The Agency for Healthcare Quality and Research has posted on its website a toolkit to help hospitals avoid unnecessary readmissions — a major federal government initiative that OPM has adopted. Although the toolkit is designed for hospital discharge unit staff members, the FEHBlog expects that health plan case managers will find it useful as well.

Also of interest to case managers may be the new Medicare Chronic Condition Dashboard announced today by CMS. “The dashboard offers researchers, physicians, public health
professionals, and policymakers an easy-to-use tool to get current data
on where multiple chronic conditions occur, which services they require,
and how much Medicare spends helping beneficiaries with multiple
chronic conditions.” Here is a link to the dashboard.

The American Society of Clinical Oncology announced that it is gathering de-identified data from electronic health records to build a “knowledge-generating computer network [known as CancerLinQ] that will collect and analyze cancer care data from millions of patient visits, together with expert guidelines and other evidence, to generate real-time, personalized guidance and quality feedback for physicians.”  The Wall Street Journal explains

In the ASCO project, called CancerLinQ, almost all patients would, in effect, become part of a clinical study. The system would collect data that doctors routinely record in a patient’s files, such as age, gender, medications and other illnesses, along with the patient’s diagnosis, treatment and, eventually, date of death. Once the outcome of a sufficient number of patients is pooled, doctors could tap the database for help in developing treatments for other patients.
For instance, consider a 77-year-old man with stage 3 colon cancer, heart failure and diabetes, said W. Charles Penley, a cancer doctor at Tennessee Oncology in Nashville. “That patient wouldn’t have been included in a clinical trial, but those are the folks we take care of in the real world all the time,” he said.
Using the database, Dr. Penley could see how the top three chemotherapy regimens for similar patients performed, and how age, heart failure and diabetes might have affected the treatment.
“If you can query a database in real time for a patient in your office, this is a potential game changer,” Dr. Penley said.
The database also would “give us more evidence for the treatments we actually use,” said Sandra Swain, ASCO president and a breast-cancer specialist at Medstar Washington Hospital Center in Washington, D.C.

That is cool stuff — an innovation that could help pull the cost curve down (gasp).

The Standard and Poor’s Healthcare Cost Indices for January 2013 recently were released:

In January 2013 eight of the nine headline healthcare indices we publish showed acceleration in their annual growth rates,” says David M. Blitzer, Chairman of the Index Committee at S&P Dow Jones Indices. While eight of the nine key components increased, the increases were small to moderate.
“The Composite Index posted an annual rate of +3.83%, the Commercial Index +5.41% and the Medicare Index +1.41%. In January, four of the nine healthcare indices ticked up from their historic lows posted in December. They were the Composite Index, the Medicare Index, the Professional Services Medicare Index and the Hospital Index. The Commercial Index at +5.41% went 0.03 percentage points above its recent low posted in December. The only index that decelerated in January was the Hospital Commercial; it posted a historic low of +2.86%.

The Catalyst for Payment Reform issued its first National Scorecard on Payment Reform. The Scorecard shows that notwithstanding the best efforts of insurers and health plans “only about 11 percent of  the health care dollars we pay to doctors and hospitals today are value-oriented — tied to how well they  deliver care or create incentives for both improving quality and reducing waste. Almost 90 percent of  payments reported remain in traditional fee-for-service, paying providers for every test and procedure  they perform regardless of necessity or outcome, or in bundled, capitated, or partially-capitated  payments without quality incentives.”    This employer coalition has created a payment reform toolkit here, but in the FEHBlog’s view the medical profession needs to start healing itself.

Finally, the Society of Actuaries “predicts that expected changes in member composition of the individual
health care market could drive up underlying claims costs by an average
of 32 percent nationally by 2017. In addition, the study predicts high
variability among states, with as many as 43 states experiencing a
double-digit percentage claims cost increase and some states
experiencing a double-digit cost decrease.”  The FEHBP and other private sector health plans are obligated to help stabilize premiums for these individual insureds in the exchanges through $63 per head (in 2014). This study suggests that Congress may wind up extending this subsidization which is now scheduled to end in 2017. This will be a wild ride.

