• Congress returns from its Thanksgiving recess this week. The Congressional leadership is sending the SCHIP reauthorization bill to the White House for a likely second veto after bipartisan negotiations failed. The Congressional leadership also is working to send the President the remaining appropriations bills either individually or as an omnibus bill before the current continuing resolution funding the federal government expires on December 14.
• The Gallup Organization released its annual poll on public attitudes toward health and healthcare in the United States — while the public views the health care system to be in crisis, they are quite satisfied with the health care that they personally receive. “The new poll reconfirms this perennial duality in healthcare attitudes – that Americans are much more concerned about the healthcare problems “out there” than about the healthcare issues they face in their personal lives.”
• The American Health Information Community recommended this week that HHS Secretary Michael Leavitt “should seek authority from Congress to mandate electronic prescribing as a condition of participation in Medicare Part B, pursuant to standards defined by the Medicare Modernization Act (MMA) for e-prescribing” subject to certain prerequisites.
  
• The Massachusetts Hospital Association announced that beginning in early 2008 “all Massachusetts hospitals will adopt a uniform policy to not charge patients or insurers for certain serious adverse events as defined by the National Quality Forum (NQF), including wrong site surgeries and serious medication errors.” Minnesota hospitals adopted a similar policy in September 2007.

• OPM Director Linda Springer announced that the appointment of Kay T. Ely as OPM’s Associate Director, Human Resources Products and Services (HRPS) Division. This Division is responsible for the Federal Employees Health Benefits Program and other federal employee retirement and benefit programs.
• President Bush announced the resignation of his advisor Al Hubbard, who had taken a lead role in the developing and promoting President’s health care agenda.
• CIGNA, a major health care insurer that has been expanding its involvement with the FEHBP, announced the acquistion of Great-West Healthcare, the Healthcare Division of Great-West Life & Annuity, Inc.
• Finally I was intrigued by this letter to the editors of the Wall Street Journal published yesterday
  

  I am saddened by Barbara Calder’s plight (“How U.S. Health System Can Fail Even the Insured,” page one, Nov. 16.) Unfortunately, most Americans seem to think that their insurance company is in business to care for their daily medical needs. The fact is that the for-profit insurance companies exist as business entities to create profits for shareholders and prevent financial catastrophe to the insured. Patient premiums are the means by which such profits are generated, and any payments made for medical care that can be denied (e.g., a referral to a specialist or a drug like Celebrex) fail the insurer’s fiduciary duty to shareholders. As I explain to my patients daily, their homeowner’s insurance doesn’t pay for the plumber to fix the clogged drain, and their car insurance doesn’t pay for a tune-up or gasoline. Those insurance policies are purchased to prevent financial catastrophe in the event that the house burns down or the car is destroyed in a wreck. Our current health-care system is in disrepair, but part of the blame must go to patients. Ms. Calder could have chosen to actually pay the specialist had she truly valued the advice she was seeking. In the current system, an internist such as myself who agrees to participate in health plans gets paid less to care for a critically ill patient than my plumber gets to fix my leaky toilet. It is for this reason that I have decided not to accept many insurance plans. My patients and I value my time and expertise, and realize that if you don’t have your health, not much else matters. Perhaps that is why I have the time to spend with patients and have diagnosed four cases of Ehlers-Danlos syndrome in the past year alone. Lyle D. Kurtz, M.D.
  Diplomate, American Board of Internal Medicine
  Beverly Hills, Calif.

Not much has happened since Wednesday due to the Thanksgiving holiday, which I hoped that everyone enjoyed.

It’s worth noting before Congress adjourned Rep. Joe Burgess (R Tex) introduced a bill (HR 4190) that would exclude members of Congress from FEHB Program coverage. Instead they would receive a voucher worth $1500 for single coverage or $3000 for family coverage that they could use to purchase their own insurance.

Also, there have been several interesting articles — here and here for example — about a new health plan model known as a “medical home” that would encourage greater use of primary care doctors to coordinate care. NCQA is holding its conference on building the medical home next month.

