• I think that this is really cool. A researcher has developed a drug that may allow radiation therapy to kill cancer cells without harming the healthy cells. According to MedHeadlines,
  

  The trick is apoptosis, or cellular suicide. When healthy cells are exposed to radiation, even at doses that produce damage than can be repaired, they instead do what seems to be suicide. The cells in the bone marrow and gastrointestinal (GI) tract are particularly vulnerable. Cancer cells, however, use various means of blocking apoptosis, enabling cancerous tumors to grow. One way they block cellular suicide is by activating a signaling pathway known as NFKB, or nuclear factor-KappaB. By imitating this tumor trick, Andrei Gudkov and his team of colleagues affiliated with the Roswell Park Cancer Institute ,were able to block apoptosis in healthy tissue by introducing flagellin, a protein made from bacteria in the GI tract, to activate the NFKB pathway. They then administered their flagellin-based experimental drug on rhesus monkeys and mice before exposing the animals to full-body, lethal doses of radiation, similar to what might be received during a widespread nuclear emergency. The drug was administered 15 minutes to one hour before radiation exposure. The remarkable result of this experimental trickery was protection of the animals’ bone marrow and GI tracts from destruction typically caused by radiation, and with no no observable side effects. What is even more exciting is that the cancerous tumors were killed, as desired, by the radiation treatment.

  I do believe that medical breakthroughs like this will be keep on coming due to the groundwork laid be basic research, such as the Human Genome Project.

• Speaking of cool, I visited Nationals Park this week. Great ballpark, great food, very easy to reach by Metro (similar to the Verizon Center). Hopefully, our team will achieve greatness in time.

• On April 2, OPM Director Linda Springer testified about her agency’s fiscal year 2009 budget before a House appropriations subcommittee. Director Springer had the following remarks about the FEHB Program:
  

  As the administrator of the FEHBP, OPM will continue to negotiate and contract with private insurance companies that offer a broad range of health insurance benefits, including high-deductible health plans with Health Savings Accounts and consumer-driven health plan options. As such, OPM will spend $26 million in FY 2009 to ensure the viability of the Program’s 283 health care plans covering over 8 million people. As usual, OPM will continue to carry out tough negotiations with health carriers to contain premium hikes. Over the years these negotiations have resulted in employee premiums that are substantially lower than those of the private sector while maintaining benefit levels, and continuing to provide, improve, and expand tools so customers can make informed health insurance decisions. In fact, the FEHBP increase for 2008 was 2.1 percent, compared to an average 8.7 percent increase for the private sector and a 6.3 percent increase for the California Public Employees’ Retirement System during that same year.

• The Chairman of the Senate Finance Committee, Sen. Max Baucus (D Mont) reportedly plans to send Medicare legislation directly to the Senate floor without a Committee markup. This is the bill that would avoid a 10% cut in Medicare reimbursement to physicians currently scheduled for July 1, 2008. The bill would not rely on Medicare Advantage payment cuts to cover bill’s costs according to ModernHealthcare.com.

• The Blue Cross Blue Shield Association has released its 2008 Medical Cost Reference Guide.

• The press has picked up on a debate over the level of charity care provided by non-profit hospitals here and here.

• The Burlington Free Press reports that the Vermont legislature is planning to tax health plan claim payments — 0.12 percent of the medical claims paid by a health insurer in a quarter — in order to provide electronic health record implementation grants to doctors. The FEHB Act, 5 USC § 8909(f), preempts the imposition of such taxes, fees, etc. on FEHB plans.

Vytorin a Schering Plough prescription drugs which combines the now generic Zocor with Schering Plough’s Zetia, has come under fire this week following the release of a study at the American College of Cariology’s annual conference this week concluding that Vytorin is no more effective in reducing plaque in neck arteries than Zocor alone. Indeed the Wall Street Journal reports today that “Schering-Plough Corp. announced a plan to cut costs by $1.5 billion by 2012, after a panel of cardiologists called for doctors to limit use of the company’s blockbuster cholesterol drugs and sent its stock down nearly 29%.”

The New Jersey Star Ledger reports that an FDA medical policy official warns that patients on cholesterol medication should be wary about abandoning treatment.

