The Federal Benefits Open Season keeps chugging along. The Federal Times offers a lengthy interview with FEHBP Expert Walt Francis. Govexec,com offers a brief interview with the FEHBlog. You choose (or read both).

The Office of Personnel Management today released a proposed rule on its Multi State Program. The MSP offers OPM approved health plans in the ACA marketplaces.

The Mercer consulting firm released the results of its own national survey of large employers regarding health coverage practices. The upshot – even broader use of high deductible, consumer directed plans.

Most employers still offer a CDHP as a choice alongside a traditional PPO or HMO. Just 7% of all large employers, and 11% of jumbo employers, offered a CDHP as the only plan available to employees at their largest worksite in 2014.  While this practice may become more common – 18% of large employers say it’s likely they will offer a CDHP as a full replacement within the next three years – for now it remains the exception 

Of course the status quo is the way the FEHBP operates.

At the recent WEDI conference on privacy and security that the FEHBlog attended last month, speakers emphasized the importance of encrypting computers, particularly mobile devices and PCs used at home. The FEHBlog appreciated the speakers’ common rationale that if an unencrypted computer is stolen from or lost by a HIPAA covered entity or business associate, it’s difficult to prove the negative that no protected health information was contained on the stolen or lost device’s hard drive. The enforcers will assume a breach of unsecured protected health information. Therefore encrypt. Here then is a chilling article from Government Health IT about a the theft of an encrypted cell phone and laptop from a hospital staff member. The thieves demanded and received the passwords from the victim. Ergo, loss of the HIPAA safeguard. Nothing is foolproof.

Finally, here’s a link to a sensible Fierce Healthcare article on how hospitals can avoid unnecessary readmissions. The article illustrates why avoiding readmissions is a hospital management issue. Health plans can help management to reduce premature discharges (which lead to readmissions) with sensible utilization review programs.

Following up on the weekend post, OPM postponed its Google hangout on Open Season topics one week to Monday, November 24th from 11:00 AM to noon EST.

OPM has released its FY 2014 financial report. You can find some interesting FEHB tidbits by searching for FEHB when you open the document in Adobe Acrobat. If there were any earth shattering items, the FEHBlog would have mentioned them.

The Senate Homeland Security and Governmental Affairs Committee held a confirmation hearing yesterday for the President’s nominee for OPM Deputy Director, Retired Navy Read Admiral Earl L. Gay. Here’s a link to the hearing on the Committee’s website.

In other Congressional News, the House of Representatives Republic Caucus named Rep. Jason Chaffetz (R Utah) as chair of the House Oversight & Government Reform Committee which has oversight responsibility over our beloved FEHBP. Mr. Chaffetz succeeds Rep. Darrell Issa (R Calif) who had reached his chairmanship term limit. Federal News Radio highlights this and other House chair changes. The other significant change is that Rep. Paul Ryan (R Wisc.) will take the helm of the powerful Ways and Means Committee.

The FEHBlog was overjoyed to read in Modern Healthcare that the eHealth Initiative, which includes the American Medical Association, BCBSA, and United Healthcare, among others, has developed a private sector roadmap to connect disparate electronic medical record systems.

Efforts to encourage greater IT use would need to include a boost from private health plans, said Dr. Sam Ho, chief medical officer for UnitedHealthcare. New value-based payment models will inevitably encourage sharing and collaboration, Ho said, which will in turn encourage increased technology adoption and interoperability.
The insurers in the eHealth Initiative are specifically considering including extra payments for technology adoption, including electronic data transfer and collaborative care plans. “Really this is about what the private sector can do to take health IT to a new level,” Ho said. “It needs to help doctors help practice more consistent, more evidence-based medicine.”
The group’s road map would reach technologies and healthcare professionals not covered by meaningful use. John Glaser, CEO of health services at Siemens Healthcare, noted that meaningful use did not include many types of professionals, such as behavioral health providers. Nor does it cover many types of technologies, and there should be an increased emphasis on connected devices like sensors, Glaser said. 

Interoperability will solve a lot of problems that health plans — other than integrated plans like Kaiser — currently face in collecting quality information from health care providers.

Speaking of healthcare quality, Healthdata Management reports that

Based on 2013 data, an annual report from the Joint Commission on hospitals’ performance to increase the safety and quality of care finds 1,224 hospitals were top performers in 2014. That is an 11 percent increase from last year

That’s certainly good news.

And here are a few more tidbits:

• NPR explains why reports of a looming national shortage of doctors may be overblown. 
• Drug Channels reports that retail generic drug price inflation “is alive and well.”
• HHS and the National Institutes of Health are taking regulatory steps to improve the transparency of clinical trials results. 

The lame duck session of Congress continues. Here is a link to the Week in Congress that looks a week back and a link to the Hill that looks week forward.

The Federal Benefits Open Season continues this week. OPM is holding a Google hangout tomorrow afternoon. The Federal Times is  holding its own Open Season webcast on Wednesday at noon. Of course, federal agencies have been holding Open Season events for their employees and annuitants since last month.

