Happy National Doctors’ Day

David Ermer

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

Happy National Doctors’ Day

David Ermer–COVID-19–

Today is National Doctors’ Day, and the FEHBlog can think of no better time to thank the medical and para-medical professions for their dedicated and brave service to America and the world.

The FEHBlog learned from reading the Great Influenza that the horrific influenza pandemic in 1918-19 eventually subsided due to a combination of people who survived the disease (and there was a mild wave of the influenza in early 1918) and the enormous number of deaths. As a result, person to person transfer stopped. (Social distancing helped reduce the spread of that illness, e.g., St. Louis, but the FEHBlog is writing about how the pandemic ended.)

NBC News reports that experts believe that people who gain COVID-19 antibodies (though infection) will have immunity for some (at present) unknown period. However, it strikes the FEHBlog, who certainly is not an expert, that a combination of immunized and vaccinated people eventually should defeat the COVID-19 pandemic. The Wall Street Journal reports today that three prescription drug manufacturers are actively seeking to develop a COVID-19 vaccine.

Johnson & Johnson is one of many companies at work on a vaccine for the disease, which has become a global health crisis. Moderna Inc. has begun human trials for a vaccine using a novel approach that relies on the virus’s messenger RNA, a type of genetic material. Sanofi, a French biotech company, has begun work on a similar approach.

Healthcare Dive and Health Payer Intelligence report on additional steps that commercial payers are taking to reduce cost sharing burdens on patients receiving COVID-19 care.

The FEHBlog is confident that due to vastly improved medical care over the past century, Government and private sector support, and public respect for social distancing (which happened in the breach in 1918-19 due in large part to World War 1), the medical and para-medical professions will be able to handle the still rising number of COVID-19 cases while vaccination development continues.

Weekend update

David Ermer–ACA, CDC, Congress, COVID-19–

Congress is on a State / district work period this week. The Health Affairs blog discusses the health coverage provisions in the CARES ACT. In addition to broadening coverage of COVID-19 testing [Section 3201] and any future FDA-approved vaccine [Section 3203] , the new law permits high deductible health plans with health savings account to pay for telehealth care before the deductible [Section 3701] and repeals the Affordable Care Act provision requiring a doctor’s prescription for over the counter medicines as a prerequisite to reimbursement from a health savings account or a healthcare flexible spending account [Section 3702].

The high deductible health plan telehealth provision took effect last Friday and the over the counter drug coverage change was made retroactively effective January 1, 2020.

Health Affairs blog adds that

Under [Section 3202 of] the CARES Act, all comprehensive private health insurance plans would reimburse a test provider based on the rate negotiated between the plan and the provider (i.e., the in-network rate) that was put in place prior to this emergency. If there is no negotiated rate between the plan and provider (i.e., the provider is out-of-network), the plan would fully reimburse the provider based on the provider’s own “cash price” (or a lower price if the plan can negotiate one). This “cash price” must be publicly available (listed on a public website) while there is a declared public health emergency. Providers that fail to make their price public could face a civil monetary penalty of up to $300/day. This provision essentially allows out-of-network labs to set their own price and expect full reimbursement from the plan, potentially leading to dramatic price increases for testing.

Fierce Healthcare reports that that healthcare actuarial consulting firm TowersWillisWatson has released a projection of healthcare spending associated with the COVID-19 emergency.

On the low end of the spectrum, should the outbreak infect just 10% of the population and prove to have low morbidity, costs will increase by under 1%. However, if the virus infected 50% of the population with high morbidity, costs could increase by 6.8%, the study found. The scenario with the highest cost increases is if the virus 30% of people with high morbidity—a combination that could lead to 7.2% in cost increases, Willis Towers Watson found.

A major federal agency and two other health plan accrediting bodies have centralized their COVID-19 emergency guidance:

Apple in partnership with the Centers for Disease Control has posted a COVID-19 screening tool for consumers.