• Mercer has issued its annual survey of employer sponsored health plans. Cost increases have been relatively stable around 6% for three years. Employers are saving money with consumer driven health plans. In 2007, health savings account based plans cost $5,679 per employee annually; health reimbursement account plans cost $6,224 per employee, and traditional PPO plans cost $7,352. See OPM chart for distinctions between HSA and HRA plans.
• House and Senate negotiations over the mental health parity bill are continuing while the House leadership tries to figure out how to resolve the pay-go issues associated with the bill. According to BNA, the major issue confronting the negotiators is whether to accept the House bill’s use of the American Psychiatric Association’s DSM-IV to define mental illnesses. OPM currently uses the DSM-IV to define the scope of the FEHB Program’s mental health parity program. However, while it would be a simple administrative matter for OPM to change definitions, it would take a lot more effort to make such a change if the DSM-IV were enshrined in law.
• BNA reports that Senate Finance Committee members favor a two year fix (2008 and 2009) of the Medicare physician reimbursement issue because it would be less expensive in total. There is no timetable for consideration of the Medicare package. Absent a legislative fix, Medicare reimbursement to doctors will be cut by about 10% on January 1, 2008.
• FCW.com reports that the Senate could not pass the Wired for Healthcare bill by unanimous consent due to objections from the American Medical Association (not enough money, etc.) and privacy zealots.
• New York State Attorney General Andrew Cuomo concluded doctor ranking agreements with United Healthcare and several other health plans this week.
• Last week, I blogged about a lawsuit between CaremarkPCS, the prescription benefits manager, and Walgreen’s, the pharmacy chain. Walgreen’s had terminated on short notice a contract with CaremarkPCS in Illinois and Wisconsin affecting four employer plans. CaremarkPCS sought a temporary restraining order which Judge Mark Filip granted. President Bush just nominated the Judge to be Deputy Attorney General.
• The Blue Cross Blue Shield Association’s National Council of Physician Executives is supporting the CMS “never events” policy of limiting reimbursement of treatment of hospital errors. This may lead individual Blues plans and other insurers to adopt the CMS policy, which takes effect October 1, 2008.

• The Federal Times featured an article on high deductible FEHB plans that are associated by law with health savings account. Approximately 9,000 federal and postal employees out of 2 million have enrolled in these plans since their introduction in 2005.
• OPM posted on its website its Fiscal Year 2007 Performance and Accountability Report. According to the agency, “The Performance and Accountability Reports provide detailed information on our audited financial statements and performance results achieved. This Report is submitted to the President, Congress, and members of the public as a measure of how well we are managing programs and finances. Reports are submitted for Fiscal Year time periods.”
• Congress is now in a two week Thanksgiving recess, and it has three weeks of work planned for December. There was no significant progress made on appropriations bills or SCHIP reauthorization last week. The Kaiser Daily Health Report notes that CongressDaily is reporting that SCHIP reauthorization compromise is dead at least for this year.
• Speaking of Congress, the Medill Report from Northwestern University published an online report about two House members who have had difficulty with their FEHB plans. I have a friend whose daughter attends Medill. She tells me that a single typographical error can lead to a failing grade. This Medill article has a doozy.
• HHS announced voluntary e-prescribing standards for doctors last week. According to Healthcare IT News, CMS Administrator Kerry Weems said that Congress, not HHS, can create a Medicare mandate on doctors to use e-prescribing.
• CMS announced that “aggressive oversight efforts have resulted in a further reduction of the number of improper Medicare claims payments, which declined from 14.2 percent in 1996, to 4.4 percent in 2006, to 3.9 percent in 2007.”
• HHS Secretary Leavitt said that he expects to recognize the first set of interoperability standards supporting health information exchange this year. These standards will be incorporated into the federal procurement process and will become part of future certification criteria. Read more at the Secretary’s blog.
• Reports on the November 13 American Health Information Community meeting can be found here, here and here.

• Open Season advice articles keep popping up — here, here, here and here for example.
• The Federal Times featured an article on FEHB plan personal health record offerings.
• Aetna took a page out of Cigna’s playbook and entered into a settlement with the New Your State attorney general concerning its hospital ranking program according to this Hartford Courant article.
• The Journal of the American Medical Association published a study concluding that the HIPAA Privacy Rule is having a chilling effect on medical research according to this Washington Post article. I am not surprised by the fact that researchers simply don’t understand this complicated section of an unnecessarily complicated rule.
• The New York Times reports that President signed the FY 2008 Defense appropriations bill that also continues funding of the federal government through December 14, 2007, beyond the end of the current Open Season.
• According to Reuters, the Congressional Budget Office Director testified that medical tests and procedures of dubious value are driving up health care costs. The Blue Cross and Blue Shield Association has proposed the creation of a national institute to study the effectiveness of medical tests and procedures.

