The FEHBlog apologizes that last Friday’s FEHBlog entry was posted after the Super Sunday entry. The system clutched and failed to post the Friday entry on the same day.
The Wall Street Journal reports today that
[I]nsurers and health systems are sending teams of doctors, nurses, physician assistants and pharmacists into homes to monitor patients, administer treatments, ensure medications are being taken properly and assess risks for everything from falling in the shower to family care-giver burnout. Some are adopting programs called “Hospital at Home” to provide hospital-level care in the home, including portable lab tests, ultrasounds, X-rays and electrocardiograms.
In large part, the aim is to avoid new financial penalties from the Centers for Medicare & Medicaid Services. … But there is also growing pressure to keep patients from being admitted to the hospital in the first place, especially if they have chronic disease. Such patients, particularly older ones, are more vulnerable to infections and complications like bed sores in the hospital, and are actually safer at home, experts say. * * *
For example, insurer Aetna is contracting with home health agencies to expand a transitional care program for customers of its Medicare Advantage plan in a number of communities around the country. A pilot for the program reduced readmissions by 20% and saved $439 per member. “It is costly to send nurses into the home, but not nearly as costly as readmissions,” says Aetna national medical director Randall Krakauer.
The Commonwealth Fund issued a report concerning lessons from early adopters of telemedicine — an important innovation in a time where the medical profession could be overwhelmed by the ACA. “Remote patient monitoring (RPM)—like home teleheath and
telemonitoring—can help improve coordination, improve patients’
experience of care, and reduce hospital admissions and costs.”
Innovation to lower overall costs. Cool. Unfortunately the Wall Street Journal also reports that the medical profession is fighting efforts by paraprofessionals like physicians assistants to fill this gap. The FEHB Act, 5 U.S.C. § 8902(m)(2), for many years has required plans to reimburse paraprofessionals acting within the scope of their licenses for services normally only covered when provided by MDs when the care is provided in medically underserved states as designated by OPM. The number of medically underserved states is likely to grow in the next few years. The fights discussed in the WSJ article concern the scope of paraprofessional state licenses. For example,
One of the bitterest fights is in Kentucky, where physician assistants are lobbying the state legislature to repeal a law that says that for the first 18 months after certification, physician assistants are allowed to treat patients only when a supervising physician is on site. Being in phone contact isn’t deemed sufficient.
AHIP released a claims processing survey today. Among the findings were the following tidbits:
- In 2011, 93 percent of electronic claims were processed within two weeks, compared to 79 percent of paper claims.
- The percentage of claims that were automatically adjudicated—processed without manual intervention—rose significantly from 37 percent in 2002 to 79 percent in 2011.
- In 2011, the average cost of processing a claim was reported at $1.36 per claim. The average cost of processing an automatically adjudicated claim was $0.99 per claim; the average cost of processing a “pended” or delayed claim (often a claim that requires additional information or more complex manual processing) was $3.99 per claim.
- In 2012, responding plans estimated that 88 percent of all claims were paid on an “in-network” basis, up from 85 percent in 2008.