task force collects $295 million in false billings
- My take
- Implementation update
- Rate reviews rules applicable to association health plans
- Rate review update
- IOM summarizes essential health benefits listening tour feedback
- GAO analysis of MLR requirement: plans adjusting business practices to comply, brokers’ commissions being cut
- AMA urges CMS to reconsider physician enrollment process
- Legislative update
- Select Committee announces first meetings
- Industry consolidation focus of committee hearing this week
- CMS finalizes MA, Part D requirements
- Nursing homes target select committee with ad campaign to fend off funding cuts
- Fraud detection emphasis increasing
- Industry news
- UnitedHealth group acquires California medical group; plans developing strategic collaboration agreements with providers
- FDA releases draft of industry user fees reauthorization
- Health care employment trends and projections: BLS outlook
- Study: EHR use increases accuracy of diagnosis, effectiveness of treatment planning
- CMS releases rule amending e-prescribing incentive program, alignment with meaningful use
- Consumer group seeks new FDA regulations on generic labeling
- AHA challenge: CMS hospital reporting requirements breach of ACA
- Central Pennsylvania urology group consolidation anti-trust settlement reached
- State news
- GOP Governors Public Policy Committee: significant flexibility for Medicaid required
- State round-up
- My take
- Implementation update
- Bundled payments program announced by CMS
- NAIC recommendation: multi-state plans must follow same rules as other plans
- Constitutional challenges: 8th Circuit Court plans to hear oral arguments
- CBO budget update: recovery slower than earlier anticipated
- Legislative update
- Key dates for Joint Select Committee on Deficit Reduction
- Transition Medicare to a voucher program: BPC recommendation to the Select Committee
- State legislators ask for flexibility in developing exchanges
- Insurance annual fee challenged by AHIP, NFIB
- CMS announces plan to streamline regulations for hospitals
- State watch
- HHS awards $137 million to states to boost prevention and public health
- GAO: PCIP costs, enrollment lower than expected in states
- State round-up
- Industry news
- CMS expands Medicare DME bidding program
- ONC seeks public comments on its plan to reduce health IT disparities
- CMS ends EHR demonstration early
- AMGA: group practices report higher operating losses
- My take
- Implementation update
- IRS releases branded prescription drug fee regulations
- Proposed guidance for summary of benefits disclosures released
- Legislative update
- OMB: FY 2013 federal agency budget requests should be at least five percent below 2011 discretionary funding
- State watch
- HHS awards grants for CHIP outreach efforts
- HHS announced ACA grants to strengthen state and local health departments
- State round-up
- Industry news
- Study: physician medical liability exposure
- Telemedicine use in rural health necessary to reduce cost: CMMI analysis
- Advanced business analytics used to identify “drug repositioning” opportunities
- OIG: drug rebates reduce Medicaid and Medicare spending
- FDA releases guidance for medical device premarket review of benefits-risk assessment
- HHS announces initiatives to improve access to physicians and health IT in rural communities
- Report: nursing homes Medicare payments reduced by $79 billion under recent regulations
- My take
- Implementation update
- Constitutional challenges: 9th, 11th Circuit Courts rule
- HHS, IRS publish proposed rules to help states establish health insurance exchange
- Legislative update
- The Joint Select Committee on Deficit Reduction: health-related interests and activity
- HHS announces $28.8 million for community health centers
- CMS seeks state applicants for Medicaid Emergency Psychiatric Demonstration
- State watch
- HHS awards $185 million to 13 states to develop health insurance exchanges
- Dual eligibles fact sheet
- State round-up
- Quality measures for Medicaid-eligible adults released
- Industry news
- Perceived adequacy of insurance coverage (Deloitte 2011 Survey of U.S. Health Consumers)
- Moody’s: nonprofit hospitals revenue growth lowest in 20 years
- EHR incentives deadlines
- Physician groups challenge reporting requirements
- Physician group demonstration results
- Study: retractions of scientific studies increasing
- ONC releases metadata guidance, part of stage 2 meaningful use
- ONC: consumer engagement a priority
- GAO report: Medicare feedback to physicians inadequate
- Lawmaker asks HHS to study costs and benefits of health IT
- CMS: two million eligible for the Medicare Low-Income Subsidy program but not enrolled
- CBO: children’s hospital GME would cost $1.57 billion
- My take
- Implementation update
- Joint Select Committee activity encouraged to be open
- FDA officials comment on biosimilar approval, oversight process
- HHS announces ACA covered preventive services for women
- Third Circuit Court dismisses challenge to ACA
- House Republicans challenge IPAB
- Industry news
- CMS releases final rules for FY 2012 Medicare payments
- HHS: average Medicare Part D premiums will be $30 in 2012
- Nursing home cuts will cost $50,000 for each facility
- State watch
- Michigan seeks MLR waiver
- GAO report: health insurance rate reviews processes vary, efforts underway in majority of states
- State round-up
- My take
- Implementation update
- Health exchange update: scenarios for planning
- CO-OP funding deadline announced
- Association health plans subject to rate review rule under ACA: NAIC
- Supreme Court petitioned to hear case challenging individual mandate
