TGIF

The FEHBlog hopes the everyone enjoys the FEHBlog’s new look and its updated / corrected links. Following up on the mid-week post, here’s a link to the CMS press release about the essential benefits rule. The press release illustrates the fact that the rule covers a lot of ground beyond essential health benefits. HHS released more ACA rules today that principally concern the individual and small group markets.

The FEHBlog wishes to clarify that the out of pocket maximum discussed in the last post applies only to in-network coverage.  This OOP maximum applies to all in-network deductibles, co-payments, and co-insurance – including Rx benefits, but not premiums. The ACA’s OOP maximum is in fact the same OOP maximum that currently applies to high deductible health plans. The 2013 HDHP maximums are $6250 self only and $12,500 self and family. The IRS will update these amounts for 2014 in May 2013.

The IRS’s latest ACA FAQ XII issued on Wednesday also addresses the scope of the ACA’s often vague preventive care mandate. For example,

Q15: Do the HRSA Guidelines include contraceptive methods that are generally available over-the-counter (OTC), such as contraceptive sponges and spermicides?
Contraceptive methods that are generally available OTC are only included if the method is both A15 FDA-approved and prescribed for a woman by her health care provider. The HRSA Guidelines do not include contraception for men.

Fierce Health.com featured an interesting story headlined “Patients opt for expensive care when given a choice.

Based on interviews with 22 focus groups of insured people, researchers found four barriers to patients considering lower-cost care options, according to the study abstract:

  • Patient preference for what they perceive as the best care, regardless of expense
  • Inexperience with making trade-offs between health and money
  • Disinterest in costs borne by insurers and society as a wholePeople’s tendency to act in their own self-interest despite recognizing they are depleting limited resources

That’s disturbing. Thank heavens then for the Choosing Wisely campaign which applies evidence based medicine to encourage doctors to eliminate unnecessary tests and procedures. Choosing Wisely came out with a new set of recommendations. For example one of those recommendation is to not to automatically use CT scans to evaluate children’s mild head injuries (observe first) and another is to schedule non-medically indicated inductions or C-sections before the 39th week of pregnancy, which also is an OPM initiative   Good work. Moreover, the Leapfrog Group reported yesterday that

the national rate of early elective deliveries dropped for the second year, according to data submitted to its annual Leapfrog Hospital Survey.

 Early elective deliveries – performing elective inductions or cesarean procedures prior to 39 completed weeks gestation without medical necessity – have been decreasing since 2010 when the Leapfrog Group became the first to publicly report hospital rates. This year, 46% of the 773 reporting hospitals met Leapfrog’s early elective deliveries target rate of less than 5%, an increase from 39% in 2011. Data from the Leapfrog Hospital Survey is the only national source of this data by hospital.

Finally, if you have some free time this week, you might want to try out the CDC’s new “’Solve the Outbreak’” app which allows mobile device gamers to fight one of three fictional outbreaks as an investigator in the agency’s Epidemic Intelligence Service,” according to Modern Healthcare. Now there’s a sequestration target for you.

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