Weekend Update / Miscellany

Well summer is coming to a close. Labor Day is next weekend. Our public schools open tomorrow, and we only have nine days before Congress returns from its summer recess. That's a big deal to me because traffic is much lighter when Congress is in recess plus the next round in the health care reform debate begins.

Kaiser Health News features an interview with Sen. Charles Grassley who is the lead Republican negotiator in Senate Finance Committee's Gang of Six:

Pianin: Do you think you can get a deal [on health care reform]?
Grassley:
“I think that it’s too early to say. If you asked me that on Aug. 6, I would
have said yes I think so, September. But you’re asking me on Aug. 27 and you’ve
got the impact of democracy in America. Everybody’s showing up at town meetings.
What sort of impact is that making? I can’t tell you except in a few instances
in my case, and [Sen. Max} Baucus can tell you in his case. But we need to talk
it over with other members….”

The Washington Post reports today that "Senate Majority Leader Harry M. Reid (D-Nev.) said during a tele-town hall Friday that health-care reform should be bipartisan, but suggested Republicans might be trying to kill reform altogether. 'If we can't do a bipartisan bill, we can do a partisan bill,' he said. 'I don't want to do that.'" We shall see.

CMS issued a fact sheet on the International Classification of Diseases 10th edition (ICD-10-CM) that health care providers and health plans will be required to use in about four years (Oct. 1, 2013). It's huge change that impacts claims systems and hospital network contracts. Before implementing the new code set, the covered entities will be required to adopt new electronic transaction standards (the 5010 standards) which utilize the ICD-10-CM codes.

Government HIT reports that last Thursday August 27 "At the Department of Health and Human Service’s first-ever “code-a-thon”, software programmers hunkered down to mash up software code for “Connect,” a set of open source tools for exchanging health information over the budding nationwide health information network." The NHIN will be a nationwide electronic patient record locator that serves as the nerve system of the regional networks. Once the NHIN is active, a health care provider participating in a regional health information organization (RHIO) will able to query providers in other RHIOs for my electronic records. Without the NHIN the provider would only be able query within the RHIO.

Dow Jones reports that

United Healthcare will soon offer $20 discounts off monthly co-pays for
members who refill certain prescriptions within about 30 days after the last
prescription runs out - essentially rewarding patients for adhering to treatment
plans, Tim Heady, head of UnitedHealth's pharmaceutical solutions unit, said in
an interview this week.

The eligible asthma drugs include GlaxoSmithKline PLC's (GSK) Advair and AstraZeneca PLC's (AZN) Symbicort. The antidepressants qualifying for the $20 discounts include Eli Lilly & Co.'s (LLY) Cymbalta, and Wyeth's (WYE) Effexor XR and Pristiq. These drugs carry $50 co-pays on some UnitedHealth preferred-drug lists, so the discounts would reduce members' out-of-pocket costs to about $30.

The so-called "adherence incentive" discounts will begin Oct. 1 for most of UnitedHealth's eight million fully insured members, and on Jan. 1 for a small percentage of them. The program is "cost-neutral" to UnitedHealth's employer customers because the discounts are at least partially factored into UnitedHealth's rebate contracts with drug manufacturers.