Thursday, February 13, 2014

Odds and Ends

The Hill reports that Senate followed the House's lead yesterday by passing a bill to suspend the federal debt ceiling until March 15, 2015. The next deadline which impacts the FEHBP is the March 31, 2014, expiration date for the current Medicare Part B fix. Congress has settled upon a solution to the problem but has not announced how they plan to pay for the solution. Modern Healthcare has more on this issue here.  

Health Data Management reports that the American Medical Association is taking asking the Secretary of Health and Human Services to reconsider the looming ICD-10 code set compliance date.  Under HIPAA, health plans must implement electronic claims transaction changes mandated by HHS like the ICD-10 code set.  The ICD is a code set that all healthcare providers use to provide diagnosis codes on electronic health claims and hospitals also use to provide procedure codes on those claims. The current ICD-9 uses five digit codes. The ICD-10 uses 6 digit codes. Just adding a digit to a field can be expensive. However, the digit was added in order to permit the explosion of codes and that explosion requires more system reprogramming and retraining for coders.

Health plans have spent millions on implementing the ICD-10, and HHS has extended this compliance date once from October 1, 2013, to October 1, 2014. HHS's principal stick is that larger medical offices must submit claims electronically to Medicare, and HHS has said that Medicare will reject electronic claims with ICD-9 codes for services provided on or after October 1, 2014.  Smaller practices can use paper claims but HHS has changed the paper claim form so that providers can fill in the ICD-10.  It's a mess. The FEHBlog does expect that HHS will delay the Medicare claim rejection date for a few months when push comes to shove later this year.

The New York Times reports that a large scale, longitudinal study that evenly split 90,000 participating women between breast exam and mammogram screening groups over a 25 year period found equivalent results in terms of identifying breast cancer and death rates. "The death rate from breast cancer was the same in both groups, but 1 in 424 women who had mammograms received unnecessary cancer treatment, including surgery, chemotheraphy, and radiation." The article concludes
In the United States, about 37 million mammograms are performed annually at a cost of about $100 per mammogram. Nearly three-quarters of women age 40 and over say they had a mammogram in the past year. More than 90 percent of women ages 50 to 69 in several European countries have had at least one mammogram.
Dr. Kalager, whose editorial accompanying the study was titled “Too Much Mammography,” compared mammography to prostate-specific antigen screening for prostate cancer, using data from pooled analyses of clinical trials. It turned out that the two screening tests were almost identical in their overdiagnosis rate and had almost the same slight reduction in breast or prostate deaths.
“I was very surprised,” Dr. Kalager said. She had assumed that the evidence for mammography must be stronger since most countries support mammography screening and most discourage PSA screening.
The FEHBlog's concern is that the ACA's "free" preventive care mandate politicizes the practice of medicine even more than it had been.

Health insurers, including FEHB plans, must implement and report on NCQA HEDIS quality metrics, but so do health care providers. A pediatrician writing in the Wall Street Journal this morning reports on quality metric overload.
There are certainly good metrics. "Med reconciliation," reviewing and updating medication lists when a patient meets with a physician, is well-accepted as a good metric. But many other measures have little bearing on improving patient health. Would you rather your doctor won the "quality" contest by doing good list management and robust box checking or spent that time listening to you?

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