HHS extended the deadline for contributing entities, including FEHB plans, to submit their headcounts and banking information for ACA transitional reinsurance fee purposes from last Saturday until December 5. The FEHBlog understand that the pay.gov site which processes this information has been a little troublesome to users/

Mark the tape. On October 9, 2014, the FEHBlog noted that an error in the Postal employee contribution chart that significantly overstated 2015 premium increases. Yesterday, Govexec.com caught up with the FEHBlog in this article.

[Postal Service] Bargaining-unit employees will pay an average of just 1 percent more
toward their insurance premiums, according to a USPS spokeswoman, while
non-bargaining workers will typically see a 3 percent increase. The
overall average premium increase will be 3.4 percent.

That;s lower than the average increase for civil service employees. As a side note, the Federal Times reports today that Postmaster General Patrick Donahoe will be retiring on February 1, 2015. USPS Chief Operating Officer Megan Brennan will be his successor.

Earlier this week, OPM announced that it will be increasing the health care flexible spending account limit from $2500 to $2550 for 2015.

Also this month, OPM submitted a couple of proposed FEHBP rules to the Office of Management and Budget for its final review before those rule officially are published in the Federal Register

AGENCY: OPM RIN: 3206-AN08
TITLE: Federal Employees Health Benefits Program Self Plus One Enrollment Type [which takes effect in 2016]
STAGE: Proposed Rule ECONOMICALLY SIGNIFICANT: No
RECEIVED DATE: 11/05/2014 LEGAL DEADLINE: None

AGENCY: OPM RIN: 3206-AN07
TITLE: Federal Employees Health Benefits Program: Enrollment Options Following the Termination of a Plan or Plan Option
STAGE: Proposed Rule ECONOMICALLY SIGNIFICANT: No
RECEIVED DATE: 11/06/2014 LEGAL DEADLINE: None

The FEHBlog still does not find on reginfo.gov an anticipated proposed HHS rule implementing the Affordable Care Acts’ anti-discrimination in coverage rule (PHSA § 1557). Nevertheless HHS’s Office for Civil Rights is accepting consumer complaints under that law. Recently, according to the New York Times, health insurer Cigna  has “agreed to reduce the out-of-pocket costs that patients in Florida must pay for H.I.V. drugs [in Cigna’s health insurance marketplaces plans beginning in 2015], settling a [Section 1557] complaint filed by advocacy groups, who said the drug pricing system in the state’s health care plans was discriminatory.

Finally, the actuarial consulting firm Aon Hewitt released a survey of U.S. employers concluding that health care plan costs will continue on an upward trend in 2015. No surprise there.

Congress started its lame duck session today. Federal News Radio’s article helpfully reviews the list of tasks for the lame duck session which of course leads with addressing the continuing resolution funding the federal government which expires on December 11.  In the lame duck session following the Democrat’s takeover of Congress following the 2006 election, Congress did enact a healthcare law which improved the rules for high deductible health plans with health savings accounts. The FEHBlog thought that in view of the Supreme Court’s decision to hear the ACA subsidy case and this recent precedent, Congress would take a crack at fixing this issue pending before the high court and other problems created by the ACA in the lame duck session. We’ll see but the FEHBlog no longer is holding his breath. This type of legislative activity may occur in the next session of Congress.

On Monday, AHIP released information on the value of provider networks which carriers can share with Plan members.

Finally, Fierce Healthcare offers four reasons to be optimistic about the U.S. healthcare system.

We have a big week ahead of us. The Federal Benefits Open Season starts tomorrow and will end on December 8. It will be interesting to see how many temporary, seasonal, and intermittent employees sign up for FEHBP coverage as a result of OPM’s rule implementing the ACA’s employer shared responsibility mandate.

Congress returns on Wednesday for its lame duck session. The continuing resolution funding the federal government expires on December 11.

The ACA health insurance marketplace open enrollment period begins on November 15 and runs until February 15, 2015. So we should hear alot about ACA premium changes this week. Last week, the ACA regulators issued FAQ XXII which puts the kibosh on tax free employer funding of employee coverage in the ACA marketplaces. Pre-ACA marketplace the IRS condoned the common practice of employers reimbursing their employees for individual health insurance premiums on a pre-tax basis. No more.  

The Wall Street Journal reported last week that the big prescription benefit manager (“PBM”) Express Scripts is considering ripping a page out of its major competitor CVS Health’s playbook by offering a no-sin pharmacy network. Express Scripts is considering creating a network of pharmacies that don’t sell tobacco or alcoholic beverages. The CVS no-sin network consists of pharmacies like CVS Health that don’t sell tobacco. Before long you won’t be able to buy a Twinkie at a pharmacy. But after all most sin product sales occur at the gas and liquor stores.

On a related note, the Motley Fool brings us up to date on the third large PBM Catamaran which is not quite in same league as CVS Health and Express Scripts but presumably it tries harder.

