The President, as anticipated, did issue today an executive order on improving healthcare price and quality transparency. The order directs administration action from the Department of Health and Human Services, the Internal Revenue Service and other agencies on pretty aggressive timelines. The Wall Street Journal reports in this regard that

Some action could come soon because the administration is already working on two unrelated rules that deal with pricing. HHS is expected in July to release a hospital payment rule that may include price-disclosure requirements, and a separate health-information rule could also require rates to be publicly shared. Either regulation could become a tool for delivering on the order.

The Journal also explains that

President Trump’s order reflects a deeper worry over the escalating cost of health care animating voters and shaping the presidential election. More than two-thirds of people say that reducing health-care costs should be a top priority for the president and Congress this year, according to a January survey by the Pew Research Center. 

The Senate Health Education Labor and Pensions Committee’s bipartisan bill to lower healthcare costs (S. 1895) has two titles (III and V) dealing with healthcare pricing and quality transparency. The FEHBlog expects this bill to pass the Senate but whether it can clear the House of Representatives is an open question.

The rules stemming from today’s Executive Order likely will face legal challenges. In this regard, the Supreme Court took another Affordable Care Act case today. The Court will consider the case discussed at this Scotusblog link during its October 2019 term. The FEHBlog wrote an article for the American Bar Association’s Health Law Section eSource on the Federal Circuit decisions that the Supreme Court will review in this case. Is there another law that has been the subject of so many legal challenges??

The FEHBlog is a fan of Russ Roberts’ EconTalk podcast. Check out today’s episode with Eric Topol about his new book Deep Medicine: How Artificial Intelligence Can Make Healthcare Human Again. Learn about incidentalomas.

Congress remains in session on Capitol Hill this week. The House of Representatives is expected to vote on the Fiscal Year 2020 Financial Services and General Government appropriations bill (H.R. 3351), which includes OPM appropriations, early this week. The House Rules Committee takes up the bill tomorrow afternoon. Also as mentioned last week, the Senate Health Education Labor and Pensions Committee will vote on its bipartisan bill to lower healthcare costs (S. 1895) on Wednesday at 10:30 am.

Last Friday, the U.S. Court of Appeals for the D.C. Circuit issued its decision in the OPM data breach case. In 2015 OPM announced a massive breach of federal employee personal data. The American Federation of Government Employees brought a lawsuit for compensatory damages on behalf of group of 38 named plaintiffs and similarly situated class members. The National Treasury Employees Union alleged that OPM violated its members constitutional right to informational privacy for which declaratory and injunctive relief is appropriate. The federal district court dismissed both cases for lack of standing / a remediable injury making federal court jurisdiction appropriate. The district court further held that the plaintiffs’ claims were barred by sovereign immunity, the government’s general protection against lawsuits which had not been waived here. The Court of Appeals held that the plaintiffs did assert standing and that the AFGE claim alleged a cognizable claim for OPM breach of the federal Privacy Act. The Court of Appeals agreed with the district court that the NTEU’s constitutional claim is not cognizable. The case now goes back to the district court although it’s likely that OPM and NTEU may ask the Supreme Court to review the Court of Appeal’s decision. Here’s a link to an article from the Hill on this decision.

The Wall Street Journal reports that

The death rate for cardiovascular disease—which includes heart disease and strokes—has fallen just 4% since 2011 after dropping more than 70% over six decades, according to mortality statistics from the Centers for Disease Control and Prevention.

Particularly alarming is that the death rate is actually rising for middle-aged Americans.

The overall cardiovascular-disease death rate is an under-recognized contributor to the recent decline in U.S. life expectancy. While that has been driven mostly by deaths from drug overdoses and suicides, improvements in cardiovascular health are no longer providing a counterbalance. 

According to the article, the cardiovascular death rate is being driven by obesity driven diabetes type 2.  The Journal also provides a list of steps that adults can take to reduce the risk of cardiocvascular disease.  Here’s a link to a similar American Heart Association list. The key step in the FEHBlog’s view is exercising self control and keeping in regular touch with your primary care provider.