“(A)n aspect of the current discussion that troubles me greatly is the implication in some stories that we’re not so sure anymore that even lowering cholesterol with statins is all that clearly beneficial,” Robert Temple, medical policy director for the FDA’s Center for Drug Evaluation and Research, told the web site. [That’s what I took away from reading a recent BusinessWeek article on statins, but I’m not an MD.] “As the recent Crestor story reminds us (for people without known cardiac disease, by the way) we sure do know it is beneficial and people who need that treatment will pay with their lives if they’re encouraged to avoid treatment.” Temple also said he hasn’t drawn any conclusions about the purported ineffectiveness of Vytorin, also known as ezetimibe, and said the agency will likely take six months to review new data about the drug.

The New York Times reports that UnitedHealth Group is recommending — in line with the FDA official’s comments — that its members who have Vytorin prescriptions remain on the drug because it presents no safety issues. CNNMoney reports that Cigna adjusted its drug coverage in response to the study. “The Philadelphia health insurer said it was immediately suspending part of a program that notified members using certain other cholesterol drugs that Vytorin was an effective and less costly alternative. The program, known as ‘step therapy,’ is an effort to help health plans control drug costs.” Similar to UnitedHealthcare, “Cigna will continue to pay for Vytorin prescriptions, and the insurer stressed that no one should discontinue any therapy without first talking to a doctor.”

• Taking a page out of Medicare’s playbook, Wellpoint, the Nation’s largest health insurer by membership, has announced that it is rolling out an in-network claims policy to exclude coverage of expenses caused by eleven preventable medical errors designated by CMS and the National Quality Council. Wellpoint’s policy will prevent network providers from balancing billing patients for these expenses. (Several states hospital associations have agreed not to charge patients or insurers for never events.) Wellpoint plans to expand the never events over time. The Indianapolis Star quotes Debora Spano, spokeswoman for Minnesota-based UnitedHealthcare as follows: “We continue to evaluate the new Medicare policies and how they may be applied to best meet the needs of our members.”
• The Centers for Medicare and Medicaid Services (CMS) published a final rule setting standard for voluntary electronic prescribing by doctors serving Medicare patients. According to CMS’s press release, “The rule adopts four standards for use in e-prescribing effective April 1, 2009:
  

  Formulary and benefits: This standard will allow doctors and other prescribers to communicate with Part D sponsors about which drugs are covered by a Medicare eligible individual’s prescription drug benefit plan. Prescribers can also learn which generic prescription drugs might offer lower-cost options for the individual.

  Medication history: This standard will allow doctors and other providers, as well as dispensers and Part D sponsors, to communicate among themselves about prescribed medications a beneficiary has taken or is taking, including those prescribed by other providers. This information can help reduce the number of adverse drug events that result from drugs negatively interacting with other drugs a beneficiary is already taking, and can ensure that the doctor or other prescriber has the necessary information about a beneficiary’s current prescription medications.

  Fill status notification: This standard will allow doctors and other providers to receive an electronic notice from the pharmacy or other dispenser telling them that a patient’s prescription has been picked up, not picked up, or has been partially filled. These notifications can help health care providers monitor patients with chronic conditions, such as diabetes or hypertension, by providing an indicator as to whether they are taking their medicines.

  Provider identifier: The final rule requires providers, dispensers, and Part D sponsors to use the National Provider Identifier (NPI) to identify individual health care providers in Part D e‑prescribing transactions. Adoption of the NPI will speed workflows by eliminating call-backs by pharmacies to medical offices to verify the identity of individual prescribers.”

  The Chair of the AMA’s Board of Trustees encourages doctors in this week’s AMA News to take the lead in e-prescribing.

• Meanwhile, Cigna closed earlier this week on its acquisition of Great-West Healthcare. According to Cigna’s press release, “The transaction includes 1.9 million covered lives, including approximately 1.4 million medical members in its employer segment.”

The American Imaging Management (“AIM”), a Wellpoint subsidiary, has created an innovative web site that advises patients about the amount of radiation that they will receive from specific CT, PET scans and other nuclear medicine tests. For instance, I had a sinus CT last year. According to this site, that’s the equivalent of 100 chest x-rays or half a year of sunlight. This site also suggests alternatives, such as endoscopy in my case. The AMA News published an article critical of the website:

Some doctors said they suspect AIM could be trying to create doubt in patients’ minds about the safety of tests to save money for its health plan clients, and they aren’t comfortable with what they see as interference with the doctor-patient relationship.
Aimee isn’t giving accurate and complete data, the doctors said, because the Web site doesn’t allow for variance in equipment, or patient gender, age or weight. It doesn’t give users a full risk-benefit analysis of a diagnostic test. “This is not a service to anyone,” said Richard L. Morin, PhD, chair of the American College of Radiology Safety Committee.

