Risk adjustment overlooks regional differences in doctor visits, research finds

Risk adjustment overlooks regional differences in doctor visits, research finds:
A flawed risk-adjustment model is causing Medicare to overpay some health plans and providers and underpay others, according to a new study published by BMJ.

The problem is that people in some parts of the country visit healthcare providers more frequently than in others, according to the findings. Based on diagnoses, though, it turns out more visits don't necessarily equate to sicker patients, suggesting Medicare has been overpaying in those regions.

"Adjusting without correction for regional variation in visit rates tends to make regions with high rates of visits seem to have lower mortality and lower costs and vice versa," the researchers conclude. "Visit-corrected comorbidity measures better explain variation in age, sex, and race mortality than observed measures, and reduce observational intensity bias."

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To learn more:
-here's the BMJ study-read Rau's blog post

HHS releases essential health benefits final rule

HHS releases essential health benefits final rule:
The U.S. Department of Health & Human Services released a final rule outlining the specific essential health benefits that insurers must cover regardless of whether they're selling plans through health insurance exchanges.
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The law ensures that health plans offer a core package of items and services, known as “essential health benefits (EHB).” Under the statute, EHB must include items and services within at least the following 10 categories:

1. Ambulatory patient services
2. Emergency services
3. Hospitalization
4. Maternity and newborn care
5. Mental health and substance use disorder services, including behavioral health treatment
6. Prescription drugs
7. Rehabilitative and habilitative services and devices
8. Laboratory services
9. Preventive and wellness services and chronic disease management
10. Pediatric services, including oral and vision care

- read the HHS statement and fact sheet

- here's the final rule (.pdf)

HIPAA Omnibus Final Rule – What’s in it for Patients?

From David Harlow's Health Care Law Blog

After years of delay, the federales finally finalized the HIPAA Privacy, Security, Breach Notification and Enforcement Rules.  HIPAA Omnibus Final Rule – What’s in it for Patients?