Sitting in the airport waiting to return to DC, no public wifi and my phone is running low on its battery so this post will be short.

Rx stuff — The Insurance Journal reports on the IMS report  Medicines Use and Spending in the U.S.: A Review of 2015 and Outlook to 2020.  Politico Pulse observed

PRESCRIPTION DRUG COSTS SPIKED 8.5 PERCENT IN 2015 — That’s according to a new report from the IMS Institute for Healthcare Informatics. That figure would be the second straight year of historically high spikes in pharmaceutical costs — but it’s significantly higher than the roughly 5 percent growth reported by both Express Scripts and CVS Caremark. Why the discrepancy? According to Murray Aitken, executive director of the IMS Institute, there’s a likely explanation: benefit managers cover retail pharmacy spending but not hospital-administered drugs, which have seen sharper cost increases.

Drug Channels timely reports here on “outrageous markups” on hospital-administered drugs.

In better news, the Washington Examiner reports that the Food & Drug Administration under Congressional pressure approved more than 700 generic drugs for marketing last year, an agency record. That should help prevent gaming the system.

Finally, Healthcare IT News warns that an ICD-10 claim delay problem may raise its ugly head on October 1, 2016, when the current AMA-CMS compromise expires.

While it’s tempting to think that the healthcare industry pretty much aced the ICD-10 deadline, and those worries have been put to rest, the 6-month mark is a good time to ask if such concerns really have been settled?
The one-year span between Oct. 1, 2015 and Oct. 1, 2016, after all, is something of a grace period during which the Centers for Medicare and Medicaid Services and commercial payers are offering more latitude on claims details.
“The bottom hasn’t been reached yet because CMS came along and said it wouldn’t be as hard on physicians for 12 months after the deadline,” [Mary Jean] Sage [a consultant] said. “There haven’t been too many denials yet, but that could change. So we may not have seen things that we will see after Oct. 1, 2016.”

The FEHBlog is attending a subrogation conference in beautiful Asheville, NC.  But that’s no reason not to share these interesting tidbits:

• Employee Benefit News reports on five things that plan sponsors should know about the new, lengthy DOL fiduciary rule. Although the rule is focused on retirement plans, it also applies to health savings accounts. 
• That publication also reports on new trends in controlling employer sponsored health plan costs according to a Willis Towers Watson survey. “Much of employers’ planned design changes will focus on creating — and maintaining — a healthier population of employees.”
• Healthcare Dive tells us about a new CMS Medicare payment model initiative involving primary care providers.  “Building on the Comprehensive Primary Care initiative launched in late 2012, the five-year CPC+ model seeks to benefit patients by helping primary care practices support patients with serious or chronic diseases to achieve their health goals and work with hospitals and other clinicians, including specialists, to better coordinate care.”
• Employer sponsored coverage must be minimum value (bronze level) and affordable in order to meet the requirements of the ACA’s employer share responsibility mandate. Coverage is affordable if the employee share of the self only premium for minimum value coverage does not exceed a certain percentage of the employee’s W-2 income (or another proxy).  The IRS has announced that for 2017 that percentage will be 9.69%.
• Finally Beckers Hospital Review reports that “Even though CMS’ star ratings system for hospitals is based solely on patient experience scores, researchers from Harvard have found that higher rated hospitals do in fact have lower mortality and readmission rates than their lower rated counterparts.” Surprise!

Both Houses of Congress will be in session on Capitol Hill this coming week. Friday is the deadline for Congress to pass an FY 2017 budget resolution. The Hill discusses the significance of the date here.

The Washington Post this morning featured a story on an unfortunate woman from rural Oklahoma who died at age 54 due to alchohol abuse.  The bright light in this sad story is a rural letter carrier.  The Post used the story as evidence to support its lead story asserting that

progress for middle-aged white Americans is lagging in many places — and has stopped entirely in smaller cities and towns and the vast open reaches of the country. The things that reduce the risk of death are now being overwhelmed by things that elevate it, including opioid abuse, heavy drinking, smoking and other self-destructive behaviors.
White men are also dying in midlife at unexpectedly high rates. But the most extreme changes in mortality have occurred among white women, who are far more likely than their grandmothers to be smokers, suffer from obesity or drink themselves to death.

