Around this time of the year, OPM issues its annual Performance and Accountability Report. The report includes, among other items, the agency’s financials statements and the Inspector General’s management recommendations.  This year the Inspector General released those recommendations separately. Several pages of recommendations beginning on page 3 concern the FEHB Program. 

Because the FEHBlog is the blog of record for the FEHB Program, here is a link to OPM’s Open Season announcement issued yesterday.  Emphasis is placed on the federal employees flexible spending account programs.

Today, the Centers for Medicare and Medicaid Services finally announced 2016 Medicare Parts A and B cost sharing amounts.  Complete tables of premiums, deductibles and other cost sharing amounts may be found at the link. Thank heavens.

The Hill provides a progress report on Congressional efforts to kill the 40% excise tax on high cost employer sponsored coverage.

The Robert Wood Johnson Foundation and the University of Wisconsin released their 2015 U.S. county health rankings, right here.  Modern Healthcare reports

The analysis ranks the health of each state’s county against the healthiest county in the state and provides strategies for improvement. It doesn’t compare counties from different states.  “Americans love rankings,” said Bridget Catlin, who directs the program at the Population Health Institute in Madison. “But we wanted to identify opportunities toward providing everybody a fair chance to be their healthiest and how many deaths could be avoided if every county could be as healthy as the healthiest.”

The Federal Benefits Open Season begins tomorrow and will end on December 14.  Self plus one enrollment will be available in the FEHB Program this Open Season. The Washington Post warns that some plans charge an enrollee premium for self plus one coverage that is more than the enrollee premium for self and family coverage.

In all FEHBP plans, the total self plus one premium (government plus enrollee contribution) is less than the total self plus family premium. Nevertheless because the government contribution for self plus one coverage is less than the government contribution for self and family coverage, the enrollee contribution for self plus one can exceed the enrollee contribution for self and family if the total premiums for the two enrollment types are close to one another in amount. The Washington Post article explains the reason for such an outcome (it’s the FEHB Program’s demographics at work)

For example, assume the following facts — the total premium for self and family is $100 and the government contribution is $75; the total premium for self plus one is $90 and the government contribution is $60. In that event the enrollee contribution for self plus one would be $30 and the enrollee contribution for self and family would be $25.  You can elect self and family if there are two people in your family group.  Look before you leap.

As the FEHBlog noted on Friday, Congress is out of town this coming week.  The Hill reports that the Democratic leadership in Congress is actively pushing for repeal of the 40% excise tax on high cost employer sponsored health coverage.

Opponents of the 40 percent excise tax on high-cost health plans believe 2015 is their last, best chance to get the provision repealed before presidential politics grind the legislative process to a halt.
With just two months left in the year, sources say the most ideal option for Democrats is attaching repeal to the package known as “tax extenders.” The cost of the extenders bill is typically not offset, making it an attractive vehicle for ending one of ObamaCare’s biggest revenue generators.
Reid and Pelosi have not settled on a plan and are leaving their options open, the aide said, adding that the work on ending the tax could carry over into next year.
“It is clearly a commitment for the Democratic leadership,” AFL-CIO lobbyist Tom Leibfried said in an interview in his downtown office Friday. “We think there’s a real chance to get this done, as big a lift as this is.”

Hope springs eternal.

Last week, Truven Analytics issued its annual list of top performing cardiovascular hospitals in the U.S. as reported in Cardiovascular Business.  Modern Healthcare adds that

Leaders at Truven’s top cardiovascular hospitals say standardizing care enables them to be more cost-effective. “By adhering to guidelines, you should see better quality,” said Dr. Mohamed Hamdan, chief of cardiovascular medicine at the University of Wisconsin. “I don’t think that ordering more tests results in better quality. But ordering the right test is better and less costly.” 

Here’s a link to The Week in Congress’s report on what happened up on the Hill this past week. The Hill reports on the ongoing battle over the excise tax on high cost employer sponsored coverage. Congress is adjourned until November 16.

Next Monday is the beginning of the Federal Benefits Open Season. OPM has updated its FEHB website with 2016 plan information. The FEHBlog noticed that OPM is offering a link to plan benefit summaries for 2016 which also can be helpful.

The Washington Post reports that OPM has hired Clifton Triplett to serve  as the senior cyber and information technology adviser to the acting OPM Director Beth Cobert. Mr. Triplett says “his mission is twofold: To create a ‘new culture of security’ at the OPM and upgrade some of the oldest information technology systems in government — quickly.”  Best wishes.

