Govexec.com brings us up to date on the lawsuit against OPM and its contractor over the massive 2015 data breach.

The Justice Department sought to have the entire U.S. Court of Appeals for the D.C. Circuit rehear the case after a panel of the court in June largely sided with two federal employee unions in granting them standing to sue the Office of Personnel Management and a federal contractor for their roles in the hacks that led to mass disclosures of personal records. The court denied the en banc hearing request on Monday, however, meaning the lawsuit can likely now proceed at the district court level.

The Department of Health and Human Services’s Office for Civil Rights (“OCR”) announced another HIPAA security and breach notification rule breach settlement today.

OCR’s investigation revealed a HIPAA compliance program that had been in disarray for a number of years,” said OCR Director Roger Severino. “This hospital system’s [Jackson Health System of Miami. FL] compliance program failed to detect and stop an employee who stole and sold thousands of patient records; lost patient files without notifying OCR as required by law; and failed to properly secure PHI that was leaked to the media.” 

Not good.

Healthcare Dive offers an interesting interview with CVS Health’s CEO Larry Merlo.

CVS Health CEO Larry Merlo, who’s been with the company for almost three decades, chatted with Healthcare Dive about its main competitors, the prolonged Aetna acquisition, taking on Amazon and opportunities in the chronic care market.

Check it out.

The FEHBlog will be attending the Health Care Payment Learning and Action Network annual summit here in our Nation’s Capitol tomorrow. The plenary events at the free event will be streamed live.

Today, OPM released its much anticipated (at least from the FEHBlog’s perspective) benefit administration letter on significant plan changes to the FEHBP and FEDVIP for 2020. The agency also released its FEHB Fast Facts for use with upcoming Open Season. Enjoy.

Congress remains in session on Capitol Hill this week. The Hill reports that Senate leadership will be bringing up Fiscal Year 2020 appropriations bills up for a vote. “The first, as an olive branch to Democrats, will include domestic priorities. The second package will include a mammoth defense bill, which is considered a top priority for Republicans.” The current continuing resolution funding the federal government in the 2020 FY that began on October 1 expires a month from tomorrow November 21 (absent a further extension).

NPR Shots offers an interesting article on the use of genetic tests to identify the preferable drug to be dispensed to the tested individual.

Companies that make [these] genetic tests * * *say they can save patients and doctors from prolonged searching for the right medication and save insurance companies from paying for ineffective drugs. But many researchers say the tests don’t have enough evidence backing them up. The Food and Drug Administration has warned that the tests could potentially steer patients towards the wrong medications. Nonetheless, UnitedHealthcare, the nation’s largest insurer, began covering them October 1 for its 27 million individual and group plans.

The Wall Street Journal reports that

Vaping-related illnesses and deaths have spurred more young people to seek help to quit, physicians and psychologists treating teenage users of e-cigarettes say, but few treatment options exist and there is rising concern that the public-health response for cessation programs is inadequate. * * *

Dr. Melodi Pirzada, chief of pediatric pulmonology at NYU Winthrop Hospital on Long Island * * * said the hospital has long offered smoking-cessation sessions for adults. But given the vaping epidemic among teens, “we’re considering implementing similar teen-only programs to help teens stop vaping,” she said. The hospital is also looking to do increased screening of teens.

Another tool, she said, is a law change that would permit physicians to prescribe nicotine patches or gum to teens. It is now illegal in New York for anyone under 18 years of age to buy such over-the-counter products.

Rep. Elijah Cummings, the City of Baltimore’s Congressman and Chair of the House Oversight and Reform Committee passed away this week. That Committee has oversight over OPM and the FEHBP. The FEHBlog admired Congressman Cummings for his strong endorsement of public health centers to care for lower income people. Here’s a link to a Federal News Network article and a link to OPM Director Cabaniss’s statement on Rep. Cummings’ passing.  This article adds that Rep. Carolyn Maloney, a veteran Democrat from New York, will for now take over leadership of the House oversight committee, according to a senior Democratic leadership aide who spoke on condition of anonymity to discuss the decision publicly. Here’s a link to Congresswoman Maloney’s bio.

Speaking of Congress, Fierce Healthcare reports on the status of Speaker Pelosi’s bill to lower prescription drug costs. The House plans to vote on the bill which will be renamed in honor of Congressman Cummings, soon. Likelihood of its Senate passage is uncertain at best.

On the public health front:

• Here’s a CNBC article on the latest Centers for Disease Control report on the vaping crisis.

The number of fatalities continues to rise as a deadly vaping illness sweeps across the country, taking 33 lives and making 1,479 people sick so far, the Centers for Disease Control and Prevention said Thursday. 

