The Centers for Medicare and Medicaid Services and the Health and Human Services Inspector General issued related proposed rules today intended to modernize the Stark self-referral proscription law and the federal health programs anti-kickback act’s safe harbor provisions. The actions stem from the HHS Patients over Paperwork Initiative. Healthcare Dive explains that

• The long-awaited proposals from the Trump Administration seek to alter physician self-referral and anti-kickback laws to account for the healthcare system’s shift from fee-for-service to value-based arrangements. Backers of the revamp say current regulations discourage providers from entering into partnerships aimed at improving quality outcomes due to fear of harsh criminal penalties.

• A number of new safe harbors are being proposed to encourage value-based care, allow patient engagement through furnishing of certain tools and supports and permit certain remuneration when provided in connection with some CMS-sponsored models to cut down on the need for fraud and abuse waivers. They also provide guidance aimed at clarifying when compensation provided to a doctor by another provider must be paid for at fair market value.

Pharmaceutical companies often preach value. Yet, for seven top-selling drugs, prices went up in 2017 and 2018 despite limited new evidence showing patients receiving treatment experienced greater benefit, according to a new report.

Taken together, the price hikes added more than $5 billion to U.S. spending on those drugs over the two-year period, a study published Tuesday by the Institute for Clinical and Economic Review said.  * * *

Unsurprisingly, PhRMA, the industry’s principal lobby, took issue with ICER’s findings, as did drugmakers flagged for taking unsupported price increases. 

The bipartisan Senate Health Education Labor and Pensions bill (S. 1895) to lower prescription drug costs and address surprise billing currently appears stalled. While visiting Arizona, the FEHBlog saw a political ad favoring arbitration over S. 1895’s out of network price setting approach which by the way the ACA already uses to a limited extent. As Forbes consultant Avik Roy commented the arbitration approach would raise costs. That’s common sense.

The FEHBlog and most of his family have been vacationing in Arizona since last Saturday morning.  Very enjoyable.

It’s the time of the year when a lot of FEHBP news appears.

The Federal Times and Mike Causey from the Federal News Network offer advice on how to prepare for the impending Federal Benefits Open Season. While OPM has launched its 2020 Open Season website, it has not yet launched its 2020 Plan Comparison Tool site. That usually happens closer to the start of Open Season which is November 11 this year.

Healthcare Dive reports that Blue Cross FEP, the largest FEHB plan, has contracted with Livongo for diabetes care beginning next year.

Beginning Jan. 1, Livongo will offer FEP beneficiaries with Type 1 or Type 2 diabetes a glucose meter, unlimited test trips and lancets at no additional cost, plus remote access to nutrition and lifestyle coaches via Livongo’s mobile app.

GEHA, which sponsors the second largest plan outside of FEP, issued a press release on its 2020 FEHBP offerings.

Healthcare Dive also reports on a recent Journal of the American Medical Association study on waste and potentials for saving in America’s healthcare system.  The JAMA study finds that waste consumes about 25% of healthcare spending down from a 30% finding in 2012.

Congress is on its State / district work period for another week.

The Supreme Court begins its October 2019 term tomorrow. Here’s a Scotusblog report on the orders that the Court issued last Friday.

Healthcare Dive reports that last Thursday the President issued an executive order concerning the Medicare Program.

The order would allow Medicare Advantage (MA) plans to offer more novel benefits and allow beneficiaries to join in on some of the savings payers are able to deliver through cash or rebates.

The order also calls on regulators to examine ways to modify payments in the fee-for-service program to bring them in line with those paid under Medicare Advantage and to find ways to improve the enrollment process.

The FEHBlog dreams of such an order for the FEHBP, e.g., allowing carriers more flexibility in benefit design.

Federal News Network had not one but two articles on the currently stymied effort to distribute OPM’s functions to the Office of Management and Budget and the General Services Administration.

Becker’s Hospital Review identifies the 56 hospitals with the maximum Medicare readmission penalties under the latest round of penalties announced last week. Compare it against your plan’s network.

Here’s OPM’s Open Season announcement which includes a discussion of FEHBP and FEDVIP premiums for 2020. .

Tammy Flanagan has posted a useful Open Season article on Govexec.com. Here’s a key point from the article:

Two health plans will no longer participate in FEHBP in 2020: MVP Health Care, which covers 3,200 employees and more than 4,000 retirees in New York; and Highmark Choice Co. (also known as Keystone Health Plan West), which  covers 718 employees and 323 retirees in Pennsylvania. Enrollees in these plans will have to select a new plan during open season. Otherwise, they will be automatically enrolled in the lowest-cost nationwide plan option, which for 2020 is GEHA Elevate {one of the new government wide indemnity benefit plan options.]

On the prescription drug front —

• Fierce Healthcare reports that 

A recent survey of major payers found that 58% had executed an outcomes-based contract with a drug manufacturer in 2019, up from 24% in 2017. The survey released Tuesday from the consulting firm Avalere shows that outcomes-based contracts, where the drugmaker is paid by an insurer based on the effectiveness of their product, are gaining steam despite concerns over regulatory hurdles. The survey updates prior versions conducted in 2017 and 2018.

• Healthcare Dive reports

Civica Rx, a coalition of health systems that banded together in 2018 to make prescription drugs, has made its first delivery and a patient has now been treated with one of its medications.