Happy Summer Solstice!

The Wall Street Journal reports that on Monday the President will issue an executive order mandating healthcare price transparency.  “It’s unclear how aggressive the order will be because of the pushback from industry, and some White House advisers who have urged a more measured approach, sources said.”

Healthcare Dive reports on Cigna CEO David Cordani’s encouraging address to an AHIP conference earlier this week.

“We all know there is an election coming up and we all know there is a present narrative around this because society demands more value from us today. The question is: are we going to resist, are we going to collaborate, or as we look at the path forward, will we choose to lead by being able to identify the bright spots that are working?” he asked.

For its part, Cigna is promising to bend the cost curve of healthcare by committing to deliver a rate of medical cost growth that will not exceed the consumer price index by 2021. 

Health Payer Intelligence informs us about an AHIP initiative on social determinants of health known as Project Link.

Project Link encompasses three major components:

•     A learning collaborative in which insurance providers can discuss social determinants of health and social barriers, sharing how to set up new programs, what tools to use for tracking results, and how to know if the programs are successful
•     The new Project Link Website shares positive solutions for non-medical health factors through access to AHIP staff’s research, AHIP members’ programs, and various digital resources including The Healthcare Policy Podcast
•     New payer partnership opportunities with different kinds of entities encourage healthy outcomes through conquering social barriers

The Joint Commission, which accredits hospitals, nursing homes, etc. announced a new antibiotic stewardship accreditation standard for outpatient facilities that takes effect on January 1, 2020.

Tammy Flanagan, on govexec.com, offers helpful information on the options available to married couples with at least one employed federal worker for survivor benefits, including continuation of FEHBP coverage. Check it out.

Following up on yesterday’s Senate Health Education Labor and Pensions Committee hearing, “Senate health committee Chairman Lamar Alexander (R-Tenn.) and Ranking Member Patty Murray (D-Wash.) today introduced S.1895, the Lower Health Care Costs Act of 2019 — bipartisan legislation to deliver better health care at lower cost.” The Committee leadership has scheduled a markup and vote on the submitted bill for June 26 at 10:30 am. Here’s a link to a Workshare Comparison of the discussion draft of S. 1895 vs. the submitted version of S. 1895.

Also today the Federal Trade Commission sought public comment on a proposed consent decree approving United Healthcare’s acquisition of Davita’s medical group for $4.3 billion. The settlement principally involves divestiture of the Davita medical group in the Las Vegas area. The consent decree will be open to public comment for 30 days after the decree is published in the Federal Register.

Yesterday, the FEHBlog pointed out a recent American Healthcare Quality and Research report on hospital readmission. Becker’s Hospital Review explains AHRQ focused on readmissions for 18 of the 21 principal diagnosis categories listed in ICD-10’s diagnosis coding system. Three categories were excluded for lack of data, or because they involved planned aftercare. The average readmission cost for any diagnosis in 2016 was $14,400.” The Review then listed the average readmission cost in 2016 for those 18 evaluated diagnoses.

Healthcare Dive reports on today’s Senate Health Education Labor and Pensions Committee hearing on its bipartisan bill to lower healthcare costs. The FEHBlog understands that the next step will be the release of a revised bill.

Health Payer Intelligence informs us about America’s Health Insurance Plans’ Congressional testimony last week criticizing vertical healthcare provider mergers.  AHIP’s “statement emphasizes that one major cause of rising health care costs is vertical provider consolidation—when more and more of a region’s doctors and medical experts work for the same hospital or health system. We highlight research findings showing that when health systems in a region get bigger and squeeze out competition, prices go up for consumers.” Of course, as Health Payer Intelligence points out, the provider associations make similar claims about payer consolidation. In the FEHBlog’s view, there’s no doubt that the Affordable Care Act gave tremendous momentum to provider and payer consolidations.

