FEHBlog

Congress remains at work on Capitol Hill this week. Here is a link to the Week in Congress’s report on last week’s activities on Capitol Hill. The FEHBlog did notice that the U.S. Senate has freshenened up its website.

Here are a few tidbits from last week’s OPM AHIP FEHBP carrier conference:

• OPM’s medical director, Dr. Christine Hunter, received a prestigious Presidential Rank award from President Obama last December. What’s more, OPM’s FEHBP tribal coverage desk received a Presidential customer service award.  Mazaal tov! 21,000 Indian tribal employees who work for 100 tribes are covered under the FEHBP. 
• A National Business Group on Health speaker called attention to his group’s issue brief on specialty pharmacy costs. In that regard, a CVS medical director predicted that the biosimilar market will “take off” in three to four year. The FEHBlog certainly hopes so. 
• OPM’s unlocktalent.gov is a data visualization tool that’s
  available to the public.  The tool
  includes Federal Employee Viewpoint Survey and the Enterprise Human Resources
  Integration database.  To see the publicly available information, you need to scroll down the home page.  There’s a United States map that shows where federal employees live, for example. Federal employees can register for a deeper dive. 

The Trump administration has named Roger Severino as the new director of the Department of Health and Human Services’ Office for Civil Rights, which enforces HIPAA[‘s Privacy and Security rules] and protects patients rights.
An OCR spokesperson confirmed on March 24 that Severino had been named to the position, and his bio has been posted on the office’s website.
Meanwhile, former Rep. John Fleming, R-La., has reportedly been selected for the newly created position of deputy assistant secretary for health technology. It’s not yet clear whether Fleming would lead HHS’ Office of the National Coordinator for Health IT. ONC oversees standards and policies for the HITECH Act electronic health records “meaningful use” financial incentive program, and also carries out various health IT-related provisions in the 21st Century Cures Act, which was signed into law last year.

Finally, Fierce Healthcare reports that last week, the Centers for Medicare and Medicaid Services announced that the agency is delaying at least until October 1, 2017, the mandatory Medicare bundled payment programs that the Obama Administration rolled out last year.  “The latest delay came as welcome news to the Federation of American Hospitals and the American Hospital Association, which expressed concern last year that the accelerated pace of the program.”

We’re going to be living with Obamacare for the foreseeable future,” though he argues that replacing it would actually have done a favor to Democrats.  He says that tax reform will move forward, even though the plan has been complicated by the Obamacare taxes remaining in place.

The Journal further reports that

Going forward, [President] Trump said he would seek bipartisan support for a bill to overhaul the health-care system, saying that would be “the ultimate” and drawing a contrast with the Affordable Care Act, which he said was “rammed down everyone’s throat” with only Democratic support.

Also today, a three judge panel of the U.S. Court of Appeals for the D.C. Circuit heard oral argument in the Anthem / Cigna appeal of the district court decision blocking their merger agreement from closing. The Wall Street Journal reports

A federal appeals court panel on Friday asked tough questions of health insurer Anthem Inc., which is attempting to salvage its proposed $48 billion acquisition of Cigna Corp. after a trial judge blocked the combination as anticompetitive.
The Anthem appeal, which took place in front of a large crowd at the U.S. Court of Appeals for the District of Columbia Circuit, was surprisingly lively—and lengthy—as three judges said the case presented novel and difficult issues.
“We haven’t had a case like this,” Judge Brett Kavanaugh said.
The session was supposed to last for 40 minutes; the judges instead asked questions for about two hours.

That’s an engaged panel. This case was expedited so that the panel could issue its decision before the Anthem – Cigna merger agreement’s termination date – April 30, 2017.

Over the weekend, the FEHBlog will share some bon mots from the FEHBP carrier conference. Nothing earthshaking occurred but some useful tidbits were shared by the speakers.

Tomorrow, the seventh anniversary of President Obama signing the Affordable Care Act into law, the House of Representatives is expected to vote on the American Health Care Act.  The legislative process is quite engaged this evening according to the press.

Today the House of Representatives passed two healthcare related bills — a Small Business Healthcare Fairness Act (HR 1101) and a Competitive Health Insurance Act (HR 372).  The first bill would permit small businesses to purchase health insurance coverage through association health plans.  The second would subject all health insurers to the full application of federal anti-trust laws.  Whether the first bill passes the Senate is anyone’s guess, but the second bill is a slam dunk to become law in view of the 416-8 vote for House passage. More details on the first bill can be found in Kaiser Health News, and more detail on the second bill can be found in Bloomberg BNA.

Let’s tie up a couple loose ends

• As the OPM IG was walking out the door just about a year ago, he tossed a grenade into the acting Director’s office by asserting that Ms. Cobert should have stepped down when President Obama nominated her to serve as permanent OPM director. The OPM IG relied on a DC Circuit decision called NLRB v. SW General, 796 F.3d 67. As the FEHBlog noted at the time, the D.C. Circuit opened the Director’s actions to legal challenge but did not render all of her actions illegal per se.  In any event, on Monday, in a 6-2 decision written by the Chief Justice, the Supreme Court affirmed the D.C. Circuit decision. 
• Five years ago, a major health care crisis erupted when the New England Compounding Center was accused of causing 2012 fungal meningitis outbreak that killed 64 people and hurt more than 700.  The crisis was attributed to 14,000 contaminated vials of drugs that NCCC had prepared and distributed nationwide. Following the crisis, Congress passed a law cracking down on compounding pharmacies.  NPR reports that today a federal district court jury in Boston found one of the NECC owners guilty of racketeering but not murder.
   