The new cases — up from 26 deaths and 1,299 illnesses a week ago — show that U.S. officials are no where closer to getting the outbreak under control since it emerged as a public health threat in July. 

“This is extremely complicated and difficult. It’s fatal or potentially fatal with half of the cases requiring intensive care,” CDC Principal Deputy

•  The Wall Street Journal reports also regrettably 

The suicide rate among people ages 10 to 24 years old climbed 56% between 2007 and 2017, according to the report from the Centers for Disease Control and Prevention. The rate of homicide deaths decreased by 23% from 2007 to 2014 but then increased by 18% through 2017.

Violent death, including homicide and suicide, is a major cause of premature death for the age group. Around 2010, the death rate of suicides among adolescents and young adults surpassed the rate of homicide deaths, according to the report.

“The chances of a person in this age range dying by suicide is greater than homicide, when it used to be the reverse,” said Sally Curtin, a statistician at the CDC and an author of the report. “When a leading cause of death among our youth is increasing, it behooves all of us to pay attention and figure out what’s going on.”

 On the survey front

• The TransAmerica Center for Health Studies presents its annual consumer survey on health insurance. 

Federal News Network reports that Postmaster General Megan Brennan is retiring on January 31, 2020, after five years in her current position and 33 years at the Postal Service.

This summer, Brennan told members of the House Oversight Committee that absent postal reform — either from Congress or from the Postal Regulatory Commission — USPS was on track to run out of cash by 2024.

Members of the House and Senate have introduced several postal reform bills over the past few years, but none have made it far in Congress despite bipartisan support. Most of the bills would address a 2006 mandate for USPS to pre-fund health benefits for future retirees.

Because of this requirement, USPS has defaulted on billions of dollars in payments to the fund.

Meanwhile, Postal Service officials this summer briefed committee members on a draft business plan that would outline the agency’s path forward for the next 10 years.

Modern Healthcare reports that

Use of opioid-alternative pain medications is surging as the U.S. tries to wean off the addictive painkillers, giving physicians concern that the opioid crisis will be substituted by a new prescription drug epidemic, according to a new report.

Nearly two-thirds of primary-care physicians shared that sentiment while nearly three-quarters worry that chronic pain patients will turn to illicit drugs if they do not have access to prescription opioids, according to a new report from Quest Diagnostics, which polled 500 primary-care doctors and analyzed 4.4 million lab test results. The report reflects physicians’ apprehension that the healthcare system is ill-equipped to properly transition from an over-utilization of opioids.

If it’s not one thing, it’s another.

The Wall Street Journal tells us that

Doctors are urging Americans to get their flu shots right away after a bad flu season in Australia has raised concerns about the coming season in the U.S.

Public health experts often look to the Southern Hemisphere’s influenza patterns for clues of what’s to come. This year Australia saw an earlier-than-usual peak of flu cases and had a tough season overall. The predominant flu strain in Australia, as in recent years in the U.S., was the H3N2 virus, which generally causes more severe illness, particularly among the elderly, and more hospitalizations and deaths.

“It does lead you to believe that this H3N2 virus is definitely on the move and is changing, which is never a good situation,” says pediatrician Randy Bergen, clinical lead for the Kaiser Permanente flu vaccine program in Northern California. “It does make me a little bit more nervous than I am in general looking ahead to the flu season.” 

And Health Care Dive lets us know that

Medical practices continue to be frustrated with red tape and reporting requirements, with 86% saying regulatory burden has increased in the past 12 months, according to a Medical Group Management Association survey released this week.

Prior authorization was the main culprit — 83% of respondents said that issue was either “very” or “extremely” burdensome. The Medicare Quality Payment Program, which includes the Merit-Based Incentive Payment System, was next with 77%. Rounding out the top five were audits and appeals, lack of EHR interoperability and Medicare Advantage chart audits.

It’s interesting that these Medicare oriented objections exist notwithstanding CMS’s Patients over Paperwork initiative. It appears that CMS has more work to do.

The FEHBlog, already stoked by the Nationals 3-0 advantage over the Cards, was excited to read this Medpage article headlined “Senator: Surprise Billing Law Will Pass Congress Within Weeks
“I’m telling you, this will be decided soon,” says Louisiana’s Bill Cassidy, MD.”  Sen. Cassidy, although a Republican, favors the use of baseball arbitration to resolve surprise billing disputes. The FEHBlog is concerned that the use of baseball arbitration, instead of maximum rates, will encourage providers to stay out of network. Undoubtedly, the use of baseball arbitration, although a boon for the legal profession, will not lower healthcare costs.

Healthcare Dive informs us that UnitedHealthcare reported $60 billion third quarter 2019 revenue. Revenues were “up 6.7% year over year, was primarily driven by double digit growth in its health services arm Optum, the Minnetonka, Minnesota-based healthcare behemoth reported Tuesday. Optum reported revenue of $28.8 billion, up 13.3% year over year.”  Wow.

