Monday, September 29, 2014

According to a recent study,

25% of all U.S. hospital spending consists of administrative costs, compared to 20% in the Netherlands, 16% in England and 12% in Canada.
Source: "A comparison of hospital administrative costs in eight nations: US costs exceed all others by far," The Commonwealth Fund,

Tuesday, September 23, 2014

CMS update on consumers who have data matching issues


FOR IMMEDIATE RELEASE                                             Contact: CMS Media Relations

September 15, 2014                                                           (202) 690-6145 or



CMS update on consumers who have data matching issues


Of 966,000 individuals with citizenship or immigration data matching issues as of May 30th, 851,000 are now closed or in progress, a reduction of 88 percent


Of 1.2 million households with income data matching issues as of May 30th, 897,000 households are now closed or in progress; consumers will be getting letters this week asking for information


The Centers for Medicare & Medicaid Services (CMS) is committed to assisting consumers and protecting taxpayers by helping to ensure those who are enrolled in Marketplace coverage meet the eligibility requirements. As CMS prepares for the next Marketplace open enrollment period beginning on November 15, it is resolving data matching issues that occurred during the first year so that its records are accurate before the renewal process begins, and so that consumers have the information they need about their coverage. Throughout this process CMS has worked to maintain coverage for those who have sought it in the Marketplace, while meeting its obligation to the taxpayer to spend its dollars wisely.


Today, the Federal Health Insurance Marketplace (Federal Marketplace) began sending notices to consumers who have an income-related data matching issue. Individuals who do not respond to numerous previous attempts to contact them by September 30, 2014 may see the costs of their coverage change. For instance, this may impact the cost of their monthly premium, deductibles, copays, and co-insurance, and even their tax bill or refund during filing season.


“The Affordable Care Act is working for millions of Americans who are able to access quality health coverage at a price they can afford. In fact, most individuals who selected a plan with tax credit in the Federal Marketplace are paying less than $100 a month in premiums,” said CMS Administrator Marilyn Tavenner. “We are committed to keeping coverage affordable for the millions of Americans who depend on it, and to doing so in an efficient, transparent way that protects taxpayers. It’s critically important that consumers who still owe income-related documents to the Marketplace send them in by September 30 so we can continue to hold down their costs. We are pleased that the number of individuals who were at risk of losing their Marketplace coverage, or seeing changes in their costs because of data matching issues has been dramatically reduced in the last three months.”


Consumers often have more up-to-date information than what’s in CMS data sources. For example, the Marketplace verified income by checking 2012 tax return information, but a consumer could have switched jobs since those returns were filed. Just because CMS is double-checking data and requesting more documentation, doesn’t mean that a consumer has provided false information or that he or she is ineligible for help paying for coverage or health services – it simply means that the information on their application doesn’t match what’s in trusted data sources and therefore has to be verified.


On May 30, there were roughly 1.2 million households with income-related data-matching issues. This represents about 1.6 million people. We’ve made significant progress since then based on an extensive outreach campaign and enhanced operational effectiveness. As of September 14, approximately 467,000 household income data-matching issues have been closed and an additional 430,000 are currently in the process of being resolved. There are still about 279,000 households with unresolved income-related data-matching issues that haven’t sent in supporting information, representing 363,000 individuals. CMS will send letters starting today to individuals who, if they do not send in supporting documents by September 30, may see their costs change.


Income-related data matching notices are being sent in English and Spanish and will provide straightforward instructions on how consumers should submit the necessary information to the Marketplace to help keep their costs down. Those individuals receiving a letter referencing September 30 should log into their account and select their current application to upload their documents. They can also mail their information to our consumer center. To facilitate timely processing, consumers mailing in a copy of their documents should include the bar code page from the notice with their documents. Consumers may also contact our call center at 1-800-318-2596 to see what documents they need to submit and check whether the Federal Marketplace has received their information.


A network of partners, local assistors and other stakeholders including community health centers are actively communicating and engaging consumers to help them keep their health insurance and eligibility for financial assistance. Consumers may contact one of our partners in their community to get one-on-one help. To find one of these local partners, visit Find Local Help on


Today, CMS is also providing an update on individuals with citizenship and immigration data matching issues. In August, we sent letters to about 310,000 Federal Marketplace consumers who had not submitted any outstanding citizenship or immigration documents after numerous requests.   We’ve made progress in resolving these cases. We received hundreds of thousands of documents in response to the September 5th deadline resulting in a decrease from 966,000 as of the end of May to 115,000 as of September 14. To date, 115,000 individuals with citizenship and immigration data matching issues have not responded to our numerous contacts and will be receiving notices saying their last day of Federal Marketplace coverage is September 30, 2014. Those who submit information that confirms their eligibility after the deadline may be eligible for a special enrollment period to enroll in coverage.


