Weekend Update

The House of Representatives and the Senate are closing to taking a break for the elections, and the federal government’s fiscal year expires on September 30. Govexec.com reports that both legislative bodies are working on a continuing resolution to maintain the funding of federal government operations, including the FEHB Program, past that date.

Business Insurance reports that “The U.S. Government Accountability Office has appointed 19 members of a new center for comparative effectiveness research [known as the Patient-Centered Outcomes Research Institute] established by the Patient Protection and Affordable Care Act.” According to GAO’s press release which includes the appointees’ biographies

PCORI [is] a non-profit organization to assist patients, clinicians, purchasers, and policy-makers in making informed health decisions by carrying out research projects that provide quality, relevant evidence on how diseases, disorders, and other health conditions can effectively and appropriately be prevented, diagnosed, treated, monitored, and managed. The Act directs the Comptroller General to appoint 19 of the 21 members of the PCORI Board of Governors. In addition to these 19 members appointed today, the Director of the Agency for Healthcare Research and Quality and the Director of the National Institutes of Health, or their designees, are the other two members who will serve on the PCORI Board.

The FEHBlog understands that the PCORI Board is one of the Affordable Care Act initiatives intended to bend the health care cost curve down.  Unfortunately, however, as interpreted by the National Association of Insurance Commissioners last week, costs that health insurers incur to actually hold down costs such as utilization review and anti-fraud measures do not count as medical expenses. Draft regulation, p. 31.  If an insurer does not spend at least 85% of premiums on medical expenses (for group insurance — 80% of individual insurance), the difference between the spend and this minimum percentage must be rebated.

Yesterday, the FEHBlog noticed a road sign stating that our nearby hospital Suburban Hospital is a member of the Johns Hopkins Medicine. The Washington Post reported today that Johns Hopkins Medicine has its eye on acquiring another local hospital, Sibley. According to this report

The acquisitions are part of a wave – particularly in the mid-Atlantic region – of consolidations leading to fewer independent hospitals and doctors, a trend that many industry executives say will grow because of the health-care overhaul.

The action in the mid-Atlantic is being watched closely, with experts saying consolidation in other parts of the country has led to higher health-care prices – size is power, and commanding market share can give hospitals an edge in negotiations with insurers. 

Last week, “CAQH® [an industry coalition of health insurers and health care providers] released the results of a landmark study to assess the quality and accuracy of data reported by providers about their professional credentials and practice information at its 2010 Administrative Simplification Conference.”  This data is part of CAQH’s Universal Provider Datasource (“UPD”).  CAQH explains that “By streamlining data collection electronically, UPD is reducing duplicative paperwork and millions of dollars of annual administrative costs for more than 800,000 physicians and other health professionals, as well as over 550 participating health plans, hospitals and healthcare organizations.” According to its press release.

The results showed that the sampled UPD data was 93.9% accurate. Based on the study findings, CAQH has initiated an array of system edits, adjustments to data fields and respondent prompts to make instructions clearer for providers. These system refinements will improve UPD provider data quality: accuracy is expected to increase to 97% or more. This will strengthen the utility of UPD for enterprise-wide adoption by health plans, hospitals, healthcare delivery organizations, healthcare information exchanges, and state and federal governments.

Good news.