The lame duck session of Congress hurtles toward its impending conclusion. Three important bills remain in play — the National Defense Authorization Act, the 21st Century Cures Act, and the resolution continuing funding for the federal government. The House has passed the first two bills and the Senate is expected to act on them today or tomorrow. The House leadership unveiled the new continuing resolution last evening.

• Here’s the Wall Street Journal’s latest report on the NDAA.  
• The Boston Globe’s STAT provides an overview of the Cures Act under the guise of listing winners and losers.  
• The Hill reports on the proposed continuing resolution which would fund the federal government through April 28, 2017.  

This is the last full week for the Federal Benefits Open Season, which ends on December 12.

Congress continues at work on Capitol Hill this week. We can expect that Congress will extend the continuing resolution funding the federal government which expires this coming Friday.  The FEHBlog thinks it’s safe to say that there is no chance of a government shutdown due to a funding lapse. The question on the table is how long to extend the resolution. Here is a link to The Week in Congress’s report on last week’s actions.

Following up on the Congressional hearing on federal long term care insurance premiums discussed in last Thursday’s post, the FEHBlog is offering a link to the NARFE testimony which includes a laundry list of possible reforms.  The federal long term care insurance act was developed and enacted at the turn of the century as they say. The Wall Street Journal points out in this article that the long term care market launched in the 1990s based on key pricing errors and peaking right at the time that the law was passed, the year 2000.  Bad mojo.

The Hartford Courant brings us up to date on the trial over the federal government’s effort to block the Anthem-Cigna merger.  The trial over the government’s effort to block other big health insurer merger – Aetna and Humana — starts today also in the federal district court here in Washington, D.C. Both cases are tried to a federal district judge, not to a jury.

On the innovation front,

• Medcity News discusses three telehealth approaches “which show how the sector is diversifying.” One of then is the American Well / Tyto Care approach that the FEHBlog noted on Friday. Check out the article to read about the other two.
• The Wall Street Journal reported on Saturday about Aspire Health, a start up company lead by former Senate Majority Leader Bill Frist, who is an MD.  Aspire Health’s objective is to use claims data to identify plan members who are expect to die in the next year and “lower their medical costs by providing palliative care in their homes.”  “The Nashville-based company, which recently won $32 million in funding from GV (formerly called Google Ventures), has managed the care of more than 20,000 Medicare Advantage patients in 19 states in exchange for a monthly fee. It estimates that it can save health plans $8,000 to $12,000 per patient.” Interesting. 

Also the Centers for Medicare and Medicaid Services released the 2015 National Healthcare Expenditures study. Cost curve up.

Nothing frosts the FEHBlog’s cake more than the fact that taxpayers paid over $30 billion for government approved electronic health records systems that weren’t designed to communicate with each other. Health Data Management reports that the 21st Century Cures Act which likely will become law next week includes provisions intended to boost EHR interoperability.

Let’s wrap up for the week with a couple of innovations:

• Telehealth vendor American Well announced yesterday “a new partnership [with Tyto Care] to combine video telehealth visits with comprehensive remote examinations. Together the companies will offer the tools needed to conduct the most complete virtual visit in telemedicine, significantly expanding the scope and safety of care delivered to consumers via telehealth.”

• The Wall Street Journal reports that 

There are more than 120,000 people in the U.S. waiting for an organ transplant and not enough donors. The dire shortage has led some researchers to consider an unusual solution: They are breeding genetically modified pigs whose organs could be compatible for human transplant.

Researchers have been trying for decades to make animal-to-human transplants work, a process known as xenotransplantation. Pigs are a particularly promising source of organs. They produce big litters. Organs such as the kidney and liver are similar in size to those of humans. “Nobody has come up with a better animal,” says Joseph Tector, a professor of surgery who runs the xenotransplantation program at the University of Alabama at Birmingham.

Then last year, a group led by George Church of Harvard University published a paper describing their use of a new gene-editing technology called Crispr-Cas9. Unlike previous gene-editing systems, Crispr allowed the researchers to make multiple changes simultaneously to inactivate viral remnants in the pigs’ genes.

Crispr has helped renew enthusiasm for xenotransplantation.

Luhan Yang, one of the authors of the paper and now president and chief scientific officer of EGenesis Bio, which she and Dr. Church co-founded, says the company has used Crispr to create pig embryos designed to keep human immune systems from rejecting them. They have also used Crispr to inactivate pig retroviruses. The researchers are gathering data and hope to have pigs next year whose organs can be tested in trials with animals.

Here’s another article on the use of this new gene editing technology in humans if your interest has been whetted. 

