Congress remains in session on Capitol Hill this week.  Last Friday, the health subcommittee of the House Energy and Commerce Committee held a hearing on the topic of mental health parity.  The Hill reports on the hearing here.

Robert Pear wrote in the New York Times this morning about Dartmouth’s decision to withdraw its accountable care organization from the Medicare Advantage program.

An evaluation for the federal government found that Dartmouth’s accountable care organization had reduced Medicare spending on hospital stays, medical procedures, imaging and tests. And it achieved goals for the quality of care. But it was still subject to financial penalties because it did not meet money-saving benchmarks set by federal officials.
“We were cutting costs and saving money and then paying a penalty on top of that,” said Dr. Robert A. Greene, an executive vice president of the Dartmouth-Hitchcock health system. “We would have loved to stay in the federal program, but it was just not sustainable.”

In contrast to the private sector, the Medicare program, whose governing laws resemble the Internal Revenue Code in complexity, is not very nimble. It concerns the FEHBlog that red tape generated by the Affordable Care Act and federal government procurement regulators could create similar difficulties for the FEHBP.  

The New York Times also reported last week on efforts by prescription benefits manager Express Script to control the spiralling costs of anti-inflammatory drugs.

Insurers and employers — who pay the bulk of the cost for drugs — say that a bigger financial shock has come from a largely overlooked source: expensive anti-inflammatory medications like Humira and Enbrel, drugs taken by millions of people for conditions like rheumatoid arthritis. In recent years, the prices of the medications have doubled, making them the costliest drug class in the country by some calculations. 

Now, one of the most powerful forces on the side of drug payers is pushing back. On Thursday, Express Scripts, the nation’s largest drug benefits manager, changed its recommendations to insurers and employers, saying they should cover fewer drugs for many inflammatory conditions. The idea is that the new limits will force drug companies to lower their prices, saving insurers and employers money.

No doubt other PBMs are taking similar steps.

Here’s a link to the Week in Congress’s report on this week’s activities on Capitol Hill.  The Hill reports that the House leadership found a good Republican caucus reception to the idea of passing a continuing resolution until December 9 in order to pass small blocks of appropriations or minibuses in a lame duck session rather than an omnibus. This is in line with the Senate majoritty leadership approach.

In big news for doctors, the CMS Acting Administrator announced yesterday four options for participating in the new Medicare quality improvement program next year without incurring a penalty.  The announcement was well received by the medical associations.

Healthcare Dive reports on an AMA study finding that doctors spend more time with their electronic medical record systems than with their patients. That’s $34 billion in taxpayer money shot down the train on a rush to implement these systems.

Also on the waste front, Fierce Healthcare reports that

• “Hospitals use their chargemasters and a relative lack of price transparency to overcharge for CT scans and other specialty services,” and
• “A study by researchers at the University of California at San Francisco, published in the Journal of Neurosurgery, examined 58 neurosurgeries performed at their own facility. They discovered that nearly $1,000 in medical supplies on average were discarded with every surgical procedure.”

The Hill reports on efforts to get an omnibus appropriations bill done so Congress can get back on the campaign trail. “Senate Republicans are defending 24 seats, and McConnell is in great
danger of being demoted to minority leader in the next Congress. That
has created an incentive to finish work on a funding bill quickly so
that vulnerable senators can return to their home states to campaign.”  The Senate is considering a bill that would fund the government until December 9 while some House members want to fund the government through March in order to avoid a lame duck session.  The House Speaker is meeting with his caucus on Friday.

Federal News Radio and FCW, among others, report on a flurry of reports on the OPM data breach that came out this week. The majority staff of the House Oversight and Government Reform Committee issued a detailed report. The executive summary in particular is worth reading.  The minority staff and the OPM director responded to the majority staff report.

On the business consolidation front —

•     Modern Healthcare reports on an Avalere Health study finding that 

In 2012, about one in seven physician practices were owned by a hospital. In mid-2015, one in four medical practices, or 67,000 practices, were owned by hospitals. 

The report also found that in the same three-year period, physicians employed by hospitals increased by 50%. In 2015, about 140,000 physicians were employed by hospitals or systems, a rise from the 95,000 physicians who were employed by hospitals in 2012. Overall, about 38% of physicians in the U.S. are employed by a hospital or system, according to the report. 

• Drug Channels analyzes a new business arrangement between the Walgreens Pharmacy chain and Prime Therapeutics, a prescription benefit manager owned by 14 non-profit Blue Cross licensees.  

