Tuesday’s Tidbits

Photo by Patrick Fore on Unsplash

In FEHB news, Federal News Network interviews Kevin Moss, editor of Consumers’ Checkbook Guide to Health Plans for Federal Employees, about OPM’s approving the use of Medicare Part D EGWPs in FEHB plans for 2024. Mr. Moss shares the FEHBlog’s excitement about this cost-saving development. Two nifty features of Medicare Part D EGWPs in contrast to Medicare Advantage Prescription Drug plans are that Medicare Part A only annuitants can enroll in them and the Plan’s prescription drug benefits can gap fill them. However, Mr. Moss indicates for 2024 and beyond, the gaps in Part D coverage are fewer. In addition, the OPM AHIP carrier conference, which begins tomorrow, will feature a session on Medicare Part EGWPs.

The carrier conference also provides a session on Social Determinants of Health. In addition, the Agency for Healthcare Quality and Research reminded us today about the availability of its October 2022 National Healthcare Quality and Disparities Report.

From the public health front —

  • WebMD tells us
    • “Good news and bad news on the long COVID front: Certain groups of people – like women, smokers, and those who had severe COVID-19 infections – are at a higher risk of long COVID, a review of more than 800,000 patients has found. 
    • “That’s the bad news. Yet, researchers also found that patients who had at least two doses of the COVID vaccine had a significantly lower risk of getting long COVID down the line.”
  • The NIH Directors Blog discusses using a whole-person approach to lifting the burden of chronic pain from service members and veterans. This approach is currently in use at VA facilities.
  • Healio tells us about a retrospective atrial fibrillation (AF) diagnosis study.
    • “In a retrospective study, Turakhia and colleagues analyzed patient information from five U.S. medical claims data sets from 2012 to 2017. Researchers estimated undiagnosed AF based on the observed incidence of ischemic stroke, systemic embolism and AF incidence after a stroke or systemic embolism.
    • “The estimated U.S. prevalence of AF (diagnosed and undiagnosed) in the third quarter of 2015 was 5,628,000 cases, of which 11% were undiagnosed. 
    • “The assumed 2‐year undiagnosed AF prevalence was 23% of the total prevalent patients with AF. Compared with diagnosed patients, those who remained undiagnosed tended to be women, to be older, to have more comorbidities and to have higher CHA2DS2‐VASc scores.” 
    • “Together with the known burden of AF, this expanding unmet need underscores the critical importance of early detection. Our data can support both disease surveillance and future research and policy initiatives aimed at addressing this diagnostic gap.”

From the U.S. healthcare business front —

  • The American Hospital Association reports
    • “Hospital operating margins dipped again in February to -1.1% and continue to remain negative, though with less month-to-month variation, according to the latest report on hospital finances from Kaufman Hall. Costs of goods and services are now increasing faster than labor, with both labor and non-labor expenses per adjusted discharge 21% higher than in February 2020.
    • “Due to external economic factors, relatively flat margins are likely to continue in the near term,” the report states.”
  • STAT News notes
    • “The tech-forward insurer Oscar Health has tapped former Aetna CEO Mark Bertolini to be its new chief executive, a move to jump-start the business as it seeks to win new customers and become profitable.
    • “Bertolini, 66, is a progressive thinker in the use of technology to deliver health services and has already been advising Oscar for the past 18 months. His appointment gives him an opportunity to put a stamp on the future of digital services and analytics in the industry he has served for four decades.
    • “I’m returning to the health care industry because I believe there is still work to be done,” Bertolini said during a conference call to announce his appointment on Tuesday. He said Oscar presents a unique opportunity to challenge the status quo in the industry and accelerate the shift toward a more “consumer-oriented” business model.”
  • Fierce Healthcare is covering the 2023 ViVE conference currently being held in Nashville, TN, here and here. “Focused on digital health innovation, the conference, sponsored by HLTH and the College of Healthcare Information Management Executives (CHIME), had 5,000 attendees in 2022,” its inaugural year, and 7,500 attendees this year.
    • “On Monday morning, a heavily armed attacker entered a Christian school in Nashville and fatally shot three 9-year-old children and three adults.
    • In a joint statement from conference co-organizers CHIME and HLTH, the organizations said they have committed to a combined $50,000 donation “on behalf of ViVE for the victims and their families of today’s tragic Covenant School shooting.”
  • STAT News offers a special report on the wisdom of using artificial intelligence to replace medical transcription.

In a noteworthy legal development, the American Hospital Association informs us

The AHA and AHIP today filed a [joint] friend-of-the-court brief in a False Claims Act case before the U.S. Supreme Court, arguing that the federal government’s erroneous construction and expansion of the FCA threatens the legitimate business activities of every government contractor, hospital, health care provider, health insurance provider and grant recipient in the nation.

In a separate statement, the organizations said, “While AHA and AHIP may not always share the same opinion on matters of litigation and policy, we agree that the current regulatory landscape and construction of the False Claims Act (FCA) creates an untenable situation for health care providers and health insurance providers. “If the government’s argument is accepted, our members will be forced to spend more on litigation and less on patient care.”

“We urge the Supreme Court to adopt an interpretation of the FCA that does not undermine the ability of our members to ensure that Americans have access to high-quality, affordable health care.”

Amen to that.