The House Oversight and Government Reform Committee’s
Subcommittee on the Federal Workforce, USPS and the Census will be holding an
FEHBP oversight hearing on April 11 at 10 am in Room 2154 of the Rayburn
Building.  The hearing will focus on the administration of and potential
improvements to the program, including the types of plans and benefits
available to enrollees, categories of enrollment, and premiums.  The
hearing also will consider the relationship among Medicare, the Affordable Care
Act, and the FEHBP. The FEHBlog will be there with bells on. 


The President today signed the continuing resolution funding the federal government through the end of the current federal fiscal year on September 30, 2013, with the federal employee pay freeze and the sequester still in place according to govexec.com  On a related note, the AMA News compares the healthcare provisions in the budget resolutions that the House and Senate passed before going on recess this week. 


Also Modern Healthcare reminds us that today is the effective date for the 563 page long omnibus HITECH Act rule modifying the HIPAA Privacy and Security Rules.  Govinfo Security reports on the importance of encrypting protected health information.  The compliance date for this rule is six months from now. There is a lot to do, particularly in terms of educating business associate subcontractors about the new legal requirements on them. 

Congress is in recess this week after completing work on the continuing resolution extension and their budget resolutions.

Of course, yesterday was the Affordable Care Act’s third birthday. The Hill reviews implementation challenges facing federal and state governments.

On January 1, 2014, Senators, members of Congress, and their personal staffs will have to exit the FEHBP. Reg Jones in the Federal Times answers a staffer’s question about the wisdom of retiring on December 31, 2013, to preserve his FEHBP coverage. (Smart move.) It will be interesting to see the details of this transition develop.

Tammy Flanagan in govexec.com explains why it would not be prudent for a federal employee to cancel his FEHBP coverage as a way to cut personal expenses in the face of a furlough. The FEHBlog agrees. Govexec.com also maintains an agency by agency furlough watch here.

AHIP has issued a report on rising hospital service prices and a retort to Commonwealth Fund report poo-pooing health plan efforts to improve patient care.  

Congressman Stephen Lynch (D Mass) who chaired the House Oversight and Government Reform Committee when Rep. Nancy Pelosi was Speaker has reintroduced his “FEHBP Prescription Drug Integrity, Transparency, and Cost Savings Act” (HR 1367). Back in 2010 OPM responded to the bill by imposing very strict transparency requirements on contracts between nationwide fee for service plan carriers and prescription benefit managers. OPM’s rules require that the PBMs charge actual costs for prescriptions drugs both at retail and at mail / home delivery and credit the plans for all rebates and related revenues. These rules have been implemented.

Govexec.com reports that “Pharmacy claims account for about 30 percent of FEHBP premiums, according to OPM. This equates to more than $10 billion annually, Lynch said.” The prescription drug spend in the FEHBP like all employer sponsored programs is a large dollar amount. However, the prescription drug spend percentage for the FEHBP is skewed by the fact that the FEHBP has a very large cadre of annuitants whose hospital bills are paid by Medicare Part A. FEHBP pays their prescription drug bills. That’s not a bad deal because hospital costs still outweigh prescription drug costs. If you were to add the hospital bills that Medicare pays to the total FEHBBP benefit spend, the drug spend percentage would drop significantly. The FEHBP expects that the percentage would be in line with other employer sponsored plans, considering the fact that the average age of a FEHBP enrollee is around 60. The sky is not falling.

Congressman Lynch’s press release comments that “Regrettably, the FEHBP is paying between 15% and 45% more for its prescription drugs than other federal programs, including those at the Veterans Administration, the Department of Defense, Medicare, Medicaid, and the Public Health Service’s 340B Program.” The FEHBlog cannot vouch for any percentages but he knows that these public health programs like the VA and Medicaid, clamp down hard on utilization by using closed formularies and other common techniques. Cutting back on choice is how drugs costs are controlled, but the unions, NAGE and AFGE, who wildly support Congressman Lynch’s bill, would have a bird if FEHB plans adopted the same techniques. Always be careful what you wish for.

