Weekend Update

SCOTUS

Weekend Update

David Ermer–CDC, Congress, COVID-19, Employee Wellness Programs, OPM, SCOTUS–

Happy Fathers’ Day.

The House and Senate are holding committee hearings and floor votes this week. On Tuesday the Senate Health Education Labor and Pensions Committee will hold a hearing on applying lessons learned from the current COVID-19 emergency to prepare for the next pandemic emergency.

Speaking of the current pandemic:

  • The FEHBlog was wondering about whether there has been an uptick in COVID-19 related hospitalizations to accompany the uptick in COVID-19 cases over this month. The FEHBlog was delighted to find this handy CDC website on COVID-19 related hospitalizations which shows that new hospitalizations have continued to trend down this month.
  • On Friday, OPM released guidance on the relationship paid leave / other time off and COVID-19 work by Federal employees. According to the guidance, OPM plans to issue “regulations [that ] will deem the COVID-19 national emergency to be an exigency of the public business for the purpose of restoring forfeited annual leave. The regulations [among other things] will provide that employees who would forfeit annual leave in excess of the maximum annual leave allowable carryover because of their essential work during the national emergency will have their excess annual leave deemed to have been scheduled in advance and subject to leave restoration.”

The U.S. Supreme Court has 15 decisions left to issue before its summer break. The Court is expected to issue some of those decisions tomorrow at 10 am. The Court is continuing to hold its Thursday conferences so all of 15 of the decisions may not be ready for issuance.

Georgetown Law Professor Katie Keith provided a welcome Health Affairs blog analysis of a complicated topic — federal regulation of employee wellness programs. The key complicating factor is that there are so many different applicable federal laws in play.

Tuesday Tidbits

David Ermer–COVID-19, Medicare, SCOTUS–

On the COVID-19 front —

  • The Wall Street Journal reports about the importance of exercising common sense during the COVID-19 emergency:

Six months into the coronavirus crisis, there’s a growing consensus about a central question: How do people become infected?

It’s not common to contract Covid-19 from a contaminated surface, scientists say. And fleeting encounters with people outdoors are unlikely to spread the coronavirus.

Instead, the major culprit is close-up, person-to-person interactions for extended periods. Crowded events, poorly ventilated areas and places where people are talking loudly—or singing, in one famous case—maximize the risk.

  • The Boston Globe reports about a new treatment:

Researchers in England say they have the first evidence that a drug can improve COVID-19 survival: A cheap, widely available steroid called dexamethasone reduced deaths by up to one third in severely ill hospitalized patients.

Results were announced Tuesday and researchers said they would publish them soon. The study is a large, strict test that randomly assigned 2,104 patients to get the drug and compared them with 4,321 patients getting only usual care.

The drug was given either orally or through an IV. After 28 days, it had reduced deaths by 35% in patients who needed treatment with breathing machines and by 20% in those only needing supplemental oxygen. It did not appear to help less ill patients.

  • The Harvard Business Review offers an interesting article concerning the ongoing role of employers and employer sponsored healthcare in addressing the COVID-19 emergency.

In other news

  • The Congressional Budget Office made a presentation on how its factors preventive care savings into federal budget calculations. This could be helpful for health plan actuaries and underwriters.
  • Georgetown University Law Professor Katie Keith discusses the impact of yesterday’s Supreme Court opinion on the Department of Health and Human Service’s revised Section 1557 rule. By the way that rule will be published in the Friday June 19 Federal Register which means that it is currently scheduled to take effect on August 18, 2020. The FEHBlog expects HHS to pull back the final rule for re-evaluation in view of the Supreme Court opinion.
  • Today, the U.S. Court of Appeals for the D.C. Circuit upheld a district court decision striking down a Centers for Medicare and Medicare Services rule that would have required prescription drug manufacturers to disclose the average manufacturer price for their drugs in related television advertisements. The Court held that “the Disclosure Rule’s blunderbuss operation falls beyond any reasonable exercise of the Secretary’s statutorily assigned power.” If you find administrative law interesting, you should read the opinion.

Monday Roundup

David Ermer–ACA, OPM, SCOTUS, Telehealth–

Health Payer Intelligence reports that “Major payers and payer organizations objected to the finalized HHS nondiscrimination rule—Affordable Care Act Section 1557—saying that the rule eliminates much of the specific language in the original rule, particularly relating to gender and sexual discrimination.” In that regard, this morning, per the Wall Street Journal, “The Supreme Court ruled that bedrock federal civil-rights law [Title VII of the Civil Rights Act of 1964] prohibits employers from discriminating against workers on the basis of their sexual orientation or gender identity, a decision that for the first time extends federal workplace protections to LGBT employees nationwide.”

