Here’s a link to the Week in Congress’s description of recent activities on Capitol Hill.  In two interesting developments, a bipartisan pair of Senators have introduced a bill to repeal the ACA’s 40% excise tax on high cost coverage according to Bloomberg and Sen. Tom Carper (D Del.) has introduced a new version of his Postal Reform bill according to Federal News Radio.

Modern Healthcare reports that NCQA is replacing its health plan rating system with a five step ranking system similar to Medicare Advantage’s star rating system. The article concludes

Quality ratings have proliferated throughout healthcare as a means to direct patients toward the hospitals, doctors and health plans that have the best clinical outcomes and the lowest costs. Healthcare researchers wrote this week in JAMA that most quality metrics rely on “professional standards,” but those metrics sometimes “can fail to capture what matters most to each individual.” “Patients, family members and friends should be able to report whether the patient received what he or she most needed and wanted,” the researchers wrote in the medical journal.

The Hartford Courant reports on discussions that top Aetna and Cigna managers held with analysts at a health care conference this week.  The analysts were interested in their respective merger plans.

Employee Benefit News offers a perspective on the new fact of health assessments, a start part of wellness programs.

Thanks to the proliferation of apps and monitoring devices, it is becoming much easier to engage people in such teachable moments beyond receiving annual health assessment results and beyond the workplace. Technology has created a world where people can continually connect to resources supporting their personal health whenever they are open to it. The ability to provide wellness tools that are with people throughout the day opens exciting possibilities to the developer that “gets it right” in triggering and sustaining true engagement over time.

In that vein,  this article links to another report that the FitBit wellness program is now HIPAA compliant. What’s more, according to this Phoenix TV news station report, the U.S. Preventive Services Task Force now has an app that doctors and patients can download from the Apple and Google app stores. The FEHBlog downloaded the app ePSS — it appears to be handy.

Finally, if you need a little healthcare related humor check out this Healthcare Dive article on the 16 most absurd ICD-10 codes.  It’s no wonder the AMA fought this zany change.

Today, OPM’s final rule implementing the self plus one enrollment type was posted on the Federal Register’s public inspection list.  The self plus one enrollment type takes effect for 2016.  FEHBP enrollees who want to enroll for self plus one will have to make an affirmative change using the SF 2809, Employee Express, etc., during the upcoming Open Season.  The change will not happen automatically if you currently have only two people covered under a Self and Family enrollment type. The rule also explains how folks can switch from self and family to self plus one outside of Open Season. You can find those answers in a pithier format at OPM’s self plus one website too.

OPM should be announcing the 2016 premiums in the next week or so.  Then federal and postal employees and annuitants will have the final piece of the self plus one puzzle.

The Altarum Institute reported last Friday that

Health care prices in July 2015 were 1.1% higher than in July 2014, for the 4th consecutive month, and only a 10th above the decade-plus low of 1.0% growth registered in August 2013. Year-over-year hospital prices rose 0.9% in July, the highest since September 2014. Physician and clinical services prices fell 1.1%, only a 10th above the multi-decade low recorded in June. Prescription drug prices rose 4.4%, down from 4.8% in June and 6.4% in December 2014.

Business Insurance reports that the ACA regulators are sticking to their position, discussed from time to time in the FEHBlog that group health plans must embed a self only in-network out-of-pocket maximum in the self and family in-network out-of-pocket maximum.  OPM has insisted that all FEHB plans include this feature for 2016.  These administrative mandates simply push premiums closer to the 40% excise tax thresholds.

Fierce Healthcare reports on a JAMA published study finding that half of readmission disparities are outside the hospitals’ control.

Under the standard Medicare formula [created by the Affordable Care Act], which only controls for patient age, sex and certain conditions, the top hospitals have 4.4 percent fewer readmissions than the worst performers. However, when researchers from Harvard Medical School applied a set of 29 more specific variables such as cognition, functional status, income, education and self-reported health, the difference fell to 2.3 percent.

Fierce Health Payer offers an interview with a cybersecurity expert who thinks that the recent megabreaches have focused business and government attention on improving data security.

