The FEHBlog enjoyed the Super Bowl and hopes that everyone else did too. Congress is in session this week and the Presidents FY 2013 budget will be released next Monday.

While researching for this post, the FEHBlog ran across the comments that Essential Health Benefits Coalition sent to HHS last Monday. The FEHBlog previously has noted the Stop the Health Insurance Tax coalition, which recently advertised on the Politico Pulse, and the coalition seeking to repeal the Affordable Care Act’s medical device tax. The medical device tax and the $2500 annual cap on health care flexible spending accounts both take effect next year. The health insurance tax takes effect in 2014.  The Affordable Care Act has been good to the association industry.

The FEHBlog is surprised that Congress has not yet repealed the Affordable Care Act requirement that health plan members obtain a prescription in order to obtain reimbursement, e.g., from a flexible spending account, for an over-the-counter drug purchase. Of course, there’s a coalition to advocate for a repeal of that requirement, which doesn’t make a lot of sense to the FEHBlog, but the requirement has been in effect since January 1, 2011.

Health plans beware. The New York State Attorney General is on the warpath again. Last time, his target was the Ingenix system for setting out of network reimbursement rates. Now the target is out of date in network provider directories. The AMA News reports that  

In response to complaints from patients who were
frustrated by out-of-date physician directories, New York Attorney
General Eric Schneiderman has ordered a group of health plans [New York State subsidiaries of Wellpoint, EmblemHealth, and United Health Group] of to improve
their listings and pay back patients who were unexpectedly faced with
paying out-of-network rates.

The Medical Society of the State of New York “views this action by
the AG favorably,” said Moe Auster, the association’s vice president for
legislative and regulatory affairs. He said MSSNY members adopted a
resolution in 2010 calling on the state to require insurers to make
timely updates to their directories and penalize insurers for inaccurate
listings.

The article explains that the health plans expect cooperation from the providers to keep the directories up to date, but no matter.

Govexec.com reports on OPM’s problems in processing federal retirement claims. The other day, the FEHBlog was speaking with a veteran Congressional staffer who is expecting a wave of staffer retirements next year on Capitol Hill because Congress and many staffers shift to the health insurance exchanges in 2014. Retiring in 2013 will allow them to preserve their FEHB coverage.

Kaiser Health News has a brief survey of comments submitted to HHS on the Essential Health Benefits bulletin. Quite a hash.

Modern Healthcare reports that the AMA is appealing to HHS Secretary Sebelius to back off on ICD-10 code set implementation. The AMA complains that doctors are facing an onslaught of regulatory mandates. The AMA suggests that HHS has an opportunity to ease the burdens on physician practices by halting the implementation of ICD-10 and calling on appropriate stakeholders, including physicians, hospitals, payers to assess an appropriate replacement for ICD-9 within a reasonable time frame. Hey the ICD-11 is coming out in 2014! But seriously the problem is that Congress decided in HIPAA to embed technology in law. However, that ship has sailed. If the AMA prevails on this one, it would be a sea change (to continue the analogy).

Today was the deadline for commenting on the HHS Essential Benefits Bulletin, and AHIP submitted an interesting comment letter. The FEHBlog was puzzled by the Bulletin’s statements that state benefit mandates don’t add that much to health plan costs. The AHIP comments blow that statement out of the water. Fortunately, federal law exempts FEHB plans from those state benefit mandates. FEHB plans, of course, are subject to federal mandates, such as those created by the Affordable Care Act.

OPM has informed agencies to consult a recent IRS notice giving employers a heads up on compliance with the Affordable Care Act requirement that 2012 W-2s include a block informing the employee about the cost of employer-sponsored health care coverage, including FEHBP coverage.

Modern Healthcare reports about a sobering Congressional Budget Office report projecting that federal healthcare outlays will double over the next decade.

A Wellpoint press release today announced that  “Medical and pharmacy benefits managed by Wellpoint’s affiliated [Blue Cross Blue Shield] health plans are linked to lower medical costs of $8 to $16 per employee monthly compared to those without an integrated pharmacy program, according to an independently verified analysis of members in WellPoint’s health plans.”  This is latest study militating against OPM’s legislative proposal to carve out FEHBP prescription dru contracting to the agency.

Two articles tickled the FEHBlog’s funny bone:

• The Wall Street Journal’s Health Blog points out that doctors represent a large percentage of the the fabled 1% that the Occupy Wall Street movement has assailed.  “Fully 27% of doctors are     1%ers — the highest percentage of all occupations, including lawyers.
• The AMA News reports about the one diagnosis that patients miss — “cyberchondria.” In other words, the 1% is growing frustrated with the members of the 99% who attempt to self diagnosis their illnesses on the internet.

