Midweek update

Uncategorized

Midweek update

David Ermer–Congress, Uncategorized–

Today the House Ways and Means Committee passed its surprise billing proposal (H.R. 5826) by voice vote. This bipartisan bill is strongly by hospital and other healthcare provider organizations. Enough said.

The Hill reports on the state of efforts in the Senate to lower prescription drug prices. The efforts currently are up in the air according to the Majority Leader Mitch McConnell.

Speaking of prescription drugs, Bioworld informs us that a

New analysis from Clarivate Analytics’ Cortellis Forecast Team predicts 11 medicines set to enter the market in 2020 will reach more than $1 billion in sales by 2024. Drugs for central nervous system indications and cancer dominate the list, almost universally accelerated in their development by orphan drug status or other designation intended to speed their path to market. Most medicines are for indications in markets already crowded with competitors, meaning they’ll face substantial pressures to differentiate from existing products.

The Office of National Coordinator of Health Information Technology discusses last week’s 10th annual ONC conference in a blog post.

We heard about standards for clinical data and financial transactions, technology for matching you with your (snail) mail, and how leading innovators are using application programming interfaces and the HL7® FHIR® standard to advance access. And yet, these technologies are not always working in sync. Several new and proposed policies from HHS – including ONC’s and CMS’s proposed interoperability rules and the Trusted Exchange Framework and Common Agreement – are set to move the nation one step closer to making these technologies work for the patient.

It can’t happen too soon, in the FEHBlog’s view.

Also this week Healthgrades issued its best U.S. hospitals list. Healthgrades explains that its ratings are “based solely on clinical quality outcomes for 32 conditions and procedures. This premier distinction rewards hospitals that consistently exhibit exceptional, comprehensive quality care.” Although none of the D.C. located hospitals are included on the list, there are several in the D.C. suburbs of Maryland and Virginia.

Tuesday Tidbits

David Ermer–ACA, Congress, Uncategorized–

Earlier today, the House Education and Labor Committee advanced its bipartisan surprise billing proposal (H.R. 5800) today by a 32-13 vote. As the FEHBlog mentioned last Friday, the House Ways and Means Committee has released the legislative text of its bipartisan surprise billing proposal (H.R. 5826). While these proposals seek to protect consumers, which is a good thing, they also will impose new administrative burdens on the health system but won’t encourage out-of-network providers to go in-network. The FEHBlog anticipates that if bipartisanship on this issue continues in the House, then it’s likely that the House bill will wind up in the Senate’s bill to lower healthcare costs (S. 1895) and eventually become law.

The Association of Community Health Plans has proposed

a certification framework for digital health care pricing tools that makes quality and pricing information accessible, understandable and actionable for consumers. Outlined in a new issue brief, ACHP offers a core set of standards for meaningful price transparency and lays out a roadmap for independent certification of these tools.

Smart move given the federal government’s push for price transparency tools.

The Wuhan or novel coronavirus has an official name. Forbes reports that

Today, the World Health Organization (WHO) announced the official new name of nCoV2019 (2019 novel coronavirus), the strain of coronavirus that has infected over 43,000 people worldwide, resulting in 1017 deaths.

COVID-19, as the virus will now be known, was decided on by the WHO, with the organization giving a number of reasons as to why it was chosen.

Evidently the FEHBlog was violating WHO guidelines by referring to this disease as the Wuhan virus. Lo siento.

Healthcare Dive reports on Change Healthcare survey of healthcare provider and payer executives. The article describes differences of opinion between payer and provider executives. Here’s one —

Their positions on social determinants of health seem to reflect one of the widest splits. Providers appear to have the edge in terms of gathering information on substance abuse among patients (71.4% of provider executives versus 52.5% of payers). However, payers are much more effective at pinning down the income data of their enrollees (45.9% versus 26.5%). They also had a 10-point advantage in focusing on health literacy (39.3% vs. 29.6%), although the numbers suggest both factions did not consider it a major issue.

Big Monday

David Ermer–Congress, Federal employment benefits, Uncategorized–

The U.S. Office of Personnel Management (“OPM”) released its call letter for 2021 FEHBP benefit and rate proposals today. The carrier proposals are due on Sunday May 31, 2020. To prepare the proposals carriers also need OPM’s technical guidance, which is a separate Carrier letter, and to submit their proposals, carriers also must complete OPM’s extensive “ADC” information request. OPM expects a lot from its FEHBP carriers.