Earlier this week CMS released an interactive map “which shows geographic comparisons at the state, county, and ZIP code levels of de-identified Medicare Part D opioid prescription claims – prescriptions written and then submitted to be filled – within the United States” in 2013. This new mapping tool allows the user to see both the number and percentage of opioid claims at the local level and better understand how this critical issue impacts communities nationwide.” There is widespread use of opioids across the court with the heaviest utilization in Alabama, Nevada, and Oklahoma.

The Federal Times brings us up to date on the recently resolved Medicare Part B issue and discusses where we stand with the ongoing self plus one roll out in the FEHBP.

Congress remains in session this coming week.  The Federal Benefits Open Season starts a week from tomorrow so the OPM and FEHB plan Open Season websites, such as this one, should be up and running this week.  OPM has added a lot of information to its self plus one enrollment type website.

The FEHBlog noticed today this Fedsmith.com article which explains more angles on the Medicare Part B premium fix. The upshot is that the $104.90 monthly hold harmless premium for 2016 is only available to those Medicare beneficaries who currently pay their Medicare Part B premium from the Social Security check. People who become eligible for Medicare going forward will pay the new $123.70 monthly premium.  So will current CSRS annuitants who don’t receive Social Security benefits and high income seniors (who will see greater Medicare Part B premium increases.)

The Washington Post reports that about 100,000 federal employees (perhaps 5% of the workforce) will be eligible for new locality pay areas that were created under rules published last week.

Last week the FEHBlog noted many articles  in the press about a prescription drug manufacturer Valeant and a mail order pharmacy Philidor. It turns out that according to this Los Angeles Times article, Valeant is one of the business that snaps up, and then jacks up, the prices of single source generic drugs. According to this New York Times article, Philidor was in some sort of unholy alliance with Valeant to sell those drugs to consumers.  Valeant did not own Philidor, but it had an option to purchase Philidor.  The alliance became public recently and the major prescription benefit managers have terminated their contracts with Philidor, which is closing down.  The PBMs are also looking for similar unholy alliances.  What a mess.

The FEHBlog has been on a rampage about the lack of interoperability in electronic medical records (“EMR”). As this 2008 American Medical Association News article illustrates, the last Administration was pushing the idea of interoperable EMRs.

In 2004, President [George W.] Bush set a goal of most Americans using an electronic medical record by 2014. In his vision, doctors by then would be using EMR systems with interoperable standards that would allow them to share lab results, images, computerized orders and prescription information with hospitals and other health facilities.

The AMA News article explains that doctors were reluctant to shell out for EMRs. A 2009  law, the HITECH Act provided $30 billion of funding to give health care providers EMRs in return for the provider’s agreement to adhere to the government’s meaningful use standards. The EMR developers adhered to the meaningful use standards which mysteriously did not provide for interoperability.  So by 2014 most providers were usings EMRs which are not interoperable.  HHS does not expect widespread EMR interoperability to occur through retrofitting the EMRS until the 2021 to 2024 era in its recently issued roadmap to interoperability.

Happy Nevada Day!  Health Day reports that “fewer Americans are dying from heart disease, cancer, stroke, diabetes and injuries” according to an American Cancer Society report.

CMS finalized its complicated 2016 Medicare Part B payment to providers rule today. It appears that CMS will begin to star ratings on physician and group practice quality of care based on its Physician Quality Reporting System (“PQRS”) beginning in 2017.  CMS already makes negative payment adjustments to providers who fail to satisfactorily report PQRS data. This will be the second shoe to drop.

The EEOC has proposed a rule that would permit “employers that offer wellness programs as part of group health plans [to] provide limited financial and other inducements (also called incentives) in exchange for an employee’s spouse providing information about his or her current or past health status.”  Basically, the proposed rule would extend the current rules to spouses of plan enrollees. Here’s a link to the EEOC’s FAQs.

Fierce Healthcare reports that while CMS penalized hospital readmissions have been decreasing since 2011, observation stays have been increasing at similar rates.  “Further study is needed, the [Health Affairs] authors write, to determine whether readmission rates are a reliable measure of how well hospitals reduce complications and coordinate care, and emphasizing readmission rates so heavily may allow hospitals to simply relabel patients rather than actively deliver better care.” American ingenuity at work.

The Drug Channels blog assesses the Walgreen’s acquisition of Rite Aid announced earlier this week. Of interest to the FEHBlog is the Drug Channel’s observation that Walgreen’s does not plan, at least immediately, to expand its presence in the prescription benefit manager market place with Rite Aid’s EnvisionRx unit.

The Washington Post reports that the Senate, following the lead of the House of Representatives, passed the budget deal over night. Rep. Paul Ryan (R WI) became the Speaker of the House this week as well. Here’s a link to the Week in Congress.

