The press continues to hammer on drug prices.  Kaiser Health News reports that drug price increases hurt the bottom line of hospitals and the Wall Street Journal reports that those increases hurt the bottom line of consumers with high deductible health plans.  The FEHBlog would not be surprised to see Congress eviscerate the current drug pricing system which raises prices on the front end but allows for a volume rebate to third party payers on the back end. Bear in mind that this model is based on Medicaid’s drug program.  Whether Congress would apply such a solution to Medicaid is another question.

Becker’s Healthcare tells us about the growing practice of doctors de-prescribing medicines for older patients.  Becker’s identifies the following five things to know:

1. Of patients in their 60s, almost 40 percent are taking more than five medications.
2. To lower this figure, physicians conduct comprehensive medication reviews to determine which drugs they can decrease the dosage or de-prescribe if they do not benefit a patient’s overall health.
3. Alongside pharmacist Barbara Farrell, Cara Tannenbaum, MD, created the website, deprescribing.org, which allows physicians in the Untied States and Canada to obtain information to help them assess if a patient should cease taking certain medications that are unnecessary or even harmful. Canadian Deprescribing Network maintains the site.
4. In 2015, The American Geriatric Society updated its Beers Criteria, which features a list of 40 medications or classes of drugs that the society deems as possibly inappropriate for older adults. The American Geriatric Society added three new drugs and two new classes of medications to its warning lists for older adults or people with certain health concerns last year. Currently, an expert panel is working on an update for that list for 2018.
5. Physicians have issued warnings about using sedatives in older adults and recently, there have been warnings about proton pump inhibitors. WSJ reports new studies show an association between these pumps and a higher risk for bone loss, fractures and serious bacterial infections.

Here’s a cost reduction effort that health plans should support.

In a bit of good news for the human team,  Healthcare Dive reports on a study finding that human doctors perform signficantly better than computerized algorithms when making initial diagnoses.

Researchers from Harvard Medical School, Brigham & Women’s Hospital and The Human Diagnosis Project used 45 clinical vignettes to compare the diagnostic accuracy of 23 online or app-based symptom checkers with that of 234 physicians.  The results show 72.1% of doctors listed the right diagnosis first, versus 34% of the algorithms. 

One of the many tortured ACA provisions is the requirement to cover with no enrollee cost sharing preventives services with A or B reecommendations from the National Preventive Services Task Force when provided in-network. The basic problem is that the NPSTF recommendations provide medical not insurance coverage advice. Moreover, NPR reports that “The former chairmen of the U.S. Preventive Services Task Force say the link between medical recommendations and insurance coverage leads to financial incentives that can corrupt the process and distort people’s health care decisions.”  If you build it, they will come.

Health IT Security reinforces the burning need for HIPAA patient identifiers in order to get the full bang for the buck out of the $32 billion that the federal government has spend on electronic medical records.

Finally, OPM last week “released the detailed government-wide Federal Employee Viewpoint Survey (FEVS) results for 2016. The complete governmentwide results for 2016 contain scores from indices such as Employee Engagement, Global Satisfaction, and the New IQ. Also included are promising practices on employee engagement, very practical advice on what works to help improve engagement and performance. The 2016 FEVS provides government employees with the opportunity to candidly share their perceptions of their workplace, their agencies, and their leaders. This year, 407,789 employees responded to the survey out of the 889,590 to whom it was sent, for a response rate of 45.8%.”

It’s a long weekend for federal employees.  Medicare’s open enrollment period for Medicare Advantage and Part D plans starts on Saturday and runs through December 7. Hopefully before then we’ll know what’s up with Medicare cost sharing for 2017.

The Federal Benefits Open Season starts on November 14 and runs through December 12. By now plans typically have posted 2017 benefits info on their websites.  In the next week or two, OPM will release the handy benefits administration letter on significant FEHBP and FEDVIP changes for 2017. The FEHBlog will be sure to link to it once it’s posted.

