Dear NVOS Members,
The articles contained in this e-newsletter are excerpted from AAOS newsletters and other media sources to help our members stay current on national issues.
The NVOS Staff |
Report: Medicare HI Trust Fund To Be Depleted In 2030
|  A report released by the trustees of the Social Security and Medicare trust funds projects the depletion date for the Medicare Hospital Insurance (HI) Trust Fund to be 2030-4 years later than estimated in the 2013 report. "The improvement in the outlook for HI long-term finances is principally due to lower-than-expected spending in 2013 for most HI service categories," the authors write, "which reduced the base period expenditure level about 1.5 percent and contributed to the Trustees' decision to reduce projected near-term spending growth trends. The authors note that their projections assume "that reductions in Medicare payment rates for physician services called for under the Sustainable Growth Rate (SGR) formula will be overridden in the future as they have been from January 2003 through March 2015."
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Trend Toward Risk-Sharing Payment Models Marches Forward
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An article in HealthLeaders Media looks at the trend toward risk-sharing reimbursement models, which reward providers for improvement in health outcomes and costs. The writer notes that Cigna recently met its goal of covering one million healthcare consumers under its so-called Collaborative Accountable Care program-a quality and performance-based reimbursement model, and UnitedHealthcare announced earlier this year that $27 billion of its annual reimbursements to physicians and hospitals are now tied to accountable care and performance-based programs. The insurer hopes to increase that payout to $65 billion by 2018. The writer cites research suggesting that smaller provider groups may be less likely to have the resources to transition smoothly to risk-sharing payment models. Read more... |
CMS Data Suggests Many Hospitals Still Don't Use Surgical Checklists
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According to information presented in HealthLeaders Media, as many as 10 percent of hospitals report that they do not use surgical safety checklists, despite evidence that such checklists may reduce mortality and complications. The writer draws data from the U.S. Centers for Medicare & Medicaid Services (CMS) Hospital Compare website, which recently began reporting on the use of surgical checklists across 4,136 hospitals in the United States. Overall, 366 hospitals said they still don't use surgical checklists, while 497 couldn't say whether they did or not. According to one expert, the use of such checklists is further clouded by the fact that the Hospital Compare site only tracks hospital policies, not actual usage.
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View the Hospital Compare website...
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Physicians Experience Glitches On Open Payments Website
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ProPublica reports that a number of physicians have experienced glitches while attempting to review their information on the federal Open Payments (Sunshine Act) website. Some have reported waiting an hour or more for the site to verify their identities. In addition, physicians who have received no payments from industry have reported receiving error messages. The U.S. Centers for Medicare & Medicaid Services (CMS) has made Open Payments data available to physicians who have registered in the CMS Enterprise Portal and Open Payment systems. Registration is optional, but required if a physician wishes to review data relating to his or her financial interactions with industry. To review or dispute data submitted by industry for the 2013 reporting period (August-December, 2013), physicians must be registered and have reviewed any data reported about them no later than Aug. 27, 2014. CMS recommends completing the registration process as soon as possible and not waiting until the end of this initial 45-day review and dispute period. The information will be made available to the public on Sept. 30, 2014.
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The American Medical Association has published a brief guide to disputing incorrect Open Payments data.
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Do Narrow Networks Increase Financial Pressure On Providers?
| An article in Modern Healthcare looks at the possible effect insurance companies' narrowing of provider networks may have on physician reimbursement. According to the author, "...insurance companies have sought to save money by narrowing their provider network, and doctors are lowering compensation demands to keep from being dropped." The author also references statements attributed to Thomas C Barber, MD, chair of the AAOS Council on Advocacy, regarding the roles that narrow provider networks and Medicare payment cuts have in limiting compensation.
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Report Looks At State Laws Designed To Encourage Competition In Healthcare Markets
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A report released jointly by the National Academy of Social Insurance and Catalyst for Payment Reform examines the effectiveness of state laws that attempt to regulate or encourage competition within healthcare markets in the face of consolidation. The authors cataloged state laws and conducted targeted interviews with state attorneys general, the Federal Trade Commission, academics, and various other experts to identify state activity. Included among the findings are the following:
- 42 states have laws on price transparency, but the information is frequently not easily accessible to consumers
- 18 states have banned anti-competitive "favored nation" clauses that can prevent new health plans from entering local markets
- 5 states have Certificate of Public Advantage statutes that permit exemption from antitrust provisions for providers merging or consolidating for the purposes of cooperation and healthcare delivery improvements
- A number of states are forming regulatory bodies to monitor healthcare prices
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Read the report...
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Many Physician Employment Contracts Will Soon Come Up For Renewal
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According to an article in Modern Healthcare, many physician employment contracts signed with hospitals in the early days of healthcare reform will soon be coming up for renewal. One expert predicts that future value-based payments will be similar to capitation models and may be affected by the current emphasis on value. In addition, having physicians involved in governance and decision-making may make the negotiating process run more smoothly while simultaneously helping to identify areas where integration and reimbursement issues intersect. Another expert observes that, "Once they become employed, doctors never again have the leverage they had during negotiations to sell their practice," but points out that physicians who are savvy about data strengthen their negotiation position by showing they met certain metric goals and generated a certain level of revenue.
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Are Narrow Networks The Future Of Health Insurance?
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An article published in HealthLeaders Media suggests that the practice of narrowing provider networks is likely to increase in coming years. A spokesperson for one insurer argues that, as consumers become a more important factor in the health insurance market, they are likely to demand greater value, and limiting provider networks is one want to achieve that. In addition, a drive toward increased efficiency through the shift to affordable care organizations creates de facto narrow networks. However, at least one expert disagrees, noting that an observed backlash against health maintenance organizations was driven in part by a demand for broader provider networks.
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2014-2015 Board of Directors
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