Tuesday Tidbits

Tomorrow will be the final day of this current U.S. Supreme Court session. The Court is expected to issue its Defense of Marriage Act constitutionality decision. The FEHBlog projects that the Court by a wide margin will strike down the law because the Constitution reserves to the states the right to govern domestic relations, a violation of the Tenth Amendment to the Constitution. We shall see.

The AMA News is dancing a cautious jig over a Supreme Court decision two weeks ago in a doctor’s lawsuit against a health plan. “The U.S. Supreme Court ruled class arbitration can be utilized for doctors’ payment disputes with an insurer when the contract is silent on the issue. A U.S. Supreme Court decision upholding a potent legal tactic for physicians against insurance companies could lead insurers to use more restrictive provisions in contracts with doctors, legal experts said.”  Oooh, the bad insurance companies. Note to bad insurance companies — see footnote 2 of the Court’s opinion and related text to understand why this case is nothing for the AMA to celebrate.

Speaking of the AMA, the AMA News reviews the actions taken at the recent AMA annual meeting here. The FEHBlog noticed in the press that the AMA had voted a resolution deeming obesity to be a disease state. The AMA News reports that “Designating obesity as a disease could lead to greater investments by government and the private sector to develop treatments and ensure that doctors are paid for those services.” (Emphasis added.)  In another guild action, the AMA sought to swat away pharmacists who dare to question a physician’s judgment. The AMA News reports “Delegates voted to adopt policy that says pharmacists who make inappropriate queries to verify a physician’s rationale behind a prescription, diagnosis or treatment plan are interfering with the practice of medicine.”  Finally the AMA News reports that the AMA has not given up on its jihad against implementation of the ICD-10:

Delegates voted to support federal legislation that would require all payers to implement ICD-10 or ICD-11 over two years. The move gives “our members time to get used to the sticker shock” of ICD-10, said Reid B. Blackwelder, MD, president-elect of the American Academy of Family Physicians. Payers during that period “will not be allowed to deny payment based on specificity of ICD-10-11 diagnosis,” but would be required to give doctors feedback for incorrect diagnoses, the policy says. “We should not allow payers to find loopholes to not pay us for services we provide under contract,” said M. Eugene Sherman, MD, an alternate delegate for the American College of Cardiology and a cardiovascular disease specialist from Englewood, Colo.

This is rich. Insurers are spending millions of dollars to implement the ICD-10 in order to adhere to the law, not to deny claims. 


Finally, Politico reports on the status of OPM’s efforts to implement the multi-state plan program. As part of the ACA, OPM is expected to contract for at least one for profit and one non-for-profit carrier ultimately to participate in all of the state exchanges.  

Leave a Reply

Your email address will not be published.