As for preventing attacks at their own organizations, healthcare companies should take two major steps, according to [the interviewee David] Damato:
Identify the organization’s risk, or the data security issue it’s most concerned about. For most in the healthcare industry, this will be personal health information, Damato says.
Find ways to surround that sensitive information with the right number of controls that make it difficult to obtain, such as multifactor identification or data encryption. Data encryption alone, however, isn’t sufficient, he notes.  Insurers also should avoid storing members’ data online past the point that it’s absolutely necessary, [according to another expert].

The FEHBlog agrees with both experts.  In particular, the OPM data breach highlighted the key importance of multi factor authentication and careful data management policies that protect the organization’s crown jewels. Unfortunately lengthy government record retention requirements, e.g., the 10 year limitations period for the False Claims Act, lead to health plans retaining records for long periods of time.

Finally, Crain’s Chicago Business reports that the healthcare industry is anxious about the looming October 1 compliance date for the ICD-10 coding system.  That’s no surprise. A train wreck may be in the offing. And the distressing part is that the switchover is totally unnecessary. It will not improve electronic claims processing which is HIPAA’s objective and as a doctor notes at the end of the Crain’s article “We’re ready [for the ICD-10],” he said. “But I’m not happy about it. There is nothing about ICD-10 that is going to help me with patient care.” The only folks happy about this change are the public health experts who hope that the new complex system will give them better information. But it could wind up being a case of garbage in, garbage out.

Happy New Year to the FEHBlog’s Jewish readers. Congress will be in session this week. Here is a link to the The Week in Congress’s report on last week’s activities on the Hill.

The lead story in Saturday’s Washington Post was a story about the need for older Americans to lower their blood pressure.  “The new [federal government] research advises people with high blood pressure to keep their “systolic” pressure — the top number in the reading that health-care providers routinely tell patients — at 120 or below. Clinical guidelines have commonly called for systolic blood pressure of 140 for healthy adults and 130 for adults with kidney disease or diabetes.”

Recently, the FEHBlog noted a new Medicare mandate that hospitals accept bundled payments for hip and knee replacements.  Modern Healthcare reports that the medical community is not amused by this initiative.

Reuters reports that CALPers is finding that reference pricing is helping to control the cost of colonoscopies.  Reference pricing directs plan members to facilities that will accept the reference price. Members who use other facilities pay the difference between the other facility’s price and the reference price.

“In the short term, the major beneficiary of reference pricing is the employer and insurer, as they are paying most of the cost and hence reap most of the savings,” [Prof.] Robinson  [the study’s author] said. “In the long term, the consumer is the beneficiary, since their premiums don’t rise as fast as they would otherwise and, perhaps more importantly, providers begin to moderate prices in hopes of retaining their customers.” A number of leading insurers and employers now use reference payment for services like knee replacement surgery, arthroscopy, cataract removal, laboratory tests and drugs, he said.

Employee Benefit News indicates that employers are clutching on whether or not to continue offering on-site clinics in view of the impending application of the 40% excise tax.  This illustrates another inequity of the excise tax.  A health plan premiums may be below the excise tax threshold but if the employer decides to offer additional benefits subject to the tax, those benefit costs could drive the total cost above the threshold. In that case, the health plan even though the law mandates the coverage will bear the brunt of the excise tax because the tax is allocated pro rata among the various coverages and health insurance is the most costly.    

The FEHBlog is up in the Nutmeg State again, and there’s limited blogging time this morning so here are some quick hits.

