Mid-week update

Fierce Healthcare brings us up to date on status of the government’s antitrust lawsuits to block the Aetna/Humana and Anthem/Cigna mergers as those cases hurtle toward trial next month.

A study published in Health Affairs suggests that seven days or fewer following hospital discharge is a reasonable benchmark for judging unnecessary readmissions.  The government uses 30 days following discharge as its benchmark. The study authors remark that

We examined risk-standardized thirty-day risk of unplanned inpatient readmission at the hospital level for Medicare patients ages sixty-five and older in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. The hospital-level quality signal captured in readmission risk was highest on the first day after discharge and declined rapidly until it reached a nadir at seven days, as indicated by a decreasing intracluster correlation coefficient. Similar patterns were seen across states and diagnoses. The rapid decay in the quality signal suggests that most readmissions after the seventh day postdischarge were explained by community- and household-level factors beyond hospitals’ control. Shorter intervals of seven or fewer days might improve the accuracy and equity of readmissions as a measure of hospital quality for public accountability.

NCQA take note too. (OPM applies NCQA’s 30 day following discharge readmission measure to FEHB plans.)

As we approach the Medicare open season, a large group of organizations is pleading with Congress to help out seniors who are ineligible for the so-called hold barmless rule governing Medicare Part B premiums. That law protects federal and postal annuitants who retired on FERS but not those who retired on CSRS.  What’s the difference you ask — Medicare Part B premiums are paid out of Social Security checks for FERS annuitants but not for CSRS annuitants who pay those premiums out of their federal annuity checks. This distinction is non-sensical in the FEHBlog’s view.

Last Saturday October 1 marked the one year anniversary of ICD-10 coding implementation (and the birthdate of the FEHBlog’s first grandchild).  This anniversary marked the end of the CMS grace period for ICD-10 coders.  Health Data Management reports that small provider offices, and Health IT News reports, that hospitals are nervous about this change.

Modern Healthcare reports that

More employers are setting up value-based reimbursement and payment arrangements with health insurers and providers to encourage better employee health outcomes and reduce costs, survey data released Tuesday show.
This year, 45% of employers are giving employees access to centers of excellence, or COEs, organizations that have high quality ratings in specialties such as cardiac or orthopedic services and infertility, according to the survey data released Tuesday by risk management and employee benefit consulting firm Willis Towers Watson.
That’s up from just 37% of employers in 2015 who provided access to COEs, the survey of 600 U.S. employers with more than 1,000 employees each showed. Collectively, the companies employ 12.2 million full-time workers in various industries. 

FEHB plans are taking these steps too.

Finally, HHS announced that

HHS’ Office of the National Coordinator for Health Information Technology (ONC) awarded a cooperative agreement to the National Health Information Sharing and Analysis Center (NH-ISAC) of Ormond Beach, Florida to provide cybersecurity information and education on cyber threats to healthcare sector stakeholders. HHS’ Office of the Assistant Secretary for Preparedness and Response (ASPR) awarded a cooperative agreement to NH-ISAC to help build the infrastructure necessary to disseminate cyber threat information securely to healthcare partners. 

The FEHBlog took note because he had not been aware of this Center.