Monday musings

David Ermer

I am an attorney who practices law in Washington DC. My practice has involved the Federal Employees Health Benefits Program since 1983.

Monday musings

Posted By David Ermer–Categorized In Medicare–

Healthcare Dive reports that people finally are using patient portals and apps in substantial numbers.

Nearly 60% of patients report their provider or insurer offered them online access to their medical record in 2019, and nearly 40% viewed their record electronically at least once in the past year. Both are significantly up from 2018, analysts said.

Happy day. People taking more interest in their health will help control healthcare spending over time, in the FEHBlog’s view.

The Centers for Medicare and Medicaid Services (CMS) announced today that

Over the last several years, CMS has been actively monitoring the rapid innovation of [Next Generation Sequencing] NGS [genetic] tests and the evolution of cancer diagnostic tools. NGS tests provide the most comprehensive genetic analysis of a patient’s cancer because they enable simultaneous detection of multiple types of genetic alterations. Medicare first began covering laboratory diagnostic tests using NGS in March 2018 for Medicare patients with advanced cancer that met specific criteria. As a result of today’s decision, more Medicare patients will have access to NGS in managing other types of inherited cancers to reduce mortality and improve health outcomes.

Health Payer Intelligence provides more background on today’s CMS decision.

Last Friday, the FEHBlog called attention to a Fedweek article discussing a new OPM Inspector General report on FEHBP dependent eligibility issues. The FEHBlog could not readily track down the report discussed in the article. A friend of the FEHBlog discovered that the Fedweek article is referencing 2019 Top Management Challenge No. 9 (pp 21-22) which was released early last November. Mystery solved!

Weekend update

Posted By David Ermer–Categorized In ACA, CDC, Congress–

Both Houses of Congress are in session this week on Capitol Hill. The FEHBlog has signed up for Congress.gov alerts for S. 1896, Senator Lamar Alexander’s bipartisan bill to lower health care cost. The FEHBlog received his first alert this morning — the addition of a summary of key bill provisions:

Among other things, the bill

applies in-network cost-sharing requirements to certain emergency and related nonemergency services that are provided out-of-network, and prohibits health care facilities and practitioners from billing above the applicable in-network cost-sharing rate for such services; 

revises certain requirements in order to expedite the approval of generics and biosimilars, including requirements relating to citizen petitions, application effective dates, and labeling; 

requires health care facilities and practitioners to give patients a list of provided services upon discharge and to bill for such services within 45 days; 

limits prices that pharmacy benefit managers (PBMs) may charge health insurers or enrollees for prescription drugs, based on prices paid by PBMs to pharmacies; 

establishes grant programs to support vaccinations and data modernization; and 

requires health insurers to make certain information, including estimated out-of-pocket costs, accessible to enrollees through specified technology (e.g., mobile applications).

The Hill reports that the Centers for Disease Control will begin to publish Wuhan coronavirus updates on Mondays, Wednesdays and Fridays. There are now five confirmed cases in the U.S., all of whom are hospitalized. One hundred other people under being watched for the virus.

Chicago’s Crain Business informs us about the merger for four southside Chicago hospitals.

The combination [Advocate Trinity Hospital, Mercy Hospital & Medical Center, South Shore Hospital and St. Bernard Hospital] aims to bolster the precarious finances of the safety-net hospitals that treat large numbers of low-income patients on Medicaid, which pays less than Medicare and commercial insurance.

With an estimated $1.1 billion investment—including private donations and government dollars intended for hospital transformation—the plan is to build at least one new hospital and open up to six new community health centers that would expand access to preventive services and address social determinants of health, such as food insecurity, the four hospital leaders said today.

That’s a hopeful twist on such deals.

The Wall Street Journal reports today that

Hundreds of regional grocery stores in cities from Minneapolis to Seattle are closing or selling pharmacy counters, which have been struggling as consumers make fewer trips to fill prescriptions and big drugstore chains tighten their grip on the U.S. market. * * *

Grocery pharmacies are the latest casualty of industry consolidation that has for years been forcing mom-and-pop drugstores to close. Even some big players have rethought the market. Target Corp. sold off its pharmacy business to CVS Health Corp. five years ago. * * *

The tougher conditions come as the entire drugstore industry copes with a shift to online shopping and shrinking profits in prescription medicines, which often disproportionately affect smaller players.

And so it goes.

