Thursday notes

David Ermer–Uncategorized–

The FEHBlog just watched his beloved UConn Huskies men’s basketball team lose a heartbreaker to Cincinnati. But the FEHBlog has a lot of news to share so he has to soldier on.

The FEHBlog was too pessimistic about Congress reaching an agreement on the Medicare Part B fix. The House and Senate announced today a bipartisan measure to repeal and replace the faulty sustainable growth rate (“SGR”) formula that is used to calculate Medicare Part B payments to doctors. According to Medpage, the pay go funding for the bill has not been worked out yet. But there’s reportedly a lot of confidence that this issue will be resolved too.

According to the Congressional press release, the bill would

  • Repeal the SGR and end the annual threat to seniors’ care, while instituting a 0.5 percent payment update for five years.
  • Improve the fee-for-service system by streamlining Medicare’s existing web of quality programs into one value-based performance program. It increases payment accuracy and encourages physicians to adopt proven practices.
  • Incentivize movement to alternative payment models to encourage doctors and providers to focus more on coordination and prevention to improve quality and reduce costs.
  • Make Medicare more transparent by giving patients more access to information and supplying doctors with data they can use to improve care.
A resolution to this issue for is important to FEHB plans because the FEHB Program has a large cadre of annuitants with Part B coverage. Plus fee for service plans use Medicare pricing to pay doctors for services rendered to annuitants over 65 without Medicare Part B. Congress needs to enact the bill before the end of March. 
The FEHBlog’s radar was better attuned to the Senate Postal reform bill (S. 1486) which the Homeland Security and Governmental Affairs Committee approved today. The bill, which would create a separate Postal Service Health Program within the FEHBP, now moves to the Senate floor. The House Oversight and Government Reform Committee approved its own version of Postal reform (H.R. 2748) last year. That bill has not yet reached the House floor. Here’s a link to the Federal News Radio story. 
Government Health IT reports on a final HHS rule that was published in today’s Federal Register. The rule

(1) expressly allows [federally regulated / most medical] labs to provide patients direct access to their lab test results and (2) requires labs covered under HIPAA [again practically all medical labs] to provide test results directly to patients in the form or format requested, (i.e., paper or electronic) if it is readily producible in that manner.
Today, patients’ access to clinical lab information is determined by the states. Only seven states and the District of Columbia allow such direct reporting and thirteen states prohibit it. Twenty-three states have no laws addressing the issue. The new rules will preempt state laws and regulations that prohibit medical laboratories from providing patients access to their test reports.

The change will take effect 240 days from now — October 6, 2014. The FEHBlog will continue to rely on his physician to provide these results. 
Finally, the FEHBlog cannot resist commenting on CVS’s decision to stop selling tobacco products on October 1. According to the Wall Street Journal, CVS which also owns one of the largest prescription benefits managers Caremark believes that this move will improve its relationships with customers — both insurers and the man or woman on the street — because cigarettes “have no place in a drugstore company that is trying to become more of a health-care provider.”  It’s a big revenue hit for CVS, but from a macro public health perspective pharmacies as a whole only have a 3% share of the retail tobacco market. Most tobacco products are sold at gas stations and convenience stores. The FEHBlog wonders whether CVS has started down a slippery slope. The FEHBlog has never used tobacco products, but he has (but no longer does) bought lots of sugary soda and candy at CVS. Those purchases did have a bad impact on his health .As Newman said once on Seinfeld, it’s a real conundrum.