Weekend update

The 114th Congress will convene on Tuesday January 6, 2015.  Unless Congress takes action on Medicare sustainable rate of growth (“SRG”) formula by the end of March, Medicare Part B payments to doctors will drop. Congress extended the ICD-10 coding mandate for at least one year in last winter’s temporary SRG fix, but the FEHBlog doubts that there will be another extension.

It is unfortunate that HHS chose an implementation date that coincides with the federal fiscal year and not the calendar year which is a common transition point for health plans and providers.  We will have to keep an eye on CMS to learn its transition plan, e.g., how long it at all will Medicare accept ICD-9 codes on claims with dates of service on or after October 1, 2015?  The FEHBlog expects that most health plans will follow CMS’s lead. This has the potential to be a claims processing nightmare because while health plans generally are prepared for the conversion, doctor’s offices tend to be behind the curve. It is unfortunate because the conversion will do nothing to enhance the electronic payment of claims which was HIPAA’s goal.

Meanwhile, the Obama administration continues to enforce the ACA in a draconian manner. But its enforcement approach is rather even handed because it seeks to burden both health plans and providers. The New York Times wrote last month about the Administration’s investigation of rather garden variety claims practices as unlawfully discriminatory presumably under PHSA Sec. 1557 which does apply to the FEHBP.  Last week, the IRS announced a new final rule clamping down on the billing practices of non-profit hospitals. The IRS rule does not take effect until 2016.  In both cases, consumer advocacy groups are instigating the enforcement actions.

The WSJ’s Phamalot blog reports on drug pricing trends for 2015. It’s an article worth reading.

Finally, the FEHBlog really enjoys reading the weekend issue of the WSJ and yesterday’s issue did not disappoint. The issue included this op-ed by two experts, one of whom, Stephen R. Quake, invented the molecular telescope. The authors pointed out that in 1816 roughly 200 years ago a French physician invented the current stethoscope, which is a listening device to help doctors hear bodily noises.  The molecular stethoscope is a blood test which identifies alien DNA in the blood. The alien DNA can be a sign of disease. The article explains in pertinent part.

Replacing expensive and dangerous invasive procedures with an
inexpensive and safe blood test is a major medical advance, and a safer
alternative to amniocentesis is only the beginning. Similar invasive
tests—such as biopsies—are beginning to be eliminated in areas ranging
from cancer detection to transplant rejection, potentially increasing
safety and performance while lowering the cost of care.
prenatal molecular stethoscope is the first truly widespread clinical
application to result from the human-genome project. The National
Institutes of Health has an opportunity to build on this new knowledge
of “alien” DNA in healthy individuals, and determine whether it may
change their clinical course—the molecular-stethoscope approach.
Meanwhile, whole genome sequencing of the germ-line, or native, DNA from
populations is under way, with seven ongoing world-wide projects, each
sequencing the native DNA from 100,000 or more individuals. It’s
projected that nearly two million people will be sequenced by 2017.

The FEHBlog believes that human genome project will deliver major improvements in health care over time. The improvements may bend the cost curve down. Keep hope alive. 

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