Congress returns to Capitol Hill tomorrow. The current federal fiscal year ends on September 30, and Congress goes out on the campaign trail just about at the same time.  

On Wednesday, the White House announced, according to Federal News Radio, that “Civilian employees will receive an across-the-board raise of 1 percent, with an additional 0.6 percent adjusted in locality pay” next year.

Here are a few quick hits to tide you over the long Labor Day Weekend:

• The Washington Post offered another story in its series on the state of women’s health in America.
• The CDC issued an updated obesity prevalance map for the U.S. and the Robert Wood Johnson Foundation issued another report on childhood obesity in our country.
• Medical Dive has an interesting story about why U.S. hospitals are missing the medical tourism boat and another about common consumer uses of telemedicine according to a new Deloitte report.  

The FEHBlog also was pleased to read that Business Insurance ahs a new owner and his subscription will be restored.  Every penny counts.

Note: As a result of some Blogger goof my last Weekend Update was not timely posted. So now it appears after the Midweek Update but it continues to have fresh info.

Congress remains engaged in its home work period through the Labor Day weekend.

OPM’s once in a blue moon Federal Employees Group Life Insurance Program open season starts on Thursday September 1 and runs through the end of this month.  Although an FEHBP open season change starts a few weeks after the decision is made, FEGLI open season changes won’t take effect until October 1, 2017.  Check FEHB plan websites for non-FEGLI life insurance options available to federal employees. For example. GEHA rolled out a set of ancillary benefit offerings earlier this month.

The Wall Street Journal offers five things to know about U.S. healthcare spending.  In contrast to private sector employers which have been funnelling their employees into high deductible plans with health savings accounts, the FEHBP offers a wide range of PPO, HMO, and other models including these consumer driven plans.  Consequently, a smaller percentage of federal employees participate in the consumer driven plans compared to the private sector.

The Office of Personnel Management (“OPM”) issued two FEHBP-related proposed rules this week.  The FEHBlog discusses the first proposed rule, which concerns extension of FEHB coverage while an employee is on leave without pay, in this Govexec.com article. In short, the proposed rule permits agencies to require LWOP employees to pay as they go for FEHBP coverage except in certain circumstance such as Family and Medical Leave or workers compensation. A friend of the FEHBlog pointed out to him that “The USPS has had a process in place for many years that automatically bills for the employee share of FEHB premiums after an employee has been in LWOP for six pay periods [/ twelve weeks].” That’s a sensible approach.

Today, OPM promulgated proposed rules governing the ACA created program that makes FEHBP coverage available to Native American tribal employers.  OPM rolled out this program a few years ago relying on subregulatory guidance.  A major difference between the federal employee program and the tribal employee program is that

Section 890.1417 [of the proposed rules] states that an FEHB enrollment cannot be continued into retirement from employment with a tribal employer. This is a statutory requirement as the law entitles tribal employers to purchase FEHB for employees but it does not extend that entitlement to permit tribal employers to purchase FEHB for retirees.

The public comments deadline for both proposed rules is Halloween, October 31, 2016.

Earlier this week the Health and Human Services Department issued its proposed 2018 Notice of Benefit and Payment Parameters, a major annual ACA issuance.  Professor Timothy Jost requires two articles in the Health Affairs Blog to discuss it.  If you are glutton for punishment here is a link to the notice which will be published in the Federal Register on September 6.  As noted in CMS’s three page long fact sheet on the notice,

Annual Limitation on Cost Sharing: The maximum annual limitation on [in-network] cost sharing [for group health plans other than high deductible plans with health savings accounts] is the product of the dollar limit for calendar year 2014 ($6,350 for self-only coverage) and the premium adjustment percentage for 2018, rounded down to the next lower $50. We are proposing a maximum annual limitation on cost sharing for 2018 of $7,350 for individual coverage and $14,700 for family coverage.

A friend called my attention to the fact that next Wednesday August 31 is the deadline for submitting comments to the Labor Department’s mental health parity task force.  The FEHBlog will provide his comments to you.  The national mental health parity law requires health plans to separate our mental health and substance abuse benefits so that they can be compared to medical and surgical benefits. The FEHBlog’s suggestion is to end the benefits siloing (simply cover hospitalizations and office visits for all diagnoses just the way that prescription drugs are covered now) and focus instead on network adequacy for all providers, including mental health providers.

Here’s a link to a Blue Cross report on caesarian deliveries which happily finds that

While geographic disparities exist, the data found a consistent decline in the national rate of cesarean births reversing a 20-year trend of increasing rates. During a five-year period between July 2010 and June 2015, the cesarean rate decreased slightly each year within the Blue Cross and Blue Shield (BCBS) member population, to 33.7 percent from 35.2 percent. The 1.5 percentage point decrease in cesarean deliveries represents approximately 36,000 more vaginal births than expected during the five-year study period. 

