The FEHBlog forgot to mention in yesterday’s Weekend Update that last Friday afternoon the ACA regulators issued their latest ACA frequently asked question (“FAQ”).  In this FAQ, the ACA regulators confirmed Prof. Timothy Jost’s prediction that the new but not yet final summary of benefits and coverage template will be place in use for plan years beginning on or after April 1, 2017 – in other words for the FEHBP Open Season that takes place in late 2017 for the plan year beginning January 1, 2018.  Also the ACA regulators switched the FAQ number from Roman to Arabic / regular numbering.

While the FEHBlog is on line, here are a few quick hits:

• The Wall Street Journal reports this morning that Bristol-Myers is bucking the personalized medicine tide by marketing a specialty cancer drug with an optional diagnostic test. Merck’s latest personalized medicines to combat cancer require a diagnostic test before use.  Evidently, Bristol-Myers is banking on the fact that doctors who prescribe these drugs aren’t crazy about taking the time to perform the diagnostic test. That’s reassuring. 
• The Boston Globe’s Spotlight team (featured in the Academy Award winning movie called Spotlight) is reporting on problems associated with “concurrent surgery” where one surgeon moves back and forth between two patients. Again that’s reassuring. The Globe reports today that Sen. Orrin Hatch, the chairman of the Senate Finance Committee, has asked twenty hospital systems to report back to his committee on their use of concurrent surgery. Put that question down on your list for the next time you need surgery. 
• NPR reports on how hospital emergency rooms are adapting their operations to provide routine care in a welcoming environment, given the wealth of insured patients created by the ACA. 

Both Houses of Congress will be in session this coming week. (honest!) A House appropriations subcommittee will consider OPM’s FY 2017 budget at a hearing tomorrow afternoon at 3 pm.

The Hill reports that early next month the Senate Health Education Labor and Pensions Committee will consider a bill to speed up approval of generic drugs at the Food and Drug Administation. A slow FDA approval has been identified as a principal cause of pricing spikes in generic drugs.

Modern Healthcare reports on AHIP’s recent healthcare policy conference. The FEHBlog got a kick out of this line from the article — “The ACA has encouraged the healthcare system to work more together to
reduce costs and improve clinical outcomes, but it has rarely led to
consensus on policies.” The next AHIP conference is the FEHBP carrier conference on March 31 and April 1 in beautiful Arlington VA. The FEHBlog will be there.

The legislation would establish grant programs to help state and local governments improve education and treatment for drug abuse, encourage medical providers to reduce unnecessary prescriptions, commit resources to help veterans deal with addiction, and give local law enforcement and mental health officials tools to lower the death rate from overdoses. A key provision would provide states with incentives to make naloxone, which can counteract overdoses, more widely available by offering liability protections to officials who distribute it. The bill’s fate in the House remains unclear.

Earlier this week, the Centers for Medicare and Medicaid Services unveiled “a public data set that provides information on services provided to Medicare beneficiaries by skilled nursing facilities (SNFs).  The Skilled Nursing Facility Utilization and Payment Public Use File (SNF PUF) contains information on utilization, payments, and submitted charges organized by provider, state, and resource utilization group (RUG).  The data include information on 15,055 skilled nursing facilities, over 2.5 million stays, and almost $27 billion in Medicare payments for 2013.”

On March 9, the Antitrust subcommittee of the Senate Judiciary Committee held an oversight hearing on the enforcement of antitrust laws. Fierce Health Payer reports that

While [Assistant Attorney General William] Baer was careful not to offer too many details about the DOJ’s pending investigation of the [Cigna / Anthem and Aetna / Humana] mergers, he did offer some clues about the factors the agency is taking into account as it conducts its review. In response to a question from Chuck Grassley (R-Iowa) about whether the DOJ will consider how the mergers affect consumers’ in-network provider choice, Baer noted that “If there’s a reduction in quality that results from a merger–even if there’s no price increase–that is a legitimate concern of merger enforcement both at the FTC and the antitrust division.”

