FEHBlog

As Americans return to full work weeks following the holiday season, Congress begins the second session of the current 116th Congress here in the Nation’s capital.

On Friday, according to the Volokh Conspiracy, the intervenor defendant, appellant States and House of Representatives filed separate requests for expedited review of the Fifth Circuit’s decision in the Texas v. United States decision holding the Affordable Care Act’s individual shared responsibility provision / mandate unconstitutional.  As you will recall, the Fifth Circuit directed the lower court — Northern District of Texas — to carefully reevaluation its December 2018 decision that the ACA is inseverable from the unconstitutional individual shared responsibility responsibility. The petitioners seek to short circuit this step by taking the case to directly to the Supreme Court. For what it’s worth, the FEHBlog expects the Supreme Court to decline this request in order to allow the record to more mature before high court review.

Govexec.com reports that

In a report dated Dec. 19 and released on the Office of Personnel Management’s website last week, the President’s Pay Agent, which is a board comprised of Labor Secretary Eugene Scalia, Office of Management and Budget Acting Director Russell Vought and OPM Director Dale Cabaniss, greenlit a series of recommendations from the advisory Federal Salary Council. Chief among them were the creation of a new Des Moines, Iowa, locality pay area, and the addition of Imperial County, Calif., to the Los Angeles locality pay area.

The inclusion of these new regions is “subject to rulemaking,” meaning OPM must act over the course of the next year to finalize the additions. The pay agent also approved the salary council’s recommendation that officials should consider human capital indicators when weighing regions’ requests to be granted a locality pay area despite not meeting the established criteria for inclusion.

The Wall Street Journal reports today that while antibiotic manufacturers have adequate government funding to research superbug antibiotics, the commercial market for these drugs is insufficient to support manufacture.

Washington has taken notice of the problem, but near-term action remains unlikely. The Disarm Act, short for Developing an Innovative Strategy for Antimicrobial Resistant Microorganisms and introduced in Congress in 2019 (HR 4100 and S 1712), would have Medicare pay for certain antibiotics in full. Despite bipartisan support for the bill, executives worry its progress could be hindered by impeachment proceedings and the coming election.

Disappointing.

Fierce Healthcare offers a bunch of snippet forecasts on the future of healthcare in 2020. For example

We have a lot of hospital beds in brick-and-mortar institutions and
we’re going to move to community- and home-based sites of care, which is
more convenient for the patient. Consumers are demanding easier access
to services.

The telehealth capabilities and sensors that we can put into the home
now, these devices are not just gadgets but good enough for diagnosis
and treatment. And we’re going to see more security risks so we need to
redouble our efforts to make sure data is protected and data integrity
as well. If data is altered, that can be worse than if the data were
deleted.”

— John Halamka, M.D., president, Mayo Clinic Platform

The Wall Street Journal reports today that 

More than 60 [prescription] drug makers raised prices in the U.S. on Wednesday,
according to an analysis from Rx Savings Solutions, which sells software
to help employers and health plans choose the least-expensive
medicines. The average increase was 5.8%, according to the analysis,
including increases on different doses for the same drug. The average is just below that of a year ago, when more than
50 companies raised the prices on hundreds of drugs by an average of more than 6%, according to the analysis.

The CPI-U increased by 2.1% over the period November 2018 to November 2019.

Healthcare Dive informs us that

• Hospital consolidation is associated with poorer patient experiences and doesn’t improve care, according to a study published Thursday in the New England Journal of Medicine, refuting a common provider justification for rampant mergers and acquisitions.
• The study funded by HHS’ health quality research division, the Agency for Healthcare Research and Quality, found that acquired hospitals saw moderately worse patient experience, along with no change in 30-day mortality or readmission rates. ​Acquired hospitals did improve slightly in clinical process, though that can’t be directly chalked up to the results of an acquisition, researchers found.
• It’s further evidence that bigger isn’t always better when it comes to hospitals, and adds onto a heap of previous studies showing provider mergers lead to higher prices for commercially insured patients.

