Archives for October 2021

In 2018 B.C (before COVID) my morning commute was about 31 to 32  minutes.  Door-to nice-parking space. Then just steps to the building. Not a lot but also not-much-fun.

Then the pandemic hit. People started working from home (or losing their jobs) and traffic in this city of traffic circles, tourists and sometimes devil-may-care diplomats almost disappeared.

Now it takes me about 13 minutes in the a.m. Driveway to parking spot. Until two weeks ago…

Back to work and back to school. What a difference a day makes.

Suddenly I am back to 32 minutes — if I’m lucky! — on the road. I know that’s a joke for many who spend three or four times that amount just getting to work.

It started just as Congress narrowly avoided a government shutdown that would have directly hit 800,000 feds, at least, and many, many more federal contractors. The feds, if the past is prologue, would have eventually gotten paid. The contractors probably not. At least that’s the way the last one, a 35-day fiasco that included Christmas, went. During that one some feds actually had to visit regular and makeshift soup kitchens, and exhausted the funds of FEEA, a feds-helping-feds-charity. The really dumb thing is that the shutdown issue will return in December. Once again feds and contractors — but not the House and Senate members who may trigger the shutdown — will go without pay. Maybe for a long time. The politicians will continue to work, and get paid, because they are the only ones who can fix the problem they created.

One bright spot is that feds are looking at an almost-sure-thing pay raise. Not as much as unions say they need and deserve. But something.

The good news for federal retirees is that they will be getting a cost of living adjustment (COLA) in January. The exact amount is being calculated now at the Bureau of Labor Statistics. And it will be announced soon and will also go to Social Security recipients and military retirees. Also it will be one of the largest in years, something in the neighborhood of 6%. For most…

The bad news is that a COLA that high means that inflation is up. As are prices for most things. Many economists  say this is the beginning of a period of rising prices for everything.  And that even this projected high figure won’t cover all costs for things — like medical treatments — that are rising faster than the regular rate of inflation.

For FERS retirees, higher COLAs can be bittersweet. Because of the diet COLA formula, FERS retirees get less when inflation exceeds 3%. So if the January 2022 COLA is 6% for CSRS and Social Security retirees it will be 5% for FERS retirees. Over time, and not too much time at that, that negative compounding could dramatically reduce the amount of money they have in retirement versus rising costs of things they must buy.

Meantime many people who’ve grown accustomed to working from home (or who hate it) are returning to work. Or if the mission to vaccinate the unvaccinated fails and herd immunity isn’t achieved this could be a rough fall and winter.

Lots of people can’t wait to get back to the office work environment and their colleagues. The wisdom-of-the-crowd effect. But for others, individuals, corporations and government agencies, telework is here to stay. Many say they are more productive, and actually work longer because they are free from the commute.

Ida, a fed in Boston, wrote to thank Washington (in this case our Nationals Baseball Team) for losing Sunday’s game, thus keeping the Red Sox alive in the pennant race. But she also said she loved working from home, has been much more productive “and I expect to get even more done now that my kids have returned to school.” She said teleworking is a win-win and that she might consider retiring early and taking another job if ordered back to work.

Jim in Philadelphia says as far as telework is concerned, “the proverbial genie is out of the bottle” and can’t be put back in.

Several other feds have pushed it further. Their plan is to keep working for the same agency, but from a town hundreds of miles away where people are nicer, the weather is more mild, and where their money will go farther than in the big city. Several asked or predicted that the issue of locality pay is going to become very important, very soon. Should/can feds whose jobs are based in Houston, New York City or the D.C.-Baltimore area move and work into RUS (the nationwide locality pay zone known as Rest of U.S.) work on Maryland’s Eastern Shore but get paid DC locality rates? Or transfer from Manhattan to central Pennsylvania and keep their current rate? Should you pay depending on where you live or the locale of your agency? Many private firms are encouraging people to work from where they are comfortable and continue to get paid big city rates.

So what do you think is gonna happen? What should happen? We’re doing it at my office which now has people working from Portland — both in Maine and in Oregon — New Jersey and New Orleans. And it is working beautifully.

Let me know what you’re doing (mcausey@federalnewsnetwork.com). You can remain confidential (generally a good rule if you are a fed) or use a pen name. The main thing is what’s going on out there. And especially where you live and work!

Nearly Useless Factoid

By David Thornton

In the southern African Kingdom of Eswatini, formerly known as Swaziland, it is illegal for witches to fly on broomsticks higher than 150 meters off the ground. The infraction carries a fine of R500,000, or just under $33,300. There is no fine for flying lower than 150 meters.

Source: Times Live

TRICARE pharmacy copays are set to increase in 2022, and they’re going to keep increasing for years to come.

TRICARE beneficiaries who get their drugs through home delivery or through a retail pharmacy will pay anywhere from $1 to $8 more in copayments starting in 2022.

“Congress and the Department of Defense worked together on these cost changes as part of the National Defense Authorization Act for Fiscal Year 2018,” said U.S. Public Health Service Cmdr. Teisha Robertson, a pharmacist with the Defense Health Agency’s pharmacy operations division. “The changes are part of a larger effort to help fund improvements in military readiness and modernize the TRICARE health care benefit.”

Beneficiaries will see increases in generic, brand name and non-formulary drugs. The new cost will depend on the type of pharmacy used.

TRICARE Pharmacy Home Delivery (Up to a 90-day supply)

• Generic formulary drugs will increase from $10 to $12
• Brand-name formulary drugs will increase from $29 to $34
• Non-formulary drugs will increase from $60 to $68

TRICARE retail network pharmacies (Up to a 30-day supply)

• Generic formulary drugs will increase from $13 to $14
• Brand-name formulary drugs will increase from $33 to $38
• Non-formulary drugs will increase from $60 to $68

For non-network pharmacies, the costs will remain the same. Beneficiaries will pay 50% of the costs.

