The U.S. Office of Personnel Management begins to hold a series of five Federal Benefits Open Season webinars beginning tomorrow. Of course the first session is an introduction to the Open Season. OPM advises that

• Each webcast will be viewable starting at 1:30pm Eastern Time. To view the webcast online, you must use a broadband (high-speed) internet connection.
• The webcast stream will become active 24 hours before the
  webcast is scheduled to begin. Be sure to test the webcast stream
  during that 24 hour window. To test the webcast stream, click on the
  link below.
• The link to view the webcast is http://pointers.audiovideoweb.com/stcasx/il83winlive3146/play.asx.
  • You will need Windows Media Player 9.x or higher to view the webcast.
• If you miss one of our shows, or if you need to see part of one again, you can watch a recording of each webcast at www.opm.gov/insure/openseason/videos.asp. The recordings will be posted the same day that they are broadcast.

The Centers for Medicare and Medicare Services announced the sustainable rate of growth formula driven change to Medicare Part B physician reimbursement in 2012 — a 27.4% reduction instead of the initially estimated 29.4% reduction. The announcement explains certain adjustments that are being made to the geographic factor in the resource based relative value schedule that Medicare Part B uses. This factor has been a hot bed of litigation and contention between urban and rural areas. Also,

In the CY 2012 final rule, CMS is expanding the potentially misvalued
code initiative, an effort to ensure Medicare is paying accurately for
physician services and more closely managing the payment system.  This
year, CMS is focusing on the codes billed by physicians in each
specialty that result in the highest Medicare expenditures under the
MPFS to determine whether these codes are overvalued.  In the past, CMS
has targeted specific codes for review that may have affected a few
procedural specialties like cardiology, radiology or nuclear medicine
but has not taken a look at the highest expenditure codes across all
specialties. This effort results in increased payments for primary care
services that have historically been undervalued by the fee schedule.

Modern Healthcare reports on the industry’s take on this annoucement. As the FEHBlog has explained, Congress has to dig the physicians out of this hole and soon.

Following up on last Thursday’s post, here’s a link to a better chart discussing the changes to the Medicare Parts A and B deductibles and premiums for 2012. With respect to Medicare Part A which provides inpatient coverage

The Part A deductible paid by a beneficiary when admitted as a hospital
inpatient will be $1,156 in 2012, an increase of $24 from this year’s
$1,132 deductible.  The Part A deductible is the beneficiary’s cost for
up to 60 days of Medicare-covered inpatient hospital care in a benefit
period. Beneficiaries must pay an additional $289 per day for days 61
through 90 in 2012, and $578 per day for hospital stays beyond the 90th
day in a benefit period. For 2011, per day payment for days 61 through
90 was $283, and $566 for beyond 90 days. For beneficiaries in skilled
nursing facilities, the daily co-insurance for days 21 through 100 in a
benefit period will be $144.50 in 2012, compared to $141.50 in 2011.

Speaking of waste and abuse, Kaiser Health News reports that primary care doctors are running up the Nation’s health care bill to the tune of $6.8 billion in 2009 by ordering unnecessary tests and procedures in connection with routine visits, which now are cost sharing free to patients thanks to the Affordable Care Act.

For many adults, a routine visit to a primary care physician might
involve blood tests, a urinalysis, an electrocardiogram, maybe a bone
density scan. Too often, however, these tests are inappropriate and they
cost a bundle, according to a recent study,  not only for the health care system but also for individuals, who are increasingly footing more of the bill for their care.

The study, led by physicians from the Mount Sinai Medical Center and
the Weill Cornell Medical College in New York, was published online in
October in the Archives of Internal Medicine. The researchers examined
the cost of common primary care practices that were identified as being overused earlier this year in a study by another group of physicians, known as the Good Stewardship Working Group.

The newest study, using data from federal medical surveys, estimated
that 12 of those unnecessary treatments and screenings accounted for
$6.8 billion in medical costs in 2009. The activity most frequently
performed without need was a complete blood cell count at a routine
physical exam. In 56 percent of routine physicals, doctors
inappropriately ordered such tests, accounting for $32.7 million in
unnecessary costs. In terms of dollars, the biggest-ticket item by far
was physicians ordering brand-name statins before trying patients on a
generic drug first: That accounted for a whopping $5.8 billion of the
$6.8 billion total.

But let’s wrap things up with good news, the AMA News reports, much to the medical profession’s chagrin that

The number of visits patients make to physicians in a
given month — a vital sign for the whole health care economy — has
been declining consistently, according to multiple tracking studies,
companies and researchers.

Analysts say those numbers may not bounce back, even with health
system reform. That’s because a struggling economy, higher insurance
deductibles, and the efforts by health plans and others to reduce
utilization have altered patient patterns, perhaps permanently. Patients
now often seek office visits — or any interaction with the health
system — only when a problem can’t be ignored.

The cost curve bends down for once!