FEHBlog

Tuesday’s Tidbits

David Ermer–AHRQ, CDC, Congress, COVID-19, Rx coverage, U.S. Healthcare–
Photo by Patrick Fore on Unsplash

From Washington, DC, the House Rules Committee held a four-hour hearing on the debt ceiling compromise bill (HR 3746) this afternoon. The Wall Street Journal adds

“House Republican leaders projected confidence Tuesday that the debt-ceiling deal struck with President Biden would draw enough support to pass, while some conservative lawmakers angrily denounced the agreement.

“The bill advanced (7-6 vote) past a closely watched procedural hurdle in the Rules Committee late Tuesday, and a final House vote is expected as soon as Wednesday night. While the bill appears on track to gain sufficient Republican and Democratic votes to pass the House and then the Senate by the June 5 deadline, it could still run into procedural obstacles, complicating the race to avoid an unprecedented default.”

From the public health front —

  • The University of Minnesota informs us
    • “[As of last Friday] the two main metrics that the Centers for Disease Control and Prevention (CDC) uses to track US COVID-19 activity—hospitalizations and deaths—continue to decline, according to the latest data. Hospitalizations for COVID are down 11% compared to a week ago, and deaths from the virus are down 13.3%.
    • “The hospitalization map, which reflects activity by county, replaces the CDC’s earlier community levels, and there are currently only a few hot spots, some in Texas and in small portions of Nebraska and Louisiana.
    • “Early indicators—regional test positivity and emergency department (ED) visits—also show no signs of increase. Test positivity at the national level is 4.3%, down 0.7% from a week ago. The only region showing a slight increase is the part of the Southwest that includes California, Nevada, and Arizona. Only 0.5% of ED visits last week were due to COVID, down 10.8% from the previous week. There are no major rises in COVID positivity in wastewater surveillance.”
  • HHS’s Agency for Healthcare Quality and Research issued a report on “Treated Prevalence of Commonly Reported Health Conditions, 2016 to 2020.”
  • PBS informs us,
    • “The United States grew older, faster, last decade.
    • “The share of residents 65 or older grew by more than a third from 2010 to 2020 and at the fastest rate of any decade in 130 years, while the share of children declined, according to new figures from the most recent census.
    • “The declining percentage of children under age 5 was particularly noteworthy in the figures from the 2020 headcount released Thursday. Combined, the trends mean the median age in the U.S. jumped from 37.2 to 38.8 over the decade.
    • “America’s two largest age groups propelled the changes: more baby boomers turning 65 or older and millennials who became adults or pushed further into their 20s and early 30s. Also, fewer children were born between 2010 and 2020, according to numbers from the once-a-decade head count of every U.S. resident. The decline stems from women delaying having babies until later in life, in many cases to focus on education and careers, according to experts, who noted that birth rates never recovered following the Great Recession of 2007-2009.”

From the Rx coverage front —

  • Fierce Healthcare updates us on the soaring employee demand for anti-obesity drugs.
  • Also, Fierce Healthcare relates,
    • “Optum Rx is rolling out new programs aimed at supporting independent and rural pharmacies in closing care gaps beginning in June.
    • “The pharmacy benefit manager said Tuesday that the new initiatives will focus on three key areas: helping patients in underserved areas connect to community resources, improving maternal and fetal health by boosting access to key supplies and deploying community pharmacies to address healthcare deserts.
    • :The new initiatives kick off what Optum said is a “broader, industry-leading commitment to bridge resource gaps in the community.”
    • “These initiatives provide opportunities not only to help patients but also to offer appropriate compensation that recognizes the clinical expertise and unique capabilities our community and independent pharmacy partners have to meet the needs of their patients,” said Heather Cianfrocco, CEO of Optum Rx, in the release.”

From the medical and prescription drug research front

  • The NIH Director’s blog tells us,
    • “Biomedical breakthroughs most often involve slow and steady research in studies involving large numbers of people. But sometimes careful study of even just one truly remarkable person can lead the way to fascinating discoveries with far-reaching implications.
    • “An NIH-funded case study published recently in the journal Nature Medicine falls into this far-reaching category [1]. The report highlights the world’s second person known to have an extreme resilience to a rare genetic form of early-onset Alzheimer’s disease. These latest findings in a single man follow a 2019 report of a woman with similar resilience to developing symptoms of Alzheimer’s despite having the same strong genetic predisposition for the disease [2].
    • “The new findings raise important new ideas about the series of steps that may lead to Alzheimer’s and its dementia. They’re also pointing the way to key parts of the brain for cognitive resilience—and potentially new treatment targets—that may one day help to delay or even stop the progression of Alzheimer’s.”
  • BioPharma Dive reports
    • “An experimental hemophilia drug developed by Pfizer significantly reduced bleeding frequency compared to on-demand or preventive clotting factor proteins, the drugmaker said Tuesday. Called marstacimab, the drug was not associated with the kind of dangerous blood clotting that has delayed or sidelined similarly acting drugs from Novo Nordisk and Bayer.
    • “If approved, marstacimab would compete with established medicines like Roche’s Hemlibra as well as newer treatments like CSL Behring’s gene therapy Hemgenix and Sanofi’s long-acting drug Altuviiio. These therapies offer options for patients beyond regular infusions of engineered clotting factor proteins.
    • “Marstacimab requires a weekly subcutaneous shot, while Hemlibra can be administered subcutaneously as infrequently as once every four weeks after an initial dosing phase. Gene therapies like Hemgenix, or another from BioMarin Pharmaceutical that’s now under review, are intended to be a one-and-done treatment, although their long-term durability has not been proven.”

From the U.S. healthcare business front

  • Per Healthcare Dive
    • “Nonprofit hospital operator Ascension Healthcare reported a loss from operations of $1.8 billion on revenue of $21.3 billion for the nine months ending March 31, as it struggled with higher operating costs and sustained revenue challenges driven by continued impacts of the COVID-19 pandemic and inflationary pressures.
    • “An improvement in total surgical volumes, especially outpatient surgeries and emergency room visits, didn’t outpace growing expenses for Ascension, which increased by $804 million year over year in the nine-month period.”
  • Per Fierce Healthcare
    • “Advocate Health, the newly formed marriage of major nonprofits Advocate Aurora Health and Atrium Health, reported a $10.4 million operating income (0.1% operating margin) and $578.7 million net gain in its first-ever Q1 earnings report, released Tuesday.
    • “The 67-hospital entity tallied more than $7.54 billion in total revenue during the three months ended March 1 thanks to year-over-year increases across each of its major divisions—Advocate Aurora Health, Atrium Health’s Charlotte-Mecklenburg Hospital Authority and Atrium Health Wake Forest Baptist.”

From the litigation front, STAT News reports, “A federal appeals court ruled Tuesday Purdue Pharma can shield its owners — members of the wealthy Sackler family — from thousands of lawsuits over the role the company played in the opioid crisis in exchange for a contribution of up to $6 billion to a proposed bankruptcy settlement. * * * The U.S. Court of Appeals for Second Circuit, though, ruled a U.S. bankruptcy court was correct in approving the immunity and, moreover, that it was “equitable and appropriate under the specific factual circumstances of this case.” The decision reverses a ruling made last December by a federal judge had sided with the U.S. Trustee. The case now goes back to U.S. bankruptcy court to approve the settlement, although the U.S. Trustee could ask the U.S. Supreme Court to review the appeals court ruling.”

Happy Memorial Day

David Ermer–CDC, Congress, Mental health care–

Today we honor our service members who died for our Country. While many of my forebearers served, it was the son of one of the FEHBlog’s first cousins, Army Capt. Eric T. Paliwoda, who died in combat. Next January 2 will mark the 20th anniversary of his death in Iraq. Rest in peace. Never forget.

The Senate is in session this week for floor voting and Committee business, while the House of Representatives, which had planned to take a District work break, will resume floor voting and hold a Rules Committee meeting tomorrow.