Friday Stats and More

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

Here are the week by week COVID-19 case statistics for this month from the Centers for Disease Control:

3-6-203-13-203-20-203-27-20
Travel36138290712
Person to Person181293101326
Cause under invest.1101362984283,318
Total Cases164162910,44285,356
Total Deaths1501246
Deaths over cases1.44%1.46%

Quite a spike. In the FEHBlog’s view, it will be interesting to see whether there is any leveling off in the case count increase.

The CDC’s latest Fluline reports “that [according to CDC estimates] so far this season there have been at least 39 million flu illnesses, 400,000 hospitalizations and 24,000 deaths from flu.” That represents a deaths over cases percentage of .06%.

With regard to COVID related guidance from that is relevant to FEHBP carriers and others

  • The Department of Health and Human Services Office for Human Rights has gathered together all of its COVID-19 emergency guidance on the HIPAA Privacy and Security Rules in one website.
  • The Department of Labor and the IRS have issued additional guidance on the Families First Coronavirus Response Act’s paid sick leave mandate and expanded FMLA leave.
  • The National Committee for Quality Assurance has assembled its COVID-19 emergency guidance here.

As previously mentioned the Office of Personnel Management has taken the same consolidated approach with its online COVID-19 emergency guidance which generally is directed at federal agencies.

CARES Act Passes Congress

David Ermer–Congress, COVID-19–

The FEHBlog just watched on C-SPAN the House of Representatives join the Senate in adopting the CARES Act (H.R. 748) so the $2 trillion COVID-19 emergency relief bill heads to the President for his expected signature later today.

Thursday Miscellany

David Ermer–Medicare, OPM–

The Centers for Medicare Services plans to start a new pilot program known as ET3 that allows certain ambulance companies to take traditional Medicare patients who call 911 to less acuity health care facilities than the usual hospital emergency room.

Under the ET3 Model, Medicare will pay participating ambulance suppliers and providers to: 

Transport a beneficiary to an alternative destination (such as a primary care doctor’s office or an urgent care clinic), or

Initiate and facilitate treatment in place by a qualified health care practitioner, either in-person on the scene or via telehealth. 

Upon arriving on the scene of a 911 call, participating ambulance suppliers and providers may triage Medicare beneficiaries to one of these Model’s interventions. 

The ET3 program will begin later this year for a two year period.

One of OPM’s heaviest weighted HEDIS measures turns on whether a pregnant woman visits her obstetrician in the first trimester of her pregnancy. Interestingly, Health Affairs Blog explains that

Prenatal care has been largely left out of the growing national conversation about the rise in maternal morbidity and mortality and the stark racial disparities in maternal health outcomes. This notable absence may be a consequence of how little is understood about the content and quality of prenatal care services and their relationship to maternal and infant health. Increased understanding of what happens during labor, delivery, and the postpartum period is essential to improving outcomes: the Centers for Disease Control and Prevention (CDC) estimates that roughly two-thirds of maternal deaths occur during childbirth and the first year thereafter. The remaining third of deaths occur during pregnancy. Prenatal care—spanning most of a year and consuming substantial time and resources from patients and providers alike—may represent an important opportunity to prevent these deaths, as well as to identify and mitigate risks of subsequent mortality or morbidity. 

There are three primary impediments to rigorous research in this area:

Reliance on blunt quality metrics that do not reflect important dimensions of care;

Limited access to data on what occurs during prenatal care; and

Empirical challenges to evaluating the impact of prenatal care on maternal and infant outcomes.

In other words, it’s complicated.

Fierce Healthcare reports on a survey about the extent to which patients lie to their physician and offers tips to doctors on how to encourage their patients to be truthful. If patients lie to their doctors, then members may well lie to their health plan too so the tips in the article should be generally helpful.

