Here’s a link to the Week in Congress’s useful review of activities on Capitol Hill.

Federal News Radio posted an article on the upcoming limited open season in the month of February that will allow federal employees another opportunity to switch to self plus one.  Annuitants can always drop down an enrollment type. The FEHBlog was intrigued by these Open Season transaction statistics provided by OPM:

2015 — 709,556
2014 — 434,853
2013 — 421,553
2012 — 304,439

OPM advised that around 1,000,000 FEHB enrollees were in a position to elect self plus one. Even assuming that some of these folks switched to self plus one and another plan concurrently, one would have expected at least 300,000 more transaction in the 2015 Open Season. It does take a while for changes to take hold in large programs like this one.

Let’s end the week with some good news.  According to this NPR article, “the teen pregnancy rate has halved since its peak in 1990, declining in all 50 states and among all racial and ethnic groups.”  That is a public health victory.

The Obama Administration announced in evident response to the Robert Pear article discussed in the latest Weekend Update that it would be tightening up the rules for enrolling in the ACA exchange plans outside of the ACA open season according to the Wall Street Journal. The power of the press in action.

In other Obama Administration news, Health Care IT News reports that the Centers for Medicare and Medicaid services plan to replace their unloved meaningful use program with a new pay for performance program intended to win over the hearts and minds of the medical community. The meaningful use program was the consideration for the $30 billion that the federal government used to fund electronic medical record systems for health care providers which don’t communicate with each other.

In other healthcare IT news, MedCity News reports on the recent demise of HealthSpot a telehealth kiosk operator that had appeared to be gaining traction with pharmacies and healthcare systems.

Competitors are not exactly celebrating the failure of HealthSpot. “I am actually not happy at all about the demise of HealthSpot,” said Dr. Roy Schoenberg, CEO of American Well. He lauded the company for demonstrating through its partnerships with the likes of Rite Aid, Cleveland Clinic and others that there is value in remote care. * * *
Schoenberg, for one, does not believe the kiosks were HealthSpot’s Achilles’ Heel, since AmericanWell also offers a kiosk option. “Our kiosks have actually been a very fast-growing part of the business,” he said. A bigger issue, according to Schoenberg, is that HealthSpot required patients and providers to pre-arrange appointments; it was not truly telemedicine on demand. “You actually have to build a lot of administration around it,” he said.

The Wall Street Journal reported that prescription drug manufacturer have continued their practice of jacking up prices around the beginning of the new year. For example,

Since New Year’s Day, Pfizer has raised list prices an average of 10.6% for more than 60 branded products with annual U.S. sales of at least $10 million, according to Deutsche Bank. Prices for eight of the products went up at least 20%. Pfizer also left prices unchanged for about 10 products.

No bueno.

FCW.com reports that the FBI and DHS have released an unclassified report full of “recommended security practices [evidently] based on the OPM breach.”  The report is informative but does not provide a link to the report.

Finally seekingalpha.com reports that Aetna and Anthem independently have stated their corporate expectations that their mergers with Humana and Cigna, respectively, remain on track to close later this year.

Interesting weekend, all of the home teams in the NFL wild card playoffs lost, including the FEHBlog’s team, the Washington Redskins.  Time marches on.

Congress is in session this week. The FEHBlog was cheered to find that the Hill is again printing its summary of events that will be occuring on Capitol Hill this week, such as the President’s final State of the Union address.

For decades, the FEHBP had Open Seasons with no pre-existing conditions. There were limited opportunities during the calendar year to enroll. There was no penalty for waiving coverage. The system has worked smoothly.  The ACA adopted the same approach. Nevertheless, the FEHBlog expected that there would be implementation bumps in the road because it was a much larger diverse population with a penalty for not signing up. And there were. But one expected bump that didn’t show up was outrage by people with health problems who needed to enroll outside of the ACA Open Season but couldn’t.  Robert Pear of the New York Times reported yesterday that

Eager to maximize coverage under the Affordable Care Act, the Obama administration has allowed large numbers of people to sign up for insurance after the deadlines in the last two years, destabilizing insurance markets and driving up premiums, health insurance companies say. * * * 

The National Association of Insurance Commissioners, representing state officials, is troubled by the trend.

“State regulators are concerned that consumers are not required to provide documentation to substantiate their eligibility for a special enrollment period,” the association said in a letter to the federal Department of Health and Human Services. “We know of many cases where individuals with serious medical conditions purchased coverage midyear by simply checking the right box or using the right language, and their eligibility was not questioned.”

There you go.

