OPM reminds us that today is dedicated to efforts to improve heart health. The FEHBlog had no idea.

Yesterday, OPM acting director Beth Cobert had her confirmation hearing before the Senate Homeland Security and Governmental Affairs Committee. Everyone on the Committee and the FEHBlog agrees that Ms. Cobert is well qualified for this position. Nevertheless, the Federal Times explains that there are five issues hounding her nomination to serve as permanent OPM direction. The FEHBP is not one of them.

Also the House Government Reform and Oversight Committee held a hearing on prescription drug pricing. Health Data Management offers this interesting perspective on the causes of rising prescription drug spending.  The article identifies electronic prescription devices, which Congress mandated, as one cause.

In other legislative news  –

• The Hill suggests that Sen. Tom Carper’s Postal reform bill called iPOST may get enacted this year. The bill would create a Postal Service Health Program within the FEHBP.  
• Healthcare Dive reports on a bipartisan bill to expand coverage of everyone’s darling, telehealth. 
• The Week in Congress provides its look back on this week’s activities on Capitol Hill. 

Tomorrow at 10 am the Senate Homeland Security and Governmental Affairs Committee will hold a hearing on the President’s nomination of Beth Cobert to serve as permanent OPM Director. Ms. Cobert currently is the acting Director.  Roll Call is reporting that Sen. David Vitter (R MI) may exercise his privilege to place a hold on Ms. Cobert’s nomination until the agency furnishes him requested information about the OPM rule permitting members of Congress and their staffs to enroll for DC SHOP coverage with a government contribution.

Federal News Radio reports that yesterday OPM’s long standing Inspector General Patrick McFarland announced his retirement as of February 19.  His deputy Norbert Vint will serve as acting OPM Inspector General after that date.  Inspector Generals are nominated by the President.

Yesterday as the Hill reports the House of Representatives was unable to achieve the 2/3s majority vote required to override the President’s veto of the reconciliation measure repealing key parts of the ACA.  Repeal now becomes an issue for the Presidential election.

On the health care cost front, the Altarum Institute released its monthly health care sector report for January 2016

Health care prices grew by 1.1% in 2015, the slowest annual rate ever in our historical series going back to 1990
• The historically low 1.1% growth in health care prices in 2015 was heavily influenced by physician prices, which actually fell by 1%; and more generally by economy-wide inflation, which, at 1.0% in 2015 (as measured by the gross domestic product deflator), barely exceeds the 0.8% rate seen in 2009, the last year of the recession.
• Prescription drug prices grew by 4.6% overall in 2015, but the rate of growth declined over the course of the year, from a peak of 5.5% in Q1 to a low of 3.2% in Q4 2015.

As part of the FEHBlog’s ongoing efforts to place the Zika virus in perspective, here’s a link to an article about the particular mosquito which spreads the virus as well as Yellow Fever and dengue fever. It’s a bad mammer jammer. Just don’t leave any standing water if you live along the Eastern Seaboard (up to NYC or so).

Both Houses of Congress are in session this week as the snow continues to melt here in the D.C. metropolitan area.  At 9 a.m. on Thursday February 4 the full House Oversight and Government Reform Committee will hold an oversight hearing on developments in the prescription drug market. An hour later the Senate Homeland Security and Governmental Affairs Commitee will hold a confirmation hearing on the President’s nomination of Beth Cobert to be permanent OPM Director. 

The spotlight has shifted from provider reliability to patient outcomes — the improvement of which is, after all, the real goal of health care. This means the goal of performance analysis is not to judge providers, but instead to assess what is happening to the health of their patients. And if the answer to that question is “Not much,” clinicians have some explaining to do.

Whatever happened to personal responsibility?

The snow continues to melt and a warming trend begins tomorrow.  That’s good news.

On the bad news front, the New York Times ran an investigative piece this morning on drug shortages afflicting hospitals and the Federal Times tells us that the GAO is concerned the the federal government’s multi billion dollar Einstein data protection system is still not up to snuff.

On the too early to tell front, the Centers for Medicare and Medicaid Services announced today

[proposed] rules, as required by the Medicare Access and CHIP Reauthorization Act (MACRA), will allow organizations approved as qualified entities to confidentially share or sell analyses of Medicare and private sector claims data to providers, employers, and other groups who can use the data to support improved care. In addition, qualified entities will be allowed to provide or sell claims data to providers.