For more helpful tips and the steps these consumers need to take, visit


26% of covered workers are enrolled in grandfathered health plans

...(plans that are exempt from many provisions of the Affordable Care Act), down from 36% of covered workers in 2013.

Source: "2014 Employer Health Benefits Survey," The Henry J. Kaiser Family Foundation, September 10, 2014,

The Highest Health-Care Cost Per Capita By Country

1.    Norway - $9,055

2.    Switzerland - $8,980

3.    United States - $8,895

4.    Denmark - $6,304

5.    Australia - $6,140

6.    Canada - $5,741

7.    Netherlands - $5,737

8.    Austria - $5,407

9.    Sweden - $5,319

10.  Japan - $4,752

Source: Bloomberg

Government Health Insurance [Medicare/Medicaid/Etc] Users By Age Group (In Thousands)

1.    Under age 65: (65,913)

2.    Under age 18: (30,410)

3.    Under age 19: (31,557)

4.    Aged 19 to 25: (6,033)

5.    Aged 26 to 34: (6,601)

6.    Aged 35 to 44: (6,214)

7.    Aged 45 to 64: (15,507)

8.    Aged 65 and older: (41,668)

Source: U.S. Census Bureau, Current Population Survey, 2014 Annual Social and Economic Supplement

29% of MDs would not choose Medicine if they had their Careers to do over

According to the Physicians Foundation:

  • 81% of physicians describe themselves as either overextended or at full capacity.
  • 44% of physicians plan to take one or more steps that would reduce patient access to their services.
  • 72% of physicians believe there is a physician shortage.
  • 35% of physicians describe themselves as independent practice owners.
  • 53% of physicians describe themselves as hospital or medical group employees.

Note: Survey conduced on behalf of the Physicians Foundation by Merritt Hawkins. Completed September, 2014. Based on over 20,000 survey responses.

Source: Physicians Foundation

Friday, September 19, 2014

Today's Datapoint

3.3% ... was the 2013 increase in U.S. spending on outpatient prescription drugs, with 6.8% and 6.4% increases projected for 2014 and 2015 respectively, according to a Pembroke Consulting, Inc. analysis of new national health expenditure data from CMS.

National Partnership to Improve Dementia Care exceeds goal to reduce use of antipsychotic medications in nursing homes



FOR IMMEDIATE RELEASE                                     Contact: CMS Media Relations

September 19, 2014                                                         (202) 690-6145 or


National Partnership to Improve Dementia Care exceeds goal to reduce use of antipsychotic medications in nursing homes: CMS announces new goal

Coalition provides tools and support to achieve continued decreases


The National Partnership to Improve Dementia Care, a public-private coalition, today established a new national goal of reducing the use of antipsychotic medications in long-stay nursing home residents by 25 percent by the end of 2015, and 30 percent by the end of 2016. The coalition includes the Centers for Medicare & Medicaid Services (CMS), consumers, advocacy organizations, providers and professional associations.


Between the end of 2011 and the end of 2013, the national prevalence of antipsychotic use in long-stay nursing home residents was reduced by 15.1 percent, decreasing from 23.8 percent to 20.2 percent nationwide. The National Partnership is now working with nursing homes to reduce that rate even further.


“We know that many of the diagnoses in nursing home residents do not merit antipsychotics but they were being used anyway,” said Patrick Conway, M.D., deputy administrator for innovation and quality and the CMS chief medical officer. “In partnership with key stakeholders, we have set ambitious goals to reduce use of antipsychotics because there are – for many people with dementia – behavioral and other approaches to provide this care more effectively and safely.”


Coalition members, including AMDA – The Society for Post-Acute and Long-Term Care Medicine, American Health Care Association (AHCA), LeadingAge and Advancing Excellence in America’s Nursing Homes, are committed to achieving these new goals. The groups set these goals because they are challenging, yet achievable with the continued hard work of many stakeholders. These goals build on the progress made to date and express the coalition’s commitment to continue this important effort. The National Partnership seeks to optimize the quality of life for residents in America’s nursing homes by improving care for all residents, especially those with dementia.


“We have created many tools for nursing homes to use to help achieve these goals,” said Dr. Conway. “Ultimately, nursing homes should re-think their approach to dementia care, re-connect with the person and their families, and use a comprehensive team-based approach to provide care.”


While the initial focus is on reducing the use of antipsychotic medications, the Partnership’s larger mission is to enhance the use of non-pharmacologic approaches and person-centered dementia care practices. CMS will monitor the reduction of antipsychotics as well as the possible consequences. For example, CMS will review prescriptions of anxiolytics and sedative/hypnotics to make sure nursing homes do not just replace antipsychotics with other drugs. In addition, CMS will review the cases of residents whose antipsychotics are withdrawn to make sure they don’t suffer an unnecessary decline in functional or cognitive status as a nursing home tries to reduce its usage.


