Aimee Miles, �鶹Ů�� Health News Staff Writer, Author at �鶹Ů�� Health News

OPM Health Database Stirs Privacy Concerns

Aimee Miles, �鶹Ů�� Health News Staff Writer — Mon, 06 Dec 2010 10:50:00 +0000

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An Office of Personnel Management plan to launch a comprehensive database of federal workers’ health care records has raised the ire of some privacy advocates, employee unions and consumer groups.

OPM is organizing a research database of insurance claims filed by the eight million workers and dependents enrolled in the Federal Employees Health Benefits Program, as well as participants in two other federally administered programs. The claims data, which will be supplied by the private insurers that participate in the FEHBP, will help OPM figure out ways to lower costs, improve quality and fight fraud, the agency has said.

But critics – which include the American Civil Liberties Union, Consumers Union and the American Federation of Government Employees – argue that the government should avoid setting up a repository of sensitive information that could be vulnerable to privacy breaches. At minimum, they say, OPM should provide more information about how the database, called the Health Claims Data Warehouse, will work and who will have access to it.

“We’re talking about a government database with health diagnoses, payment information, and procedures,” said Harley Geiger, policy counsel at the Center for Democracy and Technology, a public interest firm based in Washington. “Enrollees are almost certainly unaware that the government plans to compile all that into one big federal database.”

OPM has asserted that it has “a strong track record” of protecting the privacy of sensitive employee information. It also extended, until Dec. 15, the comment period for the project, and said it’s considering putting out “a more detailed explanation of how the records in this system will be protected and secured.”

The database, approved as part of the new health care law, will collect health-services data from about 230 private health plan options offered to federal workers through the FEHBP.

Information will also be compiled from enrollees in two other programs created by the health law. One involves the high-risk pools set up by the Department of Health and Human Services for people who can’t get insurance because of medical problems.

The other involves private “multi-state plan options” for individuals and small businesses. These plans, to be administered by OPM, will be available on state-based exchanges beginning in 2014. The database will be the largest government aggregation of private health plan data compiled in the United States, analysts say.

Once the OPM database is functioning, the agency plans to gather monthly updates on everything from medical diagnoses to surgical procedures to prescription-drug use. In theory, the database will allow OPM to scrutinize a specific group of enrollees – those with diabetes, for example – to identify the most effective treatments.

The data, according to an Oct. 5 Federal Register notice by OPM, will be used by agency analysts as well as some other federal agencies, to discern costs and trends. Certain outside researchers also could get access to the material, almost always in an aggregated form, according to a senior OPM official involved in the project who didn’t want to be identified because the details for the database details are still under review.

Researchers say the database could be helpful if constructed and used properly; it could, for example, lead to wider adoption of “best practices” as well as lower costs, said Kevin O’Brien, a director of the California-based data analytics firm Berkeley Research Group.

Even modest cost reductions could produce substantial savings for the government and workers. OPM Director John Berry, in a report on the agency’s 2009 performance, said reducing annual premium growth by 0.1 percent for three consecutive years would save the FEHBP $1.25 billion over 10 years. The agency, on average, picks up 70 percent of the cost of premiums; workers pay the rest.

But privacy advocates aren’t assuaged. They note that the data collected by OPM will include names, birthdates and other personal identifying information. In addition, they say it’s unnecessary for OPM to set up its own database, since insurers already store health information.

“One of the big concerns here is the duplication,” said Chris Calabrese, legislative counsel to the ACLU. Calabrese would rather see OPM use a “pointer system” to locate the information it needs. “Instead of having all the information in one database, if you want info on Patient ‘X’ go directly to the record source,” he said.

OPM officials counter that the privacy concerns are overblown. The senior OPM official said researchers won’t be permitted to see personal identifiers. The agency had said earlier that the health data could be subject to the “routine uses” that apply to most federal databases under the Privacy Act of 1974. That means the records could be pulled by law enforcement officials in a criminal investigation or used in a congressional inquiry. Now, the official said, the agency is considering narrowing the list of agencies that would be granted special access to its records. Within OPM, the data will only be made available to analysts with the proper clearances, the official said.