The Government Accountability Office made public a report on OPM’s retirement application processing delays. On page 7 there’s a chart breaking down the following statistic given in the report:

31.6 percent of federal employees who were on board as of September 30, 2017, will be eligible to retire in the next 5 years. Some agencies have particularly high levels of employees eligible to retire in the next 5 years.

The federal Agency for Healthcare Quality and Research released an updated report on the frequency and associate cost of hospital readmissions occurring within 30 days of discharge. The following bullets caught the FEHBlog’s eye:

• In 2016, blood diseases had the highest readmission rate (25.3 percent), followed by neoplasms (17.9 percent). Pregnancy/childbirth had the lowest readmission rate (3.6 percent).
• The average cost of readmission was higher than the average cost of the index admission for two-thirds of the types of principal diagnoses.

Congress remains in session on Capitol Hill this coming week. On Tuesday, the Senate Health Education Labor and Pensions Committee will hold a hearing on its bipartisan bill to lower health care costs.

This bill seeks to resolve the problem of surprise out of network billing. Kaiser Health News discusses a prime example of this problem — air ambulance billing. The article notes that the current version of the HELP bill does not tackle air ambulance billing, but the bill is expected to be refined over the next weeks.

The FEHBlog was very impressed by this Wall Street Journal essay by a Johns Hopkins University bio-ethicist, Dr. Travis Reider, who became addicted to opioids following a motorcycle crash.  Here’s an excerpt:

Opioids are not only dangerous; they also can be powerfully effective. Perhaps the greatest challenge about them today is to resist the urge to be simplistic or reactionary. America’s current crisis of overuse has led some prescribers to avoid the drugs completely, and it has led politicians to occasionally consider ham-fisted policy solutions, like limiting the lengths or dosages of prescriptions regardless of any individual patient’s needs. But when a medication has both risks and benefits, what we need isn’t one-size-fits-all policies but nuance.

The author goes onto explain what he means by nuanced policies. For example,

Doctors also must provide an exit strategy. In many instances, this would only require a plan for the number of days of use and a modest taper. But the longer a patient is exposed, the more complex the strategy may be. For every patient on opioid therapy, there must be a clinician who sees long-term management and tapering as their job. We cannot allow medical professionals to play hot potato with opioid patients, trying to toss them to someone else before the timer goes off. 

Yesterday, the Trump Administration finalized a rule that will permit large, medium, and small employers to offer individual coverage and excepted benefit health reimbursement arrangements to their employees effective January 1, 2020.  Here’s a link to the FAQs on the new rule. 

The FEHBlog is a fan of Trump Administration rules, such as the association health plan rule, the limited duration plan rule and this rule, that expand consumer choice of health plan coverage in the wake of Congress’s decision to zero out the individual health insurance mandate at the beginning of this year. The new rule can be used by employers who are subject to the ACA’s employer mandate which has remained in effect subject to certain conditions.

Beckers Hospital Review reports briefly on a House Ways and Means Committee hearing on Medicare for All bills held yesterday. Medicare for All would provide no consumer choice at all.

Speaking of Medicare, the Centers for Medicare and Medicaid Services issued FAQs on its expanded Section 111 reporting program for group health plans, including FEHB plans, that kicks in on January 1, 2020.

Healthcare Dive reports on a House Energy and Commerce Health subcommittee hearing held yesterday on the surprise billing issue.  Payers prefer that Congress set a rate for surprise out of network care and providers prefer that Congress requires independent dispute resolution to resolve the surprise billing disputes, such as baseball arbitration in which a third party selects one the parties’ proposals without negotiation. The Affordable Care Act does include a requirement that health plans pay a certain minimum amount for emergency care but that law does not require the out of network provider to accept the payment as setting the patient’s debt. See ACA FAQ #15 at this link.    The payers want that finality.  In any event the new law will have a broader scope than true emergency care. The legislators were warning the industry representatives yesterday that they needed to resolve this issue quickly or legislation will happen. Expect enacted legislation.