The President did transmit his FY 2021 budget proposal to Congress today. The Administration intends to propose to statutory change to the FEHBP government contribution formula (5 USC Sec. 8906):

to base it on a plan’s score from the FEHB Plan Performance Assessment would improve healthcare quality and affordability within the program. The enactment of the proposals in 2021 will not begin to impact program financials until 2023. [Page 1168]✦

This appears to be a retread from the last budget cycle. However, the FEHBlog does not recall reviewing the proposed legislative language for the 2019 proposal. This proposal assuming its the same one didn’t get very far then, and it’s unlikely to get further this year in the FEHBlog’s view. Federal News Network discusses other federal employee compensation found issues in the budget proposal.

Russ Roberts the host of the Econtalk podcast held a fascinating conversation with “physician and author Marty Makary of Johns Hopkins University talks about his book The Price We Pay.” The book concerns fixing our healthcare system. Dr. Makary made a lot of sense to the FEHBlog. He encourages readers to listen to this podcast or read the transcript.

Thursday Miscellany

David Ermer–ACA, Uncategorized–

The Wall Street Journal reports that a Wuhan physician Dr. Li who had issued public warnings about the Wuhan or novel coronavirus has died from the disease. Not the first nor the last physician to sacrifice his or her life in the interest of public health and patient care. RIP

Last March, the FEHBlog heard Dr. Amy Tuter, a retired obstetrician, speak on Econtalk about the need for maternal ICUs. Consequently, the FEHBlog was pleased to read this American Hospital Association news article about

Titus Regional Medical Center, Mount Pleasant, Texas

Since implementing best practices related to maternal hemorrhaging, Titus Regional Medical Center’s maternal morbidity rate related to blood loss has been reduced significantly. The hospital employs a stage-based approach to maternal hemorrhage, simulates for staff emergent hemorrhage situations and provides intense education regarding the physiology of a hemorrhage.

Bravo!

Finally Healthcare Dive reports that

  • With the release of their fourth quarter earnings, Cigna executives touted the company’s ability to contain medical cost growth at 4% over 2019, continuing a streak.
  • The payer’s medical loss ratio of 82.3% for the fourth quarter of 2019 beat Wall Street expectations even though it increased from the prior-year period. It’s still “an encouraging sign” given several misses from other payers, David Windley of Jefferies said in a recent note.

Cigna did pay a significant amount in Affordable Care Act driven rebates for 2018 according to an HHS report. (When looking at the chart remember that insurers pay rebates based on state level MLRs over a rolling three year period. Consequently there are several CIGNA entries.)

President nominates permanent OPM Inspector General

David Ermer–Uncategorized–

Yesterday, according to WhiteHouse.gov,

President Donald J. Trump announced his intent to nominate the following individual to a key position in his Administration:

Craig Edward Leen of the District of Columbia to be the Inspector General at the Office of Personnel Management.

Craig E. Leen presently serves as the Director of the Office of Federal Contract Compliance Programs (OFCCP) at the United States Department of Labor, where he oversees audits of Federal contractors and ensures compliance with Federal civil rights requirements.  He also serves on the Special Education Advisory Board for District of Columbia Public Schools, as a professorial lecturer in law at the George Washington University Law School, and previously served on the constituency board for the University of Miami-Nova Southeastern University Center for Autism and Related Disabilities.  Prior to his work at OFCCP, Mr. Leen was the City Attorney of Coral Gables, Florida, where he served as chief ethics officer, oversaw city prosecutions and the city prosecutor, oversaw reviews and investigations as directed by the City Commission, and provided legal opinions and guidance on behalf of the city to public officials and stakeholders to assist in compliance with law.  He is also known for his work helping establish a comprehensive disability inclusion program at the City of Coral Gables.  Mr. Leen received his J.D. from Columbia University School of Law and his B.A from Georgetown University.

This nomination requires Senate confirmation.

Tuesday Tidbits

David Ermer–ACA, CDC, Uncategorized–

The Affordable Care Act (“ACA”) regulators issued a new ACA frequently asked questions (number 41) yesterday. Number 41 discusses the 2019 revised summary of benefits and coverage template and related documents intended for use in the 2021 plan year.

OPM Director Dale Cabaniss sent a letter yesterday to the federal government’s Chief Human Capital Officers about the Wuhan or novel coronavirus.

Although the risk of contracting 2019-nCoV remains very low, agencies should remind employees to use good health habits such as hand washing and encourage sick employees to seek medical treatment and use sick leave or other appropriate workplace flexibilities.  Where necessary, agencies should consider implementing social distancing, including the use of telework. 

That strikes the FEHBlog as good advice for the flu too.

The FEHBlog ran across today this Healio article which takes a deeper dive into last week’s CDC findings that drug overdose deaths dropped by 4% when comparing 2017 and 2018 statistics.

Other data published in Morbidity and Mortality Weekly Report show that opioid prescribing rates dropped in 11 states — California, Delaware, Florida, Idaho, Kentucky, Louisiana, Maine, Ohio, Texas, Virginia and West Virginia — during 2010 to 2016. These states represent about 38% of the U.S. population, according to researchers.

