The month of October starts this week. That means

The FEHBlog expected that there would be no government shutdown on October 1, and mark the tape the Washington Post reports today follow the Speaker of the House John Boehner’s unexpected resignation,  “House Republicans said there was agreement to pass a clean spending bill to avert a government shutdown.” Presumably this decision is aligned with the Senate Republican leadership’s plan to vote for a continuing resolution that would expire on December 11 as reported by Federal News Radio.  House Majority Leader Kevin McCarthy (R Calif) is expect to be the new Speaker on November 1.

OPM has posted a recent benefits administration letter providing helpful details on the self plus one enrollment type roll out.

Last August 19 marked the 19th anniversary of the Health Insurance Portability and Accountability Act or HIPAA.  HHS still has not released all of the transaction standards, e.g., the claims attachment standard, or code sets, e.g., the patient identifier. Congress has blocked HHS from issuing a patient identifier which is wrongheaded because a patient identifier is needed for interoperable medical records. Also the claims attachment standard may just be a bridge too far.  In any event, the FEHBlog thinks that the industry would have worked out the standards and code sets without a law. But the law remains there and Congress doubled down on that law in the ACA by coopting CAQH’s effort to create operating rules for the standard transactions. Today CAQH announced the released of its fourth round of operating rules. By HHS regulation, these CAQH rules will apply to all HIPAA covered entities and business associates.  The operating rules fill in gaps in the transaction standards in a uniform way.

Speaking of HIPAA and the 2009 HITECH Act, CMIO reports that the HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules plans to start engaging in proactive desk audits of HIPAA covered entity and business association privacy and security policies and procedures. These audits will supplement the existing practice of auditing HIPAA covered entities and business associates that report large unsecured protected health information breaches in accordance with federal law.

The trade association AHIMA, which supports the ICD-10 implementation, has announced ten metrics that health information management professionals should be monitoring in the immediate wake of the looming ICD-10 code set compliance date next Thursday October 1.  Good idea.

The Washington NFL and Major League Baseball teams won today so it has been a good weekend. Congress continues its work on Capitol Hill this week. The federal fiscal year ends in a week and a half on Wednesday September 30.  The FEHBlog expects Congress to enact a temporary continuing resolution before then.  Of course, the following day October 1 is the initial compliance date for the new ICD-10 coding system.  The ICD-10 system could rival the October 2013 healthcare.gov launch in terms of technological trainwrecks. It will take a few weeks to tell.

Following up on Friday’s post, Govexec reports that there is a lot of serious opposition to Sen. Carper’s recently introduced postal reform bill. The FEHBlog follows the legislation because it would create a separate Postal Service Health Plan within the FEHBP. That’s not the controversial provision. 

The Sacramento Business Journal reports on more impending ACA confusion for employers.  Only under the ACA can employers with 50 to 99 employees be subject to the ACA’s employer mandate as large employers and also subject to the ACA’s premium rules for small employers, like the FEHBlog’s law firm.  The FEHBlog can tell you that the small employer rating rules are costly because every family member is charged an age rated premium. The ACA fortunately for the FEHBP permits large groups to compositely rate.

OPM announced to benefit officers on Friday (but the FEHBlog can’t find any press release) that ADP is withdrawing the Plan Smart Choice internet based plan comparison tool from the FEHBP marker for the upcoming open season.  OPM explains that

For the 2015 Open Season, resources to assist FEHB and FEDVIP subscribers in choosing an insurance plan include:

The OPM Plan Comparison Tool:

▪   FEHB:            www.opm.gov/fehbcompare

▪   FEDVIP:        www.opm.gov/fedvipcompare

·   Consumer’ Checkbook’s “Guide to Health Plans for Federal Employees & Annuitants – An FEHBP Plan Comparison Tool” www.checkbook.org/newhig2/hig.cfm.  Please note that many Agencies make the electronic version of Consumers’ Checkbook available to employees on their intranet.

If history is any guide, OPM should be announcing 2016 premiums this week. The timing could slip due to the complicating factor of the new self plus one enrollment type. 

Here’s a link to the Week in Congress’s description of recent activities on Capitol Hill.  In two interesting developments, a bipartisan pair of Senators have introduced a bill to repeal the ACA’s 40% excise tax on high cost coverage according to Bloomberg and Sen. Tom Carper (D Del.) has introduced a new version of his Postal Reform bill according to Federal News Radio.

Modern Healthcare reports that NCQA is replacing its health plan rating system with a five step ranking system similar to Medicare Advantage’s star rating system. The article concludes

Quality ratings have proliferated throughout healthcare as a means to direct patients toward the hospitals, doctors and health plans that have the best clinical outcomes and the lowest costs. Healthcare researchers wrote this week in JAMA that most quality metrics rely on “professional standards,” but those metrics sometimes “can fail to capture what matters most to each individual.” “Patients, family members and friends should be able to report whether the patient received what he or she most needed and wanted,” the researchers wrote in the medical journal.