- CBO: modification to ACA Medicaid eligibility could save $3 billion
- Legislative update
- CMS actuaries: health spending to increase 5.8 percent annually through 2020
- House subcommittee approves Children’s GME program
- Proposed law would require Medigap plans to meet ACA MLR requirements
- Commonwealth Fund analysis: provider preparedness for ACOs risk-sharing low
- Industry news
- 510(k) medical device review process update: IOM report and FDA guidance
- Physician groups challenge Medicare eRx Incentive Program
- NFIB study: small employers concerned over ACA, anticipate benefits cuts
- My take
- Implementation update
- HHS publishes proposed rule on ACA CO-OPs
- Senate bills prevent early retirees from becoming Medicaid eligible
- NCOIL supports exempting agent and broker fees in new MLR rules
- IOM recommendation: coverage for contraceptives, women’s preventive services
- CMS proposes Medicare coverage for depression screening
- Legislative update
- Debt ceiling negotiations and ACA
- Senator moves to halt SSN display on Medicare cards
- State watch
- Bill to encourage generic drug use in Medicaid introduced
- OIG analysis: Medicaid EHR incentive compliance is lacking
- State round-up
- Industry news
- Bipartisan letter focuses on hospital payment cuts
- FDA proposes oversight for mobile medical applications
- Health groups form new coalition to focus on health care disparities
- Study: drug prices five years after Medicare Part D
- Bipartisan group of senators to President: stop Medicare payment cuts for imaging services
- My take
- Implementation update
- Health insurance exchange proposed rules published; comment period for 75 days
- CBO coverage projections challenged by Senator
- House bill would prevent early retirees from becoming Medicaid eligible
- Senators request flexibility with essential health benefits
- HHS announces ACA funding for school-based health centers
- Legislative update
- Repeal on ACA restriction for OTC drug reimbursement sought
- Energy and Commerce Chairman concerned about medical malpractice reform policies
- Supplemental funding for HIT usage in multi-campus hospitals sought
- NAIC committee does not endorse broker and agent exemption
- State watch
- Study: state governments to spend at least $90 billion less under ACA
- NGA: Medicaid spending target harmful to states
- State round-up
- Industry news
- Study: small group health insurance market profile
- Study: biopharmaceutical industry impact on U.S. economy
- Hospital drug shortages significant and growing problem
- FDA personnel changes announced
- My take
- Implementation update
- Federal requirements for health exchanges will be announced today
- Ohio District Court upholds the individual mandate
- Restaurant groups ask FDA for flexibility on ACA menu labeling requirements
- CMS implements clinical lab test demonstration
- CMS to conduct insurance premium rate reviews in ten states
- Legislative update
- HHS announces three new dual-eligible initiatives
- ONC coordinator: Stage 2 meaningful use delay recommended
- State watch
- Health Affairs study: Medicaid spending varies by state, volume key driver
- FY 2012 begins for states, deficits loom
- Medicaid cuts to providers
- Governors ask HHS to reimburse states for payments made due to SSA mistakes
- State round-up from last week
- Study: impact of Medicaid coverage on previously uninsured
- Industry news
- Reports examine repeal and caps to employer health insurance tax inclusions
- Surgical groups: CMS physician payment rule undervalues their work
- FDA issues draft guidance on new dietary ingredients
- CMS home health update: 3.35 percent Medicare payment cut for home health agencies in 2012
- CMS home health update: Medicaid policy changes for face-to-face requirements
- CMS value-based purchasing update for home health update
- My take
- Implementation update
- Sixth Circuit Court of Appeals to uphold the individual mandate
- CMS publishes rule on administrative simplification of electronic health transactions
- APHA report: ACA public health provisions unfunded
- CRS report: president authorized to recess-appoint IPAB members
- Legislative update
- Senators propose plan to reduce Medicare spending
- CMS proposes physician pay formula for 2012
- Hospital outpatient, ambulatory surgery center, dialysis center oversight changes: CMS proposed rules
- CMS: almost 500,000 received 50 percent drug discounts in 2011
- State watch
- Iowa health plans to sell child-only policies for six weeks
- Utah seeks to convert Medicaid contracts into ACO model
- NY law would ban health plan mail-order prescription fill
- Health information exchange allows emergency room access prescription drug history
- Minnesota shutdown over budget
- State revenues up, deficits anticipated
- Industry news
- Congress to hold hearings on FDA prescription drug user fees Thursday
- Fees for overseas drug manufacturers considered
- Avastin, Provenge to be covered by Medicare
- Hospitals launch campaign against Medicare and Medicaid cuts
- Physicians petition White House for SGR repeal
- Physicians oppose cuts for diagnostic imaging services in proposed South Korean trade agreement
- Study: declines in physician acceptance of Medicare and private coverage
- My take
- Recent studies about the potential for employer exit from health insurance as a result of ACA
- Implementation update
- HHS announces $500 million in ACA funding for “Hospital Engagement Contractors”
- CMS report: 5.5 million Medicare beneficiaries used ACA-provided prevention benefits
- Proposed bill would repeal employee health plan auto-enrollment requirement
- Provider comments on ACO advanced payment initiative
