This morning, a House appropriations subcommittee approved the committee’s leadership’s version of the financial services and general government appropriations bill by voice vote along party lines. No FEHBP surprises. The next step is the full committee.

The FEHBlog realized today that he should have provided links to Prof. Tim Jost’s accounts of the HHS final rule implementing PHSA Sec. 1557 and the EEOC’s final rules concerning application of Americans with Disabilities Act and the Genetic Information Non-Discrimination Act, assuming readers what more information.  HHS’s PHSA Sec. 1557 rule is a particularly complex and burdensome rule which the FEHBlog has heard described as “catnip to the plaintiff’s bar.”  The FEHBlog looks forward to reading OPM’s take on the extent to which this rule applies to the FEHBP. The underlying law applies to the FEHBP and HHS encourage its fellow agencies to promulgate implementing rules for their own health programs and activities.

Beckers Hospital Review reports on a Centers for Disease Control population survey of health information technology use.  The survey highlight is that” the gap between how much the over 65 crowd uses health IT compared to younger generations isn’t so large — 33 percent, compared to 54.8 percent.”

The consulting firm Milliman issued its 2016 Medical Index which concludes that in 2016, the cost of healthcare for a typical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan is $25,826.” There always are many interesting tidbits to be found in the report. In that regard, it’s worth noting that FEHB plan carriers are putting the finishing touches on their 2017 benefit and rate proposals which must be submitted to OPM by next Tuesday May 31.

Following up on Sunday’s FEHBlog post, Fierce Healthpayer reports that Anthem’s CEO Joseph Swedish, [s]peaking at the UBS Global Healthcare Conference on Tuesday, acknowledged [that his company and its merger partner Cigna] have experienced an expected degree of ‘dynamic tension,’ noting that ‘quite frankly, along the way you hit these bumps, but we’re going to overcome this.’ Swedish said the companies are collaborating closely as they go through the regulatory process, which he described as having ‘a very, very long tail to it.'”

Last week, the Obama Administration posted its semi-annual regulatory agenda for Spring 2016. Here is a link to OPM’s agenda.  Several FEHBP tweaks  are found therein. Bear in mind that the preamble advises that “This publication does not impose a binding obligation on OPM with regard to any specific item on the agenda. Regulatory action in addition to the items listed is not precluded.”

The Wall Street Journal reported this morning that

Quarrels have broken out behind the scenes of Anthem Inc.’s $48 billion proposed acquisition of Cigna Corp. as the health insurers seek regulatory approval for their landmark deal, according to a series of letters reviewed by The Wall Street Journal.
People on both sides say the squabbles could delay or derail antitrust approvals, which are typically harder to obtain if both parties aren’t in sync. While neither company has sought to terminate the merger, the people say, and it doesn’t appear in danger of imminent collapse, Anthem and Cigna are bickering on several fronts.

It’s not a good sign when sensitive information like this leaks out to the press.

The FEHBlog has been out of town this week.  He wants to fit in the end of week message before heading back to DC tomorrow.  Here’s a link to the Week in Congress’s report on this week’s activities on Capitol Hill.

A commenter asked the FEHBlog for details about the Inovalon study mentioned in the Wall Street Journal article about rural health care costs.  The FEHBlog did discover that Inovalon had acquired the health care consulting firm Avalere but he couldn’t find the study in question.  He has written to the article’s author. In the meantime, the National Rural Health Care Association offers a litany of rural health care problems.   On the bright side, Health Day reports that

Having a commonplace surgery — such as a gallbladder removal — may be safer when done in a rural hospital compared to a suburban or city hospital, a new study finds. “This study gives credence to what rural surgeons long suspected — that well-done rural surgery is safe and cost-effective,” study author Dr. Tyler Hughes said in a University of Michigan news release. Hughes is one of only two surgeons at McPherson Hospital in rural McPherson, Kan., and a director of the American Board of Surgery.

Go figure.

Forbes reports on a new Blue Cross study finding that  “the high cost of specialty drugs like the new hepatitis C pills, saying they contributed another $87 annually in [2013 – 2014] costs per enrollee whether they used the expensive medicines or not.” That adds up to a lot of money.

Also on the Rx front, the Minneapolis Star Tribune reports that United Healthcare’s PBM OptumRx beat out CVS Caremark and Express Scripts for the enormous CALPers prescription drug benefits contact.  The five year long contract is worth $4.9 billion. That is a lot of money.  It also indicates that OptumRx has formed a big three of PBMs with CVS and Express Scripts.

Stat reports on efforts by naturopaths to get reimbursed by health insurers.  Their efforts are spurred on by the ACA’s Public Health Service Act Section 2706(a) and vitamin manufacturers. Everyone wants a piece of the pies.

Finally Health Day reports about health care pricing transparency problems.  