CARES Act Update

David Ermer–Congress, COVID-19–

The Hill reports that “[House of Representatives] Speaker Nancy Pelosi (D-Calif.) said Thursday that the House will move quickly on Friday to approve the Senate’s massive, $2 trillion coronavirus relief package [the CARES Act, H.R. 748] through the lower chamber and on to President Trump, who has vowed to sign it immediately.” NPR has provided a link to the text of the bill that the Senate passed unanimously at 11:17 pm last night.

Turnabout is fair play

David Ermer–OPM–

Federal News Network reports tonight that “The White House has tapped Michael Rigas, the newly-appointed acting director of the Office of Personnel Management [and Senate confirmed OPM Deputy Director], to serve concurrently as the acting deputy director for management at the Office of Management and Budget.” This means that Margaret Weichert is leaving the federal government for a consultancy. Ms. Weichert who was the Senate confirmed OMB Deputy Director for Management served as OPM Acting Director between Senate confirmed yet temporary OPM Directors Jeff Pon and Dale Cabaniss.

CARES Act Update

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

The President and the entire Senate leadership have agreed on a third COVID-19 relief bill known as the CARES Act (H.R. 748). Senator Charles Grassley, the Senate Finance Committee Chair, has released a summary of the bill’s taxation and unemployment insurance provisions and summary of its health provisions. The key health provisions affecting federal employees benefits are the following:

Sec. 3701. Health Savings Accounts for Telehealth Services
This section would allow a high-deductible health plan (HDHP) with a health savings account (HSA) to cover telehealth services prior to a patient reaching the deductible, increasing access for patients who may have the COVID-19 virus and protecting other patients from potential exposure.

Sec. 3702. Over-the-Counter Medical Products without Prescription
This section would allow patients to use funds in HSAs and Flexible Spending Accounts for the purchase of over-the-counter medical products, including those needed in quarantine and social distancing, without a prescription from a physician.

The FEHBlog mistakenly stated on Sunday that that the House of Representatives would be back on Capitol Hill yesterday. In fact, as the Wall Street Journal explains, House members remain on recess this week. Should the Senate as anticipated pass the CARES Act today, the House leadership is expected to seek approval by a unanimous consent motion. A single member of Congress can block such a motion so a lot rides on entire House leadership support for the bill. According to the Wall Street Journal, House Speaker Nancy Pelosi wants the unanimous consent to clear the House. This motion could be brought to the House floor on tomorrow or Friday. The Journal further reports that the President is ready to sign the bill into law.

The FEHBlog has found a link to a COVID-19 statistics site, The COVID-19 Tracking Project, that displays aggregated lab results from COVID-19 testing, U.S. state by state, where available.

Government Guidance Tuesday

David Ermer–COVID-19, OPM–
  • The Labor Department released FAQs on the newly enacted COVID-19 emergency sick pay law. According to the FAQs the law takes effect on April 1.
  • The Internal Revenue Service issued Notice 2020-18 and related FAQs on the recent Treasury Department decision to move this year’s Tax Day from April to July 15. Remember that “this relief applies only to Federal income tax payments. State filing and payment deadlines vary and are not always the same as the Federal filing and payment deadline. [The IRS] urge[s] you to check with your state tax agencies for those details. More information is available at https://www.taxadmin.org/state-tax-agencies.
  • The Center for Medicare and Medicaid Services Actuaries’ Office released the health care spending cost trend for the next ten years on Health Affairs. “National health expenditures are projected to grow at an average annual rate of 5.4 percent for 2019–28 and to represent 19.7 percent of gross domestic product by the end of the period. Price growth for medical goods and services is projected to accelerate, averaging 2.4 percent per year for 2019–28, which partly reflects faster expected growth in health-sector wages.”
  • Last but not least the Office of Personnel Management released a final rule making self plus one coverage and contract matrix changes to its FEHB Acquisition Regulation, 48 C.F.R. Ch. 16. OPM also released “technical guidance” to FEHB carriers on the preparation of 2021 benefit and rate proposals due May 31, 2021.