CVS Health announced this week according to Fortune Magazine that the company will spend $50 million on efforts to reduce tobacco use in the U.S. over the coming years. As evidence of its focus on good health, CVS Health took tobacco products off its retail shelves last September which resulted in a $2 billion loss in sales.

The company said on Thursday it would provide funding over five years to leading anti-tobacco and youth-oriented programs with a view to further reducing tobacco use among young people, under the name “Be the First,” a reference to the goal of making today’s youth the first tobacco-free generation. Smoking rates have sharply declined over the past decade — from 20.9% of American adults in 2005 to 16.8% in 2014, according to the Centers for Disease Control and Prevention.

Let’s wrap the week up with a couple quick hits.

• Fierce Health Care offered an interesting review of studies on effective approaches to reducing hospital readmissions. 
• Fierce Health Finance reported that hospitals “throw out about $3 billion worth of oncology drugs each year unused.” The problem evidently stems from the fact that manufacturers put too much cancer medicine in a single use vial. 

Some drugs, such as bortezomib, used to treat multiple myeloma, comes only in 3.5 milligram vials in the United States, even though 2.5 milligrams is the standard dose. Some $309 million in annual sales are attributed to the discarded doses. But 1 milligram vials of the drug are available in the United Kingdom.

The study noted that not every cancer drug creates such a quandary of waste; bendamustine, which is used to treat leukemia, comes in a wide array of vials, which means that about 1 percent of that drug is wasted every year.

 

Whoops, I realized today that the Senate is in session this week. The Hill reports that the Senate is tearing apart the House’s mental health reform bill, which is a shame in the FEHBlog’s view. The House is out of town.

Stat reports on an HHS report on prescription drug spending which accompanied the Medicare Part B drug spending control initiative announcement yesterday. Needless to say cost curve up.  In this regard, Drug Channels discusses the top 15 speciality pharmacies here.

In a Benefits listserv message on Monday, OPM announced  at least to the FEHBlog’s surprise that

This Listserv is a follow up to BAL 14-205 dated April 14, 2014 and BAL 15-206 dated September 28, 2015, concerning the Federal Employees Health Benefits (FEHB) Program Family Member Audit).  BAL 15-206, advised that OPM contracted with HMS Federal Solutions to perform the audit.  The purpose of this ListServ is to inform you that the audit is postponed indefinitely.   OPM will notify the agencies when we are prepared to move forward.

Also on Monday, OPM awarded the FSA Feds administration contract to WageWorks. Presumably the change from ADP to WageWorks will take effect on 1-1-2017. Here is a link to the WageWorks press release.  

In other government contracting news, HHS gave a two year contract to Accenture for the purpose of establishing “a framework of best practices for the effective use of patient-generated health data (PGHD) [e.g. Fitbit results] in research and care delivery.” MobiHealth’s report on the contract adds that

The preference for remote doctor visits is increasing too: 29 percent said they prefer virtual visits to in-person ones with their doctors. That’s up from 24 percent in 2014. The benefits of remote visits are apparent to both consumers and doctors. Lower costs are one such benefit, according to 58 percent of consumers and 62 percent of doctors, while convenience is a benefit, according to 52 percent of consumers and 80 percent of docs. Timely access to care was cited as a benefit of virtual care by 42 percent of consumers and 49 percent of physicians.

The Washington Times reports that before heading out of town the Chairman and minority leader of the House Oversight and Government Affairs Committee sent a letter to the Senate asking the Senate approve the nomination of Beth Cobert to be OPM Director.

Yesterday, the Centers for Medicare and Medicaid Services announced a proposal to control drug costs in Medicare Part B.  Medicare Part B covers doctor administered drugs which tend to be more expensive that the drugs that patients pick up at the local pharmacy or receive by mail and self administer.  The Wall Street Journal reports that “the proposal is meeting stiff opposition from the pharmaceutical industry and some providers—especially cancer centers where many high-price specialty drugs are used—because of the proposed drop in reimbursement.”  This looks like another major cost shift from Medicare to the employer sponsored and exchange plans is brewing.  In this regard, and to reinforce an ongoing FEHBlog leitmotif, take a look at this AHIP Coverage article, “It’s not the cost of health care, it’s the price” that’s the problem. Also with regard to these Medicare intiatives, read this Health Data Management report from the HIMSS conference that health care providers are concerned about the pace of the shift to value based compensation.

