The Red Sox are clobbering the Rockies so why not do a little blogging?

• The Health Information Technology Standards Panel has released a privacy and security architecture for electronic medical records.
• The Employee Benefits Research Institute has released its 10th annual study on consumer confidence in our health care system. The interesting twist is that high medical costs are encouraging Americans to take better care of themselves and talk with their doctors about the cost of medical care. Aren’t these the primary objectives of consumer driven health care? In this regard, CIGNA just released a two year study of its consumer driven health plans which finds that medical trend and member out of pockets costs were significant lower for consumer driven plan members as compared to CIGNA PPO plan members.
• Washington Post correspondent Steve Barr held on online chat today with OPM Deputy Associate Director Kathy McGettigan.

Much has been written in the press about the rise of primary care clinics, such as Minute Clinic, located inside chain pharmacies, and the American Medical Association has gone on the war path against these competitors. Vanessa Fuhrman wrote an article in the Wall Street Journal today about a Wheeling WV doctor of osteopathic medicine, Vic Wood, who is offering unlimited urgent and primary care for $83 per month for an individual or $125 per month for a family. Medical Economic magazine has described Dr. Wood’s practice as a bargain basement version of concierge medicine. Ms. Fuhrmans reports that health insurers are exploring the merits of these prepaid plans. Dr. Wood is speaking at December 2007 conference of the Society for Innovative Medical Practice Design.

Meanwhile the Orange County California Register reports that “When retail clinics [such as Minute Clinic] first started, all visits were cash-only. But lately, as health care costs continue to soar, some insurers have started covering the visits as a less expensive alternative to a traditional doctor’s office. Locally, Aetna and Cigna are among about a dozen insurers that cover visits to Minute Clinics.

It’s a sure sign of fall when Washington Post columnist Steve Barr writes his first Open Season piece in the Federal Diary column, and that happened today. OPM also has begun to gear up its Open Season web site. Open Season begins November 12.

• The President’s veto of the compromise SCHIP reauthorization bill was sustained last Thursday as the House of Representative’s override vote fell short by 13 votes. Meanwhile, Congress is not making much progress in bringing its 12 appropriations bills for the current federal government fiscal year to the President’s desk. According to Govexec.com, the Congressional leadership plans to present the President first with a Labor- HHS appropriation bill that the President has vowed to veto. We are less than one month (Nov. 16) from a likely showdown between these two branches of government.
• OPM issued a benefits administration letter establishing the ground rules for the Federal Benefits Open Season to be held next month.
• Perhaps in reaction to the FEHBlog entry on preventive health care, OPM issued an FEHBP carrier letter on that topic.
• OPM also issued an interesting report on the FEHB Program’s compliance with the President’s August 2006 Executive Order on health information technology and health care pricing and quality transparency. It is evident from the report that FEHB plans have made great progress in implementing the four cornerstones of the Executive Order. Personal health records are available to 90% of the federal and postal employees and annuitants enrolled in the FEHB Program. However, according to OPM less than 5% of FEHB Program enrollees have taken advantage of this opportunity. As over 4 million people are enrolled in the FEHB Program, 5% of the enrollment is 200,000 people. Nevertheless, that is a surprising statistic that OPM and carriers are sure to investigate.
• Also this week a Coalition for Patient Privacy urged Congress to incorporate greater privacy protections in any health information technology legislation. Ironically, Microsoft, whose products are afflicted by security issues, joined in the letter as a member of the Coalition. Of course, Microsoft just released its Health Vault product. Google announced this week that its health initiative will be launched early in 2008.
• New York State Attorney General Cuomo is questioning the efforts of New York health insurers to rank the performance of doctors. The American Medical Association is applauding his efforts, according to Modern Healthcare.com.
• The Federal Times reports that according to a study by the U.S. Merit Systems Protection Board, the average age of a new federal employee is 33.

• An annual report on cancer rates in the U.S. released yesterday “shows cancer death rates decreased on average 2.1 percent per year from 2002 through 2004, nearly twice the annual decrease of 1.1 percent per year from 1993 through 2002.” According to HealthDay, Dr. David Espey, a cancer epidemiologist
  from the U.S. Centers for Disease Control and Prevention in Atlanta,
  

  “We have a lot of work [to do] in colorectal cancer. We’ve been making progress in lung cancer, but that’s a perennial battle to try to control tobacco use initiation and tobacco cessation.” The “low-hanging fruit” in terms of cancer prevention and early detection right now is colorectal cancer, Espey continued. Less progress has been made here than in breast and cervical cancer, he said.

