OVERNIGHT HEALTHCARE: ObamaCare program saves Medicare $400 million

A pilot program created under ObamaCare to change Medicare's payment system saved almost $400 million and will be expanded, the administration announced Monday. 

An independent report released by the Department of Health and Human Services on Monday finds that the pilot program saved Medicare more than $384 million across 2012 and 2013. 

The pilot program, called Pioneer Accountable Care Organizations, is part of an effort to shift Medicare to paying for quality instead of quantity of care. 


Under the program, groups of doctors agree to accept lump payments under Medicare instead of individual payments for each service they provide, as in the traditional Medicare payment system.

The idea is to discourage unnecessary tests and procedures and better coordinate care. If the groups of doctors, known as Accountable Care Organizations (ACOs), end up keeping costs below the target, they get to keep some of the leftover money, providing an incentive to keep costs down. 

The Obama administration is touting the pilot program, claiming it's paid off and generated savings.

"The Affordable Care Act gave us powerful new tools to test better ways to improve patient care and keep communities healthier," HHS Secretary Sylvia Mathews Burwell said in a statement. "The Pioneer ACO Model has demonstrated that patients can get high quality and coordinated care at the right time, and we can generate savings for Medicare and the health care system at large."

The independent Office of the Actuary of the Centers for Medicare and Medicaid Services (CMS) has now certified that the program can be expanded. It currently applies to about 600,000 Medicare beneficiaries. Read more here.

SENATORS WANT BETTER OBAMACARE SPENDING OVERSIGHT. Two Republican committee chairmen are pressing the Obama administration to improve its oversight of how state-run ObamaCare marketplaces use federal dollars, citing an inspector general report on potential violations of law. 

Sens. Orrin HatchOrrin Grant HatchOrrin Hatch Foundation seeking million in taxpayer money to fund new center in his honor Mitch McConnell has shown the nation his version of power grab Overnight Health Care — Presented by PCMA — Utah Senate votes to scale back Medicaid expansion | Virginia abortion bill reignites debate | Grassley invites drug execs to testify | Conservative groups push back on e-cig crackdown MORE (R-Utah) and Chuck GrassleyCharles (Chuck) Ernest GrassleySenate approves border bill that prevents shutdown Grassley raises voice after McConnell interrupts Senate speech Senate confirms Trump pick William Barr as new attorney general MORE (R-Iowa) wrote to the head of the Centers for Medicare and Medicaid Services (CMS) on Monday asking for the agency to issue clarifying guidance on how the federal dollars can be spent. 

State-run ObamaCare marketplaces received federal funds to help set themselves up, but after Jan. 1 of this year, they marketplaces are supposed to be self-sustaining. They are now prohibited by law from using federal funds for "operating expenses." They can only use the money for "design, development, and implementation." 

The problem is that the definition of these two categories can be unclear, as noted by an HHS Inspector General report late last month. The senators want clearer definitions from CMS. 

State-based marketplaces (SBMs) "cannot be allowed to use hard-earned taxpayer dollars for expenses that are statutorily prohibited," the senators write.

Hatch and Grassley also point to the Inspector General's finding that many of the 13 state-run marketplaces are in financial trouble, possibly raising their need to rely on federal funds. Read more here.

ER VISITS CLIMB UNDER OBAMACARE, POLL FINDS. Emergency room visits have increased under ObamaCare despite the law's intention to reduce their use for standard medical care, a new survey finds.

The survey of ER doctors finds that three-quarters say their number of patients has increased since ObamaCare's insurance mandate took effect at the beginning of 2014.

The American College of Emergency Physicians (ACEP), which conducted the survey, pointed to the shortage of primary care doctors and the low payment rates from Medicaid, which accounts for much of ObamaCare's coverage expansion. 

"America has severe primary care physician shortages, and many physicians will not accept Medicaid patients because Medicaid pays so inadequately," Dr. Michael Gerardi, president of ACEP, said in a statement. "Just because people have health insurance does not mean they have access to timely medical care."

The inability to get a timely appointment with a primary care doctor leaves people still relying on emergency rooms, he argued. One of the goals of ObamaCare was that, as people gained insurance, they would be able to go to other doctors and not rely on emergency rooms as much. Read more here

Tuesday's Schedule

The Senate HELP Committee holds a hearing on precision medicine.

The American Hospital Association conference continues in DC.

State by State

Louisiana takes possible step towards Medicaid expansion

Kansas, Texas join Florida Medicaid lawsuit

Va. AG: Abortion clinics can be exempted from new standards

What we're reading

Chief Justice Roberts at center stage on ObamaCare decision

Patients not hurt by hospital closings, study finds

What you might have missed from The Hill

Push to boost medical research gains traction

Almost 12 million gained Medicaid coverage under ObamaCare

Please send tips and comments to Sarah Ferris, sferris@thehill.com, and Peter Sullivan, psullivan@thehill.com. Follow on Twitter: @thehill@sarahnferris@PeterSullivan4