In addition, the OPM official said asking insurance companies to independently analyze their own data would defeat a key purpose of the database – which is to compare health plans. For example, one health plan might charge more than another for prescription drug programs and the data might help OPM decide whether to drop one pharmacy benefits manager in favor of another. About 30 percent of FEHBP’s spending goes for prescription drugs.

OPM’s plans aren’t unprecedented – TRICARE, the military’s health care program, has data on its participants, and the federal Centers for Medicare and Medicaid Services keeps information on Medicare beneficiaries. But TRICARE, Medicare and Medicaid are public health programs; OPM’s database will be collecting health information from private plans. The California Public Employees’ Retirement System maintains a database on the private health plans it manages. OPM’s project would be similar.

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3 States To Vote On Health Insurance Mandate

Aimee Miles, �鶹Ů�� Health News Staff Writer — Sat, 30 Oct 2010 15:29:00 +0000

Voters in Arizona, Colorado and Oklahoma will have the chance Tuesday to repudiate the new health care law’s keystone provision, one that requires almost everyone to have health insurance or face a tax penalty beginning in 2014.

Ballots in the three states include proposed amendments to the states’ constitutions that would prohibit the enforcement of the individual mandate and other provisions of the law. They echo a that Missouri voters approved by more than 70 percent in August. Legislatures in several other states, including Georgia, Idaho, Louisiana and Virginia, have also with similar language.

But the ballot initiatives have set off a fierce debate: If they succeed, will they have any effect?

Critics of the referenda say they’re nothing more than a political gesture, misleading voters to believe that amending their state constitutions would allow them to opt out of the health care law. Given that the Supreme Court will likely have the final say on the constitutionality of the law before 2014, the public’s vote wouldn’t impact the national law, they say.

Some policy analysts agree.

“To me it’s more of a polling statement,” said Elizabeth McGlynn, an associate director at the RAND Corp., a nonprofit research organization based in California that has no position on the amendments. “It’s not clear to me in this case that the federal law wouldn’t override state mandate that will be something the courts decide. It’s not really clear to me what that does at the state levels.”

Proponents argue that the amendments have a strategic function beyond the scope of individual states.

“As more and more states pass these kinds of amendments it’s going to embolden legislative action to repeal or defund legislative provisions” of the federal health law, said Robert Alt, deputy director of the Center for Legal and Judicial Studies at the Heritage Foundation, a conservative think tank in Washington.

‘New Avenues Of Litigation’

Having the new amendments in place would give states greater standing in the current litigation brought by 20 states against the federal law, says Christie Herrera, a director at the American Legislative Exchange Council (ALEC), which has provided used by several states.

If the Supreme Court were to uphold the individual mandate in that case, a state constitutional amendment would “open new avenues of litigation,” she said. States could also file suit to argue that the health law violates their 10th Amendment rights to keep powers not otherwise delegated to the federal government by the U.S. Constitution.

Opponents of the ballot amendments say the measures could complicate health care issues within the states.

Dr. Michael Pramenko, president of the Colorado Medical Society, which opposes the ballot initiative, said the amendment could affect any state efforts to set up a program to expand insurance coverage. “It would tie our hands at the state level,” he said, adding that the amendment would prevent the state from setting up its own version of the individual mandate, independent of the federal government, in the future.

The proposed amendments in ,��Ի� are nearly identical, while the amendment differs in subtle but significant ways. The measures are centered on a few key provisions: that no individual can be forced to participate in a public or private health plan; that a person’s ability to make or receive direct payments for medical services cannot be restricted; and that no one should be forced to pay a penalty for failing to enroll in a health plan.

Colorado Controversy

The Colorado amendment makes clear that it applies only to state efforts to impose such requirements.

