Friday, October 19, 2012


Yesterday, another U.S. Court of Appeals (this time the Second Circuit which sits in New York City) held the Defense of Marriage Act is unconstitutional, Reuters reports. Here's a link to the 2-1 decision. At this point the U.S. Court of Appeals for the First Circuit which sits in Boston and a federal district court which sits in San Franciso have reached the same conclusion. Both of those cases are pending before the Supreme Court which has not yet decided to hear the cases. But the FEHBlog is sure that the Supreme Court will take the case and ultimately reach this result principally on federalism grounds because the Constitution vests the States with authority over domestic relations. Less than ten states currently recognize same sex marriage. If the Supreme Court holds against the statute, then same sex spouses would be entitled to enroll under FEHBP self and family coverage.

The Highmark saga continues. Recently, the FEHBlog noted that Highmark's deal to invest in a major Pittsburgh hospital chain, West Penn Allegheny, had fallen apart when West Penn walked away from the deal. Healthcare Finance News reports that earlier this week, Highmark, a Blue Cross licensee, had committed $65 million to create a "strategic affiliation" with Erie PA based St. Vincent's Health System.

Following up on news articles about how hospitals may be using electronic medical records paid for by the Government (most recently to the tune of $7.7 billion) to increase their Medicare reimbursements, EHR Intelligence reports that four Senate leaders have sent HHS Secretary a letter about the program inquiring about this issue and requesting a meeting. This letter comes on the heels of a House leadership call to halt the program according to Modern Healthcare.

The FEHBlog has noted Medicare and health plan efforts to reduce surgical complications. Modern Healthcare reports that "Efforts to reduce post-surgical complications such as infections could lead to substantial drops in hospital revenue, according to a study published online in Health Affairs that examined the business case for such programs."  The study's authors recommend to tactical responses -- increase patient volume and negotiate shared savings agreements with health plans.

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