At 2 pm tomorrow, Sept. 13, OPM Director Linda Springer will hold a press conference to announce 2008 premiums for the Federal Employees Health Benefits Program and the Federal Employees Dental and Vision Program. As a point of reference, a Kaiser Family Foundation study released yesterday states that employer sponsored health insurance costs have increased 6.1% on average in 2007. The Wall Street Journal reports that

This is the fourth straight year premiums have decelerated since soaring nearly 14% in 2003.But after a decade of inflation-topping increases, the annual cost for family coverage through an employer plan is now more than $12,000, well over what a minimum-wage worker earns in a year. Workers now pay on average $3,281 a year to cover their share of that family policy, double what they did in 2000, the survey found.

• Congressional Quarterly reports that the Senate Republican leadership is delaying the naming of a Conference Committee with the House on the State Children’s Health Insurance Plan (SCHIP) reauthorization bills. It further reports that a brief extension of the SCHIP law, e.g., to November 15 may be in the offing. Absent such action, the SCHIP Program authorization will expire on September 30.
• Govexec.com reported this week on federal employee union and NARFE efforts to require FEHB plan carriers to purchase prescription drugs off the Federal Supply Schedule, just like VA and Defense Department health care facilities. Govexec.com also reported this reaction from OPM Associate Director Nancy Kichak:
  

  Nancy Kichak, associate director for strategic human resources policy at OPM, said the agency opposes such a bill. “We want our carriers to have the flexibility to offer a variety of products to encourage competition,” she said, adding that OPM would prefer making the supply schedule discounts optional for FEHBP carriers.Kichak added that while use of the FSS would lower drug costs, it could do away with valuable elements of some plans, such as encouraging the use of generic drugs and allowing employees to obtain prescriptions through mail order. Use of the supply schedule “would only help in one element of the drug purchase, which is cost, and only for those drugs on the schedule,” she said.

• Modern Healthcare.com reported on HHS’s September 5 forum on converting the American Health Information Community to a private sector organization.
• The September 2007 issue of AIS Health’s Report on Patient Privacy is freely available online to sample. My colleague Theresa Defino wrote the interesting front page article on how to handle security breaches and yours truly is quoted inside the publication.
• The Senate confirmed President Bush’s appointment of Jim Nussle to serve as Office of Management and Budget Director.

In my view, the one great hope for resolving our health care crisis (besides the private market) is the ongoing research to inexpensively decode the human genome at an individual level. The New York Times and the Washington Post featured fascinating articles today about recent progress in this research. The Washington Post article explains that

Cost trends [in personalized genome sequencing] are encouraging. The first 3 billion-letter genome sequences took more than a decade to complete and cost billions of dollars. During Venter’s latest project, costs dropped precipitously, and today, several scientists said, an entire diploid genome could probably be done for about $100,000. Some predict that a $1,000 genome will be available within five years.Venter and others hope that at that point many people will get sequenced and, as Venter has already done with his own, will post their genomes on public databases along with their medical information and family history. That will allow computers to start drawing connections between gene patterns and diseases.

• The U.S. Office of Personnel Management (OPM) announced this week that it is expanding the Open Season guide, which traditionally has focused on the FEHB Program, to include the federal supplemental dental and vision program (FEDVIP) and federal flexible spending account (FEDFSA) offerings. OPM’s benefits administration letter explained that
  

  You can find more information about these programs at www.opm.gov/insure. OPM will post FEDVIP and FEHB premiums for 2008 in mid-September. You will be able to find specific Federal Benefits Open Season information on our web site during the first week of November. The 2007 Federal Benefits Open Season will be held from Monday, November 12, 2007, through Monday, December 10, 2007.

• On a weekly basis, I scout around the HHS website for interesting Medicare and health information technology information. The week, I discovered that HHS Secretary Leavitt has his own blog where he currently is reporting on his trip to Africa. On the more mundane front, CMS completed the third phase of its regulation project to implement the Stark Act’s prohibition against physician self-referral of Medicare business. The press release notes that “the Phase III final rule eliminates the requirement that entities providing professional courtesy provide written notice to an insurer of a reduction of any coinsurance obligation.”
• The New York Times reports that the American Cancer will devote its entire $15 million advertising budget to the issue of covering the uninsured.
• The U.S. Centers for Disease Control (CDC) released child and adolescent vaccination rates on Thursday. The CDC voiced concern over lagging vaccination rates for older children:
  

  The percentage of adolescents who had received recommended vaccines varied widely by both vaccine and age, with the nation′s Healthy People 2010 goals for adolescents ages 13-15 years not being met for any of the vaccines.
  The lowest estimates were associated with the most recently recommended vaccines. About 60 percent of 13-to-17 year olds received a tetanus-diphtheria or tetanus, reduced diphtheria and acellular pertussis vaccination since age 10, but only 10.8 percent for tetanus, reduced diphtheria and acellular pertussis alone, and 11.7 percent had received a meningococcal conjugate vaccine vaccination. “The new survey information shows we have more work to do to protect older children from vaccine-preventable diseases,” said Dr. Melinda Wharton, deputy director of CDC′s National Center for Immunization and Respiratory Diseases. “We need to continue to build awareness of these recommendations among parents and health care providers, and we need to continue our efforts to educate everyone about the health benefits of these vaccines.” Wharton encouraged parents of all 11- and 12-year-olds to have their child get a routine checkup as a way to ensure the children receive recommended vaccinations.

The U.S. Census Bureau today released its 2006 report on health insurance coverage, among other topics. The report notes that

The number of people with health insurance increased to 249.8 million in 2006 (up from 249.0 million in 2005). In 2006, the number of people covered by private health insurance (201.7 million) and the number of people covered by government health insurance (80.3 million) were not statistically different from 2005.