The out-of-pocket price for a standard chest X-ray, CT scan or ultrasound can vary by hundreds of dollars, depending on where the imaging is done, new research reveals.
“The lack of price transparency is certainly not isolated to the field of radiology alone,” said study co-author Dr. Mindy Licurse, a diagnostic radiology resident with the University of Pennsylvania Health System. For example, a 2014 analysis by the Health Care Incentives Improvement Institute in Connecticut and Catalyst for Payment Reform in California revealed that most states lack laws making health cost information available to consumers.
“Our study certainly contributes to the underlying hypothesis that pricing information within health care, specifically imaging in this case, may be difficult to obtain depending on the setting, and therefore comparison-shopping by patients is limited,” she added.

This is a problem that healthcare providers can and should fix in cooperation with insurers.

The FEHBlog noticed studies on

• Rural health care — from the Wall Street Journal — 

Using a health-insurance claims database that includes about two million exchange enrollees, Inovalon found that rural residents racked up significantly higher medical costs than urban enrollees in 2015.  “Individuals in less populated areas tend to be sicker” according to the data, said April Todd, an executive at a consulting unit of Inovalon. But the cost gap was also driven by higher expenses at rural health-care providers, she said.

• Children’s health care — from the Health Care Cost Institute —  

Per capita spending on health care for children covered by employer-sponsored insurance (ESI) grew an annual average of 5.1 percent per year between 2010 and 2014, reaching $2,660 in 2014. At the same time, there was a general decline in the use of health care services between 2012 and 2014. Out-of-pocket spending on children increased an average annual 5.5 percent, to $472 in 2014. This growth was due in part to higher out-of-pocket spending on ER visits, which increased an average annual 11.7 percent or $21 per capita.

• Telemedicine — again from the Wall Street Journal – which suggests that insurers should give thought to the way in which members are steered toward or away from from telemedicine:

Researchers posing as patients with skin problems sought help from 16 online telemedicine companies—with unsettling results.  *  * * “The services failed to ask simple, relevant questions of patients about their symptoms, leading them to repeatedly miss important diagnoses,” said Jack Resneck, a dermatologist with the University of California, San Francisco, and lead author of the study, published online in JAMA Dermatology on Sunday. Ateev Mehrotra, an associate professor of health-care policy at Harvard Medical School who wasn’t involved with the current study, said it “identifies a number of egregious quality issues that raise significant concern.” 

And of course there are more rules. The Equal Employment Opportunity Commission released a final rule yesterday on employer sponsored wellness programs which will take effect next year.  USA Today indicates that reaction to the rule is mixed.  Professor Timothy Jost in his Health Affairs blog provides more details on the Public Health Service Act Section 1557 rule released last Friday.  He also discusses an HHS rule released a couple weeks ago that loosened the regulatory leash on health care co-ops.

Congress remains in session on Capitol Hill this coming week. Here is a link to the Week in Congress’s report on last week’s activities, which included the passage of 18 House bills concerning opioid abuse.

Last week, the Partnership for Public Service released its annual report on best places to work in the federal government. OPM ranked in the middle for medium sized agencies.

The FEHBlog ran across a Pharmalot post. Pharmalot is a blog that previously appeared on the Wall Street Journal site but now is now on the Boston Globe’s Stat site. In any event, Pharmalot reports that “a new study found that Americans spent an extra $73 billion between 2010 and 2012 on pricier brand-name drugs because physicians failed to sufficiently recommend these copycat treatments to their patients. And consumers paid nearly one-third of those additional costs through out-of-pocket payments.” Hopefully the implementation of electronic prescription tools is remediating this problem.

Also on the pharmacy front, Walgreen’s is adding telemental visits to its app and website and is providing mental health treatment training to its pharmacists. Walgreen’s mental health website also provides a link to these mental health screening tools provided by Mental Health America.

Sen. David Vitter (R Louisiana) continues to maintain a hold on Beth Cobert’s nomination to serve as permanent OPM Director according to this Federal News Radio report.  The Senator “isn’t satisfied with OPM’s response to his questions about a final rule that lets members of Congress and their staff buy health insurance on the Small Business Health Options Plan (SHOP) exchange. And he’s blaming OPM — as well as members of Congress — for being complicit to an exemption in the Affordable Care Act that members shouldn’t have.”  This ball properly should be in Congress’s court not OPM’s.

Speaking of OPM’s Nextgov.com offers an interview with OPM’s senior cybersecurity advisor Clifton Triplett. Mr. Triplett “used OPM’s upcoming “unfortunate [data breach announcement] anniversary” to discuss [in the article] the agency’s security posture in the year since the big breach was announced.”

HHS issued its final non-discrimination in health programs rule today. The rule applies Public Health Service Act Section 1557 added by the ACA to HHS funded and administered programs. While PHSA Sec. 1557 applies to the FEHBP, it’s not clear to what extent this HHS rule applies to the FEHBP. But in any event the rule deserves attention.

