The FEHBlog

Midweek Update

It’s another rainy night in Bethesda.

Fierce Pharma reports that “the U.S. has ordered 800 million doses [of various COVID-19 vaccines currently in phase 3 testing] for a country with a population of about 330 million, likely under the assumption that some vaccines won’t make it through clinical testing. The government is “assembling a broad portfolio of vaccines to increase the odds that we will have at least one safe, effective vaccine as soon as the end of this year,” HHS secretary Alex Azar said in a statement.”

The Wall Street Journal informs us that

Doctors, nursing homes and federal officials are scrambling to get rapid-response Covid-19 antigen testing supplies from the two companies that secured emergency approval to produce them, as cases continue to rise in the U.S.

Rapid-response antigen tests make up a small but growing area of Covid-19 testing in the U.S. and are seen as helpful in tamping down outbreaks because they offer faster results than many molecular tests that must be sent to labs for processing. The tests search for virus proteins while other tests look for the virus’s genetic material.

Quidel Corp. QDEL 4.36% and Becton Dickinson & Co., the only companies that so far have federal emergency authorization to supply such diagnostic tests, also make machines that process them. The boxlike test-analyzers, which before the pandemic processed tests for ailments such as the flu, are found in doctors’ offices and nursing homes, allowing facilities to avoid shipping samples to commercial labs for processing. They can deliver results in about 15 minutes and process dozens of samples an hour.

Quidel is struggling to produce enough analyzers to meet demand, while Becton Dickinson’s challenge is making enough tests, the companies say. * * *

Public health officials have raised some concerns that rapid antigen tests deliver false-negative results at a higher rate than other tests. But federal officials have said that, as these tests become more widespread, they appear equal in sensitivity to the more broadly used polymerase chain reaction diagnostic tests.

Perhaps Kodak can help (FEHBlog humor).

Fierce Healthcare lets us know that “According to the J.D. Power 2020 U.S. Pharmacy study, the expansion of pharmacy companies into the primary care realm has driven ‘significant increases in both satisfaction and consumer spending.'” On a related note, Forbes reports that “CVS Health is back on track with the rollout its new health hub concept to 1,500 stores across the U.S. within the next two years despite the continuing spread of the coronavirus strain Covid-19. CVS Health currently has 205 HealthHubs opened in 22 states. “CVS HealthHubs dedicate more than 20% of the store to health services that include new durable medical equipment, supplies and various new product and service combinations. CVS is adding thousands of new personal care items as well as additional services at its MinuteClinics in the HealthHub stores.”

The Centers for Medicare and Medicaid Services announced today its proposed national coverage decision that would allow local Medicare administrative contractors to make the initial decision on whether to cover an artificial heart or a ventricular assist device for Medicare beneficiaries with end stage heart disease. Currently the devices are treated as experimental treatments that CMS can cover on an exception basis. The CMS announcement explains that 6.5 million Americans “are living with heart failure.” A CMS decision whether or not to finalize the proposal will be made within 60 days following the end of the 30 day public comment period which began today.

Earlier this week the Centers for Disease Control announced their “Hear Her” campaign to reduce maternal mortality.

Over 700 women die each year in this country from problems related to pregnancy or delivery complications. Every death is a tragedy, especially when we know that two thirds of pregnancy-related deaths could be prevented. As many as 50,000 women experience severe, unexpected health problems related to pregnancy that may have long-term health consequences.

CDC’s Division of Reproductive Health is committed to healthy pregnancies and deliveries for every woman. The Hear Her campaign supports CDC’s efforts to prevent pregnancy-related deaths by sharing potentially life-saving messages about urgent warning signs.

Women know their own bodies better than anyone and can often tell when something does not feel right. The campaign seeks to encourage partners, friends, family, coworkers, and providers—anyone who supports pregnant and postpartum women—to really listen when she tells you something doesn’t feel right. Acting quickly could help save her life.

How true. This campaign deserves support from health plans as well as healthcare providers.

