The Center for Affordable Health Insurance released the results of a Zogby nationwide poll which finds that 84% of Americans agree that hospitals, doctors, and pharmacies should post their prices for all goods and services and that 79% of Americans are likely to price shop for health care based on that information. The margin of error is plus or minus 2.9%.
The Center for Studying Health System Change released a report yesterday stating that “After remaining stable since the mid-1990s, the proportion of U.S. physicians without any managed care contracts rose from 9.2 percent in 2000-01 to 11.5 percent in 2004-05.”Compared with physicians with one or more managed care contracts, physicians without managed care contracts are more likely to have practiced for more than 20 years, work part time, lack board certification, practice solo or in two-physician groups, and live in the western United States, the study found.”
Tip of the hat to my journalist friend Theresa Defino for pointing out this interesting study.
On May 1, 2006, President Bush spoke before the American Hospital Association (AHA) convention. He had the following comments on price transparency: “My administration is working with the AHA and other health care associations to provide patients with reliable information about prices and quality on the most common medical procedures. And I want to thank the AHA board for adopting a resolution this week supporting transparency. I appreciate your leadership on this vital issue. (Applause.) “We must work together to get patients the information they need so they can get the best quality care for the best price. If you’re worried about increasing costs, it makes sense to have price options available for patients. That’s what happens in a lot of our society; it should happen in health care, as well. By increasing transparency, the idea is to empower consumers to find value for their dollars and to help patients find better care and to help transform this system of ours to make sure America remains the leader in health care. “Secretary Leavitt has met with leaders in the health care industry in 13 cities to encourage them to work with the Department of Health and Human Services to increase transparency in the marketplace. We’re asking doctors and hospitals and other providers to post their walk-in prices to all patients. I directed the Department of Health and Human Services to make data on Medicare’s price and quality publicly available on the Internet. The first data will be available to all Americans by June 1st. We’re also asking insurance companies to increase health care transparency by providing their negotiating prices and quality information to their enrollees. And the federal government will do the same. “My administration will be requiring transparency from insurance plans participating in federal programs. Beginning this year, the Federal Employees Benefit Program and the military’s Tricare system are asking contractors to begin providing price and quality information. “Today, I’m asking for your help. Every hospital represented here should take action to make information on prices and quality available to all your patients. If everyone here cooperates in this endeavor we can increase transparency without the need for legislation from the United States Congress. By working together, transparency — to increase transparency, we can help lower costs.” Here’s a link to the AHA’s new price transparency policy. The AHA asks for federal standards on the presentation of pricing information and for insurers to provide an explanation of benefits before care is provided – an advance EOB. (I believe that easier said than done.) According to the AHA, Aetna is piloting an advance EOB in Cincinnati, OH. AHA also points out that the amount of pricing information that a consumer needs depends on their type of health care coverage.
Medco , a major prescription benefits manager, released its first quarter earnings today and in doing so it announced an agreement in principle on financial terms to settle the False Claims Act lawsuit pending against it in the U.S. District Court located in Philadelphia. The lawsuit relates to Medco’s FEHB Program business.
Marketwatch.com reports that
“Medco said it’s reached “an agreement in principle on financial terms” with the U.S. Attorney’s office, with final disposition contingent on the parties striking what the company called a “corporate integrity agreement.”
Medco’s stock price is up 4.61% today on a strong earnings report and the settlement news.
OPM just publicly releases the following information:
U.S. Office of Personnel Management has selected the companies that will offer supplemental dental and vision benefits under the new Federal Employee Dental and Vision Insurance Program which will begin December 31, 2006. Following a review of proposals, OPM has selected MetLife, GEHA, United Concordia, Aetna, GHI, CompBenefits, and Triple-S to offer dental benefits and Vision Services Plan, BCBS Vision, and Spectera to offer vision benefits.
Earlier today, the USPS Board of Governors proposed to increase the price of a first class stamp from 39 cents to 42 cents in 2007. In its press release, the Board blamed the increase on rising fuel costs and on FEHB premiums: “Like other businesses, the Postal Service has also experienced significant growth in health benefit payments for more than 621,000 current employees and 445,000 retirees. In 2005 alone, these costs increased by $437 million, reaching a total of $6.6 billion.” But that’s only a 7.1% increase, which is pretty reasonable these days.
The Washington Post reports that Rep. Tom Davis (R-VA), who chairs the House Government Reform Committee, immediately criticized the decision in a press release “I am disappointed the Board of Governors did not see fit to wait until comprehensive postal reform legislation becomes law before making a decision on whether to seek rate increases,” he said. “The bill that emerges from the House-Senate conference will most likely significantly alter the Postal Service’s costs and may alter the process by which rate cases are decided.” The proposal now goes to the Postal Rate Commission for review. Given Rep. Davis’s reaction, I think that we can expect a Congressional hearing on this.
I am interested in the Medicare Program for FEHBlog purposes because there are hundreds of thousands of Medicare eligible enrollees in the FEHB Program. Generally, Federal employees who have had five years of FEHBP coverage immediately preceding retirement carry their FEHBP coverage into retirement with the full government contribution. Federal employees who retired after 1982 are eligible for Medicare Part A and can subscribe for Medicare Part B.