The amendments do not deal with some of the other preparations for the health law that are falling to states, such as the health insurance exchanges and the expansion of Medicaid that will begin in 2014.

“They’re operating on two bandwidths,” trying to oppose the federal law while also trying to implement it, said McGlynn. “Most of what states are going to have to do, they don’t get to avoid through these amendments.”

Colorado’s situation is unique because its amendment was brought to the ballot through citizen initiative, and doesn’t follow ALEC model legislation as closely. Its language allows for a much broader interpretation of the measure than other states have allowed for, argued Alec Harris, a policy analyst at the Colorado Center on Law and Policy, which opposes the amendment.

“It’s getting billed as — and people seem to view it as — a referendum on federal health reform,” Harris said. “This has no ability to do anything about federal health reform.”

Instead, Harris says, the language of the bill, which prohibits “the state of Colorado, its departments and agencies” from requiring that a person participate in a health plan, could interfere with the state’s auto-enrollment of Medicaid and Child Health Plan Plus beneficiaries.

“Quite a bit of this stuff doesn’t go away even if the Affordable Care Act is ruled completely constitutional,” Harris said. “It’s the unintended consequences that we’re worried about.”

The president of the Independence Institute, which drafted the amendment, disagreed. “It doesn’t stop the government from offering all sorts of alternatives and plans,” said Jon Caldara. ” Really it means that the state legislature can’t mandate that people should buy something they don’t want to by without getting voter approval.”

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When Hospital Checklists Don’t Tell The Whole Story

Aimee Miles, �鶹Ů�� Health News Staff Writer — Mon, 18 Oct 2010 18:15:00 +0000

The whole idea behind HHS’ is simple: patients can shop around by putting in their zip codes and the website churns out a list of nearby hospitals, with detail on available services, care outcomes, patient satisfaction ratings and more.

The aim: to help consumers and companies that pay for their care – make informed decisions about where to seek medical care; and to pressure hospitals to improve the quality of their services.

But a that appeared today in the says the website isn’t helping Medicare beneficiaries in need of certain high-risk surgery find better facilities.

If hospitals are forced to publicly report the measures they’re taking to prevent surgical infection and blood clots, the thinking goes, they’ll have a stronger incentive to comply with recommended safety measures, and thereby reduce the number of preventable deaths from surgical complications.

That may not be the reality, according to this report. Researchers analyzed the information on the Hospital Compare site from Medicare inpatient stays for 325,052 patients in over 2,000 hospitals who underwent one of six “high-risk” surgeries such as some open-heart procedures in 2005 and 2006. Some hospitals only followed certain safety measures in about half the patients, while others did it more than 90 % of the time.

But interestingly, the higher compliance rate didn’t correspond to a lower rate of post-operative deaths most of the time.

The “safer” hospitals did make a difference in one significant way patients had a lower risk of having an “extended stay” in the hospital.

The lack of association may be due to the fact that the CMS only collects data on “low-leverage” safety measures that aren’t good indicators of surgical quality, the report’s authors say. Their bottom line: CMS needs to find better measures and “devote greater attention to profiling hospitals based on outcomes for improved public reporting and pay-for-performance programs.”

Some of this may come as no surprise: previous studies with the Hospital Compare data have shown wide variations in cost and quality and : if you spend more, it doesn’t necessarily mean you’ll have better care.

This is one of KHN’s “Short Takes” – brief items in the news. For the latest from KHN, check out our

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Studies Highlight High Medicare Costs For People In Nursing Homes

Aimee Miles, �鶹Ů�� Health News Staff Writer — Tue, 12 Oct 2010 17:16:15 +0000

Medicare beneficiaries who reside in long-term care facilities account for an excessive and preventable portion of Medicare spending because of high rates of hospitalization, emergency room visits and skilled nursing care, according to released Tuesday by the Kaiser Family Foundation (�鶹Ů��).

The findings suggest policymakers looking to trim Medicare expenditures in accordance with the new federal health care law may want to take a closer look at developing a more coordinated system of care for this narrow subset of the Medicare population.