Active duty service members and survivors will still get free drugs from military pharmacies, retail network pharmacies and through home delivery.

Medically retired service members and their family members will not see an increase in copayments.

The 2018 NDAA allows TRICARE to increase its drug copayments every year until 2026, meaning it is likely that copayments will continue to rise. After 2026, DoD would be able to keep the previous year’s price and increase it the following year based on cost adjustments.

The lawmakers did not give a specific reason for the cost increases in the 2018 NDAA, however, for years the Congressional Budget Office has been suggesting that DoD require more cost sharing from its TRICARE beneficiaries.

In 2017, CBO came out with a report on how DoD could save money in the Military Health System and pointed to cost sharing as one of its top options.

The Pentagon spends at least $50 billion a year on the system.

“Policymakers and analysts have raised concerns about DoD’s rising health care costs, the quality of care provided at its facilities, and how well the department’s medical establishment prepares for wartime missions,” CBO authors wrote. “Efforts to change the system are complicated, however, partly because the resources used to accomplish the various goals are often intermingled or unclear.”

Pharmaceutical cost sharing is only one small area where DoD could recoup some funds by asking TRICARE beneficiaries to pitch in.

This content is sponsored by Kaiser Permanente.

The Office of Personnel Management (OPM) has been pushing for more transparency in Federal Employee Health Benefit Plans for years. OPM required participating carriers to begin providing drug transparency tools in 2016 and has been working towards certain improvements since then. In 2019, they called on carriers to provide tools by 2021 that would “allow members to estimate accurately the dollar amount they should expect to pay for a defined set of common outpatient and elective in-patient health care procedures and services … based on the member’s plan option and deductible status.” And by 2022, all carriers are expected to publicly post the network contracting status of certain specialty physicians, physician groups, and urgent care services.

Know before you go

Some FEHBP carriers stand out in their efforts towards transparency. Kaiser Permanente, for example, isn’t just a health insurance provider. It’s an integrated health system that provides both health insurance and health care. Because of this synergy, information about pricing and quality becomes simpler and easier to access. This transparency is important for fostering the continued quality and affordability of Federal Employees Health Benefits (FEHB) plans and aiding in personal health care decision-making.

Most providers charge coinsurance—a percentage of the total cost of the service. Without knowing the total cost in advance, Federal employees never know what the price tag will be until they get their bill. In health plans that primarily charge copays, like Kaiser Permanente, costs are predetermined for nearly every service. This makes costs more predictable and eliminates surprise bills—not to mention paperwork.

“So with those price certainties in place with Kaiser, you don’t have that surprise element,” said Gavin Toner, manager of the Federal Employee Benefit Plans at Kaiser Permanente. “I frankly welcome this push for transparency, because with Kaiser, generally speaking, when you shine light on us, it really reflects in a good way on how we do business, in the community and with our members.”

Quality of care

An integrated care system doesn’t just enhance transparency. When plan members get their health care and health insurance through the same system, everything is connected, improving ease and quality of care. At Kaiser Permanente, every doctor has shared access to members’ health information which allows them to provide personalized care. This results in the right diagnoses and faster treatments. And since all Permanente physicians are connected, members don’t have to go looking for third-party specialists or negotiate referrals—the heavy lifting is done by their care team, within the integrated care system.

Where do we find information about quality of care? Carriers in the FEHB Program make various tools available on their websites to help interested individuals find cost and quality information about the providers in their networks. OPM follows the National Committee for Quality Assurance (NCQA) measure reporting guidance to assess quality of care. Kaiser Permanente and many other carriers may make this information available to members on their websites and other materials. NCQA recently released their current ratings, placing three of Kaiser Permanente’s plans among the top in the nation. Their commercial and Medicare plans for DC, MD, and VA are the top-rated plans available to Federal employees.

Tools to easily understand quality and costs

Beginning in 2016, OPM has asked all carriers to provide prescription cost estimator tools to help inform FEHB plan members. In 2021, this has been expanded to ensure Federal employees have easy access to quality and pricing information. Federal employees can compare plan quality and costs with OPM’s comparison tool.

To meet OPM’s request, Kaiser Permanente makes quality and pricing information available on their own website and in their enrollment materials. Most carriers, including Kaiser Permanente, publish a plan books that details all its benefits. Many health plans do the same, but they tend to get lost in the fine print. “ Kaiser Permanente provides easy to understand companion pieces with snapshots of everyday services like primary care, emergency care, and mental health to make comparison easier.”, Toner said.

“Around 90% of your costs are those predictable, everyday costs,” Toner said. “And so we make sure that the people know what those costs are upfront. And when you look at our charts, you’ll see that it’s all copay driven. So there’s nothing that’s going to catch you on the backside after a service.”

As a nonprofit, Kaiser Permanente isn’t motivated by financial incentives, further enhancing predictability. Permanente physicians are all salaried, not paid per service, there’s no incentive to raise or obscure prices. Instead, they’re focused on providing the best care possible while personally informing their patients of costs—and helping them stay on top of their health. All care decisions are made by members and their care teams, not an insurance company.

“Those annual things that you’re meant to get done, if you use Kaiser Permanente, we make sure that it’s done because everybody that works in the medical group can ensure that we’re constantly working to close any health gaps and make sure that your outcomes and your health in general is the best it can possibly be,” Toner said. “We have the same specialties at Kaiser Permanente, we have richer benefits, we have better health outcomes, and we have lower premiums.”.

The price of a health plan has no correlation with quality of care received. That’s why OPM requires carriers to make information about their quality of care easily accessible so Federal employees can make better health care decisions for themselves and their families.