Weekend Update

It's now just three weeks until Congress returns from the campaign trail and the Federal Benefits Open Season begins on November 12.

The AMA News recently has featured valuable articles providing the medical professions viewpoint on two Affordable Care Act creations -- the Patient Centered Comparative Research Institute and the controversial Medicare Independent Payment Advisory Board.   The PCORI article raises the concern that comparative research studies even if conclusive do not necessarily change actual medical practices. In an effort to address this problem, the law funnels 20% of the PCORI funding fees contributed by insurers for publicity of findings through a HHS agency. The IPAB provides a vehicle for cutting Medicare funding of doctors services and prescription drug services (not hospital services until 2020). You can imagine how the AMA feels about that.

Kaiser Health News offered a report on the difficulty that people can encounter in trying to find coverage for certain eating disorders such as binge eating. According to the report,  "insurers say that experts have not identified clear protocols for treatment. They note that there is little research on how best to treat the mental and the physical aspects of an eating disorder." Perhaps this is where the PCORI may fit in. In any event, here's the rub:

To be sure, such disputes are not limited to eating disorders. With rising health care bills, insurers have demanded more rigorous evidence of the effectiveness of many treatments and pushed patients to cover a greater share of their medical costs across the board. Patients, in turn, have mounted consumer campaigns to pressure insurers and even turned to lawmakers and regulators to force insurers to cover a variety of diagnosis. For instance, strong parent advocacy efforts led 31 states to mandate coverage for autism, despite insurers’ concerns about the cost.

In the latest call letter, OPM approved FEHB plan coverage for applied behavioral analysis to treat autism. Previously, OPM had classified that therapy as a non-covered educational service. The advocacy group Autism Speaks reports that 38 FEHB plans will cover ABA therapy in 2013.