Tuesday Tidbits

David Ermer–Uncategorized–

Congress did enact its 17th Medicare Part B payment fix yesterday which is good news for the FEHBP due to its large cadre of annuitant members over age 65. In the course of doing so, Congress also delayed the ICD-10 coding compliance date until at least October 1, 2015. Health Data Management reports on reactions to this development. You can read the FEHBlog’s right here.

In compliance with HIPAA and HHS’s implementing rules, health insurers have spent millions making their claims processing systems capable of handling claims bearing ICD-10 codes in anticipation of the HHS mandated October 1, 2014, compliance date. As readers of the FEHBlog know, the American Medical Association (“AMA”) has been crying the big tears about the cost of ICD-10 compliance to medical practices. The FEHBlog agrees with the AMA that the ICD-10 conversion will do nothing to advance HIPAA’s express objective of administrative simplification. The FEHBlog has noted that the AMA should have put more pressure on Congress at the time that HHS was considering whether or not to implement the ICD-10 late in the last decade. The FEHBlog thought that the AMA had missed its opportunity to defeat the ICD-10. But NOOOOOO, the AMA at the eleventh hour pulled out a legislative victory. Never underestimate the AMA’s legislative power.  In any event, the current delay is not all bad because HHS’s hard core approach to ICD-10 implementation this year portended a claims processing train wreck at Medicare.

Next the FEHBlog expects the AMA to argue that HHS should just stick with current ICD-9 until the ICD-11 is released later this decade. The FEHBlog would prefer that Congress just repeal HIPAA”s electronic transaction rules and let the industry work these problems out on its own. But the FEHBlog has no legislative clout.

At last week’s carrier conference, a medical director from the Blue Cross Blue Shield Association spoke about the need for health plans to consider community attitudes and resources at the zip code level when making decisions about promoting better health. The FEHBlog was reminded earlier this week that one of the best available public resources on community level health care is the Robert Wood Johnson Foundation’s online U.S. County Health Rankings.

Finally, here’s a potpourri of interesting pharma stories:

  • A Wall Street Journal article about soaring sales for a new biologic drug called Solvadi that treated hepatitis C. A 12 week course of treat costs $84,000. 3.2 million Americans may be infected with this disease. You do the math. 
  • A Wall Street Journal article about a promising and as yet still experimental class of biologic drugs to lower cholesterol — one of the Million Hearts campaign recommendations to avoid heart attack and stroke. “The companies [developing these drugs [called PCSK9 inhibitors] are vying in a market that includes millions of patients who can’t control their cholesterol with statins, which are among the most widely used and most lucrative drugs ever developed by the pharmaceutical industry.”
  • Fierce Pharma reports that the Food and Drug Administration approved last Friday a  request to move 24 hour Nexium, a blockbuster acid reflux drug losing its patent protection, to over the counter status.  The prescription drug manufacturer Pfizer which owns the rights to the over the counter version of Nexium sought this FDA approval. Over the counter status simply means that the drug can be taken safely without a doctor’s supervision.