The FEHBlog hopes that everyone has been enjoying the Thanksgiving holiday weekend. Congress returns to work yesterday after a Thanksgiving break. The Hill has its closer look at the week ahead column. One of the expiration of the Medicare Part B doctor reimbursement fix on December 31 confronts the lame duck Congress. The Hill reports that the latest CBO projection ups the cost of a one year fix from $18.5 billion to $25 billion. This may lead Congress to enact a shorter fix, e.g., to the end of March 2013 which would align with expiration of the continuing resolution funding the federal government.

The Federal Benefits Open Season continues through December 10, 2012. The Washingotn Post’s Federal Diary column discussed Open Season last week.

Healthcare.gov now has working websites with fact sheets about the proposed rules on essential benefits  market reforms, and wellness programs issued last week. Modern Healthcare predicts more controversy over the essential benefits rule.

The FEHBlog is on record opposing federal laws dictating technology standards and rules in healthcare.  Another example of adverse consequence is found in the Kaiser Health News report about a study finding that offering patients online access to doctors — a requirement of a 2009 federal law — has increased the number of office visits. If this weren’t a law, it would be easy to tweak the policy.

Another headscratcher is the AP report that “Mammograms have done surprisingly little to catch deadly breast cancers before they spread, a big U.S. study finds. At the same time, more than a million women have been treated for cancers that never would have threatened their lives, researchers estimate.” The article notes that “Men have heard a similar message about PSA tests to screen for slow-growing prostate cancer, but it’s relatively new to the debate over breast cancer screening.” Medicine remains as much as art as a science. Here’s a link to the NCI’s fact sheet on mammography which recognizes a risk of overdiagnosis but on balance recommends a screening mammogram every other year for women over 40 years old.

The FEHBlog wishes everyone a very Happy Thanksgiving (and hopes that the Redskins lead by RG3 beat the Cowboys.)

HHS issued a torrent of proposed Affordable Care Act regulations yesterday that will govern prohibition on pre-existing condition exclusions, essential benefits, and market reforms / wellness programs in 2014, once finalized. This development gives the FEHBlog something to do over the long holiday weekend.

The Washington Post reports that the U.S Preventive Services Task Force is considering making an HIV test co-payment free for all people between 15 and 65, not just those at high risk which is currently the case. The PSTF wants to remove any stigma from the testing. This change, if finalized would be implemented for 2014 in the FEHBP.

The For Your Benefit show on Federal News Radio has been featuring Open Season reports. You can catch up on those reports here.

OPM released the 2012 Federal Employee Viewpoint survey results today. You can view those results here.

As we head into the second week of the Federal Benefits Open Season, Congress begins to buckle down to work on avoiding the fiscal cliff created by the end of the Bush tax cuts on December 31, 2012 and the default sequestrations created by last year’s deficit reduction law. The Federal Times reports that leaders are upbeat.  Govexec.com reports that retiring Sen. Daniel Akaka (an alumni of the FEHBlog’s law school George Washington) is warning Congress against adopting the Simpson Bowles proposal to place the FEHB Program on a voucher system. This squib caught the FEHBlog’s eye:

Walton Francis, an independent consultant and author of Consumer’s Checkbook  Guide to Health Plans for Federal Employees,
said the federal government currently pays 70 percent of its employees’
health care premiums, which is “right square in the middle” of what
large, private sector employers pay their for their employees’ care.
“It would be an arbitrary cut,” Francis said. “There’s no reason per se to make that reduction.”

Francis added that while some may favor such a cut, it could have the
unintended consequence of motivating lower income federal workers to opt
out of FEHBP in favor of the open-market exchange, which could in turn
increase costs to the government. 

The FEHBlog agree but notes that federal employees who opt out in favor of the exchanges would not receive the government contribution unless Congress allowed the voucher to be used for exchange coverage. However, Congress in 2011 repealed an ACA provision that created such a free choice voucher for all employees in limited circumstances as a destabilizing measure.