The budget deal brings the curtain down on partial government shutdown drama that has marked the Age of Obama since 2011.  The budget dead creates a structure within which Congress can reach agreement to finalize the continuing resolution funding the federal goverment before the temporary CR expires on December 11. Other features of the deal that bear on the FEHBP have been discussed in earlier posts this week.

The FEHBlog has spent a good deal of this week attending a Workgroup for Electronic Data Interchange (WEDI) in nearby Reston, Virginia.  Last year, a keynote speech by AMA President elect Steven Stack, MD, was energizing.  Dr. Stack pointed out the flaws in the ICD-10 code set and in the lack of interoperability among the electronic medical record (“EMR”) systems funded by the federal government to the tune of $30 billion.  Dr. Stack’s entirely valid point was that HHS missed the boat by failing to consult the medical profession when (a) approving that complicated code set and  (b) setting the meaningful use standards for development of the EMR systems.

This year’s keynote speaker was former HHS Secretary and Kansas Governor Kathleen Sebelius.  The former Secretary lauded the implementation of the ICD-10 coding system.  “We finally caught up with the rest of the world.”  The coding system implemention has gone quite smoothly.  Fierce Health Payer reports on discussion of the implementation process at the WEDI Conference here. The FEHBlog suspects that Dr. Stack, who opposed the ICD-10 implementation, deserves credit for this outcome due to the simplified implementation approach that the AMA negotiated with CMS this summer.  Who knows what will happen when (if?) CMS shifts to full blown ICD-10 coding? 

The former Secretary also lauded the $30 billion investment in the EMR system comparing it an integrated EMR system that blew up in Great Britain a few years ago. But how can our system be declared a success when its not interoperable? Doctors cannot easily share information unless they belong to the same practive. That big HHS mistake greatly diminishes the value of the investment. This gap also makes life difficult for FEHB and other health plans that need to collect health care data for NCQA HEDIS measures.

Finally, the former Secretary claimed that the current Administration is the first one to take real steps to convert fee for service medicine to value based medicine. The FEHBlog has been following such efforts for his entire career which spans over 30 years. Gatekeeper HMOs in the 1980’s and 1990’s, health plans shifting risk onto providers in the 1990s and again now, Medicare + Choice in the 1990’s, Medicare Advantage in the 2000’s.  This effort is nothing new. If the effort finally pays off that would be great.

Today, OPM posted on the Federal Register’s public inspection list a final rule that would assign to the lowest cost nationwide FEHB plan (excluding high deductible plans and plans that charge associate member dues) any enrollee who fails to select a replacement plan after his or her FEHB plan leaves the FEHBP.  Currently, this protection is ohttp://www.bloomberg.com/news/articles/2015-10-27/walgreens-agrees-to-acquire-rite-aid-for-9-42-billion-in-cashnly afforded to annuitant enrollees.  If a plan terminates one of several options, the enrollees in the terminated option would default into the lowest cost remaining option in that plan.

Details about the budget deal have been reported in the Washington Post and elsewhere. As noted yesterday, the deal does address the Medicare Part B premium problem for 2016. As this Washington Post article explains, the deal does not simply extend the hold harmless protection to all Medicare beneficiaries. Instead for those 15 million Medicare beneficiaries whose Medicare Part B premium is paid from a  source other than Social Security, e.g., many CSRS annuitants,  “Medicare’s Part B premiums * * * will increase from the current rate of $104.90 per month to $120 per month next year, plus a $3 surcharge. After holding level since 2013, the monthly premiums for these people would have soared to nearly $160 without the legislative adjustment.” The deal also limits the projected Part B deductible increase.

The budget deal also will repeal an Affordable Care Act provision that requires employers with more than 200 employees to auto enroll their new employees in their health benefits program. This provision which amended the Fair Labor Standards Act, which applies to the federal government and the Postal Service, included no effective date. The Labor Department advised employers back in 2010 that the provision would take effect when it said so. So far, it hasn’t.  The House is scheduled to vote on the budget deal tomorrow and the Senate on Thursday. The President is prepared to sign it.

Finally, this afternoon, Walgreen’s, the second largest U.S. pharmacy chain,  announced an agreement to acquire the third largest chain Rite Aid according to this Bloomberg report.  That reports notes significantly that “the Rite Aid deal gives Walgreens its first foray into the business of managing drug benefits for insurers and employers, an area where rival CVS is a leader. Rite Aid entered that business by acquiring Envision Pharmaceutical Services Inc. for about $2 billion this year.” The combined company would have 12,800 locations, which exceeds CVS.  The deal is subject, of course, to anti-trust review.