The FEHBlog is back from the beach and will be carefully following the Scotusblog’s live coverage of the Supreme Court’s decision day tomorrow morning.

The House and the Senate are in session this coming week before the Fourth of July holiday. No doubt the outcome of the Supreme Court’s healthcare decision may be impact their schedule this week.

The Washington Post had front page coverage on Saturday about a cool arrangement between Aetna and Inova Health Systems which seeks to coordinate care and bend the cost curve down. Indeed the arrangement will share any savings with participating employers in northern Virginia where Inova is located. What puzzles me about the article is its man hits dog tone. Cooperation like this between insurers and providers is good news. Insurers don’t need to be banged on the head to recognize the benefits of collaboration. Insurers are incented to control costs like this regardless of the Affordable Care Act’s status. The article criticizes providers for their reliance on fee for service medicine but that reliance stems from the fact the Medicare and Medicaid are so penurious in their payments. It will take innovation like this to change the rubric.

It’s not a usual Friday for the FEHBlog because it’s the end of the beach week but it’s a Friday nonetheless.

The Supreme Court did not issue its healthcare decision yesterday but it is expected to do so next week — likely on Monday. While that is the last scheduled decision day of this term, the Court can create an additional decision day.

The American Medical Association, which is holding its annual meeting this week, issued its fifth annual health insurer report card. Piling chutzpah on top of chutzpah, the AMA, which typically objects to rating doctors, takes credit for reducing an unbelievably high error rate found in last year’s survey. AHIP responded

‘Health plans and providers share the responsibility of improving the accuracy and efficiency of claims payment,’ AHIP spokesman Robert Zirkelbach wrote in an email to MedPage. Health plans are doing their part by collaborating with providers and investing in new technologies to improve the process for submitting claims electronically and receiving payments quickly. At the same time, more work needs to be done to reduce the number of claims submitted to health plans that are duplicative, inaccurate, or delayed,’ Zirkelbach wrote.”

In other words, take the log out of your eye, AMA, first.

Standard & Poors issued its monthly healthcare index report yesterday.  The cost curves continue to point up.

As measured by the S&P Healthcare Economic Commercial Index, healthcare costs covered by commercial insurance plans increased by 8.46% over the year ending April 2012, up from the +7.78% reported for March 2012. Growth rates in Medicare claim costs rose by 2.60%, according to the S&P Healthcare Economic Medicare Index, up from March’s +2.42%.  The Professional Services Index annual growth rate also increased from its March 2012 +5.58% rate to April’s +6.18%. The Hospital Index annual growth rate increased to +5.81% in April, from its +5.44% March rate.

Happy Summer Solstice!

The Hill reports that on Monday Congressional leaders announced that a compromise had been reached on the Food and Drug Administration user fee bill. This is a big deal for big Phrma. Nevertheless, it’s also good news for health plans and consumers because the bill includes new user fee programs for all types of generic drugs which hopefully should get the FDA off the dime onapproving a regulatory pathway for bio-similar specialty drugs.  As the FEHBlog has noted that pathway was created in the EU several years ago.

Modern Healthcare reports on a House Ways and Means Health subcommittee hearing on a June 2012 Medicare Payment Advisory Commission report to Congress. In the FEHBlog’s view, the report and the hearing illustrate the problems faced by a public option like traditional Medicare in keeping current.

The AMA News reports that Consumer Reports included a 24 page insert in its July 2012 issue being mailed to Massachusetts residents. The insert provides ratings on internist and pediatric practices with three or more primary care doctors in that state. The ratings are based on surveys of over 64,000 Massachusetts residents. “Survey questions covered six general areas of the patient experience:
communication; coordination of care; how well physicians get to know
patients; the patient’s experience with office staff; whether the
physician advised the patient on staying healthy; and pediatric care.” Consumer Reports is working with the Robert Wood Johnson Foundation and others  to test different methods of rating primary care doctors in the U.S. “The magazine already has ratings of thoracic and heart surgeons, hospitals and insurance companies.”

The FEHBlog is vacationing on the Outer Banks of North Carolina this week. He delayed the weekend update until this morning to watch the U.S. Open and the NBA Finals and see if the Supreme Court issued its healthcare decision. It didn’t. The last two decision days are next Thursday and next Monday. The Scotusblog live blogs the Court’s announcement which is geeky fun.

