Midweek update

Yesterday the Senate confirmed Steven Mnuchin to be Secretary of the Treasury, and today the Labor Department nominee Andrew Puzder withdrew from Senate consideration.  So one seat on the ACA triumerate remains open.

Also today, in Tom Price’s first major action as HHS Secretary, the Centers for Medicare and Medicaid Services issued a proposed to rule to help rationalize the ACA marketplace.  It’s a good first step in the FEHBlog’s view.

Employee Benefits News reports on employer sponsored benefit groups efforts to have the ACA regulators take some steps to relieve the heavy ACA burden on group health plans in keeping with the President’s executive orders.  Good luck with that.

Also today, CMS’s actuaries released a report projecting national healthcare expenditures over the next decade.

National health expenditure growth is expected to average 5.6 percent annually over 2016-2025, according to a report published today as a ‘Web First’ by Health Affairs and authored by the Centers for Medicare & Medicaid Services’ (CMS) Office of the Actuary (OACT). These projections are constructed using a current-law framework and do not assume potential legislative changes over the projection period. 

National health spending growth is projected to outpace projected growth in Gross Domestic Product (GDP) by 1.2 percentage points. As a result, the report also projects the health share of GDP to rise from 17.8 percent in 2015 to 19.9 percent by 2025. Growth in national health expenditures over this period is largely influenced by projected faster growth in medical prices compared to recent historically low growth. This faster expected growth in prices is projected to be partially offset by slowing growth in the use and intensity of medical goods and services.


Healthcare Dive reviews the denouements of the two block health insurance company mergers.  Yesterday, Aetna and Humana parted ways amicably, while Anthem and Cigna took the less than amicable I’ll see you in court approach. You would have thought the two companies would have seen enough of courtrooms over the past year.

Drug Channels blog dissects the Express Scripts’ annual report which the FEHBlog recently mentioned herein. Note bene —

On page 4 of the report’s Executive Summary, Express Scripts highlighted an uncomfortable fact about managing healthcare costs. As its chart shows, drug spending growth was much lower when plans were “tightly managed.” Express Scripts states that one-third of the most aggressive plan sponsors actually experienced a drug spending decline from 2015 to 2016.

Finally, the U.S. Justice Department issued a press release concerning

Dr. Paul B. Tartell, an ENT physician practicing in Plantation, Florida and his practice Paul B. Tartell, M.D., P.L., have agreed to pay $750,000 to resolve allegations that he violated the False Claims Act by billing for surgical endoscopies with debridement and laryngeal stroboscopies that were not provided or not medically necessary.

In addition to the allegations regarding surgical debridements, the settlement also resolves the United States’ allegations that Dr. Tartell systematically billed federal health benefit programs, in particular, Medicare and the Federal Employment Health Benefits Program, for claims arising from laryngeal video stroboscopies that were not performed or were not medically necessary.

O, what a tangled web, etc.

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