- Legislative update
- Bill to allow federal government to purchase drugs directly from manufacturers introduced
- Nurse practitioners, physician assistants, and certified nurse midwives scope of practice expansion to home care services
- Medicare and Medicaid fraud: bill would strengthen surveillance and multi-state collaboration
- State watch
- Massachusetts AG report: global payments alone will not reduce health costs
- State legislative activity
- Industry news: consumerism in health care
- Consumer view of the U.S. system: underperforming, complicated, and inefficient
- CHPA: self-care could save $5 billion annually
- Social security solvency
- Industry news: technology enabled health care
- 2011 Medicare EHR Incentive Program update
- NLM launches tool to link patient portals and EHRs to consumer health information
- Ambulatory EHR market: $3 billion
- Supreme Court strikes down prescription drug data-mining regulation
- Industry news: delivery system integration, efficiency, and effectiveness
- AMA annual meeting highlights: support for individual mandate and health plan report cards
- AAMC report: medical student enrollment trends
- Industry news: evidence-based care
- The NPC report: employers support CER
- Industry news: federal oversight, coordination, and collaboration
- GAO report: FDA should enhance its oversight of medical device recalls
- Post market surveillance: FDA
- New FDA plan to police food imports
- Industry news: health insurance transformation
- White House announces new appeals process for health plan enrollee denial of coverage
- Amended interim final rule on insurance appeals provides additional state flexibility
- Industry news: correlation of health cost containment and economic recovery
- Federal forecast for weaker recovery
- Industry news: growth and innovation
- Business analytic tool applied to HIV/AIDS
- My take
- Implementation update
- CMS announcement: end to mini-med waivers
- Republican governors, Senator Hatch ask for Medicaid “management of effort” flexibility
- Senate bill aims to repeal FSA and HSA reforms from ACA
- HHS announces the National Prevention Strategy
- GAO report: use of ARRA and ACA funding for comparative effectiveness research
- HHS announces $4 million in ACA funding to support Community Transformation Grants
- Legislative update
- Imaging focus of federal utilization review effort
- Study: Medicare enrollee responsibility for home health copayments
- Administration intensifies fraud reduction efforts
- CMS rule permits mental health centers participation in Medicare
- Democrats propose Part D legislation
- Legislation proposed to promote antibiotic development
- State watch
- Study: Medicaid prescription drug costs could be less with tight national formulary
- Managed Medicaid promoted
- OIG analysis of state 340B drug discount programs
- Commonwealth Fund study: Medicaid managed care plans administrative costs and quality of care
- Industry news
- AHA recommends delay in Stage 2 EHRs meaningful use program
- SGR options: CBO
- White House releases framework for coordination, regulation of nanotechnology
- Senators ask for industry input on how to streamline regulations to promote innovation
- Imaging over-utilization focus of MedPAC recommendation
- NAIC report: MLR options for brokers
- My take
- Implementation update
- ACO rule update
- ACA constitutional challenges update: Atlanta circuit court
- House subcommittee focuses on IPAB repeal
- IRS extends deadline for BCBS health plans to implement MLR provision
- Revisions to CLASS Act sought by House GOP
- Tax on home care devices focus of advocacy effort
- FDA report: budget cuts threaten biosimilar pathway development, generic review approval processes, and food safety
- HHS funds ACA demonstration projects for Federally Qualified Health Centers
- HHS announces $40 million in ACA funding for state chronic disease programs
- AMGA asks OMB to use lower ACO savings estimates in its budgeting process
- Legislative update
- Democratic lawmakers form Health Care Innovation Task Force
- Senate Democrats urge Administration to reject GOP Medicaid proposal
- Bipartisan effort to protect NIH funding
- Industry news
- AHRQ analysis: employee health care costs are increasing
- Medical Device Manufacturers Association encourages investment in R&D
- AdvaMed outlines recommendations to sustain leadership in the medical technology industry
- State watch
- U.S. Supreme Court to hear case to determine if hospitals can sue states over Medicaid payment rates
- Insurance exchanges: update
- OIG audits identify $61 million in improper Medicaid claims in NC, WA
- My take
- Implementation update
- Constitutional challenges: update
- Trade groups weigh in on ACO rules
- HHS releases final regulation on Medicaid payment adjustments for provider-preventable conditions
- Prescription drug excise tax calculation provided by IRS
- CMS clarifies Medicare Prescription Drug (Part D) enrollee financial responsibility for those in higher income brackets
- House Blue Dog Coalition asks CMS to simplify regulations on home health certifications
- State watch
- Medicaid cuts prominent in state FY12 budgets
- Insurance exchange oversight: update from CMS
- Legislative actions
- Industry news
- New CMS rule: Medicare data accessible
- HHS lowers premiums to encourage enrollment in Pre-Existing Condition Insurance Plan
- Antibiotic resistance, development focus of new legislation
- Hepatitis drug approved, second in recent months
- IOM recommends revisions to calculating labor costs used to determine Medicare provider payments
- FDA official defends device approval process, says European device approval process will not work in U.S.
