Midweek update

David Ermer

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

Midweek update

David Ermer–AHRQ, Congress, COVID-19, Medicare, OPM–

On the COVID-19 front —

  • The Senate this afternoon approved H.R. 6021, the Families First Coronavirus Response bill. HR Dive explains the paid leave revisions that the House made to the bill first passed last Saturday before sending the bill to the Senate. Three attempts in the Senate to further amend the bill were rejected. The President has indicated that he will sign the bill.
  • H.R 6021 will mandate all types of health plans, including FEHB plans, cover FDA approved COVID-19 testing without cost sharing or medical management by the health plan. OPM already has required this for FEHB plans. However, the no cost sharing aspect of this coverage does not extend to treatment of the COVID-19 disease. A recent survey “of nearly 600 individual and family health insurance enrollees released today by eHealth, Inc. more than two thirds (69%) feel they lack a basic understanding of how testing and treatment of coronavirus (COVID-19) would be covered by their health insurance plan.” A word to the wise, etc.
  • Federal News Network reports “Federal agencies have 48 hours [until tomorrow] to review, modify and start implementing policies and procedures that will realign critical resources to slow the spread of the coronavirus. This includes offering “maximum telework flexibilities” for the federal workforce and may even include mandatory telework orders, the Office of Management and Budget said Tuesday night.”
  • The Wall Street Journal’s Journal podcast offers an interesting 20 minute long take on the race for a cure to the COVID-19 disease. One of the drugs discussed on the podcast is a Regeneron arthritis drug Kevazara that acts to calm the body’s immune system. Severe cases of COVID-19 cause lung inflammation. The FEHBlog read in the Great Influenza that the flu pandemic caused a spike in the death rate for healthy young adults. This flu struck deep in the lungs where the alveoli tissues transfer oxygen to the blood stream. The body’s immune system took great umbrage with this type of attack and threw everything at the disease. The body’s immune system attack often was the cause of death in young adults who have the strongest immune systems. The modern treatment is to try to calm the immune system and use a ventilator, options that didn’t exist in 1918.
  • Verily Health, the Google / Alphabet affiliate, issued an update on its development of a COVID-19 testing platform for patients. The Washington Post reports on COVID-19 testing sites in the DC metropolitan area.
  • Medicare has expanded the availability of telehealth for traditional Medicare beneficiaries during the COVID-19 emergency. HHS has issued guidance to health care providers on how to maintain HIPAA Privacy and Security rule compliance in the brave new world of telehealth.

In other news–

  • The Labor Department’s Employee Benefits Security Administration has released its latest report to Congress on improving health plan compliance with the federal mental health parity law and its report and an appendix on EBSA enforcement of that law in 2019.
  • Healthcare Dive reports that “The Trump administration is considering pushing back the timeline for payers, providers and health IT vendors to come into compliance with its two sweeping rules to promote interoperability as the healthcare system struggles with the novel coronavirus outbreak.” It would make sense to slow down the effort to ensure that it is done correctly, in the FEHBlog’s opinion.
  • AHRQ wisely points out the need to rethink the role of primary care in reducing hospital readmissions. Check it out.
  • Fierce Healthcare reports that

Aetna is linking Unite Us, a social care coordination platform, with its Guardian Angel program for members who have suffered an opioid overdose. The insurer, owned by CVS Health, will roll out the joint effort first in North Carolina, it announced this week. Using the Unite Us platform, care managers will be able to more effectively link members with social supports and other nonclinical options to aid in recovery, such as housing and healthy food.

Bravo.

The OPM Director has resigned

David Ermer–OPM–

Federal News Network reports this evening that

“OPM has received the resignation of OPM Director Dale Cabaniss,” an agency spokesperson said in an email to Federal News Network.

Michael Rigas, OPM’s deputy director, will lead the agency on an acting basis, the spokesperson added.

Ms. Cabaniss was in office for around six months. Stunning.

Federal News Network adds that

[Ms.] Cabaniss joined OPM back in September, replacing Margaret Weichert, who had served as the agency’s acting director and permanent deputy director for management at the Office of Management and Budget for nearly a year. [Ms.] Weichert, who was supposed to leave on March 13, is staying on at OMB for the short term, sources confirmed to Federal News Network. It’s unclear what the resignation of Cabaniss would mean for [Ms.} Weichert’s length of stay in government.

Monday Musings

David Ermer–CDC, COVID-19–

The FEHBlog was pleased to learn about the President’s initiatives to expand COVID-19 testing discussed in last Friday’s post. The President explained that Google would offer a website that allows concerned persons to find out if they need to be COVID-19 tested and if so arrange for a drive thru appointed. The Wall Street Journal reports that Google/ Alphabet ‘s Verily Health subsidiary launched a pilot platform in northern California. The pilot platform was “overwhelmed” by requests. Here’s a Verily Health link to more information on the platform. It’s good to see that Verily already is engaged in a trial and error pilot process and hopefully the platform will be ready for prime time soon because testing for disease also is important.