The FEHBlog expects that this ground breaking Supreme Court decision will cause the Department of Health and Human Services to reconsider last Friday’s revised final Section 1557 rule either on its own initiative or upon a federal court order. That rule does not take effect until late August 2020.

In other news

  • The International Foundation of Employee Benefit Plans reports that the Centers for Medicare and Medicaid Services has created flexibilities to allow insurers to advance 2019 medical loss ratio rebates to individual policyholders. The 2019 medical loss ratio report normally would be due on June 30, 2020.
  • The American Hospital Association evaluates whether legislation or regulations can be used to extend various current telehealth flexibilities beyond the end of the COVID-19 emergency.
  • Govexec.com informs us that “Officials at the federal government’s 401(k)-style retirement savings program announced Monday that the Thrift Savings Plan has implemented provisions of the CARES Act coronavirus response package making it easier for participants impacted by the pandemic to access money in their accounts.” Here’s a link to this announcement.

Weekend Update

David Ermer–Congress, SCOTUS, Telehealth, U.S. Healthcare–

Happy Flag Day.

Both Houses of Congress will be conducting committee and floor business this week. The House had added floor voting days for Thursday and Friday next week as well as all of the following week (except for next Friday which is the work holiday associated with the Fourth of July.)

The Senate Health Eduction Labor and Pensions Committee is holding a committee hearing of relevance to the FEHBP — Telehealth: Lessons from the COVID-19 Pandemic — on June 17 at 10 am.

The Supreme Court has nineteen more opinions to release before its summer break. This week the Court is releasing opinions tomorrow and Thursday, both days at 10 am ET.

Here are a couple of non-COVID-19 research items that caught the FEHBlog’s attention over the weekend:

  • Precision Vaccinations reports that “With a surprisingly simple approach in which cancer cells are first grown, ruptured and converted into nanoparticles, and then used as a vaccine, Vanderbilt University researchers say they have developed what appears to be a promising treatment for breast cancer metastasis. Metastasis is the last stage of cancer, responsible for about 90 percent of cancer-related deaths.
  • The Wall Street Journal reports that

Scientists may be just a few years away from delivering new treatments for age-related macular degeneration (AMD), the leading cause of irreversible vision loss in people more than 50 years old.

Over the past 15 years there has been only one class of successful AMD drugs, known as anti-VEGF agents, and they have worked for a minority of AMD sufferers. Now researchers are having success fighting AMD from new directions. They include an immune-system inhibitor and stem-cell therapy, which show promise for treating the dry form of AMD in its advanced stage, for which there is currently no treatment approved by the U.S. Food and Drug Administration.

“I’m cautiously optimistic that we will have markedly improved treatments for both wet and dry AMD within two to three years,” says Joshua Dunaief, professor of ophthalmology at the Scheie Eye Institute at the University of Pennsylvania.

Weekend update

David Ermer–Congress, Rx coverage, SCOTUS, Telehealth–

The Senate is engaged in legislative and committee business this week. Last week the Senate passed by unanimous consent a bill (S. 279) to amend the FEHB and FEGLI Acts for the purpose of extending coverage to employees of Indian tribal grant schools. This bill would close a gap created by the Affordable Care Act which generally extended coverage under these programs to Indian tribal employees. There are 128 tribal grant schools in the U.S.

The House of Representatives is engaged in committee business this week. That body is next scheduled to hold votes over the period June 30 through July 2.

The Supreme Court continues this week to release the remaining opinions from its October 2019 term. The Hill includes an article discussing the seven opinions that are expected to be politically controversial.

In other news Fierce Healthcare reports

  • “A top Department of Health and Human Services (HHS) official acknowledged [last week] that telehealth is here to stay after an explosion of use due to COVID-19 but hedged on whether new regulatory flexibility on reimbursement is going to stick around.” The permanent flexibility depends largely on Congress and state regulators, and
  • “OptumRx researchers are highlighting three more drug products that payers should be keeping an eye on in 2020″ — Roche’s Risdiplam, NS Pharma’s Viltolarsen, and Immunomedic’s Trodelvy.

Weekend update

David Ermer–CDC, Congress, COVID-19, COVID-19 testing, OPM, Rx coverage, SCOTUS–

The House of Representatives and the Senate both will be in session on Capitol Hill this coming week, Of note from an FEHBP perspective is that Senate Homeland Security and Governmental Affairs Committee has scheduled a confirmation hearing for the President’s nominee for OPM Inspection General, Craig E. Leen, for Tuesday June 2 at 2:30 pm. Mr. Leen currently is Director of the Office of Federal Contract Compliance Programs (OFCCP) at the U.S. Department of Labor. The FEHBlog plans to tune in.