TGIF

Posted By David Ermer–Categorized In Uncategorized–

Fedweek reports that the OPM Inspector General has issued a report on FEHBP dependent eligibility issues. While the FEHBlog cannot locate it online, Fedweek informs us that the Inspector General

recommended that agency benefit officers verify the FEHB eligibility of dependents at the time of initial enrollment and when a family member is added to coverage by collecting and maintaining documentation such as proof of birth and marriage certificates. OPM would “need to work with its partners (agencies, payroll offices, carriers) to develop and implement a system to verify and maintain supporting eligibility documentation to reduce the aforementioned issues related to unentitled FEHB enrollments,” it said.

About five years ago, OPM added a clause to the standard FEHBP contracts requiring carriers to share the cost of dependent eligibility audits. However, those audits have not yet materialized. In any event, the FEHBlog agrees with the Inspector General’s approach.

Centene which owns an FEHB carrier Health Net closed on its acquisition of Wellcare, which among other things is a Medicare Part D (prescription drug) carrier according to a Healthcare Dive report. “The blockbuster acquisition will make Centene the country’s third-largest publicly traded managed care company and double its Medicare footprint.”

The Centers for Disease Control advises that

the second infection with 2019 Novel Coronavirus (2019-nCoV) in the United States has been detected in Illinois. The patient recently returned from Wuhan, China, where an outbreak of respiratory illness caused by this novel coronavirus has been ongoing since December 2019.

The CDC announcement explains the appropriate steps that the agency is taking to prepare for the disease. Kaiser Health News reminds us

There’s a deadly virus spreading from state to state. It preys on the most vulnerable, striking the sick and the old without mercy. In just the past few months, it has claimed the lives of at least 39 children.

The virus is influenza, and it poses a far greater threat to Americans than the coronavirus from China that has made headlines around the world.

“When we think about the relative danger of this new coronavirus and influenza, there’s just no comparison,” said Dr. William Schaffner, a professor of preventive medicine and health policy at Vanderbilt University Medical Center.

Quite true.

Thursday Miscellany

Posted By David Ermer–Categorized In CDC, Federal employment benefits, Rx coverage–

At last year’s OPM AHIP FEHBP Carrier Conference, a Centers for Disease Control scientist announced that the U.S. Surgeon General soon would be issuing a new comprehensive report on tobacco use in the U.S. That report was issued today. It

  • Examines the effectiveness of various smoking cessation tools and resources;
  • Reviews the health effects of smoking and catalogues the improvements to health that can occur when smokers quit;
  • Highlights important new data on populations in which the prevalence of smoking is high and quit rates are low; and
  • Identifies gaps in the availability and utilization of programs, policies, and resources that can improve cessation rates and help smokers quit.

Here’s a link to OPM’s Quit Smoking website which discusses the FEHBP generous tobacco cessation benefits.

The CDC updated the public on its important antibiotic resistance solutions initiative.

CDC’s AR Solutions Initiative invests in national infrastructure to detect, respond, contain, and prevent resistant infections across healthcare settings, food, and communities. CDC funding supports all 50 state health departments, six local health departments, and Puerto Rico and the U.S. Virgin Islands.  Through these investments, CDC is transforming how the nation and world combat and slow antibiotic resistance at all levels.

Good luck.

The FEHBlog has discussed the relatively new, cooperative effort of hospitals to create a public asset, known as Civica Rx, to help solve drug shortages and lower the cost of generic drugs. Today, Civica Rx and the Blue Cross Blue Shield Association announced

their partnership to create a new subsidiary dedicated to lowering the cost of select generic drugs. The subsidiary is being formed in response to the impact of high drug costs on the health of Americans and the overall affordability of health care. Other health plans, employers, retail partners and health care innovators who share the belief that patients and their needs come first are invited to join the initiative.

The subsidiary will acquire and develop Abbreviated New Drug Applications (ANDAs) for select generic drugs and partner with Civica and manufacturing partners to bring more affordable generic drugs to uncompetitive markets in exchange for aggregated volume and multiyear purchasing commitments. Initially, several generic medications identified as having high potential for savings will be prioritized by the partnership and will evolve into a platform that can be used to enhance competition for additional generic drugs.

The new operation expected to start delivering product in early 2022. Strong move.

The American Hospital Association now offers a webpage with updates and resources concerning the Wuhan coronavirus.