Fierce Health Payer reports on an academic study published in Health Affairs cautioning insurers about the growing use of retail clinics typically based in pharmacies.  But as a practical matter what are insurers expected to do as the cat is out of the bag.

Modern Healthcare informs us that Health Affairs includes another study which estimates the high cost of provider reporting of quality measures — time that otherwise could be spent with patients.

Researchers at Weill Cornell Medical College in New York City teamed up with the Medical Group Management Association to put a price on the time providers spend to enter the data into the electronic health record, keep track of newly introduced measures and create protocols to track and report them.
The answer is about $15.4 billion a year, according to their study published Monday in the health policy journal Health Affairs.
That’s “a large amount of money being wasted on checking this box and that box,” said lead study author Dr. Lawrence Casalino, chief of the division of health policy and economics at the Weill Cornell Medical College in New York City. “It’s time physicians could spend on not rushing a patient, or thinking about a diagnosis more carefully.”

Congress is out of town this coming week. Here’s a link to the Week in Congress’s account of last week’s activities.

Speaking of last week’s activities, here’s a link to Healthcare IT News’ summary of major events at the HIMSS conference, which focuses on healthcare technology.

The New York Times offered an interesting piece on wellness programs this morning. The upshot of the article is that “adjusting people’s health insurance premiums is not a good way to motivate them to lose weight. Such incentives need to be designed better.” OPM is asking Congress for that authority.  The article discusses ways to craft effective programs with incentives that are separated from the insurace premiums.

Modern Healthcare reports on healthcare provider CEO reactions to healthcare mergers and acquisitions activity which has been brisk.

Although 72% of the surveyed healthcare leaders said they believe government scrutiny will grow regardless of who wins the White House, it won’t deter executives from pursuing transactions they deem beneficial. “The market forces, quite frankly, have been unleashed, [by the Affordable Care Act] and they are going to move regardless of what happens in the presidential election,” [one executive] said.

Like all Americans, Federal employees who plan to travel for business or personal reasons in the upcoming weeks and months may be understandably concerned. My advice is to visit the State Department and Centers for Disease Control and Prevention’s (CDC) Travelers’ Health websites for the most updated travel information. This CDC website also details preventive measures you can take to protect yourself against Zika if you do plan to travel to one of the affected areas. The locations with ongoing Zika virus transmission are likely to change over time, so be sure to check back to these websites before each trip you are planning to take.

Several years back, the New York Attorney General successfully took up the cudgel against health insurer use of the commonly used out of network fee “reasonable and customary” fee schedule then in use.  According to a Fierce Pharma report, that Attorney General now is tangling with health insurers over Hepatitis C drug coverage. The Attorney General believes that eligibility for the expensive drugs should include members who are in the chronic / asymptomatic as well as the acute / sympotomatic stage of the disease.

Unsurprisingly, the health insurance industry is not pleased about the recent probe. The New York AG’s subpoena “is overly broad and does not take into account evolving guidance related to these new therapeutic classes of drugs,” Leslie Moran, a spokeswoman for the industry group New York Health Plan Association, told the news outlet.  And some of the blame should be placed on drugmakers, rather than insurers, Moran said. The latest investigation “does not take into consideration the impact of excessive and unsupported pricing of these drugs–which has a negative impact on affordability of coverage,” Moran said, as quoted by Bloomberg.

The FEHBlog will be following this fight.

The FEHBlog is interested in genomic developments.  The Wall Street Journal this morning included an interesting opinion piece by two medical specialists titled “Genetics and Mental Illness – Let’s not get carried away.” It’s worth a read.  