The Supreme Court heads into the home stretch of its October 2019 term tomorrow. The Court has 25 decisions left to issue before adjourning for the summer according to the Scotusblog.

OPM released more COVID-19 guidance last Friday. This guidance concerns preparedness for returning to OPM facilities.

Fierce Healthcare brings us up to date on COVID-19 testing at home options. The latest product receiving FDA approval is offered by Quest Diagnostics a/k/a Quest Labs.

The FEHBlog ran across on Twitter today this May 24 column from Reason senior editor Jacob Sillum.

According to the Centers for Disease Control and Prevention (CDC), the current “best estimate” for the fatality rate among Americans with COVID-19 symptoms is 0.4 percent. The CDC also estimates that 35 percent of people infected by the COVID-19 virus never develop symptoms. Those numbers imply that the virus kills less than 0.3 percent of people infected by it.

The FEHBlog also found this reassuring (at least to the FEHBlog) Science News article on COVID-19 mutations.

[C]oronavirus mutations are guaranteed to pop up over the coming months — and experts will continue to track them. “The data will tell us whether we need to worry, and in what way we need to worry,” [Louise] Moncla[, an evolutionary epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle] says. “Everyone should take a deep breath and realize that this is exactly what we’ve always expected to happen, and we don’t necessarily need to be concerned.”

Friday Stats and More

David Ermer–ACA, COVID-19, SCOTUS–

Per the CDC’s COVID-19 Cases in the U.S. that the FEHBlog tracks, the number of COVID-19 cases crossed the 1.4 million mark and the number of COVID-19 deaths exceeded 85,000 today. The CDC’s COVIDView confirms that the rate of increase continues to slow. For what it’s worth, the FEHBlog-calculated COVID-19 case mortality rate has been pretty stable for the past month. The Wall Street Journal’s Numbers columnist discusses COVID-19 stats her latest column.

Dividing fatalities by the number of confirmed illnesses produces the case fatality rate. [That’s FEHBlog’s approach] A better estimate of lethality divides fatalities by the number of people infected. But no one knows how many people are infected with Covid-19.

“Right now the death rate is a guess,” Dr. [Fred] Brauer said. “I’ve seen ranges from one-tenth of a percentage point to 3%.”

The FEHBlog has been tracking the simple case mortality rate to find a plateau and the FEHBlog thinks we may be there.

Recently, the filing of Supreme Court briefs defending the Affordable Care Act’s constitutionality have lead some press outlets to raise an alarm. The best chill pill is to read this Reason article by Prof. Jonathan Adler who filed on the 38 friends of the Court briefs supporting the statute’s constitutionality. The article’s title says it all — “The Penalty-less Individual Mandate Is Severable from the Rest of the ACA No Matter How You Look at It.” Amen to that.

A friend of the FEHBlog brought to his attention this C-SPAN interview with Dr. David Kimberlin. Dr. Kimberlin is pediatric infectious diseases chair at the University of Alabama at Birmingham. He talked about how the COVID-19 pandemic is impacting children. He expresses concern that the COVID-19 pandemic is discouraging parents from taking their children to pediatrician for routine childhood vaccinations. He encourages parents to contact their pediatrician to learn how the vaccinations can be obtained safely. That’s important advice.

In other news —

  • Becker’s Hospital Review discusses each of the fifteen hospital closures that have occurred in the United State this year.
  • STAT News reports that “fueled by the Covid-19 pandemic, remote heart monitoring could become tech’s next big target.
    • “Both Apple and Alphabet spinout Verily have watches equipped with EKGs that detect the heart abnormality atrial fibrillation, or A-fib. Apple and Amazon have recently hired prominent cardiologists to fill their ranks, while Facebook is hiring for a team overseen by Freddy Abnousi, a cardiologist and the social network’s new head of health technology. Among the new roles: an expert in the same type of technology used to monitor the heart in Fitbits and Apple Watches.”

Friday Stats and More

David Ermer–CDC, COVID-19, SCOTUS–

Per the CDC’s COVID-19 Cases in the U.S. that the FEHBlog tracks, the number of COVID-19 cases crossed the 1.2 million mark and the number of COVID-19 deaths exceeded 70,000 this week. The case mortality rate hit 6% on Thursday after being in the 5 to 6% range for 2 1/2 weeks. Before then the case mortality rate was increasing much faster. So we evidently are plateauing. The Wall Street Journal reports that the leading cause of death in our country remains heart disease. For an even better perspective, check out the CDC’s COVIDView which is released on Fridays.