On Friday, the Centers for Medicare and Medicaid Services released notices in the Federal Register (no press release) about Medicare Parts A and B premiums and beneficiary cost sharing for 2013. Oddly the announcements were made one month after the Medicare open season began on October 15. In a blog post, the CMS Acting Administrator explained that the monthly Medicare Part B premium will increase $5 to $104.90 for most beneficiaries.  Boston.com explains that for higher income beneficiaries (income over $85,000) the laddered premium (which already is substantially higher) will increase by “$42 to $230.80 a month, depending on income.” The Acting CMS administrator also announced that

Medicare Part A Premium: Part A
covers inpatient hospital stays, care in a skilled nursing facility,
hospice care, and some home health care. Only about 1 percent of people
with Medicare pay a premium for Part A services—you need to have paid
Medicare payroll taxes for 40 quarters of employment or be married to
someone who did. For those few affected, the 2013 Part A premium is
decreasing to $441, down from $451 in 2012.

Medicare Part A Deductible: This
deductible is the cost to people with Medicare for up to 60 days of
Medicare-covered inpatient services in the hospitals for each benefit
period (a benefit period starts the day a patient is admitted and ends
when the patient has been out of the hospital for 60 days in a row.) 
This will increase to $1,184 in 2013, up from $1156 this year (an
increase of 2.4%).

Medicare Part B Deductible: The deductible will increase to $147 in 2013, from $140. This is still $15 below the deductible in 2011.

HHS did issue a press release about a new consolidated government anti-tobacco website called betobaccofree.gov 

Business Insurance reports “Aided by the move of more employees into lower-cost consumer-driven
health care plans, group plan costs increased by just over 4% in 2012,
the smallest increase in 15 years, according to a survey of more than
2,800 employers released Wednesday by Mercer L.L.C. in New York.”  This is in line with the recent FEHBP increases which also are driven in part by enrollees moving to lower premium plans.

Standard & Poors released its latest healthcare cost indices late last week:

All nine S&P Healthcare Economic Indices posted a deceleration in their annual growth rates in September 2012. Professional Service Medicare and the Hospital Index posted their lowest annual rates since January 2005; additionally, the Hospital Commercial Index hit a new recent low with an annual growth rate of +5.12% – its lowest since May 2010. As measured by the S&P Healthcare Economic Commercial Index, healthcare costs covered by commercial insurance plans increased by 7.05% over the year ending September 2012, down from the +7.81% reported for August 2012. Annual growth rates in Medicare claim costs rose by 2.04%, according to the S&P Healthcare Economic Medicare Index, down from the +2.48% recorded in August 2012. The Professional Services Index annual growth rate was +6.13% in September 2012, down from the +6.67% August 2012 print. The Hospital Index’s growth rate fell to its seven-and-a-half year historic low of +3.84% in September from +4.54% recorded in August 2012.

OPM recently asked FEHB plans for data on hospital readmissions.  Policymakers think that reducing readmissions is a key to improving health care quality, as reflected in this new NCQA report. As the FEHBlog has noted Medicare began to penalize hospitals for high readmission rates last month. Psychcentral reports on a new readmissions study conducted by the University of Wisconsin

The study found some significant associations between social environmental factors, and suggested some pathways by which these effects occur. Patients’ functional ability — their ability to take care of themselves — was influenced by their living arrangements and by the type and frequency of informal care they received. The greater the difference between the patients’ clinical condition and functional status, the greater the risk of rehospitalization.

Shocker. Family and other informal support systems help patients avoid hospital readmissions.

The AMA News reports that

A study in the Fall edition of Perspectives in Health Information Management found that of those who were willing to use a personal health record, 65% self-reported a high health literacy level. For those who were not willing to use a PHR, 38% self-reported a high level of health literacy.

Shocker. Only 7% of patients use a PHR, according to this study.

Doctors are interested in this study because PHR use is a factor that the government considers in deciding whether doctors and hospitals have lived up to bargain that they cut when they took free electronic health records from the government.

