Friday, April 29, 2016


The Centers for Medicare and Medicaid Services issued two massive rules this week -- the first discussed at this Morning Consult link made changes to the Medicaid and CHIP programs and the other discussed at this Diagnostic Imaging link  proposed to implement the MACRA law that created a Medicare Part B pricing system to replaced the physician detested sustainable rate of growth formula. MACRA along with the ACA is the law that generated all of the excitement at the LAN Summit earlier this week. The Diagnostic Imaging article which requires registration is the best overview that the FEHBlog ran across. Plus it's headlined "MACRA to hit small practices hard." The FEHBlog is concerned that the new law will continue to drive doctors out of Medicare.

In follow up to a much earlier post, the FEHBlog notes that the New York Attorney General reached a settlement earlier this week with seven insurance companies over the timing of coverage of the new Hepatitis B drugs. "As a result of these agreements, nearly all commercial health insurance plans in New York State will cover treatment for chronic Hepatitis C without requiring members to develop advanced disease, such as liver scarring, and will not deny coverage because the member uses alcohol or drugs, or because the authorizing physician is not a specialist."

The Washington Post reported yesterday on the skyrocketing costs of emergency surgeries.
In a paper published in JAMA Surgery on Wednesday, researchers found a surprising pattern. In an analysis of 421,476 patient records from a national database of hospital inpatients, they discovered that a mere seven procedures accounted for approximately 80 percent of all admissions, deaths, complications and inpatient costs related to emergency surgeries. The sample included only adults who underwent a procedure within two days of admission from 2008 to 2011.
The seven dangerous and costly procedures are mostly related to the organs of the digestive system: removing part of the colon, small-bowel resection, removing the gallbladder, operations related to peptic ulcer disease, removing abdominal adhesions, appendectomy and other operations to open the abdomen.

Finally, the Health Care Cost Institute confirmed with a new study that the prices of medical procedures vary.

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