Healthcare Dive also discusses how Humana has integrated real time benefit information, e.g., cost sharing, prior authorization, into the popular Epic electronic medical record via a tool called IntelligentRx. Smart move. Expect to see more of this integration.

Fierce Healthcare offers an interesting interview with Walgreen’s Chief Medical Officer.

FH: Going forward, how do you see consumers’ use of digital platforms for accessing healthcare services changing?
PC: We see that the digitization of healthcare has been well received by consumers, but there are some situations where you need to be physically there. For example: lab services. We’re running a full primary care practice at Walgreens and to be able to have that direct face-to-face interface with the provider we also find is valuable. I don’t think those two areas compete; I think they are more complementary than competitive.
As a primary care physician, I find these changes in offerings in terms of different venues of care to be very exciting. We have a challenge in this country in terms of an aging population and the increasing prevalence of chronic disease. I think we need many different ways to approach healthcare and the digital aspect is very exciting.

The Hill reports that the Senate Health Education Labor and Pensions Committee will hold a hearing on its bipartisan bill to lower health care costs next Tuesday June 18. The Committee Chairman, Sen. Lamar Alexander (R TN) plans to move the bill through Committee quickly as he reported “has said he hopes the full Senate can vote on the package in July. It could be combined with another bipartisan health care package aimed at lowering drug prices that the Senate Finance Committee is working on.”

Today, the House Appropriations Committee approved for floor consideration the financial services and general government appropriations bill for the next fiscal year. The vote was along party lines.  The Federal Times reminds us that “Appropriations legislation often goes through thorough changes as it moves from House to Senate consideration and back, making it likely that the general government and financial services bill will likely look different in some ways by the time it is signed into law.”

Following up on Express Script’s roll out of a digital formulary, CVS Health has announced a new vendor management services for employers and other plan sponsors. Healthcare Dive explains that the new program “will allow employers to contract and manage their relationship with third-party vendors that offer employee benefits, which could be both digital and non-digital tools.” Big Health’s Sleepio app is the first available tool. CVS Health advises that “Moving forward, CVS Health will be actively working to identify and onboard additional vendors to participate in the new service. This may include solutions such as smoking cessation and substance abuse support, care management solutions, medication optimization and adherence, and tools that help members navigate their benefits.”

Finally, here’s a Reuter’s report on the state of the measles breakout.

Well yesterday the FEHBlog could not find a relevant Congressional hearing this week. Today FCW.com reports that the House Appropriations Committee will mark up its subcommittee approved financial services and general government appropriations bill tomorrow.  Here’s a link to the Committee’s announcement.

The OPM appropriations discussion begins on page 74 of the Committee report.  FCW.com explains that the Committee “calls on OPM to do a better job on its own, with the $309 million in funding allowed by the bill. Lawmakers want OPM to speed up retirement processing, eliminate delays to federal hiring and improve the user experience at USAJOBS, the only front door for applicants to federal jobs.”

Health Payer Intelligence reports that the large Blue Cross licensee is acquiring Beacon Health Options, a behavioral managed care company that serves millions of people across the country.  Here’s a link to the companies’s press release issued last Thursday.  Health Payer Intelligence explains that

Beacon Health Options is not a payer, but instead contracts with different payers to help manage mental and behavioral health for beneficiaries. It also works with employers to help offer this as a benefit to workers. 

The acquisition by Anthem will allow Beacon Health Options to fully scale its offerings, the organizations said. In combination with Anthem’s existing mental and behavioral health management programs, the pair will be able to promote patient-centered care. 

Fierce Healthcare discusses the American Medical Collection Agency data breach. Because the company connects consumer debts for large laboratory companies, among other heath care providers, the breach is estimated to effect 20 million people.  The FEHBlog found this Krebs on Security post illuminating.

Studies

• Fierce Healthcare informs us that

Individuals who are living with chronic or acute conditions have a much different view of the social determinants of health (SDOH) compared with researchers and the media, according to a new study (PDF) out of the Anthem Public Policy Institute.