FEHBlog

I am exhausted from attending my favorite education event of the year — the OPM AHIP FEHBP carrier conference — and then trying to catch up on the NCAA tournament. I will be sharing some highlights over the weekend.

The Congressional leadership did release the Congressional Budget Office report and the 153 page managers’ amendment which serve as the reconciliation sidecar. The President postponed his Asian trip until June and the House leadership is scheduling a floor vote for Sunday, according to the Politico. Here is the Rules Committee’s summary of the managers’ amendment. Here is the Politico’s arena of opinions on the CBO report. (Yes, I am in the tank for the Politico).

Govexec.com has an interesting report about the how the managers’ amendment links the increased 40% high cost excise plan tax thresholds to premium increases in the Blue Cross Federal Employees Plan standard option. The tax would take effect in 2018 rather than 2013 as provided under the Senate bill.
Business Insurance reports that  “In all, the changes [to the excise tax] would reduce the amount of revenue generated by the tax by 80%, according to the Congressional Budget Office.

The Politico’s Live Pulse blog says it all — No Congressional Budget Office numbers on the undisclosed health care reform bill tonight. CBS News reports that

There are currently 431 members of the House of Representatives. Assuming all Republicans vote no, Speaker Pelosi needs 216 Democrats to vote yes – meaning she can afford to lose 37 of her members at most.

As of now, CBS has tallied 19 Democrats who say they plan to vote no; 48 more say they are on the fence.

Those members are getting so many calls from constituents on both sides that house phone lines were overloaded today. Back in their home districts, the pressure is just as intense.

In an interesting development, the House of Representatives approved by voice vote a further extension of the COBRA / TCC subsidy program and the moratorium on the scheduled 21% Medicare Part B payment cut to physicians until the end of April (H.R. 4851). The current extensions expire at the end of this month. According to Business Insurance, “As part of a broader bill, H.R. 4213, the Senate last week approved a longer extension to enable employees laid off through the end of the year to receive the subsidy [and continues the moratorium until September 30, 2010], but the House has yet to take up that measure because of funding concerns about certain provisions in the bill, observers say.”

The HHS Office for Civil Rights (“OCR”) which enforces the HIPAA Privacy and Security Rules made an important announcement:

OCR will implement important privacy and security provisions of the Health Information Technology for Economic and Clinical Health (HITECH) Act through notice and comment rulemaking, as required by the Administrative Procedure Act.  These provisions include: business associate liability; new limitations on the sale of protected health information, marketing, and fundraising communications; and stronger individual rights to access electronic medical records and restrict the disclosure of certain information.  OCR continues work on a Notice of Proposed Rulemaking (NPRM) regarding these provisions.  Although the effective date (February 17, 2010) for many of these HITECH Act provisions has passed, the NPRM and the final rule that follows will provide specific information regarding the expected date of compliance and enforcement of these new requirements.

However, interim final rules implementing HITECH Act provisions in two areas have already been issued and are currently in effect: enforcement and breach notification.  New civil money penalty amounts apply to HIPAA Privacy and Security Rule violations occurring after February 17, 2009.  Covered entities and business associates must comply now with breach notification obligations for breaches that are discovered on or after September 23, 2009. OCR announced previously that it would use its enforcement discretion not to impose fiscal sanctions with regard to breaches discovered before February 22, 2010. Since that date has passed, OCR will enforce the Breach Notification Interim Final Rule, including with the possible imposition of sanctions, as it does with the HIPAA Privacy and Security Rule requirements.

Finally, the American Medical Association as part of its ongoing effort to bend the cost curve upward “unveiled its new National Managed Care Contract (NMCC) and database to help physicians analyze and negotiate contracts with insurers and help provide relief from unfair corporate business practices.”

The health care reform effort still remains a behind the scenes operation while the Speaker of the House and her leadership team continue in their efforts to whip up 216 House votes for the Senate bill plus the House managers’ “side car” reconciliation bill. The House Budget Committee approved the use of budget reconciliation yesterday by a 21-16 vote. The next step is to go to the Rules Committee before which point  the manager’s sidecar bill — amendments to the Senate bill — would be unveiled. Fox News is reporting that the Rules Committee plans to hold this meeting on Friday, March 18, which would allow a vote on Saturday.  There’s no real deadline here other than the adjournment of the current Congress at the end of the year.