Here’s a link to yesterday’s House Oversight and Government Reform Committee hearing on Federal Long Term Care Insurance premium hikes. Govexec and Federal News Radio have reported on the hearing. Nothing much apparently happened, but it was the beginning of the conversation not the end.  The FLTIC statute needs updating.

The Washington Post reports that the House of Representatives this evening passed by a wide margin the 21st Century Cures bill.  The bill is focused on drug and device development and mental health reform.  The Post explains that “The final bill, running at close to 1,000 pages, contains a cornucopia of health-related provisions, including $1 billion for opioid abuse prevention.” The Senate is expected to approve the bill next  week and the President then is expect to sign it into law.

Federal News Radio reports that Congress continues to work on the National Defense Authorization Act which is a piece of must past legislation for the lame duck session. According to Federal News Radio, the conference report will include a 2.1% pay increase for the military and TRICARE reforms.

Congress also must pass an extension of the continuing resolution funding the federal government. The current continuing resolution expires Friday December 9. The FEHBlog has been reading that the debate concerns whether to extend funding to the end of March or May.  The FEHBlog anticipates that the lame duck session will end once that matter has been resolved.

OPM will be releasing two proposed rules in tomorrow’s Federal Register.  One creates a procedure for removing ineligible family members from a self and family or self plus one enrollment.  This rule sets the stage for implementing OPM’s long standing plan to conduct dependent eligibility audits in the FEHBP. The other, which surprised the FEHBlog, creates a procedure for cancelling the self and family enrollment of spouses and adult children who are financially independent of the enrollee.  “This proposed rule is in response to [presumably an avalanche of] enrollee requests to remove family members from
existing enrollments.”  The public comment period for both proposed rules will end on January 31, 2017.


Finally, in an interesting development, the Drug Channels blog discusses a recently announced deal between the OptumRx prescription benefit management company and CVS Pharmacies. Drug Channels explains that

The surprise announcement echoes the arrangement that OptumRx established with Walgreens. The new deal signals that CVS is starting to counter Walgreens’ aggressive partnering strategies. OptumRx customers also get to choose which chain will be their preferred 90-day at retail provider.

In contrast, customers of CVS’s own PBM, Caremark, only have a choice between CVS pharmacies and Caremark mail service for 90 day scripts of maintenance medications.  Drug Channels provides more background if you are interested.

We are now about halfway through the lame duck session of Congress and the Federal Benefits Open Season.

On Friday, the FEHBlog noted a report that national health care spending increased 5% in 2015. The report attributed the increase largely to health care provider and pharmaceutical price increases.  He described it as bad news. To elaborate, he means that the report illustrates the fact that the Affordable Care Act is failing at its stated objective of lowering the health care cost curve.

This doesn’t surprise the FEHBlog in the least. As the FEHBlog has noted throughout the law’s history the basic problem is that the law encourages health insurance to be used as a price support by for example mandating coverage of low priced items across the board. There’s has to be more flexibility built into the system.

Of course, that’s not the only problem. The Wall Street Journal reports today that drug manufacturers raise their retail prices in lock step. In other words, drug manufacturers see no reason to take advantage of a pricing advantage.

Even when there is competition, prices can continue to climb. That is because patients tend to stick with a drug that works for them, and health insurers and drug-benefit managers sometimes have contracts for drugs that prevent switching to cheaper options.

The odd aspect of the article is while Viagra was given as an example of lock step pricing, insurers only cover that drug in special circumstance.  The inertia in that case must be created by the prescription requirement. Anyway it’s a screwed up market if manufacturers don’t want to compete based on price.

The Hill reported on Friday that the House of Representatives will consider this week a set of health care related bills. The bills concern medical innovation and mental health reform. There’s a good change that this legislation will be enacted in the lame duck session.

Employee Benefit News draws our attention to a recent Mercer Consulting survey of employer sponsored health plan coverage in the United States. The survey points out the rapidly growing coverage of telehealth services which FEHBP enrollees should notice next year. Be sure to sign up for the service before you need to use it.

Finally, Consumer Reports tells us about hospital efforts to reduce central line infections.

Central-line infections account for roughly 5 percent of all hospital-acquired infections, striking more than 27,000 people in 2015, research shows. And they’re a particularly important subset, says Arjun Srinivasan, M.D., associate director for Healthcare Associated Infection Prevention Programs at the CDC.
For one, they are deadly—proving fatal in up to a quarter of cases, in part because people with the IVs are often already frail. They’re costly, too, averaging $46,000 to treat, more than other hospital-acquired infections, according to a 2013 study in the Journal of the American Medical Association. And they’re almost entirely preventable.

Consumer Reports alerts us to which hospitals have been successful in their prevention efforts and which hospitals have more work to do.  It’s a survey that the FEHBlog would check if he need to be hospitalized.

