One week into the partial federal government shutdown, OPM is highlighting a Furlough Guidance page on its website. It appears that the shutdown will continue for another week.

The FEHBlog is a big fan of primary care doctors. The Wall Street Journal has a front page article today about hospital / health system employed primary care doctors:

Patients are often in the dark about why their doctors referred them to a particular physician or facility. Increasingly, those calls are being driven by pressure [by hospital health system employers] to keep business within a hospital system, even if an outside referral might benefit the patient, according to documents and interviews with doctors, current and former hospital executives and lawyers. 

Losing patients to competitors is known as “leakage.” Hospitals, in response, use an array of strategies to encourage “keepage” within their systems, which in recent years have expanded their array of services. 

The efforts at “keepage” can mean higher costs for patients and the employers that insure them—health-care services are often more expensive when provided by a hospital. Such price pressure and lack of transparency are helping drive rising costs in the $3.5 trillion U.S. health-care industry, where per capita spending is higher than any other developed nation.

Of course, the Affordable Care Act has lead to a big jump in the number of primary care doctors who are employed by hospitals or health systems that join together hospitals and doctors. Another irony is that the employers are using their federal government funded electronic medical records to track their employed doctors’ referral practices. No bueno.

A few tidbits to wrap up the week:

•  Health Data Management discusses three cybersecurity trends for 2019. 
• Med City News reports that the Justice Department recovered over $2.5 billion based on False Claims Act claims in 2018. It’s the ninth consecutive year that the Justice Department’s False Claims Act recoveries topped $2 billion. The article discusses the recoveries obtained from the healthcare industries. 
• One of the FEHBlog’s most illuminating books of 2018 was journalist Sam Quinones’ Dreamland about the opioid crisis (currently selling on Amazon as a Kindle book for $6.99). I follow Mr. Quinone’s blog. His latest post is an eye opener.  

In Los Angeles, Craigslist has emerged in the last few months as a major new marketplace for illicit fentanyl. The online classified ad service has for several years been a virtual street corner, a place where drugs are sold under lightly veiled pseudonyms: black-tar heroin (“roofing tar”), crystal methamphetamine (“clear sealant”), or generic and most likely counterfeit oxycodone 30 mg pills (“M30”). But fentanyl, the deadliest of them all, is a new arrival, apparently within the last year, and for the moment appears to be for sale on Craigslist only on its Los Angeles site.

As the FEHBlog noted in earlier posts, heroin and fentanyl aren’t available at your local CVS or Walgreen’s pharmacy. Who would have thought Craigslist?