The Wall Street Journal reports

  • “The path to a tentative agreement to raise the debt limit started in January with the election of Kevin McCarthy as House speaker on the 15th ballot, after he made conservatives a host of promises to cut spending and gave them the ability to oust him if he wavered.
  • “It ended with President Biden caving from his pledge not to negotiate and the two sides crafting an accord that neither the right nor left wanted, which places new limits on spending for two years and raises the nation’s borrowing limit for the same period. 
  • “The agreement represents a compromise, which means not everyone gets what they want,” Biden said. “That’s the responsibility of governing.” McCarthy called the deal an “agreement in principle” and warned: “We still have a lot of work to do.”

The agreement has been reduced to legislative language that the House of Representatives will consider on Wednesday. Roll Call describes the deal in English. The Senate is expected to take up the bill on Friday if all goes well. The FEHBlog at least expects it will.

From the miscellany department —

  • Last week, the Centers for Medicare and Medicaid Services proposed a rule to improve prescription drug price transparency in Medicaid.
  • The Wall Street Journal explains why “Early detection of dementia can help people make important decisions and weigh possible treatments. But getting a diagnosis can be difficult.”
    • “Getting an early and correct diagnosis for dementia gives those with the condition time to make financial and legal plans while they still can. A timely diagnosis could become even more important with new drugs, such as Biogenand Eisai’s Leqembi and Eli Lilly’s donanemab that help slow decline in early stages of Alzheimer’s. The drugs wouldn’t be used to treat frontotemporal dementia, or FTD, but they hold promise for future treatments across a broader spectrum of dementia.” * * *
    • “Yet, dementia remains difficult to diagnose. About half of those affected go undiagnosed, according to studies on dementia diagnosis and prevalence. 
    • “Doctors who specialize in dementia cite several reasons for high undiagnosed rates, including a shortage of specialists such as cognitive neurologists, geriatric psychiatrists and gerontologists, and limited access to tests, including certain PET scans that help reveal specific abnormalities in the brain but may not be covered by insurance. Blood tests to detect Alzheimer’s risk aren’t widely used.  
    • “Many individuals, family members and primary-care doctors are reluctant to talk about dementia because they are afraid, embarrassed or think nothing can be done. Early symptoms are often attributed to stress, lack of sleep and forgetfulness.”
  • NPR Shots reports on the “intriguing” results of a study of multivitamin use by older Americans.
  • Fortune Well tells us
    • Symptoms of prostate cancer [the second deadliest cancer in the U.S.] can vary widely, and some patients don’t show symptoms at all, according to the U.S. Centers for Disease Control and Prevention. The following symptoms, however, may be telltale signs:
      • Difficulty beginning to urinate
      • Weak urine flow, or interrupted flow
      • Frequent urination
      • Trouble fully emptying bladder
      • Pain or burning while urinating
      • Blood or semen in urine
      • Back, hip, and/or pelvis pain that doesn’t go away
      • Painful ejaculation
    • Patients diagnosed in early stages of the condition can have a “high expectation of cure,” Knudsen says, and “can continue to have a wonderful quality of life.” In fact, the five-year survival rate for prostate cancer detected early is virtually 100%, Siddiqui says.
    • The outlook for late-diagnosed patients, however, is not nearly as rosy. There is no “durable cure” for such cancer, Knudsen points out. The five-year survival rate for advanced prostate cancer is only 31%, according to Siddiqui.
    • When it comes to prostate cancer prevention, “what’s good for your heart is good for your prostate,” Oh advises. He encourages men to pack their diets full of leafy green veggies and colorful fruits, and to limit dairy and barbecued meat, which are associated with a higher risk of prostate cancer and aggressive prostate cancer.

Cybersecurity Saturday

David Ermer–Cybersecurity–

From the cybersecurity policy front —

  • DefenseScoop reports
    • The Department of Defense sent its new classified cyber strategy to Congress this week, the Pentagon said Friday.
    • The highly anticipated strategy is the first since 2018 and follows the release of the National Cybersecurity Strategy in March.
    • The DOD also publicly released an unclassified “fact sheet” on Friday, and said an unclassified “summary” will be provided in the “coming months.” 
    • Of note, the fact sheet explains that the updated strategy is based upon real-world operations. Prior to 2018, the Pentagon had only conducted a limited number of cyber ops due to a variety of factors such as stringent authorities and a high-risk calculous.
    • The 2018 National Defense Authorization Act combined with changes to executive policy streamlined authorities and made it easier for the DOD to approve and conduct operations.\
  • Politico adds
    • “President Joe Biden has nominated U.S. Air Force Lt. Gen. Timothy Haugh, the no. 2 at U.S. Cyber Command, to serve as the new head of both Cyber Command and the National Security Agency, according to an Air Force notice.
    • “The notice, obtained by POLITICO, was sent out on Monday and is titled “General Officer Nomination.” It announces that the president has nominated Haugh to the Senate for promotion to four-star general and assignment in the dual-hatted role. * * *
    • “If confirmed, Haugh will replace Gen. Paul Nakasone, who has led both NSA and Cyber Command since 2018. Nakasone is planning to step down sometime this year.”
  • Cyberscoop also tells us
    • “Microsoft rolled out a blueprint for regulating artificial intelligence on Thursday that calls for building on existing structures to govern AI.
    • “Microsoft’s proposal is the latest in a string of ideas from industry on how to regulate a technology that has captured public attention, attracted billions of dollars in investments and prompted several of its principal architects to argue that AI is in desperate need of regulation before it has broad, harmful effects on society. 
    • “In remarks before a Washington, D.C. audience on Thursday, Microsoft President Brad Smith proposed a five-point plan for governing AI: implementing and building upon existing frameworks, requiring effective brakes on AI deployments, developing a broader legal and regulatory framework, promoting transparency and pursuing new public-private partnerships.”

From the cybersecurity breaches and vulnerabilities front —

  • Cybersecurity Dives informs us
    • “PillPack, an online pharmacy owned by Amazon, has reported a data breach affecting more than 19,000 customers.
    • “The cyberattack exposed users’ email addresses, prescription information and their providers’ contact details. Social Security numbers and credit card information weren’t involved. PillPack said more than 3,600 affected accounts included prescription data.
    • “The online pharmacy said it discovered the breach on April 3, and it determined an unauthorized person used users’ email addresses and passwords to sign into their accounts between April 2 and April 6.”
  • Dark Reading relates
    • “China-sponsored threat actors have managed to establish persistent access within telecom networks and other critical infrastructure targets in the US, with the observed purpose of espionage — and, potentially, the ability down the line to disrupt communications in the event of military conflict in the South China Sea and broader Pacific.
    • “That’s according to a breaking investigation from Microsoft, which dubs the advanced persistent threat (APT) “Volt Typhoon.” It’s a known state-sponsored group that has been observed carrying out cyber espionage activity in the past, by researchers at Microsoft, Mandiant, and elsewhere.”
  • Cyberscoop adds
    • “A rare form of malicious software designed to infiltrate and disrupt critical systems that run industrial facilities such as power plants has been uncovered and linked to a Russian telecom firm, according to a report released Thursday from the cybersecurity firm Mandiant. 
    • “The discovery of the malware dubbed “CosmicEnergy” is somewhat unusual since it was uploaded to VirusTotal — a service that Google owns that scans URLs and files for malware — in December 2021 by a user with a Russian IP address and was found through threat hunting and not following an attack on a critical infrastructure system. 
    • “Whatever the motivation for developing it and uploading the code to VirusTotal, CosmicEnegy joins an highly specialized group of malware such as Stuxnet, Industroyer and Trisis that are purpose built for industrial systems. Furthermore, the discovery adds another layer of concern for critical infrastructure operators and organizations that are increasingly targeted by criminal and nation-backed hackers.
    • “Researchers at Mandiant, which is part of Google Cloud, noted that its highly unusual for this type of code to be discovered or even disclosed to the public. Yet, it’s not clear if the malware was intended for use in a cyberattack or it could have been developed for internal red-teaming exercises before the code was released into the wild.”
  • Health IT Security reports
    • “The Cybersecurity and Infrastructure Security Agency (CISA), the Federal Bureau of Investigation (FBI), and the Australian Cyber Security Centre (ACSC) released a joint cybersecurity advisory (CSA) regarding BianLian ransomware group.
    • “The group has been observed targeting a variety of United States critical infrastructure sectors since June 2022, as well as Australian critical infrastructure sectors. BianLian typically gains access via valid Remote Desktop Protocol (RDP) credentials and uses open-source tools for credential harvesting. In 2023, BianLian has threatened negative financial, legal, and business impacts if victims refuse to pay the ransom.
    • “BianLian group actors then extort money by threatening to release data if payment is not made,” the advisory stated. “BianLian group originally employed a double-extortion model in which they encrypted victims’ systems after exfiltrating the data; however, around January 2023, they shifted to primarily exfiltration-based extortion.”
  • CISA warned of hurricane/typhoon-related scams and identified three and then one more known vulnerabilities to its catalog.

