Sunday, October 11, 2015

Weekend update

Congress is out of town this week of Columbus Day. Here's a link to The Week in Congress's account of last week's actions. Federal News Radio reports  that a Republican member and a Democratic member of the House Oversight and Government Reform Committee sent a joint letter to the Office of Management and Budget recommending changes to the federal employee and contractor security clearance process, including a switch in responsibility for clearance record holding from OPM to an agency that is focused on national defense or intelligence.

Govexec reports that on Thursday October 15 the Bureau of Labor Statistics will release a report which will give us the final word on whether federal and postal annuitants will receive a cost of living adjustment for 2016.  "The annual COLAs are based on the percentage increase (if any) in the average CPI-W for the third quarter of the current year over the average for the third quarter of the last year in which a COLA became effective."  Govexec expects that the decision will be no COLA for 2016. Federal employees will be receiving a 1.3% raise for 2016 plus increases in locality adjustments.

Last week, HHS issued its final roadmap of electronic medical record ("EMR") interoperability. To recap, in return for "free" EMR software, health care providers must comply with meaningful use standards developed by HHS. The EMR developers relied on those standards which did not include interoperability among different systems. After issuing $32 billion in EMR payments, HHS has issued a final roadmap to EMR interoperability which it outlined as follows:

  •  2015-2017: Send, receive, find and use priority data domains to improve health care quality and outcomes
  • 2018-2020: Expand data sources and users in the interoperable health IT ecosystem to improve health and lower cost.
  • 2021-2024: Achieve nationwide interoperability to enable a learning health system, with the person at the center of a system that can continuously improve care, public health, and science through real-time data access.
For those keeping track, 2024 is fifteen years after Congress authorized the free EMRs. 

Why does the FEHBlog care?  OPM and other federal healthcare agencies are putting enormous weight on NCQA's HEDIS scores.  A staff model HMO like Kaiser which has its own interoperable EMR can have the HEDIS surveyor plug into the EMR and voila good HEDIS scores pop out.  (Because doctors are subject to these standards under the PQRS system, my base assumption is that the doctors are doing the work expected of them.)  Other / most health plans which rely on provider networks that lack interoperability are forced to gather HEDIS data in a cumbersome, inefficient way.  Their scores are lower.  These health plans are being punished for the lack of interoperability which the government created. No bueno.

Kaiser Health News reports on a  Health Affairs study that reached the obvious conclusion that "[p]rices for many common medical procedures are higher in areas where physicians are concentrated into larger practice groups."  The ACA encouraged such provider concentration. 

Drug Channels has an interesting perspective on Express Scripts' decision to include both expensive PSCK9 inhibitors in its national preferred formulary.  "This formulary approach contrasts sharply with the approach used for the Hepatitis C products. As Drug Channels explains [in the article], perhaps Express Scripts has learned an important lesson about the business risks of formulary exclusion. AmerisourceBergen [a drug wholesaler], however, may find that it was dealt a losing hand."

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