Tuesday Tidbits

The U.S. Office of Personnel Management today announced the companies that were awarded FEDVIP contracts for a seven year term beginning January 1, 2021. OPM added two new dental carriers — UnitedHealthCare (nationwide) and and HealthPartners (regional) for a total of twelve dental carriers. OPM added one new vision carrier — MetLife (all vision plans are nationwide) — for a total of five vision carriers beginning next year.

The Centers for Medicare and Medicaid Services announced an initiative to “transform rural health.” Healthcare Dive explains

CMS’s new payment model for rural hospitals and accountable care organizations that will use upfront and capitated payments. Participating facilities will be able to waive cost-sharing for Medicare Part B services, provide transportation for beneficiaries and expand telehealth services, among other flexibilities.

The Community Health Access and Rural Transformation model has two tracks, one of which is focused on ACOs. In the other track, $75 million will be provided to lead organizations in 15 rural communities, which will be announced early next year with a planned start of the model next summer.

The lead organizations, which can be state Medicaid agencies, local health departments or academic medical centers, among others, will receive $2 million after being accepted and another $3 million in upfront funding as the model progresses.

Fierce Healthcare discusses Teladoc’s acquisition of Livongo which was announced Wednesday August 5. “The combination of two of the largest publicly-traded virtual care companies announced Wednesday will create a health technology giant just as the demand for virtual care soars.” However,

Both companies’ stock dropped Wednesday after news of the deal broke. Teladoc’s stock was down 15% and Livongo’s stock also fell by 14%. As of Thursday, both companies’ stock was still trading lower.

Analysts say the total deal price of $158.99 per share represents a 10% premium over Livongo stock’s record closing price of $144.53 as of Aug. 5, leading to the market pushback on the high valuation.

The Drug Channels blog offers its useful annual update “on pricing at five of the largest pharmaceutical manufacturers—Eli Lilly, Janssen, Merck, Novartis, and Sanofi.” Drug Channels finds that

Average discounts from [prescription drug manufacturer] list prices have been deepening.Merck’s average discount rate went from -41% in 2016 to -44% in 2019, while Lilly’s rate went from -50% to -57%. We estimate that in 2019, the total value of gross-to-net reductions for brand-name drugs was $175 billion. That figure has doubled over the past six years.

In other encouraging news, STAT News tells us about an experimental drug to treat coronaviruses like COVID-19.

A research team at the University of California, San Francisco, has synthesized a molecule that they say is among the most potent anti-coronavirus compounds tested in a lab to date. Called nanobodies because they are about a quarter of the size of antibodies found in people and most other animals, these molecules can nestle into the nooks and crannies of proteins to block viruses from attaching to and infecting cells.
The lab-made one created by the UCSF team is so stable it can be converted into a dry powder and aerosolized, meaning it would be much easier to administer than Covid-19 treatments being developed using human monoclonal antibodies. While the work is still very preliminary, the goal is to deliver the synthetic nanobody via simple inhaled sprays to the nose or lungs, allowing it to potentially be self-administered and used prophylactically against Covid-19 — if it’s shown safe and effective in both animal tests and clinical trials.

Let’s go. This my friends is the difference between 1918 and 2020. We must have faith in medical research.

Finally the FEHBlog’s favorite podcast EconTalk provided a timely insight into Shakespeare’s Romeo and Juliet in this week’s episode. Journalist and author Ben Cohen talked about his book, The Hot Hand, with EconTalk host Russ Roberts. The Hot Hand concerns streaks. and Shakespeare wrote three of his most popular plays, including Romeo and Juliet, from 1605-1606 when London was suffering from the plague. What’s more,

The reason why Romeo doesn’t know that Juliet has taken this potion and that she is simply sleeping and not actually dead is because this whole harebrained scheme had not been explained to him because he never gets the [explantory] letter [that a messenger was tasked to bring him].

So, if you think about it, it’s really a bonkers plot line. The flyer says, ‘I will–Juliet, take this sleeping potion, it will knock you out. Your family will think you’re dead. When they think you’re dead, Romeo is going to come back and he’s going to sweep you away and take you and live happily ever after.’

Now, this is the stuff that like you wouldn’t even see on a reality show or some terrible soap opera now. And yet, it’s our most famous love story.

