FEHBlog

CAQH has created a 100 member coalition called the Committee on Operating Rules for Information Exchange that has developed a standard operating rules to be used with the HIPAA 270 and 271 transactions in order to provide providers with useful eligibility and benefits information electronically. These operating rules have now been established, and this week the VA announced that it will participate in the program. If you are a health plan or a health care provider, this initiative appears to be worth your investigation assuming that you are not already involved.

The consumer driven plans in the FEHB Program seed their enrollees’ health savings accounts with contributions from the plan. Enrollees could make additional contributions up to the annual limit with after tax dollars and then claim a deduction on their tax returns.

Last Friday, OPM released a benefits administration letter announcing it is implementing payroll technology that will allow these enrollees to make pre-tax contributions to their health savings accounts via the Federal Flexible Benefits Plan. This new technology is being implemented across the government throughout this year.

At the OPM FEHBP Carrier Conference last month, Medco CEO David Snow explained the of reducing waste in the health care system will provide the funding for new technologies, such as human genome research applications. (Remember that April 25 is National DNA Day!) Mr. Snow pointed out how new genetic based testing will pinpoint the proper dosage of medication. Three physician researchers at the VA Outcomes Group and faculty members at Dartmouth Medical School wrote an interesting article in the Washington Post health section today headlined “Finding More Cancer isn’t the Answer.” Much public emphasis is placed on finding cancer early, but the authors point out that in some cases finding cancer early does save lives but in other cases it is irrelevant because either the cancer is very aggressive or it’s not particularly dangerous. The trick is to identify and use the testing that will save lives. I trust that this is where the various quality initiatives that are part of the Government’s quality transparency initiative will play an important role.

In commemoration of the fourth anniversary of HIPAA Privacy Rule compliance date, April 13, 2003, the American Health Management Information Association (AHIMA) is sponsoring a National Health Information Privacy and Security Week. An AHIMA article and quiz for the public is available here. Go and lock up some health information right now!

The New York Times reports today that the leaders of Congress are crafting a compromise bill that will open the pathway for generic versions of biological drugs. Biological drugs, the fastest growing and most expensive segment of the pharmacetical market, were not even on the radar screen when Congress passed the Hatch-Waxman Act in 1984. That Act gave birth to the thriving generic drug industry.

Generic drugs are chemically identical to their branded counterparts, and no additional human testing is required to market them. The only prerequisite is patent expiration for the branded drug. The biotechnology industry claims that the complexities of biological drugs necessitates human testing of generic versions. The Times reports that

“Supporters of the legislation received an unexpected boost when the chief medical officer of the Food and Drug Administration, Dr. Janet Woodcock, told Congress last month that the agency had the expertise and experience to decide what types of human and laboratory tests were needed to ensure that copies of a biotechnology drug worked as well as the original.”

Dr. Woodcock gave this testimony at a hearing held on March 26, 2006 before the House Oversight and Government Reform Committee. Stay tuned.

AARP turned up the heat on the Senate this week to pass its own bill akin to H.R. 4 that would permit the Government to “negotiate” Medicare Part D drug prices. UPI reports that a Senate bill should be introduced soon after the Senate reconvenes on April 10.

On Tuesday, CMS released information on its Physician Quality Reporting Initiative (PQRI). PQRI offers Medicare participating physicians a 1.5% bonus on the Medicare fee schedule for participating in the quality improvement study beginning July 1, 2007. There are 74 PQRI measures. Many of the measures relate to elderly patients, the principal Medicare population, but several of them apply to younger patients and even children. PQRI is required by the Tax Relief and Health Care Act of 2006.

HIT News.com reports that “At a webinar last December, Thomas B. Valuck, MD, a CMS medical officer and senior advisor said CMS is searching for the “sweet spot” that might entice more doctors to participate in P4P. ‘CMS is currently analyzing what the ultimate amount would be to engage the majority of physicians in voluntary participation,” Valuck said. ‘The 1.5 percent incentive is just a start. It could take as much as 20 percent to motivate physicians.’”

It’s widely agreed the electronic prescribing will improve patient safety. However, Modern Healthcare.com reports on Health Affairs study identifying the hurdles that doctors face in using e-prescribing 1.0. Rome was not built in a day. (Rome was an excellent HBO series by the way.)

Modern Healthcare.com featured an in-depth article on the HHS enforcement guidance, reported in the FEHBlog yesterday, that permits the establishment of contingency plans for problems encountered in implementing the HIPAA National Provider Identifier. Those problems are cataloged in this Healthleaders’ article.

Of particular note in the Modern Healthcare.com article is the report by Robert Tennant, senior policy adviser for health informatics at the Medical Group Management Association, and George Arges, senior director of the health data management group at the American Hospital Association of “rumors circulating that the CMS will soon issue a second advisory, with a different, possibly shorter extension for compliance with the NPI provisions for transactions with the Medicare program.” Unless CMS creates Medicare contingency plan, FEHB plans, which serve as secondary payer for hundreds of thousands of Medicare beneficiaries, will be faced with a significant claims and customer service problem when Medicare starts rejecting claims for missing NPIs.

Wellpoint, the largest health insurer in the country, has established a Member Health Index (MHI). A Wellpoint press release explains that

WellPoint’s MHI is comprised of 20 clinical areas that reflect the quality of care an individual has received – some developed using national standards and others developed by WellPoint’s clinical experts. These measures focus on prevention and screening, care management, clinical outcomes and patient safety. Together, the measures will be combined in a proprietary statistical model to determine the quality of health care the company’s members receive year after year. For example, for members who have diabetes, the index will help to measure if they are getting necessary eye exams, maintaining their blood sugar level to reduce complications and having their blood pressure level controlled. For children, the index will measure if they received their immunizations. WellPoint will be able to analyze the data in many different sub-populations, including Medicare beneficiaries, Medicaid members and large national employer groups, in order to target improvement efforts.

Wellpoint has announced plans to tie a portion of its employee incentive compensation to improvements in the MHI. According to Wellpoint, “linking progress to incentives represents an effort to ensure that all associates are fully engaged and focused on improving the lives of the people WellPoint serves and the health of its communities.” Yes, indeed.