The House and the Senate are in session this week. Last week, the Senate Appropriations Committee approved a Fiscal Year 2013 financial services and general government appropriations bill. This is the bill that funds the FEHBP. The bill includes the traditional FEHBP related appropriations provisions. Here’s a link to the Federal Times article on the bill’s broader implications for federal employee compensation.

The Hill reports that Steve Larsen, the CMS executive who runs the Center for Consumer Information and Insurance Oversight, is leaving the agency next month. CCIIO is responsible for ACA implementation.

Firehouse.com reports that “A seasonal wildland firefighter with the U.S. Forest Service started an online petition in late May to extend federal healthcare benefits to him and thousands others, and within the last few days it has really begun to pick up some steam.”  The problem is that such seasonal employees do not meet the FEHBP’s statutory eligibility requirements. Congress addressed a similar problem by extending FEHBP coverage to Indian tribal employers in the Affordable Care Act. There were Indian tribal employees who worked for the federal government (typically the Indian Health Service) for part of the year and the tribe for the other part. Congress could extend FEHBP coverage to seasonal firefighters but the question then becomes where do you draw the line because there are a lot of people who work for the federal government or the Postal Service on a part time basis who are not eligible for the FEHBP.

OPM has been encouraging FEHBP carriers to introduce wellness initiatives in their plans. The AMA News reports on the trend of health insurance carriers that offer their members personal / lifestyle coaching on smoking cessation, weight control, etc.   (Of course the AMA News sees evidence of a nefarious health insurer plot to attract good risks.)  The FEHBlog received an email from DPS Health which provides a virtual weight loss coaching program to a major FEHB plan carrier, GEHA. The FEHBlog was alerted that readers can download a white paper about this program at this link.

The FEHBlog really got a kick from this ihealthbeat article and this Healthcare Finance News article about the annual Physicans Sentiment Index compiled by Athenahealth. To sum it up,

Physicians remain concerned over the future of U.S. healthcare, a new survey reveals. Among the survey’s findings, most physicians think EHRs and the ACA will adversely affect the quality of patient care, and nearly two-thirds anticipate that quality of healthcare will worsen over the next five years.

This is an ironic — not a humorous — line because the ACA’s burdens on health insurers dwarf those imposed on doctors. What’s more the government has spent over $5 billion on electronic health records systems and doctors are dissatisfied. That’s really no surprise to me because the doctors didn’t have to invest any capital in the systems. There’s no incentive on the doctors to make the systems work. They evidently would rather complain. It’s not unusual to complain about regulatory burdens like the meaningful use of electronic health records rules but those rules were the government’s consideration for the $5 billion expended on those systems. In contrast all that health insurers get from ACA compliance is the right to stay in business.

Speaking of the ACA, the Wall Street Journal reports that the Supreme Court will have three more decision days in the current term, Monday and Thursday of next week and Monday of the following week. The experts are betting that the ACA decision will come down on the final decision day.  The FEHBlog is already receiving invites to listen to talks about the decision.

Of course, the Supreme Court did not issue its decision on the constitutionality of the Affordable Care Act yesterday. The Court has two more decision days this term, next Monday June 18, and the following Monday June 25. It would be just the FEHBlog’s luck if the Court issued its decision next Monday when he is on vacation.

The FEHBlog noted on Sunday that the American Medical Association was urging calm in the face of the impending decision. Kaiser Health News reports that several large health insurers took the same tack by “promising to continue following some of the rules in the federal health law that are already in effect.” It’s, of course, presumptuous to assume that the Supreme Court will strike down the entire law, but if it does, it will be up to Congress and not just the insurance companies or the doctors to pick up the pieces. For example, the health insurers indicated that they have no problem keeping on covering employees’ children up to age 26. But while the employers and insurers could agree to do so, the tax code in effect before the ACA would have imputed income tax on the premiums paid to cover adult children. What’s more Congress never aligned the FEHB Act’s dependent eligibility provision with the ACA. So, if worse comes to worse for the Obama administration’s position before the Supreme Court, Congress will have to act quickly.

There’s an interesting piece in the Hill’s Healthwatch about the ACA. The ACA requires non-grandfathered group health plans to cover preventive services with grade A or B recommendations from the U.S. Preventives Services Task Force with no employee cost sharing. OPM has applied this requirement to all FEHB plans regardless of grandfathered plan status. The PSTF recently lowered the recommendation of PSA testing below the mandate threshold. Health plans can continue to cover this prostate cancer test without cost sharing but they aren’t required to do so. According to this article, Sen. Kay Hutchinson (R TX) went nuts about this decision.   “Hutchison denounced the group as a ‘panel of bureaucrats’ denying access to a vital test by ‘fiat.'” But the decision affects the cost of the test, not access to the test.

