According to the Federal Times, NARFE is trying to get Congress and/or the Centers for Medicare and Medicaid Services to expand the Medicare Part B hold harmless provision to all Medicare beneficiaries.  Under this provision, if, as expected, there is no Social Security cost of living adjustment for 2016 then there will be no Medicare Part B premium increase for FERS annuitants (this is the hold harmless aspect) but there will be a whopping increase for CSRS annuitants (who in contrast to FERS annuitants did not pay Medicare taxes during employment).  Because a large number of current retirees are under CSRS, the hold harmless exception would  throw a monkey wrench into OPM’s plans to encourage FEHBP annuitants to sign up for Medicare Part B.

The mid-week update has been delayed by the FEHBlog’s cataract surgery which happened yesterday — a miracle of modern medicine.  (The other eye will undergo the procedure right after Labor Day.) Here are a few quick hits:

• The Kaiser Family Foundation reports that many employers will be impacted by the ACA’s 40% high cost excise tax. In fact all employers will be impacted by it because they will have to report on whether or not they owe the tax.  It would make a lot more sense to replace this convoluted tax with a straightforward 50% limit on health plan premiums for all high wage earners, not just self employed individuals.  
• CVS pharmacies plan to expand the use of telemedicine services in its MinuteClinic offices according to Modern Healthcare. This decision follows a successful pilot program. 
• Modern Healthcare also reports that Medicare’s accountable care organization program, another ACA initiative, continues to struggle. The FEHBlog is will to bet that private insurer ACA programs are doing better because they are not bound by complicated laws and regulations. 
• Information Age discusses how healthcare organizations are responding to cyberliability risks.  CSO Online reports on a survey finding not surprisingly that “Just 1 percent of employees are responsible for 75 percent of cloud-related enterprise security risk, and companies can dramatically reduce their exposure at very little additional cost by paying extra attention to these users.”
• Drug Channels reports that the slowdown in generic drug price inflation is “real.” And with that bit of good news it’s time for some eye drops. 

Congress remains out of town until after Labor Day.

Modern Healthcare has listed the 100 most influential people in healthcare for 2015.  The Chief Justice tops the list, followed by the President. The FEHBlog was astonished by the fact that the IRS Commissioner John Koskinen and the Labor Secretary Tom Perez are not listed. Of course the HHS Secretary Sylvia Burwell and the CMS Administrator are listed but the HHS Secretary, the IRS Commissioner and the Labor Secretary are the Three Musketeers of the Affordable Care Act. Independent of the ACA, taxes affect everything and so do labor regulations. For example, on Friday, the DC Circuit upheld the Labor Department’s new protections for home healthcare workers. But quibbles aside, it’s fun to look the chart over.

Speaking of influence, a Wall Street Journal article on pricing pressure that the U.S. and China are placing on the prescription drug industry. To illustrate the U.S. aspect of the story, the Journal’s reporter linked to an earlier story about research into the cost effectiveness of cancer therapies. The Financial Express identifies other approaches under development or already released:

The NCCN, an alliance of 26 cancer centers, envisions the new tool as a supplement to its widely followed guidelines for oncology care, which set out protocols for treating a range of cancers based on diagnosis, disease stage and other factors, such as age.

Other medical groups are also trying to address the cost issue, but not as directly as the NCCN. The American Society of Clinical Oncology (ASCO) is developing its own tool for valuing treatments, but says that its “net health benefit” scores will not consider costs, although prices will be noted alongside the scores. In June, New York’s Memorial Sloan Kettering Cancer Center launched an interactive calculator, called “DrugAbacus,” that allows users to decide how much one of 54 newer drugs should cost based on factors like side effects and novelty.  {previously noted by yours truly.]

The NCCN scale, to be launched in mid-October, will employ “evidence blocks” that assign a score of up to five points for each of five measures – price, effectiveness, safety, quality and consistency of clinical data. Initially, it will evaluate drugs used for multiple myeloma and chronic myeloid leukemia. Similar guidelines are expected for most other types of cancer by the end of 2016.

Here are a couple of other articles that caught the FEHBlog’s eye over the weekend:

•  Kaiser Health News reports that “In one of the largest population studies on pain to date, researchers with the National Institutes of Health estimate that nearly 40 million Americans experience severe pain and more than 25 million have pain every day.” American needs more doctors who specialize in treating pain. 
• MedPage proactively asks whether people can deliberately lower their risk of Alzheimers’ disease. In the FEHBlog’s view it’s worth a shot. 

Last Friday, the Food and Drug Administration approved for marketing a female libido drug called Addyi. The effective date of the decision is mid-October which explains why you haven’t seen any commercials for the new drug yet. Yesterday, Sprout Pharmaceuticals, the company which obtained the FDA approval, was bought out by Valeant for about $1 billion according to the New York Times. The Indianapolis Business Journal reports that health plans and prescription benefit managers are not evaluating coverage of the new drug. The article explains that

“I think it’s a mistake for any third-party payer to pay for a medication that doesn’t come with a reasonably solid evidence of value,” said David Juurlink, a physician and professor at the University of Toronto who studies drug safety. “The data for flibanserin [Addyi] make it very clear that the majority of women who take it are not going to experience any meaningful benefit.”
The FDA is requiring doctors to get certified through an online training program to be able to prescribe Addyi, and patients will have to sign a form saying they understand the risks.