The FEHBlog has been expecting Congress to consider the House Oversight and Government Reform Committee’s bipartisan Postal reform bill in the lame duck session following the national election on November 8.  A National Association of Postal Supervisors legislative representative opines in the Postal Times that this viewpoint is a “long shot”. The FEHBlog is not suprised to possibly have made an incorrect educated guess. He is suprised that nearly two months after the House committee cleared the bill, the Congressional Budget Office has not scored it.  That was the next step according to Committee leadership.

It’s a HIPAA kind of day.  The 20 year old law was intended to accelerate electronic claims processing which it did.  (Well really HIPAA set the stage but a law pass about five years later required healthcare providers to use the electronic claims processes that health insurers and plans had created.)  The downside remains that technology is intertwined with law.  Technology moves fast while the law is cumbersome.  

WHO will organize a high-level ICD-11 Revision Conference for Member States, hosted by the Collaborating Centre WHO-FIC in Japan.
This meeting will be held in conjunction with the annual meeting of the WHO Family of International Classifications Network (WHO-FIC), which will also take place in Tokyo, Japan from 8-12 October 2016. The theme for this year is: “Health Information in the New Era” (「保健医療の新時代：ICD-11改訂会議」).  

HIPAA required HHS to implement a nationwide patient identifier. However, Congress, based on advice from an HHS advisory group, has refused to fund this effort for 18 years. A patient identifier would improve electronic claims processing and offer public health benefits.  Modern Healthcare reports that America’s Health Insurance Plans, the Blue Cross Blue Shield Association and about 20 other organizations are asking Congress to lift this ban.  Based on reading the organizations’ letter to Congress, the timing appears propitious.  Good luck.

Fierce Healthcare brings us up to date on status of the government’s antitrust lawsuits to block the Aetna/Humana and Anthem/Cigna mergers as those cases hurtle toward trial next month.

A study published in Health Affairs suggests that seven days or fewer following hospital discharge is a reasonable benchmark for judging unnecessary readmissions.  The government uses 30 days following discharge as its benchmark. The study authors remark that

We examined risk-standardized thirty-day risk of unplanned inpatient readmission at the hospital level for Medicare patients ages sixty-five and older in four states and for three conditions: acute myocardial infarction, heart failure, and pneumonia. The hospital-level quality signal captured in readmission risk was highest on the first day after discharge and declined rapidly until it reached a nadir at seven days, as indicated by a decreasing intracluster correlation coefficient. Similar patterns were seen across states and diagnoses. The rapid decay in the quality signal suggests that most readmissions after the seventh day postdischarge were explained by community- and household-level factors beyond hospitals’ control. Shorter intervals of seven or fewer days might improve the accuracy and equity of readmissions as a measure of hospital quality for public accountability.

NCQA take note too. (OPM applies NCQA’s 30 day following discharge readmission measure to FEHB plans.)

As we approach the Medicare open season, a large group of organizations is pleading with Congress to help out seniors who are ineligible for the so-called hold barmless rule governing Medicare Part B premiums. That law protects federal and postal annuitants who retired on FERS but not those who retired on CSRS.  What’s the difference you ask — Medicare Part B premiums are paid out of Social Security checks for FERS annuitants but not for CSRS annuitants who pay those premiums out of their federal annuity checks. This distinction is non-sensical in the FEHBlog’s view.

Last Saturday October 1 marked the one year anniversary of ICD-10 coding implementation (and the birthdate of the FEHBlog’s first grandchild).  This anniversary marked the end of the CMS grace period for ICD-10 coders.  Health Data Management reports that small provider offices, and Health IT News reports, that hospitals are nervous about this change.

Modern Healthcare reports that

More employers are setting up value-based reimbursement and payment arrangements with health insurers and providers to encourage better employee health outcomes and reduce costs, survey data released Tuesday show.
This year, 45% of employers are giving employees access to centers of excellence, or COEs, organizations that have high quality ratings in specialties such as cardiac or orthopedic services and infertility, according to the survey data released Tuesday by risk management and employee benefit consulting firm Willis Towers Watson.
That’s up from just 37% of employers in 2015 who provided access to COEs, the survey of 600 U.S. employers with more than 1,000 employees each showed. Collectively, the companies employ 12.2 million full-time workers in various industries. 