And so, why does it fall apart? She takes the sleeping potion, right? She gets knocked out. Her family thinks she’s dead. Romeo comes back and sees her in the open crypt. All of the crazy stuff [Romeo and then Juliet committing suicide] actually turns out–where the whole scheme falls apart–is simply on getting a letter to Romeo. And it falls apart because the plague is sweeping through and the messenger gets stuck in quarantine.

So, all of this is the plague.

Now that’s a 1605 twist that rings true nearly 400 years later.

Monday Roundup

The Washington Examiner reports that the House Majority Leader announced today that the House, which currently is in recess, will be in session for three weeks beginning September 14 (unless required to address COVID emergency relief legislation). Beginning no later than October 2, the House will recess for the November 3 election. The House will commence a lame duck session on November 13. A short term continuing resolution to fund the federal government past September 30 is looking like a sure thing.

Healthcare Dive informs us that the large for profit hospital chains, like the large health insurers, are reporting profitable second quarter results.

“[Federal relief funding for healthcare providers in] The CARES Act was instrumental ensuring we did not have a financial crisis while we were fighting the pandemic crisis,” Tenet CEO Ron Rittenmeyer said during last week’s earnings call with investors. A similar story emerged among Tenet’s competitors — volume plunged but profits did not.

Today, the Department of Health and Human Services made public all of the State COVID-19 testing plans through the end of 2020, which have received HHS oversight.

A multidisciplinary team of experts from HHS has completed a technical review for each jurisdictions’ plan to ensure that it is sufficient to mitigate the spread of the virus, protect vulnerable groups, and account for adequate testing supplies and reagents to reach jurisdiction testing goals. The review panel, chaired by the HHS Assistant Secretary for Health, includes subject matter experts from the Laboratory and Diagnostics Task Force within the Office of Assistant Secretary for Health, the National Institutes of Health (NIH), CDC, and other agencies. The panel also reviews state testing progress, needs assessment, and plans on a monthly basis to determine if modifications are required or additional assistance is needed. Modifications may be necessary if patterns of virus transmission change or are projected to change, case rates increase or additional types of testing and inventory of tests and reagents become available through the Rapid Acceleration of Diagnostics (RADx) program at NIH or other sources.

In healthcare award news —

  • Fierce Health announced its choices of most influential minority healthcare executives. The award winner from the health insurance sector is AHIP’s Chief Operation Officer John Matthewson.
  • A friend of the FEHBlog pointed out that “The American Hospital Association (AHA) [on July 27, 2020] announced that it will honor five programs with the AHA Dick Davidson NOVA Award for their hospital-led collaborative efforts that improve community health. The winning programs are Eagle Valley Behavioral Health, Vail Health, Vail, Colo.; Hackensack Meridian School of Medicine at Seton Hall University, Edison, N.J.; Supportive Housing for the Homeless, Baltimore City Hospitals, Baltimore; Healthy Roanoke Valley, Carilion Clinic, Roanoke, Va.; and Mothers in Recovery, Memorial Healthcare System, Hollywood, Fla.

Congratulations to all of the award winners.

The FEHBlog recently noted that the federal government had awarded a large business loan to Kodak to uses its chemical expertise on drug manufacturing. Today the FEHBlog read in Fierce Pharma that the loan has been put on hold due to Congressional and SEC investigations.

Weekend update

The House and Senate are on State / district work breaks until after Labor Day which is September 7 this year. On Friday the President issued three executive memoranda on 1) Student loan payment relief, (2) assistance to renters and homeowners, (3) deferring payroll tax obligations and one executive order on additional unemployment assistance. All of the actions are related to the COVID-19 emergency. The Wall Street Journal discusses what’s in and not in these executive actions. Legal beagle details on the actions can be found at the Volokh Conspiracy blog. Congress can change these actions at its discretion by enacting a law.