Midweek update

Posted By David Ermer–Categorized In Federal employment benefits, Medicare–

CVS announced the following six health trends for 2020

  1. Continued evolution in kidney care 
  2. Greater consumer scrutiny on wellness products 
  3. The need for data stewardship as digital health rolls on 
  4. Pharmacies as a tool to reach underserved populations 
  5. Efforts to mitigate loneliness 
  6. Increased transparency around drug pricing 

The Centers for Medicare and Medicaid Services has decided to extend Medicare coverage to acupuncture for chronic low back pain as an alternative to opioid based pain killers. The CMS decision ” will cover up to 12 sessions in 90 days with an additional 8 sessions for those patients with chronic low back pain who demonstrate improvement.” Previously Medicare excluded acupuncture from coverage.

Retired OPM official Reg Jones discusses survivor benefits related to federal employment in Fedweek. FEHBP survivor benefits are generous if the prerequisites are met:

If your spouse receives an annuity in any amount and was covered under either the self plus one or self and family option of your FEHB plan, he or she and all eligible children may continue coverage. If the annuity amount is less than the premiums required, your spouse will be able to directly make payments to cover the rest of the cost.

Tuesday Tidbits

Posted By David Ermer–Categorized In ACA, CDC, SCOTUS–

This morning without comment, the Supreme Court denied the motion of the petitioners defending the Affordable Care Act to expedite the Court’s review of the Fifth Circuit Court of Appeal’s decision on the ACA’s constitutionality (Nos. 19-840, 841). The FEHBlog has long given up on trying to predict Supreme Court decisions. Now. the respondents seeking to take down the law will have until shortly after the Super Bowl to submit their briefs. The petitioners will have an opportunity to reply, and then the Supreme Court can consider the petitioner in due course, perhaps late March or April. If the Court decides to review the Fifth Circuit opinion, which the FEHBlog assumes is unlikely, the case would be argued next fall. As yet, Federal District Judge Reed O’Connor has not begun the process of reconsidering his vacated decision holding the entire remainder of the ACA inseparable from the unconstitutional ACA individual mandate at least according to the docket sheet available on PACER. The stay order that the Judge Reed entered in December 2018 states in pertinent part that “The parties are directed to notify the Court upon the conclusion of the appeal of the partial judgment within 14 days of any decision.” As the Court is busy, it’s likely that the Judge will tend to other matters until the Supreme Court decides what to do at this stage at least in the FEHBlog’s view.

The Centers for Disease Control (“CDC”) announced today that the agency

is closely monitoring developments around a novel (new) coronavirus first identified in Wuhan, Hubei Province, China. Chinese authorities identified the new coronavirus, which has resulted in close to 300 confirmed cases in China, including cases outside Wuhan City, with additional cases being identified in a growing number of countries internationally. The first case in the United States was announced on January 21, 2020. There are ongoing investigations to learn more.

The Wall Street Journal reported over the weekend that

Nancy Messonnier, the CDC’s director for the National Center for Immunization and Respiratory Diseases, said that as health officials develop diagnostic tests and start testing people with symptoms who have traveled to Wuhan, more cases are likely to be identified around the world, including in the U.S. 

“As we start testing more, I expect that we’re going to see more cases,” she said. 

“I think it’s highly plausible there will be at least a case in the United States.” 

She called the spread a “serious issue,” but added that the CDC has “faced this challenge before.”

“Based on the info CDC has today, we believe the current risk from the virus to the general public is low,” Dr. Messonnier said in a telephonic press conference.

FYI, the Government Accountability Office (GAO) has issued a report on Artificial Intelligence in Healthcare: Benefits and Challenges of Machine Learning in Drug Development. Here’s a link to the GAO’s version of Cliff Notes on the report.

Weekend update

Posted By David Ermer–Categorized In CDC, Congress, Wellness–

OPM directs us to the National & Community Service website for ideas on how to celebrate tomorrow’s Martin Luther King Jr. holiday. The FEHBlog believes that our country is indebted to Dr. King for his bold, essential leadership.

The House of Representatives has a district work period this week, while the Senate will be holding a trial on the House’s impeachment of the President.

Last Friday, the Centers for Disease Control announced updates to its vaping restriction recommendations in light of the subsiding vaping-related lung injury known as EVALI crisis. The FEHBlog appreciates the caution that the CDC has shown in handling this crisis.

Fierce Healthcare recently announced its Fierce 15 of 2019.

Big and small, high-tech and not, we’re honoring this collection of companies across the U.S. that are trying to change the world by changing the healthcare industry. 

The FEHBlog is not familiar with any of these companies but in time?