Some states have achieved significant reduction in their rate of antipsychotic usage. For example, Georgia reduced its rate by 26.4 percent and North Carolina saw a 27.1 percent reduction. CMS released a fact sheet today with full state-by-state data as well as other data from the program.


CMS and its partners are committed to finding new ways to implement practices that enhance the quality of life for people with dementia, protect them from substandard care and promote goal-directed, person-centered care for every nursing home resident. The Partnership has engaged the nursing home industry across the country around reducing use of antipsychotic medications with momentum and success in this area that is expected to continue. In 2011, Medicare Part D spending on antipsychotic drugs totaled $7.6 billion, which was the second highest class of drugs, accounting for 8.4 percent of Part D spending.


In addition to posting a measure of each nursing home’s use of antipsychotic medications on the CMS Nursing Home Compare website, in the coming months CMS plans to add the antipsychotic measure to the calculations that CMS makes for each nursing home’s rating on the agency’s Five Star Quality Rating System.


Seven Ways Telemedicine Changes The New Face of Healthcare Landscapes

1.    Stronger relationships

2.    Convenience

3.    Reduced complexity

4.    Greater awareness

5.    Shared purpose

6.    Improved efficiency

7.    Enhanced flexibility for physician

Source: Forbes

Medicare Modernization Act Six Classes of Drugs Required to be Included in Medicare Part D

1.    Immunosuppressants

2.    Anticonvulsants

3.    Antineoplastics

4.    Antidepressants

5.    Antipsychotics

6.    Antiretrovirals

Source: Mondaq

32% of employers plan to offer a CDHP (consumer-directed health plan) as their only benefit plan option in 2015

... compared with 22% this year, according to a recent survey.

Source: "U.S. Employers Changing Health Benefit Plans to Control Rising Costs, Comply with ACA, National Business Group on Health Survey Finds," National Business Group on Health, August 13, 2014,

Medical malpractice claims with catastrophic payouts of $1 million or more

... comprised 7.9% of all paid claims during 2004-2010, according to a recent study.

Source: "Catastrophic Medical Malpractice Payouts in the United States," Journal for Healthcare Quality, abstract only, July/August 2014,

According to a recent study of the 600 most commonly used mobile health apps for iOS and Android,

...only 183 (30.5%) had privacy policies.

Source: "Availability and quality of mobile health app privacy policies," Journal of the American Medical Informatics Association (JAMIA), August 21, 2014,

According to a recent assessment of a proactive implementation strategy for an interactive patient portal in 8 primary care practices:

  • 25.6% of the patients used the patient portal
  • The rate of patient use increased 1.0% per month over 31 months
  • 23.5% of patients signed up for patient portal use within 1 day of their office visit

Source: "Engaging Primary Care Patients to Use a Patient-Centered Personal Health Record," Annals of Family Medicine, abstract only, September/October 2014,

Today's Datapoint

$140 million ... were the combined operating losses of Massachusetts Medicaid plans since the start of 2014, $99 million of which was reported by Neighborhood Health Plan, the Boston Globe reported on Aug. 20.

Quote of the Day

“If you were appealing [Medicare claims denials] willy-nilly, without regard to whether you had a good case, taking [CMS’s offer of a 68% buyout] probably is a reasonable strategy. If you were being selective and only appealing the good cases, I wouldn’t take the settlement because you probably will win most of them.”

— Minneapolis attorney David Glaser, who is with Fredrikson & Byron, told AIS’s Report on Medicare Compliance.

Wednesday, September 17, 2014

Today's Datapoint

22 ... accountable care organizations are left in the Medicare Pioneer program — down from 32 ACOs at the start — with the recent departure of Sharp HealthCare.

Tuesday, September 16, 2014

50% of healthcare organizations block access to social sites on company networks

According to a recent survey by Wolters Kluwer Health:

  • 89% of healthcare organizations allow nurses to use online search engines at work.
  • 60% of respondents say they use social media to follow healthcare issues at work.
  • 86% of respondents say they follow healthcare issues on social media outside of work.
  • 50% of the respondents say that their organization blocks access on company networks to social sites.
  • 48% of respondents say their healthcare institutions encourage nurses to access online resources.
  • 41% of respondents allow occassional use to online resources.
  • 5% of respondents allow access to online resources as a last resort.
  • 77% that use mobile devices at work are Nurse Managers.
  • 58% that use mobile devices at work are Staff Nurses.
Source: Wolters Kluwer Health

About 17.5% of new nurses leave their first job

...within one year of starting their jobs, according to a recent study.