The medical authorities quoted in the article would support an “unbiased” website. The Center for Studying Health System Change issued a brief on this issue titled Health Plans Target Advanced Imaging Services: Cost, Quality and Safety Concerns Prompt Renewed Oversight in February.

• OPM released its annual federal employee survey results for 2007. The FEHB Program was well received by about 2/3s of respondents.
• HHS unveiled an upgrade to its Hospital Compare website.  According to the HHS press release,  “In addition to adding the new information from Medicare patients about their hospital stays [from the HCAHPS survey], CMS is adding information about the number of certain elective hospital procedures provided to those patients and what Medicare pays for those services.  For the first time, consumers have the three critical elements — quality information, patient satisfaction survey information, and pricing information for specific procedures — they need to make effective decisions about the quality and value of the health care available to them through local hospitals.  It’s important to know that Hospital Care reports quality results on hospital care to all of its patients and not just Medicare patients.
• Business Week reports that Blue Cross of South Carolina is contracting with foreign hospitals such as the Bumrungrad Hospital in Thailand in order to serve American health plan members who engage in medical tourism.  Business Week further reports that “Last year, “65,000 Americans went to Bumrungrad for in-patient or outpatient treatment, up from just 10,000 in 2001. And of those 65,000, about half of them were U.S. residents who flew across the Pacific to Thailand for medical care. (The others were American expatriates living in Thailand or other parts of Southeast Asia.)”
•  Govexec.com reported that “The Office of the Coordinator of Health Information Technology “plans to integrate the [National Health Information Network] with the health care databases that Google and Microsoft launched last year, on which individuals can store their health records.  [ONCHIT]  plans this year to expand its Nationwide Health Information Network to also include electronic health records stored in networks operated by the departments of Defense and Veterans Affairs, and the Indian Health Service, and integrated health care systems that span numerous communities.” 

• Modern Healthcare.com reports that AHRQ released its 2007 State Snapshots “which are individual looks at every state and the District of Columbia, include 149 separate measures of quality, 20 more than last year’s 129 measures. The analysis also has a new feature to track state progress on meeting federal goals through the Healthy People 2010 initiative.” Minnesota and Wisconsin lead the pack.
• The Medicare Trustees issued another dire report about Medicare Program funding or the lack thereof as reported in the New York Times. The Secretary of HHS blogs about the issue here. Medicare Part A funds are expected to run out in 2019 just before I become eligible for Medicare. USA Today reports that Pete Stark, D-Calif. said: “Reports of Medicare’s death have been greatly exaggerated.”

Happy Easter!

• OPM has published the 2009 call letter here. The Federal Times and Govexec.com both featured articles on the call letter last week. NARFE issued a press release about the call letter’s request for FEHB plan proposals for sub-options to cover Medicare eligible annuitants. In the press release, NARFE’s President Margaret Baptiste states that
  

  “While OPM says that enrollees in the Medicare pilot “sub-option” would pay the same premiums set for their counterpart FEHBP plans, we are troubled that a plan specifically created for Medicare-eligible federal annuitants could open the door for separately rated retiree plans in the future with substantially higher premiums than other FEHBP plans,” . “In the 48 year history of the program, there has never been a separate FEHBP plan based on retirement status or age.”

  In fact all FEHB fee for service plans offer Medicare eligible annuitants reductions in deductibles, coinsurance, and copayments if they are enrolled in Medicare. Consequently, in my opinion, OPM’s request is not a sea change and it simply seeks to take advantage of Medicare and tax law provisions that can benefit annuitants who are enrolled in both the FEHB Program and Medicare.

• Modern Healthcare.com featured an article written by an executive of the Depository Trust and Clearinghouse Co. He explains that
  

  The National Securities Clearing Corp. and Depository Trust Co. were created in the 1970s to fulfill the vision of an industry-owned and industry-governed utility to fully automate the back-office environment for the post-trade processing of securities transactions and settlement of money owed. The Depository Trust & Clearing Corp., the corporate parent of NSCC and DTC last year settled in excess of $1.8 quadrillion in securities transactions.

  Since the Depository Trust & Clearing Corp. operates solely for the benefit of its users on an “at cost” basis—fees are charged only to cover the cost of running its operations and any profit gained through centralized processing is returned to customers ($984 million in 2007).

