TGIF doesn’t have the same meaning when you have been on vacation all week like the FEHBlog has.

Federal News Radio (which has better coverage of federal employee issues than Federal Times or Govexec at the last from the FEHBlog’s perspective reports that the House Oversight and Government Reform Committee is making progress on a House Postal Reform bill. The article notes that the Postmaster General remains gung ho on pulling the Postal Service out of the FEHBP because it will cure the headache created by the statute that requires the Postal Service to prefund future retiree coverage under the FEHBP.  Any such pullout would require labor union approval because health benefits coverage is a mandatory topic of collective bargaining. All four Postal Service labor unions sponsor FEHB plans.

The FEHBlog is curious how healthcare transparency impacts patient care. The AMA News reports on how doctors are reacting to the ability of patients to get their lab test results on line.

Modern Healthcare reports that CMS has added to angioplasty related readmission statistics to its Hospital Compare website. The statistics are based on readmissions within 30 days for patients undergoing the most prevalent cardiac procedure. “This measure is extremely valuable for patients in that they are, for the first time, getting easy access to information on how their local hospital is performing in terms of readmissions after these procedures,” Dr. John Harold, president of the American College of Cardiology, said in a release.

AHIP has posted quick facts on healthcare reform and premiums.  Second and third year premiums, reflecting actual health care benefit costs and the growing impact of the health insurer fee, will be much more telling than estimated first year premiums in the exchanges.

The President’s nominee for OPM Director, Katherine Archuleta, had her Senate confirmation hearing yesterday. The Washington Post reported on the challenges facing her.  The number one challenge is improving the pace of retirement claims processing. The Post and the Federal Times report that Ms. Archuleta committed to improving the agency’s information technology systems as the way to best tackle this problem.  The roadblock as the FEHBlog understands it is not technology but rather the federal retirement system’s overly complicated plan designs.  There are plenty of off the shelf systems that can process pension claims if you have a simpler plan design. The FEHBlog expects that this design issue is confounding the IRS and other ACA regulators as they attempt to build the systems necessary to the support the Affordable Care Act. These are problems that only Congress can fix.

Update — Federal News Radio this morning reports on the exchanges between Senators and Ms. Archuleta about our beloved FEHBP and the not so beloved ACA.

It may be Monday morning but everyday is a weekend day for the FEHBlog this week because he is on vacation in the beautiful Outer Banks of North Carolina. Congress is hard at work this week according to  the Hill. Of course, Congress is off for the entire month of August.

The Wall Street Journal has a thought provoking article this morning about whether the current slowdown in health care costs will continue given the fact that 10,000 Baby Boomers turn age 65 every day. Here’s the kicker which really should come as no surprise to FEHBlog readers

Another big driver of health-care costs is technology. In almost every other industry, innovation generally makes things more efficient and less costly. But in health care, it often brings higher costs with little added value.

A Rand researcher recommends that in response health plans should cover in full the lowest cost, highly effective treatment. Plan members would pay the difference between that treatment and the selected treatment. This is the reference pricing approach that the FEHBlog mentioned a few weeks ago.

The Journal also has an article about insurers that are conducting research to predict the profitability of different types of plans in the ACA’s health insurance exchanges. The article begins with this FEHBP axiom:

The federal health overhaul’s big requirement that most people carry health insurance is still months away, but already insurers like Blue Cross & Blue Shield of Rhode Island have a sense of what will matter most to consumers: price.

The FEHBlog believes that the other key concern to FEHBP enrollees is whether the enrollee’s doctor is in the plan’s network.  Of course, that concern would not be relevant to new exchange subscribers who did not have health insurance previously.

The AMA News reports on a survey of patients that finds that patients, particularly younger ones, are interested in using smart phone apps to manage their health care. In the same vein, the Minnesota Star Tribune recently reported on the trend of self service health care kiosks, such as the Solohealth kiosk, popping up in pharmacies, etc. Here’s the key takeaway from both articles in the FEHBlog’s view:

Dr. David Thorson, chairman of the Minnesota Medical Association, also sees potential. “There are a lot of people that we don’t reach,” he said, and if kiosks help them to pay attention to their health, “that’s a wonderful thing.”  The question, Thorson said, is how reliable the medical information is and what people do with it. “If nobody ever follows up, then it’s simply an advertising gimmick.”

Following up on Sunday’s post, the FEHBlog notes that a House appropriations subcommittee released a draft of the financial services and general government appropriations bill for FY 2014. The bill includes the usual FEHBA appropriations clause, including a provision barring cost accounting standards coverage on these contracts, a restriction on abortion coverage, and a contraceptive coverage mandate.  Sen. Tom Udall (D NM) has been named chairman of the Senate appropriations subcommittee with responsibility for this bill. He replaces Sen. Frank Lautenberg (D NJ) who recently passed away. At this point the House has passed three  of 11 appropriations bills and the Senate hasn’t passed any. September may be an interesting month.

