Congress is on its State / district work period for another week.

The Supreme Court begins its October 2019 term tomorrow. Here’s a Scotusblog report on the orders that the Court issued last Friday.

Healthcare Dive reports that last Thursday the President issued an executive order concerning the Medicare Program.

The order would allow Medicare Advantage (MA) plans to offer more novel benefits and allow beneficiaries to join in on some of the savings payers are able to deliver through cash or rebates.

The order also calls on regulators to examine ways to modify payments in the fee-for-service program to bring them in line with those paid under Medicare Advantage and to find ways to improve the enrollment process.

The FEHBlog dreams of such an order for the FEHBP, e.g., allowing carriers more flexibility in benefit design.

Federal News Network had not one but two articles on the currently stymied effort to distribute OPM’s functions to the Office of Management and Budget and the General Services Administration.

Becker’s Hospital Review identifies the 56 hospitals with the maximum Medicare readmission penalties under the latest round of penalties announced last week. Compare it against your plan’s network.

Here’s OPM’s Open Season announcement which includes a discussion of FEHBP and FEDVIP premiums for 2020. .

Tammy Flanagan has posted a useful Open Season article on Govexec.com. Here’s a key point from the article:

Two health plans will no longer participate in FEHBP in 2020: MVP Health Care, which covers 3,200 employees and more than 4,000 retirees in New York; and Highmark Choice Co. (also known as Keystone Health Plan West), which  covers 718 employees and 323 retirees in Pennsylvania. Enrollees in these plans will have to select a new plan during open season. Otherwise, they will be automatically enrolled in the lowest-cost nationwide plan option, which for 2020 is GEHA Elevate {one of the new government wide indemnity benefit plan options.]

On the prescription drug front —

• Fierce Healthcare reports that 

A recent survey of major payers found that 58% had executed an outcomes-based contract with a drug manufacturer in 2019, up from 24% in 2017. The survey released Tuesday from the consulting firm Avalere shows that outcomes-based contracts, where the drugmaker is paid by an insurer based on the effectiveness of their product, are gaining steam despite concerns over regulatory hurdles. The survey updates prior versions conducted in 2017 and 2018.

• Healthcare Dive reports

Civica Rx, a coalition of health systems that banded together in 2018 to make prescription drugs, has made its first delivery and a patient has now been treated with one of its medications.

Riverton Hospital, an Intermountain Healthcare facility in Utah, received the first batch of vancomycin hydrochloride, an injectable antibiotic that is commonly in short supply for hospitals across the country, Civica Rx said Wednesday.

The antibiotic will be available to all health systems by the end of the month. Shortly after that, another essential antibiotic, daptomycin, will be made available, according to the company.

• MedCity News reports that the President most likely will nominate Dr. Stephen Hahn. Dr. Hahn currently is the CEO of the University of Texas M.D. Anderson Cancer Center. 

• Fierce Healthcare further reports that 

OptumRx has released the second of its quarterly insights in the pharmaceutical pipeline, highlighting five more drugs in development that could have a significant impact on insurers and patients. The third-quarter list stands in contrast to prior reports as most of the featured drugs are emerging treatments for common conditions such as Type 2 diabetes and chronic migraines instead of “orphan” drugs or those targeting rare diseases, which are typically quite costly. 

The Centers for Disease Control today released their latest report on the vaping crisis.

The Department of Human Services Office for Civil Rights issued a press release on a HIPAA privacy rule settlement with a Dallas Texas dental practice. The settlement arose from the provider’s over-inclusive response to a Yelp review.

OPM released 2020 FEHBP premium rates this afternoon. The Washington Post, Govexec.com, Federal Times and Federal News Radio all have articles on the rate action. The Federal Employee Benefits Open Season begins on November 11. Check plan websites for 2020 benefits information.

Today is the beginning of the 2020 federal fiscal year.

The Health Affairs Blog posted an article about the demise of OPM’s Multi-State Plan Program created by the Affordable Care Act. I was interested to learn that

Recently the Office of Personnel Management (OPM) decided to discontinue operations of the Multi-State Plan (MSP) Program. The decision came as the program, which provided health insurance through the Affordable Care Act (ACA) health exchanges, had gone from providing coverage to more than 400,000 people in 35 states and the District of Columbia in 2015 to one state this year. 

