Mid-week update

HHS announced today that “more than half of all doctors and other eligible providers have received Medicare or Medicaid incentive payments for adopting or meaningfully using electronic health records (EHRs).” Any why not as the federal government has shelled out $6 billion in this effort. Meanwhile, as a loyal reader of the AMA News, the FEHBlog is aware that doctors are not altogether happy with the situation. A Modern Healthcare article adds that

Last month, six Republican U.S. senators issued a white paper calling for a reboot of the federal efforts. The senators criticized the program as lacking a clear path toward interoperability, and they cited earlier concerns raised by the Justice Department that health information technology systems may facilitate billing fraud. They also cited an HHS inspector general’s report criticizing the CMS for a general lack of oversight of the EHR incentive payment program. More recently, in response to the senators’ call for comments, several healthcare organizations praised the federal program for boosting EHR adoption, while also noting the need for more standardization and interoperability. 

The AMA News also reports a “seismic shift” in hospital system revenues. Primary care providers rather than specialists are generating more revenue for hospital systems due to the development of accountable care organizations, health care system employment of physicians, and other ACA initiatives like “free” in-network preventive care.

In the category of specialists, noninvasive cardiology, invasive cardiology, gastroenterology, general surgery, neurology, neurosurgery, ophthalmology and pulmonology showed decreases from the 2010 survey, while hematology-oncology, nephrology, obstetrics-gynecology, orthopedic surgery, psychiatry and urology went up. Otolaryngology was added to the survey for the first time in 2013.

A few specialties had notable declines from 2010 to 2013. Ophthalmology fell from $1.7 million to $725,000. Neurology dropped from $940,000 to less than $700,000. Neurosurgery declined from $2.8 million to $1.7 million.

The New York Times reports that the Obama Administration is trying to get the cash strapped pre-existing condition plan across the December 31, 2013, finish line by issuing an interim final rule that caps provider reimbursements at Medicare rates and prohibits providers from balance billing patients enrolled in this ACA initiative.

The administration had predicted that up to 400,000 people would enroll in the program, created by the 2010 health care law. In fact, about 135,000 have enrolled, but the cost of their claims has far exceeded White House estimates, exhausting most of the $5 billion provided by Congress.

At the end of next week, FEHB plan carriers will be submitting their 2014 benefit and rate proposals to OPM. Business Insurance reports that “The average increase in medical costs for families enrolled in employer-sponsored preferred provider organizations was just 6.3% in 2012, according to a report that Seattle-based Milliman Inc. released Wednesday ”  Of course, FEHB plans have been able to hold their rate increases on average well below this benchmark.  According to the report highlights,

  • Is this pattern of lower rates of increase over the past four years a sign that America is “bending the cost curve?” It is difficult to pinpoint a single cause of the slowing rates of increase, as a number of factors may be influencing trends. Possible explanations include the economy, provider integration, and a shortage of new “blockbuster” drugs coming online.
  • We expect that the emerging reforms required by the Patient Protection and Affordable Care Act (ACA) will have little impact on the cost of care for our family of four in 2013 because this family tends to be insured through a large group health plan.

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