The Wall Street Journal article explains that

Mr. Trump directed the Treasury Department to defer the 6.2% Social Security tax on wages for employees making less than about $100,000 a year. That suspension would last from Sept. 1 through Dec. 31.  If employers stop withholding those taxes, the move would deliver an increase in take-home pay just as Mr. Trump is running for re-election but also create a looming liability in 2021 because the taxes would still be due eventually. Mr. Trump said he would press Congress to turn the deferral into an actual tax cut.

The FEHBlog was wrong about Congress and the White House reaching a compromise on a new COVID-19 relief bill before the August recess. He was also wrong in expecting the Senate to approve the OPM Inspector General nomination before the August recess. Consequently, at this time, the FEHBlog does not plan to bet real dollars “on the come” against future Congressional action approving the tax cut. Let Congress act first.

It is worth noting that this is the traditional week in which FEHB benefit and rate negotiations conclude. Historically (by which the FEHBlog means a long time ago), OPM would announce the next year’s government contribution change shortly after Labor Day. For the past decade, that announcement has not been made until much later in September. But things are moving along.

Federal News Network offers its perspective on OPM’s interim final paid parental leave regulation. The public comment deadline is September 9, 2020.

If you have a spare hour, listen to this past week’s EconTalk episode in which “John Kay and Mervyn King talk about their book, Radical Uncertainty, with EconTalk host Russ Roberts. This is a wide-ranging discussion based on the book looking at rationality, decision-making under uncertainty, and the economists’ view of the world.” The three economists have useful perspectives on the application of statistical modeling to the COVID-19 emergency. (If you have a spare 15 minutes you can read the transcript (lower right hand side of the website, and in fairness although I read a lot of the books that are discussed on EconTalk, I won’t read this one because I don’t have a Ph.D in economics. If you want a fascinating book to read check out A.J. Baime’s recent book on the 1948 U.S. Presidential election. The FEHBlog by the way is a big admirer of Harry Truman.)

Friday Stats and More

Based on the CDC’s Cases in the U.S. website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 20th through 31st weeks of this year (beginning May 14 and ending August 5; using Thursday as the first day of the week in order to facilitate this weekly update):

and here is the CDC’s latest chart of weekly rates per 100,000 of COVID-19 hospitalizations without regard to age:

The CDC’s weekly surveillance summary states that

Nationally, levels of influenza-like illness (ILI) are below baseline but higher than typically seen at this time of year. Indicators that track ILI and COVID-19-like illness (CLI) showed decreases nationally from week 30 to week 31, with decreasing or stable (change of ≤ 0.1%) levels in all regions of the country. Nationally, the percentage of laboratory tests positive for SARS-CoV-2 decreased from week 30 to week 31 and decreased in nine of ten HHS regions.

As of today’s CDC report the nation has experienced nearly 4.9 million cases of COVID-19 and 158,887 COVID-19 related deaths this year.

Kaiser Health News reports that two COVID-19 vaccine developers are having no problem recruiting 60,000 Americans to test their still experimental vaccines. One of the vaccines in the third and final phase of trials is made by Pfizer and BioNTech, a German company, and the other by biotech startup Moderna with support from NIH.

The Wall Street Journal reports tonight that the latest round of COVID-19 relief bill negotiations today was unsuccessful.

It wasn’t known whether negotiations could later resume, potentially among a different constellation of leaders. Both Mr. McConnell and Mr. Trump haven’t been in the room for the past two weeks of talks. Mrs. Pelosi said Democrats weren’t interested in peeling off a short-term extension of just the federal unemployment insurance, as Republicans had proposed in the closed-doors negotiations. One possibility is that the debate over coronavirus aid gets merged with discussions expected in September about keeping the government running when its current funding expires on Oct. 1.

In the meantime, we may see executive orders from the White House.

The Federal Times reports on the U.S. Postal Service’s second quarter financial results. “Though revenue for the first three quarters of 2020 is $553 million greater than for the same period in 2019, due in part to a strong increase in package volume, the agency continues to report significant losses of $2.2 billion in the third quarter of this year compared to a net loss of $2.3 billion for the same quarter last year.”