The article discusses why the program failed. In my view, it was too complicated. 

Becker’s Hospital CFO Reports informs us that

In fiscal year 2020, CMS will penalize 2,583 hospitals for having too many Medicare patients readmitted within 30 days, according to federal data released Sept. 30 cited in a Kaiser Health News report.

Ouch. 

Becker’s Hospital Review has created a list of the thirteen U.S. hospitals that received the most emergency room visits in 2018. They are spread around the country, at least at first glance.

Federal News Radio reports that last Friday the President signed into law the continuing resolution funding the federal government in the new fiscal year that begins on Tuesday October 1 through November 21. 

On September 28, 1959, sixty years ago today, President Dwight D. Eisenhower signed the FEHB Act into law. (This photo does not identify the bill being signed but you get the idea.)  The FEHBlog owes his livelihood to this law. Enjoy the day and reflect with me on the benefits that this law has bestowed on federal and postal employees and annuitants over the years.

The Senate approved the House passed continuing resolution (“CR,” HR 4378) which funds the federal government from October 1, 2019, through November 21, 2019. The bill goes to the President who is expected to sign it.

The Federal News Network reports that

Notably, the CR includes an additional $48 million for the Office of Personnel Management, which faces a funding shortfall on Oct. 1 when the National Background Investigations Bureau and the governmentwide security clearance portfolio transfers to the Pentagon [with full Congressional authorization]..

In addition, the CR gives OPM the authority to transfer roughly $29.7 million from “appropriate trust funds … without regard to any other provision of law” to maintain agency operations.  OPM administers health and retirement benefits to more than 2.7 million active employees and nearly 2.6 million annuitants, survivors and their family members through the Earned Benefits Trust Funds, which have close to $1 trillion in combined assets 

The Senate also confirmed Eugene Scalia as the Secretary of Labor. Mr. Scalia is the son of the late Supreme Court Justice Antonin Scalia and has been a partner at the law firm of Gibson Dunn and Crutcher. His confirmation is relevant to the FEHBP because the Secretaries of Health and Human Services, Labor and Treasury are the principal Affordable Care Act regulators

The Centers for Medicare and Medicaid Services announced the issuance of its

Omnibus Burden Reduction (Conditions of Participation) Final Rule{. The rule]  strengthens patient safety by removing unnecessary, obsolete, or excessively burdensome health regulations on hospitals and other healthcare providers. This rule advances CMS’s Patients over Paperwork initiative by saving providers an estimated 4.4 million hours previously spent on paperwork annually, with overall total provider savings projected to be approximately $8 billion over the next 10 years, giving doctors more time to spend with their patients.  

The FEHBlog dreams of OPM granting such massive deregulatory relief to FEHB carriers.

CMS also announced issuing a Discharge Planning final rule.

[The rule] empowers patients preparing to move from acute care into post-acute care (PAC), a process called “discharge planning.” Today’s rule puts patients in the driver’s seat of their care transitions and improves quality by requiring hospitals to provide patients access to information about PAC provider choices, including performance on important quality measures and resource-use measures – including measures related to the number of pressure ulcers in a given facility, the proportion of falls that lead to injury, and the number of readmissions back to the hospital. The rule also advances CMS’s historic interoperability efforts by requiring the seamless exchange of patient information between healthcare settings, and ensuring that a patient’s healthcare information follows them after discharge from a hospital or PAC provider. 

This rule could help payers and providers better avoid hospital readmissions.

The Wall Street Journal calls our attention to the Kaiser Family Foundations annual survey of employer healthcare costs.

Annual premiums rose 5% to hit $20,576 for an employer-provided family plan in 2019, according to the yearly poll of employers by the nonprofit Kaiser Family Foundation. On average, employers bore 71% of that cost, while employees paid the rest.

For an individual employer plan, the average total premium cost was $7,188 in the 2019 survey, or 4% higher than last year. 

Health Payer Intelligence reports on the National Business Group on Health’s annual survey on large employer health benefit plan trends.

