Here are links to the OPM press release, the FEHBP rates, and the FEDVIP rates, Enjoy and go Nats!

The FEHBlog mentioned a week or so ago that the renewal premium for his family group (wife and two over 18 kids) increased 58% in the ACA/Obamacare era. The FEHBlog has discovered that under the ACA’s pricing scheme there is no difference between individual and small group pricing. Each member of my family group is separately priced based on the family member’s age. What this means is that the FEHBlog will be moving to a high deductible plan, thereby putting his money where is mouth is and then getting his 24 year old daughter who thankfully is happily employed to shift her coverage over to her employer. It’s a brave new world.

This week OPM should announce 2015 FEHB premiums. Business Insurance reports 

Average health care benefit cost increases for active group and pre-Medicare retiree coverage are projected to range between 6.2% and 10.4% depending on the plan type, reflecting flat-to-moderate reductions in cost trend rates in 2014, according to Segal Group’s 18th annual Health Plan Cost Trend Survey, released Thursday.  Segal’s report also predicts an average 8.6% rise in prescription coverage costs in 2015, compared with an average 6.3% increase in the previous year.

We’ll see how FEHB premium changes stack up against this latest projection for all employers.

Kaiser Health News reports on the latest round of potentially avoidable readmission penalties that CMS has imposed on Medicare participating hospitals. The report explains that

As the penalties have played out, an increasing number of prominent experts are voicing concerns that the punishments are too harsh and doled out unfairly. For one thing, Medicare lowers payments to hospitals even if they have reduced their readmission rates from the previous year—so long as their rate is still higher than what the government believes is appropriate for that hospital. Medicare uses the national readmission rate to help decide what appropriate rates for each hospital, so to reduce their fines from previous years or avoid them altogether, hospitals must not only reduce their readmission rates but do so better than the industry did overall.
“You have to run as fast as everyone else to just stay even,” [AHA quality expert Nancy] Foster said. Only 129 hospitals that were fined last year avoided a fine in this new round, the KHN analysis found. 

And of course the safety net hospitals are taking it in the chops. All of these hospitals will increase rates on private sector, including FEHB plans, to recover the losses created by these penalties.

ISACA has a post on the five truths of HIPAA Security Risk Assessments. Risk assessments are write ups on the security threats that keep you up at night. Risk assessments are the starting point for HIPAA Security Rule compliance and it’s incumbent on covered entities and business associates to keep their risk assessments routinely updated.  

In the same vein, Government Health IT weighs in with five tips for managing HIPAA Security Rule risks created by third parties. Congress has in a sense reduced the risk on the covered entity by directly imposing Security rule compliance obligations on business associates. The article concludes with some sound advice:

Healthcare organizations should document their risk management policies and procedures. Documentation needs not be daunting — simply write down what your job entails, and have an independent party review it. This helps organizations identify gaps and avoid future security incidents.
The best way to prevent a breach is to have a robust program to assess how your vendors are managing data risks. That’s the only control you have. These five strategies can help covered entities stay in control of data, whether inside their firewall or in the hands of business associates and subcontractors.

The FEHBlog is rushing through work to get to the Nats game against San Francisco this afternoon. OPM has not released the 2015 rates yet. The odder situation is that CMS has not released the 2015 Medicare Part B premiums yet as far as I can tell and the Medicare Open Season begins in less than two weeks (October 15).

The FEHBlog did notice this interesting article from MedCity News today about best strategies for getting people engaged in their own healthcare.  

The focus is not so much on signups for fitness programs or penalties for smokers, but building the right support system. Each member of the “Direct From Big Employers: How Can Healthcare Help Them?” panel described the most effective strategy they have seen: building a support structure that includes navigators to help people make good decisions and traverse the healthcare system

The FEHBlog got engaged when his doctor scared the you know what out of him just about three years ago. Of course, all healthcare is local.

Welcome to federal fiscal year 2015 which began today, the first anniversary of the partial government shutdown and the healthcare.gov implosion. Fedweek joins the FEHBlog in asking where is OPM’s 2015 FEHBP premiums announcement.

