Following up on last Sunday’s New York Times article, the Pittsburgh Post Gazette printed an article about the multi-state plans that will be offered in the state health insurance exchanges based on OPM contracts, similar to the FEHBP. The reporter observes that

Traditional insurers * * * would seem to have little incentive to assemble and sell a multistate plan when they can sell products in the exchanges directly.

“Many questions remain unanswered because the federal government has yet to issue the request for proposal that will outline the requirements” of the multistate plans, said Janice Maszle, spokeswoman for Highmark Inc., Pennsylvania’s largest health insurer. “We do feel strongly that these plans must operate on a level playing field with the other qualified health plans on the exchanges, [which] will prevent adverse selection.”

The Federal Times reports that “While insurers report a growing willingness of federal [employee health benefit plan] enrollees to tap into their systems to make use of their medical information, the size of the growth is mixed. It’s still small for most carriers, with the large majority of their federal membership still balking at using the health records system, even though electronic records advocates insist they offer widespread benefits to users.”  The article does not mention that OPM’s most recent initiative has been to require FEHB plans to offer their members “blue button” access to their electronic records. The Blue Button permits plan claim records to be readily imported into a personal health records program like Microsoft Healthvault or a spreadsheet. The FEHBlog thinks that this technology will be more useful when offered by a healthcare provider because the providers records directly deal with the member’s health — as opposed to payment for the member’s health care. But experts have noted that while the medical community is getting accustomed to their brand new medical record systems, people sometimes need to fall back on their health insurance records, particularly in a pinch like “Superstorm” Sandy.

The FEHBlog has noted that the HHS Office for Civil Rights has been routinely slapping health care providers with $1.5 million fines under HIPAA when large volumes of electronic protected health information has been stolen. (Health plans are subject to these penalties as well but recently health care providers have been in the OCR bullseye.)  The FEHBlog took note of an U.S. Justice Department press release about a settlement with a check cashing company that failed to properly dispose of paper records containing confidential personal financial information subject to protection under the analogous Gramm-Leach-Bliley Act.

“A company that operates payday loan and check cashing stores in at least nine states has settled with the government over allegations that it violated federal regulations, the Justice Department announced today.   In April 2010, law enforcement officers retrieved boxes of intact consumer documents, including credit reports, from trash cans and dumpsters near four PLS Financial Services stores in the Chicago area.   The improper disposal of these documents led to an investigation by the Federal Trade Commission (FTC).  “

The company accepted a $101,500 fine. It’s good advertising for shredding companies and a reminder to HIPAA covered entities including health plans about the need to shred documents containing personal health information. .

Happy Halloween!  As we inch ever closer to the beginning of Open Season on November 12, OPM announced today that it has reactivated its Federal Benefits Facebook page (which the FEHBlog likes) and its Twitter feed (which the FEHBlog follows).

The Federal Times offered its first Open Season article yesterday on the topic of whether a low premium FEHB plan may be the right choice.

Following up on the Weekend post about health care costs, the FEHBlog noticed that AHIP is now offering an Ipad app called “U.S. Health Care Spending 101,” that “provides policymakers and stakeholders
with comprehensive health care spending data in an easy-to-use digital
format.”

As you know from reading the FEHBlog, the FEHBlog’s money is on personalized medicine bringing down the cost curve. The Wall Street Journal has an article aibout the progress being made in that area.

The AMA News claims that there’s a new trend toward domestic medical tourism, but the upshot is that many large employer health plans are refocusing attention on centers of excellence for certain high cost procedures like transplants. This good idea is nothing new. You will find that most FEHB plans particularly the nationwide plans offer centers of excellence arrangements.

Yesterday’s Washington Post had an article about domestic medical tourism from an uninsured individual’s standpoint. Hip replacement surgery overseas or in Oklahoma City?

OPM has required for the past two years that FEHB plan offer comprehensive tobacco cessation program with no enrollee cost sharing. Forbes Magazine reports that “Four new studies offer powerful evidence of the dangers of smoking and the health benefits of quitting or not being exposed to secondhand smoke.”

As the FEHBlog has mentioned, November 12 also will feature the return of Congress for its lame duck session. One must pass measure is legislation postponing the Medicare Part B’s sustainable rate of growth formula driven cut in Medicare payments to doctors or in the AMA’s dreams repeal and replacement of the SRG formula. The AMA News this week lays out the medical community’s repeal and replace strategy. Time will tell.