From the ransomware front —

  • Cybersecurity Dive informs us, “A trio of [recent] ransomware attacks targeting the Dallas metro area have the hallmarks of a targeted campaign. They also underscore a very real problem: society is becoming desensitized to disruption.”
  • Here’s a link to the latest issue of Bleeping Computer’s The Week in Ransomware.

From the cybersecurity defenses front —

  • Cybersecurity Dive reports
    • “The Cybersecurity and Infrastructure Security Agency for the first time since 2020 released an updated version of #StopRansomware, in partnership with the FBI, National Security Agency and the Multi-State Information Sharing and Analysis Center. 
    • “The updated guide, developed through the Joint Ransomware Task Force, reflects lessons learned over the last few years, adding the FBI and NSA as co-authors for the first time. It offers recommendations to prevent initial intrusion as well as steps to protect data using cloud backups. * * *
    • “It includes a comprehensive list of best practices to defend against attacks, including: 
      • “Maintain offline, encrypted backups of critical data and regularly test those backups in a simulation of disaster recovery. This should include “golden images” of critical systems, including preconfigured operating systems and associated applications. 
      • “Develop, maintain and practice a basic cyber incident response plan for ransomware and data breaches. This should include a communications plan, including disclosure notifications to government authorities. 
    • “The guide also includes a comprehensive set of measures to prevent and mitigate ransomware and data extortion, including: 
      • “Conduct regular scanning to identify and address vulnerabilities, particularly on internet facing devices. 
      • “Regularly patch and update software and operating systems to the latest versions. 
      • “Make sure all on premises, cloud services, mobile and bring your own devices are properly configured and security features are enabled. 
      • “Implement phishing-resistant multifactor authentication.
      • “Enforce lockout policies after a certain number of failed login attempts.
    • “The guide suggests creating illustrated guides that provide detailed information about data flows inside an organization. This will help incident responders understand which systems to focus on during an attack.” 
  • The Wall Street Journal informs us
    • “Cyber insurance prices in the United States rose 11% year over year on average in the first quarter of 2023 according to insurance broker Marsh. This was a noticeably smaller increase than the 28% rise in Q4 2022 and was the fifth straight quarter that prices rose by less than the previous quarter. Additionally, rate increases moderated during 2022, with an average increase of 17% in December 2022, which was down significantly from a December 2021 high average increase of 133%. 
    • “Marsh said increased competition, improved cybersecurity controls, and a reduction in ransomware attacks in 2022 were factors that affected the continued moderation in pricing, while noting there has been an upturn in ransomware incidents and claims since Q4 2022.”
  • Tom’s Guide updates us on best VPN logging practices.
  • The Harvard Business Review offers ideas on creating effective cybersecurity training programs.

Friday Factoids

David Ermer–Congress, COVID treatment, FDA, Federal employment benefits, OPM, Telehealth, U.S. Healthcare–
Photo by Sincerely Media on Unsplash

From Washington DC

  • The Wall Street Journal reports
    • “President Biden said negotiators were closing in on a deal to cut spending and raise the $31.4 trillion debt limit, seeking to overcome final hurdles on issues regarding the budget as well as requiring more people to work to receive federal benefits.
    • “He said talks are “very close” to reaching an agreement and that he was hopeful that there could be a breakthrough as soon as later on Friday. “I hope we’ll have some clear evidence tonight, before the clock strikes 12, that we have a deal,” he said as he departed the White House for Camp David on Friday evening.
    • “Negotiators are hoping to strike a deal soon in order to set up votes on the legislation next week. The Treasury Department, which is currently using extraordinary measures to avoid exceeding the debt ceiling, estimated Friday that the government could run out of money to pay its bills if Congress doesn’t act by June 5.
    • “Treasury had previously put the deadline as early June, saying it could come as soon as June 1. Any legislation would likely take at least several days to pass both the House and Senate.
  • Govexec tells us
    • “The federal government’s HR agency on Wednesday unveiled new guidance aimed at standardizing and revitalizing employee assistance programs across the federal government, an effort officials said would prioritize employee wellness and improve productivity.
    • “Like many private sector employers, federal agencies often offer employees access to employee assistance programs, which provide services related to maintaining one’s mental and physical health, as well as resources related to substance use issues.
    • “The Office of Personnel Management, spurred by a provision of President Biden’s management agenda tasking agencies with promoting “awareness of employee well-being and [supporting] initiatives that extend beyond the workplace,” underwent a year-long effort to design a “standardized approach” to employee wellness programs, consulting with focus groups, health experts and vendors who provide assistance programs to employers.
    • “The result is a 19-page guidance document for agencies to reassess their assistance program offerings and, if necessary, expand them.
  • The FEHBlog wonders why OPM silos its various benefit programs rather than integrate them to get more bang for the buck.

From the healthcare costs front —

  • Milliman has released its 2023 Medical Index. Milliman estimates the healthcare cost for a hypothetical family of four enrolled in a hypothetical PPO plan is $31,065, a 5.6% increase over 2022.
  • The Medical Group Management Association issued its 2023 Physician Compensation and Productivity Benchmarks.
    • “Productivity remained relatively flat or only slightly increased relative to pre-pandemic benchmarks, with the biggest change in work RVUs posted in dermatology, hematology/oncology, and family medicine (without OB). 
    • “The growth in median total compensation for primary care physicians (PCPs) doubled from 2021 (2.13%) to 2022 (4.41%), but was outpaced by inflation at 7% and 6.5%, respectively. 
    • “Surgical and nonsurgical specialists saw their change in median total compensation cool slightly in 2022, dropping from 3.89% for surgical specialists in 2021 to 2.54% in 2022, and from 3.12% for nonsurgical physicians in 2021 to 2.36% in 2022. 
    • “APPs [advanced practice providers]— who saw the biggest change in median total compensation from pre-pandemic levels — saw their 2022 growth ebb slightly to 3.70%, down from 3.98% growth in 2021.” 

From the U.S. healthcare business front,

  • Beckers Hospital Review points out
    • “There are 293 rural hospitals at immediate risk of closure due to inflation, staffing shortages and other financial stress, according to the Center for Healthcare Quality & Payment Reform. 
    • “Hospitals at immediate risk of closure have lost money on patient services for multiple years, excluding 2020 during the pandemic, and aren’t likely to receive sufficient funds to cover the losses with public assistance ending, according to the report. These hospitals also have low reserves and more debt than assets.”
  • MedCity News relates
    • “The pandemic prompted a great need for technology-enabled care delivery, so the regulations surrounding reimbursement for these services were tossed out the window in 2020. Now that the public health emergency has ended, the healthcare industry has to figure out how it is going to pay for digital health services going forward.
    • “It’s clear that services like telehealth and remote patient monitoring have potential to provide value, but hospitals and digital health companies need to show payers clearer evidence of the outcomes these care modalities can produce, panelists argued during a Wednesday session at MedCity News’ INVEST conference in Chicago.” 
  • STAT News adds market perspective on the Food and Drug Administration’s full approval of Paxlovid, announced yesterday.
    • “The full approval for treating adults at high risk of progression to severe disease will help Pfizer expand its marketing campaign. U.S. officials plan to work through much of the government’s Paxlovid inventory, which is available for free at pharmacies around the country, before moving to a normal commercial market for the drug. Pfizer has sold the U.S. government nearly 24 million courses at around $530 a course, but it is not clear yet what price the company will charge.”