The qualified entity program was authorized by Section 10332 of the Affordable Care Act and allows organizations that meet certain qualifications to access to patient-protected Medicare data to produce public reports. Qualified entities must combine the Medicare data with other claims data (e.g., private payer data) to produce quality reports that are representative of how providers and suppliers are performing across multiple payers, for example Medicare, Medicaid, or various commercial payers. Currently, 13 organizations have applied and received approval to be a qualified entity.  Of these organizations, two have completed public reporting while the other 11 are preparing for public reporting. 

Finally the Drug Channels Institute produced a list of the top 15 U.S. pharmacies by dispensing revenues. The top three are CVS/Caremark (22.8%), Walgreen’s (14.9%), and Express Scripts (11%). The top 15 pharmacies generate 73.4% of the total dispensing revenue — $364.1 billion. That’s a lot of dough.

Modern Healthcare published an article yesterday contending that Sen. Tom Carper’s postal reform bill would “push” Postal Service annuitants aged 65 and older into Medicare. Hey Modern Healthcare, those annuitants already are in Medicare for the most part.  Senator Carper’s bill would better integrate FEHBP with Medicare, which is an objective that OPM shares.  It’s not punitive, and the savings would benefit the Postal Service and Postal service employees and annuitants.

Govexec.com is reporting that the Obama Administration is mobilizing to stop the spread of the Zika virus.  The University of Connecticut, the FEHBlog’s alma mater, offered an illuminating article this morning concerning that virus which has “dengue fever like symptoms.

Should people be worried?
Once Brazilian officials learned about the link between Zika virus and microcephaly, they took the unprecedented action of advising women in the most affected areas to avoid or delay pregnancy. The Brazilian outbreak has now spread to a number of countries in South and Central America, including the Caribbean, and more recently, Mexico, and thus cases of microcephaly in these areas are also likely to start rising in the next few months. Even in Brazil, as infected pregnant mothers continue to reach full term, these numbers are expected to increase. That has led the Centers for Disease Control (CDC) to recently issue travel advisories to the countries battling the outbreak. So at this very moment, unless you have traveled or are planning to travel to these areas while pregnant, you should not be worried. 

Do you see Zika becoming widespread in the U.S.? If so, how soon?
In the U.S., a dozen cases of human infection have been reported, but so far they have all been acquired abroad. The potential for what we call autochthonous, or local, transmission exists, because the Aedes mosquitos that are required to transmit the virus are present in the U.S., particularly in the southeast. Locally acquired cases of Zika virus infection have been reported in Mexico and Puerto Rico, so the potential for active transmission in the U.S., particularly as summer approaches, is real. The World Health Organization (WHO) now estimates that all countries in the Americas, with the exception of continental Chile and Canada, where Aedes mosquitos are not found, will likely have outbreaks. As an example, Hawaii is currently battling an outbreak of dengue fever in the Big Island transmitted by Aedes mosquitos. But in general, any outbreaks in the U.S. will be restricted to areas where Aedes mosquitos are found, and careful surveillance, vector control, and other preventive practices such as use of insect repellent, should minimize their effects.

Snowzilla pushed back Beth Cobert’s confirmation hearing before the Senate Homeland and Governmental Affairs Committee to next Thursday February 4 at 10 am.  

Well the weather forecasters were correct on this snow storm. It was a doozy as evidenced by the backyard of the FEHBlog’s house this morning.

The federal government is shutdown tomorrow. The House of Representatives is punting all votes to next week and the Senate is holding off on votes until Wednesday. It is not clear whether or not Ms. Cobert’s confirmation hearing will be held as scheduled on Tuesday. Here’s a link to the Hill’s article on the hearing.

The FEHBlog nearly fell out his breakfast nook when he read this Wall Street Journal article yesterday. Due to overuse of antiobiotics, medical reseachers are turning to an old school cure called bateriophages.

Little known among doctors in the West, phages have been part of the antibacteria arsenal in countries of the former Soviet Union for decades. Doctors in the U.S. and much of Europe stopped using phages to fight bacteria when penicillin and other antibiotics were introduced in the 1940s. Now, though, Western scientists are turning back to this Stalin-era cure to help curb the dramatic growth of bacterial resistance to antibiotics.

Heavens knows what the drug manufacturers will charge for this specialty drug.

