• The U.S. District Court for the District of Columbia decided yesterday that the Centers for Medicare and Medicaid Services must comply with Consumer Checkbook’s FOIA request for 2004 Medicare claims records on physicians located in Washington, DC, Maryland, Virginia, and Illinois. Consumer Checkbook plans to use the information to create on its website a publicly available database on the number of specific medical procedures that doctors have performed in return for Medicare reimbursement. The government has not announced whether it will appeal this decision according to the Wall Street Journal.
• Modern Healthcare.com reported on a public meeting held on August 17 at which the privatization of the American Health Information Community (AHIC) was discussed.
• Modern Healthcare.com also featured a two part report (part one and part two) on a recent government funded report released on August 9 that calls for re-engineering the national health information network so it facilitates the health care fraud fighting activities of third party payors.
• A Potomac MD cardiologist this week agreed to repay the federal government $476,000 based on charges that he billed the FEHB Program and Medicare for services that he did not perform. The cardiologist did not admit to the charges, however.

HHS Secretary Michael Leavitt is celebrating the first anniversary of the President’s executive order on health care pricing and quality transparency and health information technology.

“In its first year, the President’s Executive Order has begun to have a culture-changing effect in the health care sector,” Secretary Leavitt said. “For the first time, we are working effectively together to make possible reliable and consistent measures of quality and price. This is the foundation we must have for a future of affordable, effective, and high quality health care.”

Each of the federal agencies subject to the order, including the U.S. Office of Personnel Management, submitted progress reports. Secretary Leavitt noted in his press release that

OPM, which administers the Federal Employees Health Benefits Program, is promoting health care price and quality transparency through its contracts with private sector insurance carriers and is also requiring them to report on new quality
of care measures. This fall, federal employees will see enhanced consumer information on price and quality transparency in the 2007 Guide to Federal Benefits on OPM’s Web site.

• Last year, the FEHBlog included a post on a major employer initiative called Dossia that was intended to create an electronic health record databank. Dossia has caused consternation among privacy advocates because it sought to sidestep the HIPAA Privacy Rule through the use of patient authorizations. Now a contract dispute has cropped between the employers, such as Intel, who form the Dossia consortium and the vendor, Omnimedix Institute, that is creating the database. The vendor has stopped work on the project as a result of this dispute.
• Also last year, the FEHBlog included reports on a U.S. Court of Appeals for the District of Columbia Circuit opinion, Abigail Alliance v. von Eschenbach, holding in reliance on Washington v. Glucksberg, 521 U.S. 702 (1997) that the due process clause of the Fifth Amendment to U.S. Constitution protects the right of terminally ill people to access investigational new drugs that have cleared initial safety testing at phase I of the trials when the patient’s doctor holds the opinion that the drug is potentially life saving, even though its efficacy has not yet been proven. The D.C. Circuit reversed that decision in an 8-2 vote by the entire court on August 7 holding that “there is no fundamental right ‘deeply rooted in this Nation’s history and tradition’ of access to experimental drugs for the terminally ill.” The judges who were in the majority on the panel decision (Judge Rogers and Chief Judge Ginsburg) wrote a dissent.

• The House last month approved an FDA appropriations bill (HR 3161) that would permit prescription drug reimportation from foreign countries. The White House has advised Congress that it would veto this bill because, among other reasons, the drug importation provisions threaten the safety of the U.S. drug supply. A friend reminded me yesterday about the deaths of over twenty Panamanians last year due to adulterated cough syrup imported from China. The White House has issued formal veto warnings, known as Statements of Administration Policy, about several appropriations bills, including the bill that funds the FEHB Program (H.R. 2989).
• The House Committee on Small Business held a hearing on August 1 at which health care provider group representatives urged Congress to pass a federal prompt payment law that would define the meaning of the term “clean claim.” No insurance industry representatives testified at the hearing.
• URAC has released voluntary accreditation standards for prescription benefit management companies.
• HHS’s Agency for Healthcare Research and Quality (AHRQ) recently released a set of reports titled Privacy and Security Solutions for Interoperable Health Information Exchange. The reports review 34 state Health Information Exchange plans and identify the challenges and feasible solutions for ensuring the safety and security of electronic health information exchange. These reports are intended to form the basis for the development of privacy and security milestones in the National Health Information Network development process. According to BNA, HHS Secretary Mike Leavitt remarked that he was “impressed by the progress but daunted by what needs to be done.”
• Sen. Max Baucus (D MT) has introduced a bill (S. 1951) that would significantly alter the recent Medicaid rule on generic drug reimbursements in favor of pharmacies.