The Wall Street Journal offers a perspective on State reopening here. The FEHBlog got a kick out of listening too this 20 minute long WSJ podcast on office reopenings titled “Welcome Back to the Office. Your Every Move Will Be Watched.”

The Wall Street Journal also has a regularly updated site on COVID-19 testing and treatments.

Health Payer Intelligence brings us up to date on the Texas v. U.S. case over the Affordable Care Act’s constitutionality. The Supreme Court will hear the case next fall.

Weekend Update

David Ermer–Congress, COVID-19, OPM, SCOTUS–

The Senate, but not the House of Representatives, returns to Capitol Hill tomorrow. On Wednesday, the Senate Homeland Security and Governmental Affairs Committee is holding a roundtable discussion about how new COVID-19 information should drive policy. On Thursday, the Senate Health Education Labor and Pensions Committee is holding a “Shark Tank” about new tests for COVID-19.

Federal News Network reports that George Nesterczuk who was President Trump’s first nominee to be OPM Director, has become a senior advisor to OPM’s current acting Director Michael Rigas. In 2017, Mr. Nesterczuk asked the President to withdraw the nomination in the face of criticism from federal employee unions.

The Wall Street Journal estimates the revenues that major health insurers will receive at some point due to the Supreme Court’s favorable decision in the Affordable Care Act risk corridor case last Monday. The Supreme Court begins its series of May telephonic oral arguments tomorrow.

The Journal further reports

The promise of new payments comes as the health-insurance industry has seen little financial pressure from the pandemic. In earnings calls over the past few weeks, insurers said they’d seen minimal impact on first-quarter results, and they were benefiting from reduced health-care costs due to the widespread cancellation of elective procedures and patients steering clear of routine care.

But the insurers said they could see costs ramp back up later in the year. Overall, several big companies including UnitedHealth Group Inc., Anthem Inc. and Humana left their financial guidance on earnings for 2020 in place despite the coronavirus impact.

A WSJ article posted today adds that

With fewer claims to pay out, some health insurers are using their improved balance sheets to help struggling providers secure loans, pay claims earlier and, in some cases, underwrite patients’ outstanding bills. And they have good reason to ensure providers survive the pandemic: “There is a risk that there is a smaller provider network after this,” said Brad Ellis, a senior director at Fitch Ratings. “So health insurers are trying to maintain the network.”

Well done.

Tuesday Tidbits

David Ermer–ACA, COVID-19, OPM, SCOTUS–

Following up on yesterday’s post on the Supreme Court’s decision in the Affordable Care Act risk corridor case, read Katie Keith’s article in Health Affairs on all of the decision’s reverberations. Fascinating.

The FEHBlog did virtually attend the NCQA Quality Talks 2020 conference today. Two speakers favorably caught the FEHBlog’s attention:

With regard to OPM’s concern about rooting out low value care in the healthcare system, Cardiologist Rita Redberg, MD, has been editing for years a series in the JAMA Internal Medicine Journal titled “Less is More.” Dr. Redberg blasted the medical device industry for promoting artery stents before first obtaining reliable evidence of the device’s safety and efficacy. As it turns out the device is no more effective than a placebo.

The good doctor explained that normally it’s difficult to perform a blinded research study with a new medical device because the research participant usually knows whether or not she received the device (as a opposed to a sugar pill.) In this recent Orbita study, the researchers convinced all of the study participants that they had received a stent. The good doctor also spoke about a friend who unnecessarily received a stent and wound up needing a heart transplant.

The FEHBlog also was quite impressed by Dana Lewis a young go-getter who along with a colleague developed a small closed loop computerized system to control her continuous glucose monitor as she has type 1 diabetes. She then founded an “open source artificial pancreas system movement (#OpenAPS)” to help others. She is not resting on her laurels.

An article in Medical Economics discusses a proposed Labor Department rule intended to protect TRICARE medical networks. However, the rule if finalized would disrupt FEHBP medical networks. The FEHBlog submitted comments to the Labor Department on the proposed rule for the FEHB plan trade association he represents. The comments asked the Labor Department to protect both TRICARE and FEHBP networks. He hopes the Labor Department will pull back the rule given the COVID-19 emergency.

In a bit of good COVID-19 news, the New York Times reported progress being made in two efforts to create a COVID-19 vaccine. Fingers crossed.

Also the Hill reported this afternoon that the House of Representatives has changed its mind about returning to Capitol Hill on May 4. The Senate continues to plan to return to the Capitol next Monday.