Well, the FEHBlog had a happy Thanksgiving (except for the Redskins loss), and he hopes that his readers are enjoying the holiday too.

The Health Care Cost Institute, a private payer claims data research organization, issued its 2015 healthcare cost and utilization report. The news was not good.

Spending on health care for the privately insured in the United States increased 4.6 percent in 2015, outpacing previous years’ growth, finds a new report from the Health Care Cost Institute (HCCI). Spending grew just 3.0 percent in 2013 and 2.6 percent in 2014. Prices for outpatient, inpatient, professional services, and prescription drugs increased between 3.5-9.0 percent in 2015, a bigger hike than in the prior two years, according to the analysis. Price increases were the primary reason spending grew more quickly in 2015 than in previous years, and were the largest driver of spending growth throughout the four-year study period. * * *

“Using data from four of the nation’s largest health insurers, we’re able to look closely at the changes in health care use and prices over time to understand what is driving costs,” said HCCI Executive Director David Newman. “Year after year in our study period we see that rising prices are leading to spending growth.” 

 Here’s a link to the complete report.

Also Health Data Management reports that the HHS Office for Civil Rights took another healthcare provider scalp — a $650,000 negotiated fine and a corrective action plan against the University of Massachusetts.

The sanctions follow UMass reporting to OCR in June 2013 that a workstation infected with malware resulted in disclosure of protected health information on 1,670 individuals. Malware infected a workstation in the UMass Center for Language, Speech and Hearing because no firewall was in place.
OCR contends that UMass had incorrectly determined that the Center for Language, Speech and Hearing, which was the unit that experienced the breach, was not a covered entity under the HIPAA rules.
Further, OCR determined that while the breach occurred in mid-2013, UMass did not conduct and accurate and through risk analysis until September 2015. In recent years, OCR has increasingly been stringent on the need of HIPAA-covered entities to conduct risk analyses and address vulnerabilities.

Finally, the FEHBlog noticed this afternoon that the House Oversight and Government Reform Committee has scheduled a hearing on Federal Long Term Care Insurance premium spikes for next Wednesday November 30 at 2 pm.

The FEHBlog is outside the Capital Beltway for Thanksgiving again this year.  Nothing personal.

Inside the Beltway. according to Govexec.com

• Paul Conway will head up the [Trump transition /] landing team at OPM, where he served as chief of staff during the George W. Bush administration. He previously held the same role at the Labor Department and began his career in public service as an Education Department appointee in the Reagan administration. [Mr. Conway also is a patient advocate as President of the American Association of Kidney Patients.] and
• Lawmakers are preparing to bring renewed attention to U.S. Postal Service reform in the lame-duck session of Congress.

Congress is out of town this week for the Thanksgiving holiday.

The trial of federal government’s antitrust case against the Anthem-Cigna merger begins tomorrow before U.S. District Judge Amy Berman Jackson here in Washington, D.C.  Modern Healthcare explains that

In the first portion of the trial, expected to last through Dec. 2, U.S. District Judge Amy Berman Jackson will hear arguments on the national implications of the deal. The companies compete for business from large, self-insured employers to handle functions such as claims administration and designing provider networks. A second portion of the trial—unless Jackson decides there’s already enough cause to spike the deal after the first—will address regional markets.  Jackson has said she plans to rule on the case by late January. 

The Wall Street Journal adds some color:

The first few days of the trial could be crucial in setting the tone. The Justice Department is expected to start its case by summoning as witnesses Anthem CEO Joseph R. Swedish and Cigna CEO David Cordani.

The Journal adds that “A negative decision almost surely means the end of the Anthem deal, given its tensions with Cigna. Companies rarely keep litigating merger cases if they lose at trial because it is very difficult to keep a deal together for another year or two of litigation.”

The trial of the government’s antitrust case against the Aetna-Humana merger begins soon after the Thanksgiving holiday before U.S. District Judge John Bates, also in Washington, D.C.  The Journal explains that

The Aetna case, in contrast [to the Anthem-Cigna case], focuses heavily on the market for private Medicare plans, Humana’s main line of business. The government says the merger would eliminate aggressive competition between the companies to enroll seniors in so-called Medicare Advantage plans. The insurers say their transaction would combine two complementary companies that would offer better, more cost-effective insurance products.

All four insurers participate in the FEHBP in various capacities.

FCW reports that on Friday the U.S. Office of Personnel Management’s Inspector General issued a report on the state of the agency’s compliance with the federal information security law for federal government information technology systems, FISMA.  “More than a year after the massive data breach at the Office of Personnel Management was revealed to the public, the agency still has a litany of IT weaknesses and deficiencies, according to a new inspector general report.” Meanwhile the Federal Times reports about a speech that the acting OPM Director Beth Cobert recently made to a contractors’ association.