West Georgia Ambulance, Inc. (West Georgia), has agreed to pay $65,000 to the Office for Civil Rights (OCR) at the U.S. Department of Health and Human Services (HHS) and to adopt a corrective action plan to settle potential violations of the Health Insurance Portability and Accountability Act (HIPAA) Security Rule. West Georgia is an ambulance company that provides emergency and non-emergency ambulance services in Carroll County, Georgia.

West Georgia stepped into hot water when it reported a data breach to OCR as required by law.

The FEHBlog is pleased to announce that the name of his law firm has changed from the Ermer Law Group PLLC to Ermer & Suter, PLLC.  Jason Suter has been the FEHBlog’s partner since 2014 and it’s high time that he got due recognition. Soon the FEHBlog will be available on our renamed firm’s refreshed website (which should be launched in the new few days.)  Our staff is writing a TPRS Blog on our refreshed Third Party Recovery Services site, which is up and running.. 

When the decade began, we were enmeshed in Congressional actions which lead to the enactment of the Affordable Care Act in March 2010. From a health policy perspective, this has been the ACA’s decade for better or for worse.

The FEHB Program celebrated its 60th anniversary in 2019. The FEHBP which was once a fairly uncomplicated program, was burdened — like other group health plans — with ACA obligations and uniquely with new OPM initiatives, such as the agency’s plan performance system. The decade ended with a ray of sunshine created by the repeal of the ACA’s health insurer and Cadillac taxes and a well deserved raise for federal employees.

Will the FEHBP see its 70th anniversary or will be it folded into a Medicare for All arrangement in the 2020s?  Time will tell, but the FEHBlog bets that the FEHBP will see 2030. Let’s hope that we all do.

For a longer trip down memory lane, check out this Becker’s Hospital Review article.

Fun fact to know and tell, as CNBC reports, the 2010s were the only decade in American history without an economic recession.

Happy New Year.

The Affordable Care Act created, and required health insurers and plans to fund, a Patient Centered  Outcomes Research Institute.The FEHBlog thinks that the PCORI duplicates the work of existing government agencies, such as AHRQ.  He also cannot understand why the cost of PCORI was not spread over other segments of the health care industry. The ACA provided PCORI with health plan / insurer funding through this year. Some thought that this meant the annual PCORI funding obligation would end. Those observers must not work inside the Beltway like the FEHBlog does. So the FEHBlog was not surprised to learn today that the FY 2020 final spending bills extended the current funding system for PCORI over the next ten years. As the same bills repealed the ACA’s health insurer and Cadillac taxes, this is a small price of health plans and insurers to pay. Hopefully, the fruits of the PCORI will be on display in the next decade.

Congress remains out of town until next week.

Readers may recall that the health insurer trade associations had requested the Department of Health and Human Services to extend by at least 90 days the comment period o the proposed out of pocket cost transparency rule applicable to health plans. Fierce Healthcare reports that the Department has granted a 15 day extension through January 29, 2020.

Health Payer Intelligence brings us up to date on health insurer efforts to take social determinants of health into account. The FEHBlog expects this effort to continue to grow over time.

The percentage of adults living with diagnosed and undiagnosed diabetes varied significantly by race/ethnicity and among Hispanic and non-Hispanic Asian subgroups. Broadly, the age-sex-adjusted percentage of adults living with diagnosed or undiagnosed diabetes was 22% in Hispanics, 20% in non-Hispanic blacks, 19% for non-Hispanic Asians and 12% for non-Hispanic whites.

Yesterday the President signed an executive order implementing the Congressionally approved federal employee pay increase for the 2020 calendar year. Federal News Network explains why and by how much the pay raise depends on the employee’s work location.

FEHBP Open Season changes take effect on January 1 for annuitant enrollees and the covered family members and on the first day of the first full pay period in January for employed enrollees.  In 2020, that Open Season effective date for employees falls on Sunday January 5. 

The Journal of Accountancy helpfully outlines the federal tax changes made by the final FY 2020 spending bills.

The Society for Human Resource Management discusses the Internal Revenue Services overhauled W-4 form which employees use to calculate tax withholding.

