What’s New in Health Care Reform: Sept. 7

doctor-pointing-at-voice-vocal-cords-monitor-1024x576What's New in Health Care Reform provides an overview of the past week’s news, updates, and commentary in health care reform and utilization management.

CMS Identifies Hospitals Paid Nearly $1.5B in 2015 Medicare Billing Settlement

A year after paying nearly $1.5 billion to more than a third of U.S. hospitals to resolve longstanding Medicare billing disputes, the Obama administration has disclosed who got paid. New York-Presbyterian Hospital, one of the nation’s largest academic medical centers, received nearly $16 million, more than any other hospital, according to data released by the Centers for Medicare & Medicaid Services. Via Kaiser Health News.

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State of Telehealth: HHS Report to Congress Outlines Successes, Challenges

Value-based purchasing programs and alternative payment models, such as Accountable Care Organizations and bundled payments, offer opportunities to boost adoption of telehealth services, according to a report from the Office of the Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services. Via Fierce Healthcare. 


Hospitals See Decline in Charity Care Costs

As health insurance coverage has expanded under the federal health law, hospitals in Minnesota have seen a significant decline in costs to cover free and discounted care. The 10 largest hospital systems in the state last year spent about $236 million on what the industry calls charity care—a decline of $43 million, or 15%, from 2013, according to a Star Tribune analysis. The Rochester-based Mayo Clinic saw charity care costs decline by 14%, or $11.4 million, between 2013 and 2015. Via Star Tribune.

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Analysis Predicts 10.1 Million Will Be Enrolled in Exchanges at End of 2016

A new analysis predicts there will be 10.1 million people enrolled in exchange plans by the end of 2016, less than half of the number originally predicted by the Congressional Budget Office in 2010. The analysis, conducted by Avalere Health, is about on par with the Obama administration, which said in January it expects 10 million enrollees by the end of the year. Avalere is an independent consulting firm. Via Morning Consult.


GOP Obamacare Replacement Plan Would Decrease Coverage, Lower Premiums

The House GOP’s Obamacare replacement plan would decrease coverage over the next 10 years, but lower individual insurance premiums and decrease the federal deficit by $481 billion, according to an analysis publishing by the Center for Health and Economy and provided in advance to Morning Consult. Via Morning Consult.

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States Sue to Block Obamacare's Transgender Protections

Five Republican-led states and several provider groups are suing to block a new Obamacare rule that's meant to prevent health care providers and insurers from discriminating against transgender patients. The five states—Texas, Wisconsin, Kentucky, Nebraska, and Kansas—and the provider groups argue that the nondiscrimination rule requires doctors to perform gender transition procedures even when they are against the doctor’s medical judgment. Via Politico.

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Could Medicare’s New Doctor Payment System Endanger Small and Rural Practices?

The latest challenge—a target of growing physician anger and frustration nationwide—is a 2015 federal law that changes the way Medicare pays doctors. Many fear it will sharply increase the financial pressures that physicians in rural, solo, and small practices face. The Medicare Access and CHIP Reauthorization Act was Congress’s boldest step since the 2010 Affordable Care Act to push the health care system to reward quality over quantity. The law, which passed with bipartisan support, seeks to use monetary incentives and performance measures to promote better care. It replaced a widely derided reimbursement formula that Congress regularly ignored because it would have cut payments to doctors. Via Washington Post.

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As the For-Profit World Moves into an Elder Care Program, Some Worry

The business appeal is simple: A baby boom-propelled surge in government health care spending is coming. Medicare enrollment is expected to grow by 30 million people in the next two decades, and many of those people are potential future clients. Adding to the allure are hefty profit margins for programs like these—as high as 15%, compared with an average of 2% among nursing homes—and geographic monopolies that are all but guaranteed by state Medicaid agencies to ensure the solvency of providers. The goal of the program, known as PACE, or the Program of All-Inclusive Care for the Elderly, is to help frail, older Americans live longer and more happily in their own homes, by providing comprehensive medical care and intensive social support. It also promises to save Medicare and Medicaid millions of dollars by keeping those people out of nursing homes. Via Kaiser Health News.

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Most Marketplace Consumers Will Have Affordable Coverage Options

A majority of consumers purchasing health insurance on the federal marketplaces will continue to have affordable options in 2017, the Department of Health and Human Services argues in a new report. Marketplace tax credits and consumers’ ability to shop around on the exchanges help ensure consumers will access affordable health insurance, the report released today from the HHS Office of the Assistant Secretary for Planning and Evaluation says. Via Morning Consult.

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Obamacare Subsidies Preserve Access as Premiums Climb, U.S. Says

Most buyers of Obamacare plans won’t see their costs jump, even if premiums increase next year, because of government subsidies, the U.S. said in a study that pushes back on reports of challenges facing the health-coverage overhaul. Government contributions to premiums will mask the rise in costs for most buyers on the program’s exchanges, according to the report from the U.S. Health and Human Services Department. Via Bloomberg.

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Andy Tofilon

Andy Tofilon is a Marketing Segment Manager at Mayo Medical Laboratories. He leads strategies for corporate communications, public relations, and new media innovations. Andy has worked at Mayo Clinic since 2003. Outside of work, Andy can be found running, hiking, snapping photos, and most importantly, spending time with his family.