5 Things We’re Watching – Washington, July 2013

With only a few months until our Inland Northwest event in Spokane on September 12th, we sort of thought we knew the scope of topics that might break this summer.

We didn’t see some of these coming.  Mental health system redesign.  Medicare fraud by area hospitalists.  Big CMS rules on reimbursement.

It’s a lot – and our 5 Things We’re Watching this month.

DJ Wilson - Host, State of Reform

1. Mental health system in WA declared “invalid”

Last week’s news that CMS had declared the Washington State mental health system effectively “invalid” came as a shock to some, and an opportunity to others.

Why?  For the first time in a generation, Washington State can have a more open conversation about fully integrating mental and physical health for patients in the Medicaid system.

Almost everyone I’ve talked to sees this as an opportunity for real reform, whether revolutionary or incremental.  The upside of innovation to the system seems so high – particularly for kids.  But, change of this magnitude will be very, very difficult.

2. Agenda for Inland Northwest event released!

With so much going on this year, we’re thrilled to host our first Inland Northwest event September 12th – right ahead of open enrollment on the exchanges.

We released our Topical Agenda this week, and have already gotten a tremendously positive response from folks!  Our Convening Panel has some of the smartest names in health care from the Inland Northwest.

We’d love to have you join us!  You can register now at early bird rates (and we’ll even throw in this added discount code for the first five folks that register with it:  5Things).

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3.  It’s in the weeds but it’ll hit the bottom line

On July 8th, CMS proposed a rule to make outpatient payments more “episodic” or in “packages,” which some identify as like the bundled payment methodology in hospitals.

Later, CMS proposed a new rule that would trim or raise select physician payments, with some cuts of up to 26%, in order to facilitate episodic payment to physicians.

Finally, MedPAC identified 78 different services performed across multiple settings – inpatient versus outpatient – which were paid different rates.  By paying the lower amount for the same service (typically the outpatient rate) MedPAC reports it can save Medicare $1.5 billion annually.

4.  States market Exchanges reflecting their unique cultures

It takes a lot to educate folks on a new way to buy their health insurance.  So, exchanges across the country are spending a lot of money – and a lot of mental creativity – on outreach, education and marketing.   In Washington, the Exchange is looking to spend $5.2m in 2013.

In Oregon, the Exchange is asking folks for, well, folk songs.  Connecticut underwhelms.  Colorado overstates.  And, Kentucky animates.

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5. Huge Medicare fraud by South Sound hospitalist group

Sound Inpatient Physicians will pay $14.5m to the US Treasury for “knowingly…inflated claims” to Medicare.  The amount is settlement with the US government to avoid a “determination of liability,” but the announcement from US District Attorney Jenny Durkan is pretty clear.  The “whistle blower” will get $2.7m of the settlement for alerting the authorities.

It reminds me of another major Medicare fraud in Puget Sound in recent years at UWP.  Makes me wonder if something is in the water…  Or, more likely what the US government should expect for chronically underfunding Medicare.