Source: "What Does Nurse Turnover Rate Mean and What Is the Rate?," Policy, Politics & Nursing Practice, abstract only, August 25, 2014,

58% of healthcare CEOs say social media users are influencing their business

According to a survey by PwC:

  • 24% healthcare CEOs post about their health experiences or updates.
  • 27% comment about their health experiences or updates.
  • 16% post reviews of medications or treatments or doctors or health insurers.
  • 16% share health-related videos or images.
  • 18% trace and share their health symptoms or behavior.
  • 20% join a health-related cause.
  • 28% support a health-related cause.

Note: HRI surveyed 1060 consumers; selected demographics may result in smaller sample sizes.

Source: PwC HRI Social Media Consumer Survey

According to a recent report:

  • For single coverage, the average annual premium for employer-sponsored health insurance in 2014 is $6,025, 2% higher than in 2013
  • For family coverage, the average annual premium for employer-sponsored health insurance in 2014 is $16,834, 3% higher than in 2013
  • During the same period, workers’ wages increased 2.3% and inflation increased 2%
  • Over the last ten years, the average premium for family coverage has increased 69%, while the worker contributions for family coverage increased 81%
  • Premiums have increased 26% over the last five years (2009 to 2014), compared to 34% for the five year period of 2004 to 2009
Source: "2014 Employer Health Benefits Survey," The Henry J. Kaiser Family Foundation, September 10, 2014,

9 Top Connected Health Devices Consumers Use, Intend To Buy

1.    Exercise equipment with built-in app support: 13% own and use, 6% intend to buy

2.    Digital pedometer or fitness tracker: 7% own and use, 5% intend to buy

3.    Blood pressure cuff: 6% own and use, 4% intend to buy

4.    Digital weight scale: 4% intend to buy, 4% use

5.    GPS watch: 4% use, 3.5% intend to buy

6.    Sports watch with built-in heart-rate monitor: 3.5% use, 4% intend to buy

7.    Sleep-quality monitor: 2.5% use, 4% intend to buy

8.    Smart pill box: 2% use, 4% intend to buy

9.    Glucometer: 2% use, 3.5% intend to buy

Source: Becker's Hospital CIO

Cities with Higher Unfunded Liabilities for Retiree Health Than Pensions (Health Care/Pensions)

1.    Austin, TX $1,036/$949

2.    Baltimore, MD $2,397/$678

3.    Boston, MA $4,554/$1,242

4.    Bridgeport, CT $862/$206

5.    Charlotte, NC $174/$79

6.    Columbia, SC $162/$112

7.    Detroit, MI $4,977/$553

8.    Fort Worth, TX $995/$432

9.    Honolulu, HI $1,885/$955

10.  Houston, TX $3,096/$2,252

11.  Indianapolis, IN $140/$74

12.  Jersey City, NJ $908/$443

13.  Memphis, TN $1,824/$563

14.  Milwaukee, WI $960/$-545

15.  Nashville, TN $1,779/$43

Source: Pew Center on the States

Award Requirements to Help Consumers Navigate their Healthcare Coverage

1.    Navigator grantees must maintain a physical presence in the Marketplace service-area.

2.    Navigator grantees are required to be trained on and comply with strict security and privacy standards.

3.    Navigators required to submit progress reports detailing their activities in the communities they serve.

4.    Required training course on advanced Marketplace issues with detailed information on topics.

Source: United States Department of Health and Human Services (HHS)

Today's Datapoint

$1,503... on average was spent per enrollee by state-run exchanges, while the average per-member cost in federally facilitated exchange states was just $647, according to a recent paper from the consulting firm of Leavitt Partners.

Thursday, September 11, 2014

According to a recent phone survey:

  • 38% of respondents said they were “very likely” to accept an invitation to see their healthcare provider via video
  • 28.1% were “somewhat likely”
  • 33.8% were “not at all likely"
  • 75% of the respondents had broadband
  • 36% of the respondents had a Web camera

Source: "Perceptions of Video-Based Appointments from the Patient's Home: A Patient Survey," Telemedicine and e-Health, abstract only, August 28, 2014,

25% of Americans have more medical debt than emergency savings

According to a survey conducted by Princeton Survey Research Associates International:

  • 55% are worried they will find themselves overwhelmed by medical debt.
  • 27% are very worried they will find themselves overwhelmed by medical debt.
  • 28% are somewhat worried they will find themselves overwhelmed by medical debt.
  • 43% are either not too worried or not worried at all about being overwhelmed with medical debt.

Note: Interviews were done in English and Spanish by Princeton Data Source from August 21 to 24, 2014.  1,006 adults living in the United States were interviewed by phone.

Source: Bankrate, Inc.