TGIF

The Wall Street Journal reports that 

Lawmakers reached a bipartisan deal on Thursday to keep the government open until after the midterm elections, while also passing a first tranche of spending bills and sending them to President Trump’s desk.

The House passed the package of bills, known as a “minibus,” in a 377-20 vote Thursday afternoon, a day after the Senate passed the same package. House and Senate negotiators from both parties had hammered out an agreement on the three spending bills earlier this week, which includes funding for the Energy Department, Veterans Affairs and the legislative branch of government, and their passage puts Congress on pace to avoid the deadline dramas of the past decade.

The House and Senate conferees are meeting about two other minibus appropriations bills, one of which includes FEHBP financing.  Here's a link to Govexec.com's minibus report which understandably focuses on whether federal employees will receive a pay increase in 2019. The answer will be found in the same minibus the covers FEHBP financing.

Fierce Healthcare tells us that physicians expressed their great displeasure with CMS's proposed Medicare Part B fee rule for 2019.

The plan would collapse payment rates for eight office visit services for new and established patients down to two each. Doctors also offered comments. “This is a ridiculous proposal that will only be a detriment to patients and providers alike,” said one anonymous commenter.

A geriatrician who cares for patients with multiple, complicated medical issues said he could see no benefit from the proposal. “It does not make sense to assign the same payment for both a 15-minute visit for a 20-year-old with no known issues and no complaints and for a 40-minute visit for an 80-year-old with a multitude of acute and chronic illnesses,” he wrote.

The American Medical Association submitted 136 pages of comments. How was the play Mrs. Lincoln?

In other medical news, the Association of American Family Physicians announced its support for  "ACT for Better Diagnosis,(betterdiagnosis.org) an initiative of the Society to Improve Diagnosis in Medicine (SIDM) that launched Sept. 13 and aims to improve the diagnostic process by calling on organizations to identify and spread practical steps to better ensure diagnoses are accurate, communicated and timely."

Members of the Coalition to Improve Diagnosis have collaborated for months to identify initial obstacles they think impede diagnostic accuracy, such as:

• Incomplete communication during care transitions -- When patients are transferred between facilities, physicians or departments, there is potential for important information to slip through the cracks.
• Lack of measures and feedback -- Unlike many other patient safety issues, there are no standardized measures through which hospitals, health systems or physicians can understand their performance in the diagnostic process to guide improvement efforts or to report diagnostic errors. Providers rarely get feedback if a diagnosis was incorrect or changed.
• Limited support to help with clinical reasoning -- With hundreds of potential explanations for any one symptom, clinicians need timely, efficient access to tools and resources to assist in making diagnoses.
• Limited time -- Patients and their caregivers overwhelmingly report feeling rushed by limited appointment times, which poses real risks to gathering a complete history that is essential to formulating a working diagnosis; such time constraints also allow scant opportunity to thoroughly discuss any further steps in the diagnostic process and set appropriate expectations.
• The diagnostic process is complicated -- There is only limited information available to patients about which questions to ask, who to notify when changes in their condition occur or what constitutes serious symptoms. It's also unclear who is responsible for closing the loop on test results and referrals and how to communicate follow-up.
• Lack of funding for research -- The impact of inaccurate or delayed diagnoses on health care costs and patient harm has not been clearly articulated, and only a limited amount of published evidence exists to aid in identifying what improves the diagnostic process.

Health Payer Intelligence reports that 

Widespread rates of poor consumer literacy within the healthcare industry creates administrative burdens for payers and contributes to an additional $4.8 billion in health plan costs, according to a new Accenture report.

Fifty-two percent of healthcare consumers in the United States do not understand how to properly navigate the healthcare system and struggle when learning about new health plan types, premium expenses, and available in-network providers. In addition, 16 percent of respondents claim to have a thorough understanding of the healthcare system while 33 percent have no experience in making healthcare decisions.

Ouch.