Yesterday HHS posted on the internet pharmaceutical payments to doctors and teaching hospitals. Having read a Wall Street Journal article earlier this week that pharmaceutical manufacturers are shifting their marketing attention from doctors to hospital administrators, the FEHBlog assumed that the open payments information may be a date late and a dollar short. Boy was the FEHBlog wrong. As noted in the CMS press release and the Wall Street Journal today,

Drug and medical-device companies paid at least $3.5 billion to U.S. physicians and teaching hospitals during the final five months of last year

That is a staggeringly large number which suggests that something is wrong in the state of Denmark.

“The financial relationships between doctors and drug companies and medical-device companies are a source of conflicts of interest,” said Allan Coukell, director of the Pew Prescription Project, which has supported the Sunshine Act. “They have the potential to influence the care that patients get and so they’re a matter of interest both to individual consumers and to policy makers.”

The FEHBlog credits Sen. Chuck Grassley (R Iowa) for pushing this initiative.  

The FEHBlog wishes to call readers attention to this Becker Hospital Review article suggesting ways that accountable care organizations can coordinate care by keeping patients in network. Health plans may be able to use these tips.

The FEHBlog and his wife watched Jordan Zimmermann pitch a no hitter against the Miami Marlins at Nationals Park this afternoon. What a lovely day! This was the first no-hitter pitched at Nationals Park.

Of course, Congress is out on the campaign trail but may come back before the midterms to address the situation in the Middle East. The Supreme Court returns a week from tomorrow.

The Wall Street Journal featured an interesting story about how groups of family members and friends of chronically ill patients hack into medical devices in order to improve their usefulness. The process sidesteps the FDA which is responsible for approving these devices. For example a parent figured out a way to use the internet to transmit glucose readings from his teenage daughter’s glucose monitor so she could take overnight trips. American ingenuity is amazing.

On Friday afternoon, the ACA regulators issued a final rule clarifying the scope of benefit programs that are excepted from the ACA’s reforms, e.g., child coverage up to age 26. The rule concerns dental, vision, health care flexible spending accounts, and employee assistance programs (“EAP”), all of which the federal government offers.  The rule which takes effect for 2015 explains how to structure these programs to avoid the ACA’s impact. LifeHealthPro explains that that the rule helps dental and vision plan sponsors, but  may “hurt” EAP sponsors.  

A week or so ago, the IRS issued a new notice that identifies two limited situations in which an employee participating in a cafeteria plan can revoke his employer health plan coverage in favor of ACA marketplace coverage.  Over time, employers may find themselves competing for good risks with the marketplace plans. That would be counterproductive, in the FEHBlogs view.

Here it is September 26. According to OPM.gov, OPM released the next year’s premiums on September 26, 2011 (for 2012), September 20, 2012 (for 2013), and September 24, 2013 (for this year). It appears that the 2015 premiums won’t be released until at least September 29, 2014. This allows the FEHBlog an opportunity to vent about his own health insurance premiums. His firm’s carrier kindly renewed coverage on December 1, 2013, to allow me one last year before ACA rating kicked in. The FEHBlog received his December 1, 2014, renewal rates this week. A 58% increase. It turns out that for small group each family member is age rated and because my wife and I are around the same age BANG ZOOM as Jackie Gleason would have said. The FEHBlog is exploring options such as a high deductible plan with an HSA. In this regard, the FEHBlog notes this Business Insurance report that employers in anticipation of the imposition of the Cadillac tax in 2014 are attempting to integrate their high deductible health plan offerings with voluntary (employee pay all) offerings such as hospital indemnity and critical illness coverage.

J.D. Powers came out today with its annual customer satisfaction study on brick and mortar pharmacies broken out by supermarket (the winner was Publix), chain drug store (Good Neighbor), and mass merchandiser (Sam’s Club).  Walgreens was rated above average and CVS Health below average in the study.

In an interesting but not particularly surprising development, the ranks of original participants in Medicare’s Pioneer Accountable Care Organizations has dropped from 32 to 19  according to this Wall Street Journal story. Here’s the punch line:

Chas Roades, chief of research at the Advisory Board Co., said that while ACOs did give hospital systems experience in managing population health, many are finding that Medicare Advantage programs or ACOs with commercial insurers are more advantageous.
“The [original Medicare] ACO program is just too complex—there are too many quality metrics to track, and the incentives aren’t strong enough, so they’re moving forward with other coordinated care strategies,” he said.

The FEHBlog is off for the next two nights to watch Washington’s baseball and football teams so he has decided to offer a few Tuesday Tidbits.

