Mid-week update

Govexec.com interviewed House Oversight and Government Reform Committee Chairman Jason Chaffetz in Monday’s edition.  Mr. Chaffetz explained that his focus of attention will shift from oversight to reform in this session of Congress as he has an opportunity to enact some legislation with  both the Executive and Legislative Branches in the hands of his party for at least the next two years. The FEHBlog was interested to read that “Chaffetz will meet with the cosponsors of his bill to reform the U.S. Postal Service, including [Rep.] Connolly, this week and expects to reintroduce a bill very similar to the one that cleared the committee last year.” The FEHBlog was surprised to read that “The main point of contention is a provision to require all postal retirees to enroll in Medicare as their primary health insurance provider.”

The Postal Service has been pushing for full Medicare integration for at least five years in order to significantly reduce the burden of pre-funding post-retirement coverage for its retirees. The FEHBlog looks forward to reading the new version of the bill which was HR 5714 in the last Congress.

Also on Monday, the OPM Inspector General made public a December 2016 management report on the Multi-State Plan Program.  This program, which OPM administers, was intended to add more plans to the ACA marketplace.  The Inspector General explains why that effort has run into roadblocks. He overlooks perhaps the key roadblock — the difficulty of making a profit in the ACA marketplaces.

Yesterday, the Obama Administration’s ACA regulators issued perhaps their final ACA FAQ which is no. 35 — well less than the number of Super Bowls.  This FAQ responds to a U.S. Supreme Court for a regulatory compromise that would resolve religious institution objections to the Administration’s birth control coverage mandate. The ACA regulators kicked the can down the road to the new Administration by refusing to compromise.

The Labor Department’s Employee Benefits Security Administration which enforces ERISA issued an FY 2016 Fact Sheet on enforcement of the mental health parity law.  Also the ACA regulators posted public comments on a series of related mental health parity questions raised by ACA FAQ 34 last year. Those questions concerned how to educate consumers and health plans about the mental health parity rule’s complex non-quantitative treatment limitation requirements.  Title XIII of the recent 21st Century Cures Act addresses the same issue with a requirement that the regulators issue guidance on NQTL requirements.

Modern Healthcare reported earlier this week that

In an effort to fulfill its mission to expand its provider footprint to serve about two-thirds of the U.S. population, OptumCare has agreed to acquire Surgical Care Affiliates for about $2.3 billion in a cash and stock deal.  Deerfield, Ill.-based SCA owns or operates 190 ambulatory surgery centers and surgical hospitals, most as joint ventures with physicians and health systems. The company says SCA and its affiliates serve approximately 1 million patients per year in more than 30 states. In 2015, it had operating revenue of around $1.1 billion.

OptumCare is an arm of the largest health insurer in the U.S., United Health. The article explains

UnitedHealth has said Optum aims to provide primary care and ambulatory services in 75 markets, representing about two-thirds of the U.S. population. Over the past year, Optum has purchased physician practices around the country. It also acquired urgent-care provider, MedExpress. In 2014, Optum agreed to acquire MedSynergies, a physician practice consulting firm, and care-monitoring company Alere Health for $600 million.


On the HIPAA privacy and security front, the HHS Office for Civil Rights announced another scalp resulting from a health plan’s failure to give prompt notice of a protected health information data breach. $475,000 was required to settle the matter.  OCR also created a new FAQ which clarifies the circumstances under which doctors, hospitals, and health plans can share information with a person who is not married to the patient or is not one of the patient’s relatives.

Finally, an op-ed in the Wall Street Journal this week provided some background on the continuing problem of lack of interoperable electronic medical records, which of course the FEHBlog’s major pet peeve. The Obama Administration missed the boat by failing to include interoperability requirements in the EMR standards that were created as part of the government’s $30 billion investment.  The op-ed writer explains that the largest EMR vendor is refusing to ally with the smaller vendors to resolve the problem. The op-ed writer suggests.

The real incentive is insurers paying for this data, and they are figuring out that early detection is worth it. It’s a lot cheaper to find a disease before it turns into expensive chronic care for heart disease or cancer. The machine learning output might be: “You may have pre-Stage 1 cancer in your pancreas, but no worries—we can zap it out for you.”

The article is worth reading.