• Happy Veterans’ Day! The FEHB Program’s Open Season starts tomorrow, and the benefit mavens are offering their perspectives here and here, among other places.
• There was a break in the appropriations logjam last week as Congress approved a Fiscal Year 2008 Defense appropriations bill (HR 3222) that the President plans to sign. This bill includes an extension of the current continuing resolution funding the federal government to December 14. Congress also sent the President a Labor-HHS-Education appropriations bill (HR 3043) that the President plans to veto. That bill currently lacks a veto proof majority. Thought is now being given to an omnibus appropriations bill according to the Hill. The Hill report, “The question ultimately remains whether either side will let the fight lead to a shutdown of the government, like the infamous standoff between the Clinton White House and the Republican-led Congress in 1995. Neither side seems to have much appetite for that scenario to repeat itself, but neither side is backing down.”
• Rather than send the second SCHIP bill to the President for a certain veto, Congressional negotiators are trying to work out a veto-proof compromise bill according to the Hill, which also reported that “The core group of negotiators included Majority Leader Steny Hoyer (D-Md.), Sen. Orrin Hatch (R-Utah), House Energy and Commerce panel Chairman John Dingell (D-Mich.) and Rep. Judy Biggert (R-Ill.).”
• Congress is also working to fix the 10.1% physician reimbursement cut built into the Medicare program for 2008. The prescription benefit manager’s (PBM) trade association, PCMA, is lobbying to include a Medicare e-prescribing mandate in this bill.
• In an interesting footnote, a major PBM, CaremarkPCS, is suing the Walgreen’s pharmacy chain for Walgreen’s decision to terminate its provider contract with respect to four Chicago area health plans, none of which are FEHB plans. The PBM’s TRO motion hearing is set for November 13.

OPM has issued its always interesting report of significant FEHB Program changes for 2008 (Benefit Administration Letter No. 2007-405). What’s more OPM has unveiled its 2008 Open Season web site.

• The Center for Medicare and Medicaid Services (“CMS”) last Thursday issued its final rule revising Medicare’s outpatient hospital prospective payment system for the 2008 calendar year. “CMS estimates hospitals will receive an overall average increase of 3.8 percent in Medicare payments for outpatient services in CY 2008.” CMS is linking Medicare reimbursement to quality measure reporting by hospitals.
  

  In CY 2008, CMS is requiring that hospitals report seven consensus quality measures, including five emergency department acute myocardial infarction transfer measures and two surgical care improvement measures. Hospitals that are paid under the Inpatient Prospective Payment System are required to report the applicable hospital outpatient quality measures in order to receive the full OPPS market basket update in CY 2009; otherwise, their CY 2009 update will be reduced by 2.0 percentage points.

• CMS also announced its final rule on Medicare Part B payments to physicians. CMS explains that a statutory formula mandates a 10.1% reduction in those payments for the 2008 calendar year, unless Congress changes the formula which is likely in my opinion. CMS currently is paying physicians who participate in the voluntary Physician Quality Reporting Initiative (PQRI) Medicare payment incentives of up to 1.5 percent of their total allowed charges, subject to a cap. “The 2008 rule also adopts recommendations of the American Medical Association’s Relative Value Update Committee to increase the payments for the work involved in providing anesthesia services by 32 percent. In addition, the value of the work component of certain physician visits to patients’ homes will increase.”
• The Philadelphia Inquirer is reporting the the Medicare Part D prescription drug program is one the factors causing a substantial reduction in prescription drug imports from Canada.

• There has not been much progress in the appropriations process since last week. Congress passed another SCHIP reauthorization bill this week that the President again intends to veto. Neither the House nor the Senate passed the bill by a veto proof margin. Business Insurance reported on the burdens that the SCHIP reauthorization bill will place on employers that sponsor health plans.
  

  Among these are requirements to: disclose plan information to states upon request; create special enrollment periods for employees and dependents who lose eligibility for the federal program; and extend the Family and Medical Leave Act to 26 weeks from the current 12 weeks for employees to care for injured members of the armed services.

  A Congressional Conference Committee agreed upon a combined Labor-HHS-Education (HR 3043) and Military Construction – Veterans Affairs (HR 2642) appropriations bill. According to the Washington Post. the leadership is betting that the President who has threatened to veto HR 3043 will not veto a bill that includes funding for veterans. The FY 2008 continuing resolution (H. Jt. Res. 52) that currently funds the Government and the SCHIP program expires on November 16.

• The New York Times business section today featured an article by a Harvard economics professor N. Gregory Mankiw who debunks “three of the true but misleading statements about health care that politicians and pundits love to use to frighten the public.”