I was asked today whether I think that Congress will pass comprehensive healthcare reform. My response was your guess is as good as mine. Modern Healthcare reports that House Majority Leader Steny Hoyer (D Md) distanced himself today from White House press secretary Robert Gibbs statement that reform must happen by March 18 (although Rep. Hoyer does think that it will happen).

Business Insurance reports that the Senate is close to passing a tax extenders bill (H.R 4213) that will extend the COBRA / TCC subsidy program to employees who lose health care coverage due to involuntary termination of employment on or before December 31, 2010. Currently the program will expire with employees who lose employment involuntarily on or before the end of this month. The program provides a 65% subsidy for up to 15 months. If the Senate gives it approval, the bill must go back to the House for its approval of the Senate version (just like health care reform!).

I discovered today that on February 25, 2010, the Congressional Research Service published a report on the FEHB Program’s available options. The report concludes

FEHBP’s wide range of options allows enrollees to use their own authority to hold down their health insurance costs, and because premiums are based on an average of all plan costs, individual decisions ultimately affect all enrollees. Eligible enrollees must weigh personal factors, such as how much of their wages they are willing to contribute to health insurance and how risk averse they are to potential out-of-pocket costs. However, FEHBP-eligible individuals may revisit their decision every year during the annual open season. Individuals who find themselves with too much or too little risk, under- or over-coverage, and those whose health status changes, may change plans each year. In the past, however, there has been very little movement from one plan to another each year.

On the HIPAA Privacy Rule front, Thomson Reuters reports that

[The HHS Office for Civil Rights, which is responsible for enforcing the HIPAA Privacy and Security Rules]  is collecting views regarding [HIPAA Protected Health Information] de-identification approaches, best practices for implementation and management of the current de-identification standard and potential changes to address policy concerns. OCR will take written comments until March 12 at OCRPrivacy@hhs.gov.

[Susan] McAndrew[, OCR’s deputy director of health information privacy,] said that in addition to guidance, HHS is working on an NPRM regarding business associates, marketing, fundraising, “‘minimum necessary,” the sale of PHI and other issues.

CNN reports that “More than 1,000 protesters — including representatives of organized labor — marched through the streets of downtown Washington before parking themselves in front of the Ritz Carlton, site of the annual conference of America’s Health Insurance Plans, an insurance industry lobbying group.” Next week AHIP co-sponsors the annual FEHB carrier conference at the Washington Hilton. I’ll be there. Will the protestors be there too?

The New York Times reports about a bioethicist Howard Brody, MD, who in a New England Journal of Medicine editorial encouraged his colleagues to bring down health care costs  by using the “Top 5 solution.” In an interview with Dr. Brody, the good doctor explained that

The basic idea is that each [medical] specialty would decide on the top five procedures or diagnostic studies that are done commonly but only really help a small fraction of patients. These are things like arthroscopy for osteoarthritis of the knee or MRI’s and CAT scans, all of which are massively overused, not because they help but because of our enthusiasm regarding high technology.
Once each specialty has gone through the research evidence and decided on its “Top Five,” the respective professional organizations would take a public stand, issuing guidelines and recommendations against overuse of those “Top Five” procedures or studies.
By taking a public stand and making it harder for individual doctors to say, “Oh, I know better,” we could build real momentum for cost containment. And we would ultimately all benefit because we don’t need all that technology. You can still be as healthy without it.

How I do love common sense.

In the strange bedfellows department, the American Medical Association (“AMA”) has announced that it “has selected Ingenix CareTracker(TM) as the first electronic health records (EHR) system offered through the AMA’s new online health information solutions platform for physicians.” For the past decade, the AMA has been bludgeoning Ingenix and its parent company United Healthcare over the alleged errors in the Ingenix ususual, reasonable and customary databases that many insurers used to price out-of-network physician services. In January 2009, the AMA and Ingenix settled the AMA’s lawsuit. The settlement and the New York Attorney General’s separate resolution of the Ingenix UCR database controversy likely will bend the healthcare cost curve up, which had been the AMA’s objective.

The President’s press secretary set March 18 as the deadline for Congress to enact general health care reform according to the Washington Post. That’s just two weeks from today for the House to pass the Senate bill and for both bodies to pass a set of modifications to the Senate bill using budget reconciliation. That’s also a tall order.

The Secretary of Health and Human Services and the President met with chief executives from five health insurance companies to complain about health insurance rate increases.  Secretary “Sebelius asked the executives to post proposed rate increases and actuarial data supporting them online.” The White House blog speaks about putting the American people ahead of insurance companies.  The insurance executives tried to look on the bright side according to Modern Healthcare.  Rhetorial question — when will the healthcare executives be called on the carpet for fueling the health insurance premium increases?

Asparity Decisions Solutions, Inc., announced its Plan SmartChoice awards for the 2010 FEHBP open season.

Senator Jim Bunning (R Ky) agreed tonight to permit the Senate to consider H.R. 4691 by unanimous consent. H.R. 4691 is the bill in addition to extending unemployment compensation benefits, will prolong the COBRA/TCC premium subsidy program and will avoid the 21% Medicare reimbursement cut to doctors until March 31, 2010. Sen. Bunning was allowed to offer a pay-go amendment to the bill. USA Today reports that the Senate may pass the bill tonight.

Update: H.R. 4691 was enacted last night.

The House Energy and Commerce Committee “sent letters to the four largest for-profit health insurance companies [Welllpoint, United Healthcare, Aetna, and Humana] asking for information about claim denials related to pre-existing conditions and company policies related to coverage of maternity care in the individual health insurance market. [The Committee} also requested that the CEOs of the companies testify on these issues at a Subcommittee on Oversight and Investigations hearing on March 23, 2010.