The stories are worth reading.   Public health problems like these are very complicated and broadly based that can’t be solved with HEDIS scores.

As an aside, Kaiser Health News reports that majority of consumers according to a recent Health Affairs study don’t “associate price with quality” which in the FEHBlog’s view is an accurate perception that should help health plans.

The acting OPM director Beth Cobert wrote a blog post and tweeted yesterday about OPM’s decision to mandate FEHB coverage of applied behavioral analysis for children on the autism spectrum for 2017.  If you are interested in this expansion of coverage, take a look at these OPM FAQs.

Mid-week, the ACA regulators finalized the summary of benefits and coverage template that will be used in the 2018 FEHBP open season. Prof. Tim Jost provides his detailed assessment of the new SBC here.

In other follow up points —

• Healthcare Dive reports that the doctor shortage in the U.S. is real. What’s more telehealth is not going to fill the gap by itself because the shortage is particularly striking in surgical specialties. 
• According to Employee Benefit News, the Congressional Budget Office projects that “In 2016, most Americans between the ages of 18 and 65 will get their health insurance from their employer—and they will get it for less because the federal government will give them tax breaks to the tune of $266 billion.” This large number causes many economists to pine for the 40% high cost plan excise tax, a/k/a the Cadillac tax. But rather than follow through on that insanely complicated and counter-productive tax, Congress could reduce tax exclusion for high wage earners which is what already happens to small business owners.  

Federal News Radio reports that OPM has awarded a new seven year long Federal Long Term Care Insurance contract to John Hancock, the incumbent contractor. FLTCI Program coverage is employee pay all. “John Hancock was the only bidder to provide long-term care insurance services to the federal market despite the fact OPM had the solicitation on the street for almost seven months.”

HHS has provided updated information on the Zika virus here.

Kaiser Health News reports on a Health Affairs study concluding that doctors need to speak with their patients about of pocket costs.  That’s more support for the FEHBlog’s idea that health care providers should provide their patients with a summary document about the networks in which they participate and their pricing practices.  Implementing the idea at a minimum would solve the erronoeous provider directory kerfluffle.

On a related note, WBUR points out another Health Affairs study that “looked at the health care shopping habits of 332,255 members of insurer Aetna in 2011 and 2012. The top shopped service was a colonoscopy. Coming in at second and third, respectively: a mammogram and childbirth services” Interesting tidbit.

The Senate is back in session on Capitol Hill this week. The Senate Homeland Security and Government Relations Committee is holding a business meeting tomorrow afternoon to consider various Presidential nominations. However, Beth Cobert is not on the prepared agenda.  The House is holding a district work session for one more week. House sessions resume on April 11.

With respect to the carrier conference last week, the most important thing that the FEHBlog picked up is that last year OPM significantly improved the online FEHB plan comparison tool.  FEHBP enrollees can obtain a lot more comparative information now.  The tool does not provide a link to each Plan’s summary of benefits and coverage which Congress intended to be the principal tool for health plan shoppers.  That would be a helpful addition to the PCT.

Managed Healthcare Executive has a useful article on the valued based payment initiatives that CVS Health and Express Scripts are rolling out for oncology drugs.

For the past day and a half, the FEHBlog has been attending the OPM AHIP FEHBP carrier conference in Crystal City, VA.  OPM has posted the acting Director’s keynote speech. Govexec.com and Federal News Radio have reported on that address.  The FEHBlog’s head is spinning from all of the data and new acronyms that he acquired. Expect more reflections on the conference in the weekend update.

The conference included an informative panel on cybersecurity.  The talk caused the FEHBlog to check up with the Ponemon Institute which recently published a report on the cyberthreats faced by healthcare organizations. The Hill reported today in a bit of good news that “The {Department of Homeland Security told Congress] that 29 [federal’ agencies have reported 321 incidents of ransomware-related activity since last June. But in no case did the agencies have to pay up, as the ransomware was not able to successfully infect the government’s networks.” Evidently a sensible way to protect against ransomware is to back up your data in a way that is protected from the primary server.  