- Energy and Commerce Health Subcommittee leaders send letter to MedPAC regarding payment cuts to diagnostic imaging services
- House approves a measure to require the FDA to use “hard science”
- HITECH update
- EHR adoption increasing: ONC
- CMS seeks comments on the Physician Quality Reporting System electronic health record measures
- ONC publishes proposed regulations for ONC-Approved Accreditors participating in the Permanent
- Certification Program for Health IT
- CMS releases Exchange/Medicaid IT Guidance 2.0
- My take
- Implementation update
- CBO, JCT address impact of funding cuts for ACA implementation
- Trade groups weigh in on ACO rules: Pioneer ACO more attractive than shared savings models proposed
- GOP Senators ask HHS to withdraw ACO rule
- MLR study: excluding agent and broker commissions reduces consumer rebates
- FDA extends menu labeling comment period
- Legislative update
- CMS Office of the Actuary analysis: Medicare Trustee Report projections too optimistic, do not account for physician payments accurately
- FY 2012 budget votes in Senate
- Regulatory overhaul proposed by OMB
- House panel recommends FDA 2012 budget cut
- House Appropriations Committee trims $1.3 billion from President’s budget
- CBO: malpractice reform reduces the federal deficit by about $57 billion over ten years
- Energy and Commerce Subcommittee discusses purchasing insurance across state lines
- Senate legislation to repeal ACA health insurer tax introduced
- House repeals graduate medical education mandatory funding
- Constitutional challenge update: judges named in multi-state challenge to ACA
- State watch
- Health exchanges: update
- Management of effort waivers: update
- MLR waivers: update
- Prescription drug fulfillment costs formula changed for state Medicaid programs
- Governors asked for Medicaid modernization ideas
- Health Information Technology
- CMS announces $75 million in Medicare EHR Incentive Payments
- ONC provides exam to help identify HIT experts
- Behavioral health, federally qualified health centers lobby for inclusion in HITECH funding
- HITECH repeal efforts
- CMS proposes changes to the Medicare eRx Incentive Program
- New accounting disclosure requirements align HIPAA with HITECH
- Industry news
- CBO: banning direct-to-consumer advertising would decrease prescriptions filled
- FDA approves drug for hospital-acquired infection, first in 25 years
- My take
- Implementation update
- Comparative effectiveness research board names Selby director
- Health insurance plan premium oversight rule published
- HHS drafting regulations on 340B drug program
- CBO: repealing IPAB to cost $2.4 billion
- Legislative update
- Marketing guidelines for Medicare Advantage, Part D issued
- Medicare EHR incentive payments expected soon
- AMA launches ad campaign for liability reform
- State watch
- Medicaid expansion costs: CBO
- Nine more states and Guam apply for medical loss ratio waivers
- Regional exchange center update
- My take
- ACA implementation update
- Costs for implementing ACO up to 15 times higher than government estimate: AHA
- ACO update: big groups push back
- $100 million in ACA grants to help create healthier U.S. communities
- Constitutional challenge update: Virginia circuit
- HHS announces new office to assist states in coordination for dual eligibles
- Kaiser report: House GOP budget plan would cut Medicaid funding by $1.4 trillion over ten years
- Legislative update
- Medicare trust fund will be exhausted in 2024: report
- House panel approves bill lifting maintenance of effort requirements
- Law seeks waiver of co-pay for telehealth
- CMS: health reforms will save Medicare $120 billion by 2015
- House Committee approves malpractice bill that sets cap on noneconomic damages
- Single-payer health system bill introduced
- Bipartisan caucus to make drugs more affordable
- ASPE study: uninsured unable to pay hospital bills
- State watch
- MLR waivers update: New Hampshire, Nevada join Maine in getting waiver
- Round-up
- My take
- ACA implementation update
- House passes bills to cut funding for health insurance exchanges, school-based clinics
- IRS seeks comment on employer shared responsibility requirements
- Constitutional challenges update
- Legislative update
- House Energy and Commerce Chair wary of Medicaid block grants and Medicare vouchers
- CMS announces new Chief Medical Officer
- Physician pay fix focus of house committee, new bill
- State watch
- CMS proposes new Medicaid rate setting process
- Round-up
- Life sciences update
- Study: awareness of comparative effectiveness research high, preparation widely varied
- Court reverses stem cell ruling; allows funding for stem cell research
- Stakeholders comment on FDA direct-to-consumer genetic tests
- FTC releases report on pay to delay activity
- Military health
- GAO report: weaknesses in policies and oversight of Medical supplies and equipment pose risk to veterans’ safety
- Study: excluding Medicare eligibles from the military health plan could save $104 million
- Provider update