Speaking of diseases, here are some highlights from the Centers for Disease Control’s latest Fluline report:

  • Laboratory confirmed influenza associated hospitalization rates for the overall U.S. population remain moderate compared to recent seasons, but rates for children 0-4 years and adults 18-49 years are now the highest CDC has on record for these age groups, surpassing rates reported during the 2009 H1N1 pandemic. Hospitalization rates for school-aged children (5-17 years) are higher than any recent regular season but remain lower than rates experienced by this age group during the pandemic.
  • Pneumonia and influenza mortality has been low, but 144 influenza-associated deaths in children have been reported so far this season. This number is higher for the same time period than in every season since reporting began in 2004-05, except for the 2009 pandemic.
  • CDC estimates that so far this season there have been at least 36 million flu illnesses, 370,000 hospitalizations and 22,000 deaths from flu.

The Health Affairs blog discusses one of the FEHBlog’s favorite topics — opportunities for providers, payers and governments in the U.S. to expand telehealth use in response to the COVID-19 emergency. FEHBP plans generally offer telehealth benefits and there’s no time like the present to promote them.

Weekend update

David Ermer–Congress, COVID-19–

Congress had been scheduled to be on State / district work breaks this coming week. However, after the House passed a bipartisan COVID-19 relief bill (H.R. 6201) on Friday, the Senate leadership decided to consider H.R. 6201 week. According to the Wall Street Journal, the President is ready to sign the bill into law.

The Congressional bill summary explains

This bill responds to the coronavirus outbreak by providing paid sick leave (Divisions D, E, and F) and free coronavirus testing [Division G, a new mandate on all types of health plans], expanding food assistance and unemployment benefits, and requiring employers to provide additional protections for health care workers. 

The Hill reports that

Dr. Anthony Fauci, the head of the National Institute of Allergy and Infectious Diseases, said Sunday that it is possible it will take “a few months” before life goes “back to normal” amid the coronavirus outbreak.

“Can you try to help us understand, when will life get back to normal?” ABC’s Jonathan Karl asked Fauci on “This Week.”

“It’s going to be a matter of several weeks to a few months, for sure,” Fauci responded.

The FEHBBlog’s current read, the Great Influenza, has made him a strong believer in the social distancing principle that Dr. Fauci and many others are advocating in the face of the COVID-19 outbreak.

COVID-19 Picture

David Ermer–COVID-19–

The FEHBlog’s featured image for certain recent posts has been a CDC picture of the COVID-19 virus. The Great Influenza book that the FEHBlog has been reading includes this explanation of the picture:

The virus itself is nothing more than a membrane—a sort of envelope—that contains the genome, the genes that define what the virus is. It is usually spherical (it can take other shapes), about 1/10,000 of a millimeter in diameter, and it looks something like a dandelion with a forest of two different-shaped protuberances—one roughly like a spike, the other roughly like a tree—jutting out from its surface. These protuberances provide the virus with its actual mechanism of attack [as viruses invade the body’s cells]. That attack, and the defensive war the body wages, is typical of how shape and form determine outcomes.

Barry, John M.. The Great Influenza (p. 103). Penguin Publishing Group. Kindle Edition.

TGIF

David Ermer–AHRQ, CDC, COVID-19–

The President declared COVID-19 to be a national emergency this afternoon. The Wall Street Journal reports that the President announced that efforts are well underway to greatly expand COVID-19 testing, including drive thru testing. Furthermore,

A new, high-speed coronavirus test was earlier granted emergency clearance by the Food and Drug Administration. Developed by Roche Holding AG, the test is designed to run on the company’s automated machines, which are already installed in more than 100 laboratories across the U.S. It will be available immediately.

The FEHBlog understand that these high speed tests can turn around results in 24 hours, rather than a few days.

The FEHBlog compared the Centers for Disease Control’s COVID-19 U.S. case statistics from last Friday compared to today.

CDC COVID-19 stats
6-Mar13-Mar
Travel-related36138
Person-to-person spread18129
Under Investigation1101362
Total cases1641629

That’s quite a jump. CMS and Healthcare Dive also have offered their perspectives on the import of the emergency declaration.

In other news

  • Healthcare Dive reports on a Rand study on the value of out of network cost controls.
  • On this last day of AHRQ’s Patient Safety Week, the agency called public attention to its “Guide to Patient and Family Engagement in Hospital Quality and Safety.” The FEHBlog thinks its important for health plans to help families to support their hospitalized family members.

