Weekend Wrap-Up / Miscellany

  • There’s reportedly efforts underway to harmonize the House and Senate mental health parity bills but no details have been released as yet. Meanwhile, Business Insurance reports that Rep. Robert Andrews (D N.J.) has introduced a bill to require prosthetic appliance parity with group health plan medical/surgical benefits (HR 5615). Many health plans, including FEHB plans, cap coverage of prosthetic appliances. OPM’s 2008 call letter provided the following guidance on the broader benefits category of durable medical equipment:

    Carriers should review their coverage for durable medical equipment (DME) in light of advances in technology for assistive devices designed for individuals with special needs; including vision, hearing, mobility and movement, and cognition. Examples include augmentative and alternative communication (AAC) products such as speech generating devices and audible prescription reading devices. Please provide a statement concerning your coverage for these types of benefits.

  • Business Insurance also reports on a standard methodology for rating health care provider performance known as the “Patient Charter for Physician Performance Measurement, Reporting and Tiering Programs” that was released earlier this month by a multi-stakeholder group known as the Consumer-Purchaser Disclosure Project. The standards comply with last year’s settlement agreement between CIGNA and the New York State Attorney General. AHIP endorsed the Patient Charter. Health care quality transparency has become a standard requirement in OPM’s call letter as it is one of HHS Secretary Leavitt’s four cornerstones.
  • While on the topic of disclosure, the AP reports that

    For years, the nation’s largest drug and medical device manufacturers have courted doctors with consulting fees, free trips to exotic locales and sponsoring the educational conferences that physicians attend. Those financial ties in most cases need not be disclosed and can lead to arrangements that some say improperly influence medical care. Now, under the threat of regulation from Congress, the two industries are promising to be more forthcoming about their spending. A dozen of the nation’s leading drug and device makers have told Sen. Charles Grassley, R-Iowa, that they have plans or are working on plans to publicly disclose grants to outside groups. The details will be provided on each company’s Web sites.

  • The Las Vegas Review Journal reports today that

    Although Southern Nevada Health District officials maintain there is no evidence that the unsafe injection practices they believe led to six people contracting hepatitis C at a Las Vegas endoscopy clinic took place before March 2004, at least one health insurance provider isn’t taking any chances. Anthem Blue Cross Blue Shield plans to alert all members treated at the Endoscopy Center of Southern Nevada at 700 Shadow Lane to speak with their physicians about having tests for blood-borne diseases regardless of procedure date. Anthem spokeswoman Sally Vogler said Friday that the notification will appear in the form of an advertisement in the Review-Journal on Sunday and on April 20. She said the advertisement stems in large part from the possibility of patients who were treated at the clinic before March 2004 testing positive for hepatitis C or another blood-borne disease.

  • Finally, Healthcare IT News reports that the Trizetto Group which sells claims payment and related software to health plans has been acquired for $1.4 billion by Apax Partners. Apax plans to take Trizetto private. Trizetto’s press release explains that “BlueCross BlueShield of Tennessee and The Regence Group, both customers of TriZetto, are providing a portion of the funding for the transaction and will be equity investors in the newly private company.”