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In This Issue
U.S. Department of Justice Sues To Block Insurance Mergers
CMS Data Brief Explains Distribution Of Hospital Quality Star Ratings
National Academies Release Social Risk Factors Analysis
MLN Connects Provider eNews Available
DHSS Posts Economic Impact Of CAHs
Barnes-Jewish West County Hospital Names New President

Health Law Insight

U.S. Department of Justice Sues To Block Insurance Mergers

Staff Contact: Jane Drummond

The Department of Justice, along with several states, moved to block the Aetna/Humana and Anthem/Cigna mergers in two separate lawsuits filed today. The actions claim that the mergers, which involve four of the five largest health insurers, violate the Clayton Act and would result in higher prices and reduced benefits while stifling innovation needed to improve the quality of care. The department alleges that individuals who buy insurance through the public exchanges will be harmed by both mergers, including consumers in 14 Missouri counties and the City of St. Louis. The DOJ also claims that the Aetna/Humana merger would virtually eliminate competition in the Medicare Advantage market in hundreds of counties across the nation, including 54 counties in Missouri. The Missouri Department of Insurance based its recent denial of a post-merger license to Aetna on similar grounds.

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Regulatory News
the latest actions of agencies monitoring health care

CMS Data Brief Explains Distribution Of Hospital Quality Star Ratings

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services released a data brief about the distribution of hospitals under the Overall Hospital Star Ratings system. CMS states that the star rating system is intended to reflect comprehensive quality information about the care provided within hospitals. Although the date of publication is unknown, CMS states that the ratings will be posted shortly. The data brief provides details about the measures used, the methodology and sources of data. The brief also illustrates the current distribution of star ratings.

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National Academies Release Social Risk Factors Analysis

Staff Contact: Andrew Wheeler

The National Academies Press released the third in a series of five reports which analyze the influence of social risk factors on the Medicare pay-for-performance programs. The report identifies potential criteria for determining whether social risk factors should be accounted for, then identifies potential metrics and methods in the application of social risk factors to quality, resource use or other measures used within the Medicare payment programs. Researchers provided eight conclusions.

1. Three overarching considerations encompassing five criteria could be used to determine whether a social risk factor should be accounted for in performance indicators used in Medicare value-based payment programs.
2. There are measurable social risk factors that could be accounted for in Medicare value-based payment programs in the short-term.
3. There are some indicators of social risk factors that capture the basic underlying constructs and currently present practical challenges, but they are worth attention for potential inclusion in accounting methods in Medicare value-based payment programs in the longer term.
4. It is possible to improve on the status quo with regard to the effect of value-based payment on patients with social risk factors. However, it is also important to minimize potential harms to these patients and to monitor the effect of any specific approach to accounting for social risk factors to ensure the absence of any unanticipated adverse effects on health disparities.
5. Characteristics of a public reporting and payment system that could accomplish the goals of reducing disparities in access, quality and outcomes; quality improvement and efficient care delivery for all patients; fair and accurate public reporting; and compensating providers fairly.
6. To achieve goals of reducing disparities in access, quality and outcomes; quality improvement and efficient care delivery for all patients; fair and accurate public reporting; and compensating providers fairly, a combination of reporting and accounting in both measures and payment are needed.
7. Strategies to account for social risk factors for measures of cost and efficiency may differ from strategies for quality measurement because observed lower resource use may reflect unmet need rather than the absence of waste, and thus lower cost is not always better, while higher quality is always better.
8. Any specific approach to accounting for social risk factors in Medicare quality and payment programs requires continuous monitoring with respect to the goals of reducing disparities in access, quality and outcomes; quality improvement and efficient care delivery for all patients; fair and accurate public reporting; and compensating providers fairly.

MLN Connects Provider eNews Available

Staff Contact: Andrew Wheeler

The Centers for Medicare & Medicaid Services issues updates to MLN Connects Provider eNews. eNews includes information about national provider calls, meetings, events, announcements and other MLN educational product updates. The latest issue provides updates and summaries of the following.

• IRF and LTCH quality reporting program data submission deadline: August 15
• Billing for nursing visits in home health shortage areas by an RCH or FQHC
• SNF readmission measure: top 10 things you should know
• Enhanced administrative simplification website

Noteworthy

DHSS Posts Economic Impact Of CAHs

Staff Contact: Jim Mikes

The Missouri Department of Health & Senior Services has posted a brief titled “The Economic Impact of Critical Access Hospitals.” This report calculates the downstream economic impact of CAHs and may be a useful tool for informing hospital boards and community stakeholders.

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CEO Announcements

Barnes-Jewish West County Hospital Names New President

Staff Contact: Carol Boessen

Trish Lollo has been named President of Barnes-Jewish West County Hospital in St. Louis, effective Aug. 15. Lollo has been with Barnes-Jewish Hospital since 2011 and served as vice president of oncology services at the Siteman Cancer Center, as well as laboratories and radiology. Before joining Barnes-Jewish Hospital, she served as associate administrator of oncology services for the University of California San Diego Health System. She succeeds Doug Black, who left in January. A list of CEO changes is available online.

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Consider This ...

In 2012, nearly 5,000 emergency department visits were linked to chemicals in pools. Almost half of the patients needing care were under 18 years old.

Source: Centers for Disease Control and Prevention