At the August 2 hearing, House Federal Workforce Subcomittee chairman Danny Davis (D IL) announced that his federal employee short term disability bill will include a provision increasing from 22 to 25 the maximum age for unmarried dependent children to remain covered under the FEHB Program. (There is a separate rule for seriously disabled dependents.) A Govexec.com article report published today informs us that “[A]ccording to [OPM Associate Director Nancy] Kichak, OPM does not view such a proposal favorably. Agency officials believe increasing the dependent care age would actually hike the costs of FEHBP group insurance, Kichak said. She did not indicate whether any studies have been conducted to assess the cost of boosting the age.” Ms. Kichak added that dependents who lose coverage as a result of reaching age 22 may purchase temporary continuation of coverage to age 25.

CMS announced today that the average Medicare Part D (prescription drug) plan premium will increase from $22 to $25 per month, or 14%, beginning January 1, 2008. Medicare beneficiaries will have an open season later this year.

• CMS has released its final Fiscal Year 2008 rules on changes to Medicare’s inpatient propective pricing system (IPPS) and its physician reimbursement system. The changes are largely driven by statute and the hospital and physician trade associations have expressed strong opposition to the changes, several of which may be overridden through the FY 2008 appropriations process and/or the SCHIP reauthorization process. Today’s NY Times features an article about hospital earmarks found in the House State Childrens Health Insurance Program (SCHIP) reauthorization bill. The article includes the following quote from Rep. Pete Stark (D CA): “Under Medicare, he added, ‘you are basically setting prices, and the system is clumsy.’” The Newark Star Ledger headlined an article about an interesting feature of the Medicare IPPS rule — its new Medicare exclusion for six hospital created medical problems.
• News reports indicate that Senate Finance Committee Charles Grassley (R IA) is urging a pre-conference committee talks with the House this month about resolving the differences between the House and Senate SCHIP reauthorization bills. According to the National Journal, Sen. Trent Lott (R MS) predicted that ” If [the conference report] goes one iota beyond what was in this bill, we will be able to sustain the veto,” he said. Former acting CMS Administrator Leslie Norwalk is predicting that the President and Congress will compromise by agreeing on a shorter extension of SCHIP, e.g., two years as opposed to five years, which would punt the issue to the next Administration.

• The Fiscal Year 2008 FDA appropriations bill passed by the House of Representatives last week (HR 3161) includes a provision “effectively permitting the importation of lower-cost prescription drugs from places such as Canada, Australia and Europe,” according to the Associated Press. The bill now moves onto the Senate
• CMS announced today that HIPAA National Provider Identifiers will be publicly disclosed over the National Plan and Provider Enumeration System (NPPES) beginning September 4, 2007.

• Congress has adjourned for its summer recess after the House and the Senate had passed their respective versions of the State Childrens Health Insurance Program reauthorization bill, which the House leadership has rechristened as the CHAMP (Children’s Health and Medicare Protection) bill. The two Houses will have to hold a conference committee to reconcile the two bills. The President has stated that he would veto both bills, but the Senate version passed with 68 votes which is sufficient for a veto override in that House. The AMA, other health care provider groups and the AARP are lining up to support the CHAMP bill because it also would improve Medicare reimbursement to providers in part by taking money from the Medicare Advantage plans. AHIP, the health insurance lobby, supports the Senate bill which provides for a SCHIP expansion funded by a tobacco tax increase.
• HHS is seeking public comment on its proposal to convert the American Health Information Community from a federal advisory committee to an independent public/private partnership. September 10 is the deadline for submitting comments.
• This was a busy week for the OPM Director, Linda Springer. The FEHBlog has noted her testimony on federal employee benefits before the House Federal Workforce subcommittee on Thursday. But she also testified on federal employee pay issues before that subcommittee on Tuesday. On Friday, she applauded the introduction of a bill in the Senate (S. 2003) to encourage federal annuitants to return to part-time federal employment. At Thursday’s hearing, Director Springer described this bill as OPM’s most important legislative initiative.
• The Senate Homeland Security and Government Operations Committee approved a federal procurement reform bill (S. 680).

The House Federal Workforce subcommittee held an entertaining hearing on federal workforce benefits on Thursday August 2. The statements and testimony are now posted on the subcommittee’s website. Steve Barr of the Washington Post and Govexec.com each published accounts of the hearing. OPM also issued a press release.