The Hartford Courant reports on discussions that top Aetna and Cigna managers held with analysts at a health care conference this week.  The analysts were interested in their respective merger plans.

Employee Benefit News offers a perspective on the new fact of health assessments, a start part of wellness programs.

Thanks to the proliferation of apps and monitoring devices, it is becoming much easier to engage people in such teachable moments beyond receiving annual health assessment results and beyond the workplace. Technology has created a world where people can continually connect to resources supporting their personal health whenever they are open to it. The ability to provide wellness tools that are with people throughout the day opens exciting possibilities to the developer that “gets it right” in triggering and sustaining true engagement over time.

In that vein,  this article links to another report that the FitBit wellness program is now HIPAA compliant. What’s more, according to this Phoenix TV news station report, the U.S. Preventive Services Task Force now has an app that doctors and patients can download from the Apple and Google app stores. The FEHBlog downloaded the app ePSS — it appears to be handy.

Finally, if you need a little healthcare related humor check out this Healthcare Dive article on the 16 most absurd ICD-10 codes.  It’s no wonder the AMA fought this zany change.

Today, OPM’s final rule implementing the self plus one enrollment type was posted on the Federal Register’s public inspection list.  The self plus one enrollment type takes effect for 2016.  FEHBP enrollees who want to enroll for self plus one will have to make an affirmative change using the SF 2809, Employee Express, etc., during the upcoming Open Season.  The change will not happen automatically if you currently have only two people covered under a Self and Family enrollment type. The rule also explains how folks can switch from self and family to self plus one outside of Open Season. You can find those answers in a pithier format at OPM’s self plus one website too.

OPM should be announcing the 2016 premiums in the next week or so.  Then federal and postal employees and annuitants will have the final piece of the self plus one puzzle.

The Altarum Institute reported last Friday that

Health care prices in July 2015 were 1.1% higher than in July 2014, for the 4th consecutive month, and only a 10th above the decade-plus low of 1.0% growth registered in August 2013. Year-over-year hospital prices rose 0.9% in July, the highest since September 2014. Physician and clinical services prices fell 1.1%, only a 10th above the multi-decade low recorded in June. Prescription drug prices rose 4.4%, down from 4.8% in June and 6.4% in December 2014.

Business Insurance reports that the ACA regulators are sticking to their position, discussed from time to time in the FEHBlog that group health plans must embed a self only in-network out-of-pocket maximum in the self and family in-network out-of-pocket maximum.  OPM has insisted that all FEHB plans include this feature for 2016.  These administrative mandates simply push premiums closer to the 40% excise tax thresholds.

Fierce Healthcare reports on a JAMA published study finding that half of readmission disparities are outside the hospitals’ control.

Under the standard Medicare formula [created by the Affordable Care Act], which only controls for patient age, sex and certain conditions, the top hospitals have 4.4 percent fewer readmissions than the worst performers. However, when researchers from Harvard Medical School applied a set of 29 more specific variables such as cognition, functional status, income, education and self-reported health, the difference fell to 2.3 percent.

Fierce Health Payer offers an interview with a cybersecurity expert who thinks that the recent megabreaches have focused business and government attention on improving data security.

As for preventing attacks at their own organizations, healthcare companies should take two major steps, according to [the interviewee David] Damato:
Identify the organization’s risk, or the data security issue it’s most concerned about. For most in the healthcare industry, this will be personal health information, Damato says.
Find ways to surround that sensitive information with the right number of controls that make it difficult to obtain, such as multifactor identification or data encryption. Data encryption alone, however, isn’t sufficient, he notes.  Insurers also should avoid storing members’ data online past the point that it’s absolutely necessary, [according to another expert].

The FEHBlog agrees with both experts.  In particular, the OPM data breach highlighted the key importance of multi factor authentication and careful data management policies that protect the organization’s crown jewels. Unfortunately lengthy government record retention requirements, e.g., the 10 year limitations period for the False Claims Act, lead to health plans retaining records for long periods of time.

Finally, Crain’s Chicago Business reports that the healthcare industry is anxious about the looming October 1 compliance date for the ICD-10 coding system.  That’s no surprise. A train wreck may be in the offing. And the distressing part is that the switchover is totally unnecessary. It will not improve electronic claims processing which is HIPAA’s objective and as a doctor notes at the end of the Crain’s article “We’re ready [for the ICD-10],” he said. “But I’m not happy about it. There is nothing about ICD-10 that is going to help me with patient care.” The only folks happy about this change are the public health experts who hope that the new complex system will give them better information. But it could wind up being a case of garbage in, garbage out.