This Guide reminded me of a related human nature anecdote that I heard on the Econtalk blog which I can share

Russ Roberts: I was talking to this nurse about the challenges of doing a good job because it can be a very boring job, and then all of a sudden it’s unbelievably intense. And at one point he said to me–and at this point, my brother and sister, our mom had all been in the room for hours over a course of three or four days.

He said, he conceded, that–he said, ‘It really helps to have family here with the patient.’

And I thought he was going to say, you know, ‘Because it helps them sustain their morale.’

He said, ‘I think it makes us do a better job.’

And I thought, of course, of Adam Smith’s impartial spectator. It’s like we’re the actual spectator, watching him, and he said–this was a great thing–he said, ‘It shouldn’t be that way.’ And he’s right, of course. It should be that you’re equally motivated whether no one’s watching. But as human beings we sometimes fall short. He said, ‘It shouldn’t be that way, but sometimes it is.’

Russ Roberts is a University of Chicago trained economist who has written on Adam Smith.

Thursday Thoughts

David Ermer–COVID-19, Federal employment benefits, Medicare, Rx coverage–

Fedweek reports that

The largest FEHB carrier, Blue Cross-Blue Shield, has loosened several policies, for those diagnosed with COVID-19, the respiratory condition caused by the COVID-19 virus including waiving:

prior authorization requirements for diagnostic tests and for covered services that are “medically necessary and consistent with CDC guidance”;

any copays or deductibles for diagnostic tests or treatment under that same standard;

early medication refill limits on 30-day prescription maintenance medications and cost sharing for prescriptions for up to a 14-day supply; and

copays for telehealth services related to COVID-19.

The FEHBlog was pleased to see that FEP is waiving telehealth cost sharing related to COVID-19. OPM’s carrier letter mentioned in yesterday’s post overlooked telehealth which is an important tool to mitigate the spread of COVID-19. If your plan offers a telehealth benefit, it is important to pre-register for that benefit before you need to use it. The FEHBlog found his plan’s pre-registration program to be quite efficient.

You will find that FEHBP plans prominently have links to their special COVID-19 coverage features on their websites.

The Wall Street Journal has put its helpful COVID-19 update website outside its general website paywall.

In other news,

  • The Centers for Medicare and Medicaid Services announced earlier this week “the Part D Senior Savings Model, a voluntary model that enables participating Part D enhanced plans to lower Medicare beneficiaries’ out-of-pocket costs for insulin to a maximum $35 copay per thirty-day supply throughout the benefit year. Beneficiaries who take insulin and enroll in a plan participating in the model should save an average of $446 in annual out-of-pocket costs for insulin, or over 66 percent, relative to their average cost-sharing for insulin today.” This program will launch next year. Time will tell whether the prescription benefit plan can extend this discount to FEHBP and other commercial health plans.
  • The National Cancer Institute released the Annual Report to the Nation on the Status of Cancer. The report presents good news
    • Overall cancer incidence rates are leveling off among males and increasing slightly among females.These trends reflect population changes in cancer risk factors, screening test use, diagnostic practices, and treatment advances. 
    • This year’s Special Section focused on progress toward select Healthy People 2020 objectives related to four common cancers (lung, colorectal, female breast, and prostate). The Healthy People 2020 target death rate (161.4 deaths per 100,000 persons) for all cancers combined was met overall and in most sociodemographic groups.
    • During 2007-2017, cancer death rates decreased 15% overall, and the percent improvement target (-10%) was met in many sociodemographic groups.
    • Many of the Healthy People 2020 objectives for death rates, cancer screening, and major risk factors related to lung, colorectal, female breast, and prostate cancer were met.
  • Becker’s Hospital Review provides an overview of seven key dates of the HHS interoperability rule released earlier this week.
  • Healthcare Dive discusses the five additional healthcare apps that CVS/caremark has added to its curated app “formulary” for the benefit of plan sponsors. “Livongo Health, Hinge Health, Hello Heart, Torchlight and Whil are now available for CVS’ PBM clients to use, in addition to Sleepio, a personalized digital sleep program and the first participating program when the service launched in 2019.”

Midweek Update

David Ermer–AHRQ, COVID-19, OPM, Uncategorized–

The Office of Personnel Management issued a guidance letter to FEHB carriers on the COVID-19 virus today.

The Internal Revenue Service today issued a Notice 2020-15 which permits high deductible health plans used with health savings accounts (under Internal Revenue Code Section 223) to cover COVID-19 testing on a first dollar basis. To its credit, OPM references the IRS notice in the above linked carrier letter.

The U.S. Labor Department also issued FAQ guidance on COVID-19 or Other Public Health Emergencies and the Family and Medical Leave Act.