• The FEHBlog belatedly discovered that the IRS issued FAQs on the onerous IRC 6055 and 6056 reporting processes late last month. While these reporting requirements take full effect next year with first reports due in January 2016, health plans needs to start gathering dependent SSN’s for the 6055 reporting now. 
• A few months ago, the FEHBlog noted how the Food and Drug Administration was questioning the safety of a power tool that surgeons to remove uterine fibroids. The Wall Street Journal reported yesterday on how the FDA’s informal action has created a controversy among surgeons. The point of the article is that the FDA has limited regulatory reach into the practice of medicine. Its statement (couple with fear of the FEHBlog’s profession) has encouraged surgeons to provide their patients with fuller disclosure about the risks of this power tool known as a morcellator. That’s a good thing. 
• The FEHBlog also has discussed the Choosing Wisely campaign. which highlights medical services that are unnecessary in the view of medical specialty organizations. The Wall Street Journal has reported today about how the Choosing Wisely campaign findings should be implemented. A Delaware hospital chain vastly reduced the number of non-ICU patients receiving cardiac telemetry by creating implementing a Choosing Wisely finding: 

In cardiac telemetry, electrodes are used to monitor the heart for abnormal rhythms. To try to cut inappropriate use of the monitoring at Christiana Care, which operates two hospitals, a group of physicians redesigned the electronic system that doctors use to order tests and other care.

First, they removed the option to order telemetry for conditions not included in the AHA guidelines. Doctors could get around this and order the monitoring, but they had to take an extra step to do so, according to Robert Dressler, who helped lead the study. “We didn’t want to get in the way of the bedside clinician who had a demonstrable concern” and wanted to use telemetry despite contradicting guidelines, he said.

For conditions for which telemetry is AHA-approved, Christiana Care attached a fixed, AHA-recommended time period for telemetry duration in the computer system. If the patient was still in the hospital after that period had elapsed, nurses were instructed to automatically stop the monitoring, unless they believed it to be unsafe, in which case they were required to ask a physician to weigh in.
After the changes, the researchers found the hospital group’s mean daily number of non-ICU patients monitored with telemetry fell by 70%, from 357.5 to 109.1, while the mean daily cost for delivering non-ICU telemetry also fell by 70%, from $18,971 to $5,772. The changes had no negative effect on patient care; mortality rates at the hospitals remained stable, as did the number of “code blue” emergency calls to resuscitate patients.

The Choosing Wisely campaign needs to be implemented by the medical profession (healer heal thyself), not rammed down the profession’s throat by others.

• Finally, the FEHBlog assumed that ACA marketplace participants would be grateful for coverage and would not object to narrow provider networks. Of course, the consumer advocates and medical groups squawked about the narrow networks. But Modern Healthcare reports that  

Researchers at Georgetown University’s Health Policy Institute studied narrow-network plans sold on the individual-market exchanges last year in six states: Colorado, Maryland, New York, Oregon, Rhode Island and Virginia. Health insurers have said the healthcare reform law is spurring them to offer more narrow networks, which they say save them money and lead to lower monthly premiums in exchange for a smaller number of in-network hospitals and physicians. After speaking with several state officials and insurers that offer exchange plans, researchers found that few consumer complaints have emerged to date about the networks’ offerings. 

That”s good news.  

The New York Times lead business section story today was about the 34 year old CEO of a company called Zenefits which is eating the lunch of health insurance brokers with a smartphone app. The article discloses that one of the authors of the Affordable Care Act, Bob Kocher MD has cashed in by investing in this company. The article explains

The Affordable Care Act also called for the creation of state-run insurance exchanges aimed at small businesses; those have been delayed, but eventually they, too, may streamline the way small businesses buy health care. But because the exchanges will allow firms to use brokers, the Zenefits business would still work under that model.
In the long run, such efficiencies could help keep down the costs of health care. “When you can see all the plans online, people tend to choose narrower-cost ones — and that has the effect of pushing doctors and hospitals to try to get into those lower-cost plans,” Dr. Kocher said.

As the FEHBlog has noted, consumer groups empowered by the ACA have strongly objected to narrow networks. In in ironic twist, the lead article in today’s New York Times is about doctors who fly the pirate flag by slyly proving out of network services as assistant surgeons or surgical consultants. It’s a rather sad story because the patients tried to control their expenses but failed to do so because the doctors did not provide transparent pricing. It’s too bad that the ACA did not hold the primary surgeon or other doctor responsible for the prices charged by the other team members.

