Happy Memorial Day

The FEHBlog hopes that his readers have enjoyed a safe and happy Memorial Day weekend. The FEHBlog remembers his cousin, Army Capt. Eric Paliwoda, who was killed in combat on January 2, 2004, in Iraq.

Congress is not in session this week.  Following up on last week's post, the Washington Post reports that President Obama has nominated "Katherine Archuleta, a top official in his 2012 campaign, to head the Office of Personnel Management."

The AMA News reports on how actress Angelina Jolie's disclosure of her preventive double mastectomy has driven patient interest in a genetic mutation test called BRCA. The article explains that

More than 90% of women with family histories not linked to increased risk of the genetic mutations will not benefit from genetic counseling or testing, according to the U.S. Preventive Services Task Force. Although the testing is not physically burdensome, for average-risk women, it often yields ambiguous results that can heighten their anxiety.

“At this point, scientific evidence only shows that BRCA1 and BRCA2 testing is beneficial for women who have reviewed their family history of breast or ovarian cancer with a primary care professional and discussed the pros and cons of the screening test with a trained genetic counselor,” task force chair Virginia Moyer, MD, MPH, said in April before the Jolie news broke.

The article also notes that the test currently costs $3000 because the originator patented the test. A challenge to the patent is pending before the U.S. Supreme Court and a decision is expected in June. CNN reviews  this and the other big cases pending a Supreme Court decision next month here. The AMA News article indicates that if the Supreme Court rules against the patent, the charge for the test could drop to $200.

OPM is asking FEHB plans to update their bariatric / obesity treatment surgery coverage for 2014. For that reason, the FEHBlog's attention was drawn to this Kaiser Health News article reporting that several states, including Alabama, Louisiana, Texas, Arkansas, and Mississippi, will not consider bariatric surgery to be an essential health benefit that plans in the individuals and small business markets must cover in 2014. This policy may not be as short-sighted as Kaiser Health News suggests because a recent study in the AMA Journal found that

"[O]verall health care resource use among obese individuals undergoing bariatric surgery is relatively stable during the six years following surgery. When these individuals’ health care costs are compared with those of a matched comparison group, total costs are significantly greater in the surgical cohort in the second and third years following surgery, but overall costs of those undergoing surgery are not lower than those of the matched comparison group during follow-up years four through six,” the authors note.

The study results indicate that total costs were greater in the bariatric surgery group during the second and third years following surgery but were similar in the later years. But the bariatric group’s prescription and office visit costs were lower and their inpatient costs higher. The study also suggests that those undergoing laparoscopic surgery had lower costs in the first few years after surgery, but those differences did not last.

“Bariatric surgery does not reduce overall health care costs in the long term. Also, there is no evidence that any one type of surgery is more likely to reduce long-term health care costs. To assess the value of bariatric surgery, future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings,”

The FEHBlog is not questioning OPM's letter which of course, considers bariatric surgery to be a last resort treatment. The FEHBlog is pointing out that public health cost savings are not self-evident.

To wit, Modern Healthcare reports that

Engaging patients in their care is often touted as a surefire way to control costs and reduce utilization of services, but new research calls that assumption into question. Armed with eight years of survey data from more than 20,000 patients, researchers from the University of Chicago argue that shared decision-making may actually result in increased inpatient spending and longer lengths of stay.

While engaging patients can improve health care quality and patient satisfaction,  that qualitative improvement does not necessarily translate quantitatively into lower costs.

The Washington Post meanwhile reports this weekend that the State of Maryland plans to turn the screws on hospitals by tying total hospital spending to long term economic growth in the state. Maryland is unique among the fifty states in that Medicare allows the State to set hospital prices for individual procedures. The new aggregate caps will be placed on top of the individual caps. "State officials hope to get approval from federal officials over the next several months so they can put the new system in place by January."  Hospitals are not happy with the proposal, and the FEHBlog is not a fan of government price fixing.

Just for fun, the FEHBlog calls attention to this LA Times article about premiums in the California health insurance exchange / marketplace next year and an AHIP analysis of that article.