Thursday Miscellany

David Ermer

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

Thursday Miscellany

David Ermer–COVID-19, HIPAA Privacy and Security Rules, Medicare–

The Centers for Medicare and Medicaid Services today announced wide ranging Medicare changes to make healthcare more accessible during the COVID-19 emergency. For example,

For the duration of the COVID-19 emergency, CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.

CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.

It will be interesting to see whether commercial plans adopt these changes (perhaps they already have). Check out the lengthy list. Hopefully many of these changes will be made permanent following the COVID-19 emergency.

As the FEHBlog has listed major COVID-19 testing locations. It occurred that he should also link to the COVID-19 sites for the major actuarial consulting firms, all of which provide useful information for health plans:

These sites are a valuable public service in the FEHBlog’s view.

HHS’s Office for Civil Rights today provided a helpful COVID-19 cyber threat resources. While the FEHBlog could not find a link to the list, he was able to upload the email to Dropbox.

Midweek update

David Ermer–COVID-19, HSA–

Healthcare Dive reports that health plans, health care providers, and the Chamber of Commerce have sent Congress a joint health care wish list for the fourth COVID-19 relief bill.

Becker’s Hospital Review provides an updated list of state by state peak dates for COVID-19 hospital resources from IMHE. According to the chart virtually all of the State have hit their peak by today.

Health Payer Intelligence discusses Oscar Health’s population health oriented approach to connecting with its plan members during the COVID-19 emergency. On a related note, Fierce Healthcare summarizes the steps that the country’s tech giants, Apple, Amazon, and Alphabet/Google, have taken in response to the COVID-19 emergency.

Employee Benefit News provides useful COVID-19 emergency tips for sponsors and holders of health savings accounts.

MedCity News reports good news on the cancer detection front:

A test designed for early detection of cancers from a blood sample was able to more than double the number of cancers picked up through screening, including seven cancers that currently do not have any standard-of-care screening methods, according to a new study.

The study, sponsored by Cambridge, Massachusetts-based Thrive Earlier Detection and carried out by Johns Hopkins University and Geisinger Health, was presented Tuesday at the American Association for Cancer Research’s [virtual] annual meeting.

Bravo.

Tuesday Tidbits

David Ermer–ACA, COVID-19, OPM, SCOTUS–

Following up on yesterday’s post on the Supreme Court’s decision in the Affordable Care Act risk corridor case, read Katie Keith’s article in Health Affairs on all of the decision’s reverberations. Fascinating.

The FEHBlog did virtually attend the NCQA Quality Talks 2020 conference today. Two speakers favorably caught the FEHBlog’s attention:

With regard to OPM’s concern about rooting out low value care in the healthcare system, Cardiologist Rita Redberg, MD, has been editing for years a series in the JAMA Internal Medicine Journal titled “Less is More.” Dr. Redberg blasted the medical device industry for promoting artery stents before first obtaining reliable evidence of the device’s safety and efficacy. As it turns out the device is no more effective than a placebo.

The good doctor explained that normally it’s difficult to perform a blinded research study with a new medical device because the research participant usually knows whether or not she received the device (as a opposed to a sugar pill.) In this recent Orbita study, the researchers convinced all of the study participants that they had received a stent. The good doctor also spoke about a friend who unnecessarily received a stent and wound up needing a heart transplant.

The FEHBlog also was quite impressed by Dana Lewis a young go-getter who along with a colleague developed a small closed loop computerized system to control her continuous glucose monitor as she has type 1 diabetes. She then founded an “open source artificial pancreas system movement (#OpenAPS)” to help others. She is not resting on her laurels.

An article in Medical Economics discusses a proposed Labor Department rule intended to protect TRICARE medical networks. However, the rule if finalized would disrupt FEHBP medical networks. The FEHBlog submitted comments to the Labor Department on the proposed rule for the FEHB plan trade association he represents. The comments asked the Labor Department to protect both TRICARE and FEHBP networks. He hopes the Labor Department will pull back the rule given the COVID-19 emergency.

In a bit of good COVID-19 news, the New York Times reported progress being made in two efforts to create a COVID-19 vaccine. Fingers crossed.

Also the Hill reported this afternoon that the House of Representatives has changed its mind about returning to Capitol Hill on May 4. The Senate continues to plan to return to the Capitol next Monday.

Monday Musings

David Ermer–Congress, COVID-19, Electronic health records, SCOTUS–

Here’s a musing for you. The FEHBlog expects that everyone is familiar with the spiritual titled “Sometimes I feel like a motherless child.” Well after reviewing lots of news, the FEHBlog to paraphrase this spiritual sometimes feels like the only person in America who believes that the U.S. healthcare system can pull us through this pandemic.

The House and Senate announced today that each body of Congress will be returning to Capitol Hill next Monday May 4. Welcome back.