Under stage 2 of the Medicare incentive program for the meaningful use of electronic health records [which kicks in next year], physicians must ensure that at least 5% of their patients access, download or transmit their medical records. [Can you say Blue Button?] For stage 1, physicians were required to provide electronic copies of health records to at least 50% of those who requested them. Seventy percent of physicians who received incentive payments for stage 1 said they did not have any patient requests for records.

Personal health records containing actual medical records no doubt will be more useful than personal health records containing health plans claims data. The FEHBlog notes that his internist has a new electronic medical records system but he does not recall being offered a personal health record. The FEHBlog will inquire.

On a related note, Modern Healthcare reports that “the American Hospital Association T wants to work with the government to
ensure that the sellers of electronic health-record systems are
producing systems that comply with federal law and don’t lead healthcare
providers to submit bills that later get them in trouble.” Government Health IT reports on a Congressional hearing held today that was trigged by news reports about perceived hospital abuse of their free electronic medical record systems.

Happy Veterans’ Day (observed).  The Federal Benefits Open Season begins today, November 12, and will end on December 10, 2012 (subject to OPM’s right to extend the Open Season to account for unusual circumstances).

On Friday, OPM posted an immediate effective interim final rule  (“IFR”) that “allows agencies such as the Federal Emergency Management Agency (FEMA) to apply to OPM for authorization to offer FEHBP coverage to intermittent employees engaged in emergency response functions.” This IFR closes the loop on the IFR  released last summer extending FEHBP coverage to temporary federal employees who fight forest fires for the Interior Department. That IFR solicited suggestions on further expanding coverage to other first responders. Govexec.com also credits an online petition but the FEHBlog thinks that the wheels were in motion for this IFR before the online petition coinciding with last month’s “super storm” and its timing is attributable to the start of Open Season.

The AMA News reports on the Centers for Medicare and Medicaid Services final rule on Medicare Part B reimbursement to physicians for the 2013 calendar year. This rule is obviously a big deal to doctors as it features the doctor’s “fiscal cliff” — a 26.5% reimbursement cut attributable to the statutory sustainable rate of growth formula that Congress is expected to address in the lame duck session that begins tomorrow. The rule also includes a number of other features stemming from the ACA that will take effect in January:

The fee schedule includes other rate cuts to some physicians, such as
lower payments for multiple advanced imaging scans and penalties for not
submitting quality measurements to the Centers for Medicare &
Medicaid Services. But CMS also finalized additional hardship exemptions
the doctors can use to prevent pay reductions for not reporting
electronic prescribing activity, and it further limited the number of
physicians who will have their rates adjusted according to quality and
cost scores by a value-based payment modifier in 2015.

Finally, the FEHBlog was interested to read (in a Pittsburgh Post Gazette article) that a Pennsylvania state court judge on Friday granted Highmark a preliminary injunction against the West Penn Allegheny Hospital System restoring for the time being the affiliation agreement between health insurer Highmark and the hospital system. Back in August the hospital system walked away from the deal which had not yet closed (although Highmark had invested a lot of money in the facility.) The FEHBlog knows that the law establishes a high bar for obtaining this relief. The hospital system can appeal even though the case is not over.

Although it’s the FEHBlog’s job as a lawyer to belabor the obvious. the FEHBlog sees no reason in recounting yesterday’s election results. The upshot from the FEHBP’s perspective is that implementation of the Affordable Care Act continues full speed ahead. For the FEHBP, that means that Congress and their personal staff members will leave the FEHBP for the exchanges in 2014. Perhaps then the FEHBP will not be treated like a political football. (Query is that necessarily a bad thing.) The other change is that a plethora of ACA required taxes and fees will rain down the FEHBP necessarily leading to premium increases for 2014 above the low levels of the past two years.

Modern Healthcare compiled healthcare leader reactions to the election results here.

