Weekend Update

Happy Fathers’ Day. Congress remains in session this week as the Hill’s Floor Action blog details. The Supreme Court may issue some major decisions tomorrow. Following up on Thursday’s post about the Supreme Court’s DNA patent decision, the FEHBlog notes that Quest Diagnostics announced that it is entering the BRAC test market and Myriad Genetics’ stock price sagged in late trading on Thursday and Friday.

An HHS Office of Inspector General report released last week finds that the three largest FEHB plans and Medicaid plans pay less than Medicare for laboratory tests. The report finds that

As the largest health insurer in the United States, Medicare has great influence on the actions of other health care insurers. For example, Federal law prohibits State Medicaid program payments that exceed the  Medicare payment amount for lab tests.20 Eighty-three percent  (24 of 29) of responding local FEHB plans and networks reported that  they use the Medicare Medicare Clinical Laboratory Fee Schedule (CLFS) as a basis for establishing their own fee schedules and payment rates.

However, State Medicaid programs and local FEHB plans reported that they consider factors when establishing payment rates for lab tests that  Medicare does not consider. For example, eight Medicaid plans and four  local FEHB plans reported that technological changes (e.g., benchmarking  payment rates for new tests to the actual cost of performing them) are taken into account when establishing payment rates. Thirteen local FEHB plans reported taking into account market considerations, such as competitor information, membership size, and market analysis. Other factors reported by State Medicaid programs and FEHB plans include provider requests to review the adequacy of a payment rate for a certain lab test and legislative and/or budgetary changes. 

Also Medicare in contrast to the FEHB plans and Medicaid does require any member cost sharing for diagnostic tests.  Flexibility is a good thing.

Modern Healthcare reports that the heralded drop in hospital readmissions may be the readmission numbers may be attributable at least in part to the fact that

hospitals increasingly are handling patients on so-called outpatient observation status, which in many cases is indistinguishable from inpatient admission. Since observational-status patients aren’t counted as admissions, they aren’t counted as readmissions if those patients are hospitalized within 30 days. Similarly, if observational patients had been hospitalized within 30 days prior to the observational-status treatment, that treatment wouldn’t be counted as a readmission.

Health plans take note!  Kaiser Health News adds that the readmission penalty programs puts the screws on hospitals serving the neediest communities.

Finally the Baltimore Sun reports that on wellness programs that the Defense Department and the Social Security Administration offer their employees.

The Office of Personnel Management helps guide government agencies in establishing health and fitness initiatives, which include smoking cessation programs, blood pressure screenings, health fairs and exercise classes.  Services are designed by individual agencies. Some provide on-site gyms or access to nearby fitness clubs, while others offer walking groups, weight lifting instruction and fitness assessments that measure a worker’s ability to run a mile or do a push-up.

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