TGIF

Tammy Flanagan offers FEHB Open Season tips and secrets in Govexec.com.

The Wall Street Journal offers higher income Medicare beneficiaries tips on how to control their Medicare Part B and D premiums.

For 2018, the latest data available, about 7% of 54.6 million total Medicare Part B recipients owed premium surcharges on that coverage, according to Juliette Cubanski, an analyst with the nonprofit, nonpartisan Kaiser Family Foundation.

Next year some people paying surcharges will benefit because inflation adjustments have resumed for the first time since 2011. This change will drop some people into a lower surcharge category, saving them hundreds of dollars.

Healthcare Dive reports that large hospital systems have been contracting with a Nashville based start up called Contessa “to help them deliver at-home hospital care to patients who otherwise would have been admitted.”  After all, as the old saw goes, people die in hospitals.

The Health Care Cost Institute has provided a very interesting claims based study on the use of out of network providers, who give rise to the surprise billing problem.

The frequency of out-of-network bills varies by type of service. In 2017, nationally:

  • 16.5% of visits with emergency room services had an out-of-network claim from an emergency medicine specialist.
  • 12.9% of visits with lab/pathology services had an out-of-network claim from a pathologist.
  • 8.3% of visits with anesthesiology services had an out-of-network claim from an anesthesiologist.
  • 6.7% of visits with behavioral health services had an out-of-network claim from a behavioral health provider.
  • 4.2% of visits with radiology services had an out-of-network claim from a radiologist.
  • 2.1% of visits with surgical services had an out-of-network claim from a surgeon.
  • 2.0% of visits with cardiovascular services had an out-of-network claim from a cardiovascular specialist.

Variation across states differs by type of service

  • Pathology and emergency services had the largest variation.
  • Cardiovascular and surgery services had the the smallest variation.

Potential surprise bills for surgery visits are orders of magnitude larger than for other types of service.

  • Nationally, the average potential surprise bill associated with an inpatient surgery was $22,248; outpatient surgery was $8,493.
Celebrations —
  • HHS’s Agency for Health Care Quality and Research (“AHRQ”) is celebrating its 20th anniversary. 
  • CMS celebrated National Rural Health Day yesterday. 
A friend of the FEHBlog called his attention to this sad story in Vox which illustrates. the confusion still existing over proper treatment of opioid addiction.