From the interoperability front —

  • The Pharmacy Times tells us
    • “Integrating Immunization Information Systems (IIS) vaccination records into claims data (collected by health insurers) increased the number of people identified as being vaccinated against COVID-19, according to the results of a study published in JAMA Network Open. Having accurate COVID-19 vaccination data is important for future COVID-19 vaccine studies that capture efficacy and safety, according to the study.
    • “When claims data were supplemented with IIS vaccination records, the proportion of participants with at least one vaccine dose rose from 32.8% to 48.1%. And when IIS vaccine records were included with claims data, the percentage of people who completed a vaccine series increased from 24.4% to 41.9%, varying by state.”
  • Per FCW
    • The Food and Drug Administration is looking to develop standardized “supersets of data” and improve data interoperability, analysis and management across the agency, an official said on Wednesday. 
    • The agency is planning to gather information and seek public input on the use of real-world data in its decision-making processes, according to Jose Galvez, deputy director for the office of strategic programs of the FDA’s Center for Drug Evaluation and Research. 
    • Galvez said at the Professional Services Council 2023 FedHealth Summit that the FDA is set to release a Federal Register notice “very shortly” to gain industry input on evaluating new types of data analysis.

Thursday Miscellany

David Ermer–Congress, COVID treatment, COVID-19, Electronic health records, FDA, Medical / Rx research, NIH, Rx coverage–
Photo by Josh Mills on Unsplash

From Washington, DC, —

  • The New York Times reports
    • “Top White House officials and Republican lawmakers were closing in on Thursday on a deal that would raise the debt limit for two years while capping federal spending on everything but the military and veterans for the same period. Officials were racing to cement an agreement in time to avert a federal default that is projected in just one week.
    • “The deal taking shape would allow Republicans to say that they were reducing some federal spending — even as spending on the military and veterans’ programs would continue to grow — and allow Democrats to say they had spared most domestic programs from significant cuts.
    • “Negotiators from both sides were talking into the evening and beginning to draft legislative text, though some details remained in flux.”
  • The Wall Street Journal adds
    • “The Treasury Department is preparing to change how the U.S. processes federal agencies’ payments if the debt ceiling is breached, dusting off a contingency plan crafted after the 2011 borrowing-limit standoff, people familiar with the matter said.
    • “Just days away from becoming unable to pay all of the government’s bills on time unless Congress raises the debt limit, Treasury officials have been quietly laying the groundwork for potentially delaying some payments after June 1.
    • “Under the backup plan created for a debt-limit breach, federal agencies would submit payments to the Treasury Department no sooner than the day before they are due, the people familiar with the talks said. That would represent a change from the current system, in which agencies may submit payment files well before their due dates. The Treasury Department processes them on a rolling basis, often ahead of the deadlines. Some payments are already sent to the department one day early, one person said. 
    • “The plan would enable the Treasury to make daily decisions about whether it can pay all of the government’s bills the next day.”
  • Back to the New York Times,
    • “The [U.S.] House of Representatives passed legislation on Thursday that would make permanent harsh criminal penalties and strict controls on fentanyl-related drugs, with scores of Democrats joining nearly all Republicans in a vote that reflected the political challenges of tackling what both parties consider America’s most pressing drug crisis.
    • “The bill, approved by a vote of 289 to 133, would permanently list fentanyl-related drugs as Schedule I controlled substances, a designation that mandates severe prison sentences for highly addictive, nonmedicinal chemicals, and which is now set to expire at the end of 2024.
    • “The bipartisan vote reflected agreement among Republicans and a solid bloc of Democrats that stiffening penalties for fentanyl-related drugs is a necessary component of the federal response to the crisis. According to the Centers for Disease Control and Prevention, there were roughly 75,000 synthetic opioid overdose deaths in 2022, with fentanyl being a main culprit.”
  • Federal News Network informs us
    • “With many agencies’ return-to-office plans still uncertain, Republicans on the House Oversight and Accountability Committee want to take matters into their own hands.
    • “GOP committee leaders changed their strategy for trying to get more federal telework data, now reaching out directly to agency heads. In a series of 25 letters, the lawmakers asked for up-to-date  numbers of teleworking federal employees, after saying the Biden administration was “not adequately tracking the specific levels of telework.”
    • “The Biden administration “has not provided current data about the specific amount of telework occurring within federal agencies or across the entire federal workforce. Furthermore, it has provided no objective evidence concerning the impact of elevated telework on agency performance — including any deleterious impacts,” lawmakers said in the letters, published May 18.”

From the Rx coverage front —

  • Today the Food and Drug Administration granted full marketing approval to Paxlovid, the Covid treatment pill, which in the FEHBlog’s opinion, brought us to the end of the pandemic. Here’s a link to a MedPage Today report on this FDA action
  • The Institute for Clinical and Economic Research released “a Final Evidence Report assessing the comparative clinical effectiveness and value of resmetirom (Madrigal Pharmaceuticals, Inc.) and obeticholic acid (Ocaliva®, Intercept Pharmaceuticals, Inc.) for non-alcoholic steatohepatitis (NASH).”
    • “Independent appraisal committee narrowly voted that currently available evidence for resmetirom is adequate to demonstrate a net health benefit over lifestyle management, whereas current evidence for obeticholic acid was deemed inadequate to demonstrate a net health benefit —
    • “ICER analyses suggest resmetirom would achieve common thresholds for cost-effectiveness if priced between $39,600 – $50,100 per year assuming that short-term effects on liver fibrosis translate into longer-term reductions in cirrhosis; under the same assumptions, obeticholic acid would achieve common thresholds for cost-effectiveness if priced between $32,600 – $40,400 per year.
    • “Payers should develop coverage criteria based on non-invasive testing to foster equitable access to early detection and treatment across diverse communities.
  • BioPharma Dive tells us
    • “Apellis Pharmaceuticals on Thursday became the latest drugmaker to give up on a potential treatment for amyotrophic lateral sclerosis, a neurodegenerative disorder that has frustrated researchers for decades.
    • “The decision came after a Phase 2 trial showed no benefit for the drug, known as systemic pegcetacoplan, compared with a placebo. It failed to meet the primary endpoint, measured by a statistical tool called the Combined Assessment of Function and Survival, as well as secondary goals assessing overall function, survival, lung function and muscle strength.
    • “The final results weren’t a total surprise; an independent board monitoring the study had already advised the company not to start a second, “open-label” part of the trial that would have offered the medicine to all participants after the initial 52-week research period. Apellis executives had also signaled to analysts that the trial had a low chance of success.”