We shall see.

Medpage Today reports that “The Federation of State Medical Boards (FSMB) has launched docInfo, a publicly accessible physician search tool containing licensing and state medical board disciplinary information on more than 900,000 physicians and physician assistants nationally.”  Try it — it works.

Several stories have caught the FEHBlog’s eye since his return to the Nation’s Capital on Monday. Reuters is reporting that the  data breach related lawsuits against OPM continue to pile up.  Govexec reports on the government’s ongoing efforts to re-mediate those breaches Health IT security draws lessons from those breaches for the benefit of healthcare organizations. The FEHBlog’s big takeaway was the need to implement multi-factor authentication and vulnerability scanning on IT networks.

In terms of benefit cost saving ideas —

• Fierce Healthcare discusses a survey on hospital readmissions which finds that the strongest predictors of readmissions is previous emergency department visits. “The odds ratio for patients with at least four ED visits in the past six months was 4.65, according to the study.” Other factors with high odds for readmission are patients with cardiovascular or pulmonary disease, patients discharged after a long stay, and patients discharged on a Friday. The article suggests that the hospital pay attention to patients in these risk categories. 
• Fierce Healthpayer considers what health care providers and payers can do collaboratively to increase the use of bundled payments. 
• Life Health Pro reviews state laws that restrict balance billing patients. About a quarter of the states have these laws.  Provider charges in excess of these limits may fall under the standard FEHB exclusion of charges for which the member has no obligation to pay. 
• The FEHBlog’s youngest kid (entering his junior year in college soon) is attending a three week course in basic emergency medical technician skills. The Wall Street Journal reports on a new use of paramedics, who are at the top of the EMT heap, “An initiative, called community paramedicine, is training the fast responders in chronic disease management, medication compliance and home safety. Paramedics are then sent on scheduled house calls to frail and elderly patients or those who have trouble managing chronic conditions like heart failure and diabetes.”  Expanding allied health professional resources can only be helpful.

For the second weekend in a row, the FEHBlog has been traveling on the East Coast. Fortunately there’s not much to update this weekend because it’s mid-August and everyone, including Congress, is out of town, just like the FEHBlog. (But he is returning to DC this afternoon).

A Drug Channels review of CMS’s recent healthcare spending report did catch the FEHBlog’s eye this weekend. Also the Federal Times interviewed the CEO of the contractor who is handling the employee notification services for the first OPM data breach of 2015.  Finally, Benefits Pro discusses a survey concerning the ACA’s impact on hospitals as employers, which is an interesting angle.

Although Congress is out of town, the legislative prognosticators remain on the loose. Bloomberg reports that large employers are cautiously optimistic about a successful repeal of the ACA’s 40% excise tax on high cost employer sponsored health coverage. As the FEHBlog has noted and Jonathan Gruber confirmed, the excise tax was created as an alternative to eliminating the tax exclusion for employer contributions to health benefits coverage. This tax exclusion is unavailable to people purchasing individual health insurance coverage and it is cut in half for small business owners in partnerships, S corps, etc. It strikes the FEHBlog that the 50% exclusion should apply to all higher income people which should serve as a pay go for repealing the excise tax. That tax will be a terrible burden on all employers, large and small.

A health care consultant reports in his blog that bipartisan bills are floating around on Capitol Hill that would relieve employers of the ACA’s onerous mandatory reporting on compliance with the employer shared responsibility mandate which takes effect this year.

As an aside, I have given up discussing efforts to delay the ICD-10 coding sustem as the compliance date is only six weeks away, and Congress will have to deal with appropriations when it returns from August recess.. If the ICD-10 coding mandate does create another train wreck, then Congress will step in.

The Altarum Institute reports that

National health spending in June 2015 was 5.7% higher than in June 2014, down from the 8-year high growth rate of 6.7% in the first quarter of 2015. The 5.7% growth rate is still, however, higher than the new Centers for Medicare & Medicaid Services 2014 estimate of 5.5%. The health spending share of gross domestic product was 18.1% in June, barely below the all-time high of 18.2% first recorded in March 2015.

Finally, this Wall Street Journal article caught this FEHBlog’s eye. Startups across the country are trying to replicate the success of Uber in the healthcare field.

Analysts say it’s unclear whether many of the new on-demand services [featuring home visits and tele health services] will reduce costs for those chronically ill patients—or mainly make it more convenient for the healthy and wealthy to get care they could have gone without.

These are not mutually exclusive outcomes.

Following up on the Weekend Update, the FEHBlog calls your attention to this Federal Times article indicating the federal information technology leaders are giving their support to the OPM chief information officer who has been under fire.  The FEHBlog expects that it is not easy to retain experienced information technology personnel in the federal service.