- CMS simplifies hospital use of telemedicine
- Mortality linked to culture, clinical processes
- HITECH update
- ONC extends comment period on the Federal Health IT Strategic Plan to May 6
- Study: stronger business case for HIT-enabled medication management needed
- My take
- ACA implementation update
- Update: HHS implements hospital VBP program
- Business groups organize to repeal IPAB
- Dual eligibles update: CMS releases report on dual eligibles pilot program; Part D drug coverage
- CBO: repealing state health insurance exchange funding reduces deficit by $14 billion over ten years
- Legislative update
- House GOP target cuts to exchanges, school clinics, and public health funding
- House Committee to hold hearing on Medicare physician payment system
- FY 2012 budget proposals
- Inpatient rehab increase 1.5 percent; quality reporting implemented
- Skilled nursing increase 1.5 percent
- Hospice increase 2.3 percent
- Inpatient psychiatric hospitals increase 2.7 percent
- Industry update
- AHA proposes refinements to LTACH criteria, objections to IRS Schedule H
- CMS seeks comments on seven new medication-related quality measures
- Chicago to develop largest metropolitan health information exchange
- Simplified enrollment procedures for Medicaid, Medicare, CHIP programs sought
- Mystery shopper program for primary care physicians anticipated
- Food advertising targeting kids focus of new guidelines
- May 10 arguments in Richmond, VA Fourth Circuit Virginia v Sebellius
- HITECH update
- New ONC leader sets agenda for HITECH
- Consumer electronic consent solution
- State watch
- My take
- ACA implementation update
- CMS announces new database to monitor insurance exchanges
- Ambulatory surgery update: Medicare Ambulatory Surgical Center VBP Program proposed
- House Energy and Commerce Committee requests information from trade associations; Senators ask for CLASS Act details
- DOL study: “essential health benefits” widely variable in health plans
- Group health insurance market analysis concluded
- Legislative update
- CMS releases FY 2012 payment rule for acute inpatient and long-term care hospitals; reduction of 0.5 percent proposed for hospitals
- Long-term care hospitals quality reporting: new
- Medicare Advantage bill would expand open enrollment
- Physician-owned hospitals: update
- State Watch
- State-led health reform update
- Medicaid cost containment opportunities: Deloitte Center for Health Solutions’ brief
- Provider update
- NCQA plans July launch of ACO accreditation program
- Update: Alzheimer’s diagnosis and treatment guidelines
- AMA launches AMAGINE physician portal
- Drug and device
- Drug industry consortium to develop policies for electronic labeling
- BIO releases statement on House Judiciary Committee’s Patent Reform Bill
- My take
- FY2012 Budget Proposals
- PPACA implementation update
- Federal government to reimburse states for Medicaid determination and enrollment activities
- 1099 repeal passed
- New advisory chair for National Prevention, Health Promotion and Public Health Council
- IRS reviewing community benefit activities of tax-exempt hospitals
- Constitutional challenges: update
- Dates set for circuit court proceedings
- Legislative update
- Meaningful use attestation starts today
- House, Senate approve spending bill to fund government through September
- CBO estimate of savings for eliminating parts of PPACA
- Access to Medicare data to profile physician earnings from Medicare focus of new legislation
- ONC names new National Coordinator
- State Watch
- CMS proposes to expand home and community based waiver demonstration
- Dual eligible grants to 15 states
- MLR waiver update, innovation waivers
- State-led health reform update
- Industry action
- Imaging coalition opposes prior-authorization for potentially over-used imaging services
- AdvaMed issues statement on FDA medical device labeling
- Leading industry groups launch website
- My take
- Accountable care organizations: Q and A
- Which model makes the most sense?
- How big a deal is this to Medicare and CMS?
- What are the specifications for governance of ACOs?
- If an ACO overspends above its baseline, how does it collect penalties from participating providers?
- What about start-up costs for the ACO? Are there provisions for reimbursement? And what’s the likelihood an ACO will see substantial savings?
- How are payments to be distributed among ACO participants?
- How will the cost baseline be established? What Medicare data will be used to determine benchmarks?
- Can ACO providers participate in other aligned health care delivery programs?
- Can ACOs change or add their participants? May participants be in more than one ACO at a time?
- Do ACO participants have to be “meaningful users” of electronic health records?
- How do the regulations treat clinical integration in context of anti-trust? If an ACO contracts with a commercial plan or Medicaid, would the ACO’s anti-trust provisions apply?
- Can rural care providers, federally qualified health centers, and critical access hospitals be ACOs?