From the miscellany department —

  • The National Institutes of Health announced
    • “Initial findings from a study of nearly 10,000 Americans, many of whom had COVID-19, have uncovered new details about long COVID, the post-infection set of conditions that can affect nearly every tissue and organ in the body. Clinical symptoms can vary and include fatigue, brain fog, and dizziness, and last for months or years after a person has COVID-19. The research team, funded by the National Institutes of Health, also found that long COVID was more common and severe in study participants infected before the 2021 Omicron variant.
    • The study, published in JAMA, is coordinated through the NIH’s Researching COVID to Enhance Recovery initiative, a nationwide effort dedicated to understanding why some people develop long-term symptoms following COVID-19, and most importantly, how to detect, treat, and prevent long COVID. The researchers hope this study is the next step toward potential treatments for long COVID, which affects the health and well-being of millions of Americans.
  • The New York Times discusses the miraculous case of a paralyzed man who has begun to walk again thanks to brain and spine “implants that provided a “digital bridge” between his brain and his spinal cord, bypassing injured sections” of his body.
  • HealthDay relates
    • “Older Americans are increasingly likely to log into “patient portals” to access their health care information — but confidence levels vary. 
    • “About 78% of people aged 50 to 80 now use at least one patient portal, according to the new University of Michigan (U-M) National Poll on Healthy Aging. 
    • “Five years ago, just 51% in this age range used patient portals, the researchers said. 
    • “The poll also found that 55% of those who used patient portals had done so in the past month. About 49% had accounts on more than one portal. 
    • “This surge is partly due to the increase in use of telehealth visits, said Denise Anthony, the U-M School of Public Health professor who worked on the poll.
    • “This change makes access to secure portals even more important for older adults who want to see their doctors and other health care providers virtually. It also makes the disparities we found in our poll even more troubling,” Anthony said in a Michigan Medicine news release. 
    • “Older adults with annual household incomes below $60,000, and those who were Black or Hispanic, had lower rates of portal use. These groups were also less likely to say they’re comfortable using a portal.”
  • The Washington Post reports
    • “U.S. authorities have seized increasing quantities of illegal ketamine, according to new research, a trend that coincides with the psychedelic drug’s rising popularity as a treatment for mental health ailments.
    • “The number of ketamine seizures by federal, state and local law enforcement in the United States increased from 55 in 2017 to 247 in 2022, while the total weight increased by more than 1,000 percent over that time, according to a letter published Wednesday in JAMA Psychiatry. Most of the ketamine was in powder form, which could raise the risk of being adulterated with deadly drugs such as fentanyl.”

Midweek update

David Ermer–Congress, Electronic health records, End of the PHE, NE, Generative AI, Medical / Rx research–
Photo by Manasvita S on Unsplash

From Washington, DC,

  • The Wall Street Journal reports
    • “Negotiators worked Wednesday to reach an agreement on reining in government spending, which has emerged as the central hurdle to a deal to raise the debt ceiling, with a possible government default just a week away.
    • “U.S. stocks extended declines Wednesday, reflecting rising anxieties about the debt ceiling, with the Dow Jones Industrial Average posting a fourth-straight session of losses.
    • “The White House has offered a spending freeze for next year, while GOP negotiators have insisted that any deal must result in lower discretionary spending, calling it a critical step in starting to address the country’s growing debt, which now stands at $31.4 trillion.”

Healthcare Dive, MedPage Today, and Fierce Healthcare discuss a House Oversight and Accountability Committee hearing on prescription benefit managers held yesterday.

The House Energy and Commerce Committee cleared a bunch of healthcare-related bills for floor consideration today.

STAT News tells us, “Matt Eyles, CEO of America’s Health Insurance Plans, is leaving by this October, the lobbying group said Wednesday.” Good luck, Mr. Eyles.

From the public health front —

  • Helen Branswell, writing in STAT News, points out
    • :An impressive number of vaccines and monoclonal antibody products are racing toward the end of the development pipeline, with two products aimed at protecting children expected to receive approval from the Food and Drug Administration by autumn. One, a maternal vaccine developed by Pfizer, received a recommendation last week from FDA’s vaccine advisory committee.
    • “But there are sizable hurdles standing in the way of the implementation of these products, hurdles that could see the promise they offer squandered because of bureaucracy, health systems that don’t interact with one another, and steep price tags.”
  • Ms. Branswell discusses the hurdles with experts on the matter.
  • Forbes reports
    • This week, Achieve Life Sciences announced that its drug, cytisinicline, saw strong results in its latest phase III trial. While the drug has been used for decades in eastern Europe, it’s not yet been approved by the FDA. The drug works by targeting the nicotine receptors in the brain, CEO John Bencich tells Forbes. “It works to reduce the satisfaction you get while smoking, but also helps with the cravings and withdrawal symptoms.” 
    • The study, which followed 792 patients, had patients take the drug for either 6 weeks or 12 weeks. Both patients who received the drug and those who got a placebo also went through a behavioral program about quitting smoking. The company says that over 30% of those who took the drug for 12 weeks stopped smoking completely in the last four weeks of the study, compared to less than 10% in the placebo group. For six weeks of treatment, the drug had a nearly 15% success rate compared to 6% in the placebo group. The company saw similar success in a smaller study it reported in the spring on the success of the drug in helping patients quit vaping. Patients will be monitored for 24 weeks after completing the cessation program, and the company expects to file a new drug application with the FDA in the first half of 2024. 
  • This week’s Econtalk podcast offers an interview between host Russ Roberts and University of Chicago economist Casey Mulligan about the macroeconomic angles of public health issues, like the Covid pandemic. Check it out.

From the interoperability front,

  • Fierce Healthcare relates
    • The total number of Epic customers pledging to join the electronic medical record provider in its participation in the Trusted Exchange Framework and the Common Agreement (TEFCA) has jumped to 27. 
    • After announcing the participation of 20 health systems plus health tech company KeyCare and health information exchange OCHIN on Monday, five more organizations have joined the pledge including Kaiser Permanente.
    • According to Matt Doyle, interoperability software development lead at Epic, the EMR company is optimistic that nearly all of the 2,000 hospitals and 600,000 clinicians that use Epic across the country will participate. 
  • Let’s go.

From the generative AI front,

  • Patient Engagement HIT tells us
    • Can ChatGPT really replace doctors? Probably not, at least for right now, as surveying shows that patient trust in chatbots and generative AI in healthcare is relatively low.
    • The report from The University of Arizona Health Sciences showed that around half of patients don’t fully trust AI-powered medical advice, like the information issued from chatbots like ChatGPT. Instead, patients still trust and prefer their traditional healthcare providers.
    • However, patients may be more receptive to chatbot medical advice if the AI is guided by a doctor’s or human’s touch.

Tuesday’s Tidbits

David Ermer–Congress, Generative AI, Medical / Rx research, Mental health care, NIH, Rx coverage, U.S. Healthcare, Uncategorized–
Photo by Patrick Fore on Unsplash

From Washington, DC, the Wall Street Journal explains,

“President Biden and Democratic leaders in Congress approached this year’s debt-ceiling drama with a consistent mantra: They would absolutely never, ever, under any circumstances, negotiate over raising the country’s borrowing level.

“But now they are very much negotiating on the debt limit, just about a week before the June 1 date when the Treasury Department estimates the U.S. could run out of measures to avoid default. Talks are underway about how to find a package of spending cuts and other measures acceptable to enough Republicans and Democrats to clear Congress, with House Speaker Kevin McCarthy (R., Calif.) and Biden meeting Monday and planning further talks to craft a deal framework in coming days.

“We’re not there yet” on a deal, said McCarthy on Tuesday. White House press secretary Karine Jean-Pierre said: “While areas of disagreement remain, the president, the speaker and their teams will continue to discuss the path forward.”

Govexec adds,

“Most non-defense federal agencies appear headed for at least a spending freeze next fiscal year—if not an outright cut—as President Biden has offered to back down from his proposed spending increases in exchange for an increase to the government’s debt ceiling. 

House Republicans, who are spearheading negotiations with the White House to avoid a debt default that could occur as soon as June 1, have rejected that proposal, holding out for cuts compared to current spending levels. The two sides have been locked in marathon negotiations for the last week, agreeing to some costccc-cutting measures but remaining far from an overall agreement.”