Riverton Hospital, an Intermountain Healthcare facility in Utah, received the first batch of vancomycin hydrochloride, an injectable antibiotic that is commonly in short supply for hospitals across the country, Civica Rx said Wednesday.

The antibiotic will be available to all health systems by the end of the month. Shortly after that, another essential antibiotic, daptomycin, will be made available, according to the company.

• MedCity News reports that the President most likely will nominate Dr. Stephen Hahn. Dr. Hahn currently is the CEO of the University of Texas M.D. Anderson Cancer Center. 

• Fierce Healthcare further reports that 

OptumRx has released the second of its quarterly insights in the pharmaceutical pipeline, highlighting five more drugs in development that could have a significant impact on insurers and patients. The third-quarter list stands in contrast to prior reports as most of the featured drugs are emerging treatments for common conditions such as Type 2 diabetes and chronic migraines instead of “orphan” drugs or those targeting rare diseases, which are typically quite costly. 

The Centers for Disease Control today released their latest report on the vaping crisis.

The Department of Human Services Office for Civil Rights issued a press release on a HIPAA privacy rule settlement with a Dallas Texas dental practice. The settlement arose from the provider’s over-inclusive response to a Yelp review.

OPM released 2020 FEHBP premium rates this afternoon. The Washington Post, Govexec.com, Federal Times and Federal News Radio all have articles on the rate action. The Federal Employee Benefits Open Season begins on November 11. Check plan websites for 2020 benefits information.

Today is the beginning of the 2020 federal fiscal year.

The Health Affairs Blog posted an article about the demise of OPM’s Multi-State Plan Program created by the Affordable Care Act. I was interested to learn that

Recently the Office of Personnel Management (OPM) decided to discontinue operations of the Multi-State Plan (MSP) Program. The decision came as the program, which provided health insurance through the Affordable Care Act (ACA) health exchanges, had gone from providing coverage to more than 400,000 people in 35 states and the District of Columbia in 2015 to one state this year. 

The article discusses why the program failed. In my view, it was too complicated. 

Becker’s Hospital CFO Reports informs us that

In fiscal year 2020, CMS will penalize 2,583 hospitals for having too many Medicare patients readmitted within 30 days, according to federal data released Sept. 30 cited in a Kaiser Health News report.

Ouch. 

Becker’s Hospital Review has created a list of the thirteen U.S. hospitals that received the most emergency room visits in 2018. They are spread around the country, at least at first glance.

Federal News Radio reports that last Friday the President signed into law the continuing resolution funding the federal government in the new fiscal year that begins on Tuesday October 1 through November 21. 

On September 28, 1959, sixty years ago today, President Dwight D. Eisenhower signed the FEHB Act into law. (This photo does not identify the bill being signed but you get the idea.)  The FEHBlog owes his livelihood to this law. Enjoy the day and reflect with me on the benefits that this law has bestowed on federal and postal employees and annuitants over the years.

The Senate approved the House passed continuing resolution (“CR,” HR 4378) which funds the federal government from October 1, 2019, through November 21, 2019. The bill goes to the President who is expected to sign it.

The Federal News Network reports that

Notably, the CR includes an additional $48 million for the Office of Personnel Management, which faces a funding shortfall on Oct. 1 when the National Background Investigations Bureau and the governmentwide security clearance portfolio transfers to the Pentagon [with full Congressional authorization]..

In addition, the CR gives OPM the authority to transfer roughly $29.7 million from “appropriate trust funds … without regard to any other provision of law” to maintain agency operations.  OPM administers health and retirement benefits to more than 2.7 million active employees and nearly 2.6 million annuitants, survivors and their family members through the Earned Benefits Trust Funds, which have close to $1 trillion in combined assets 

The Senate also confirmed Eugene Scalia as the Secretary of Labor. Mr. Scalia is the son of the late Supreme Court Justice Antonin Scalia and has been a partner at the law firm of Gibson Dunn and Crutcher. His confirmation is relevant to the FEHBP because the Secretaries of Health and Human Services, Labor and Treasury are the principal Affordable Care Act regulators

The Centers for Medicare and Medicaid Services announced the issuance of its

Omnibus Burden Reduction (Conditions of Participation) Final Rule{. The rule]  strengthens patient safety by removing unnecessary, obsolete, or excessively burdensome health regulations on hospitals and other healthcare providers. This rule advances CMS’s Patients over Paperwork initiative by saving providers an estimated 4.4 million hours previously spent on paperwork annually, with overall total provider savings projected to be approximately $8 billion over the next 10 years, giving doctors more time to spend with their patients.  

The FEHBlog dreams of OPM granting such massive deregulatory relief to FEHB carriers.

CMS also announced issuing a Discharge Planning final rule.

[The rule] empowers patients preparing to move from acute care into post-acute care (PAC), a process called “discharge planning.” Today’s rule puts patients in the driver’s seat of their care transitions and improves quality by requiring hospitals to provide patients access to information about PAC provider choices, including performance on important quality measures and resource-use measures – including measures related to the number of pressure ulcers in a given facility, the proportion of falls that lead to injury, and the number of readmissions back to the hospital. The rule also advances CMS’s historic interoperability efforts by requiring the seamless exchange of patient information between healthcare settings, and ensuring that a patient’s healthcare information follows them after discharge from a hospital or PAC provider. 

This rule could help payers and providers better avoid hospital readmissions.