- Implementation update
- Update: health insurance exchanges
- FDA releases rules on menu labeling and chain restaurants
- GAO finds state Medicaid and CHIP monitoring efforts lacking
- CMS delays DME competitive bidding round two until summer 2013
- State watch
- Legislative update
- GOP FY 2012 budget plan includes changes to structure of Medicare, Medicaid
- Collective bargaining for physicians
- Hospital associations challenge repeal of self-referral limits in PPACA
- CMS releases payment rule for Medicare Advantage and Part D Plans
- CMS increases dialysis provider payments 3.1 percent
- Doc fix: update
- CER influence focus of new legislation
- CMS reports hospital acquired conditions
- My take
- ACO guidance: special report
- What is in the CMS guidance?
- How might the savings be shared? What’s the upside?
- How are ACOs aligned with other programs that influence delivery system structural changes in PPACA?
- Legislative update
- Republican Senators seek repeal of IPAB, limits for CER
- Alternatives to the individual mandate: GAO report
- House Energy and Commerce challenges funding for PPACA
- Providers (hospitals, physicians, allied health, long term care)
- CMS: physician signatures for lab services not required, but face to face visits for home care referrals required
- Federal court invalidates caps for hospices
- House Energy and Commerce Committee focuses on physician payment fix
- HITECH update
- Key dates for HITECH
- Health plans and employers
- NAIC holds meetings on exchanges and MLR requirements
- Large employers express concern about health insurance exchanges; want consistency across states
- Life sciences
- FDA hearing about food coloring and hyperactivity in children
- Supreme Court rules safety-net hospitals cannot sue drug manufacturers participating in the 340B program
- State watch
- My take
- Implementation update
- HHS publishes the National Strategy for Quality Improvement in Health Care
- Update on Medicare and Medicaid Innovation
- CMS releases guidance on HRAs
- IOM recommends standards for clinical practice guidelines and comparative effectiveness
- Legislative update
- Report: impact of small business tax credits for health insurance
- Funding for ERRP
- ONC Strategic Plan released
- Health Plans
- Blue Shield of California withdraws application for rate increases
- CMS launches database to monitor consumer feedback about health plans
- Health exchange enrollment: Kaiser study
- Providers
- ACO: investment analysis
- CMS: practitioner fee for participation in $505 fee to enroll in Medicare, Medicaid, and CHIP
- Stage 2 meaningful use deadline: policy committee update
- GAO report: including certain oral-only ESRD drugs in payment bundles for dialysis providers
- State Watch
- My take
- New study: the hidden costs of U.S. health care for consumers
- PPACA implementation
- CRS analysis: HHS has authority to waive MOE requirements
- CO-OP Advisory Board releases recommendations
- Burdensome regulations focus of legislation
- Bill introduced to repeal CLASS program
- Legislative update
- House bill would repeal Medicare bidding program
- MACPAC submits report to Congress to streamline Medicaid access
- CBO: medical liability legislation would reduce national health spending by $40 billion
- OIG releases report on unimplemented policy recommendations
- HHS starts national ad campaign to alert public about fraud
- State updates
- Providers
- ACO joint venture between clinic, plan announced
- MedPAC releases annual Medicare payment recommendations to Congress
- CDC awards funding to reduce health care-associated infections
- HIT Update
- CMS to conduct study on Version 5010 and ICD-10 awareness and readiness
- Proposed legislation to extend HIT incentive payments to behavioral health providers introduced
- Drug and devices
- R&D Investment for pharmaceutical industry, 2010
- FDA and the European Medicines Agency collaborate on drug application parallel review
- My take
- Legislative update
- Budgeting process continues in both Houses; temporary measures likely
- PCORI Program Development Committee releases 12-month objectives
- ACO guidance available in two weeks: Sebelius
- CBO analysis: budget options
- House GOP identify PPACA funding cut targets
- Insurance across state lines: the data
- Constitutional challenge update
- Government appeals Florida District Court decision
- State updates
- HHS and Treasury publish proposed rule on state innovation waivers
- MedPAC comments on CMS Innovation Center proposed demonstration programs
- Medical loss ratio, annual limit waivers
- State round-up
- Drugs and medical devices
- Senate passes major patent overhaul
- FDA advisory panel provides guidance on marketing genetic tests
- Part D formulary focus of inquiry
- House committee investigates Part D drug benefit rebates
- Lupus drug approved; first in 50 years
- Providers
- Teaching hospital medical resident compensation guidance
- Medical home guidance
- CMS provides physician payment update for 2012
- HITECH update
- ONC seeks ‘physician champions’ to facilitate electronic health record adoption
- Meaningful use: physician eligibility
- Health insurance plans
- CMS posts disclosure notices to notify consumers of potential rate increases
- My take
- Legislative update
- Continuing resolution to fund government operations passes
- President opens door to state waivers
- House Energy and Commerce Committee hears Governors
- House votes to repeal enhanced 1099 reporting requirements
- Anti-fraud legislation introduced
- PPACA implementation: update
- Funding for state rate review implementation
- GAO report: private sector bundled payment programs
- GAO report: federal health program redundancy, savings opportunities
- AHRQ publishes National Quality and Disparities Reports