The Wall Street Journal (subscription required) reported on Tuesday that “Medicare beneficiaries will see a big jump in the premiums they pay for physician and other outpatient care, under the portion of the program known as Part B. Medicare officials said yesterday that premiums would increase next year by 11%, to $98.20 a month from $88.50, partly because of a surge in the volume and intensity of Part B services and a decision by Congress to override a reduction in physician payment that was scheduled to occur this year.”
Also in 2007, the Medicare Modernization Act of 2003 requires CMS to means test Part B premiums. The baseline is the 75% subsidy for beneficiaries with a taxable income of $80,000 (single) or $160,000 (couple). Above those income levels the subsidy will decrease thereby raising the Part B premium as follows:
These increases will be phased over a five year period. The change is expected to affect only 3% of Medicare beneficiaries. What’s more according to the Journal and the Washington Post , the Medicare Trustees now are projecting that Part A Trust Fund will run out of money in 2018, which is “two years sooner than predicted a year ago and 12 years sooner than had been anticipated when President Bush first took office.” This report has an immediate Congressional ramification according to the Wall Street Journal report: “Under a requirement passed with the Medicare drug benefit, legislative action is supposed to occur if Medicare’s trustees predict that, within the first seven years of their annual 75-year projections, general revenues fund more than 45% of total Medicare spending for two years in a row. Yesterday’s report said that threshold would be reached in 2012. That means the trigger for action would occur in 2007 if projections hold. President Bush would be required to propose legislative changes, and Congress would have to give them fast-track consideration.”That will be an interesting development shortly before the next Presidential election.
The HHS semi-annual regulatory agenda published on April 24, 2006, informs us that HHS expects to release the final HIPAA electronic claims attachment standard (proposed Sept. 23, 2005, 70 Fed. Reg. 55,989) in September 2008 (No. 1035) and that HHS has withdrawn the rulemaking for the HIPAA standard health plan identifier (No. 1051). Previous agendas indicated that a proposed rule on the standard health plan identifier would be released in November 2005 (e.g., 70 Fed. Reg. 26,865). So we are down to two standard identifiers, employer and health care provider, from the four originally anticipated (employer, provider, health plan, and patient).
Yesterday, I attended a DC Bar Health Information Technology (HIT) Overview. The speakers were Mark Mantooth, an HHS attorney with the Office of the National Coordinator, Dr. Bill Braithwaite of the e-health Initiative, and Ben Butler, a partner with Crowell & Moring.
Mr. Mantooth reviewed the many HHS initiatives underway, and he described how the initiatives interact. Of particular interest to me was his discussion of the work of the American Health Information Community because the OPM Director sits on that FACA committee. The Community has four workgroups — BioSurveillance, Chronic Care, Consumer Empowerment, and Electronic Health Records. The OPM Director is the co-chair of the Consumer Empowerment workgroup.
Each of the workgroups has established a “breakthough objective” upon which they are focusing their attention. All of the breakthroughs involve making recommendations to the Community so that within one year the objective can be achieved. The workgroups are preparing the recommendations now and draft letters to the HHS Secretary are posted on the website.
Bio-surveillance — Essential ambulatory care and emergency department visit, utilization, and lab result data from electronically enabled health care delivery and public health systems can be transmitted in standardized and anonymized format to authorized public health agencies within 24 hours.
Chronic care — Widespread use of secure messaging, as appropriate, is fostered as a means of communication between clinicians and patients about care delivery.
Consumer Empowerment — A pre-populated, consumer-directed and secure electronic registration summary is made available to targeted populations and a widely available pre-populated medication history linked to the registration summary is deployed.
Electronic Health Records — Standardized, widely available and secure solutions for accessing current and historical laboratory results and interpretations is deployed for clinical care by authorized parties.
Dr. Braithwaite spoke primarily about regional health information organizations (RHIOs which he wants to call RHINOs — similar to Hippos with HIPPA) and the Connecting for Health Initiative. In April 2006, Connecting for Health, a Markle Foundation project, released a common framework for a national health information network. The framework would link frequently interacting health care providers into SNOs which would be connected into a national health information network using a SNO-Bridge and a Record Locator service. I am no technology expert but the framework clearly looks like a step in the right direction to me.
Dr. Braithwaite also mentioned a peer-reviewed study titled “Systematic Review: Impact of Health Information Technology on Quality, Efficiency, and Costs of Medical Care” to be published in the May 16, 2006 issue of the Annals of Internal Medicine. The study draws the following sobering conclusions:
“This review suggests several important future directions in the field. First, additional studies need to evaluate commercially developed systems in community settings, and additional funding for such work may be needed. Second, more information is needed regarding the organizational change, workflow redesign, human factors, and project management issues involved with realizing benefits from health information technology. Third, a high priority must be the development of uniform standards for the reporting of research on implementation of health information technology, similar to the Consolidated Standards of Reporting Trials (CONSORT) statements for randomized, controlled trials and the Quality of Reporting of Meta-analyses (QUORUM) statement for meta-analyses. Finally, additional work is needed on interoperability and consumer health technologies, such as the personal health record. “The advantages of health information technology over paper records are readily discernible. However, without better information, stakeholders interested in promoting or considering adoption may not be able to determine what benefits to expect from health information technology use, how best to implement the system in order to maximize the value derived from their investment, or how to direct policy aimed at improving the quality and efficiency delivered by the health care sector as a whole.”Ben Butler provided the attendees with excellent guidance on various privacy/security and intellectual property issues.