The Senate Homeland Security and Governmental Affairs Committee has scheduled a confirmation hearing for OPM Director nominee Katherine Archuleta. The hearing will be held on July 16 at 3:30 pm in Room 342 of the Senate Dirksen Office Building. .

A week ago today. the Obama Administration’s decision to delay the employer share responsibility penalties for one year — until 2015 — became public.  Today, the IRS formally announced that the IRC §§ 6065 and 6066 reporting provisions will be optional for 2014.  Those provisions require health insurers and self-insuring employers to report to the IRS on health benefits coverage based on the Social Security Numbers of each covered individual, not just enrolled employees and annuitants..

HIPAA provided for the creation of a uniform patient identifier number along wiht uniform provider and health plan identifier numbers.  It strikes the FEHBlog that it’s unfortunate that Congress blocked implementation of the HIPAA Patient Identifier because it would be much easier to report based on that identifier than the Social Security Number which has become the default. It will be a difficult task for insurers to obtain Social Security Numbers on all dependents. A one year delay neither will simplify that task for insurers nor act as the silver bullet that necessarily will permit the IRS to develop a complicated computerized government reporting system.

The Mercer consulting firm made a sensible announcement about the employer mandate delay yesterday

While the announcement that employer shared responsibility penalties will not apply until 2015 was a welcome relief for employers, addressing the fundamental challenges raised by the reform law remains a priority. At the heart of the matter is cost.

In the short term, new fees, plan design changes and the expectation of additional enrollment will add an estimated 2%–3% or more to health plan cost in 2014, even if employers table plans to extend coverage to all employees working 30 or more hours per week. Longer-term, avoiding the excise tax on high-cost plans slated for 2018 remains a daunting challenge. More than a third of employers surveyed by Mercer in May said that they were taking steps in 2014 to help bring down cost by 2018.

The FEHBlog has to keep this short because he’s headed to the airport. However, he has time to note that Congress is back in session this week. The Hill indicates that most of the focus will be on student loans. A House Appropriations subcommittee will hold a markup on the appropriations bill that funds the FEHBP on July 10 at 9:30 am.

The Washington Post features a story in its business section about hospital system efforts to remove the insurance company middlemen. The article is provocatively headlined “Is this the end of health insurers?” Uh, no.

The FEHBlog hopes that everyone had a happy Fourth of July holiday.

On July 3, OPM issued a benefits administration letter and a carrier letter about the expansion of FEHBP coverage to same sex spouses. The FEHBlog notes that the Supreme Court’s decision which authorized OPM to define the term spouse found in the FEHBA’s definition of family member to include same sex spouses also has the same effect on the Internal Revenue Code’s dependent definition (IRC § 51). Before the June 26, 2013, Supreme Court decision, any employer that extended benefits coverage to same sex spouses would have to impute the cost of that coverage to the employee due to DOMA. That requirement no longer applies to same sex spouse coverage but it still applies to same sex domestic partners coverage. Moreover, the OPM letters explain that “This decision does not extend [FEHBP] coverage to registered domestic partners or those employees or annuitants in civil unions.”  


OPM joined with CMS in encouraging a reduction in hospital readmissions.  Newswise reports that a SUNY Binghampton study reports on the value of using social workers to assist recently discharged patients with Medicare coverage. The social workers coordinate care and visit the patient at home to assess the home environment, e.g., reduce risks for falling. Early results show that the approach is effective in reducing readmissions by over 50%. 


Health Data Management reports that NCQA is soliciting public comments on proposed changes to the HEDIS performance measures required by the transition to the ICD-10 code set. The comment period is open until December 16, 2013. HDM further reports that 

NCQA also has released the 2014 edition of technical specifications for HEDIS measures, including a new measure on non-recommended cervical cancer screening in adolescent females. Changes also were made in existing measures covering breast cancer screening, cervical cancer screening for adult females, care for older adults, potential drug-disease interaction in the elderly and relative resource use. More information is at ncqa.org/publications.

Finally, the AMA News reports on what’s next now that the AMA has decided that obesity is a disease. (Hint: more money for doctors). 

The FEHBlog nearly fell off his chair this evening when he read the news first reported by Bloomberg that the Obama Administration is delaying enforcement of the employer shared responsibility provisions of the ACA for one year until 2015. Those provisions require employers with more than 50 full time employees to provider health benefits to those full time employees (defined as working at least 30 hours per week).  Non-compliance means a $2000 penalty per full time employee over 30.  There is also a $3000 penalty per full time employee who picks up subsidized coverage in the exchange because the employer sponsored coverage is not minimum value (60% actuarial value) or unaffordable, meaning the employee contribution exceeds 9,5% of W-2 income.. 

The IRS claimed that it opted for the delay in order to provide a more thoughtful implementation of this unnecessarily complicated law. The IRS announcement explained that the agency is working on the implementing the massive reporting obligations under IRC §§ 6055 and 6066 that the ACA imposes on insurers. It wants to test these massive reporting systems before the law takes full effect. The Hill’s Healthwatch provides up to date reaction to this decision.