Happy New Year to the FEHBlog’s Jewish readers. Congress will be in session this week. Here is a link to the The Week in Congress’s report on last week’s activities on the Hill.

The lead story in Saturday’s Washington Post was a story about the need for older Americans to lower their blood pressure.  “The new [federal government] research advises people with high blood pressure to keep their “systolic” pressure — the top number in the reading that health-care providers routinely tell patients — at 120 or below. Clinical guidelines have commonly called for systolic blood pressure of 140 for healthy adults and 130 for adults with kidney disease or diabetes.”

Recently, the FEHBlog noted a new Medicare mandate that hospitals accept bundled payments for hip and knee replacements.  Modern Healthcare reports that the medical community is not amused by this initiative.

Reuters reports that CALPers is finding that reference pricing is helping to control the cost of colonoscopies.  Reference pricing directs plan members to facilities that will accept the reference price. Members who use other facilities pay the difference between the other facility’s price and the reference price.

“In the short term, the major beneficiary of reference pricing is the employer and insurer, as they are paying most of the cost and hence reap most of the savings,” [Prof.] Robinson  [the study’s author] said. “In the long term, the consumer is the beneficiary, since their premiums don’t rise as fast as they would otherwise and, perhaps more importantly, providers begin to moderate prices in hopes of retaining their customers.” A number of leading insurers and employers now use reference payment for services like knee replacement surgery, arthroscopy, cataract removal, laboratory tests and drugs, he said.

Employee Benefit News indicates that employers are clutching on whether or not to continue offering on-site clinics in view of the impending application of the 40% excise tax.  This illustrates another inequity of the excise tax.  A health plan premiums may be below the excise tax threshold but if the employer decides to offer additional benefits subject to the tax, those benefit costs could drive the total cost above the threshold. In that case, the health plan even though the law mandates the coverage will bear the brunt of the excise tax because the tax is allocated pro rata among the various coverages and health insurance is the most costly.    

The FEHBlog is up in the Nutmeg State again, and there’s limited blogging time this morning so here are some quick hits.

• Recently the FEHBlog noted that CSRS annuitants are staring down the barrel of large Medicare Part B premium increases due to a statutory quirk. The FEHBlog thought that the quirk was that CSRS annuitants did not pay Medicare taxes, but a reader commented that the FEHBlog was wrong about that rationale.  (Thanks commenter.) It turns out that CSRS annuitants will be subject to a large Medicare Part B premium increase because their Medicare Part B premiums are deducted from their CSRS annuity checks. FERS annuitants will be eligible for the statutory hold harmless against Medicare Part B premium increases because their Medicare Part B premiums are deducted from the Social Security benefit payments.  That’s nuts. The Washington Post has more details here. 
• The Hartford Courant reports that a House judiciary committee held a hearing on healthcare mergers yesterday. The American Medical Association, the American Hospital Association, and AHIP all testified. 
• The FEHBlog was amused by this Health IT Analytics article about how the lack of electronic medical record interoperability is interfering with accountable care organization population heath efforts. ACO have to offer out of network coverage.  This is the same problem facing FEHBP carriers who are under OPM pressure to manage population health. 

Also on the Rx front and at the risk of belaboring the obvious, a non-profit independent research institute has concluded that the new PCSK9 statin inhibitors are too darn expensive. Reuters reports that

The Boston-based Institute for Clinical and Economic Review (ICER) said its analyses indicated “that the price that best represents the overall benefits” the drugs may provide patients would be between $3,615 and $4,811 a year, a 67 percent discount off the list prices. “Even if these drugs were used in just over 25 percent of eligible patients, then employers, insurers, and patients would need to spend on average more than $20 billion a year for these drugs,” ICER president Steven Pearson said in a statement.

Price of course is an independent variable that bears no necessary relation to cost or value to consumers.  Of course, while jawboning can be helpful, the existence of competitive PCSK9 specialty drugs will be most helpful to prescription drug managers and health plans trying to control specialty drug costs.

This also comes as no surprise to the FEHBlog –the American Medical Association is warning that large health insurance mergers will reduce competition particularly in certain geographies.

“A lack of competition in health insurer markets is not in the best interests of patients or physicians,” said AMA President Steven J. Stack, M.D. “If a health insurer merger is likely to erode competition, employers and patients may be charged higher than competitive premiums, and physicians may be pressured to accept unfair terms that undermine their role as patient advocates and their ability to provide high-quality care. Given these factors, AMA is urging federal and state regulators to carefully review the proposed mergers and use enforcement tools to preserve competition.”

Note to Dr. Stack, whom the FEHBlog admires, your warning overlooks the fact that health insurer profits are capped by the ACA’s minimum loss ratio

Finally, Modern Healthcare in an interesting development reports that health care companies — on both the provider and payer sides — are now more willing to rate doctors on-line, and doctors prefer these ratings to Yelp and Angies’ List.