In healthcare news –

  • HHS’s Agency for Healthcare Research and Quality has issued a timely Brief on Telediagnosis for Acute Care: Implications for the Quality and Safety of Diagnosis. The Director of AHRQ’s Center for Quality Improvement and Patient Safety observed that “The use of telemedicine is growing at the same time it is evolving rapidly. These changes will make the healthcare ecosystem increasingly reliant on telemedicine for several aspects of care, including diagnosis. Now is the time for the research community to come together and help ensure telemedicine is as safe and effective as possible.”
  • MedCity News reports that an eight year old primary care company, Oak Street Health, has successfully issued public shares of stock in its business. “Oak Street [which is based in Chicago] currently operates in nine states, striking value-based care agreements to care for Medicare and Medicare Advantage patients. That model has helped Oak Street where many primary care clinics have struggled as in-person visits have dropped during the Covid-19 pandemic. More than 97% of its revenue is tied to value-based contracts, according to its prospectus.” Good luck.

Thursday Miscellany

The Wall Street Journal reports that

White House chief of staff Mark Meadows and Treasury Secretary Steven Mnuchin said Wednesday that if they don’t reach a deal by Friday with Mrs. Pelosi and Senate Minority Leader Chuck Schumer (D., N.Y.), they saw little point in continuing the daily negotiating sessions they have been conducting for nearly two weeks.

The quartet was expected to meet again early Thursday evening.

Democrats said Thursday that the slow pace of progress in the talks stems from a central clash over how much assistance the federal government should provide.

The President has stated that he plans to issue executive orders providing COVID-19 emergency relief if a compromise is reached.

Today the President signed an executive order directing administrative action to “reduce our dependence on foreign manufacturers for Essential Medicines, Medical Countermeasures, and Critical Inputs to ensure sufficient and reliable long-term domestic production of these products, to minimize potential shortages, and to mobilize our Nation’s Public Health Industrial Base to respond to these threats.” That seems sensible. Here’s a link to a Wall Street Journal article on the executive order. The Journal explains that “The order seeks to reverse the practice in recent decades of moving drug manufacturing outside of the U.S. That shift is partly because of more favorable tax rates, cheaper labor and friendlier environmental regulations, industry officials say.”

On the miscellany front —

  • The Federal Times reports that the U.S. Office of Personnel Management is poised to publish an interim final rule implementing the new paid parental leave program for federal employees. The program takes effect on October 1, 2020, and the interim final rule will be published in the Federal Register on August 10, 2020.

The act enables federal employees to substitute 12 weeks of paid leave for the same amount of time of unpaid leave authorized under the Family and Medical Leave Act of 1993.

But not all of the circumstances covered by unpaid leave apply to the new paid leave provisions.

Federal employees covered by the act may only take paid parental leave after the birth or placement of a child and may only do so within a 12-month window of that birth or placement.

  • Health Payer Intelligence reports on a Blue Cross study discussing payer strategies to improve sagging colorectal cancer screening rates in our country. OPM scores FEHB plans on the NCQA’s HEDIS measure for this preventive care measure. The article explains

“A major barrier to preventative screening is attitudinal – stemming from misperceptions surrounding discomfort, lack of risk awareness, and general fear of negative results,” [BCBSA Vice President Reed] Melton said. “Payers can start by working to change those perceptions and provide accurate, accessible resources to better inform the public.”

Payers can act on the information that this report unveiled by making colorectal cancer information—including screening information and other data—available to members online. This is a strategy that many Blue Cross and Blue Shield companies are already implementing.

  • Last week the FEHBlog called attention to successful COVID-19 vaccine tests performed on monkeys. One group of monkeys was given the experimental vaccine and the other group wasn’t. However, both groups were exposed to COVID-19 which increases the reliability of the testing. A friend of the FEHBlog shared a link to the 1 Day Sooner site. 1 Day Sooner proposes that human volunteers engage in the same type of testing which are known as challenge trials. ” Human challenge trials deliberately expose participants to infection, in order to study diseases and test vaccines or treatments. They have been used for influenza, malaria, typhoid, dengue fever, and cholera. Researchers are exploring whether human challenge trials could speed up the development of a vaccine for COVID-19, saving thousands or even millions of lives.” Who knew? Certainly gutsy. In any event, the FEHBlog shares a monkey’s picture today in gratitude to their efforts to protect fellow primates.