• Recently the FEHBlog noted that CSRS annuitants are staring down the barrel of large Medicare Part B premium increases due to a statutory quirk. The FEHBlog thought that the quirk was that CSRS annuitants did not pay Medicare taxes, but a reader commented that the FEHBlog was wrong about that rationale.  (Thanks commenter.) It turns out that CSRS annuitants will be subject to a large Medicare Part B premium increase because their Medicare Part B premiums are deducted from their CSRS annuity checks. FERS annuitants will be eligible for the statutory hold harmless against Medicare Part B premium increases because their Medicare Part B premiums are deducted from the Social Security benefit payments.  That’s nuts. The Washington Post has more details here. 
• The Hartford Courant reports that a House judiciary committee held a hearing on healthcare mergers yesterday. The American Medical Association, the American Hospital Association, and AHIP all testified. 
• The FEHBlog was amused by this Health IT Analytics article about how the lack of electronic medical record interoperability is interfering with accountable care organization population heath efforts. ACO have to offer out of network coverage.  This is the same problem facing FEHBP carriers who are under OPM pressure to manage population health. 

Also on the Rx front and at the risk of belaboring the obvious, a non-profit independent research institute has concluded that the new PCSK9 statin inhibitors are too darn expensive. Reuters reports that

The Boston-based Institute for Clinical and Economic Review (ICER) said its analyses indicated “that the price that best represents the overall benefits” the drugs may provide patients would be between $3,615 and $4,811 a year, a 67 percent discount off the list prices. “Even if these drugs were used in just over 25 percent of eligible patients, then employers, insurers, and patients would need to spend on average more than $20 billion a year for these drugs,” ICER president Steven Pearson said in a statement.

Price of course is an independent variable that bears no necessary relation to cost or value to consumers.  Of course, while jawboning can be helpful, the existence of competitive PCSK9 specialty drugs will be most helpful to prescription drug managers and health plans trying to control specialty drug costs.

This also comes as no surprise to the FEHBlog –the American Medical Association is warning that large health insurance mergers will reduce competition particularly in certain geographies.

“A lack of competition in health insurer markets is not in the best interests of patients or physicians,” said AMA President Steven J. Stack, M.D. “If a health insurer merger is likely to erode competition, employers and patients may be charged higher than competitive premiums, and physicians may be pressured to accept unfair terms that undermine their role as patient advocates and their ability to provide high-quality care. Given these factors, AMA is urging federal and state regulators to carefully review the proposed mergers and use enforcement tools to preserve competition.”

Note to Dr. Stack, whom the FEHBlog admires, your warning overlooks the fact that health insurer profits are capped by the ACA’s minimum loss ratio

Finally, Modern Healthcare in an interesting development reports that health care companies — on both the provider and payer sides — are now more willing to rate doctors on-line, and doctors prefer these ratings to Yelp and Angies’ List.

Congress returns to Washington tomorrow.  This Washington Post headline sums it up — “Iran, budget, highways and national debt on tap for Congress.”

Yesterday the Washington Post wrote about government funded efforts to improve patient adherence to taking prescription drugs, which is a public health problem.  One trial that appears to be working involves hospital distribution of “internet of things” pill bottles that issue visual and audible warnings and send messages to loved ones about non-adherence. The patients who timely take the medicine receive nominal cash rewards which is analogized to winning the lottery.

Modern Healthcare reports on a new CMS effort to boost value based coverage in the Medicare Advantage program  “In the Medicare Advantage experiment, [value based] plans can [for example] lower cost-sharing for members who participate in disease-management programs, or provide full coverage for “supplemental benefits,” such as nonemergency transportation to primary-care visits or tobacco-cessation programs.” The trial will begin in 2017 and will last five years.  Medicare Advantage plans in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee can participate.

Historically and currently, the FEHBA prohibited discrimination in enrollment. Section 1557, which is part of the Affordable Care Act, prohibits discrimination in coverage which is a distinction with a difference.  The proposed HHS rule, however, only applies to HHS funded programs.  Therefore, the FEHBP falls outside the scope of this rule.  HHS encourages other agencies to promulgate their own Section 1557 implementing rules.

HHS also took a cautious approach to interpreting Section 1557.  The Washington Post explains that

[T]he proposed rule does not provide specifics on other key protections that advocates have sought, such as including sexual orientation as a form of sexual discrimination. Officials said they are seeking more input during the comment period that ends Nov. 6 on how best to incorporate those protections. Nor does the proposal address something that many AIDS organizations say is discriminatory — when insurance plans make it difficult for HIV/AIDS patients to get access to and afford needed medications.
Under the proposed regulation, women could not be charged more than men for insurance or services because they need prenatal or maternity care. Insurers could no longer categorically exclude coverage for gender transition services, although they would not automatically be required to provide surgery or other care. Health-care providers could not refuse to treat transgender people. Individuals would need to be given access to bathrooms consistent with their gender identity.

