Tuesday Tidbits

Following up on Sunday’s post knocking the ICD-10 as a waste of money, the FEHBlog wishes to clarify that some aspects of the ICD-10 make sense, such as identifying whether the affected body part is on the left or the right side.  However, the ICD-10 is the complete public health statisticians’ wish list and as a result it is way too complicated.  Coders never will use all of the codes. As AMA President Steven Stack said last year at a WEDI conference that the FEHBlog attended, the coding community missed an opportunity to work with the medical profession to create an improved code set that works. Instead we are likely to wind up with more confusion, rather than more clarity.

The FEHBlog and OPM independently have advocated the medical profession’s Choosing Wisely campaign which relies on specialists to identify relatively common procedures which are past their sell date. Fierce Health Payer reports on a study published in JAMA Internal Medicine suggesting additional steps that need to be taken in order to make the campaign effective.

The FEHBlog also has advocated health plan use of reference pricing to control benefit costs. The New York Times Upshot column lauds Europe for its prevalent use of reference pricing with prescription drug benefits.  For your ease of reference (get it?) here’s the Times’ explanation of this technique:

Drugs are grouped into classes in which all drugs have identical or similar therapeutic effects. For example, all brands of ibuprofen would be in the same class because they contain the same active agent. The class could include other nonsteroidal anti-inflammatory agents like aspirin and naproxen because they are therapeutically similar. The insurer pays only one amount, called the reference price, for any drug in a class. A drug company can set the price of its drug higher, and if a consumer wants that one, he or she pays the difference.

Of course, our friendly ACA regulators weighed in on the technique last year.

Yesterday, according to this Fierce Health Payer article, Aetna and Humana stockholders “overwhelmingly” approved the merger agreement reached earlier this year. The regulators continue to evaluate the deal, which is expected to close next year.

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