Batten down the hatches!!  Just two weeks from tomorrow, Congress will return for its post-election lame duck session and the Federal Benefits Open Season will begin.

Govexec.com recently undertook an unscientific survey of federal employee attitudes towards our beloved Federal Employees Health Benefits Program. Govexec.com reports today that “More than 90 percent of respondents to an October Government Executive poll characterized their FEHBP coverage as “good” or “satisfactory.” The question received more than 1,200 responses.” Here’s an interesting tidbit from the report

Another long-standing complaint from enrollees, and one that several Government Executive readers mentioned, was the lack of a self-plus-one option. FEHBP offers self-only and family coverage; those enrollees with spouses and no dependents must choose the family plan if they want coverage extended to their spouse. Some enrollees have balked at having to pay more for the family plan when they don’t have children, but Francis said a self-plus-one option would not be cheaper for enrollees. “If they got their wish, they would pay higher premiums,” Francis said, because that demographic consists largely of older, empty-nesters, who are more expensive to insure than a young couple with children. “OPM actuaries have confirmed that over and over,” Francis said.

The FEHBlog has heard the same opinion from OPM’s actuaries.  Although it’s not an apples to apples comparison, the premiums in the FEDVIP program which does allow for a self and one option logically step up from self only to self and one to self and family at the top. Of course, the FEDVIP law allows for the self and one option while the older FEHBP law does not. Conngress would have to change the FEHB law in order to create a self and one option.

OPM has unveiled its 2013 Federal Benefits Open Season webpage. The site includes a link to another webpage full of Open Season resources for the FEHBP, FEDVIP, and FSAFeds.  The Federal Daily staff also offered its thoughts on preparing for Open Season.

Modern Physician.com reports that “Without hesitation, Dr. Allan Korn, the Blue Cross and Blue Shield
Association’s chief medical officer and senior vice president for
clinical affairs, declared that the patient-centered medical home has
the potential to transform the U.S. healthcare system.”  The article quotes Dr. Korn as remarking that the Blues plans no longer can be considered to be piloting PCMH’s because 5.3 members (about 5% of all members) participate in the programs which focus on primary care and are intended to better coordinate all medical care.

The FEHBlog has noted that concerns have been raised in the press that hospitals may be using their government funded electronic healthcare technology to boost Medicare reimbursements. Modern Healthcare reports that “Hospitals using electronic health records have until Friday to complete a [54 question long] survey from HHS’ inspector general’s office asking myriad questions about how they use their EHR systems—questions that come at a time when critics have accused the industry of using the programs to increase revenue.”

Speaking of health care costs, last week, Standard and Poors released its August 2012 healthcare cost index report.

The average per capita cost of healthcare services covered by commercial insurance and Medicare programs increased by 5.70% over the 12-months ending August 2012. This is a deceleration from the +6.15% annual growth rate recorded in July 2012.

As measured by the S&P Healthcare Economic Commercial Index, healthcare costs covered by commercial insurance plans increased by 7.81% over the year ending August 2012, down from the +8.36% reported for July 2012. Annual growth rates in Medicare claim costs rose by 2.48%, according to the S&P Healthcare Economic Medicare Index, down from the +2.79% recorded in July 2012. The Professional Services Index annual growth rate was +6.67% in August 2012, down from the +6.95% July 2012 print. The Hospital Index’s growth rate fell to +4.54% in August from +5.11% recorded in July 2012.

It’s now just three weeks until Congress returns from the campaign trail and the Federal Benefits Open Season begins on November 12.

The AMA News recently has featured valuable articles providing the medical professions viewpoint on two Affordable Care Act creations — the Patient Centered Comparative Research Institute and the controversial Medicare Independent Payment Advisory Board.   The PCORI article raises the concern that comparative research studies even if conclusive do not necessarily change actual medical practices. In an effort to address this problem, the law funnels 20% of the PCORI funding fees contributed by insurers for publicity of findings through a HHS agency. The IPAB provides a vehicle for cutting Medicare funding of doctors services and prescription drug services (not hospital services until 2020). You can imagine how the AMA feels about that.