Finally the FEHBlog found good and bad news on efforts to solve the hospital readmission problem. Let’s start with the bad but not surprising news. Fierce Healthcare reported on an American Journal of Managed Care report concluding that hospitals cannot control the problem without primary care provider cooperation.

Researchers, led by Ariel Linden of the University of Michigan School of Public Health, analyzed more than 500 patients in two Oregon community hospitals. They gave half the patients an intervention featuring pre-discharge education and planning, post-discharge follow-up, an available hotline and “bridging” techniques such as daily symptom checks. Linden and his coauthor, Susan W. Butterworth, Ph.D., found no statistical difference in readmissions between the two groups after both 30-day and 90-day periods, although mortality was lower in the intervention group than the control group.

Neither of these hospitals could compel PCP cooperation with the intervention group and very little PCP cooperation with offered. How can a health plan help with this mess? The second Fierce Healthcare article offered some light at the end of this tunnel.

One extra day in the hospital cuts costs and significantly reduces the chance of the need to readmit Medicare patients within 30 days, a new study from Columbia Business School found.  That extra day slashed the risk of death for patients treated for pneumonia by 22 percent. Mortality for heart attack patients was cut by 7 percent, as were readmission rates, according to an announcement detailing the findings

Today, the U.S. Supreme Court decided to decide whether or not the Affordable Care Act limits health insurance subsidies to enrollees in State operated health insurance marketplaces. Although the law itself is clear on this point, the IRS decided to provide the subsidies in the federal facilitated marketplaces as well. Most ACA enrollees are in those federally facilitated marketplaces. More information on this Supreme Court action can be found in this Scotusblog post.

How does this relate to the election results? The Obama Administration did not want the Supreme Court to take the case. The FEHBlog expects that the Supreme Court expected its decision to trigger Congressional action.

Congress can fix the law during the lame duck session, and it will be interesting to see whether the Republicans are willing to fix the law and what will be their quid pro quo. It strikes the FEHBlog that fixing the law in return for repeal of the medical device tax, increasing the number of hours for ACA full time employment from 30 to 35 or 40 hours, and one or two other sensible changes in the lame duck session is the most sensible course of action. We shall see.

In yesterday’s elections, the Republicans increased their majority in the House of Representatives by 13 seats and obtained a working but not veto proof majority in the Senate with 52 seats and a chance to gain two more in Alaska and Louisiana. Never underestimate the power of the gavel. Business Insurance and Modern Healthcare have articles on where the Affordable Care Act may fit in the Congressional Republican’s agenda.

The FEHBlog heard the President say today that he would veto bills to undo the Affordable Care Act but would consider bills to improve the Act. One item in bipartisan Congressional cross hairs is the medical device tax. The medical device tax like many other ACA taxes is a demonstrable job killer. Nevertheless, the President threatened to veto a repeal of that tax in 2012 before it took effect in 2013. It will be interesting to see if the President will reconsider that position or green light other changes with bipartisan support such as changing the ACA’s definition of full time employee (30 hours) to match reality (at least 35 in the FEHBlog’s view).  Business Insurance suggests that the Republicans also may have their eye on repealing the transitional reinsurance fee and the Cadillac plan tax. Hopefully, the health insurrr fee would be in that repeal mix too. But nothing is simple. 2015 and perhaps the lame duck session will be interesting.

In another interesting development, Reuters reports that a federal district court rejected the Equal Employment Opportunity Commission’s motion for a preliminary injunction against a Honeywell employee biometric screening program. The EEOC alleges that the program which the ACA encourages violates the Americans with Disabilities Act and the Genetic Information Anti-Discrimination Act. This is the EEOC’s third recent lawsuit challenging the legality of employer wellness programs which are are quite common among large employers but have not entirely caught on yet with the FEHBP.

Congress remains on the campaign trail. Of course, the mid-term election day is tomorrow. Congress’ lame duck session begins about a week or so following the election. The continuing resolution funding the federal government in the current fiscal year which began on October 1 (H. J. Res. 124) will expire after December 11, 2014. Extension of the CR and foreign affairs items clearly are on the lame duck agenda.

The Federal Benefits Open Season starts a week from today November 10.  OPM will post its Open Season website later this week.

The Washington Post took its own look at FEHBP coverage of gender reassignment surgery over the weekend. The Post notes that

Interestingly, employers who have added transition-related coverage report very low costs tied to the these benefits, according to a 2013 study from the Williams Institute at the UCLA School of Law. Very few have actually used the benefit, the researchers found.

The Pittsburgh Star Ledger reported on the expanded use of high quality specialist networks by large insurers. The FEHBlog thinks that these networks are jim dandy. The article expresses a concern that these networks will reduce choice and represent a return to old school gatekeeper HMOs. The first point is true. The FEHBlog is not so sure about the second point because the old school gatekeeper system focused on directly lowering costs (cheaper specialists) while the new networks focus on improving quality as a means to improved health and lower costs. What’s more the government, including OPM, is pushing for the use of these new networks.

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 http://ncvhs.us/wp-content/uploads/2014/10/140923lt5.pdf). 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.