OPM launched the beginning of the 2014 FEHBP contract negotiations with its annual benefit and rate call letter. Carriers are allowed until May 31 to submit their benefit and rate proposals. The call letter was released on day #1 of the annual OPM AHIP carrier conference. Govexec.com covered the keynote speech here. The Washington Post’s Federal Eye reported on the call letter here.

Also today, according to a Hill report, Congress passed the continuing resolution extension funding the federal government through September 30, 2013. Government shutdown avoided. However, the federal employee pay freeze continues at least. Thank heavens for little miracles.

The Robert Wood Johnson Foundation updated for 2013 its U.S. county by county health rankings. The FEHBlog’s home county ranks #2 in Maryland

The Hill reports on a compromise reached today that will permit the Senate to vote on extending the continuing resolution funding the federal government until the end of this fiscal year, September 30, 2013. The House already has passed such a bill. Absent Congressional agreement on before next Wednesday, a government shutdown will occur. The FEHBlog is hopeful for a happy resolution.

The New York Times reports on ongoing efforts to repeal the ACA’s 2.3% excise tax on medical devices.

Lifehealthpro reports on an National Association of Insurance Commissioners draft flowchart of health insurance exchange eligibility options in 2014. (There are nine potential outcomes.) The FEHBP bounce of this ball is that federal employees will have the choice between (in all likelihood) unsubsidized exchange coverage and subsidized FEHBP coverage. There is a large cadre of federal employees who do take FEHBP coverage because they are covered under a spouse’s plan or choose not to purchase it. Federal employees would be nuts not to pick up FEHBP coverage during the five years preceding retirement because that is the prerequisite to post-retirement FEHBP coverage with the full government contribution. However, before then it will truly be their choice in 2014.

Kaiser Health News has two interesting reports today. One concerns consumer confusion over the multitude of reported hospital ratings. The FEHBlog would just stick with CMS’s Hospital Compare. The other concerns “a growing number of doctors have begun holding group appointments — seeing up to a dozen patients with similar medical concerns all at once.” The concerns that are the subject of these group appointments typically are chronic illnesses like diabetes or heart disease, not contagious illnesses.

For example, in a diabetes group visit, a doctor might ask everyone to remove their shoes so he can examine their feet for sores or signs of infection, among other things. A typical session lasts up to two hours. In addition to answering questions and examining patients, the doctor often leads a discussion, often assisted by a nurse. 

But does the provider charge the health plan a group discount?

Happy St. Patrick’s Day.  This week will feature the annual OPM AHIP FEHBP carrier conference. The FEHBlog will be in attendance. Congress also will be in session working on budgets and an extension of the continuing resolution funding the federal government through September 30, 2013, the end of the current federal fiscal year. Absent an agreement before March 28, a government shutdown will occur. The House of Representatives already has passed its version of the CR and the Senate will consider its version early this week. The Federal  Times and govexec.com review the impact of these efforts on federal employees and annuitants.

Fierce Health Finance reports that according to an Alarium Institute study health care spending rate is declerating to a level similar to that found in the golden years of managed care / gatekeeper HMOs in the mid to late 1990s. But it’s still going up.  The study credits the weak economy and cost pressures on providers of care for the slowdown.

Contributing to the slowdown according to a Decision Resources study reported in Modern Healthcare is the fact that

Endocrinologists and primary-care physicians use e-prescribing for 76% of their Medicare patients and 79% of their non-Medicare patients.. About 60% of these doctors say that within their e-prescribing program, they have access to their patients’ full lists of medicines, or formularies. As a result, they suggest that they pay closer attention to patient prescription costs. About 80% of these endocrinologists and primary-care physicians say that, if given information about their patients’ formularies and copays, they would prescribe less expensive/better-reimbursed options.

CMS has begun to penalize doctors who don’t use electronic prescribing.

