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Industry News

Federal exchange stronger than the state-run ones

The Obama administration reports a significant increase in new customers signing up for health insurance in Florida, Texas and other states using the federal insurance marketplace. States running their own exchanges had more modest numbers. Overall, the administration reports more than 7 million Americans have signed up for coverage under the Affordable Care Act--6.5 million through the federal exchange. Of those signing up, 87 percent qualified for reduced premiums. (Kaiser Health News)



ACA spurs lower hospital admission rates

ACA-related changes have resulted in a 1.4 percent drop in hospital admissions to 13 large hospital systems during the third quarter of 2014. Inpatient admissions were the most affected and can be partially attributed to the "two-midnight" rule, implemented by CMS in 2013. Under the rule, an admission is assumed to be appropriate for a Medicare Part A payment if the physician expects the treatment to require a two-night hospital stay. (Advisory Board Daily Briefing; Modern Healthcare)  


Study: Medicaid PCMH doesn't affect acute care utilization

Research recently published in Health Affairs finds the patient-centered medical home had no effect on acute care use among Medicaid patients and little reduction in cost or primary care use. "Our finding that only patient-centered medical homes with substantial proportions of chronically ill patients had an impact on certain forms of utilization and cost is of relevance to stakeholders," researchers conclude. "The findings support a case-mix-adjusted payment policy for medical homes," they note, adding that their findings also raise questions about whether the PCMH model should be implemented differently based on the patient population. (Health Affairs; Medscape Medical News)

Innovation & transformation

Trinity, Heritage joint venture expands reach of accountable care

Trinity Health, an 86-hospital Catholic system, and Heritage Provider Network, a health insurer and organization of independent physician groups, have inked an agreement to advance care coordination for specific groups of patients. They are creating ACO-like care networks across the country. The joint venture, Trinity Health Partners, will help move their systems more quickly away from the current fee-for-service reimbursements and toward their shared goal of a "people-centered health system," officials say. Trinity CEO Dr. Richard Gilfillan, who led the CMS Innovation Center, has made a concerted effort to establish ACOs in each of Trinity's markets,
Modern Healthcare reports. (Modern Healthcare)


Frustrated doctor launches palliative care startup

"It's very hard for one doctor to manage the complexity of each [palliative care] individual patient and to crank it out in any way that generates productive revenue," says Dr. Michael Fratkin. So he's launched a startup to provide the kind of palliative care he believes in. ResolutionCare has no office. Funds will go into hiring and training a team of people who can make house calls and, on occasion, use video conferencing. Medicare and Medicaid don't pay for video sessions when the patient is at home. Fratkin is looking for private donors and foundation grants, and he's begun a crowdfunding campaign. (NPR)



Patient portal helps network improve care

Chicago's Medical Home Network says its members have reduced 30-day readmissions by 25 percent, increased timely post-discharge follow-ups by as much as 130 percent and reduced overall cost of care since December 2012. Executives credit MHNConnect, a web-based portal which provides real-time alerts to primary care providers whenever patients utilize inpatient or emergency hospital services across the Medical Home Network community. (Health Data Management)

Consumers & Providers

Some eligible individuals reject subsidies

Grace Brewer calls herself "a casualty of Obamacare." Brewer, 60, is a self-employed chiropractor in Kansas. She wanted to keep her catastrophic plan but it was discontinued because it did not comply with ACA requirements. Her bills have doubled to more than $400 a month. She could pay less were she to accept a subsidy, but she refuses: "I will not take a handout." Her sentiment is unusual, but not unique: Brokers say they have clients eligible for subsidies--which are based on income, not assets--but reject them. (MSN/US News & World Report)


HHS, IRS will offer resources to make tax time easier for HIX enrollees

The Health and Human Services and the Treasury departments have announced plans to make additional resources available in the coming weeks to help individuals and families understand ACA-related tax changes. "For the vast majority of Americans, tax filing under the Affordable Care Act will be as simple as checking a box to show they had health coverage all year," said HHS Secretary Sylvia Burwell. Details on the ACA's tax provisions are available at www.IRS.gov/ACA/ and www.healthcare.gov/taxes. (AHA News Now)

Eliminating subsidies would cut costs and enrollment

Eliminating subsidies for those who buy through the federal HIX would sharply boost costs and reduce enrollment in the individual market, AHA News Now reports, citing two new studies. The RAND study found that ending subsidies in the 34 states with federally facilitated marketplaces would cause enrollment to drop by 9.6 million. The Urban Institute study, funded by the Robert Wood Johnson Foundation, found that the number of uninsured Americans would jump by 8.2 million in 2016. (AHA News Now)
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New & Noted   

Fewer uninsured: A recent Gallup poll shows a drop by 4.2 percentage points of Americans without health insurance, to an average of 12.9 percent, in the fourth quarter of 2014. (Reuters) 


HCA adds HIX plans: HCA's HIX contracts are up 37 percent for 2015. It has added UnitedHealthcare in Texas and Florida. It also added Aetna and Humana in Florida. HCA made the changes despite the uncertainty over how the U.S. Supreme Court will rule on federal subsidies.(Modern Healthcare)

Docs to CMS: Recognize advanced-care planning codes: Eleven physician organizations have signed a letter urging CMS to recognize and make separate payments for two new CPT codes developed by the CPT Editorial Panel--99497 and 99498--that describe complex advanced care planning. (AAFP News)

Research: Most cancers are due to bad luck

It's apparently time to stop blaming the victim. New research suggests that most cancers can be attributed to gene mutations--in other words, bad luck. As CNN puts it:  "Ever marvel at someone who smoked and still lived to be 90? Just plain good luck, researchers say. And those who live like Puritans and get cancer anyway? That's bad luck--and it's the primary cause of most cancer cases, says a Johns Hopkins Medicine research study." (CNN)

MarketVoices...quotes worth reading


"I wanted a minimal plan and I'm not allowed to have it. That seems like an encroachment on my freedom." -- Grace Brewer, 60, a self-employed chiropractor 

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Wednesday, Jan. 14, 2014



















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