The AMA News advises its readers on three way to challenge insurer policies — joining with organized medicine, getting government assistance, and going to the media. Of course the fourth means — litigation — is offered by my profession. It’s too bad that the AMA News can’t shift the focus to trying to work together with insurers, an approach that does succeed.

Speaking of government assistance, Modern Healthcare reports on a New York State attorney general press release concerning two medical expense balance billing settlement — one with an insurer and the other with a medical group.

Finally, Health Affairs released national health expenditures study today that finds

For 2011–13, US health spending is projected to grow at 4.0 percent, on
average—slightly above the historically low growth
rate of 3.8 percent in 2009. Preliminary data
suggest that growth in consumers’ use of health services remained slow
in 2011,
and this pattern is expected to continue this year
and next.

After 2013, the ACA’s exchanges and multitude of other requirements kick in and the health care spending curve tilts up sharply according to this report.

In 2014, health spending growth is expected to accelerate to
7.4 percent as the major coverage expansions from
the Affordable Care Act begin. For 2011 through 2021, national health
spending
is projected to grow at an average rate of
5.7 percent annually, which would be 0.9 percentage point faster than
the expected
annual increase in the gross domestic product
during this period.

This is the FEHBlog’s 1300th post since 2006.

The Senate is in session tomorrow and out of the rest of the week. The House of Representatives is out all week.  The Financial Services subcommittee of the Senate Appropriations Committee will mark up the FY 2013 financial services and general government appropriations bill that, among other things, funds the FEHBP on Tuesday June 12 at 3: 30 pm (Dirksen 138).

On Friday, The U.S. Office of Personnel Management’s Inspector General released his semi-annual report to Congress (for the period ending March 31, 2012).

The U.S. Supreme Court typically issues its decisions on Monday mornings at 10 am ET when the Court is in session. June is the last month of the Court’s current term. Consequently, legal observers will be holding their breath tomorrow morning to find out whether the Supreme Court has issued a decision on the constitutionality of the Affordable Care Act, a case that was argued at the end of March over three days. After all there are only three more Mondays this month. The FEHBlog finds himself in agreement with the new American Medical Association president who according to the AP has observed that “Americans should not expect chaos if the U.S. Supreme Court rejects all or part of the sweeping health care law.”

The FEHBlog nearly levitated out of his chair yesterday when he read about a study published in Health Affairs criticizing the FEHB Program. The authors are alarmed that

“Average bi-weekly premiums for an individual were lowest ($58.48) in counties where competition between insurance providers was extremely high, compared with areas of low competition ($65.13),”[author Timothy McBride] says.
“This raises concerns about whether the competition will work in the exchanges as intended, everywhere in the country,” McBride says.

The author is freaking out over a $7 price swing??? This study cannot see the forest for the trees. The FEHBP provides many health insurance options to federal employees and annuitants. The competition keeps the Program on the cutting edge of innovation and keeps premiums below the national norm as the FEHBlog has discussed. This is nothing short of a miracle considering the FEHBP’s demographics — half of the enrollees are annuitants and the average age of an enrollee is around 60.

Yesterday, the House of Representatives approved H.R. 436, a bill to repeal two ACA provisions that the FEHBlog has discussed, the medical devices tax and the scripts for OTC drug requirement. Three dozen Democrats joined all of the Republicans in supporting the bill. However, the White House has threatened to veto the law according to Business Insurance and it is unlikely that the Senate will consider the bill this year.

The Leapfrog Group announced on Wednesday that it has begun to award U.S. hospitals letter grades on patient safety which are available at this link. Kaiser Health News has a nice write-up on the program — including a state by state grade breakdown and not surprisingly Medpage reports that

The American Hospital Association (AHA) disputed Leapfrog’s ratings.

“The
American Hospital Association has supported several good quality
measures, but many of the measures Leapfrog uses to grade hospitals are
flawed and they do not accurately portray a picture of the safety
efforts made by hospitals,” Nancy Foster, vice president of quality and
patient safety policy at the AHA, said in a statement.

If the FEHBlog is in need of hospitalization he will check the Leapfrog site.