  FEHB plans cover routine tests for colorectal cancers, such as periodic colonoscopies upon reaching age 50. Covering the cost is only half the battle when it comes to uncomfortable tests like these, but it’s hard to read stories like this without realizing extending your life is worth the discomfort.

• The Milken Institute has a created an interesting web site based on its study “An Unhealthy America: The Economic Burden of Chronic Disease.” Utah is the state with the lowest incidence rate for seven common chronic diseases and West Virginia has the highest incidence rate. The study makes two recommendations:
  

  The incentives in the health-care system should promote prevention and early intervention. Employers, insurers, governments, and communities need to work together to develop strong incentives for patients and health-care providers to prevent and treat chronic disease effectively. In many respects, we’ve received what we paid for: a tiny fraction of health-care spending is devoted to the promotion of healthier behavior, despite the fact that preventable chronic diseases are linked to smoking, obesity, lack of exercise, and drug and alcohol use.

  As a nation, we need to renew our commitment to achieving a “healthy body weight.” Increasing obesity rates threaten to send treatment costs for diabetes and related conditions, such as heart disease and stroke, soaring over the next twenty years. There needs to be a strong, long-term national commitment to promote health, wellness, and healthy body weight.

• Finally, the National Coalition on Health Care issued a report on the cost effectiveness of preventive health care services. According to the author, Louise B. Russell
  

  [I]t is impossible to generalize about preventive interventions as though they were all alike. In particular, the evidence does not support the commonly accepted idea that prevention always, or even usually, reduces medical costs – although it sometimes does. Most preventive interventions add more to medical costs than they save, at the same time that they improve
  health.

  But even that statement needs to be made more specific. Preventive interventions need to be evaluated individually. Some, like smoking cessation programs, may be good investments almost regardless of how they are applied – they bring additional good health at a very reasonable cost. Other interventions are good investments when used selectively – targeted at those people who benefit most from them – bu not such good investments when used for more broadly defined groups of people.

  At the end of the report the author has included a table that evaluate the cost effectiveness of various preventive treatments.

• OPM Director Linda Springer issued a public letter about the upcoming Open Season which offers 2008 open enrollment for the FEHB Program, the Federal employees supplemental dental and vision program and the Federal employees flexible spending account program.
• Congressional leaders plan an October 18 over-ride vote on the President’s veto of the State Children’s Health Insurance Program reauthorization bill. The federal government is operating under a continuing resolution which expires on November 16. The President has issued veto warnings against many appropriations bills, none of which has been sent to the President yet. I wonder if we will see another federal government shutdown similar to the one that occurred in 1995, which would interfere with the Open Season.
• The health subcommittee of the House Energy and Commerce Committee approved a manager’s amendment to the House version of the mental health parity act (HR 1424). The Energy and Commerce Committee is the last of three House committees that must consider the legislation before it is referred to the Rules Committee. The original version of the House bill defined the scope of covered mental health services by reference to the Blue Cross Federal Employees Plan standard option. The manager’s amendment instead refers to the American Psychiatric Association’s DSM-IV.
• The AHIMA and e-Health Initiative conferences included discussions of the HIPAA Privacy Rule and the interrelationship between privacy/security and the National Health Information Network. Speaking at the e-HI conference, former CMS administrator Mark McClellan noted that
  

  The committee report accompanying the 2008 HHS appropriations bill in the House asked for a “privacy and security framework that will establish trust among consumers and users of electronic personal health information and will govern all efforts to advance electronic health information exchange.” The report specifies elements it wants to see in the framework, such as “allowing individuals to have a say in who and how their information is used” and maintaining data integrity.

  Other speakers predicted that a health information technology bill, like the Wired for Health Care Act, would pass Congress in 2008.

• Krogers, which operates food stores and pharmacies, in the Mid-West and New Mexico is now joining Target and Wal-Mart pharmacies in offering a variety of generic drugs for a $4 copayment.

• AHRQ reported this week that “Between 1994 and 2004, risk-adjusted [U.S. hospital] inpatient mortality rates for six selected diagnoses and six surgical procedures steadily decreased by 18 to 46 percent.”
• The eHealth Initiative released a Blueprint: Building Consensus for Common Action, a “multi-stakeholder consensus [involving over 200 organizations] on a shared vision and a set of principles, strategies and actions for improving health and healthcare through information and information technology.” Healthcare IT News reports that according to eHI “the release of the Blueprint is Phase I of a two-phase process. Phase II of the process, occurring over the next 12 months, will involve eHI in the ‘wide dissemination’ of the Blueprint, support for its implementation, facilitation of the sharing of related best practices, and a search for input from additional stakeholders at the national and local levels.”
• On a more arcane level, Ingenix released its fourth annual report naming the top 200 coding hospital in our country. Healthcare IT News explains that “The report ranks hospitals by the completeness and accuracy of their medical coding practices used to bill Medicare for inpatient medical services.”
• A Chicago Tribune article threw cold water on Microsoft’s new Healthvault product. Although the headline spoke of privacy concerns, here’s what caught my attention:
  

  In an interview, Sean Nolan, chief architect of [Microsoft]’s 2-year-old Health Solutions group, characterized this “beta” launch of HealthVault as an early step into a difficult industry.

