Friday, April 10, 2015


The sun is coming out here in downtown DC which suggest a promising Spring weekend weather-wise. Congress resumes its session on Monday April 13, and Modern Healthcare suggests that the bill to repeal and replace the sustainable rate of growth formula for reimbursing doctors under Medicare Part D will pass the Senate. The House passed the bill, which includes a two year Children's Health Insurance Program extension and more funding for community health centers, by a wide bi-partisan vote late last month. This permanent doc fix is important to the FEHBP because a large cadre of Medicare prime annuitants are enrolled in Part B and the experience rated plans use Medicare Part B reimbursement rates to pay doctors for services rendered to Medicare prime annuitants who don't elect Part B. OPM is encouraging annuitants to pick up Part B.

Nothing frosts the FEHBlog's cake more than the fact that the experts who devised the meaningful use standards for the free electronic medical record systems that Congress handed out to hospitals and doctors did not include interoperability standards.  Now over five years later a lot of back-filling and mitigating is going on. It strikes the FEHBlog that authorizing HHS to create a patient identifier would boost these efforts but as Healthcare Data Management reports Congress continues to block appropriations for this logical action on privacy ground.  That publication also is reporting that the Federal Trade Commission is warning that EMR interoperability could impair competition which was a surprise to the FEHBlog. Let's just get this problem fixed so the country can receive the full benefit of its $30 billion investment in these systems.  There's no doubt in the FEHBlog's mind that interoperability will improve healthcare and lower costs.

Kaiser Health News reports that a new coalition of healthcare providers, payers and consumer organizations has launched the Clear Choices Campaign in an effort to improve healthcare pricing transparency. Good luck with that effort.

Health Affairs this month includes a study on the public health costs of mammograms that produce false negatives -- $ 4 billion annually.  That's a lot of money.
In recent years, the prevalence of false-positive mammography screenings and overdiagnosis of breast cancer (diagnosis of cancer that will never cause symptoms or death during a patient’s lifetime) has been well-documented. Until now, however, the full, national-scale cost burden has not been documented.
Mei-Sing Ong of the Boston Children’s Hospital Informatics Program and Ken Mandl, Harvard Medical School professor and Boston Children’s Hospital Informatics Program faculty member, assessed the costs from false-positive mammograms and breast cancer overdiagnoses among more than 700,000 women ages 40–59, between 2011 and 2013. Average expenditures ranged from $852 for every false-positive mammogram to $12,369 for each misdiagnosis of ductal carcinoma in situ (abnormal changes in the cells of the milk ducts of the breast—the most common type of non-invasive breast cancer).

The authors found that the national costs of false-positive mammograms and breast cancer overdiagnoses are $4 billion each year. They note that these costs must be considered in debates about whether screening guidelines should take into account additional factors beyond age.
This is an example of how the ACA's "free preventive care" mandates can boost healthcare costs. There's no doubt that preventive care together with rapidly improving cancer care is saving lives but the medical profession needs to find a happy medium here.


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