“When we step backdelivery systems reforms may not only improve quality of carebut may also reduce spending,” said Gretchen Jacobson, a �鶹Ů�� principal policy analyst and co-author of the reports. (KHN is a program of the foundation.)

The three reports include quantitative data and information from interviews with doctors, nursing home officials and other health care providers and families of long-term care residents, many of whom acknowledged an inflated emphasis on hospitalizations and testing for that patient population.

While Medicare doesn’t pay for residence in nursing homes, assisted living facilities or other long-term care programs, Medicare does cover emergency room visits, hospitalizations and other medical treatments.

According to the reports, the 1.7 million Medicare beneficiaries who were in long-term care for all of 2006, or who died in care before the year’s end, cost the program an average of $14,538 per person – more than twice the average expenditure for all Medicare beneficiaries that year. Individuals in that category comprised just 5 percent of Medicare’s 47 million beneficiaries but accounted for 9 percent of all Medicare spending, or $25 billion.

Hospital expenses accounted for nearly 40 percent of Medicare spending on patients who lived in long-term care facilities. If the number of hospital stays could be cut by 25 percent, the researchers estimated, Medicare could save at least $2.1 billion in 2010, and would likely result in additional savings to Medicaid, which pays for more than of nursing home residents. Medicaid is the state/federal health program for the poor.

Previous studies have estimated that 30 to 67 percent of these hospitalizations could be prevented with “well-targeted interventions,” according to one of the Kaiser reports.

‘A Culture of Hospitalization’

Before those savings can take place, the current system of care must overcome what one of the reports called a “culture of hospitalization” that pervades the perceptions and behaviors of physicians, caretakers , and family members alike, experts said.

Physicians often prefer inpatient treatment due to convenience: hospitals have all the diagnostic tools they need in one place, and doctors can easily divide their time between multiple patients. Nurses interviewed for the qualitative report also said they felt unprepared or unqualified to deal with patients’ health problems in a residential facility or didn’t want to risk liability by ignoring potentially life-threatening ailments.

“The perception of best care is ‘Let’s send Mrs. M to the emergency room and see what the ER finds,'” said Dr. Cheryl Phillips, who is chief medical officer of the health-focused Bay Area nonprofit On Lok Lifeways and past president of the American Geriatrics Society.

A lack of qualified staff, combined with protocols and license restrictions, have further exacerbated the trend of defaulting to hospitalization.

Proper coordination of care among nurses, physicians, and family members will be essential in preventing unnecessary hospitalizations in the future, researchers concluded.

Dr. Donald Berwick, head of the Centers for Medicare and Medicaid Services, endorsed the idea of better coordination, saying too many people are experiencing “disintegrated care.”

“The goal is to change through redesigning the system,” he said.

Records Don’t Always Move With The Patient

The reports showed that many of the hospitalizations of residents of long-term care facilities occurred within the first few months of their stay, when patients are often transitioning from a hospital setting into residential care. Providers often fail to ensure that medical records move with the patient from one facility to the next, and emergency room physicians may alter prescribed dosages without knowing a patient’s history or notifying anyone of the change.

Financial incentives for team-based, patient-centered care are needed to hold providers responsible for their patients’ health outcomes, researchers concluded. Which incentives-or disincentives-will work best is an open question. Under the current system, physicians profit from longer, more frequent hospitalizations, regardless of their necessity.

It’s unclear what role accountable care organizations, whose specifications are still being drafted under the new health care law, will play in reducing hospitalizations among long-term care residents, or whether the payment reform models will apply to them at all.

Phillips believes that a section of the reform bill that prioritizes coordination of care for individuals with multiple life-threatening ailments will by definition include most Medicare beneficiaries who are in long-term care.

An additional clause in the new health law, denying payment to hospitals that readmit certain patients within 30 days of the initial visit, is expected to further discourage unnecessary hospitalizations. That provision takes effect in October 2012.

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