As noted on Monday, this is Patient Safety Awareness week. The patient safety organization ECRI Institute released a list of top 10 patient safety concerns. The Safety Week’s key sponsor HHS’s Agency for Healthcare Quality and Research issued

Making Healthcare Safer III, a comprehensive report whose pages are filled with practical information on how today’s clinicians can keep patients free from harm.

The report reviews roughly four dozen practices that target patient safety improvement across a variety of settings. If appropriately applied, many of these practices can dramatically reduce high-impact healthcare-related harms.

The 47 patient safety practices and evidence highlighted in the report include technological and staffing-related practices, a series of specific hygiene and disinfection interventions for reducing healthcare-associated infections, and several practices designed to prevent medication errors and reduce opioid misuse and overdoses.

Tuesday Tidbits

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

The FEHBlog listened to the federal government’s COVID 19 press conference on the drive home from work. The Surgeon General urged listeners to visit coronavirus.gov. When the FEHBlog arrived home, he checked out the website and it turns out to be another url for the Centers for Disease Control’s COVID-19 website that he takes a peak at daily. At least the FEHBlog hasn’t been misdirecting readers. Here is today’s COVID-19 scorecard:

Travel-related83
Person-to-person spread36
Under Investigation528
Total cases647

The FEHBlog learned late this afternoon that COVID-19 concerns have caused OPM and AHIP to cancel the annual FEHBP carrier conference which was scheduled to run from April 1 to April 3 in lovely Crystal City Virginia. The FEHBlog while disappointed understands the decision because the event jams hundreds of people together in one hotel ballroom.

Yesterday’s Health and Human Services rules on electronic health record (“EHR”) interoperability and data blocking gave a big boost to HL7’s FHIR specification. “FHIR (Fast Healthcare Interoperability Resources) Specification is a standard for exchanging healthcare information electronically.” The FEHBlog was excited to hear about the FHIR specification early last year because it appeared to be a solution to the nagging EHR interoperability problem. HHS appears to have jumped into the FHIR specification pool with both feet.

This morning the FEHBlog listened to a HIMSS webinar on FHIR accelerators. The four HL7-designated FHIR accelerators are leading the FHIR charge to solve interoperability problems in different spheres:

  • The DaVinci Project is focused using FHIR to fix healthcare business to business exchange issues.
  • The Carin Alliance is focused on using FHIR to fix healthcare business to consumer exchange issues.
  • CodeX is focused on using FHIR to share clinical trial appropriate data found in EHRs with researchers in an effort to find cancer cures.
  • The Gravity Project is focused on sharing social determinant of health data found in EHRs with healthcare businesses for care coordination and SDOH benefit purposes.

Good luck to them all.

Monday Musings

David Ermer–AHRQ, CDC, COVID-19, Electronic health records, OPM–

The U.S. Office of Personnel Management issued additional COVID-19 guidance and FAQs on Saturday March 7. The Federal News Network summarizes OPM’s issuances here.

Here are the Centers for Diseases Control’s March 9 COVID-19 statistics for the U.S.

  • Travel-related 72
  • Person-to-person spread 29
  • Under Investigation 322
  • Total cases 423

The CDC has issued guidance for people at risk of contracting serious illness from COVID-19. According to the CDC,

Early information out of China, where COVID-19 first started, shows that some people are at higher risk of getting very sick from this illness. This includes:

  • Older adults
  • People who have serious chronic medical conditions like:
  • Heart disease
  • Diabetes
  • Lung disease

Becker’s Hospital News reports on a study recently published in the Journal of American Medical Association. The study which was conducted in Singapore finds that from a contagion standpoint the COVID-19 virus does not linger in the air but it does contaminate surfaces.

As predicted, the Trump Administration released its final electronic health record interoperability and data blocking rules today. The objective of the rules is to give patients better access to their health records. The rules take effect as early as January 1, 2021. The implementation of the interoperability rule is staged over time.

Here are links to the government fact sheets on the final interoperability rule and the final data blocking rule. WEDI, which an information technology advisor to the HHS Secretary, prepared a helpful comparison of the proposed and final data blocking rules.

Healthcare Dive reports on industry reaction to the final rules. Healthcare Dive explains

The CMS rule requires Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Affordable Care Act exchange plans to provide their collective 125 million patients with free electronic access to their personal health data, including medical claims and encounter information including cost, by 2021.

MA plans, state Medicare and CHIP programs, CHIP managed care entities, Medicaid managed care plans and qualified health plans in the federal exchanges now have to “implement, test, and monitor” a Health Level Seven FHIR-compliant API, which the government has selected as the new national standard.

Those plans also have to make their provider directories available to current and potential enrollees through the API technology, too (excepting the federal exchanges, which already do so), by 2021, with the hope insurers will carry over those practices to private plans as well.

Finally it’s worth noting that HHS’s Agency for Healthcare Quality and Research has deemed this to be Patient Safety Awareness Week.