Speaking of billions of dollars, the Wall Street Journal reports that

Three major drug distributors are in talks to pay $18 billion to settle sweeping litigation brought by state and local governments blaming them for fueling the opioid crisis, people familiar with the discussions said, potentially marking a broad resolution to lawsuits that have shaken the pharmaceutical industry.

The three distributors— McKesson Corp. , AmerisourceBergen Corp. , and Cardinal Health Inc. —would collectively pay $18 billion over 18 years under the deal currently on the table, the people said. Johnson & Johnson is also involved in the discussions to contribute additional money, some of the people said. 

It’s not a done deal though.

In response to the FEHBlog’s post last Sunday about the ability of FEHBP annuitants over 65 to suspend their FEHBP coverage in order to try Medicare Advantage coverage, a reader noted that the FEHBlog’s supporting link was not  useful In that event, feast your eyes on this OPM regulation

During an Open Season * * * (ii) An annuitant or survivor annuitant who suspended enrollment under this part to enroll in a Medicare-sponsored plan under sections 1833, 1876, or 1851 of the Social Security Act, or to enroll in a Medicaid or similar State-sponsored program of medical assistance for the needy, or to use Peace Corps or CHAMPVA or TRICARE (including the Uniformed Services Family Health Plan) or TRICARE-for-Life coverage instead of FEHB coverage, may reenroll.

5 C.F.R. Sec. 890.306(f)(1).  What’s more, Aetna for 2020 is offering a Medicare Advantage plan in the FEHBP nationwide.

Congress returns to work on Capitol Hill on Tuesday following the Columbus Day holiday tomorrow.

The Medicare Open Enrollment Period begins on Tuesday October 15 and ends on December 7. This is the period within which Medicare beneficiaries can select or change Medicare Advantage and Medicare Part D prescription drug plans for the 2020 calendar year. The FEHBlog becomes eligible for Medicare on December 1, 2019.

The FEHBlog was expecting to join a Medicare Advantage plan. However, a Medicare expert as well as his internist advised him to join traditional Medicare and add Medicare Part D and Medicare supplemental coverage.  Why? If you don’t like your Medicare Advantage plan, in most states, including the FEHBlog’s state Maryland, you don’t have guaranteed access to a Medicare supplement plan as discussed in this article. In contrast, FEHBP annuitant enrollees can join a Medicare Advantage plan without losing their right to return to the FEHBP as OPM explains here. While you can carry FEHB coverage without picking up Medicare Part B coverage, you can’t enroll for Medicare Advantage unless you have enrolled for Medicare Part B.  Live and learn.

The Fall Take Back Your Prescriptions (unused prescription safe disposal) Day is Saturday October 26. Here’s a link to the Drug Enforcement Administration Day collection site locator. Plans should use their social media to notify members about this valuable opportunity.

As the FEHBlog sits here typing away while the NFL is on TV, the FEHBlog was impressed by the NFL’s new Crucial Catch initiative with the American Cancer Society. The initiative features “The Defender, a new [online] tool that provides personalized tips on how to reduce your risk of cancer.”

Earlier this year, the Department of Health and Human Services proposed to eliminate prescription drug rebates from Medicare and the ACA exchange plans, among others, but not commercial and FEHB plans. The prescription drug manufacturers cheered on this initiative but did not promise to preserve the economic status quo by lowering their prescription drug prices.  HHS backed offed on this initiative because insurers convinced HHS that eliminating rebates would raise premiums. The FEHBlog nearly fell off his chair when he read this BioCentury article:

[The Food and Drug Administration] FDA has completed a draft guidance that would create a legal loophole for drug companies to bypass legal commitments to pay rebates to PBMs and payers. The guidance, which is under review at the Office of Management and Budget, is intended to allow companies to sell drugs at net prices that don’t include rebate payments. 

If and when it is implemented, HHS believes the guidance would enable drug companies to create a parallel market that would function alongside regular supply chains. In this separate channel, imported drugs could be sold at lower list prices to patients who are uninsured or who have large deductibles. 

The guidance could also give companies the ability to free themselves from long-term contracts and negotiate new contracts for distributing drugs through conventional supply chains. 

The scheme, first announced by HHS in a plan released in July, rests on FDA giving the green-light to a sleight of hand trick involving National Drug Codes (NDCs), codes that FDA assigns to drugs so it can track them throughout the supply chain.

Wow.

October 10 is World Mental Health Day, a creation of the World Federation of Mental Health. This year’s focus not surprisingly is on suicide prevention.