The FEHBlog is disappointed that he missed the third annual Health Data Initiative Forum which was held earlier this week at the Washington Convention Center.  HHS has a press release about the exciting events of the first day. According to the event’s website there was a walking gallery with an art display featuring

Regina Holliday, a nationally-known DC-based patient rights arts advocate, [who] began painting a series of murals depicting the need for clarity and transparency in medical records. Today, she brings together art, medicine, social media and pop-culture and creates a patient voice in health information technology.

Good luck to Ms. Holliday, a fellow blogger.

The House and the Senate will be in session this coming week. On Wednesday at 11 am the Financial Services Subcommittee of the House Appropriations Committee will mark up its appropriations bill which includes FEHBP funding. The meeting will not be webcast. According to a Hill report, the House also is expected to consider and pass H.R. 436, one of the bills that cleared the Ways and Means Committee last week. This bill would repeal the medical devices tax and the prescription prerequisite  for any OTC drug coverage created by the ACA.

Reuters reports that Express Scripts and Walgreen’s have decided to dismiss their lawsuit between them,but [both parties] said the dismissals did not mean they were any closer to reaching a new deal.” The FEHBlog knows how expensive litigation can be so it’s possible that the dismissial is completely independent of a new contract between the parties, but it has to be considered a step in the right direction.

The Washington Post reports on recent major data breaches at Howard University Hospital in Washington, DC, the University of Utah health care system, and TRICARE. Deven McGraw from the Center for Democracy and Technology  comments that

While the benefits of electronic health records far outweigh the risks, she [Deven McGraw] said, those risks can only be mitigated — not eliminated.
“No matter how good you make the technology,” McGraw said, “we’ll never get the risk down to zero. But we can do a lot better than we have been doing.”

All three cases involved criminal activity against the health care providers which means that at least you have to stay one step ahead of the crooks.

Several years ago, the FEHBlog learned from medical experts that there are not that many preventive services that are worth performing annually on healthy people. The New York Times has a report this morning in which a doctor makes the same point.

As of today, only a few screening tests are recommended as useful for healthy, asymptomatic people by the Preventive Services Task Force and some of those — like blood pressure checks — don’t require a doctor visit and could be performed in a pharmacy. “If you follow their recommendations you hardly do anything to patients,” said Dr. Brett, adding that the most important intervention doctors perform on healthy patients may be counseling about habits. For new patients, he still does the full head-to-toe medical exam — though he does not routinely order blood work — and regards some parts as more or less playacting.

Doctors have become accustomed to performing this ritual in years of training, and “patients come to expect it,” Dr. Cassel said.

“Patients say, ‘hey, why didn’t I get my CXR?’ So many docs say O.K., and order one. You don’t really need all those tests and probably most of the physical exam.”

And of course the ACA generally mandates coverage without cost sharing on the theory that all preventive care bends the cost curve down.

Yesterday, the U.S. Court of Appeals for the First Circuit, sitting in Boston, ruled that the Defense of Marriage Act (“DOMA”) is unconstitutional. DOMA requires that the word spouse be interpreted to mean a person of the opposite sex whenever the word is used in a federal statute or regulation. The FEHB Act defines family member to include the enrollee’s spouse. Pursuant to DOMA, therefore, same sex spouses cannot be enrolled for FEHBP self and family coverage. The courts generally have reacted negatively to this law in recent years as six states and the District of Columbia now will issue marriage licenses to same sex couples. The courts see DOMA as infringing on the state’s rights to regulate family law matters, among other issues.

The issue will now proceed to the Supreme Court for a decision, likely in the first half of 2013. In the meantime, the Court of Appeals has continued in place the stay of the unconstitutionality decision. The FEHBlog expects that the Supreme Court will rule DOMA unconstitutional and then the Program will be opened up to same sex spouses. These court proceedings do not have the potential to moot Sen. Lieberman’s same sex domestic partner legislation (S. 1910) because the vast majority of states do not recognize same sex marriage.

Following up on Wednesday’s post, the House Ways and Means Committee did clear four health care related bills yesterday “on a bipartisan basis.” One bill (H.R. 436) would repeal the Affordable Care Act’s medical device tax, which has been under a lot of fire lately, as its 2013 effective date nears.  The law will require manufacturers of most medical devices to pay 2.3% of their U.S. sales in taxes. Another (H.R. 5842) would repeal the ACA’s provision limiting any health plans, HSA, HRA or FSA coverage to prescribed over the counter drugs, which is a non-sequiter. The other two bills (HR 1004 and HR 5858) concern flexible spending account plans as discussed in this Business Insurance article.