- Taking a page out of Medicare’s playbook, Wellpoint, the Nation’s largest health insurer by membership, has announced that it is rolling out an in-network claims policy to exclude coverage of expenses caused by eleven preventable medical errors designated by CMS and the National Quality Council. Wellpoint’s policy will prevent network providers from balancing billing patients for these expenses. (Several states hospital associations have agreed not to charge patients or insurers for never events.) Wellpoint plans to expand the never events over time. The Indianapolis Star quotes Debora Spano, spokeswoman for Minnesota-based UnitedHealthcare as follows: “We continue to evaluate the new Medicare policies and how they may be applied to best meet the needs of our members.”
- The Centers for Medicare and Medicaid Services (CMS) published a final rule setting standard for voluntary electronic prescribing by doctors serving Medicare patients. According to CMS’s press release, “The rule adopts four standards for use in e-prescribing effective April 1, 2009:
- Formulary and benefits: This standard will allow doctors and other prescribers to communicate with Part D sponsors about which drugs are covered by a Medicare eligible individual’s prescription drug benefit plan. Prescribers can also learn which generic prescription drugs might offer lower-cost options for the individual.
- Medication history: This standard will allow doctors and other providers, as well as dispensers and Part D sponsors, to communicate among themselves about prescribed medications a beneficiary has taken or is taking, including those prescribed by other providers. This information can help reduce the number of adverse drug events that result from drugs negatively interacting with other drugs a beneficiary is already taking, and can ensure that the doctor or other prescriber has the necessary information about a beneficiary’s current prescription medications.
- Fill status notification: This standard will allow doctors and other providers to receive an electronic notice from the pharmacy or other dispenser telling them that a patient’s prescription has been picked up, not picked up, or has been partially filled. These notifications can help health care providers monitor patients with chronic conditions, such as diabetes or hypertension, by providing an indicator as to whether they are taking their medicines.
- Provider identifier: The final rule requires providers, dispensers, and Part D sponsors to use the National Provider Identifier (NPI) to identify individual health care providers in Part D e‑prescribing transactions. Adoption of the NPI will speed workflows by eliminating call-backs by pharmacies to medical offices to verify the identity of individual prescribers.”
The Chair of the AMA’s Board of Trustees encourages doctors in this week’s AMA News to take the lead in e-prescribing.
- Meanwhile, Cigna closed earlier this week on its acquisition of Great-West Healthcare. According to Cigna’s press release, “The transaction includes 1.9 million covered lives, including approximately 1.4 million medical members in its employer segment.”