Business Insurance reports that a study of more than 1,500 data breaches in 2013 and 2014 by a unit of Beazley P.L.C. reveals that the two most common sources of breaches are misdirected emails and faxes and the physical loss of paper records, mostly by health care providers. The FEHBlog thought that the lead cause was theft of records. Update your risk assessments according.

Yesterday as the Federal Times reports, Congress enacted a continuing resolution that funds the federal government through December 11, 2014. A link to the Week in Congress is here. Congress is now back on the campaign trail. There will be a lame duck session following the mid term elections on November 4.

FCW informs us that earlier this week the President nominated retired Navy Rear Admiral Earl L. Gay to fill the vacant OPM deputy director position. “[Admiral] Gay served more than 30 years in the Navy, and commanded that service’s recruiting command from 2011 to 2013. He is currently serving as a senior advisor to OPM Director Katherine Archuleta.” He also was a Navy helicopter pilot. This nomination requires Senate confirmation.

The IRS has announced that the PCORI fee will increase from $2.00 per bellybutton to $2.08 per bellybutton for plan or policy years ending on or before October 1, 2014, and before October 1, 2015. $2.08 will be the fee in effect of the 2014 FEHBP contract year. This fee that the ACA imposes on all health plans but not health care providers funds the Patient Centered Outcomes Research Institute.

CEOs from the Business Roundtable also have offered their views on how to improve the Nation’s healthcare system. Their report (available here) outlines recommendations in three major areas:

• Pursuing health system performance transparency;
• Strengthening incentives for consumers and providers to improve value; and
• Aligning public and private sector efforts.

Today is the 227th anniversary of the signing of the U.S. Constitution, a quite remarkable governing document, and the FEHBlog has returned to DC from his trip to the Northeast. Also of note, the Washington Nationals clinched the National Division Eastern Division title last night down in Atlanta. Go Nats.

Yesterday, the Wall Street Journal reported that Gilead Sciences struck a deal with  Indian generic drug manufacturers to manufacture their Hepatitis C drug Sovaldi for sale in third world countries like Honduras, Vietnam, and South Africa, for a fraction of the $1,000 per day cost here in the U.S. The FEHBlog applauds Gilead for its philanthropy. However, the article reiterates Gilead’s pricing philosophy for this country —

Sovaldi is on pace to become one of the world’s top-selling drugs, with more than $10 billion in sales this year. In the U.S., a 12-week-supply costs $84,000, which some critics say is too high for a lifesaving drug. Gilead has said the price is comparable to the cost of older, inferior treatments, and will stave off more costly health services like liver transplants.

Because the FEHBlog appreciates that price and cost are independent variables, he recognizes that the price of Solvadi does not have to be based on its cost but under this approach the cost curve will never go down.  

Warning — According to this Medical Marketing and Media article, CVS Health reports that 8% of its customers on Sovaldi unilaterally have stopped taking the drug before the end of treatment. CVS suggests the need for more patient support.

Medical Dive reports on recent CMS findings about accountable care organization performance which it describes as a “mixed bag.”

Let’s wrap things up for today with a couple tidbits:

• The Physicians’ Foundation released the results of a biennial survey of 20,000 physicians. The survey confirms widespread unhappiness with the electronic medical record systems for which the federal government has shelled out $24 billion. Moreover,

81 percent of physicians describe themselves as either over-extended or at full capacity, while only 19 percent indicate they have time to see more patients. Forty-four percent of physicians surveyed plan to take steps that would reduce patient access to their services, including cutting back on patients seen, retiring, working part-time, closing their practice to new patients or seeking non-clinical jobs, leading to the potential loss of tens of thousands of full-time-equivalents (FTEs). [Rur-roh]

• The Bipartisan Policy Center has created a CEO Council on Health and Innovation which has its own website. According BenefitsPro

The [new Council’s report urges employers to take three steps immediately that would support their overarching objectives:

• Both implement and track the outcomes of their health and wellness programs;
• Collaborate on the implementation of community-based programs;
• Improve the health care system by supporting the movement toward transparency and payment and delivery models that are based on outcomes rather than volume.