The HHS rule takes effect on July 18, 2016. HHS is allowing health plans to make benefit changes required by the rule in time for the next plan year beginning on or after January 1, 2017. The rule unquestionably applies to all ACA marketplace plans which like FEHB plans, are immersed in 2017 benefit design development now (and in some states the horse has left the barn). Here is a link to HHS’s related facts heets and the final rule itself.

Here are a few articles to give you a flavor for the Healthcare Datapalooza conference which ends today:

• Health Data Liberation Remains a Political Struggle from Healthcare Informatics. What isn’t a political struggle these days?
• HHS endorsed a AARP contest to design a new medical bill.  How about a piece of paper with the Cadusus symbol and the word “Free” written on it?  But seriously anything written for the patient specifically will lack the information that a health insurer needs to process the claim accurately so providers will be stuck with issuing two bills.  
• NPR’s story on What Feds Push to Share Data Means for Patients.  The FEHBlog is not sure because we will still need a doctor or other healthcare professional to interpret the data.  Is the level of professional trust really that low? 

Congress is in session on Capitol Hill this coming week.  On Wednesday, the House Oversight and Government Reform Committee is holding a hearing on reforming the Postal Service and the House Energy and Commerce Committee’s health subcommittee is holding a hearing on “Health Care Solutions: Increasing Patient Choice and Plan Innovation.”  

Millions of people are on opioids — most of them over 45 — and that means some are at risk of overdose. Bratberg said we should be educating patients and doctors.
“We’re really making a push nationally and regionally to educate prescribers about those risks, and to use tools available to warn folks about that.” [according to University of Rhode Island pharmacy professor Jeffrey Bratberg]
Tools that help lower the risk include naloxone, the overdose rescue drug. There’s also medication, such as buprenorphine or methadone, to assist people who have become addicted to painkillers to stop their use safely. In essence, those drugs keep a low level of opioids in the system to keep someone from going into withdrawal without getting them high.

Congress is poised to pass a bevy of laws on this issue.

The FEHBlog for many years has been looking forward to savings generated by unbranded versions of specialty drugs, so-called biosimilar drugs. However, the Wall Street Journal reports today that

Generic drugs have long delivered huge savings over their brand-name counterparts. That isn’t likely to happen, though, with knockoff versions of some of the expensive drugs on the market today.
Rival versions of so-called biotech drugs, called biosimilars, are just starting to be released, and health insurers and drug-benefit managers say they expect them to cost nearly as much as the brand-name originals did for years.
One big reason: Pharmaceutical companies have been raising prices on biotech drugs about to lose patent protection to squeeze out more revenue before competition arrives, according to insurers, drug-benefit managers and pharmaceutical-industry consultants. And makers of the knockoffs are setting their prices just below those marked-up ones.

Quelle domage.

Hospitals and Health Networks reports that

The cost to hospitalize those with opioid abuse or dependence problems has more than tripled in a decade, up to nearly $15 billion in 2012, according to a new study published in Health Affairs this week. Similarly, the number of patients hospitalized for the effects of these drugs has surged by more than 72 percent, reaching 520,000 in 2012 (the year with the most recent available data), researchers with Harvard and the Veteran’s Health Administration found. Overall hospitalizations during that time, meanwhile, stayed relatively flat.

 Wow.  Cost curve up.

In that regard, Fierce Health Finance tells us that “Expanding healthcare price transparency didn’t prompt lower outpatient spending, according to a study published in the Journal of the American Medical Association” and that 

[Health Affairs] researchers call for increased education to raise awareness of the tools insurers have made available, saying payers should do more to engage consumers in shopping for the best price option.  While that may be easier said than done, the solution may lie in using providers as navigators for price shopping.

Modern Healthcare reports that the Centers for Medicare and Medicaid Services has performed its annual data dump on Medicare payments to doctors. Here’s a link to the CMS press release that may be more accessible.

To show that the FEHBlog is not a one trick pony focused on costs, he also points out Healthcare IT News reports on a Brookings Institution analysis offering cybersecurity tips to healthcare organizations.

The media is chock full of studies. Here are a few that caught the FEHBlog’s eye today:

• The Washington Post reports tonight on a Johns Hopkins study suggesting that medical errors are the third leading cause of death in the U.S.  From a practical standpoint the FEHBlog simply does not believe that medical errors cause “nearly 700 deaths a day — about 9.5 percent of all deaths annually in the United States.”  But this eye-popping study will garner a lot of attention. 
• The Washington Post reported yesterday about a Health Affairs study finding that “Seven of the top 10 most profitable hospitals in the United States are nonprofit facilities that each netted more than $150 million from caring for patients in 2013.”  For non-profit read tax-exempt.  
• The Wall Street Journal reports today that “Retiring after age 65 may help people live longer, says a study published online in the Journal of Epidemiology & Community Health. The risk of dying from any cause over the study period was 11% lower among people who delayed retirement for one year—until age 66—and fell further among people who retired between the ages of 66 and 72, the study found.” The FEHBlog hopes to work beyond 65 but based his life experience, he’s not sure about this study either.