The Rules Committee may approve the so-called Slaughter solution (Rep. Louise Slaughter chairs the Rules Committee) which would deem the House to pass the Senate bill, rather than actually pass it. As this Politico page indicates, this maneuver has generated a lot of controversy. 

There are just so many things we don’t know yet.  The Hill reports that “As of late Tuesday afternoon, Congressional leaders were still waiting for the final numbers from the Congressional Budget Office on pending health care legislation.”  It’s unlikely we’ll see the managers’ sidecar bill until any CBO scoring issues are worked out. 

Meanwhile I look forward to the AHIP OPM FEHBP carrier conference which will be held on Thursday and Friday. Until then, I will try to take some advice from OPM’s Feds Get Fit web site.

The President has delayed his Asian trip from March 18 to March 21 in the hope (expectation?) that Congress will enact general health care reform this week.  The AP reports that

The House’s chief Democratic headcounter [Rep. James Clyburn (D SC)] said Sunday he hadn’t rounded up enough votes to pass President Barack Obama’s health care overhaul heading into a make-or-break week, even as the White House’s top political adviser said he was “absolutely confident” in its prospects.

White House spokesman Robert Gibbs predicted House passage this week, before Congress takes a two-week break and Obama travels to Asia, a trip he postponed to push for the bill.

The Politico published an email from Rep. Chris Van Hollen (D Md) projecting a schedule for this week that begins with a House Budget Committee hearing tomorrow and ends with a vote on Friday or Saturday.  The Wall Street Journal reported yesterday that under health care reform, members of Congress and their staffs will receive health benefits coverage through the state health insurance exchanges, rather than the FEHB Program. 

Meanwhile, we keep inching toward the date on which the Office of Personnel Management will issue its annual call letter for FEHB carrier 2011 benefit and rate proposals. In last year’s letter, OPM encouraged carriers to develop value based benefit designs. Kaiser Health News reports on a value based benefit design that five different health insurance carriers are offering to Oregon employers. The article explains that the design works as follows:

Just as in more traditional insurance plans, workers would pay an annual deductible of about $250 before coverage kicks in. Doctor office visits would cost workers $10 to $20. Employees would pay 20% of the cost of hospital care, up to an annual maximum of $1,500 for individuals and $3,000 a year for family coverage.

But employees with certain conditions — asthma, congestive heart failure, diabetes, depression, heart disease, chronic bronchitis or emphysema — would get prescription drugs and visits with physicians free or at greatly reduced rates. High blood pressure, another common condition, would qualify for low-cost care if it was part of an overall diagnosis of heart disease.

Conversely, they’d pay much more if they have a treatment or test from a list of about 20 broad categories, including knee or hip replacement, cardiac bypass surgery, artery-opening stents, hysterectomies, high-tech-imaging exams or emergency room visits. In those cases, they’d pay double the annual deductible, double the amount they’d normally pay for an office visit and up to half the cost of hospital or ER visit, up to the $1,500/$3,000 maximums.

Along the same lines, the Associated Press reported last week on over-utilized medical tests.

Speaking of OPM, the agency posted its 2010-2015 Strategic Report on Friday. There are no big changes to the FEHB Program reported there.

Finally, last week, PCMA, the prescription benefits manager trade association, released the results of a survey of 305 federal employees from the DC area. The survey found that “Seventy-four percent of those enrolled in the Federal Health Benefits Program (FEHBP) oppose a new effort by Congress to change the program’s prescription drug benefits,”

While Secretary of Health and Human Services Kathleen Sebelius continues to rail against health insurers, the Senate passed the tax extenders bill (H.R. 4213) which would prevent a 21% cut in Medicare Part B payments to doctors until October 1, 2010. As noted in Tuesday’s Tidbit’s the bill also extends the COBRA / TCC subsidy program until December 31, 2010.  That bill now goes back to the House for final approval.

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.