The ACA sets annual limits on out of pocket costs for in-network self only and other than self only coverage. Last year, HHS announced in the 2015 ACA notice of benefit and payment parameters that HHS intends that a self only out of pocket limit be embedded in the other than self only out of pocket limit. Surprisingly, HHS failed to include this change in the rules themselves. Rather than correct the error, the ACA regulators circled the wagons in ACA FAQ XXVII and insisted that group health plans must implement the embedding rule for 2016.  OPM has joined them by imposing the embedding rule on all FEHBP carriers for 2016. (Currently, some FEHB plans offer embedded out of pocket limits and others do not, and choice has been a hallmark of the FEHBP historically.)  Business Insurance reports that last Friday,

Reps. Paul Ryan, R-Wis., chairman of the House Ways and Means Committee; John Kline, R-Minn., chairman of the House Education and Workforce Committee; and Fred Upton, R-Mich., chairman of the House Energy and Commerce Committee, asked {HHS Secretary Sylvia Burwell by letter] what statutory authority Obama administration regulators have to set such caps. They also questioned why the policy change was made in the preamble, and not in the regulation itself.
The committee chairmen said they have “become increasingly concerned about agencies’ actions to implement the law that appears to exceed the statutory authority delegated to them by Congress.”
In addition, “While HHS has termed this change to be a ‘clarification,’ the relevant statute is clear — these are two distinct and separate limits,” the lawmakers wrote.
Employer benefits lobbying groups say they welcome congressional questioning of the HHS cost sharing limit.

These benefit mandates, while good hearted, raise premiums and push plans closer to the ACA’s 40% excise tax thresholds.

Speaking of ACA FAQs, the regulators issued number XVIII today. This FAQ highlights the fact that HHS has begun to implement another onerous ACA burden on health plans — uniform quality reporting. This obligation will sit on top of OPM’s own FEHBP quality reporting requirements.

In data breach news, OPM received the Pwnie award for the most epic cybersecurity fail at the Black Hat conference in Las Vegas this weekend according to ZDNet.  Meanwhile, according to Roll Call, House Oversight and Government Reform Committee Chair Jason Chaffetz is calling for the OPM Chief Information Officer’s removal in the wake of serious accusations that the Inspector General made against her on Friday.

Because what’s good for the goose is not necessarily good for the gander, the American Hospital Association is asking the Justice Department to take a close look at the Anthem – Cigna merger.  (The AHA is not enthralled with the Aetna – Humana merger either).  The Indiana Business Journal has a detailed story on why the Blue Cross brands create a hurdle for the Anthem – Cigna merger beyond the antitrust regulators.

Modern Healthcare has a good story following up the Medicare readmissions problem discussed in Friday’s post:

Medicare is four years into its drive to cut the number of patients who land back in the hospital within a few weeks of leaving, and only a quarter of more than 3,400 hospitals avoided penalties. The results are contributing to skepticism about the readmissions program and the broader array of metrics used to evaluate healthcare quality. * * *

[W]ith as much as 6% of a hospital’s base operating pay from Medicare expected to be on the line by 2017, health policy and quality and safety researchers, as well as organizations representing hospitals, are urging more scrutiny of metrics used in the government’s quality incentive programs. 

“The whole field is a mess—it’s all over the place,” said Dr. Robert Wachter, interim chair of the department of medicine at the University of California, San Francisco. “We need better science.”

Amen to that. There simply is too much unwarranted government reliance on these quality statistics.  

. . . because the rent is too damn high

Govexec reports that earlier this week, OPM announced premium changes to the enrollee pay-all Federal Employees Long Term Care Insurance Program effective August 1.   Today the Washington Post reported on premium changes to the Federal Employees Group Life Insurance Program.  Fedsmith.com notes that in connection with these premium changes, OPM will be holding a once in a blue moon FEGLI Open Season in the month of September 2015.

On a related note, govexec predicts that Civil Service Retirees System (CSRS) annuitants may see a $55, or 50% jump, in their Medicare Part B premiums for 2016 because of a quirk in federal law, In the 1987, Congress replaced CSRS with Federal Employee Retirement System or FERS. Federal employees at the time of the conversion could stick with CSRS or switch to FERS. Future federal employees were placed in FERS. There is still a large contingent of CSRS annuitants.

FERS is integrated with Social Security while CSRS was not. Under federal law, when low inflation results in no cost of,living adjustment (COLA) for Social Security — which is the case for next year — Social Security retirees are held harmless against Medicare Part B premium increases. The brunt of those increases then falls on Medicare participants without Social Security benefits, to wit, CSRS annuitants. To quote Larry David’s agent on Curb Your Enthusiasm, that’s a big bowl of wrong. It also will thtow a monkey wrench into OPM’s efforts to encourage annuitants to purchase Part B.

You may recall the FEHBlog discussed a smaller contingent of CSRS annuitants — those folks who retired before 1983. That cadre does not have Medicare Part A coverage.  Fee for service plan carriers can reimburse hospitals for those members using Medicare Part A’s prospective payment system but that’s a lot more than paying benefits secondary to Medicare.  CSRS participants who retired after 1982 paid Medicare taxes while employed and receive Medicare Part A coverage.  For more information, click here.