However, the report adds that

Both the percentage and the number of people without health insurance increased in 2006. The percentage without health insurance increased from 15.3 percent in 2005 to 15.8 percent in 2006, and the number of uninsured increased from 44.8 million to 47.0 million.

While the report cautions that “Research shows health insurance coverage is underreported in the [study] for a variety of reasons,” its finding that the number of uninsured children has increased from 8 million (10.9 percent) in 2005 to 8.7 million (11.7 percent) in 2006″ will play a factor in the SCHIP reauthorization debate. It is puzzling to me that the percentage of children living in poverty without health insurance — the intended beneficiaries of the SCHIP program — is 19.3% (unchanged from 2005) while the percentage of uninsured senior citizens — the intended beneficiaries of the Medicare program — is only 1.5%.

AIS.com posted this interesting report on proposals to wipe out the business associate concept in favor of sweeping application of the covered entity concept to all parties that handle protected health information except patients. Wouldn’t it be simpler for Congress to extend the HIPAA criminal and civil penalties to current business associates? It’s worth noting that these Patient Privacy articles posted on AIS.com often are written by Theresa Defino who has been helping me write the AFHO legislative reports for many years.

• The U.S. District Court for the District of Columbia decided yesterday that the Centers for Medicare and Medicaid Services must comply with Consumer Checkbook’s FOIA request for 2004 Medicare claims records on physicians located in Washington, DC, Maryland, Virginia, and Illinois. Consumer Checkbook plans to use the information to create on its website a publicly available database on the number of specific medical procedures that doctors have performed in return for Medicare reimbursement. The government has not announced whether it will appeal this decision according to the Wall Street Journal.
• Modern Healthcare.com reported on a public meeting held on August 17 at which the privatization of the American Health Information Community (AHIC) was discussed.
• Modern Healthcare.com also featured a two part report (part one and part two) on a recent government funded report released on August 9 that calls for re-engineering the national health information network so it facilitates the health care fraud fighting activities of third party payors.
• A Potomac MD cardiologist this week agreed to repay the federal government $476,000 based on charges that he billed the FEHB Program and Medicare for services that he did not perform. The cardiologist did not admit to the charges, however.

HHS Secretary Michael Leavitt is celebrating the first anniversary of the President’s executive order on health care pricing and quality transparency and health information technology.

“In its first year, the President’s Executive Order has begun to have a culture-changing effect in the health care sector,” Secretary Leavitt said. “For the first time, we are working effectively together to make possible reliable and consistent measures of quality and price. This is the foundation we must have for a future of affordable, effective, and high quality health care.”

Each of the federal agencies subject to the order, including the U.S. Office of Personnel Management, submitted progress reports. Secretary Leavitt noted in his press release that

OPM, which administers the Federal Employees Health Benefits Program, is promoting health care price and quality transparency through its contracts with private sector insurance carriers and is also requiring them to report on new quality
of care measures. This fall, federal employees will see enhanced consumer information on price and quality transparency in the 2007 Guide to Federal Benefits on OPM’s Web site.

• Last year, the FEHBlog included a post on a major employer initiative called Dossia that was intended to create an electronic health record databank. Dossia has caused consternation among privacy advocates because it sought to sidestep the HIPAA Privacy Rule through the use of patient authorizations. Now a contract dispute has cropped between the employers, such as Intel, who form the Dossia consortium and the vendor, Omnimedix Institute, that is creating the database. The vendor has stopped work on the project as a result of this dispute.
• Also last year, the FEHBlog included reports on a U.S. Court of Appeals for the District of Columbia Circuit opinion, Abigail Alliance v. von Eschenbach, holding in reliance on Washington v. Glucksberg, 521 U.S. 702 (1997) that the due process clause of the Fifth Amendment to U.S. Constitution protects the right of terminally ill people to access investigational new drugs that have cleared initial safety testing at phase I of the trials when the patient’s doctor holds the opinion that the drug is potentially life saving, even though its efficacy has not yet been proven. The D.C. Circuit reversed that decision in an 8-2 vote by the entire court on August 7 holding that “there is no fundamental right ‘deeply rooted in this Nation’s history and tradition’ of access to experimental drugs for the terminally ill.” The judges who were in the majority on the panel decision (Judge Rogers and Chief Judge Ginsburg) wrote a dissent.

• The House last month approved an FDA appropriations bill (HR 3161) that would permit prescription drug reimportation from foreign countries. The White House has advised Congress that it would veto this bill because, among other reasons, the drug importation provisions threaten the safety of the U.S. drug supply. A friend reminded me yesterday about the deaths of over twenty Panamanians last year due to adulterated cough syrup imported from China. The White House has issued formal veto warnings, known as Statements of Administration Policy, about several appropriations bills, including the bill that funds the FEHB Program (H.R. 2989).
• The House Committee on Small Business held a hearing on August 1 at which health care provider group representatives urged Congress to pass a federal prompt payment law that would define the meaning of the term “clean claim.” No insurance industry representatives testified at the hearing.
• URAC has released voluntary accreditation standards for prescription benefit management companies.
• HHS’s Agency for Healthcare Research and Quality (AHRQ) recently released a set of reports titled Privacy and Security Solutions for Interoperable Health Information Exchange. The reports review 34 state Health Information Exchange plans and identify the challenges and feasible solutions for ensuring the safety and security of electronic health information exchange. These reports are intended to form the basis for the development of privacy and security milestones in the National Health Information Network development process. According to BNA, HHS Secretary Mike Leavitt remarked that he was “impressed by the progress but daunted by what needs to be done.”
• Sen. Max Baucus (D MT) has introduced a bill (S. 1951) that would significantly alter the recent Medicaid rule on generic drug reimbursements in favor of pharmacies.