Tuesday, September 23, 2014

Tuesday Tidbits

The FEHBlog is off for the next two nights to watch Washington's baseball and football teams so he has decided to offer a few Tuesday Tidbits.

  • The FEHBlog belatedly discovered that the IRS issued FAQs on the onerous IRC 6055 and 6056 reporting processes late last month. While these reporting requirements take full effect next year with first reports due in January 2016, health plans needs to start gathering dependent SSN's for the 6055 reporting now. 
  • A few months ago, the FEHBlog noted how the Food and Drug Administration was questioning the safety of a power tool that surgeons to remove uterine fibroids. The Wall Street Journal reported yesterday on how the FDA's informal action has created a controversy among surgeons. The point of the article is that the FDA has limited regulatory reach into the practice of medicine. Its statement (couple with fear of the FEHBlog's profession) has encouraged surgeons to provide their patients with fuller disclosure about the risks of this power tool known as a morcellator. That's a good thing. 
  • The FEHBlog also has discussed the Choosing Wisely campaign. which highlights medical services that are unnecessary in the view of medical specialty organizations. The Wall Street Journal has reported today about how the Choosing Wisely campaign findings should be implemented. A Delaware hospital chain vastly reduced the number of non-ICU patients receiving cardiac telemetry by creating implementing a Choosing Wisely finding: 
In cardiac telemetry, electrodes are used to monitor the heart for abnormal rhythms. To try to cut inappropriate use of the monitoring at Christiana Care, which operates two hospitals, a group of physicians redesigned the electronic system that doctors use to order tests and other care.
First, they removed the option to order telemetry for conditions not included in the AHA guidelines. Doctors could get around this and order the monitoring, but they had to take an extra step to do so, according to Robert Dressler, who helped lead the study. "We didn't want to get in the way of the bedside clinician who had a demonstrable concern" and wanted to use telemetry despite contradicting guidelines, he said.
For conditions for which telemetry is AHA-approved, Christiana Care attached a fixed, AHA-recommended time period for telemetry duration in the computer system. If the patient was still in the hospital after that period had elapsed, nurses were instructed to automatically stop the monitoring, unless they believed it to be unsafe, in which case they were required to ask a physician to weigh in.
After the changes, the researchers found the hospital group's mean daily number of non-ICU patients monitored with telemetry fell by 70%, from 357.5 to 109.1, while the mean daily cost for delivering non-ICU telemetry also fell by 70%, from $18,971 to $5,772. The changes had no negative effect on patient care; mortality rates at the hospitals remained stable, as did the number of "code blue" emergency calls to resuscitate patients.
The Choosing Wisely campaign needs to be implemented by the medical profession (healer heal thyself), not rammed down the profession's throat by others.
  • Finally, the FEHBlog assumed that ACA marketplace participants would be grateful for coverage and would not object to narrow provider networks. Of course, the consumer advocates and medical groups squawked about the narrow networks. But Modern Healthcare reports that  
Researchers at Georgetown University's Health Policy Institute studied narrow-network plans sold on the individual-market exchanges last year in six states: Colorado, Maryland, New York, Oregon, Rhode Island and Virginia. Health insurers have said the healthcare reform law is spurring them to offer more narrow networks, which they say save them money and lead to lower monthly premiums in exchange for a smaller number of in-network hospitals and physicians. After speaking with several state officials and insurers that offer exchange plans, researchers found that few consumer complaints have emerged to date about the networks' offerings. 
That''s good news.  

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