Finally Beckers Hospital Review discusses a disturbing study published in the Annals of Internal Medicine finding that

Visits to primary care physicians fell by 24.2 percent over the study period [2008-2016]. The proportion of adults who did not visit a primary care physician in a given year increased from 38.1 percent in 2008 to 46.4 percent in 2016.

Young adults, people without a chronic disease and individuals living in low-income areas demonstrated the largest drop in primary care visits, although the trend was visible across all age groups and income levels, according to NPR.

The study blames the unfortunate situation on rising out of pocket costs. However, the Affordable Care Act made in-network preventive care visits free. So that’s at best a partial answer. Health plans should strive to encourage strong relationships between members and their primary care physicians. The FEHBlog certainly appreciates his

Monday Musings

David Ermer–ACA, CDC, HIPAA Privacy and Security Rules, Uncategorized–

The Wall Street Journal reports today that

There have been at least 19 million U.S. cases of the flu this season, 180,000 hospitalizations, and 10,000 deaths, according to preliminary estimates from the CDC. There were 61,000 flu-related deaths in 2017-18 and 34,200 deaths in 2018-19. Public health experts say the levels of hospitalization are similar to recent seasons, but deaths are lower than usual and outpatient reports of influenza-like illness remain elevated.

The article adds that

More than half of the positive influenza test results from public health laboratories this flu season have been in children and adults under the age of 25, according to the Centers for Disease Control and Prevention’s most recent weekly influenza report. That’s a higher portion than in the past few years, when less than half the cases were in kids and young adults. 

The reason: The predominant strain circulating early this season was influenza B, which causes more significant illness in children than in adults. 

It makes one wonder why the Wuhan or novel coronavirus was named as a public health emergency but evidently not the flu. The FEHBlog realizes that the public health emergency declaration was intended to free up funding for an unexpected illness but even more government and press focus should be placed on the flu in the FEHBlog’s opinion.

Recently the FEHBlog mentioned a U.S. District Court for the District of Columbia decision holding that the government mandated “patient rates” applicable to individual requests for their own medical records cannot be applied to requests that direct the records to third parties. HHS’s Office for Civil Rights issued an important notice last week advising compliance with the court’s order. The FEHBlog would not be surprised to see an appellate challenge to the decision.

Last week, the Trump Administration made available to State governments a new Medicaid Healthy Adult Opportunity block grant program. The program reminds the FEHBlog of the block grant approach in the Republican’s 2017 bill to repeal and replace the Affordable Care Act. Healthcare Dive reports

Analysts with Cantor Fitzgerald said they maintain a positive view on the manged care sector following the block grant news last week. “It remains to be seen if/when/how many states will opt into the initiative,” the analysts said in a recent note. “We continue to view Medicaid as a compelling growth area.”

The nation’s health insurance lobby didn’t take a position on the measure, but stressed the importance of having flexibility in the program and the need to cover everyone​.

“We support offering state policymakers flexibility to design their Medicaid programs to best meet the needs of their citizens. At the same time, funding mechanisms for Medicaid should not undermine Americans’ access to the care they need and deserve,” America’s Health Insurance Plans said in a statement Friday.

Even if states were interested in implementing the policy, legal experts told Healthcare Dive the demonstration is unlikely to get off the ground — as a fight in the courts is all but certain.

That’s unfortunate, in the FEHBlog’s opinion.

Weekend update

David Ermer–Congress, Uncategorized–

Happy Groundhog Day! USA Today reports that “On Groundhog Day 2020, Punxsutawney Phil could not find his shadow. And as the legend goes, this means we’re in for an early spring.” Oh, there’s also a big pro football game this evening in Miami. Go Chiefs.

Congress is in session this week on Capitol Hill. Federal News Network reports

The House will vote [this coming] week on a bill to repeal the Postal Service’s mandate to pre-fund health benefits for future retirees. The USPS Fairness Act (HR 2382) if passed, would undo one of the central provisions in the 2006 Postal Accountability and Enhancement Act. The bill, introduced by Congressman Peter DeFazio (D-Ore.), now has more than 300 co-sponsors and the support of the postal unions.

If Congress could get together to kill the three highly controversial Affordable Care Act taxes, Congress should be able to repeal this misguided mandate too.

Kaiser Health News reports on the Affordable Care Act penalties on Medicare payments that the Centers for Medicare and Medical has imposed on hospitals for certain adverse events affecting patients.

Now in their sixth year, the punishments, known as HAC penalties, remain awash in criticism from all sides. Hospitals say they are arbitrary and unfair, and some patient advocates believe they are too small to make a difference. Research has shown that while hospital infections are decreasing overall, it is hard to attribute that trend to the penalties.