Midweek Update

The Wall Street Journal reports this evening that “White House and Democratic negotiators emerged frustrated from their [latest COVID-19 relief bill} meeting Wednesday. White House officials said Democrats were dragging their feet on talks, and Democrats countered that Republicans were thinking too small.” “Absent an agreement [by this Friday, [Treasury Secretary Steven] Mnuchin said, “We’ll have to look at the president taking actions under his executive authority.”

On the vaccine front —

  • Kaiser Health News reports that obese people are less responsive to vaccines than other folks. ” Dr. Timothy Garvey, an endocrinologist and director of diabetes research at the University of Alabama, was among those who stressed that, despite the lingering questions, it’s still safer for obese people to get vaccinated than not. “The influenza vaccine still works in patients with obesity, but just not as well,” Garvey said. “We still want them to get vaccinated.” FEHBP plans typically offer effective coaching problems to help plan members with weight reduction.
  • On the brighter side, the Wall Street Journal reports that “Researchers and companies developing Covid-19 vaccines are taking new steps to tackle a longtime challenge: Those who need the vaccines most urgently, including Black and Latino people, are least likely to participate in clinical trials to determine whether they work safely.” Health plans may be able to offer support here to researchers.

Publicly traded healthcare companies have been report second quarter results recently. Healthcare Dive reports that “All of the nation’s largest insurers, Anthem, Centene, Cigna, Molina, UnitedHealth Group (which operates UnitedHealthcare) and CVS (which owns Aetna), all reported a surge in second quarter profits due to lower medical usage among members.” To the extent that these profits stem from health insurance premiums, the ACA’s requirement that health insurers rebate premium income when they fall below the minimum medical loss ratio threshold (80% for individual coverage and 85% for group coverage) is designed to prevent excess profits.

  • For more details on second quarter results CVS Health and Humana reported today. Becker’s Hospital Review inform us about other major insurer results here.

Forbes advises us that according to a recent study, deferral of care during the great hunkering down in March and April caused a concerning drop in new cancer diagnoses. “This report demonstrates that our initial response to the pandemic of limiting so-called elective screening and diagnostic tests has consequences,” said Craig Bunnell, MD, Dana-Farber Cancer Institute Chief Medical Officer. “The true incidence of these cancers did not drop. The decline clearly represents a delay in making the diagnoses, and delays matter with cancer,” Bunnell added. But physicians are keen to stress that for symptoms that cannot wait such as anything which might indicate cancer, people must not hesitate to seek medical care, despite the pandemic. “We need to safely perform these diagnostic tests and the public needs to not think of them as optional. Their lives could depend on them,” said Bunnell.

How true. Becker’s Hospital Review provides additional perspective on this issue by publishing a Census Bureau ranking of the states by the estimated percentage of deferred care due to the COVID-19 emergency.

Nationwide, 40 percent of Americans are still delaying care, according to a survey from the U.S. Census Bureau. The agency launched its Household Pulse Survey April 23, polling roughly 1 million Americans weekly on how the pandemic is affecting their household. Over the past 12 weeks, the percentage of U.S. adults delaying care has hovered around 40 percent with little fluctuation.

Finally, there was a big healthcare industry transaction announced today. STAT reports that “telemedicine provider Teladoc Health has reached an agreement to buy the diabetes coaching company Livongo in an $18.5 billion deal.” Both companies are publicly traded. The Wall Street Journal explains that

Under the deal, each share of Livongo will be exchanged for 0.5920 shares of Teladoc, plus cash consideration of $11.33 for each Livongo share. Upon completion of the merger, existing Teladoc shareholders will own 58% of the combined company, and existing Livongo shareholders will own 42%. The transaction is expected to close by the end of this year.

Tuesday Tidbits

The Wall Street Journal reports tonight that “White House negotiators said they aim to reach a deal with Democrats on a new coronavirus-relief package by the end of the week, with both sides saying they made progress in talks to bridge differences in unemployment payments and other aid proposals.” It’s hard to believe that a new law will not come out of these talks next week as it is a Presidential and Congressional election year.