- New quality measures for nursing home quality comparison
- Constitutional challenges: update
- Individual mandate challenge based on religious objection
- State watch
- Utah, Massachusetts exchanges get attention as prototypes
- HHS suggestions for state Medicaid cost reductions
- Diagnostics and therapies
- FDA to review TV ads without user fees
- HITECH update
- CDC to link public health EHRs with immunization tracking system
- My take
- Constitutional challenges: update
- Federal judge upholds PPACA’s individual mandate as constitutional
- CBO releases cost estimate for H.R. 2, the Repealing the Job-Killing Health Care Law Act
- PPACA implementation: update
- OIG report: top management and performance issues facing HHS
- CMS proposes changes to Medicare Advantage
- VA freezes drug copayments until 2010
- Kerry and Snowe reintroduce bill to eliminate Medicare mental health coverage cap
- CMS details preliminary 2012 payment policies for Medicare Parts C and D
- State watch
- Public sector employees, GOP governors clash over benefits
- Children can enroll in PCIP if they previously had a pre-existing condition
- CMS delays implementation of Medicaid RAC program under PPACA
- CMS publishes proposed rule on the Community First Choice Option for states
- HHS distributes PPACA grants to states
- States’ actions
- Discovery and innovation
- Organ transplant proposal changes eligibility procedures
- President’s budget proposal impacts biosimilars; shorter data exclusivity period problematic
- HITECH update
- Lab Interoperability Cooperative, physician alerts
- IOM study: work history feasibility in EHRs
- GAO report: inconsistencies in CMS’ EHR and e-prescribing incentive program
- HHS issues its first civil monetary penalty for HIPAA privacy rule
- ONC approves plan for Louisiana health information exchange
- My take
- Physician adoption up; incentives, demography contribute
- FY2012 budget request for HIT
- ONC study: EHR adoption increasing
- NQF converts measure to electronic reporting, seeks comments on 113 eMeasures
- HITECH implementation update: recent announcements
- White House releases FY2012 budget proposal
- House introduces funding bill for remainder of FY2011
- House reintroduces bill targeting Medicare fraud among company executives
- House Ways and Means approves repeal of 1099 requirements
- PPACA implementation: notification of long term care facility closure
- CMS data analytics said to detect fraud before payments occur
- Medically necessary food
- Elimination of FSA, HSA contribution ceilings
- PCORI elimination: proposed
- Individual mandate alternatives
- Administration asks court to clarify Florida ruling
- House resolution to expedite judicial challenges
- Medicare Advantage
- Part D online dashboard goes live
- CMS publishes rule on Medicaid payments to states for provider-preventable conditions
- Health insurance waivers
- Insurance exchange update: HIT grants
- State budget updates
- OIG report: Medicare Part B drug pricing
- Accelerated drug approvals
- Study: medical device 510k approval process
- Demand for diagnostic imaging in Medicare
- My take
- HHS announces health indicators warehouse resource
- Implementation of EHRs: update
- PPACA focus on Medicare cost: study
- Study: alternatives to the individual mandate
- Update: 5,000 in Early Retiree Reinsurance Program
- Proposed rule on student health plans published
- Funding for physician-run ACOs
- HHS announces $750 million for preventive health
- HHS provides new resources for temporary high-risk pool
- Community Health Centers funding
- Constitutional challenges: update
- House proposes cuts to health care programs
- House committee hearing on economic impact of PPACA
- Drug importation bill introduced
- House Judiciary Committee holds hearing on medical liability
- Oversight of HHS implementation sought
- Grassley encourages public access to Medicare billing records
- Wyden-Brown bill introduced to facilitate state waivers
- FMAP drawdown
- GOP governors ask HHS for waivers
- State-run co-op plans: consumer role in governance
- GAO report on CHIP eligibility
- State update
- Drug approval math
- FDA launches effort to accelerate device approval process
- My take
- Senate approves 1099 cut
- Repeal fails in Senate
- Proposed PPACA revisions and investigations
- Bipartisan bill aims to reduce government spending over ten years
- GAO accepting nominations to Medicare Payment Advisory Committee
- State watch
- Provider update: PPACA implementation guidance
- HITECH
- ICD-10, 5010
- CMS Medicare Imaging Demonstration
- Health plan update
- Salt intake reduction focus of updated dietary guidelines
- Venture-funded start-ups focus of new White House program announced Tuesday
- Injectibles market update: shortage in hospitals
- My take
- Repeal legislation: update
- Energy and Commerce Committee requests HHS high-risk pool data
- House Ways and Means hearing on economic impact of reform on jobs, coverage
- February reform calendar
- HHS study: savings for insurance provisions of PPACA
- HELP Committee report: child-only coverage gaps
- Tax credits for small businesses to purchase health coverage
- PPACA impact on employer-sponsored benefits: employers unsure about benefits changes, employees expect higher costs
- OCIIO requests comments about nonprofit health insurer plans
- AHIP study: commercial health plans saved $315 million through anti-fraud programs
- High-risk pool update: enrollment increasing as result of premium reduction
- Berwick nominated to permanent CMS post
- USDA provides funding for rural telemedicine and distance learning
- HHS, DOJ report on fraud recoveries
- FDA reopens comment period on user fees for generic drug review
- AdvaMed study: European medical device approval process faster than U.S.