One of the more intriguing of issues Cobert spoke on was the dearth of not only new talent coming into the federal government, but also the trickle of cybersecurity expertise.
“Both the government and the private sector fundamentally need more help with cybersecurity expertise working for us than exists today in the country,” she said.
She said that while estimates vary, some speculate that the cybersecurity talent shortfall could be as high as a million positions needed, prompting OPM, the departments of Defense, Homeland Security and others to develop a cyber recruitment strategy for new professionals, while navigating the issues of retaining them. 

Not a good situation.

OPM is asking FEHBP plan carriers to call their members attention to a new government website, healthfinder.gov  OPM explains that the websit

provides personalized recommendations for – and plain language information about – clinical preventive services based on age, sex, and pregnancy status.  Once users enter this information, the tool generates a list of evidence-based preventive services along with actionable guidance to help them stay healthy.  The recommendations come from the U.S. Preventive Services Task Force (USPSTF), the CDC Advisory Committee on Immunization Practices (ACIP), and the Health Resources and Services Administration (HRSA)—the same authorities that guide preventive services covered by FEHB plans.  Importantly, HHS is committed to refreshing this tool as new preventive service recommendations are implemented.

All that you have to do is type in your gender and age. Check it out.

In April 2016, the FEHBlog attended portions of the HCP/LAN spring conference in lovely Reston Virginia.   This is a government / private sector collabotative intended to boost the use of value based payments by health plans. The FEHBlog was struck by the fact that the meeting was heavily attended.  The FEHBlog must have overlooked the invitation to the fall conference which occurred last month. Here is a press release on that conference.

Time marches on. Govexec.com reports that House and Senate leadership plan to pass a continuing resolution funding the federal government through March 31 to allow the incoming Trump administration an opportunity to weigh in on spending for the last six months of the current federal fiscal year.  The current continuing resolution expires on December 9.

Walt Francis has issued another report criticizing the FEHBP elements of the postal reform bill pending before Congress, H.R. 5714. In order to place the report in perspective, readers must understand that over a decade ago Congress began to require the Postal Service to pre-fund its retiree coverage.  The Postal Service in order to control this cost is reasonably demanding that its retiree coverage be fully integrated with Medicare.  This requires a change in the law.  Because the bill would preserve one of the most important pieces of the FEHBA — single risk pools per plan option — reducing Medicare eligible annuitant costs will lower premiums for the entire population.  The Medicare law allows FEHB plans to integrate their prescription drug benefits with Medicare Part D.  The postal reform bill would require that this EGWP feature be added to the Postal Service health plans established by the law.  Mr. Francis explains:

Part D EGWP participation would apply to all postal annuitants over age 65, virtually none of whom are currently enrolled in Medicare Part D. All FEHBP drug benefits are at least as generous as those in Part D, and most are better, so almost no federal annuitants currently enroll in Part D. Moreover, the Office of Personnel Management (OPM), the agency that administers the FEHBP, would dictate EGWP designs. One might assume that under OPM-approved EGWP plans, drug benefits would remain unchanged, with no additional cost to enrollees, but OPM could nonetheless decide to force changes in drug benefits and/or premiums.

The FEHBlog wants to point out with an EGWP which are common in the private sector the plan pays the Medicare Part D premium and the plan can wrap its prescription drug benefits around the Medicare Part D benefits.

Mr. Francis is correct that the bill as currently drafted would place OPM in charge of the EGWP.  The Medicare law does not dictate this outcome, and hopefully this feature of the bill will be eliminated as it is refined before passage.  The FEHB plan carrier who hold the insurance risk must be able to manage the full suite of benefits.  

The Medicare integration provisions of H.R. 5714 must be considered and approved by the House Ways and Means Committee.  There is now a CBO report on the bill which allows that consideration to occur. (No such hearing currently is scheduled.) Because Congress is anxious to get out of town after this tumultuous year, it’s likely that postal reform will be punted into 2017.

Here’s a head scratcher.  Kaiser Health News is reporting

Even if there’s a retail health clinic less than a 10-minute drive away, consumers are just as likely to go to the emergency department for low-level problems like bronchitis or urinary tract infections, a recent study found. 

“Our results aren’t necessarily the wooden stake in the heart of retail clinics,” said Grant Martsolf, a policy researcher at the Rand Corp. and the lead author of the study, which appeared online this month in the Annals of Emergency Medicine. Retail clinics can play an important role in providing easier, more timely access to primary care services, Martsolf said. But the study results suggest that clinics aren’t the solution that policy experts have been hoping for to reduce expensive but unnecessary emergency department visits, he said.

Old habits die hard evidently.