  Creating something called the Health Care Clearing Corp., or HCCC, modeled on the successful experience of the financial services industry could be a significant step forward in cutting healthcare costs. * * * An HCCC would operate like the hub of a wheel with spokes electronically linking all medical-service providers and all health insurance companies to a central point where data can be processed and exchanged. The HCCC would eliminate the need for medical-service providers and insurance companies to manage separate procedures and processes to submit claims. And, by bringing about standardization in data exchange and record-keeping, you would speed the payment of claims.

• The OPM AHIP carrier conference featured presentations on health disparities. The New York Times published a story on a recent federal government report finding a growing gap in life expectancy in the U.S. between high and low income groups.
  

  Robert E. Moffit, director of the Center for Health Policy Studies at the conservative Heritage Foundation, said one reason for the growing disparities might be “a very significant gap in health literacy” — what people know about diet, exercise and healthy lifestyles. Middle-class and upper-income people have greater access to the huge amounts of health information on the Internet, Mr. Moffit said.Thomas P. Miller, a health economist at the American Enterprise Institute, agreed.“People with more education tend to have a longer time horizon,” Mr. Miller said. “They are more likely to look at the long-term consequences of their health behavior. They are more assertive in seeking out treatments and more likely to adhere to treatment advice from physicians.” [Mr. Miller’s article on reducing health disparities is here.]
  A recent study by Ellen R. Meara, a health economist at Harvard Medical School, found that in the 1980s and 1990s, “virtually all gains in life expectancy occurred among highly educated groups.” [The New York Times also published an article this week on the public health risks created by growing number of parents who refuse to have their children vaccinated.]
  Trends in smoking explain a large part of the widening gap, she said in an article this month in the journal Health Affairs.

OPM kicked off the new FEHB Program year by publicly issuing its call letter for 2009benefit and rate proposals at the annual carrier conference this week. Steve Barr of the Washington Post published a column about the call letter today. My partner Scott Jamison was at the carrier conference today. Scott summarized the comments of OPM representatives about the call letter, which has not yet been posted on OPM’s web site

• OPM wants plans to incent their enrollees to seek clinically effective care. OPM singled out disease managements programs as a good example of the kind of thing it was looking for. OPM expects carriers in their benefit and rate proposals to project the return on investments they expect from such design change, which I understand to be easier said than done.
• OPM is asking plans to design “suboptions” for Medicare eligible annuitants that are simple, transparent and, voluntary. The suboptions should to incent annuitants to enroll in Medicare Parts B, C, and/or D.
• OPM generally will not accept benefit increases without offsetting reductions. However, OPM will accept, within reason, additional costs for plans to enhance their coverage of hearing-related services for adults (item 3).
• OPM also asked plans to consider durable medical equipment coverage for hi-tech assistive devices that would facilitate communication, but expects any such enhancements in this area to be cost-neutral.
• OPM will continue to “reward” carriers for their health information technology efforts by publicizing the ones making the greatest strides in this area on its website, and indicated that, as in past years, a carrier letter requesting information on this initiative would be forthcoming.

Carriers must submit their 2009 benefit and rate proposals by the end of May 2008. Negotiations then ensue over the proposals. Those negotiations conclude in mid-August 2008, followed by the production of 2009 plan brochures and the Open Season for 2009 enrollment which runs from early November through early December 2008.

The plaintiffs and First Databank presented a revised class action settlement agreement to the court yesterday in the Average Wholesale Price (AWP)-fixing case. The agreement, if approved by the court, would require First Databank to pay $1 million into a settlement fund for injured consumers. The third party payer (TPP) class, which paid most of the freight, would get bumpkus. The agreement also would require First Databank to adjust the AWP on 1356 national drug codes (NDC) listed in Exhibit A to the third amended complaint. The original settlement agreement provided for a reduction to 8400 NDCs and no settlement fund. First Databank also will pay $160,000 of the plaintiff’s expert expenses plus up to $985,000 in plaintiffs’ attorneys fees.The court also certified a class action against McKesson, the non-settling party in this case. According to the allegations of the complaint, McKesson and First Databank unlawfully agreed to increase the wholesale average cost to AWP markup from 1.20 to 1.25. The court certified a TPP class and a consumer class. The TPP class is certified for damages from 8/1/2001 through 12/31/2003 for the purpose of damages and from 8/1/2001 through 5/15/2005 for the purposes of liability and equitable relief. The consumer class is certified from 8/1/2001 through 5/15/2005 for all purposes. The Court will hear McKesson’s dispositive motion next month.