Modern Healthcare discusses the status of surprise billing legislation.

Months of debate on how to protect patients from out-of-network charges at in-network facilities culminated in an eight-day period when a bipartisan, bicameral proposal with White House support came together, but ultimately fell short. Some observers aren’t so sure that a compromise exists anymore.

“Ultimately, the leadership decided that with unresolved disagreements between the committees of jurisdiction, more time was needed and surprise billing would be reserved for the must-past May health extenders vehicle,” a Democratic leadership aide said. 

Here’s a FEHBlog brainstorm exempt bills not eligible below the arbitration threshold from the law’s pricing provisions. See how the law works with larger bills first.

Healthcare Dive discusses the latest legislative activities on this front.

The House Energy and Commerce Committee is expanding its investigation into surprise billing practices by calling on some of the nation’s largest insurers and physician staffing firms to provide information and documents on the practice, lawmakers said Thursday. 

The Senate Health Education Labor and Pensions Committee also is participating in this investigation. Those two committees have been cooperating in the development of the key bipartisan surprise billing proposal, S. 1895.

Health IT Security reports that

An explanatory statement included with the Congressional Appropriations Agreement directs the Office of the National Coordinator to work with private sector initiatives focused on the development of a national strategy to improve patient identification across the healthcare sector.

The appropriations bill left out language that would allow the Department of Health and Human Services to use public funds for the development of a national patient identifier. For the last 20 years, the ban has been included in every appropriations bill, despite language in HIPAA that directs HHS to develop a unique patient identifier.

The FEHBlog recalls that the same provision was included in the FY 2019 appropriations legislation. A national payer identifier would help push interoperability forward.

Tammy Flanagan, writing in Govexec, answered questions related to the five year rule that allows retiring federal employees to carry their coverage into retirement with the full government contribution. Check it out.

Happy Holidays.

Congress is out of town until January 7, 2020. The President has signed into law the final two spending bills and the defense authorization act for fiscal year 2020 whose provisions the FEHBlog has been discussing over the past few weeks.

In an interesting development, according to Forbes, the prescription benefit managers, Express Scripts, which insurer Cigna owns, and Prime Therapeutics which a group of Blue Cross licensees owns, have formed a partnership.

The three-year collaboration is “designed to deliver more affordable care for clients and their members by enhancing pharmacy networks and pharmaceutical manufacturer value.” The collaboration will allow Prime’s member Blue Cross health plans to gain leverage through Express Scripts’ buying clout and large pharmacy network.”

The Wall Street Journal included a heartbreaking healthcare story over the weekend.

When she was in her early 30s, Katy Mathes decided to check her cancer risk. A genetic test showed a mutation on a BRCA gene, which significantly raises a person’s lifetime risk of developing hereditary breast or ovarian cancer. 

Thirteen people in the family got tested—her mother, her sister, cousins and aunts. Eleven had the mutation. Almost all did their testing with Myriad Genetics Inc., which introduced the first BRCA tests in 1996. 

“I treated my test results like the Bible,” said Ms. Mathes, now 37, an elementary-school art teacher in Colorado. “There was no questioning the report.” 

Ms. Mathes, who has one child, decided she would have no more. To reduce her cancer risk, she underwent surgery to remove her ovaries and fallopian tubes. So did her younger sister, their mother and four other relatives. Ms. Mathes and her sister also had double mastectomies. 

This year, their mother sat them down at the table of their parents’ winter home in Florida. Two weeks earlier, her genetic counselor had called. The lab was no longer sure the variant is a significant problem. 

The article explains how many variables are at play in these genomic tests. Patients should be better educated about the risks of misdiagnosis.  If you have not done so, read Russ Roberts’ interview with Adam Cifu MD about being a medical conservative on the Econtalk podcast. (You can read the interview or listen to it at the link.)

[W]e need to slow down at this point. We need to think about the evidence behind what doctors are offering patients. And we need to consider the cost/benefit of this.

N.B. In addition to being the FEHBlog’s birthday, this is his 2700th post since 2006.