The Journal also informs us that

The National Institutes of Health on Tuesday said it is launching wide-ranging studies of potential Covid-19 drugs known as monoclonal antibodies, the synthetic targeted versions of proteins produced by recovered Covid-19 patients.

The potential drugs that emerge from the research could be among the foremost medical treatments to prevent or treat infections with the new coronavirus while the U.S. and world await possible vaccines. Anthony S. Fauci, who heads the NIH institute overseeing the work, said monoclonal antibodies have great potential because they are specifically designed to block the virus from infecting a human cell.

Also on the COVID-19 front, the FEHBlog today ran across this handy CDC site full of varying U.S. map perspectives on the COVID-19 emergency. Check it out.

Promptly following up on the President’s executive order issued yesterday concerning rural healthcare access and telehealth, the Centers for Medicare and Medicaid Services has issued proposed rules that would implement significant aspects of the order. As part of this proposed rules package, CMS issued its proposed 2021 calendar year update to the Medicare Part B physician fee schedule. Here are Fierce Healthcare and Healthcare Dive articles on these actions.

Health Affairs alerts us that “Provider consolidation into vertically integrated health systems increased from 2016 to 2018. More than half of US physicians and 72 percent of hospitals were affiliated with one of 637 health systems in 2018. For-profit and church-operated systems had the largest increases in system size, driven in part by a large number of system mergers and acquisitions.” Check out this statistic — “the share of primary care physicians affiliated with vertically integrated health systems increased from 38 percent to 49 percent, or 11 percentage points, from 2016 to 2018.” This statistic is bound to keep growing as Baby Boomer physicians retire.

Since the NCQA Digital Quality Summit last month, the FEHBlog floated the idea of adding racial, ethnic, and gender identification to the ICD-10 as a way to help identify and address healthcare disparities. He notes that those codes could be added to the Z section of the ICD-10. It’s worth adding that SDOH considerations (which are not the same as racial disparity considerations) are already found in the Z section, e.g. , Z56 , Z59, and Z62 .

Monday Roundup

The Wall Street Journal reports tonight that the Democratic House leadership and the White House are cautiously optimistic about achieving a compromise COVID-19 relief bill this week. The negotiations continue tomorrow.

The FEHBlog listened to the oral argument this afternoon over the Whitman-Walker Clinic’s motion for a preliminary injunction to stay the upcoming effective date of the newly revised HHS rule implementing the ACA’s individual non-discrimination clause, Section 1557. The Court focused the parties’ attention on the Constitutionally required standing of the Clinic and its co-plaintiffs to bring the case and the justiciability of the issue. The Court allowed the government defendants to submit a brief responding to the new case law support that the plaintiffs raised at the oral argument. That brief is due on August 10 a week before the rule takes effect on August 18. Associational standing is a complicated issue.

The President today signed a wide ranging executive order on improving rural health and telehealth access. Speaking of executive orders, Health Payer Intelligence reports that America’s Health Insurance Plan’s recently criticized the President’s recent executive order against pharmacy rebating practices because “Nothing in the proposed rule would require Big Pharma to lower their prices,” the payer organization stated, referring to the rebate rule. “Instead, it undermines competitive negotiations – a misguided approach that makes the problem of out-of-control drug prices worse.” That is indeed the rub.

On the COVID-19 front,

  • Fierce Biotech reports that “Eli Lilly has started a phase 3 trial to evaluate whether its antibody LY-CoV555 stops the residents of nursing homes from developing COVID-19. Lilly has created customized mobile research units to run the clinical trial at nursing homes as the long-term care facilities lack experience running studies.”
  • The FEHBlog’s dogs requested that after all of his compliments to the monkey community last week he should point out that a German study has found that specially trained dogs may be able smell the COVID-19 virus in saliva or other human bodily discharges.

