TGIF

Here’s an interesting tidbit of FEHBP news from Fedweek. In a recent report to Congress (which the FEHBlog cannot locate), “OPM has raised the prospects of creating a centralized enrollment system for the FEHB program out of concern that ineligible persons are getting coverage under family enrollments.”  OPM already has a centralized enrollments system for enrollees called CLER. In the FEHBlog’s view, OPM should expand that database to include family members. 

The ACA regulators came out with FAQ XXV yesterday. This one concerns wellness programs in employer sponsored plans. As the FAQ points out, those wellness programs are blanketed by a crazy quilt of laws and rules. The Equal Employment Opportunity Commission issued a long awaited proposed rule yesterday on the relationship between wellness programs and Title I of the Americans with Disabilities Act which applies to the employment relationship.  Kaiser Health News reports that the proposal is earning business praise, consumer concerns.

As yesterday, the Centers for Medicare and Medicaid Service issued a new version of its on line Hospital Compare service. The new version gives hospitals star ratings (one to five).  To see a selected hospital star rating, you have to select the hospital for comparison and then click on the survey of patient experiences tab. The two hospitals closest in distance to the FEHBlog’s home both have two stars.  According to iHealtbbeat,

Medicare awarded five-star ratings to 251 of the 3,553 eligible hospitals — or about 7% of the nation’s hospitals. In addition:
1,205 hospitals, about 34%, received four stars;
1,414 hospitals, about 40 %, received three stars;
582 hospitals, about 16% received two stars; and
101 hospitals, about 3%, received one star.

Perhaps the FEHBlog should consider moving.

Yesterday’s Wall Street Journal had a fascinating story on hospital prices. Hospitals have been raising their list prices because the rack rate comes into play for Medicare purposes when the patient is consider an outlier  from / sicker than the standard patient population considered when CMS develops is standard prospective price. The prospsective price is based on diagnostic related groups or DRGs.

Hospitals’ list prices have faced criticism for years as patients—often with limited or no insurance—received towering bills. The hospitals argue that few pay those rates, often called the “chargemaster” prices. Private insurers negotiate discounts with hospitals in their networks, and Medicare has its set prices for services.
Will Fox, who advises hospitals on pricing strategies as an actuary with Milliman Inc., said that, even so, “there’s still a big reward” for increasing list prices. He said hospitals raise prices primarily to increase revenue from private insurers, which sometimes reimburse based on list prices. Higher Medicare payments, he said, are viewed as a smaller “bonus.”

The Journal notes a ripple impact on non-Medicare patients who receive out of network coverage for hospital services.

Forbes reports that “In 2014, the U.S. healthcare system spent $373.9 billion on drugs—13.1% more than it did the previous year and the highest rate of spending growth since 2001, according to a new report from IMS Health’s Institute for Healthcare Informatics.  This should come as no surprise given the Hepatitis C drugs, generic inflation, and the ACA.  Drug Channels reports on the status of generic drug inflation which may be easing after a surge last year.

Finally the big HIMSS conference wrapped up in Chicago with HHS keynote speakers.  MedCity News reports

In the face of growing criticism and impatience with the Meaningful Use EHR incentive program, National Health IT Coordinator Dr. Karen DeSalvo remains upbeat but aware of the tough work ahead to achieve the vision of a learning health system underpinned by a network of interoperable EHRs.
“Interoperability is a priority, but it is still just a means to an end,” De Salvo said Thursday morning in a keynote session on the last day of HIMSS15 at McCormick Place in Chicago. Without interoperability, it will be difficult to achieve healthcare payment and delivery reform, she added.

No kidding.

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