 From the public health front —

  • Roll Call reports,
    • New HIV infections dropped 12 percent in 2021 compared to 2017, according to new Centers for Disease Control and Prevention estimates released Tuesday, with the biggest drops among young gay and bisexual men.
    • But the agency warned that HIV prevention efforts need to be accelerated to reach the national goals.
    • The data Tuesday credited the overall decrease to a 34 percent drop in infections among 13-24 year olds, with the largest declines among young gay and bisexual men. Annual HIV infections among young people decreased from 9,300 to 6,100, but among young LGBTQ men new infections dropped from 7,400 to 4,900.
  • McKinsey Health Institute released a survey shedding “light on the health perceptions and priorities of people aged 55 and older.”
    • “Among the results, unsurprisingly, is that older adults who have financial stability—no matter their country—are more likely than their peers to be able to adhere to healthy habits, including those that boost cognitive health.3 And contrary to the perception that older adults are tech laggards compared with their younger peers, the results find widespread technology adoption, especially in smartphone use, among the older adult population.”
  • The U.S. Preventive Services Task Force issued draft recommendations and evidence reviews for the following projects: Oral Health in Adults: Screening and Preventive Interventions and Oral Health in Children and Adolescents Ages 5 to 17 Years: Screening and Preventive Interventions. Both recommendations are “I” for inconclusive. The public comment submission deadline is June 30, 2023.
  • The U.S. Surgeon General Dr. Vivel Murthy circulated “a new Surgeon General’s Advisory on Social Media and Youth Mental Health – PDF. While social media may offer some benefits, there are ample indicators that social media can also pose a risk of harm to the mental health and well-being of children and adolescents. Social media use by young people is nearly universal, with up to 95% of young people ages 13-17 reporting using a social media platform and more than a third saying they use social media “almost constantly.”

From the medical research front —

  • The New York Times reports, “Researchers have for the first time recorded the brain’s firing patterns while a person is feeling chronic pain, paving the way for implanted devices to one day predict pain signals or even short-circuit them.”
  • The NIH Director’s Blog tells us, “Basic Researchers Discover Possible Target for Treating Brain Cancer.”

From the Rx coverage front —

  • The Drug Channels blog points out “The Top Pharmacy Benefit Managers of 2022: Market Share and Trends for the Biggest Companies.”
    • “We estimate that for 2022, about 80% of all equivalent prescription claims were processed by three companies: the Caremark business of CVS Health, the Express Scripts business of Cigna, and the OptumRx business of UnitedHealth Group. 
    • “This concentration reflects the significant transactions and business relationships among the largest PBMs that have further concentrated market share. Five of the six largest PBMs are now jointly owned by organizations that also own a health insurer, as illustrated in Mapping the Vertical Integration of Insurers, PBMs, Specialty Pharmacies, and Providers: A May 2023 Update. 
      • “The big three PBMs’ aggregate share of claims was similar to the 2021 figure. Compared with 2021, however, Cigna’s share declined due to customer losses, while OptumRx’s share grew slightly. Two other notable market changes affected the 2022 figures:
      • “In January 2022, Caremark added the specialty business back to its Federal Employee Program (FEP) mail and clinical pharmacy services contract. The specialty portion of the FEP had transitioned to Prime Therapeutics in 2018. 
      • “In late 2022, Prime Therapeutics completed its acquisition of Magellan Rx from Centene. For 2022, Magellan Rx managed $22.9 billion in drug spend and had annual claims volume of 220.9 million. Magellan Rx annualized claims are included with Prime’s figures above.
    • “Beginning in 2024, Express Scripts will begin a five-year agreement to manage pharmacy benefits for more than 20 million Centene beneficiaries. We estimate that the Centene business will bring $35 to $40 billion in total gross pharmacy spend and more than 550 million prescriptions. This forthcoming shift of Centene’s PBM business from CVS Health’s Caremark to Cigna’s Express Scripts will significantly alter the relative position of these companies. 
  • MedPage Today informs us,
    • “The first nalmefene hydrochloride nasal spray (Opvee) won FDA approval for the emergency treatment of known or suspected opioid overdose in adults and pediatric patients 12 years of age and up, the agency announced.
    • “If administered quickly, the opioid receptor antagonist provides fast onset and long duration reversal of opioid-induced respiratory depression. It will be available for use by prescription in healthcare and community settings.”
  • The FDA announced
    • “approving Xacduro (sulbactam for injection; durlobactam for injection), a new treatment for hospital-acquired bacterial pneumonia (HABP) and ventilator-associated bacterial pneumonia (VABP) caused by susceptible strains of bacteria called Acinetobacter baumannii-calcoaceticus complex, for patients 18 years of age and older. 
    • “According to the World Health Organization, Acinetobacter species top the list of critical bacterial pathogens that pose the greatest threat to human health, highlighting the high level of need for additional treatment options amid growing global resistance to antimicrobial medicines.”

From the generative artificial intelligence front, STAT News provides expert perspectives and answers readers’ common questions about AI and healthcare.

From the U.S. healthcare business front —

  • Healthcare Dive relates,
    • “The newly rebranded Intermountain Health reported $549 million in net income for the first three months of 2023, an increase from the prior-year period when the health system posted a $298 million net loss. 
    • “The Salt Lake City-based system brought in $4 billion in revenue compared with $2.8 billion in the period ended March 31 last year. 
    • “Intermountain’s expenses still climbed 44% to $3.7 billion, with a large portion coming from employee compensation and benefits at $1.7 billion. But supply costs grew too, reaching $703 million during the quarter, an increase of 46% from a year earlier.”
  • Fierce Healthcare notes,
    • “Cleveland Clinic is starting 2023 on the right side of zero, reporting Tuesday a Q1 operating income of $32.3 million (0.9% operating margin) and a net income of $335.5 million.
    • “Though the nonprofit system had reported a $1.2 billion net loss across 2022, the first quarter’s numbers continue the upward momentum Cleveland Clinic enjoyed at the end of last year.
    • “Like many health systems have reported in recent weeks, the performance is also a substantial bounce back from Q1 2022when the omicron wave dragged Cleveland Clinic to a $104.5 million operating loss (-3.4% operating margin) and a $282.5 million net loss.
    • “On a year-over-year basis, total unrestricted revenues grew 15.7% by way of a 13.3% rise in net patient revenue, to $3.1 billion, and a 37.3% increase in other restricted revenues, to $425.3 million.”

Monday Roundup

David Ermer–Congress, Federal employment benefits, OPM, Rx coverage, U.S. Healthcare–
Photo by Sven Read on Unsplash

From Washington, DC, the Wall Street Journal reports

“President Biden and House Speaker Kevin McCarthy (R., Calif.) opened a high-stakes meeting on Monday evening, as negotiators worked to get back on track on reaching a debt-ceiling deal that could pass both the Republican-led House and Democratic-led Senate by the end of the month. 

“Central to the talks is setting a top-line spending level for the next year and deciding how long to lift the debt ceiling until having to raise it again. The two sides are aiming to reach a deal by June 1, when the Treasury Department estimates the U.S. could run out of money to pay all of its bills, leading to a first-ever default. Treasury Secretary Janet Yellen repeated that estimate Monday.”

About 90 minutes later, Politico adds, “President Joe Biden and Speaker Kevin McCarthy ended their one-on-one meeting Monday [with a “better tone” yet] still short of a deal to avoid a U.S. debt default that could come as soon as June 1.”