In other healthcare news —

  • Healthcare Finance reports that the second House appropriations minibus appropriations bill passed last Friday includes a provision that would permit the government to fund work on the develop and promulgation of the HIPAA patient identifier rule.
  • Forbes reports that

Health insurer Humana said [last Wednesday July 29] it is investing $100 million in the in-home primary care company, Heal, to bring in-person physician “house calls and one-touch medicine” to seniors in its Medicare Advantage plans. Heal is a fast-growing startup company that offers primary care house calls on-demand and has delivered more than 200,000 home visits in the company’s first five years in eight U.S. markets. Heal’s services also include telemedicine, telepsychology and related digital monitoring services, which Humana says will be key for its elderly health plan subscribers.

  • Health Payer Intelligence informs us today that in reaction to CMS’s decision to open Medicare Advantage to Medicare beneficiaries under age 65 suffering from end stage renal (kidney) disease “Humana will be partnering with a chronic kidney disease management and awareness organization to provide home healthcare and care coordination to Medicare Advantage members. * * * The payer is partnering with REACH Kidney Care, a nonprofit affiliate of Dialysis Clinic, Inc., in order to provide better kidney care services in Alabama, North Carolina, South Carolina, and Tennessee.”

Weekend Update

The House of Representatives has joined the Senate in deciding to conduct legislative and committee business at least through the end of this week as Congress seeks to reach a compromise with the White House on another COVID-19 emergency relief bill. reports that on Friday July 31 the House passed its second minimus appropriations bill (HR 7617) which includes financial services and general government appropriations for the next government fiscal year that begins on October 1, 2020. Surprisingly, the bill defers to the President on setting the civil service raise for the 2021 calendar year. The President has stated his plan to give the civil service a 1% increase across the board (meaning no increase in locality pay). The military is expected to receive a 3% increase in its pay for 2021.

Tomorrow at 2 pm Eastern, Federal District Court Judge James E. Boasberg will hear oral argument over the Whitman-Walker Clinic’s motion for a preliminary injunction to stay the upcoming effective date for the recently revised Health and Human Services Department final rule implementing the Affordable Care Act’s individual non-discrimination provision, Section 1557. The FEHBlog discovered on Friday that the public can call into listen to the hearing, and he will be doing so (as long as his schedule permits).

In other litigation news, Healthcare Dive reports that the U.S. Court of Appeals for the District of Columbia Circuit handed the American Hospital Association its second recent loss on Friday July 31. The Court upheld an CMS Medicare drug pricing rule affecting hospitals. “The 2-1 ruling overturns a district court decision that HHS overstepped its bounds when it cut the reimbursement rate for a certain category of outpatient drugs by 28.5% for hospitals enrolled in the 340B drug discount program.”

What’s more –

  • reports on large scale COVID-19 clinical tests which the National Institutes of Health is supporting. Fingers crossed.
  • NPR Shots discusses the importance of manufacturing transparent masks for protections against COVID-19:

At least one company — ClearMask, based in Baltimore — has gone so far as to seek and earn FDA “clearance” that its mask with a transparent panel is “substantially equivalent” to a medical-grade surgical mask for hospitals and other front-line uses. ClearMask’s founder and CEO Aaron Hsu says it took three years of research and development to develop a clear material that won’t fog up. “For a lot of children communication is nonverbal,” says Hsu. “Being able to see who we’re talking to is fundamental to how we communicate and connect.” [Of course the transparent masks also are helpful to disabled people who rely on lipreading and the elderly.] The company was started in 2017, he says, by four Johns Hopkins University students who identified the need for a niche medical product for deaf people. But now its appeal has gone global.”

  • Healio reports on the American Thoracic Society’s updated guidelines on smoking cessation which rely heavily on Pfizer’s Chantix / varenicline treatment over patches or bupropion. “Clinicians can begin varenicline treatment in tobacco-dependent adults who are not ready to discontinue tobacco use rather than waiting until they are ready to stop (strong recommendation).”
Our firm is closely monitoring the impacts of COVID-19. Effective 6/08/20, Ermer & Suter has reopened its physical offices for business, however for the continued safety of our staff, in-office capacity will not exceed 40%. We remain fully operational and are readily available from both our office and telework locations.