On Sunday, the FEHBlog noted a campaign to extend FEHBP coverage to first responders who work for FEMA as temporary employees. Earlier this year, OPM extended FEHBP coverage to first responders who work for the Forest Service as temporary employees and in the interim final rule implementing that change OPM solicited public input about adding other groups of first responders. Thus it did not come as much of a surprise to me when a colleague pointed out the following entry on reginfo.gov :

The FEHBlog ran across press releases about Humana’s acquisitions of Metropolitan Health Networks, a southern Florida company that owns 35 medical centers, and Certify Data Systems, a healthcare technology systems vendors to hospitals and other health care providers. These acquisitions are further examples of how health insurers are branching out into other related businesses where the government has not capped profits.

Finally, because the FEHBlog has been interested in the Walgreen’s / Express Scripts saga, here is a link to a story from Investor Plan that brings you up to date. (Spoiler alert: CVS came out on top.)  The article notes that Walgreen’s recently has dipped its toe back into the prescription benefit manager business by acquiring an interest in a  United Kingdom based PBM called Alliance Boots.

Well this is election week (finally). Next Monday, November 12, Congress will return to Washington and the Federal Benefits Open Season will begin. Here’s the link to OPM’s Open Season resources. Fedsmith.com announced that OPM again will be offering a series of Open Season how to webinars that begin on Tuesday November 6.

Earlier this years, President Obama ordered OPM to admit seasonal firefighters into the FEHBP. Typically seasonal employees are not eligible for FEHBP coverage. OPM complied with the President’s order in the summer and at this point these seasonal workers no longer are working for the Interior Department and are no longer receiving FEHBP coverage with a government contribution. Instead they generally must pay for temporary continuation of coverage until they are called to duty again. The FEHBlog brings this up now because the Washington Post reports that the folks who are temporarily working for FEMA to assist victims of Superstorm Sandy are complaining that they should receive FEHBP coverage. In the regulation extending coverage to the seasonal firefighter, OPM left the door open for extending FEHBP coverage to other temporary first responders. According to the Post article there are about 9,000 temporary first responders working for FEMA.

The federal government employs a lot of temporary employes who are not first responders but rather work for the IRS. Presumably this problem will resolve itself once the state health insurance exchanges are established.  It’s not clear to the FEHBlog whether the Affordable Care Act will require a large employer like the federal government to pay for health insurance for temporary employees who work more than 30 hours per week.  There has been a lot written lately about the fact that the pay or play provisions of the Affordable Care Act are limited to full time employees (30 or more hours per week).   It probably will be a case by case situation for the temporary employees.

Reuters reports that the American Hospital Association and others have sued the Health and Human Services Department challenging the way in which the Recovery Audit Contractor program is being administered.  Under the RAC program, private contractors working for HHS audit health care providers that bill Medicare and Medicaid (not the FEHBP) to identify overpayments by those programs. (FEHB plans undergo a variety of independent audits as well as audits conducted by OPM’s Office of Inspector General.)  “The RAC audit program, established under the Bush administration to curtail improper Medicare payments, has collected $1.86 billion in overpayments from October 2009 to March 2012, according to the court filing.”

The Wall Street Journal explains that the nub of the lawsuit is that when a RAC contractor concludes that inpatient care should have been provided on an outpatient basis, the hospital must refund Medicare’s payments (the RAC contractor receives a percentage of the recoveries), and Medicare refuses to cover the outpatient costs. The suit asks the court to order HHS to reimburse the hospitals for the patient’s care as if it were rendered on an outpatient bases.  

Following up on last Sunday’s New York Times article, the Pittsburgh Post Gazette printed an article about the multi-state plans that will be offered in the state health insurance exchanges based on OPM contracts, similar to the FEHBP. The reporter observes that

Traditional insurers * * * would seem to have little incentive to assemble and sell a multistate plan when they can sell products in the exchanges directly.

“Many questions remain unanswered because the federal government has yet to issue the request for proposal that will outline the requirements” of the multistate plans, said Janice Maszle, spokeswoman for Highmark Inc., Pennsylvania’s largest health insurer. “We do feel strongly that these plans must operate on a level playing field with the other qualified health plans on the exchanges, [which] will prevent adverse selection.”