The House of Representatives joined the Senate in voting to repeal fundamental provisions of the Affordable Care Act, such as the individual and employer mandates and related taxes, on Wednesday and the President vetoed the bill today. The particulars may be found in the latest Week in Congress report. According to that report, the House will vote on overriding the veto on January 26. The vote again illustrates the importance of the Presidential election later this year.

Nextgov.com reports that

When a foreign power as early as 2013 first hacked the Office of Personnel Management and retrieved IT manuals for its network, swept up in the heist were the usernames and the last four digits of the Social Security numbers of certain system users. That detail was not disclosed to lawmakers until Thursday [at a House Oversight and Government Reform Committee hearing].  Federal officials had always maintained the attackers — who would go on to nab 21.5 million background check records last year — never obtained personally identifiable information during the first breach.  

That’s a bit of a stunner considering the number of Congressional hearing on the breach that were conducted last summer. More hearing details are available at the Committee’s website.  The Committee clearly is distraught.

HHS’s Office for Civil Rights issued a compendium of guidance on patient and health plan member access to their records held by health care providers and insurers.

Fierce Health Care offers health care system executives predictions for 2016 that are worth a glance. The executives should take a look at this Reuters report that hospital discharge instructions are too complicated for most patients to understand.

Patient reading level didn’t appear to influence the odds of returning to the hospital within a month of discharge or the likelihood that they would call the hospital with questions, the study found. But often, when these things happened, the patient had a reading level too low to understand the discharge notes.

Back to the drawing board on that one.

Have a good weekend and go Washington Redskins.  

A pending matter of interest for 2016 is the pending mergers between two sets of major health insurers — Aetna and Humana on the one hand and Anthem and Cigna on the other.  Business Insurance reports that the stockholders of the four companies have approved the respective merger agreements. Nevertheless, either agreement could be derailed by federal and state regulators conducting anti-trust reviews.

This “isn’t just a ballgame” for the [U.S.] Justice Department, explained David Balto, a Washington-based antitrust lawyer and former policy director for the Federal Trade Commission. State insurance commissioners will be reviewing the mergers and will likely take a “tough stance,” Mr. Balto said. ***  Most sources said it’s unclear what the Justice Department will decide to do. It is likely to be a long negotiation process, and if negotiations fall apart, the health insurers may go to court with the department to force a decision or they could call the deals off.

The FEHBlog ran across two article which illustrate the impact that Medicare has on healthcare:

• The New York Time Upshot discusses how a change to Medicare’s reimbursement policy for inpatient confinements, which occurred 30 years ago, has reduced hospital stays, a factor which contributed to to the hospital readmission problem.  
• A contributor to the Hill explains why giving Medicare the power to purchase prescription drugs is a bad idea. The same considerations apply to OPM’s idea to assume control over FEHBP prescription drug benefits. 

Tomorrow everyone, including the FEHBlog, returns to work for a full work week following the year end holidays.  The FEHBlog has a spring in his step because his Washington Redskins are headed into the NFL playoffs with a winning record after two woeful seasons.  Consequently there is not much to report FEHBlog-wise.

What’s goodies does the ACA bring for 2016?

• Under the ACA, all of the U.S. Preventive Services Task Force A and B recommendations must be offered by FEHB carriers in-network with cost sharing if the recommendation was made before January 1, 2015. Here’s the list.  The 2014 recommendations become cost-free on January 1 in the FEHB when rendered in-network.  The earlier recommendations already were cost free. 
• Also for 2016, all FEHB plans will have self only out of pocket maximums embedded in self plus one and self and family coverages.
• FEHB plans will be providing their enrollees with IRS Form 1095-B to document enrollee and covered family member compliance with the ACA’s individual shared responsibility mandate.  The current IRS deadline for furnishing the 2015 form is March 31, 2016.  The forms should be maintained with your tax records in case the IRS has questions.  The ACA requires plans to send one form to the enrollee. If the enrollee has adult children covered under his FEHBP coverage, he or she should provide a copy of the Form 1095-B to each of those separate taxpayers.  

The FEHBlog was amused by the lengthy Washington Post article about the future of the stethoscope.  

We have reached the end of 2015.  Last week, I provided a list of FEHBP-related surprises in 2015. I should have added to the list the smooth implementation of the ICD-10 coding set. That was another heavy lift for the health care industry. The FEHBlog hopes that the more granular ICD-10 codes pay off for the data miners.

The House of Representatives will be back in session on Capitol Hill next Monday while the Senate will return on January 11.  The FEHBlog would not be surprised if Congress tackles the prescription drug cost problem in 2016.  The problem with specialty drugs is illustrated by this Wall Street Journal article. The Washington Post reminds us that most people (like the FEHBlog) use low cost generic drugs.

