Following up on a couple of last week's posts, the FEHBlog noticed an op-ed today in which the author complained that he had to bring a lawsuit against his insurer in order to correct a prior authorization decision. This isn't the case. Patient Advocate explains that ACA marketplace plan members can appeal prior authorization decisions and obtain an independent review organization decision that is binding on the insurer. Why don't people understand this when insurers are obligated to place members on notice of appeal rights. The fixable problem as the FEHBlog see it is that while member of employer sponsored plans, including the FEHBP where OPM acts as the independent reviewer, must exhaust their administrative remedies unless the insurer screws up procedurally, ACA marketplace members can choose between a lawsuit and independent review. Litigators are likely to choose the lawsuit route for their clients. Congress should align the individual marketplace with the employer sponsored plan marketplace as far as it concerns exhaustion of an available administrative remedy. That would lower costs for everyone.
The Wall Street Journal has a report this afternoon about the number one hospital caused infection. That infection surprisingly to the FEHBlog at least is pneumonia, which my father call the "Old Man's Friend," not sepsis.
Hospital-acquired pneumonia is more pervasive and urgent than most people realize, a new study warns, and hospitals in America aren’t adequately addressing prevention. “Given the mortality, hospitals should be doing a lot more,” says Dian Baker, lead author of the study, which was published in January in the American Journal of Infection Control.
Pneumonia, which typically comes from germs that enter the body through the mouth, is the No. 1 hospital-acquired infection in America, according to the Centers for Disease Control and Prevention. That includes both pneumonia infections that some patients on ventilators catch from bacteria in their breathing tubes as well as the more common non-ventilator variety, the CDC says.According to the article, NYU Langone Medical Center is requiring that patients who are about to undergo surgery brush their teeth. This has proven to be an effective technique to help stop the spread of pneumonia.
Finally Multibriefs.com reports that
Healthcare data breaches continued to rise in 2017, but the number of affected patient records declined 80 percent, a new report suggests. According to the Protenus Breach Barometer, 2017 may have simply been an off year for malicious actors, who may be regrouping for more attacks in 2018. [Let's hope not.]
A total of 477 data breaches were reported to the Department of Health and Human Services' Office for Civil Rights during the year, up from the 450 reported in 2016. However, the positive news for healthcare organizations and leaders is that fewer records were implicated in the breaches, specifically, 5.6 million in 2017 versus 27.3 million in 2016.