The Federal Times reports that “While insurers report a growing willingness of federal [employee health benefit plan] enrollees to tap into their systems to make use of their medical information, the size of the growth is mixed. It’s still small for most carriers, with the large majority of their federal membership still balking at using the health records system, even though electronic records advocates insist they offer widespread benefits to users.”  The article does not mention that OPM’s most recent initiative has been to require FEHB plans to offer their members “blue button” access to their electronic records. The Blue Button permits plan claim records to be readily imported into a personal health records program like Microsoft Healthvault or a spreadsheet. The FEHBlog thinks that this technology will be more useful when offered by a healthcare provider because the providers records directly deal with the member’s health — as opposed to payment for the member’s health care. But experts have noted that while the medical community is getting accustomed to their brand new medical record systems, people sometimes need to fall back on their health insurance records, particularly in a pinch like “Superstorm” Sandy.

The FEHBlog has noted that the HHS Office for Civil Rights has been routinely slapping health care providers with $1.5 million fines under HIPAA when large volumes of electronic protected health information has been stolen. (Health plans are subject to these penalties as well but recently health care providers have been in the OCR bullseye.)  The FEHBlog took note of an U.S. Justice Department press release about a settlement with a check cashing company that failed to properly dispose of paper records containing confidential personal financial information subject to protection under the analogous Gramm-Leach-Bliley Act.

“A company that operates payday loan and check cashing stores in at least nine states has settled with the government over allegations that it violated federal regulations, the Justice Department announced today.   In April 2010, law enforcement officers retrieved boxes of intact consumer documents, including credit reports, from trash cans and dumpsters near four PLS Financial Services stores in the Chicago area.   The improper disposal of these documents led to an investigation by the Federal Trade Commission (FTC).  “

The company accepted a $101,500 fine. It’s good advertising for shredding companies and a reminder to HIPAA covered entities including health plans about the need to shred documents containing personal health information. .

Happy Halloween!  As we inch ever closer to the beginning of Open Season on November 12, OPM announced today that it has reactivated its Federal Benefits Facebook page (which the FEHBlog likes) and its Twitter feed (which the FEHBlog follows).

The Federal Times offered its first Open Season article yesterday on the topic of whether a low premium FEHB plan may be the right choice.

Following up on the Weekend post about health care costs, the FEHBlog noticed that AHIP is now offering an Ipad app called “U.S. Health Care Spending 101,” that “provides policymakers and stakeholders
with comprehensive health care spending data in an easy-to-use digital
format.”

As you know from reading the FEHBlog, the FEHBlog’s money is on personalized medicine bringing down the cost curve. The Wall Street Journal has an article aibout the progress being made in that area.

The AMA News claims that there’s a new trend toward domestic medical tourism, but the upshot is that many large employer health plans are refocusing attention on centers of excellence for certain high cost procedures like transplants. This good idea is nothing new. You will find that most FEHB plans particularly the nationwide plans offer centers of excellence arrangements.

Yesterday’s Washington Post had an article about domestic medical tourism from an uninsured individual’s standpoint. Hip replacement surgery overseas or in Oklahoma City?

OPM has required for the past two years that FEHB plan offer comprehensive tobacco cessation program with no enrollee cost sharing. Forbes Magazine reports that “Four new studies offer powerful evidence of the dangers of smoking and the health benefits of quitting or not being exposed to secondhand smoke.”

As the FEHBlog has mentioned, November 12 also will feature the return of Congress for its lame duck session. One must pass measure is legislation postponing the Medicare Part B’s sustainable rate of growth formula driven cut in Medicare payments to doctors or in the AMA’s dreams repeal and replacement of the SRG formula. The AMA News this week lays out the medical community’s repeal and replace strategy. Time will tell.

Batten down the hatches!!  Just two weeks from tomorrow, Congress will return for its post-election lame duck session and the Federal Benefits Open Season will begin.