FEHB plans are taking these steps too.

Finally, HHS announced that

HHS’ Office of the National Coordinator for Health Information Technology (ONC) awarded a cooperative agreement to the National Health Information Sharing and Analysis Center (NH-ISAC) of Ormond Beach, Florida to provide cybersecurity information and education on cyber threats to healthcare sector stakeholders. HHS’ Office of the Assistant Secretary for Preparedness and Response (ASPR) awarded a cooperative agreement to NH-ISAC to help build the infrastructure necessary to disseminate cyber threat information securely to healthcare partners. 

The FEHBlog took note because he had not been aware of this Center.

Congress is out of session now until November 14.  Here is a link to the Week in Congress’s report on last week’s activities.

In the lame duck session, Congress will have to address FY 2017 appropriations. Politico reports that the health insurance industry understandably will be pushing Congress to extend the suspension of, or repeal, the ACA’s onerous health insurance fee in the lame duck.  The FEHBlog expects that the big FEHB related activity in the lame duck session will be postal reform.  We are still waiting for the Congressional Budget Office to score the House Oversight and Government Reform Committee’s bipartisan postal reform bill (HR 5714).

The U.S. Supreme Court begins its October 2016 term on Tuesday following the Jewish New Year holiday. (L’shana tovah!)

Modern Healthcare reports that the Government Accoutability Office’s report on health care records security has been well received by experts.

Privacy and security gurus praised the GAO for taking an unflinching look at the dual role HHS plays as both a promoter of health information technology use and the primary enforcer of the Health Insurance Portability and Accountability Act, the federal privacy, security and breach notification law. The report, experts say, should come as one more warning to the healthcare industry to better protect sensitive patient information before Congress, the courts or their own patients take action.

The courts already are taking action as the article later notes.

Fierce Healthcare reports on the lack of transparency in hosital pricing.  But as Kramer observed in Seinfeld, “retail is for suckers.

Here is a link to OPM’s 2017 FEHBP and FEDVIP premiums press release and a link to the 2017 FEHBP premiums page.  Here’s the Washington Post’s article about the OPM announcement and NARFE’s press release.

Federal employee unions and NARFE engage in a lot of percentage comparisons at this time of year. Percentage comparisons are meaningless unless the base numbers are comparable, and these organizations make no effort to demonstrate comparability. It’s interesting to note that nearly 20 years ago, Congress changed the FEHBP Act to permit employee organizations, like AFGE for example, to rejoin the FEHBP.  No organization has taken up Congress on its offer. Being a health benefits carrier is not an easy business.

Blue Cross FEP has a press release on its 2017 benefit changes and GEHA has posted its 2017 brochures if you are interested. Other plans will be following suit.  

Federal News Radio reports that earlier today the President has signed into law the continuing resolution, which Congress enacted yesterday, funding the federal government through December 9, 2016.  The resolution also provides Zika funding and means that there will be a lame duck session of Congress following the federal election on November 8. Congress now leaves town for the campaign trail.

HHS yesterday announced the winners of the simplified medical billing contest as part of National Health IT Week. The winning designs and honorable mentions can be viewed at www.abillyoucanunderstand.com. Six large medical systems are working with the developers.

Govexec.com reports on OPM’s announcement of 2017 FEHBP premiums here. Federal News Radio explains 

On average, participants in the Federal Employee Health Benefit Program will pay 4.4 percent more on their premiums in 2017. The increase is slightly lower than what federal employees and annuitants saw this past year, when FEHBP increases went up 6.4 percent, the largest rate change in recent memory.

Congress suspended the Affordable Care Act’s health insurer fee for 2017. The health insurer fee generally applies to FEHB plans.  That change likely accounts for a good chunk of the decrease between the two years.

The press is reporting that as the FEHBlog expected Congress has reached an agreement in principle on funding the federal government past September 30. No government shutdown in sight, thankfully.

Congress unfortunately has not made evident progress toward adopting a continuing resolution funding the federal government past this Friday.  The Hill’s latest report is here.  The FEHBlog still expects the logjam to break.

