Tuesday, November 01, 2011

Tuesday's Tidbits

The U.S. Office of Personnel Management begins to hold a series of five Federal Benefits Open Season webinars beginning tomorrow. Of course the first session is an introduction to the Open Season. OPM advises that

  • Each webcast will be viewable starting at 1:30pm Eastern Time. To view the webcast online, you must use a broadband (high-speed) internet connection.
  • The webcast stream will become active 24 hours before the webcast is scheduled to begin. Be sure to test the webcast stream during that 24 hour window. To test the webcast stream, click on the link below.
  • The link to view the webcast is http://pointers.audiovideoweb.com/stcasx/il83winlive3146/play.asx.
    • You will need Windows Media Player 9.x or higher to view the webcast.
  • If you miss one of our shows, or if you need to see part of one again, you can watch a recording of each webcast at www.opm.gov/insure/openseason/videos.asp. The recordings will be posted the same day that they are broadcast.

The Centers for Medicare and Medicare Services announced the sustainable rate of growth formula driven change to Medicare Part B physician reimbursement in 2012 -- a 27.4% reduction instead of the initially estimated 29.4% reduction. The announcement explains certain adjustments that are being made to the geographic factor in the resource based relative value schedule that Medicare Part B uses. This factor has been a hot bed of litigation and contention between urban and rural areas. Also,
In the CY 2012 final rule, CMS is expanding the potentially misvalued code initiative, an effort to ensure Medicare is paying accurately for physician services and more closely managing the payment system.  This year, CMS is focusing on the codes billed by physicians in each specialty that result in the highest Medicare expenditures under the MPFS to determine whether these codes are overvalued.  In the past, CMS has targeted specific codes for review that may have affected a few procedural specialties like cardiology, radiology or nuclear medicine but has not taken a look at the highest expenditure codes across all specialties. This effort results in increased payments for primary care services that have historically been undervalued by the fee schedule.
Modern Healthcare reports on the industry's take on this annoucement. As the FEHBlog has explained, Congress has to dig the physicians out of this hole and soon.

Following up on last Thursday's post, here's a link to a better chart discussing the changes to the Medicare Parts A and B deductibles and premiums for 2012. With respect to Medicare Part A which provides inpatient coverage
The Part A deductible paid by a beneficiary when admitted as a hospital inpatient will be $1,156 in 2012, an increase of $24 from this year's $1,132 deductible.  The Part A deductible is the beneficiary's cost for up to 60 days of Medicare-covered inpatient hospital care in a benefit period. Beneficiaries must pay an additional $289 per day for days 61 through 90 in 2012, and $578 per day for hospital stays beyond the 90th day in a benefit period. For 2011, per day payment for days 61 through 90 was $283, and $566 for beyond 90 days. For beneficiaries in skilled nursing facilities, the daily co-insurance for days 21 through 100 in a benefit period will be $144.50 in 2012, compared to $141.50 in 2011.
Speaking of waste and abuse, Kaiser Health News reports that primary care doctors are running up the Nation's health care bill to the tune of $6.8 billion in 2009 by ordering unnecessary tests and procedures in connection with routine visits, which now are cost sharing free to patients thanks to the Affordable Care Act.
For many adults, a routine visit to a primary care physician might involve blood tests, a urinalysis, an electrocardiogram, maybe a bone density scan. Too often, however, these tests are inappropriate and they cost a bundle, according to a recent study,  not only for the health care system but also for individuals, who are increasingly footing more of the bill for their care.
The study, led by physicians from the Mount Sinai Medical Center and the Weill Cornell Medical College in New York, was published online in October in the Archives of Internal Medicine. The researchers examined the cost of common primary care practices that were identified as being overused earlier this year in a study by another group of physicians, known as the Good Stewardship Working Group.
The newest study, using data from federal medical surveys, estimated that 12 of those unnecessary treatments and screenings accounted for $6.8 billion in medical costs in 2009. The activity most frequently performed without need was a complete blood cell count at a routine physical exam. In 56 percent of routine physicals, doctors inappropriately ordered such tests, accounting for $32.7 million in unnecessary costs. In terms of dollars, the biggest-ticket item by far was physicians ordering brand-name statins before trying patients on a generic drug first: That accounted for a whopping $5.8 billion of the $6.8 billion total.
But let's wrap things up with good news, the AMA News reports, much to the medical profession's chagrin that

The number of visits patients make to physicians in a given month -- a vital sign for the whole health care economy -- has been declining consistently, according to multiple tracking studies, companies and researchers.
Analysts say those numbers may not bounce back, even with health system reform. That's because a struggling economy, higher insurance deductibles, and the efforts by health plans and others to reduce utilization have altered patient patterns, perhaps permanently. Patients now often seek office visits -- or any interaction with the health system -- only when a problem can't be ignored.
The cost curve bends down for once!

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