In a decision sure to delight health insurers that took the initial plunge with the ACA marketplaces back in 2014, the U.S. Supreme Court ruled today in a virtually unanimous opinion that the U.S. owes many of those insurers a total of roughly $12.3 billion for unappropriated yet mandated risk corridor payments. The only dissenter was Justice Alito who agreed that the government owed the money but questioned whether there was a private right of action under the ACA to sue the government for the money. It’s not a crazy thought because the government is generally protected against lawsuits by a doctrine known as sovereign immunity.

The FEHBlog thought that this would be a good opportunity to update readers on the major commercial COVID-19 testing sites:

Castlight offers a COVID 19 testing directory which organizations can link to their own websites.

Verily Health, which is an affiliate of Alphabet/Google, has “launched COVID-19 Pathfinder— a new set of tools that provide on-demand access to COVID-19 information directly from a hospital or health system website.” Cool.

In a bit of good news for HHS, Fierce Healthcare reports that the EPIC, the electronic health record (“EHR”) giant, has switched from “fiercely” opposing to supporting the HHS EHR interoperability rules. “Epic controls more than a quarter of the hospital EHR market, according to KLAS Research, and, among hospitals with 500 or more beds, Epic has a 58% market share.”

Weekend Update

David Ermer–Congress, COVID-19, OPM–

Congress remains on a social distancing work period away from Capitol Hill for another week. Fierce Healthcare reports on the Blue Cross Blue Shield Association’s recommendations for the next COVID-19 relief bill which include COBRA/TCC subsidies (as in the 2009 Great Recession), expand tax credits for ACA marketplace plans and eliminate surprise billing through a national benchmark model. Hopefully this will be an appropriate time to adopt such a surprise billing solution that would not increase costs.

In the wake of President Trump signing the COVID-19 relief act no. 3.5 last Friday, the Centers for Medicare and Medicaid Services announced today that it will be re-evaluating how it spends the expanded pool of relief funding for hospitals and other healthcare providers created by that law.

The FEHBlog looks forward to listening to the NCQA’s virtual Quality Talks 2020 program on Tuesday. He will provide some highlights in Tuesday’s post.

The Government Accountability Office released a report on implementation of the Trump Administration’s June 2018 federal agency reorganization plan. GAO reports favorably on the transition of the background search investigations function from OPM to the Defense Department. Late last month, according to Federal News Network, OPM finalized a Congressionally mandated contract with the National Academy of Public Administration. “[NAPA] will provide Congress a report next March [2021] with its findings [on OPM and its mission], as well as its recommendations for addressing OPM’s challenges. OPM has another six months to respond to NAPA’s report to Congress.”

Friday Stats and More

David Ermer–CDC, COVID-19–

Here are the Centers for Disease Control’s top line COVID-19 statistics for the past four weeks:

4/34/104/174/24
Confirmed Cases239,279459,165661,712862,648
Confirmed Deaths5,44216,57028,82343,451
Deaths over Cases2.27%3.61%4.36%5.04%

Don’t forget to check out the CDC’s weekly COVIDView which comes out on Fridays. The COVIDView is more encouraging reading than the bare statistics.

A new study in Health Affairs estimates “that a single symptomatic COVID-19 infection would cost a median of $3,045 in direct medical costs.”

Fierce Healthcare reports that CIGNA studied “care utilization among their commercial group and individual plan members between January and March across seven [serious] conditions and found decreases in hospitalizations across the board.”

[The lead researcher] said the team was surprised by the size of these decreases and that they were found across all seven conditions, because going without treatment for these conditions can have serious consequences.

[A research team physician] added that providers can help encourage patients to seek care in these situations by developing a care plan with those at high risk for certain conditions and having open conversations that affirm they should seek care in an emergency situation even if they should stay home otherwise.

It’s a crazy time.

Thursday Miscellany

David Ermer–Congress, COVID-19, Federal employment benefits, OPM–

The House of Representatives passed COVID-19 relief bill no. 3.5 (H.R. 266) by a vote of 388-5 this afternoon. The bill restores funding for the Small Business Administration’s relief programs and provides $100 billion in funding for healthcare providers.

OPM issued a new COVID-19 letter to FEHBP carriers today. The FEHBlog was pleased to see that OPM is allowing FEHB high deductible plans with health savings accounts to cover telehealth before the “high deductible” as permitted by the CARES Act (COVID-19 relief bill no. 3).

OPM also announced today that “the Combined Federal Campaign (CFC) will conduct a nationwide special solicitation to support charities serving and affected by COVID-19. This special solicitation will run through June 30.” Good call. Here’s the link to the campaign.

Also over the past two days, OPM has issued FAQs on resuming normal workforce operations at federal facilities and the Families First Coronavirus Response Act’s (COVID-19 relief bill no. 2) paid sick leave program. Meanwhile the U.S. Department of Labor is up to nearly 90 FAQs on that program which also applies to private sector employers with under 500 employees.

