TGIF / Happy Halloween!

As we inch ever closer to the beginning of the Federal Benefits Open Season, November 10 / a week from Monday, the federal employee press gets busy,  The Federal Times has an article about the low 3.2% average FEHBP premium increase for 2015 which it illustrated with this OPM chart that goes back 25 years.  The FEHBlog has a problem with percentage charts like this because premiums were much lower in 1990. A 10% increase on a low dollar amount can be less consequential than a 3.2% increase on a high dollar amount. It would be more illuminating to track the average premium.

The trend of premiums is generally up which aligns with the trend in health care spending. No surpise there. The chart shows a drop in premium gIn the 1990s health plans cracked down on spending with gatekeeper arrangements (now known as patient center medical homes.) While there was a consumer backlash against those arrangements in the late 1990s, the FEHBlog credits premium growth in the late 1990s to the growth of prescription benefit managers (every Rx a claim) and Medicare relative value schedule for Part B which shifted costs to the private sector. Medicare cost shifting in the FEHBlog’s view has been the cause of much of the growth in health plan premiums particularly over the last 30 years.

It’s interesting that the dip in premium increases in the last decade begins at the same time Blue Cross launched its low premium basic plan with an exclusive provider arrangement. That plan grew like crazy in the first five years along with other low cost plans like GEHA’s.

The last decade’s bump followed by the more recent lower trend generally follows the economy and health care spending. Although it’s not mentioned in the Federal Times article, the FEHBlog credits the carriers for sticking with the program and doing their level best to control premiums.

Govexec reports that more that 25,000 Federal employees and annuitants will have to switch plans in the coming Open Season because their current plans are leaving the FEHBP at the end of the year.

Next Wednesday November 5 is the deadline for health plans to obtain a HIPAA plan identifier. Today HHS which administers HIPAA announced that

Effective October 31, 2014, the Centers for Medicare & Medicaid Services (CMS) Office of e-Health Standards and Services (OESS), the division of the Department of Health & Human Services (HHS) that is responsible for enforcement of compliance with the Health Insurance Portability and Accountability Act of 1996 (HIPAA) standard transactions, code sets, unique identifiers and operating rules, announces a delay, until further notice, in enforcement of 45 CFR 162, Subpart E, the regulations pertaining to health plan enumeration and use of the Health Plan Identifier (HPID) in HIPAA transactions adopted in the HPID final rule (CMS-0040-F).
This enforcement delay applies to all HIPAA covered entities, including healthcare providers, health plans, and healthcare clearinghouses.
On September 23, 2014, the National Committee on Vital and Health Statistics (NCVHS), an advisory body to HHS, recommended that HHS rectify in rulemaking that all covered entities (health plans, healthcare providers and clearinghouses, and their business associates) not use the HPID in the HIPAA transactions (see This enforcement discretion will allow HHS to review the NCVHS’s recommendation and consider any appropriate next steps.

The HIPAA plan identifier is not intended to replace the other numerical identifiers that plans currently use. (Repeal HIPAA??) Meanwhile Congress continues to prevent HHS from issuing a HIPAA patient identifier (for privacy reasons). Common sense dictates, however, that a common patient identifier would improve the interoperability of providers’ electronic medical records systems. The number also would facilitate a move away on relying on Social Security Numbers for Medicare coordination of benefits.