The Washington Post’s Capital Weather Gang has nicknamed the ongoing winter storm Snowzilla so the FEHBlog will go with that moniker. The snow started early afternoon today and is expected to continue until early Sunday morning.

Earlier today,  OPM announced a number of administation reforms to its personnel background check process in reaction to the massive breach of background check records last year.  A new OPM unit will continue to manage the process while the Defense Department will operate the information technology systems. Here’s a link to a Govexec article with reactions to the announcement.

Yesterday the Senate Homeland Security and Governmental Reform Committee held a postal reform hearing. A Federal News Radio account of the hearing can be found here.  The Committee’s ranking minority member, Sen. Tom Carper from Delaware, has been pushing postal reform legislation. With respect to health benefits, Sen. Carper observed in his opening statement that

The most important of these provisions [which the Committee has debated over the years”] address health care costs at the Postal Service, and the fact that the agency is the single largest payer into Medicare yet can’t get full value from the program. I’ve put forward legislation both last year with our former colleague Dr. Coburn and this year with Senators McCaskill, Moran, and Blunt that would allow the Postal Service to do what private business do when they coordinate their retiree health plans with Medicare.  This has the potential to virtually eliminate the unfunded liability for retiree health benefits and save the Postal Service $32 billion over 10 years.

Carper’s iPOST bill would create a Postal Service Health Program within the FEHBP. The PSHP would be fully integrated with Medicare as the Senator indicates.

The FEHBlog also noticed on the Committee’s website that on January 26 at 10 am (assuming Snowzilla does not interfere) the Committee will be holding a hearing on the President’s nomination of Beth Cobert to be the permanent OPM director.

The weather forecasters here in DC are predicting a big snowstorm for the weekend. Preparing for the storm can be more disruptive than the storm itself.  In any event,  following up on a couple of items mentioned recently in the FEHBlog:

• Health Care IT News reports on HHS’s effort to provide more details on its plans to transition the meaningful use program which the medical community detests to a new program “focused on care” rather than electronic medical record clicks. 
• HHS announced reductions in the number of special event that allow people to enroll in ACA exchange plans outside of the ACA Open Season which ends  on January 31.  
• Senate leadership announced its plans to pass several “small bore” bills in lieu of the House’s titantic 21st Century Cures Act. The FEHBlog certainly favors small bore legislation as a general rule. 

Simply increasing a deductible, which gives enrollees skin in the game, appears insufficient to facilitate price shopping. Members of HDHP and traditional plans are equally likely to price shop for medical care, and they hold similar attitudes about health care prices and quality. Despite considerable focus on increasing price transparency, HDHP enrollees express interest in greater access to health care price information.

Healer heal thyself. It’s up to the medical community to provide more price transparency.  

The Senate will be in session on Capitol Hill this week following the holiday while the House of Representatives is hold a district work week.

Here are a few insightful pieces to consider:

• A Wall Street Journal article blames humanity for cybersecurity problems. 

“History has shown us we aren’t going to win this [cybersecurity] war by changing human behavior. But maybe we can build systems that are so locked down that humans lose the ability to make dumb mistakes. Until we gain the ability to upgrade the human brain, it’s the only way.”

• Kaiser Health News reports that the Affordable Care Act is spurring the development of  new markets, e.g., ACA, Medicare, Medicaid, for a form of concierge medicine known as “direct primary care.” 

“In direct primary care, patients pay about $100 a month or less directly to the physician for comprehensive primary care, including basic medication, lab tests and follow-up visits in person, over email and by phone. The idea is that doctors, who no longer have to wade through heaps of insurance paperwork, can focus on treating patients. They spend less on overhead, driving costs down. In turn, physicians say they can give care that’s more personal and convenient than in traditional practices.

“The 2010 health law, which requires that most people have insurance, identifies direct primary care as an acceptable option. Because it doesn’t cover specialists or emergencies, consumers need a high-deductible health plan as well. Still, the combined cost of the monthly fee and that plan is often still cheaper than traditional insurance.

“The health law’s language was “sort of [an] ‘open-for-business’ sign,” said Jay Keese, a lobbyist who heads the Direct Primary Care Coalition. Before 2010, between six and 20 direct primary care practices existed across the country. Now, there are more than 400 group practices.”

•  Modern Healthcare in response to the President’s State of the Union call for a cure to cancer reports on the state of cancer research.  Good read.