From the Rx coverage front —

  • STAT News informs us,
    • “An oral version of semaglutide, the drug marketed as Ozempic and Wegovy, led to dramatic weight loss in a trial enrolling people with obesity, manufacturer Novo Nordisk said Monday, data that could bolster what is already a blockbuster medicine.
    • “In the study, which enrolled nearly 700 adults classified as overweight or obese, patients treated with a daily semaglutide tablet lost 15.1% of their body weight over the course of 17 months, while those on placebo lost 2.4%, Novo Nordisk said. The result is comparable to weekly injections of Wegovy, which in an earlier study led to 14.9% weight loss over the same period of time. In both studies, the most common side effects were gastrointestinal distress, with the majority of cases graded mild or moderate, the company said.
    • “Novo Nordisk said it plans to submit oral semaglutide for U.S. and E.U. approvals later this year. A lower-dose version of the drug is already approved as a treatment for type 2 diabetes under the brand name Rybelsus.”
  • Reuters tells us,
    • “Taking Novo Nordisk’s new obesity drug may help reduce the risk of heart disease as well as boosting weight loss, according to new research from the United States.
    • “After a year of taking semaglutide, marketed as Wegovy, patients’ risk of suffering from conditions like a heart attack or a stroke over the next ten years dropped to 6.3% from 7.6% when measured by a commonly used calculator, researchers at the Mayo Clinic found.
    • “The results, which were presented this week at the European Congress on Obesity in Dublin, are among the first indication that the weight loss induced by the new GLP-1 agonist drugs like Wegovy also brings heart health benefits – something scientists expected, but do not yet have much comprehensive data to prove.
    • “The study was only done among 93 patients, and the researchers said that more and larger studies were needed to see if the risk reduction score actually meant less illness and death long-term.
    • “Novo is expected to release results from its 5-year SELECT trial looking into the health impact of its injectable drug, particularly around heart disease, later this year. Investors, governments and insurers alike are keenly watching the data.
  • FiercePharma offers a special report about the most expensive drugs in our country.

From the U.S. healthcare business front —

  • Fierce Healthcare relates
    • Found, a company that offers an evidence-based weight loss management program for consumers, is launching a new platform that aims to help employers manage services and cost for workers struggling with weight, including GLP-1 drugs like Ozempic and Wegovy.
    • With medication-assisted obesity care in the headlines, Found for Business offers employers a solution that’s based on clinical best practices and is cost-effective and medication-agnostic. Found’s approach combines virtual clinical care with personalized medication regimens and behavioral health change, according to an announcement
  • Healthcare Dive reports
    • HCA Healthcare, one of the nation’s largest for-profit health systems, has agreed to acquire 41 urgent care centers in Texas.
    • The deal includes 19 FastMed and 22 MedPost clinics in Dallas, Austin, San Antonio, Houston and El Paso, HCA said Thursday.
    • Terms of the deal were not disclosed, but the buy is expected to close this summer, according to the operator.

In federal employee benefits news

  • OPM released “the OPM Retirement Quick Guide, a three-page guide to voluntary retirement that walks federal employees through what to expect as a retirement application is processed and benefits are determined, including helping employees estimate when they can expect to receive their interim and first annuity payments. OPM Retirement Services (RS) developed the guide in partnership with the Lab at OPM, using human-centered design principles.” 
  • Federal News Network discusses “OPM’s new approach to modernizing retirement services [which] is all about small bites.”

Weekend update

David Ermer–Congress, HSA, Medical / Rx research, Medicare, NIH, U.S. Healthcare–
Photo by Thought Catalog on Unsplash

The House of Representatives will be in session for Committee business and floor voting, while the Senate will be on a State work week this week. The Senate press gallery informs us, “In today’s (5/18/23) wrap-up, Schumer reiterated that as discussions concerning the debt ceiling continue over the next week, Senators should be able to return to the Senate within a 24-hour period.”

The Wall Street Journal reports

“President Biden and House Speaker Kevin McCarthy agreed to meet Monday afternoon in a last-ditch effort to reach a deal to avoid a default on U.S. sovereign debt after negotiations to raise the federal borrowing limit reached an impasse.

“Talks between White House and House Republican negotiators largely ground to a halt this weekend, with both sides blaming the other for a failure to bridge their differences over spending levels. But Biden and McCarthy instructed their negotiating teams to resume their discussions, starting with a 6 p.m. meeting on Sunday. * * *

“There’s no agreement. We’re still apart,” McCarthy, a California Republican, told reporters at the Capitol, though he said the call with Biden was productive.” * * *

“Leaders in Washington are rushing to come up with a deal to lift the country’s borrowing limit. If they are unable to do so, the country might be unable to pay all of its bills as soon as June 1, according to an assessment by the U.S. Treasury Department.  

“Appearing Sunday on NBC, Treasury Secretary Janet Yellen said the “odds of reaching June 15th, while being able to pay all of our bills, is quite low.”

“Economists say that failure to lift the debt ceiling, and a subsequent default, would tip the economy into a recession. Moody’s Analytics predicts that a default would cost more than seven million jobs and cause the unemployment rate to move above 8%. The ratings company also predicts that the stock market would lose a fifth of its value.”

Wow.

From the plan design front, the Wall Street Journal reports

“The Internal Revenue Service on Tuesday announced the largest-ever increase to the amount Americans can set aside in health-savings accounts each year.

“For 2024, the maximum HSA contribution will be $8,300 for a family and $4,150 for an individual. That is up from $7,750 for a family and $3,850 for an individual for 2023.

“Participants age 55 and older can contribute an extra $1,000, which means an older married couple could sock away $10,300 a year, up from $9,750 this year. In the last ten years leading up to retirement, a couple could accumulate more than $100,000 in these accounts. * * *

While workers can tap 401(k)s and individual retirement accounts for medical costs, health savings accounts offer more tax savings than both traditional or Roth retirement accounts. There is no tax going in, tax-free growth and tax-free withdrawals if used for eligible healthcare expenses.”

The FEHBlog came to love the high-deductible health plan/health savings account arrangement. The Wall Street Journal endorses the FEHBlog’s viewpoint. The FEHBlog was cut off from the arrangement when he became Medicare primary in late 2019. Because the FEHBlog’s law firm has less than 20 employees, the FEHBlog found it necessary to drop his employer-sponsored coverage in favor of Medicare. Medicare coverage has been fine, but the FEHBlog misses contributing to his HSA. Younger employees should give the HDHP / HSA arrangement a close look.

The Wall Street Journal adds

“Remember one important caveat, however: If you’re sure to spend over the deductible, other plans may be more appropriate for you, such as the PPO plan that will cost you an additional $800. (You forgo the ability to save, but you also face a lower out-of-pocket maximum.) For instance, if you know with reasonable certainty that you need access to a more-expensive provider for a one-time procedure, then you should pick a plan that gives you this access, such as a PPO plan, and switch back to an HMO plan with an HDHP-and-HSA option during next year’s open-enrollment period.

“If you do end up choosing an HDHP, please remember: Do not cut back on care haphazardly, as many people do. Following a doctor’s recommendations is much more important than saving a bit of money.”

While the FEHBlog is not yet retired, he is intrigued by the Fortune Well article on cognitive decline following retirement. The article offers four ways to avoid this otherwise “universal trend.”

  1. Keep or get connected.
  2. Keep active.
  3. Keep stress to a minimum
  4. Keep working, regardless of pay.

Next stop, Walmart greeter??

From the U.S. healthcare business front, Healthcare Dive tells us

“Physician staffing firm Envision Healthcare has filed for Chapter 11 bankruptcy, citing its $7.7 billion in debt obligations, declining patient volumes, “flawed” implementation of the No Surprises Act and exclusionary health insurers as reasons for its financial decline in a restructuring announcement on Monday.

“The bankruptcy wipes out private equity firm KKR’s investment in Envision. In 2018, the PE firm shelled out over $5 billion in 2018 to take Envision private in a deal valued at $9.9 billion, including debt. Last week, The Wall Street Journal reported that an Envision bankruptcy filing would be one of the steepest losses in KKR’s history.”

From the miscellany department, NPR Shots offers articles evaluating experimental cancer treatments and looking into a new NIH study:

There’s plenty of one-size-fits-all nutrition advice. But there’s mounting evidence that people respond differently to food, given differences in biology, lifestyle and gut microbiome.

“The National Institutes of Health wants to learn more about these individual responses through a Nutrition for Precision Health study, and this week researchers began enrolling participants to take part in the study at 14 sites across the U.S.

