CBO Shaves $100 Billion from ACA's Ten-Year Cost Projection
Since the passage of the Patient Protection and Affordable Care Act (ACA), the Congressional Budget Office (CBO) and the Joint Committee on Tax (JCT) have attempted to estimate the cost of implementing the ACA's provisions, as well as assess its overall budgetary effects. Most recently, in April 2014, the CBO reduced its estimate for the cost of health insurance coverage expansion under the ACA, projecting that these provisions will cost $36 billion for 2014, $5 billion less than the CBO's previous projection. The CBO also reduced its estimate for the cost of implementing the ACA's coverage provisions over the next decade to $1.383 trillion, an estimate that is more than $100 billion less than previous forecasts. The CBO and JCT indicated that their downward adjustments were due primarily to the CBO's decreased projection regarding federal spending on subsidies for insurance premiums, a critical feature of coverage expansions under the ACA. (Read more...)

AHA Sues HHS Over Two-Midnight Rule
On April 14, 2014, the American Hospital Association (AHA), along with several state hospital associations and large healthcare systems, filed two lawsuits in the federal district court of Washington, D.C., challenging CMS's "two-midnight" rule regarding Medicare reimbursement. The AHA's lawsuits seek to discard four elements of the rule, namely: (1) the "two-midnight" requirement for classification as "inpatient;" (2) the requirement of written physician orders for each inpatient stay at a hospital; (3) the one-year filing limit on a hospital's revised claims after claim denial by a Recovery Audit Contractor (RAC); and, (4) the 0.2% rate cut to hospitals on Medicare reimbursements to pay for RAC reviews. Although the fate of both lawsuits is uncertain, the suits serve as a direct challenge to current Medicare reimbursement regulations and could shake the reimbursement landscape in the future. (Read more...)

Diminishing Returns in Healthcare Series - Part 3 of 3: ACA's Efforts to Make Healthcare More Affordable
This third and final installment of this three-part Health Capital Topics series examines various provisions of the Patient Protection and Affordable Care Act (ACA) that are designed to combat wasteful spending and make healthcare more affordable. One of the ACA's primary strategies to reduce wasteful spending is to provide financial incentives for efficient, high quality care. Various ACA programs provide financial incentives to reduce wasteful spending, increase care coordination, and promote positive health outcomes, namely: (1) the Hospital Value-Based Purchasing Program; (2) the Medicare Shared Savings Program; and, (3) the Hospital Readmissions Reduction Program. Additionally, the ACA sought to reduce administrative complexity and healthcare fraud through the creation of health insurance exchanges and expanding liability under various federal healthcare laws. (Read more...)

CMS Proposes New Fire Safety Regulations for Hospitals
On April 14, 2014, the Centers for Medicare & Medicaid Services (CMS) announced a proposed rule regarding the adoption of the 2012 edition of the Life Safety Code (LSC) and Health Care Facilities Code (HCFC), which contains key updates regarding fire safety regulations for all Medicare and Medicaid participating hospitals; long term care facilities (LTC); critical access hospitals (CAH); ambulatory surgical centers (ASC); and, other facilities. CMS asserts that the adoption of these building codes will ease compliance across facilities, as both the LSC and HCFC are aligned with international building codes. These code updates are particularly important for hospitals, as they contain new requirements for: (1) sprinkler systems; (2) fire watch requirements; (3) patient suite sizes; and, (4) door locking, among others. (Read more...)