The FEHBlog also was happy to read that the Surgeon General has “sent a letter to 2.3 million American health professionals, asking them
to lead a national movement to turn the tide on the nation’s
prescription opioid epidemic.”   The letter also included a copy of the CDC’s pocket guide on prescribing opioids.

On the not so bright side, the Federal Times reports on the growing prospect for a jump in 2017 Medicare Part B premiums for CSRS annuitants (absent Congressional action).

This is the 2001st post in the over 10 year history of the FEHBlog.

Fedsmith.com helpfully has provided links to Federal Benefits Open Season materials that OPM circulated to other government agencies last week. The FAQs are particularly worth a gander.

FYI, the Labor Department’s Employee Benefits Security Administration, which enforces ERISA, has refreshed its website. Another ERISA website worth monitoring is the National Association of Insurance Commissioners’ ERISA Working Group which recently posted ERISA Handbook revisions.

Health IT Security.com reports that HHS’s Office for Civil Rights, which enforces HIPAA’s Privacy and Security Rules, is implementing this month “an initiative to better investigate smaller data breaches. The data breach investigation process will look further into the root causes of incidents affecting fewer than 500 individuals, according to OCR.”  The national data breach rule requires annual reporting of these “smaller” breaches (within 60 days following the end of the year in which the breach occurred). Larger “incidents” must be reported within 60 days following discovery.

In an encouraging development related to the opioid abuse epidemic in the U.S. the Food and Drug Administration last week approved an innovative opioid:

Pfizer’s (NYSE:PFE) abuse-deterrent TROXYCA ER (oxycodone hydrochloride and naltrexone hydrochloride) are extended-release capsules for the management of pain severe enough to require around-the-clock long-term opioid treatment and for which alternative treatment options are inadequate.The product is formulated in pellets with a core of sequestered naltrexone hydrochloride, an opioid antagonist, surrounded by the pain medication oxycodone hydrochloride. When taken as directed, the naltrexone remains sequestered while the patient receives extended-release oxycodone. When the pellets are crushed, naltrexone is released which counteracts the effects of the opioid.

Finally, Prof. Timothy Jost from the Health Affairs blog reports on a lawsuit that a group of States and private organizations filed in a Texas federal court today in an effort to block the onerous HHS non-discrimination in HHS funded health programs rule implementing Public Health Service Act Section 1557.   The FEHBlog will be keeping an eye on this lawsuit.

The Washington Post has another article today on the health problems afflicting rural Americans.  This article concerns McCreary County, Kentucky.

Over the last 15 years, McCreary County has seen a 75 percent increase in the mortality rate for white women between the ages of 35 and 59, one of the highest increases in the nation, according to a Washington Post analysis of national mortality rates. The analysis also showed that the mortality rate for similarly aged white women nationally increased 23 percent; for white men increased 16 percent; for black women decreased 10 percent; for black men decreased 20 percent; for Hispanic women decreased 11 percent; and for Hispanic men decreased 16 percent.

Strangely, this series of lengthy articles generally does not dig into the problems or suggest solutions.   The FEHBlog suggests that time is better spent reading Hillbilly Elegy by J.D. Vance.

The Wall Street Journal attributes the rapid increase in ransomware crime to better encryption (which criminals seem to use more than others) and more widespread use of Bitcoin.

The Federal Bureau of Investigation said ransomware attacks cost victims $209 million in the first three months of the year, including costs, such as lost productivity and staff time to recover files, that is an average of about $333,000 an incident, based on complaints that it has received. The total is up from $24 million for all of 2015, or about $10,000 an infection, the FBI said. * * *

Ransomware is deviously simple. Often after tricking the victim into clicking on a malicious link or attachment, the software then encrypts files—often targeting Microsoft Office documents—and displays a message with instructions to recover them. A ransomware maker who calls himself “The Rainmaker” offers a $39 version of his software on hacker forums. A Microsoft spokesman said, “We are committed to helping protect our customers, and Office includes features to help prevent macro-malware infections.” 

Many ransomware attacks exploit known bugs in software, and attackers depend on people not installing updates. Criminals find ransomware easier and more profitable than other scams, such as breaking into consumers’ computers and stealing money via online banking, said Juan Andres Guerrero-Saade, a researcher with Kaspersky Lab ZAO. 

What a mess.