Dow Jones reports that “Health and Human Services Secretary Kathleen Sebelius plans to meet Thursday with health-insurance chief executives she recently invited to discuss premium rates.”  

The President is expected to update his strategy for enacting general health care reform tomorrow. The Associated Press reports tonight that 

In remarks at the White House on Wednesday, the president will describe the final elements of his proposal and then ask Congress to enact it, aides said. Obama was expected to reiterate why changing the system is so important and again explain what his plans would mean to families and businesses. The aides also expected Obama to talk about the Republican ideas he wants woven into the Democrats’ plans. [The President released a letter that he issued to Congressional leaders today outlining four acceptable Republican ideas. The letter is reprinted in the Politico ]

He is expected to leave no doubt that, barring an unexpected change in Republican tactics, he wants Congress to pass the legislation using budget reconciliation rules, which prohibit Senate filibusters.

Modern Healthcare reports that the President will announce the path forward on health care reform later this week.

The Senate, to my surprise, failed last week to pass a bill already approved by the House that temporarily would extend the COBRA/TCC subsidy and avoid a 21% cut in Medicare Part B payments to doctors. The AMA News reports that the Senate will takes up these “extender” issues this coming week. According to the article,

The Centers for Medicare & Medicaid Services started informing physicians on Feb. 26 that contractors will hold Medicare physician claims for 10 business days, starting March 1, to give lawmakers more time to act. That means if Congress and the White House enact a delay before the end of the two weeks and make it retroactive to March 1, then doctors shouldn’t expect to see any Medicare checks come back with a 21% cut applied.

Last week, Health Grades “[f]or the fourth consecutive year, identified 50 hospitals that have provided outstanding clinical quality year after year and recognizes these hospitals as America’s 50 Best Hospitals.” Inova Fairfax Hospital is the only facility in the Washington, D.C., metropolitan area to receive this accolade.

The AHIP News Wire reports that “An insurer is upping the ante for doctors to meet quality standards. Blue Cross and Blue Shield of North Carolina (BCBSNC) has invited 4,000 primary care physicians to apply for the “substantially higher payments” of a reimbursement structure intended to improve the quality of patient care.” Good luck to them.

The President held his bipartisan healthcare summit at the Blair House today. The Politico reflects the general consensus as far as I can tell that there was no clear winner from the lengthy meeting. It further reports that “After a brief period of consultation following the White House health reform summit, congressional Democrats plan to begin making the case next week for a massive, Democrats-only health care plan, party strategists told POLITICO.”

“In attempting to solve a problem that doesn’t exist, this legislation is the triumph of sound bites over substance. The Congressional Budget Office has said that passage of this legislation will do nothing to reduce health care costs. Moreover, according to the National Association of Insurance Commissioners, anti-competitive ‘activities are not permitted under the McCarran-Ferguson Act and are not tolerated under state law.’ Real reform means containing costs to ensure that health care is affordable for working families and small businesses. It’s time to clear the political hurdles that stand in the way of real cost containment.”

The House Federal Workforce Committee held a hearing today on the Chairman’s bill (HR 4489) to regulate prescription drug pricing in the FEHB Program. The testimony is available here. Preceding the hearing, the Office of Personnel Management issued a letter “to provide fee-for-service carriers with new FEHB pharmacy benefit management (PBM) transparency principles.”  

Govexec.com, Joe Davidson of the Washington Post, and Federal News Radio have reported on the hearing.

The President released a summary of his health care reform proposal yesterday. The proposal drives off of the bill that the Senate passed on Christmas Eve. It does not include a public option, but it does include a new federal commission to keep health insurance premiums “affordable.”  Interestingly, the Washington Post joined the Wall Street Journal in editorializing against this commission.

Modern Healthcare reports that “At a news briefing [today], House Speaker Nancy Pelosi (D-Calif.) said the White House’s new reform blueprint was “getting a good reception” among members of the House Democratic Caucus. “We have a lot more work to do” to get all Democrats onboard with the legislation, she acknowledged.

The Politico has posted the agenda for Thursday’s healthcare reform summit.

The Republican proposal is posted here.

Well this week will feature several big events — The President is expected to release his proposal to merge the Senate and House healthcare reform bills tomorrow according to the New York Times; the House Federal Workforce Subcommittee will hold a hearing Tuesday afternoon about its Chairman’s bill (HR 4489) to regulate prescription drug pricing in the FEHBP, and the President’s healthcare reform summit will take place on Thursday.

As prescription benefit managers (“PBMs”) will be under scrutiny at Tuesday’s hearing, let me point out a worthy endeavor of those companies — promoting personalized medicine.  Business Insurance reports about Medco’s effort to use genetic testing to accurately dose the blood thinner wayfarin and tamoxifin, a drug used to treat cancer. What’s more

Woonsocket, R.I.-based CVS Caremark Corp. is preparing to introduce a similar program in May after acquiring a majority stake in Generation Health Inc., a genetic benefit management company in Upper Saddle River, N.J. The companies last fall formed a strategic partnership to expand pharmacogenomic clinical and testing services for CVS Caremark PBM clients to improve care for patients who either don’t respond to their medications or have adverse reactions.

It’s also worth noting a Federal Times column by Reg Jones which discusses how different types of federal annuities affect eligibility for annuitant coverage under the FEHBP.

Last month, OPM announced a reorganization, and this month the Centers for Medicare and Medicaid Services is doing the same. The Hill has an interesting report about the changes, which were announced on Wednesday by internal CMS email, a copy of which is included in the Hill article. The article points out that CMS has not had a Senate confirmed Administrator since October 2006 when Mark McClellan left that post.  President Obama has not nominated an Administrator. Since he took office, CMS’s chief operating officer Charlene M. Frizzera has been acting administrator.