The Hill reports on a House Energy and Commerce Health Subcommittee hearing about the expected impact of the Affordable Care Act on health insurance premiums next year. The FEHBlog’s take is that the Affordable Care Act will increase premiums but consumers who receive premium subsidies in the exchanges (up to 400% of the federal poverty line) will be shielded from the increases to one extent or another (that’s the Affordable part of the ACA).  Consumers who are eligible for employer sponsored coverage can only receive subsidized exchange coverage if there employer sponsored coverage premiums would be 9.5% or more of the employee’s W-2 annual income. If the employer offers a choice of coverage, the employer can select one low cost plan that is open to enrollment by all employees to serve as the benchmark under the IRS rules.

Earlier this month, the FEHBlog shook his head when he read the HHS press release promoting the 2014 benefits and parameters notice as stabilizing premiums in the health insurance exchanges. As the Wall Street Journal points out today  employers are recognizing to their dismay that this anticipated stabilization occurs on their backs via a $63 per covered individual payment to a transitional reinsurance fund.  

The fee comes on top of other costs employers expect to face.
Proponents of the law say it eventually will lower employers’ health
costs by expanding insurance coverage to 30 million Americans, meaning
employers won’t subsidize their unpaid medical bills.

Administrators for employee health plans
have warned federal regulators they could pare insurance benefits to
absorb the fee. Some benefits experts expect employers will at least
partially pass on the $63 to workers.

The balance will be passed on through higher consumer prices.  The article illustrates the fact that the law relies very much on cost-shifting rather than cost-reduction to cover the uninsured.

FEHB plans also will be hit with this fee next year. The article indicates that the fee is expected to add 1% to 2014 premiums.  The fee will decrease in 2015 and 2016, the last year for this three year program (unless Congress extends it). Congress expected that HHS will collect $25 billion over that period. HHS is using $20 billion for the reinsurance program in the exchanges and is refunding the balance to the U.S. Treasury to cover the cost of the ACA’s early retiree reinsurance fund. “A Boeing spokesman said the retiree program “was not advertised as a program prefunded by the government to be paid back at a later time,” according to the Journal. Boeing got $50 million out of the fund; FEHB plans got bumpkus due to an HHS rule.

Apro pos of nothing relevant to the FEHBP but certainly demonstrative of the unnecessary complexity of the ACA, the AP reports that the draft application to receive premium subsidies in a health insurance exchange is 15 pages long for a three member family and intrusive to boot. To top it off, health plans, including FEHB plans, will need to spend millions of dollars reporting to the IRS about who they cover beginning next year (IRC §§ 6055, 6006).

The FEHBlog found this interesting ihealthBeat perspective on the HIMSS conference that was held in New Orleans last week. HIMSS is a trade association for electronic health records and related vendors that is of course energized by the billions of dollars that HHS has been granting health care providers to buy EHRs. Next week is the always exciting (at least to the FEHBlog) OPM AHIP FEHBP carrier conference in sunny Arlington, VA.

The FEHBlog also ran across this report about a Consumer Reports survey on the consumer reaction to the summary of benefits and coverage (“SBC”) mandated by the ACA and rolled out last Open Season for the FEHBP and other health plans. Consumer Reports which is a proponent of the form commented that “What these results show us is that the Summary of Benefits and Coverage can make a difference in the consumer health insurance shopping experience – but too few consumers appear to be aware of the form. It’s clear that consumers like the form, but in order to get the most out of it we need to find a way to make sure consumers see the SBC when they are shopping for insurance.” How about requiring the same form for hospitals and doctors — I’m in this network but not that one, I charge $$$ for an office visit.

Finally, the AMA News reports that doctors are bracing for the 2% cut in Medicare payments that the sequester requires for services rendered on or after April 1. What to do? What to do? Hey let’s shift costs onto private sector health plans via higher prices? There’s nothing new there. For the height of chutzpah though check out the Healthcare Supply Chain Association’s Medical Device Tax Watch. This website  mau maus the medical device manufacturers that are shifting the ACA’s 2.3% medical device tax onto their customers just link any other sales tax. What do hospitals and doctors do everyday to make up for inadequate fees from Medicare and Medicaid? Raise prices for private sector health plans. Government initiatives tend to create such cost shifting and the ACA is no exception. But oh the humanity, the Washington Times reports today that the medical device tax is raising prices for veterinary care.