A final rule will be published next year.

The FEHBlog is jamming to J.S. Bach’s 3rd Brandenburg Concerto which is playing on Performance Today. It’s a very peppy version so the FEHBlog is in a good mood.

To follow up on the Weekend Update, the FEHBlog overlooked in his list of events that are thirty days out the impending end of the current federal fiscal year on September 30.  The Republicans had hoped to return to the regular order of passing individual appropriation bills,  but the Democrats have another idea. So we are looking at Congress enacting another continuing resolution. The FEHBlog does not anticipate any sort of government shutdown over appropriations, but again he is in a good mood.

The Congressional Research Service recently issued three reports on the high cost plan excise tax a/k/a the Cadillac tax, the Bicycle tax, etc.  One report is a “brief overview” of the tax. Another provides background and economic analysis. The third discusses estimated economic and market effects of the tax. CRS, in the second report, expresses an equity concern that taxing employer sponsored health insurance because large employer sponsored plans have only one rate per family group with each plan.  Therefore the tax would not necessarily be imposed on the value of the health insurance received by the particular taxpayer. Demographic groups could wind up subsidizing other groups. (Hey, CRS that’s the nature of large group health insurance.)  In contrast, under the ACA, individual and small employer plans are priced on the age of the individual employee and family members.  (There’s a battle brewing in Congress now because this pricing approach is supposed to be extended from employers with under 50 employees to employers with under 100 employees next year.)  The FEHBlog’s suggested approach of extending the 50% exclusion on health insurance premiums to all high earners, not just the self employed, may side step part of this problem. But on the other hand, who knows how much tax revenue it would generate.

Also on Sunday, the FEHBlog mentioned the impending ICD-10 coding implementation date, October 1.  Health Data Management reports that while Medicare and the American Medical Association have announced an ICD-10 transition plan,  commercial insurers and State Medicaid Plans have been rather mum on the topic. And why not, it was not their idea to implement the ICD-10.

It’s hard to believe that OPM first announced the data breach three months ago on Friday. How time flies! Yesterday OPM announced that it has selected a breach remediation vendor for the second larger breach affecting security clearance forms.  The lucky vendor is Identity Theft Guard Solutions LLC, doing business as ID Experts. Federal News Radio explains that

unlike the earlier contract to notify 4.2 million former and current feds, ID Experts only will handle identity protection services, not data breach notifications. All notifications to all victims of the second OPM breach will be handled directly by DoD and will come via dot-mil email addresses.

Tomorrow is the last day of August. This means that public schools open here tomorrow in Montgomery County, MD, that Congress will be back in town next week, and that the Supreme Court and the ICD-10 will make their appearance in about 30 days.  Ihealthbeat reports that the Centers for Medicare and Medicaid Services are showing all green lights for ICD-10 implementation. Time will tell.

On Friday, according to Federal News Radio, the White House announced that federal employees will receive a 1% across the board wage increase on January 1, 2016, plus a .3% locality pay increase for eligible employees.

Forbes reports that exchange plans and employer sponsored plans are eyeing narrow provider networks as a cost saving measure. This statement from the article caught the FEHBlog’s eye — [H]ealth benefits’ analysts say it’s not necessarily a bad thing if health plans and employers cull from their lists of doctors and hospitals those that aren’t achieving whatever quality metrics have been established.”  OPM is putting heavy pressure on FEHB plans to ensure that their providers meet these NCQA quality metrics. That is easier said than done because the current lack of interoperable electronic medical records vastly complicates the data collection process.  There’s no doubt that narrowing the network and limiting out of network coverage can help with this data collection problem.  It’s another example of the proverb be careful what you wish for.