As the Toledo Blade reports, today is the day that the Centers for Medicare and Medicaid Services roll out its mandatory bundled payment program for hospitals in 87 cities across the country. The Blade story explains how hospitals are reacting to the initiative. AHIP Coverage discusses a commercial payer’s bundled payment initiative here.

Tomorrow and Friday morning, the FEHBlog will be attending the annual OPM-AHIP FEHBP carrier conference.

Today the FEHBlog followed a CAQH webinar on its Index product which measures trends in electronic healthcare transactions.  Here is a link to all of the info that was presented.  CAQH, which is financed by health insurers, does a lot of good work for the industry.

Yesterday, the Congressional Budget Office released its analysis of the President’s FY 2017 budget. On page 8 of this spreadsheet that forms part of the analysis, CBO concludes that OPM’s five legislative initiatives for the FEHBP will produce no budget savings.

The FEHBlog noticed today that early last month the CBO released its annual FEHBP overview which is a helpful reference publication.  For example,

The Federal Employees Health Benefits (FEHB) Program is the largest employer-sponsored health insurance program in the country. It provides more than $40 billion in health care benefits annually to employees and retirees of the federal government, the largest employer in the United States. In a typical year, FEHB provides health insurance coverage to about 8.2 million federal employees, retirees, and their dependents. Employees and retirees make up roughly half of that figure, or about 4 million policyholders. Of these, about 50% are retirees. Participation in FEHB is voluntary. About 85% of federal employees participate, and about 90% of retirees participate.

And it’s a managed competition program that works just fine.

Happy Easter! The Senate is out of town for another week and the House of Representatives has left DC for two week. Here is a link to the Week in Congress’s report on last week’s activities on Capitol Hill.

The American Health Information Management Association (“AHIMA”) has isssued a helpful toolkit on consumer engagement which is available here.

Here are a couple of follow-up points on recent posts:

• Health Data Management reports why the addition of 5,600 ICD-10 codes in October may not be a heavy lift for HIPAA covered entities and their business associates. This will be the first regular ICD-10 update in five years. 
• Health Data Management and Healthcare Informatics offer more details on the new round of HIPAA privacy and security rule audits being conduced by HHS’s Office for Civil Rights. This round will affect 200 covered entities and for the first time business associates.  

The Congressional Budget Office issued two significant reports yesterday — updated budget projections and a projection of federal subsidies for people under age 65 — both for 2016 to 2026. On Tuesday March 29, CBO will release its analysis of the President’s FY 2017 budget which will reveal CBO’s projections for the costs or savings associated with OPM’s suggested legislative changes to the FEHBP that were included in the President’s budget.

The FEHBlog has been impressed by the American Medical Association’s President Steven Stack, a young emergency room doctor.  Healthcare Dive offers an interview with Dr. Stack here. Two points from the interview are worth highlighting here:

Late last month, HHS Secretary Sylvia Burwell announced a commitment among the industry, including companies that provide 90% of EHRs used by U.S. hospitals, toward creating a more user-friendly, physician-usable EHR. AMA was one of the organizations that signed the pledge. “Physicians are avid adopters of technology,” Stack said but added, “Health IT is kind of late to the game as far as its sophistication and it’s taken a long time to mature to the point where it’s a helpful tool.” 

Nearly one out of every five dollars in the U.S. economy is spent on healthcare. “In this environment, as the business has escalated in its size and the government has become an ever-larger purchaser of healthcare through programs like Medicare and Medicaid and more involved in efforts like Meaningful Use, the burden of regulations has escalated substantially,” Stack said. “So the politics and the business of healthcare have put extra strain and challenge on the humanism of healthcare, which fundamentally is what most patients rely upon in their moment of deepest need.”

Finally a few quick hits for this Friday afternoon:

• The Wall Street Journal reports today on a recent clinical study finding a strong correlation between calcium levels in breast and coronary arteries. The upshot is that before long mammograms also may help diagnose heart disease in women. Two for the price of one.
• Employee Benefit News provides more background on the application of gaming theories or “gamification” to wellness programs.
• The Centers for Disease Control have refreshed their National Diabetes Prevention Program website.