Kaiser Health News offered a report on the difficulty that people can encounter in trying to find coverage for certain eating disorders such as binge eating. According to the report,  “insurers say that experts have not identified clear protocols for
treatment. They note that there is little research on how best to treat
the mental and the physical aspects of an eating disorder.” Perhaps this is where the PCORI may fit in. In any event, here’s the rub:

To be sure, such disputes are not limited to eating disorders. With
rising health care bills, insurers have demanded more rigorous evidence
of the effectiveness of many treatments and pushed patients to cover a
greater share of their medical costs across the board. Patients, in
turn, have mounted consumer campaigns to pressure insurers and even
turned to lawmakers and regulators to force insurers to cover a variety
of diagnosis. For instance, strong parent advocacy efforts led 31 states to mandate coverage for autism, despite insurers’ concerns about the cost.

In the latest call letter, OPM approved FEHB plan coverage for applied behavioral analysis to treat autism. Previously, OPM had classified that therapy as a non-covered educational service. The advocacy group Autism Speaks reports that 38 FEHB plans will cover ABA therapy in 2013.

Yesterday, another U.S. Court of Appeals (this time the Second Circuit which sits in New York City) held the Defense of Marriage Act is unconstitutional, Reuters reports. Here’s a link to the 2-1 decision. At this point the U.S. Court of Appeals for the First Circuit which sits in Boston and a federal district court which sits in San Franciso have reached the same conclusion. Both of those cases are pending before the Supreme Court which has not yet decided to hear the cases. But the FEHBlog is sure that the Supreme Court will take the case and ultimately reach this result principally on federalism grounds because the Constitution vests the States with authority over domestic relations. Less than ten states currently recognize same sex marriage. If the Supreme Court holds against the statute, then same sex spouses would be entitled to enroll under FEHBP self and family coverage.

The Highmark saga continues. Recently, the FEHBlog noted that Highmark’s deal to invest in a major Pittsburgh hospital chain, West Penn Allegheny, had fallen apart when West Penn walked away from the deal. Healthcare Finance News reports that earlier this week, Highmark, a Blue Cross licensee, had committed $65 million to create a “strategic affiliation” with Erie PA based St. Vincent’s Health System.

Following up on news articles about how hospitals may be using electronic medical records paid for by the Government (most recently to the tune of $7.7 billion) to increase their Medicare reimbursements, EHR Intelligence reports that four Senate leaders have sent HHS Secretary a letter about the program inquiring about this issue and requesting a meeting. This letter comes on the heels of a House leadership call to halt the program according to Modern Healthcare.

The FEHBlog has noted Medicare and health plan efforts to reduce surgical complications. Modern Healthcare reports that “Efforts to reduce post-surgical complications such as infections could lead to substantial drops in hospital revenue, according to a study published online in Health Affairs that examined the business case for such programs.”  The study’s authors recommend to tactical responses — increase patient volume and negotiate shared savings agreements with health plans.

Well, we creep closer to the beginning of the next Federal Benefits Open Season on November 12, and the FEHBlog is shocked and chagrined to realize that he overlooked noting the release of OPM’s Open Season Significant Plan Changes benefits administration letter earlier this month. This annual letter provides tables of the FEHBP and FEDVIP changes for next year.  OPM also provided a set of FastFacts for enrollees affected by the changes.

While Congress is in recess until the beginning of Open Season, Kaiser Health News is reporting that Hill staffers are confident that a deal to avoid a 30% cut to physician reimbursement under Medicare Part B will occur in the lame duck session. That’s good because retroactive fixes to the sustainable rate of growth formula can wreak havoc on FEHBP carriers who typically have a large contingent of Medicare eligible enrollees.

Speaking of Medicare, the AMA News frets about the ongoing consolidation of Medicare administrative contracts from 15 numbered regions to 10 lettered regions. Medicare contractor changes in 2008 wreaked havoc on providers, and CMS is reassuring providers that the current transition will be much smoother.  The Medicare law requires CMS to recompete the contracts every five years. The FEHBlog noted in the article that

The newest Medicare contractor reforms are ending partnerships that have
been in place since the inception of the Medicare program. The
contractor Wisconsin Physicians Service, for example, had been the payer
in Wisconsin since 1966. On Sept. 27, National Government Services,
with corporate headquarters in Indianapolis, won the bid to administer
the Medicare program in Illinois, Minnesota and Wisconsin.

The FEHBlog made his first trip to Madison Wisconsin for a meeting at WPS in the late 1980s. Over the last decade, the FEHBlog has made several trips to Madison as his two daughters matriculated there.

