Missing Congress

It’s so much easier to find FEHBlog worthy material when Congress is in session. There’s still a few more weeks until November 15 when the lame duck session starts. Of course, the Congressional election is Tuesday. Healthcare IT News reports on a speech by AHIP President Karen Ignani to the Nashville Healthcare Leadership Council. Her speech emphasized the importance of quality, productivity, and cost to successful healthcare reform. 

In [Ms Ignani’s] view, it’s futile to worry about the political identity of the next Congress.

“We need all stakeholders to get out of their comfort zone and participate in finding solutions,” Ignagni said. “Healthcare costs are still crushing the country. We have to go beyond the mindset of ‘my cost containment is somebody else’s revenue deprivation.’

Amen to that.

Meanwhile, Leavitt Partners, which is headed by the former HHS Secretary and former Utah Governor Mike Leavitt, is making predictions about how the new and as yet unelected Congress might change the Affordable Care Act according to this Hill article. The Leavitt firm describes their predictions as healthcare reform bracketology.

Health Leaders Media is reporting that the final HHS rules implementing the HITECH Act, which were proposed this past summer, are likely to be finalized by the end of this year or early next year. This includes the unsecured protected health information breach notification rule and the business associate rule.

AIS published a useful report on the difficulties that insurers are facing in applying the new preventive care guidelines applicable to non-grandfathered plans (effective 2011 for non-grandfathered FEHB plans). Non-grandfathered plans must provide certain in-network preventive care services with no cost sharing. The government regulations identify those services by reference to treatment guidance to providers which doesn’t necessarily translate to claims payment rules. Hopefully, the regulators will straighten this problem out over time.

The Wall Street Journal reported  on the problems that outpatient surgery patients face in managing their own rehabilitation process.

Surgery is easier and faster than ever before: Nearly 65% of all surgeries don’t require an overnight hospital stay, compared to 16% in 1980. Hospitals that once kept patients for three weeks after some major operations now discharge them within a matter of days. But the body still heals at its own pace, and reduced time in hospital care means patients are assuming more responsibility for their own recovery—and more risks.

Patients not only have to perform rehabilitation regimens at home, but they are more often caring for their own incision wounds and dressings and having to watch for signs of infections and blood clots. They also may be managing drains, implanted IV ports and pumps, all of which can be difficult and stressful.

The move to speedier surgeries is largely the result of new minimally invasive techniques, improvements in anesthesia and cost-cutting by insurance companies and hospitals. Surgical procedures now often use smaller incisions, cut less muscle, and result in less blood loss. Newer anesthetics allow patients to regain consciousness quickly or not go to sleep at all. Pain medications are more effective.

At the same time, concern about rising health care costs has led to changes in Medicare and insurance plans that have encouraged the development of outpatient surgical centers and created financial incentives for hospitals to shift less complex surgery to their own outpatient facilities. So, many types of surgeries previously performed in hospitals with overnight stays are now being done on an outpatient basis: The number of freestanding surgery centers grew from about 240 in 1983 to more than 5,000 now.