  For one thing, 80 percent to 85 percent of doctors in private practice don’t keep electronic records, and hospitals aren’t much better, according to Lynne Dunbrack, program director of the market research group Health Industry Insights.

  And where electronic records do exist, there’s no guarantee that any two health-care providers will call the same treatment or lab work by the same name.

Unless of course they were both working at the top coding hospitals.

The Government Accountability Office released a report today on retail drug price trends.

GAO found that the average monthly usual and customary [or retail] prices reported by two state pharmacy assistance programs [New York and Pennsylvania] increased 13.6 percent from January 2004 through January 2007 for a typical 30-day supply of the 122 prescription drugs frequently used by BCBS FEP Medicare or non-Medicare enrollees. This represents a 4.3 percent average annual rate of increase. Prices increased at similar rates for the 96 drugs frequently used by BCBS FEP Medicare enrollees and the 91 drugs frequently used by BCBS FEP non-Medicare enrollees. We also found that the average monthly usual and customary prices decreased for the 57 generic drugs and increased for the 65 brand drugs from January 2004 through January 2007. Specifically, the generic drug prices decreased 12.8 percent, a 4.5 percent average annual rate of decrease, while the brand drug prices increased 21.2 percent, a 6.6 percent average annual rate of increase. During the same period, based on nationwide data from the Bureau of Labor Statistics, prices for all consumer items for all urban consumers–the Consumer Price Index (CPI)–increased 9.3 percent, a 3.0 percent average annual rate of increase. We also found that from January 2000 through January 2007, average monthly usual and customary prices increased at a faster rate for the 44 brand drugs than for the 43 generic drugs. Specifically, prices for the brand drugs increased 48.6 percent, a 5.8 percent average annual rate of increase, while prices for the generic drugs increased 7.1 percent, a 1.0 percent average annual rate of increase. During this same period the CPI increased 19.9 percent, a 2.6 percent average annual rate of increase.

• U.S. Representative Jo Ann Davis (R VA), who chaired the House subcommittee with FEHB Program oversight responsibility at the time that Congress approved the federal employee supplemental dental and vision benefit law, died from breast cancer on October 6.
• President Bush did veto the State Children’s Health Insurance Program reauthorization bill. The continuing resolution that funds the federal government temporarily also funds the SCHIP until November 16. In the meantime, the Congressional leadership will attempt to override the President’s veto, which requires a 2/3’s majority of both Houses.
• There was a lot of health information technology news last week. Microsoft introduced its Health Vault product, which offers consumers and the health care providers the opportunity to upload their medical records to a secure web site. In a Washington Post article about the product release, privacy advocate Deborah Peel was quoted as supporting the Microsoft consumer oriented site over a health insurer sponsored site as follows: “You have to have lost your mind to give them [the health insurers] any more info about you than they already have.” Health Vault’s business model relies on advertising revenue generated by consumer searches. Consumers are not charged to use the service. Hitting a similar note, the AHIC quality workgroup is predicting that over the next three to five years health care quality programs will switch from using health care claims data to electronic clinical data according to Modern Healthcare.com. Also in that same vein, the Department of Health and Human Services (“HHS”) awarded contracts totaling $22.5 million to nine health information exchanges to begin trial implementations of the Nationwide Health Information Network, or NHIN according to Health IT Magazine. Finally, the National Committee on Vital and Health Statistics, an HHS advisory body, sent HHS Secretary Leavitt a Sept. 26 letter urging upgrades to the HIPAA electronic transaction standards.
• The press is reporting that the Bush Administration is proposing legislation to means test Medicare Part D prescription drug plan premiums similar to the current means testing for Medicare Part B premiums.

In an October 2, 2007, report in the Federal Times, Sen. Tom Carper (D DE) reported that he plans to hold a hearing on his FEHBP personal health records bill before year end. According to the report, Sen.Carper now favors a demonstration project, which for all intents and purposes, is underway.