Govexec.com reports that OPM will “unveil next year’s premium rates in the Federal Employees Health Benefits Program during a late-morning briefing Wednesday with reporters.”  The FEHBlog will post the news as soon as he sees it pop up.

Here’s a link to the live chat that the Washington Post had today on the controversial federal employee long term care insurance premium increase and a related Michelle Singletary column which concludes on the following note:

I get that you may be angry about the increases. But if you can’t save enough to self-insure and you wouldn’t qualify for Medicaid, choose an option that you can afford so that you at least have some level of coverage.

It’s hard to argue with that logic.

The GAO issued a report yesterday urging the Department of Health and Human Services to improve  the HIPAA Security Rule. That rule requires health plans, health care clearinghouses, most healthcare providers and their business associates to create and maintain administrative, physical and technical safeguards over electronic protected health information.

GAO is making five recommendations, including that HHS update its guidance for protecting electronic health information to address key security elements, improve technical assistance it provides to covered entities, follow up on corrective actions, and establish metrics for gauging the effectiveness of its audit program. HHS generally concurred with the recommendations and stated it would take actions to implement them.

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This Friday is the end of the current federal fiscal year.  The FEHBlog expects Congress and the White House to agree on a short continuing resolution which will lead to a lame duck session following the national election on November 8.

OPM’s once in a blue moon Federal Employee Group Life Insurance Program Open Season also ends this Friday.

The opportunity for Federal Employee Long Term Care Insurance Program enrollees to make decisions about premium increases ends on Friday as well.  Federal News Radio reports that OPM has rejected a request from several DC metro area members of Congress to extend this decision period until Congress could hold a hearing on the issue in November.  A Washington Post columnist began a series of articles on the issue today.  The FEHBlog thinks that there’s a problem with the program structure created by the statute.

The FEHBlog expects that OPM will make an announcement about 2017 FEHBP premiums this coming week. Last week, CMS made an announcement about 2017 Medicare Advantage premiums.

This coming week is National Health Information Technology Week.  Here is an official list of ten ways to celebrate. Health IT News reports on the Week’s activities here.

Health Data Management reports on the work of a healthcare cybersecurity task force that was created by a recent federal law.

According to Theresa Meadows, co-chair of the Health Care Industry Cybersecurity Task Force and CIO of Cook Children’s Health Care System, the panel’s 20 subject matter experts are drawn from a wide variety of organizations including providers, payers, pharmaceutical companies, medical device manufacturers, IT vendors, and government agencies. 

“We have representation from all the segments within healthcare so that we can have well-rounded discussions,” said Meadows. “There’s also a patient advocate on the task force.” 

Meadows said the task force has held several public and private meetings to date and will be “wrapping up its charge” early next year, after which it will report to Congress on its findings and recommendations. 

We are a week away now from the end of the current federal fiscal year.  Govexec.com reports that it’s likely that before the deadline passes, Congress will pass a continuing resolution funding the federal government’s operations through December 9.  The Wall Street Journal provides an amusing report on the history of the federal fiscal year here.

Modern Healthcare reports based on a recent study that “rapid adoption of bundled payments remains an act of faith.”  Bundled payments for orthopedic surgery was the only category of care that appeared to reduce costs and improve quality according to the study. Meanwhile according to another Modern Healthcare article, a survey reveals that changing reimbursement methods, among other factors, is causing low morale among doctors.

HHS’s Office for Civil Rights displayed another HIPAA scalp today. The covered entity failed to update its business associate agreements for the changes wrought by the 2009 amendments to HIPAA.

Health Day reports about the growing costs of treating falls suffered by elderly Americans —  $31 billion annually for Medicare. As the FEHBP’s demographics skew older, this should be a concern for FEHB plans too.

Finally, Harvard Medical School offers a helpful article on the proper consumer use of telemedicine which is a growing option in the FEHBP. It’s important for plans to educate their members on this topic. For example, the FEHBlog has noticed that his health coverage provider, Carefirst, offers such guidance on its website.