This HAC penalty is in addition to the readmission penalty on Medicare payments that the ACA also created.

Fierce Healthcare warns

Payers better be prepared for orphan drugs.

The Food and Drug Administration (FDA) will evaluate more than 150 new approvals this year, OptumRx officials said in their latest quarterly report on the drug pipeline.

Already, there are 64 applications submitted to the agency with likely approval in 2020, the pharmacy benefit manager said. At least 11 of those drugs are set to be “blockbuster” products with over $1 billion in U.S. sales, Optum said in the report.

Optum has seen similar development activities over the past several years.

“It’s a little more than just an aberration—seeing three years in a row of high outputs is a trend, and something we think is going to continue at least for the foreseeable future,” Bill Dreitlein, senior director of pipeline and drug surveillance at OptumRx, told FierceHealthcare.

Tuesday Tidbits

David Ermer–ACA, CDC, Uncategorized–

Johns Hopkins University provides us with a Wuhan coronavirus dashboard that constantly updates the spread of the virus. AJMC.com offers coverage of HHS’s Secretary Alex Azar’s press conference on the topic held earlier today.

“Americans should know that this is a potentially very serious public health threat, but, at this point, Americans should not worry for their own safety,” Azar said. Of the 4500 cases confirmed in China, the country has reported more than 100 deaths. However, “the cases that have been identified skew severe, including patients who are older or have other illnesses. The mortality rate may drop over time as we identify a broader set of cases.”

The CDC recently announced it would begin screening travelers for the virus at 20 airports, up from an initial number of 5. “We are constantly preparing for the possibility that the situation could worsen, and your health and safety has been and will be our top priority,” Azar said.

AHRQ released a chart book on employer sponsored health coverage in our country in 2018.

Between 2017 and 2018, there was no significant change in the overall percentage of private-sector employees (47.8 percent in 2018) enrolled in a health insurance plan offered by their employers (“enrollment rate”). There was also no significant change in the enrollment rate in any firm-size category.

In 2018, average annual health insurance premiums per enrolled employee with private-sector employer coverage were $6,715 for single coverage, $13,425 for employee-plus-one coverage, and $19,565 for family coverage. These amounts represent increases of 5.4 percent for single coverage, 5.0 percent for employee-plus-one coverage, and 4.7 percent for family coverage over 2017 levels

In 2018, enrolled employees paid 21.3 percent of total premiums for single coverage, 27.1 percent for employee-plus-one coverage, and 27.8 percent for family coverage (Exhibit ES.14). The employee share of total premiums in 2018 for single coverage decreased by 0.9 percentage points from its 2017 level, while the employee shares for the other two coverage types were not significantly different from their 2017 levels.

The statutory minimum employee contribution for FEHB coverage is 25% (5 U.S.C. Sec. 8906).

Finally here’s a shocking Justice Department press release concerning an electronic health records vendor Practice Fusion Inc. which agreed to pay the Government $145 million to settle criminal and civil complaints.

The resolution announced today addresses allegations that Practice Fusion extracted unlawful kickbacks from pharmaceutical companies in exchange for implementing clinical decision support (CDS) alerts in its EHR software designed to increase prescriptions for their drug products.  Specifically, in exchange for “sponsorship” payments from pharmaceutical companies, Practice Fusion allowed the companies to influence the development and implementation of the CDS alerts in ways aimed at increasing sales of the companies’ products.  Practice Fusion allegedly permitted pharmaceutical companies to participate in designing the CDS alert, including selecting the guidelines used to develop the alerts, setting the criteria that would determine when a healthcare provider received an alert, and in some cases, even drafting the language used in the alert itself.  The CDS alerts that Practice Fusion agreed to implement did not always reflect accepted medical standards.  In discussions with pharmaceutical companies, Practice Fusion touted the anticipated financial benefit to the pharmaceutical companies from increased sales of pharmaceutical products that would result from the CDS alerts.  Between 2014 and 2019, health care providers using Practice Fusion’s EHR software wrote numerous prescriptions after receiving CDS alerts that pharmaceutical companies participated in designing

Happy Data Privacy Day

David Ermer–Uncategorized–

The Homeland Security Department informs us that “January 28 is Data Privacy Day, an annual effort to empower individuals and organizations to respect privacy, safeguard data, and enable trust.” Health Data Management provides 15 views on the importance of Data Privacy Day. Healthcare Dive adds that

The health IT world is stumping for a unique patient identifier for every U.S. citizen following signs from Congress that it’s open to the idea.

UPIs are distinct numbers, codes or data comparable to a Social Security number that differentiate one person from another. The idea of instituting one linked to patient health records is growing in popularity as a method to concretely match patients with their correct history, culling waste and avoidable medical errors.