ProPublica and NPR seek to bring the hammer down on repeat healthcare privacy offenders. These advocates wants the government to crack down on repeat offenders, but as the FEHBlog has explained there is a significant expense associated with remedying data breaches, regardless of whether the HHS Office for Civil Rights gets involved. More details can be found in this Ponemon Institute report.  

Happy New Year.

• Yesterday the IRS miraculously extended for two months the deadlines for furnishing and filing the forms that document compliance with the Affordable Care Act’s individual and employer shared responsibility mandates.  The Affordable Care Act requires health plans and insurers to report on coverage for their members/insureds and large employers to report on whether or not they offered their full time employees minimum essential coverage.  The Internal Revenue Service will use this information to enforce the ACA’s individual and employer shared responsibility mandates.  The delay does not affect the ability of taxpayers to file their 2015 tax returns.  Indeed the individual shared responsibility mandate was in effect for 2014 but the IRS delayed the associated reporting requirement until this year. So everyone successfully filed their 2014 tax returns without these reports known as the Form 1095-B. 
• The Wall Street Journal reported today that beginning with the new year the Centers for Medicare and Medicaid Services can fine insurers for defective provider directories.  For the life of the FEHBlog, he cannot understand why CMS cannot simply direct doctors to identify for their patients the networks to which they belong.  Why do all of the burdens have to be placed on the insurance companies? What happened to two way streets? 
• Another burr in the FEHBlog’s saddle is the fact that taxpayers spent $30 BILLION dollars on electronic medical record systems that don’t communicate with other health systems and insurers, even though the last Administration was advocating interoperability.  Better late than never, the HHS electronic health records czar last week “released its 2016 Interoperability Standards Advisory, providing the healthcare industry with a list of what ONC calls the “best available” standards and implementation specifications to fulfill specific clinical health IT interoperability needs,” according to Health Data Management.  
• Finally, Modern Healthcare reports

ACA critic Douglas Holtz-Eakin, a former director of the Congressional Budget Office who now heads the conservative American Action Forum, said the healthcare reform law is “riddled with some of the worst tax policy I’ve ever seen.” In his view, the projections of how much revenue its tax provisions would raise never added up.  

Still, he said Congress’ bipartisan move to freeze the three ACA taxes—with the likelihood that they never will be restored—is a blow to the law, said Holtz-Eakin, who advised Sen. John McCain on healthcare policy during McCain’s 2008 presidential campaign.  

He said the Cadillac tax was intended to push employers to pare back on gold-plated health benefit plans. The Obama administration and congressional Democrats designed it in a way that differentiated the tax from McCain’s proposal to cap the tax exclusion for employer plans, which candidate Barack Obama had sharply criticized. Now, Congress should again consider capping the tax exclusion, which could receive bipartisan support, Holtz-Eakin said.

Here’s hoping. As the FEHBlog has pointed out, small business people already have a capped exclusion and people purchasing individual coverage have no exclusion (but may have tax credits).  

Psychiatric drugs are now being given to infants and toddlers in unprecedented numbers. 

An analysis of 2013 IMS Data, found that over 274,000 infants (0-1 year olds) and some 370,000 toddlers (1-3 years age) in the U.S. were on antianxiety (e.g. Xanax) and antidepressant (e.g. Prozac) drugs. This report also found over 1,400 infants were on ADHD drugs. 

A 2014 Georgia Medicaid analyses led by Susanna Visser at the CDC (see a video of her fascinating talk) when extrapolated nationwide by the New York Times found that over 10,000 toddlers were put on ADHD treatments. (Dr. Visser is currently working on national estimates but believes that the estimate from the Georgia data is conservative.)
Prescriptions of powerful antipsychotics such as Risperdal for infants and very young children have also sharply risen. 

At least the expert concludes that this trend is misguided. How can doctors prescribe these drugs to little children whose brains are developing?   As the expert, a psychiatrist, concludes, “This is a complex problem but as the social reformer Frederick Douglass noted over a hundred years ago, “It’s easier to build strong children than to repair broken men.” Healers heal thyself.

Researchers studying brain tumors said they have discovered a new biological mechanism that causes normal cells to become cancer cells, a finding that both challenges current treatment strategies and could lead to new approaches against the disease. * * *  

[The discovery] underscores cancer’s complexity. The process appears to operate independently of the so-called driver mutations that fuel cancer. The finding may help explain why treating tumors with drugs targeted at such mutations—a strategy known as precision medicine—is having limited success. While such targeted treatment often dramatically shrinks tumors initially, in most cases, patients eventually relapse.