Midweek Update

David Ermer–Congress, COVID-19–

Recycle Intelligence reports that House of Representatives members are returning to Capitol Hill to vote on the fourth (3.5?) COVID-19 relief bill (H.R. 266) tomorrow morning.

Today, the Health and Human Services Department (“HHS”)announced how it plans to divvy up the remaining $70 billion in funding allocated to hospitals and other healthcare providers in the third relief law known as the CARES Act. The last paragraph of the announcement states that

as a condition to receiving general funds, providers must agree not to seek collection of out-of-pocket payments from a presumptive or actual COVID-19 patient that are greater than what the patient would have otherwise been required to pay if the care had been provided by an in-network provider.

If the FEHBlog’s recollection serves him correctly, the earlier version of this statement flatly prohibited surprise billing. This version permits the provider to collect in-network cost sharing from the patient. How will the provider know the amount of in-network cost sharing?, and how will the member and the patient be made aware that the provider is subject to this obligation? In any event, the government has to provide much more guidance on this well meaning initiative.

Speaking of guidance, the Centers for Medicare and Medicaid Services did provide guidance to health plans yesterday concerning limits on medical management of COVID-19 testing coverage mandated by the Families First Coronavirus Response Act as amended by the CARES Act. Check it out.

In an interesting development, the day after HHS delayed enforcement of its new electronic health record interoperability rule, the HHS Office of Inspector General proposed a rule to apply civil monetary penalties to electronic health information blocking violations.

Tuesday Tidbits

David Ermer–Congress, COVID-19, Electronic health records–

Today the Senate passed a bill expanding funding for the Small Business Administration’s COVID-19 relief programs ($370 billion), healthcare providers ($75 billion) and COVID-19 testing ($25 billion). The Wall Street Journal further reports that “the bill now goes to the House, which is expected to vote on it Thursday.” The President has tweeted that he will sign it when both Houses of Congress pass it..

Speaking of COVID-19 testing, Labcorp announced today that “it has received an Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA). The EUA permits nasal swab specimens to be collected at home using the Pixel by LabCorp™ COVID-19 test home collection kit if recommended by a healthcare provider after completing a COVID-19 questionnaire.” Furthermore, CVS Health announced today that it has opened another large scale drive up COVID testing site in Dearborn Michigan.

As anticipated the Department of Health and Human Services informed the public today about

a policy of enforcement discretion to allow compliance flexibilities regarding the implementation of the interoperability final rules announced on March 9th in response to the coronavirus disease (COVID-19) public health emergency. ONC, CMS, and OIG will continue to monitor the implementation landscape to determine if further action is needed.

Absent this new policy, the rules would have been fully enforceable on January 1, 2021.

Finally the FEHBlog ran across today this long, handy AHIP prepared list of benefit improvements and related actions that its health plan members have made in response to the COVID-19 emergency. Bravo.

Monday Musings

David Ermer–Congress, COVID-19–

The White House and Congressional leaders continue to negotiate over the bill that would expand funding for the Small Business Administration relief programs and provide more grants for health care providers and testing. According to the Wall Street Journal, the parties are close to a deal, and a Senate vote is expected tomorrow.

Healthcare Dive explains the precarious financial position in which many primary care practices find themselves as the great hunkering drags on.

Most providers have turned to telehealth in a bid to recoup patient volume, but reimbursement for virtual care is often lower than an in-office visit — if it’s reimbursed at all. A majority [of 2600 primary care providers surveyed by the Primary Care Collaborative (“PCC”)] are unsure whether they’ll be reimbursed for telehealth services, and full-scale use of virtual care is slight — 34% of practices rely mostly on video to conduct appointments, 15% on e-visits and 19% on a patient portal, compared to 48% of doctors conducting the majority of visits by phone, PCC found.

The article adds that “65% of clinicians in the PCC survey reporting they have patients who can’t use telehealth because they don’t have a computer or internet access. Congress allocated $200 million in CARES funding to the Federal Communications Commission ​to support providers’ telehealth infrastructure. FCC rolled out the first wave of grants on Friday.” Health plans can’t do much about the FCC issue, but they can provide temporary improvements on the telehealth payment issue.

Fierce Healthcare reports that the Centers for Medicare and Medicare Services announced late Sunday new guidelines on resuming “non-essential” surgical procedures such as joint replacements. “The lack of revenue from such surgeries, in addition to low patient volume overall, has sparked a cash crisis for U.S. hospitals. Some major healthcare systems such as Tenet, Trinity Health and Detroit Medical Center have had to furlough workers due to the lack of cash.” The aforementioned Healthcare Dive article indicates that resumption of non-essential surgeries will aid medical practices too. But the ramp up understandably will be slow.