The Federal Times reports that “The Office of Personnel Management encouraged other federal agencies to leverage programs that help employees maintain balance between their home and work life, as part of the 2019 National Work and Family Month.”

CNBC informs us that

The Social Security Administration announced Thursday that the cost-of-living adjustment for 2020 will be 1.6%.  That number is less than what retirees have received in recent years. In 2019, they got a 2.8% bump, while in 2018 the increase was 2%. Still, it’s better than zero, which retirees saw in 2010, 2011 and 2016.

The Washington Post explains how this announcement impacts federal retirees.  The next big announcement on the retiree front will be Medicare premium and cost sharing changes foe 2020.

Healthcare Dive alerts us that UnitedHealthcare’s new app for participants in its employer sponsored health plans will have an integrated telehealth feature.  The FEHBlog recently used Carefirst’s telehealth app. He was surprised by how long it took for the app to load. Nevertheless once loaded it was easy and effective to use. The FEHBlog’s experience reinforced his understanding that you shoul load your plan’s telehealth app on your chosen device and register for the service before you really need it.

Finally,

Today, the U.S. Department of Health and Human Services published a new Guide for Clinicians on the Appropriate Dosage Reduction or Discontinuation of Long-Term Opioid Analgesics. Individual patients, as well as the health of the public, benefit when opioids are prescribed only when the benefit of using opioids outweighs the risks.  But once a patient is on opioids for a prolonged duration, any abrupt change in the patient’s regimen may put the patient at risk of harm and should include a thorough, deliberative case review and discussion with the patient. The HHS Guide provides advice to clinicians who are contemplating or initiating a change in opioid dosage.

This guide should be helpful to health plan case managers as well.

P.S. The FEHBlog returned to the Nation’s Capital today after five days in Arizona on a too brief, fun family vacation.

The Centers for Medicare and Medicaid Services and the Health and Human Services Inspector General issued related proposed rules today intended to modernize the Stark self-referral proscription law and the federal health programs anti-kickback act’s safe harbor provisions. The actions stem from the HHS Patients over Paperwork Initiative. Healthcare Dive explains that

• The long-awaited proposals from the Trump Administration seek to alter physician self-referral and anti-kickback laws to account for the healthcare system’s shift from fee-for-service to value-based arrangements. Backers of the revamp say current regulations discourage providers from entering into partnerships aimed at improving quality outcomes due to fear of harsh criminal penalties.

• A number of new safe harbors are being proposed to encourage value-based care, allow patient engagement through furnishing of certain tools and supports and permit certain remuneration when provided in connection with some CMS-sponsored models to cut down on the need for fraud and abuse waivers. They also provide guidance aimed at clarifying when compensation provided to a doctor by another provider must be paid for at fair market value.

Pharmaceutical companies often preach value. Yet, for seven top-selling drugs, prices went up in 2017 and 2018 despite limited new evidence showing patients receiving treatment experienced greater benefit, according to a new report.

Taken together, the price hikes added more than $5 billion to U.S. spending on those drugs over the two-year period, a study published Tuesday by the Institute for Clinical and Economic Review said.  * * *

Unsurprisingly, PhRMA, the industry’s principal lobby, took issue with ICER’s findings, as did drugmakers flagged for taking unsupported price increases. 

The bipartisan Senate Health Education Labor and Pensions bill (S. 1895) to lower prescription drug costs and address surprise billing currently appears stalled. While visiting Arizona, the FEHBlog saw a political ad favoring arbitration over S. 1895’s out of network price setting approach which by the way the ACA already uses to a limited extent. As Forbes consultant Avik Roy commented the arbitration approach would raise costs. That’s common sense.

The FEHBlog and most of his family have been vacationing in Arizona since last Saturday morning.  Very enjoyable.

It’s the time of the year when a lot of FEHBP news appears.

The Federal Times and Mike Causey from the Federal News Network offer advice on how to prepare for the impending Federal Benefits Open Season. While OPM has launched its 2020 Open Season website, it has not yet launched its 2020 Plan Comparison Tool site. That usually happens closer to the start of Open Season which is November 11 this year.

Healthcare Dive reports that Blue Cross FEP, the largest FEHB plan, has contracted with Livongo for diabetes care beginning next year.

Beginning Jan. 1, Livongo will offer FEP beneficiaries with Type 1 or Type 2 diabetes a glucose meter, unlimited test trips and lancets at no additional cost, plus remote access to nutrition and lifestyle coaches via Livongo’s mobile app.

GEHA, which sponsors the second largest plan outside of FEP, issued a press release on its 2020 FEHBP offerings.

Healthcare Dive also reports on a recent Journal of the American Medical Association study on waste and potentials for saving in America’s healthcare system.  The JAMA study finds that waste consumes about 25% of healthcare spending down from a 30% finding in 2012.