The IRS is not delaying the individual shared responsibility provisions which impose a penalty of the higher of $95 or 1% of adjusted gross income in 2014 on individuals who fail to maintain minimum essential coverage. The Kaiser Family Foundation has a chart that explains this penalty which jumps in 2015 and again in 2016.  FEHBP coverage is such minimum essential coverage. 

The IRS is encouraging employers to comply with the ACA obligations for 2014.  Much of the adverse reaction stems from the ACA’s unusual definition of full time employee — only 30 hours per week. The FEHBP currently provides coverage to a portion of this cadre.  OPM explains on its website that

As a Federal employee, you are eligible to elect FEHB coverage, unless your position is excluded by law or regulation. Your agency applies these rules and determines your eligibility. However, there are numerous special provisions for people in part-time or intermittent employment, temporary appointments, and specifically named positions.

It will be interesting to see if OPM issues regulations expanding coverage in accordance with the ACA for 2014.

At the end of last week, CVS Caremark released a report on an important topic, prescription drug adherence in the US.  “An interactive online hub developed in conjunction with the report allows audiences to filter data based on market segment, health condition and adherence measure to gain deeper insight into a specific state or draw comparisons across them.”  The Pharmacy Times reports that

To supplement the report, the CVS Caremark Pharmacy Care Research Institute released a compilation of 28 studies conducted by CVS Caremark and its research partners over the last several years. “Advancing Adherence and the Science of Pharmacy Care: Volume III” includes research done in collaboration with Brigham and Women’s Hospital that attempts to understand the reasons why patients do not take their medication and that tests the best ways to improve adherence.   The researchers of these studies are currently developing and testing 4 strategies for improving adherence. The first strategy is to simplify complex medication regimens, working with pharmacists and patients to allow patients to pick up all their medications on a single day each month rather than requiring them to make multiple trips to the pharmacy. The second is to make dosage information on certain medication labels more legible, which is especially important for elderly patients.   The third is an approach called preventative analytics, which analyzes data to determine which patients are at the highest risk of non-adherence. Pharmacists then contact these patients and their physicians to stop non-adherence before it starts. The researchers are also investigating whether it is most effective to contact these patients by phone or text message or to contact their doctor. The final method for improving adherence is to increase involvement by physicians, who may be unaware of their patients’ adherence habits. Once they are provided with this information, physicians can collaborate with pharmacists to improve adherence and reduce the overall cost of care throughout the country. 

Also last week, AHIP issued is annual census on Health Savings Account / High Deductible Health Plan enrollment.   Enrollment has tripled from 2007 to nearly 15.5 million Americans.

Key findings from the census include:
    The number of individuals with HSA coverage rose to nearly 15.5 million in January 2013, up from 13.5 in January 2012. Enrollment has continued to increase each year of the census with 11.4 million enrolled in coverage in January 2011, 10.0 million in January 2010, 8.0 million in January 2009, and 6.1 million in January 2008.
    Between January 2012 and January 2013, the most significant enrollment gains occurred in the large group market. The number of HSA/HDHP covered lives enrolled in large group plans increased from 7.9 million in January 2012 to 9.6 million in January 2013.
    Forty-nine (49) percent of all HSA/HDHP enrollees in the individual market (including dependents covered under family plans) were age 40 or over; 51 percent were under age 40.
    States with the highest levels of HSA/HDHP enrollment were Illinois (903,000 enrollees), Texas (889,364 enrollees), California (808,019 enrollees), Ohio (686,616 enrollees), and Michigan (577,208 enrollees).    

The FEHB Program was practically the first to market with these consumer driven plans in 2004, and those plans have been successful.

OPM released late this afternoon guidance to human resources officers on how to implement the Supreme Court decision holding DOMA Section 3 unconstitutional. Here’s the FEHB guidance which makes sense to the FEHBlog:

Health Insurance (FEHB):  All legally married same-sex spouses will now be eligible family members under a Self and Family enrollment.  In addition, the children of same-sex marriages will be treated just as those of opposite-sex marriages and will be eligible family members according to the same eligibility guidelines. This includes coverage for children of same-sex spouses as stepchildren.  Employees and annuitants will have 60 days from June 26, 2013 until August 26, 2013, to make immediate changes to their FEHB enrollment.  Enrollees will continue to be eligible to make changes to their coverage options during Open Season later this year.  For those employees and annuitants who already have a Self and Family insurance plan, coverage for their same-sex spouse will begin immediately upon their notifying their FEHB carrier that there is a newly eligible family member.  For those employees and annuitants electing Self and Family for the first time, benefits will be effective on the first day of the first pay period after the enrollment request is received.  While online enrollment systems are updated, it may be necessary for employees and annuitants to update their elections using the paper (rather than electronic) version of the SF2809 form.