FEHBlog

• The Washington Post and the Hill are reporting that the Congressional leadership is bowing to the Bush administration’s pressure on the FY 2008 appropriations measures. Consequently, the likelihood of a government shutdown has dramatically decreased.
• The President has vetoed the SCHIP reauthorization bill for a second time according to Modern Healthcare.com and the Washington Post. A temporary extension of the SCHIP Program funding is now likely in order to punt the issue into the 2008 election campaign.
• An effort to add the Medicare reimbursement fix to the alternative minimum tax patch bill has been unsuccessful according to the Kaiser Daily Health Care Report. It grows increasingly likely that legislation to reverse the 10.1% reduction in Medicare Part B payments to physicians scheduled for January 1, 2008, will not occur this month, although Congress is not likely to adjourn until next week.
• HHS has been holding the fourth National Health Information Network forum this week. Healthcare IT News reports on the meetings. The NHIN is intended to be great big patient registry that will connect regional health information organizations Publish Postor RHIOs. However, a Harvard study published this week finds that few RHIOs actually are operating and many more are failing. Meanwhile, the National Committee on Vital and Health Statistics, an HHS agency which has been a haven for privacy zealots, is working on a report that will recommend revamping the allegedly “inadequate” HIPAA Privacy Rule according to the AIS Privacy Report written by Theresa Defino.

News reports this evening from the Washington Post and The Hill indicate that negotiations between the White House and Congress over FY 2008 have broken down four days before the current continuing resolution funding the Government expires on December 14. Christmas is only two weeks from tomorrow. It will be interesting to see whether Congress can address any health plan related bills, such as mental health parity, this month.

• The federal benefits Open Season officially ends tomorrow December 10. Commentators have offered last minute advice to federal employees and annuitants here and here.
• There has been little evident forward motion on the federal appropriations and SCHIP reauthorization fronts over the past week. It turns out that Congress did not send its second SCHIP reauthorization bill to the White House last week, and the current continuing resolution (HR 3222) funding the federal government, including the SCHIP and FEHB Programs, expires this Friday, December 14. We’ll just wait and see what the backrooms on Capitol Hill produce.
• We also are anxiously anticipating the emergence of a consolidated House mental health parity bill and Medicare reimbursement fix bill that would avoid the 10.1% cut in Medicare Part B compensation to physicians scheduled for January 1.
• Health Affairs features an interesting conversation between HHS Secretary Michael Leavitt and Leonard Schaeffer, the retired CEO of Wellpoint. I particularly enjoyed this exchange on healthcare information technology (IT) which can be categorized under the no good deed goes unpunished heading:
  

  Schaeffer:There’s no magic in IT. The benefits of health IT come from changing workflow and practice patterns based on better information. Leavitt: So, we’ve got to experiment a little. We’ve got to say, “Let’s prove up the business model here.” Everybody is optimistic about health IT, and we’ve seen it work in closed systems. But we’ve never seen it work on a large networked basis. We really do need to demonstrate this. And you’ll see that in the fairly near future. Schaeffer: I’ve got the scars to prove your point. WellPoint received awards for attempting to accelerate health IT adoption, but the truth was, we tried and failed. WellPoint gave away $42 million worth of hardware and software to doctors, many of whom happily took their laptops home to their kids. All we got from that effort was a letter from the California Medical Association accusing us of unfairly imposing a gift tax on recipients of the free IT supplies.

• Modern Healthcare featured an update on AHIC’s efforts to mandate electronic prescribing in the Medicare program. The article notes that “Wednesday [December 5], U.S. Sens. John Kerry (D-Mass.), Debbie Stabenow (D-Mich.) and John Ensign (R-Nev.) held a news conference to ballyhoo a separate piece of legislation, the Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007, a bill they’ve sponsored to support e-prescribing. The Senate Judiciary Committee also scheduled hearings Wednesday on the Drug Enforcement Agency policies toward e-prescribing.”
• WEDI and the North Carolina Healthcare Information and Communications Alliance, Inc. released this week a projected HIPAA standard transactions and code sets regulatory timeline. According to their press release, “[t]he timeline estimates that, based on current assumptions, implementation of the 5010 version of HIPAA transactions will be complete in 2014. This date is important because the ICD-10 clinical coding system cannot be used until 5010 transactions are implemented and can be processed using the ICD-10 codes.”
• AHIP, the Blue Cross Blue Shield Association, and Health Level 7 signed a memorandum of understanding on maintaining the electronic transaction standard to transfer subscriber information between gaining and losing health plans that they developed for public use.
• EBRI released a report on the future of employment based health benefits that concludes that the current system is stable.

• Modern Healthcare reports that HHS Secretary Michael Leavitt “said that a Medicare bill expected to emerge from the Senate later this week should tie the use of health information technology to higher Medicare physician reimbursement.” This is the Senate Finance Committee’s bill to avoid the 10.1% cut in Medicare Part B reimbursement to physicians that will be effective on January 1, 2008, unless Congress acts.
• The AMA News reports that the AMA House of Delegates recently voted to call for national legislation to allow physicians to bill patients for fees that Medicare does not cover. Currently, physicians may choose whether or not to participate in Part B. Participating physicians generally receive 5% more money from Medicare than non-participating physicians but participating physicians may only balance bill patients for the Medicare deductible and co-insurance. A non-participating physician may balance bill for these items plus no more than 15% above the Medicare reimbursement amount. Several states, including Massachusetts, prohibit physicians for balance billing this 15% surcharge. The AMA wants Medicare to preempt those state laws.
• HHS has appealed a U.S. District Court for the District of Columbia order that would have required HHS to provide the Center for the Study of Services HHS claims data that the Center planned to use for the purpose of evaluating provider quality of care. The lower court order has been stayed pending this appeal to the U.S. Court of Appeals for the District of Columbia Circuit. The Center’s press release is available here.

• 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.