TGIF

Following up on the AMA New's article about the uptick in doctors visits, the Wall Street Journal explained in an article yesterday that

UnitedHealth Group and Aetna both said that part of the recent outpatient boost stems from their initiatives to get certain services moved out of inpatient settings. UnitedHealth, for instance, has a program, pegged to a heart association's guidelines, that aims to test for heart attacks in a hospital's outpatient suite rather than sending chest-pain patients straight to an intensive-care unit. "Some of that outpatient growth is purposeful on our part," said Joe Zubretsky, Aetna's chief financial officer, in an interview.

Similarly,

Health plans that encourage primary care are one reason visits have increased at Village Health Partners, a 20-physician family practice in Plano, Texas, said Christopher Crow, its president, who said he sees employers using "benefit designs that include both carrots and sticks" to get folks to seek preventive services and tests. Dr. Crow also pointed to improvements in the local economy.

That makes sense.

 HHS announced new operating procedures for electronic health care transactions this week.

Administrative Simplification: Adoption of Operating Rules for Health Care Electronic Funds Transfers (EFT) and Remittance Advice Transactions were developed through extensive discussions with industry stakeholders. The rule adopts the Council for Affordable Quality Healthcare's Committee on Operating Rules for Information Exchange (CAQH CORE) Phase III EFT & ERA Operating Rule Set, including the CORE v5010 Master Companion Guide Template, with the exception of Requirement 4.2 of the Phase III CORE 350 Health Care Claim Payment/Advice (835) Infrastructure Rule. Collectively, these rules are referred to as the EFT & ERA Operating Rule Set.

This drives the FEHBlog nuts. CAQH, a collaborative effort between health care providers and health plans developed this operating rules. The ACA then hijacked them and required HHS to issue them as federal regulations which allows HHS to trumpet that they are cutting more red tape. But the red tape was being cut and now we have technological requirements set in law. That doesn't make sense.

HHS this week submitted to OPM for final review and approval its HIPAA rule creating a plan identification number and extending the ICD-10 compliance date by one year to October 1, 2014. HHS was authorized to issued a plan identifier rule when HIPAA was enacted in 1996.  HHS has been issuing health care provider identifying numbers for several years now. The FEHBlog does not understand the delay in the health plan identifier rule. Again the problem lies in HIPAA setting technological standards via regulatory action. Not a good idea.