- FDA pulls draft guidance on menu labeling
- CRS report: PPACA reduces direct spending by $400 billion over ten years
- $3 million appropriated to National Health Care Workforce Commission for 2011
- ONC will absorb costs for regional extension centers
- Federal court ruling: hospital charity care does not qualify toward DSH payments
- Medicare payment increase for inpatient psychiatry
- CMS actuary testimony: PPACA will “reduce deficit if provider payment cuts implemented”
- State watch
- My take
- U.S. House of Representatives passes “Repealing the Job-Killing Health Care Law Act”
- AHRQ seeks comments on barriers to meaningful use for Medicaid providers
- FDA releases 2011 plan for medical device approval process
- CMS extends the comment period for Self-Referral Disclosure Protocol (SRDP)
- HHS seeks nominations for 2011 Healthy Living Innovation Awards
- White House Executive Order: streamline regulatory processes
- CRS report: upcoming PPACA regulations
- PPACA authorizations set to expire in fiscal year 2011: Congressional Budget Office
- Update: health insurance exchange implementation
- Vermont seeks reform waiver, proposes single-payer system
- High-risk pool update: enrollment increasing as result of premium reduction
- State watch
- Update: legal challenges to PPACA; DOJ preparing for next round
- Appointments announced to PCORI’s Methodology Committee
- Focus on states: Daschle, Frist, Strickland
- High Court to hear arguments on state collection of physician prescription data
- Medicare Advantage HMO performance improvement noted: MedPAC report
- MedPAC critical of CMS MA bonus recommendation
- AHA: hospitals should step up activity in health and wellness for employees
- My take
- House to vote on PPACA repeal Wednesday
- Update: essential health benefits
- MedPAC recommends home health co-pays, increased payments for providers and hospitals
- High court says medical residents are not 'students'
- BMJ reverses autism research, cites fraud
- Herger to lead Subcommittee on Health
- OIG report: Medicare payments for new generic drugs
- State watch
- Update: hospital value-based purchasing guidance
- Fitch ratings: health insurance industry outlook “stable”
- U.S. Department of Justice weighs in on 340B drug discount lawsuit
- Update: data exclusivity rights for biologics
- My take
- Health spending up four percent to 17.6 percent of GDP
- Repeal bill introduced, vote scheduled January 12
- HHS releases plan to improve Medicaid and CHIP quality of care
- MedPAC study: regional variation in Medicare
- CMS eliminates end of advance care planning from Medicare annual wellness visit
- Senate hearings on health reform
- State watch
- Sharfstein leaving FDA for Maryland post
- Implementation update: OCIIO gets name change, moves to CMS
- CMS to upgrade computer and IT systems
- Physician Compare website launched
- ONC update: HIT certification program
- Funding for Health Insurance Cooperatives focus of Advisory Panel meeting this Thursday
- AHRQ publishes methods guide on assessing studies for comparative effectiveness research
- Health savings accounts limits for 2011
- Higher Medicare premiums in 2011
- My take
- Health reform review: key events leading to the passage of PPACA and events since its passage
- Health reform 2.0 calendar: 2011 look ahead
- HHS publishes proposed rule on “unreasonable premium increases”; ten percent or higher increases the focus of scrutiny
- Guidance for health plan compliance with enrollee notifications, steering enrollees to high value providers, et al.
- RFI about value-based insurance design for coverage of preventive services published; comments requested by February 28, 2011
- Guidance for health exchanges from NAIC
- Long term care: three month delay for face-to-face encounter requirements for hospices and home care providers
- Payment changes for therapy services
- Three major Medicare drug benefit changes per PPACA: January 1, 2011
- GAO report: Medicaid pharmacy reimbursement for generic drugs
- Nurse midwives’ payment increase
- Electronic health records grants available today: CMS
- Dual eligibles focus of FCQ
- MLR waiver indications in states
- Medicaid quality measures posted
- Florida Constitutional challenge: update
- Advance-care planning in Medicare rule
- Fifteen states get bonus payments for Medicaid program expansion
- 2011 DSH payments: slightly less than 2010
- Safe harbor changes anti-kickback statute brought by OIG; ACO guidance anticipated
Memo: November 3, 2010 - Special Edition
Memo: Special Edition - February 26, 2010
