Weekend Update

Well, tomorrow is the last day of this year’s Federal Benefits Open Season, and Monday also begins the last week in which both Houses of Congress are in session for this calendar year. According to the Hill’s floor action blog, Congress has a lot on its plate. including a budget deal and a short term or long term fix to the Medicare sustainable growth rate formula.

The FEHBlog, being an old guy, still likes to read the Sunday newspapers and here are three interesting articles that he noted:

  • From the Washington Post (lead article in fact), a story about how a pharmaceutical manufacturer Genentech and doctors take advantage of the Medicare and Food and Drug laws to charge Medicare an extra billion dollars annually for dispensing a $2000 per injection drug when its $50 per injection cousin (made by the same company) is equally effective. The article also illustrates how off label use can be driven by the drug manufacturers who refuse to seek FDA approval for a particular use because a more expensive drug is already labelled for that use. 
  • The FEHBlog recently wrote about the expansion of concierge medicine to folks who live below the upper 1% income level. The New York Times has an article today about two doctors who are establishing an old school Park Avenue concierge medical practice ($25000 annual retainer — 400 patients). These doctors are willing to hold a patient’s toe during a difficult MRI. I wish that I could make this up. 
  • Finally, the New York Times business section lead with a story about how the British government is putting to effective use a book called Nudge that was written a few year ago by two U.S. academics, Richard Thaler and Cass Sunstein, who was head of OIRA in OMB during the current administration. The article discusses how the British government is using behavioral psychology to successfully encourage people to find jobs and pay their taxes and fines. “In their book, Professor Thaler and Mr. Sunstein defined their approach as steering people toward decisions deemed superior by the government but leaving them free to choose. “Libertarian paternalism,” they called it, and while that term is not used much in Britain, there is broad agreement on the subject among the left and the right.” Health plans try to nudge people; maybe there are more effective ways to do it. 
The FEHBlog noted last week about a government Tiger Team that is discouraging a technological grounds the idea to require electronic health records to generate access reports. The happy bounce of this ball for health plans is that the Tiger Team report may discourage the Health and Human Services Department from finalizing a rather wacky 2011 proposed rule that would have required health plans and providers to keep track of routine uses and disclosures of claims and medical records. HIPAA refers to these uses and disclosures as treatment, payment, and health care operations related. As it stands the law requires that non-routine uses and disclosures be accounted for upon request. That approach has worked for a decade and hopefully the Tiger Team report means that the status quo will prevail.