“It’s part of the All of Us research initiative that aims to use data from a million participants to understand how differences in our biology, lifestyle and environment can affect our health.

“Holly Nicastro of the NIH Office of Nutrition Research says the goal of the precision nutrition study is to help develop tailored approaches for people. “We’ll use machine learning and artificial intelligence to develop algorithms that can predict how individuals will respond to a given food or dietary pattern,” Nicastro says.

“The study will take into account a person’s genetics, gut microbes, and other lifestyle, environmental and social factors “to help each individual develop eating recommendations that improve overall health,” Nicastro says.”

Cybersecurity Saturday

David Ermer–Cybersecurity–

From the cybersecurity policy front —

  • Defense One reports,
    • “By November, Pentagon cybersecurity leaders aim to lay out just how private contractors will be expected to work with government agencies to safeguard data and ward off attacks.
    • “We are working on a strategy—a [defense industrial base] cybersecurity strategy—that we hope to have out later this year,” David McKeown, DOD’s chief information and security officer, said at GovExec’s Cyber Summit event Thursday. “Our strategy is bringing all of the pieces and parts within the department together…laying it out who’s going to be doing what, and we overlay everything on top of the NIST cybersecurity framework.”
    • “Lawmakers requested the strategy as a step toward reducing the vulnerabilities created by doing sensitive business with hundreds of thousands of private contractors.”
  • Cyberscoop tells us,
    • “Lawmakers on Wednesday [May 17, 2023] passed a series of bills to give the Cybersecurity and Infrastructure Security Agency new responsibilities when it comes to safeguarding open source software, protecting U.S. critical infrastructure and expanding the cybersecurity workforce. 
    • “The Senate Homeland Security and Governmental Affairs Committee advanced a bill that would require CISA to maintain a commercial public satellite system clearinghouse and create voluntary cybersecurity recommendations for the space sector. Additionally, the committee advanced legislation requiring CISA to create a pilot civilian cyber reserve program to respond to incidents.
    • “The House Homeland Security Committee advanced legislation that would require CISA to work with the open source community to better secure it as well as create a framework to assess the general risks of open source components for federal agencies. The House advanced another bill that would give CISA the authority to train employees at DHS that aren’t currently in cybersecurity positions to move to such a role.”
  • Health IT Security adds,
    • “At a House Committee on Energy and Commerce hearing held on May 16, 2023, experts from the energy, water, and healthcare sectors testified on how sector-specific agencies within critical infrastructure are taking steps to protect their industries from cyberattacks.
    • “Each of the 16 critical infrastructure sectors has a designated Sector Risk Management Agency (SRMA) that is responsible for managing threats faced by each sector. The hearing gave committee members a chance to explore how various federal agencies work to secure critical infrastructure against cyber threats, assess their responses to emerging threats, and learn more about the roles and responsibilities of each agency.
    • “Brian Mazanec, PhD, deputy director at the HHS Administration for Strategic Preparedness and Response (ASPR) Office of Preparedness, delivered both a spoken and written testimony to the committee on the growing threats facing the healthcare sector and the role of HHS in mitigating these threats.
      • HHS is working diligently to strengthen cybersecurity and address the impacts of cyberattacks on the healthcare system. As we move forward, there are additional authorities and resources that would advance ASPR’s ability to fully implement its plan to bolster HHS’s Cyber Sector Risk Management Agency (SRMA) activities. For example, we are in the process of establishing a dedicated Cyber Division within ASPR’s Office of Critical Infrastructure Protection. If ASPR is granted direct hire authority, as requested through the Pandemic and All-Hazards Preparedness Act (PAHPA) reauthorization process, we would be able to bring critical staff with cyber expertise into the organization more quickly and move forward to address challenges without delay. We would also be better positioned to immediately expand and enhance our efforts as the SRMA lead for the HPH sector. Additionally, we are looking to establish a new HHS cyber incident ticketing system to better track incidents and strengthen threat intelligence sharing through embedded liaisons within CISA and the FBI. Dedicated resources are needed to implement and operate supporting systems, as included in the FY 2024 President’s Budget request. We continually assess and identify whether any additional authorities are needed to support our 

From the cyber vulnerabilities and breaches front —

  • The Health Sector Cybersecurity Coordination Center issued its April 2023 Cybersecurity Vulnerability report.
    • In April 2023, vulnerabilities to the health sector have been released that require attention. This includes the monthly Patch Tuesday vulnerabilities released by several vendors on the second Tuesday of each month, along with mitigation steps and patches. Vulnerabilities for April are from Microsoft, Google/Android, Apple, Mozilla, SAP, Cisco, Fortinet, VMWare, and Adobe. A vulnerability is given the classification as a zero-day if it is actively exploited with no fix available or is publicly disclosed. HC3 recommends patching all vulnerabilities with special consideration to the risk management posture of the organization.
  • Dark Reading points out three ways hackers use ChatGPT to cause security headaches.
  • MeriTalk informs us
    • “The Department of Transportation (DoT) is investigating a data breach affecting administrative systems at the department, an agency spokesperson confirmed to MeriTalk today.
    • “According to a Reuters report, DoT notified Congress of the data breach on Friday, which exposed the personal information of about 237,000 current and former Federal government employees. * * *
    • “DoT did not say when the hack was first discovered or who might be responsible for it.
    • “DoT is the latest agency to face a data breach after the U.S. Marshals Service (USMS) responded to a ransomware attack and data breach in February that compromised sensitive law enforcement information.”
  • Dark Reading adds
    • “PharMerica Healthcare has disclosed that its systems were breached earlier this year by an unauthorized third party, which resulted in the leak of the personal details of more than 5.8 million deceased people.
    • “PharMerica provides pharmacy services for patients under long-term care, including those in senior living facilities, hospice care, and using behavioral health services.”

From the ransomware front,

  • Cyberscoop and Healthcare Dive reports
    • “A new and highly active ransomware threat actor, RA Group, is targeting organizations in the manufacturing, finance, insurance and pharmaceuticals sectors, researchers at Cisco Talos said Monday.
    • “Within a week of its emergence on April 22, RA Group compromised three organizations in the U.S. and one in South Korea. The group listed its first three victims on its leak site on April 27 and added a fourth victim on April 28, according to Cisco Talos.
    • “Initial victim organizations have had their data encrypted and stolen, a form of double extortion designed to increase pressure on the organizations to pay the ransom.
  • CISA announced
    • CISA, the Federal Bureau of Investigation (FBI), and the Australian Cyber Security Centre (ACSC) have released a joint Cybersecurity Advisory (CSA) with known BianLian ransomware and data extortion group technical details. Microsoft and Sophos contributed to the advisory.
      To reduce the likelihood and impact of BianLian and other ransomware incidents, CISA encourages organizations to implement mitigations recommended in this advisory. Mitigations align with the Cross-Sector Cybersecurity Performance Goals (CPGs) developed by CISA and the National Institute of Standards and Technology (NIST).
  • Here’s this week’s link to Bleeping Computers Week in Ransomware.
  • Cybersecurity Dive provides guidance on why and how to report a ransomware attack.

From the cyber defenses front —

  • The Wall Street Journal reports on how tabletop exercises can improve cyber preparedness, while Cybersecurity Dive tells us,
    • Corporate programs designed to boost the cyber resilience of employees are falling short on their goals, with more than half of cybersecurity leaders saying their workforce is not prepared for an attack, according to an Osterman Research report sponsored by Immersive Labs. 
    • At two-thirds of organizations, there is a fear that almost all employees, 95%, will not understand how to recover following a cyberattack. Priority tasks might include operating without core IT systems and switching to manual processes to get important tasks completed. 
    • “There is an unfortunate disconnect between leaders’ confidence in team preparedness and real cyber resilience,” Max Vetter, VP of cyber at Immersive Labs, said via email. “This is because legacy training measures attendance, not real capabilities.”