Modern Healthcare reports an interesting healthcare business development — “Retail pharmacy giant Walgreens said it will deliver prescriptions to
hospitalized patients and manage their medications for the first 30 days
after they leave the hospital under new contracts with a dozen
hospitals and health systems.” It’s interesting that hospitals would turn over presumably lucrative pharmacy business to Walgreens. The article explains that the objective of the arrangement is to reduce readmissions within 30 days of discharge — now a Medicare penalized event. “Participating hospitals include Sarasota (Fla.) Memorial Health Care
System, Washington Adventist Hospital in Takoma Park, Md., and Marion
(Ind.) General Hospital.”

The Wall Street Journal reported this week that another new Medicare penalty is incenting hospitals to improve the food and hospitality services to patients. “Nearly $1 billion in payments to hospitals over the next year will be based in part on patient satisfaction, determined by a 27-question government survey administered to patients. Hospitals with high scores will get a bonus payment. Those with low ones will lose money.”

Congress remains on the campaign trail until November 12. The FEHBlog has been reading that further major ACA and related  regulations such as the omnibus HITECH Act rule will not be issued until sometime after the November 6 election which is not that far away.

The FEHBlog in an effort to illustrate that he has a life outside the law waxed rhapsodic about the National’s win on Thursday. The FEHBlog was in the ball park on Friday but that Nationals loss is best described as the ecstasy and the agony. Suffice it to say that the FEHBlog has faith in the National’s management and the team and there will be another season. (Also with respect to the Redskins which are still playing, RG3 is the real deal).

The FEHBlog ran across a useful website — statereforum.org —  in the course of reading an AMA News article kvetching that most of the 24 states (including DC) have selected an essential health benefits benchmark using a popular, cost effective small employer plan. The article notes that “various medical organizations, such as the American Academy of Pediatrics and the American Medical Association, have voiced concerns that too many of the private benchmark plan options available to states would fall short on needed children’s benefits.” The article concludes that if the state benchmark does not include all of the statutorily required benefit categories including pediatric oral and vision care then federal officials can fill that gap.


The AMA News also reports on the uptick in office visits to primary care physicians in particular crediting the ACA’s preventive care mandate in part. The article illustrates the continuing importance of the fee for service payment model to doctors.  The FEHBlog has been reading about the problems created by that model for at least 20 years, but it continues to hang on. Two experts opine in the Wall Street Journal this morning that “The ultimate success of these Medicare innovations [mandated by the ACA to move away from the fee for service system] is unlikely unless the care-delivery system is controlled by salaried, primary-care physicians groups held accountable for staying within a budget,” similar to Kaiser Permanente. 

The FEHBlog is lucky to have been able to purchase post-season Nationals tickets due to his partial season ticketholder status and some moolah. He went to this afternoon’s crucial game against the St. Louis Cardinals with his son John. The game was tied one – one in the bottom of the ninth inning and Jayson Werth, the National’s lead off hitter, came up to bat. On the thirteenth pitch of the at bat, Werth hit a home run into the National’s bullpen. It was an electrifying moment. I don’t think that I have ever heard such a roar from a crowd. The crowd didn’t want to leave. The FEHBlog is looking forward to tomorrow night’s game which will decide whether the Nationals or the Cardinals will face the San Francisco Giants for the National League championship.

Modern Healthcare reports that

The federal government’s 4-year-old nonpayment policy for
hospital-acquired conditions has had no measurable effect on rates of
several types of healthcare-associated infections specifically targeted
by the program, according to a study published in the New England Journal of Medicine.

In
October 2008, the CMS stopped reimbursing hospitals for 12
hospital-acquired conditions, including patient falls, late-stage
pressure ulcers, air embolisms and certain healthcare-associated
infections.

Either the sanctions are not strong enough as one blogger commented or the hospitals don’t have as much ability to avoid these infections as policymakers expected. The FEHBlog’s gut reaction is that the latter conclusion is more likely the correct conclusion than the former.

In more good news, Business Insurance reports that changes sparked by the Affordable Care Act is causing medical malpractice insurance premiums to increase.

Medical malpractice coverage costs are expected to experience
modest increases in the short term, driven upward in reaction to the
ongoing consolidation of hospital physicians’ offices and other
providers in the U.S., due in large part to dramatic changes to health
care delivery and reimbursement models. 

Of course, medical malpractice premium increases cause providers to ask for more money from the health insurers.

And because this is the FEHBlog, it should be noted that Kaiser Health News is giving advice on whether to drop FEHBP coverage for a Medigap plan.