Tuesday Tidbits

The ACA regulators came out with the summary of benefits and coverage 2.0 today. It’s FAQ XIV. The changes are relatively minor. It’s a shame that the law does not require health care provider to disclose in summary fashion its pricing and the health plan networks to which it belongs. 

The ACA requires health plans to fund a patient centered outcomes research institute with millions and millions of dollars. Modern Healthcare reports that the PCORI will be spending some of those millions on national patient-powered networks.

OPM is encouraging FEHB plans to be more creative in offering coverage to treat obesity. The AMA News has suggestions from the medical community.

Addressing obesity is “challenging in terms of the time required to do it right and the lack of coverage” by most insurers, said Yul David Ejnes, MD, a Cranston, R.I., internist and past chair of the Board of Regents of the American College of Physicians.

Although Medicare covers a series of primary care visits for obesity counseling among patients with a body mass index of 30 kg/m2 or greater, such appointments are not covered by most other insurance companies, said Scott Kahan, MD, MPH, director of the National Center for Weight and Wellness. The multidisciplinary obesity treatment center is based in Washington. As a result, physicians often must squeeze complicated discussions on improving diet, boosting physical activity and changing eating behaviors into short appointments that are scheduled for a separate health problem.

Kaiser Health News reports that a robotic surgical tool called DaVinci that health plans generally cover and that adds cost to procedures is not uniformly cost effective. Shocker!

Modern Healthcare also provided a link to an HHS Office for Civil Rights PowerPoint discussing the results of the first round of Privacy and Security Rule compliance audits of HIPAA covered entities. “Security was overwhelmingly an area of concern,” the OCR presenter said, noting that 47 of the [61 audited] providers had not done a complete and accurate risk assessment for potential data problems.” That’s a big bowl of wrong.

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