Congress is in session this week. On Wednesday at 2:30 p.m. the Oversight and Government Management subcommittee of the Senate Homeland Security and Governmental Affairs Committee will hold a hearing on ensuring timely and proper federal employee retirement payments by OPM.

Kaiser Health News notes that on Friday the Bipartisan Policy Center issued a report on what needs to be done to achieve the promised cost efficiencies of electronic medical records.

Reuters UK wrote a blue sky piece about the options available to Medco and Express Scripts if the fedeal government blocks their merger. The FEHBlog thinks that outcome is more likely than not.

The Wall Street Journal reported this morning that Wellpoint and Aetna are offering more money to primary care doctors in their provider networks who are willing to engage in more care coordination efforts.  “The ‘scale is so much bolder than things we’ve seen,’ said Paul Ginsburg, president of the Center for Studying Health System Change, a Washington nonprofit group. “‘This isn’t an experiment.'” Sounds like a win-win.

Everytime the FEHBlog looks at the HHS website, it seems like the Administration is throwing more and more Affordable Care Act and HITECH Act dollars at the medical community. It’s gratifying to see these targeted actions by insurers.

On the preventive care front, USA Today reports that the Centers for Disease Control is concerned that the number of Americans being screened for breast, cervical, and colon cancer continued to fall below national targets in 2010. It will be interesting to see if the percentages trend up because the Affordable Care Act makes the testing “free.” The AMA and AARP has released a new Medicare Preventive Services Brochure.

Aetna announced a new initiative to support dentists in adopting the U.S. Public Health Service’s tobacco cessation guidlines. What a good idea!

Health Data Management reports on the American Medical Association’s quixotic campaign to stop implementation of the ICD-10 code sets next year. CMIO tells us that the AMA’s Executive has written to the House Speaker John Boehner about the issue. The AMA complains that it’s an unfunded mandate. Sure the code set implementation will be disruptive to doctors but insurers have been implementing the new code sets for a couple of years due to a government mandate. The only government support is HHS allowed a portion of the ICD-10 conversion costs to be treated as benefit expenses for purposes of the new federal minimum loss ration. Where was the AMA in 2009 when it could have stopped the train before it left the station?

Finally Modern Healthcare reports that the Federal Trade Commission has sue to block long term care pharmacy Omnicare’s bid to buy competitor Pharmerica Corp. That can’t be encouraging news for Express Scripts and Medco.

Medscape Today is reporting that the American Medical Association and 109 other medical societies are urging Congress to use the peace dividend to fund a credible replacement for the sustainable rate of growth formula.  That formula is intended to set adjustments to Medicare Part B reimbursements to doctors but Congress has prevented the use of the formula for several years because it would slash those reimbursements.

Employee Benefit News reports that an Emory University researcher told the National Academy of Health Underwriters that  “The key,” [to saving costs on]  those whose lifestyle may lead to chronic diseases, such as being overweight, “is not to charge them more but engage them and keep them healthier, keep them out of the clinic, keep them from being readmitted to the hospital.” Hey, it’s a lawyers job to belabor the obvious.

Meanwhile the AMA News complains that patients are confused when the preventive visit is “free” in accordance with the Affordable Care Act but the treatment of problems identified during the visit isn’t. The solution apparently is to make everything free to the patient. This, of course, is the basic problem — health insurance isn’t insurance — it’s a price support for the medical industry.

Both Houses of Congress will be back to work tomorrow. Just about five weeks until the current two month tax extenders law, including the Medicare Part B doctor reimbursement patch, expires (February 29 — Happy Leap Year)

The Wall Street Journal is offering opposing perspectives on various health policy issues. One of the issues is whether there should be a universal patient identifying number. When Congress enacted HIPAA, it required HHS to issue several identifying numbers — including numbers for health plans, employers, doctors, and patients. HHS issued the uniform identifiers for employers and health care providers. But 15 years after HIPAA’s enactment, HHS has not adopted a health plan identifier (although thanks to the private marketplace those identifiers are out there). In the late 1990s Congress due to privacy concerns barred HHS from using federal funds to adopt a uniform patient identifier. However, the federal government under the HITECH Act of 2009 is now hurling money at doctors so that they will adopt health information technology. The federal government also has plans for health information exchanges and an electronic patient information finding service so that my doctor would be able to find who else holds electronic health records on me. How can all of this work without an identifying number? This strikes the FEHBlog as a train that has left the station.

The Leapfrog Group for patient safety has posted report cards on the progress that major health insurers are making toward the Group’s policy objectives.

The FEHBlog is still experiencing internet difficulties at home.