Following up on Monday’s post about the final HHS 2017 benefits and payment parameter notice (to be published in the March 8 Federal Register), Prof. Tim Jost published three blog entries — here, here, and here where you can find out everything about this annual monster notice.  For FEHBP purposes, the key aspect of the notice is that the maximum out of pocket limits for group health plans in 2017 will be $7,150 for self only coverage and $14,300 for other than self only coverage. The current limits are $6,850 for self only coverage and $13,700 for other than self only coverage. Most of notice applies to the ACA marketplace plans.

The New York Times reports on the resurgence of HMO plans in the ACA marketplaces. The new HMOs typically feature lower cost sharing, no primary care gatekeeper to limit access to specialists, and a narrow provider network.

[P]atients must sacrifice choice for the promise of lower costs and managed care, whether the plan is called an H.M.O., an A.C.O. or a narrow network. Insurers are able to get low prices for care when they can offer doctors and hospitals a large volume of patients, and providers say they need to have more control over where their patients can get care if they are going to be responsible for costs and the long-term quality of care.

That’s a logical product of the ACA.

OPM’s call letter included several points on Rx benefits, including speciality drugs and medication adherence, Business Insurance lead me to this 2016 Pharmacy Benefit Management Institute Report on  Specialty Drugs (sponsored by Walgreen’s). If you want a copy, you’ll have to register with PBMI.  The FEHBlog nearly fell off his chair when he read on Medpage Today that

Getting physicians to focus on patients’ medication adherence may
result in more patients taking their medicines, but it does not
necessarily lead to improved health outcomes, a small pilot study has
found.

Wow.

Finally, Physicians’ Briefing reports that according to a New England Journal of Medicine study hospital readmissions are down since the ACA began imposing readmission penalties on hospitals. What’s more, “After implementation of the ACA there was no significant correlation between changes in observation-unit stays and readmissions, within hospitals.”

Because leap day gives us an extra workday this year, the FEHBlog decided to offer these quick hits:

• If you don’t feel like reading OPM’s call letter for 2017 benefit and rate proposals (last Friday’s post), you can read this Govexec.com article which hits the highlights. 
• The FEHBlog’s Workshare Comparison program broke when he tried to compare the current summary of benefits and coverage template against the newly proposed template.  It finally dawned on the FEHBlog that he should have checked out Timothy Jost’s blog which does break down the changes here.  
• HHS released a raftload of ACA related rules today. 
• The Dickson blog highlights several popular prescription drugs that will be eligible for generic competion this year. 

Congress will continue to be in session this week on Capitol Hill. The Week in Congress is back in action with an account of recent activities up there.  Drilling down a little, here’s a link to a Federal Times article about the House Oversight and Government Reform Committee hearing about the Obama Administration’s efforts to tighten security around goverment background check records. There’s a discussion of the Anthem data breach at the end of the article. The irony there of course is that the same Chinese hackers struck OPM and Anthem.

The ACA regulators, as promised, released a revised draft version of the summary of benefits and coverage that health plans must provide to their customers.  The ACA regulators expect health plans to use the new version in their next open season once it is finalized.  The FEHBlog noticed that the ACA regulators added another coverage example (a simple fracture) and made some happy to glad word changes. One wonders whether it’s worth the effort. The FEHBlog still does not understand why the law does not require health care providers to disclose the networks in which they participate to their patients.  The ACAburden always falls on the health plans.

The FEHBlog noticed a television advertisement today announcing that M&M candies will celebrate their 75th anniversary tomorrow. HIPAA will celebrate its 20th anniversary of its passage into law this September. Last week the HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules took a couple of actions discussed in this Fierce Health IT article.

HIPAA required HHS to adopt a patient identifier. Congress blocked funding for that initiative soon after enactment.  Healthcare Informatics offers thoughts and recommendations on the adoption of a patient safety identifier. Healthcare Data Management suggests that new credit card technology may save the day.  Some sort of patient identifier would simplify matters.

Health Grades issued its annual list of top 100 hospitals last week.  No hospital in the Washington DC metro area made the list.