Healthcare Dive helpfully summarizes five key trends fo providers and payers. The FEHBlog is familiar with all of these.

Kaiser Health News discuss the latest hot item in wellness programs — helping employees sleep.

TGIF

Posted By David Ermer–Categorized In Uncategorized–

The Supreme Court accepted an Affordable Care Act case for review this afternoon but it was not the one that the FEHBlog has been tracking. The Court granted “cert” in a scope of the contraceptive mandate case (No.s 19-431 and 19-454). The FEHBlog will keep an eye out for action the Texas v. United States case (No. 19-840) over the law’s constitutionality.

The Centers for Disease Control issued a report yesterday on adult physical inactivity prevalence by state and race / ethnicity. .

All states and territories had more than 15% of adults who were physically inactive.

In 4 states (Colorado, Washington, Utah, and Oregon) and the District of Columbia, 15% to less than 20% of adults were physically inactive.

In 24 states, 20% to less than 25% of adults were physically inactive.

In 15 states, 25% to less than 30% of adults were physically inactive.

In 7 states (Tennessee, Oklahoma, Louisiana, Alabama, Kentucky, Arkansas, and Mississippi), and 2 US territories (Puerto Rico, and Guam), 30% or more of adults were physically inactive.

The South (28.0%) had the highest prevalence of physical inactivity, followed by the Northeast (25.6%), Midwest (25.0%), and the West (20.5%).

Ruh roh

Govexec reports that early this month the Postmaster General Megan Brennan has delayed her retirement past the scheduled January 31, 2020 date in order to allow the Postal Service authorities more time to appoint her successor.

Thursday Miscellany

Posted By David Ermer–Categorized In Uncategorized–

As the JP Morgan healthcare conference closes, Fierce Healthcare’s reports provide a summary of the highlights.

Employee Benefit News informs us about how CVS Health is leveraging its Aetna acquisition to make gene therapies more affordable to patients.

Healthcare Dive reports that the federal government has today released for public comment a health information technology roadmap for the next five years.

The plan will act as a blueprint for federal agencies like the Department of Defense and the Department of Veteran’s Affairs, along with private sector partners, as they work to make it easier for patients to electronically access health data. Much of the plan focuses on proliferating standardized application programming interfaces and stimulating a new “app economy” in healthcare.

Health Payer Intelligence discusses about a new “path forward” for mental health care.

Launched in November 2019 by the National Alliance of Healthcare Purchaser Coalitions (NAHPC), along with other healthcare partners, the Path Forward for Mental Health and Substance Use initiative aims to strengthen mental health parity through stakeholder collaboration.

“What we have developed is an approach that is thoughtful and comprehensive in terms of how we need to approach rebuilding a health system that can support people with mental health and substance use,” says Michael Thompson, NAHPC president and chief executive officer. 

“It’s basically about making sure that we are taking the same rigor in the treatment of mental health as we would with any other health condition collaborative care, which is providing better support and improving the treatment that is provided through primary care physicians and telebehavioral health.”

Midweek update

Posted By David Ermer–Categorized In Uncategorized–

Fierce Healthcare reporters update us on day 3 of the JP Morgan healthcare conference. CMS Administrator Seema Verma was today’s principal speaker.

Today, about a half dozen groups submitted friends of the court briefs in support of the parties seeking immediate Supreme Court review of the 5th Circuit’s decision on ACA constitutionality. The FEHBlog was impressed by the America’s Health Insurance Plan’s amicus brief.

Over the course of nearly a decade, the ACA has fundamentally reshaped the nation’s health care system. Congress in 2017 chose not to disturb that paradigm shift—including the promise of affordable coverage for those with preexisting conditions—when defanging the individual mandate without repealing any other part of the ACA. Invalidation of the entire ACA would flout Congress’s manifest intent, with profound consequences for our health care system and the hundreds of millions of people it serves. This Court should grant certiorari now to make clear that even if the individual mandate falls, the balance of the ACA will remain in force.

Agreed.

Federal News Network reports that the U.S. Postal Service released to the public their five year strategic plan today. The sooner that Congress considers this report and the legislative issues it raises, and other stakeholder views, the better.

Reg Jones in FedWeek explains in FedWeek on whether deferred and postponed federal annuitants are eligible for FEHBP coverage in retirement. It turns out that postponed annuitants (a CERS feature) can pick up FEHBP coverage in retirement but deferred annuitants (CSRS and FERS feature) cannot.