OPM announced on Wednesday that it is requiring FEHB plans to offer “Blue Button” technology to their members in mid-March 2012. “Blue Button allows patients to see, download and keep their personal health data by clicking the ‘Blue Button’ on a secure Internet site.” The Veterans Affairs healthcare system successfully has implemented the Blue Button for its patients. Although this strikes the FEHBlog as a good idea, the fly in the ointment is that while the VA delivers healthcare to patients, the FEHBP delivers benefit payments to enrollees. Now this is not black and white. Kaiser Permanente  is an example of a health care provider that participates in the FEHBP. It will be interesting to see how enrollees react to this new technology.

Standard and Poors reported yesterday that

The S&P Healthcare Economic Composite Index indicates that the average per capita cost of healthcare services covered by commercial insurance and Medicare programs increased by 5.13% over the 12-months ending November 2011. This is a decline from the +5.29% annual growth rate posted for October 2011.

As measured by the S&P Healthcare Economic Commercial Index, healthcare costs covered bycommercial insurance plans increased by 6.96% over the year ending November 2011, down from the +7.10% reported for October. Growth rates in Medicare claim costs rose by 2.37%, as measured by the S&P Healthcare Economic Medicare Index, down from the 2.55% reported for October.

The S&P Healthcare Economic Professional Services Medicare Index also dropped from +4.15% in the year ending October 2011 to +3.62% in November. The S&P Healthcare Economic Hospital Medicare Index increased slightly to +1.33% in November from its +1.28% October value.

That growth rate is somewhat higher than the CMS actuary report that health care costs increase about 3.9% in 2010.

In less than encouraging news related to this topic, Medscape reports that “Most Medicare demonstration projects aiming to reduce costs and improve the quality of care — prime goals of healthcare reform — miss their mark, according to a new study from the Congressional Budget Office (CBO) published online Wednesday.” And the AMA News reports that medical specialists are hiring laid off drug representatives to sell their services to primary care physicians.

The House of Representatives is back to work today and the Senate returns next Monday to face the tax extenders issue again. The American Medical Association is pushing for a permanent replacement for the sustainable rate of growth formula used to set Medicare Part B reimbursements to doctors. The Hill’s Healthwatch blog reports that

The AMA wants Congress to use savings from ending the wars in Iraq and Afghanistan to offset the cost of replacing the SGR. Some lawmakers have balked at using the savings as an offset, though Sen. Jon Kyl (R-Ariz.) warmed up to the idea last year, saying the war savings and the SGR both amount to fake money. [FEHBlog note — Good point!]

If Congress doesn’t tap into the war savings to offset its next doc fix, it will likely make targeted cuts to hospitals and other healthcare providers.

The New York Times reports that Walgreens is standing firm on its decision to end its contract with the large prescription benefits manager Express Scripts. According to the article, Walgreen’s stock price dropped by 25% in the last sixth months of 2011 while the contract negotiations ground onto failure. “A spokesman for Express Scripts said the company remained open to having Walgreen in its network, ‘but only at rates and terms that are right for our clients and in line with other pharmacies in our network.’”

The pharmacy benefit managers trade association announced today the launch of

a new ad campaign – “That’s What PBMs Do” – that highlights the core value proposition of pharmacy benefit managers (PBMs). The ad campaign focuses on key themes including:

• PBMs reduce pharmacy costs for employers, unions, and consumers
• PBMs play a key role in the Medicare Part D success story
• PBM mail-service pharmacy improves safety, savings, and convenience

“This ad campaign will educate policymakers and opinion leaders about the important savings and safety benefits PBMs provide to more than 216 million Americans,” said PCMA President and CEO Mark Merritt.”

Meanwhile Chain Drug Review reports that a coalition of consumer groups and “a growing number” of federal lawmakers are asking the Federal Trade Commission to reject the  Express Scripts merger with Medco on antitrust grounds.

OPM also has encouraged FEHB plans to offer discounts on fitness center membership. The Washington Post this morning reports about a study recently published in the New England Journal of Medicine finding that Medicare Advantage plan members who take advantage of similar programs were in better health than those who don’t. But there’s always a catch, the researchers express concern that the fitness programs can create adverse selection.

Finally, Federal News Radio reports on OPM’s efforts to expand the FEHBP to Indian tribal employees as required by the Affordable Care Act.  According to the article,

At most, 350,000 employees of tribes or tribal organizations could join FEHB.
“The population that we’re bringing into the FEHB is young and relatively healthy,” said National Congress of American Indians Policy Director Ahniwake Rose.

But with more than 8 million people already in the federal healthcare program, it “is probably not going to have any measurable impact one way or the other,” on existing participants, [OPM Healthcare and Insurance Director John] O’Brien said.

He expects about 25,000 employees of tribes to join the plan this year. They should have insurance cards by May 1, he said.