“While most large employers are not planning major changes to their plan design, they continue to increase efforts to improve quality, access and convenience by providing workers with more plan choices and greater access to virtual care solutions and mental health services,” said Brian Marcotte, president and CEO of the National Business Group on Health. “Additionally, more employers are providing decision-support tools and technology to simplify their employees’ experience and help them navigate the health care system.” 

The FEHBlog received an email from NCQA today inviting him to vote in Modern Healthcare’s annual poll of the 100 most influential people in healthcare. You too can vote at this link until October 7.  The ballot offers 300 candidates and allows a reader to make five choices.  Out of gratitude for NCQA alerting me to this vote, one of my five votes went to Peggy O’Kane, NCQA’s president. The FEHBlog is not among the 300 candidates so you have all five of your votes.

As we now are in the middle of National Healthcare Information Technology Week, here’s a link to the HIMSS trade association’s celebratory site.

Fierce Healthcare informs us that CVS Health is launching

a new pharmacy solution aimed at cutting down the time it takes for patients to obtain specialty drugs.  The new tool is built in two parts: Specialty Expedite and Specialty Connect. The former is designed to cut down the prior authorization and onboarding process significantly with the goal of reaching a three-day process.  

Onboarding for a new medication can take a long time—sometimes weeks—for some patients, which can leave them falling off the wagon for needed care, CVS said in a brief on the new solution.

The Centers for Medicare and Medicaid Services today announced Medicare beneficiary premiums for Medicare Advantage and Medicare Part D prescription drug plans. It’s good news. The next step will be for CMS to announce beneficiary premiums and other cost sharing amounts for traditional Medicare Parts A and B.  The Medicare open season begins on October 15.

The federal Agency for Healthcare Research and Quality is celebrating its 20th anniversary.

After spending the last 18 months listening to patients, systems leaders, researchers, policymakers, and other stakeholders, we have identified the following three challenges that are front and center in the minds of healthcare experts, and which require long-term strategies to address. 

Improving care for Americans living with multiple chronic conditions (MCC) —
More than 25 percent of Americans live with MCCs, including 80 percent of Medicare beneficiaries. Care for these patients is often fragmented, leading to poor outcomes and increased costs. We stand ready to support a multifaceted initiative designed to augment primary care and leverage AHRQ’s core competencies in health systems research, practice improvement, and data and analytics. 

Providing data and analytics to policymakers to empower informed decision making — Many policymakers still make decisions based largely on expert opinion rather than tapping into the explosive potential of new data resources and analytic strategies. We plan to transform the delivery of vital information by establishing an integrated data and analytics platform, one  to help Federal, State, and local policymakers get access to timely and accurate data and analytic resources to make informed policy decisions. Central to this effort will be continued expansion of AHRQ’s premier data resources—the Medical Expenditure Panel Survey and the Healthcare Cost and Utilization Project. 

Reducing diagnostic errors —  An estimated 12 million people per year are affected by diagnostic errors, including 4 million suffering serious harm. Research suggests the cost to the U.S. healthcare system exceeds $100 billion annually. Our initial work should focus on the three largest areas of diagnostic errors: cancer, vascular conditions, and infections.

Kaiser Health News reports on how local healthcare authorities are using data to help reduce suicide rates. For example,

data revealed a surprising number of suicides at hotels and motels. It also showed a number of those who killed themselves had experienced eviction or foreclosure or had a medical visit within weeks or days of their death. It revealed that people in crisis regularly turn their pets over to the animal shelter.

But what to do with that information? Experts have long believed that suicide is preventable, and there are evidence-based programs to train people how to identify and respond to folks in crisis and direct them to help. That’s where Debra Darmata, Washington County’s  [Oregon] suicide prevention coordinator, comes in. Part of Darmata’s job involves running these training programs, which she described as like CPR but for mental health.

The training is typically offered to people like counselors, educators or pastors. But with the new data, the county realized they were missing people who may have been the last to see the decedents alive. They began offering the training to motel clerks and housekeepers, animal shelter workers, pain clinic staffers and more.

 Bravo.