Tomorrow also is the beginning of the annual AHIP-OPM FEHBP carrier conference.  The FEHBlog will be there.

Yesterday, the House of Representatives leadership released a set of AHCA amendments.  The House Speaker Paul Ryan explained that

The first amendment makes technical revisions to the original bill to ensure compliance with the Senate rules governing reconciliation bills. It is purely technical and achieves the same policy goals as previously drafted.
The second amendment includes improvements drafted by both of the authorizing committees.
Under jurisdiction of the Ways and Means Committee: Moves up repeal of Obamacare taxes from 2018 to 2017, strikes a provision allowing excess tax credits to be deposited into Health Savings Accounts, and provides budgetary space for the Senate to increase tax credits for older Americans.
Under jurisdiction of the Energy and Commerce Committee: Immediately prohibits any additional states from expanding the current broken Medicaid program, allows states to opt-in to a traditional Medicaid block grant as well as implement work-requirements for Medicaid, protects the equitable state-federal partnership, and enhances the growth rate for the aged and disabled population on Medicaid. 

It will be a busy week on Capitol Hill with four days of confirmation hearing for Supreme Court justice nominee Neil Gorsuch before the Senate Judiciary Committee beginning tomorrow and a House of Representatives vote on the American Health Care Act scheduled for Thursday.   Here is a link to the Week in Congress’s one pager on last week’s activities on the Hill.

The American Enterprise Institute features an article on the economic lessons that can be drawn from pricing trends in cosmetic surgery over the past 20 years.  Of course, as we all know, the cost curve for health care services has been up over the period. According to the article health care inflation rivals college education inflation.  Cosmetic or plastic surgery is paid out of pocket by the patient with no health benefits coverage and no income tax deduction, except in limited circumstances.  The author compared average cost increases in general health care to cost increases in cosmetic surgery.

The average price increase between 1998 and 2016 for the [top] 20 cosmetic procedures displayed above was 32%, which is less than the 47.2% increase in consumer prices in general. Of the 20 procedures above, 14 increased in price by less than overall inflation (and therefore decreased in real terms) and only six increased in price by more than inflation. And most importantly, none of the 20 cosmetic procedures in the table above have increased in price by anywhere close to the 100.5% increase in the price of medical care services or the 176.7% increase in hospital services since 1998. 

The Affordable Care Act exacerbated this trend by mandating the coverage of a multitude of low priced services and items.  Hopefully, the American Health Care Act and HHS will allow health insurers and consumers more flexibility going forward.

The FEHBlog is anxiously awaiting the annual FEHBP carrier conference sponsored by OPM and AHIP. The conference will be held on Thursday and Friday of this week in beautiful Crystal City, Virginia.

Yesterday, the House Oversight and Government Reform Committee approved the bipartisan 2017 Postal Reform Act (H.R. 756) by a voice vote. The bill would create a separate Postal Service Health Benefits Program within the FEHBP effective January 1, 2019. The bill remains pending before the Ways and Means and Energy and Commerce Committees, but this was a big boost toward final House and Senate passage.

Also yesterday, the President released a budget “blueprint” for discretionary federal government expenses. A complete budget with income and mandatory spending, e.g, Medicare, Medicaid, Social Security, will be issued in May. In that regard, earlier this week the President issued an executive order seeking a federal government reorganization according to Federal News Radio.

Continuing federal appropriations funding requires Congressional action next month. The current continuing resolution expires on April 28. Furthermore, the Hill reports that “Lawmakers will have until sometime this autumn to raise the debt ceiling before the Treasury runs out of ways to make essential payments, putting the nation at risk of its first-ever debt default.”

Finally Federal News Radio also reports that President Trump withdrew President Obama’s nomination of Elizabeth Field to serve as OPM Inspector General.

Erin go bragh.

The American Health Care Act cleared the House Budget Committee on a 19-17 vote today. (The FEHBlog wrote this on March 16 but it wasn’t posted until March 17.)  The Wall Street Journal reports that “The bill will now proceed to the House Rules Committee, which will vote and determine the rules governing the process to alter it on the House floor.”

Lest it pass us by, let’s not forget that it’s National Patient Safety Awareness Week. ECRI Institute has created a list of the top ten patient safety concerns:

Information Management in EHRs
Unrecognized Patient Deterioration
Implementation and Use of Clinical Decision Support
Test Result Reporting and Follow-Up
Antimicrobial Stewardship
Patient Identification
Opioid Administration and Monitoring in Acute Care
Behavioral Health Issues in Non-Behavioral-Health Settings
Management of New Oral Anticoagulants
Inadequate Organization Systems or Processes to Improve Safety and Quality

Speaking of which, the FEHBlog’s attention was drawn to this EHR Intelligence article about a “new study published in the Journal of the American Board of Family Medicine found patient-reported self-assessments and provider-reported assessments of patient health rarely align.”  The article explains that

“A closer look at the reasons given by patients and physicians helps explain that discordance,” the researchers wrote. “We found that physicians tended to focus on disease in their reasoning for all patients, whereas those patients with excellent and very good self-reported assessments focused on feeling well. In medicine, wellness is often considered the absence or prevention of disease, but other concepts within wellness, such as happiness and contentment, may be equally or more important to patients.”
While self-reported assessments are considered an important complement to provider-reported information in EHRs, small biases like emotional wellbeing potentially impacts patient opinion of personal physical health.
Because providers and patients appear to occasionally consider different factors when assessing a patient’s health, researchers believe more face-to-face discussion is imperative to closing gaps in knowledge of patient information and forming a more accurate overall assessment of health.

The FEHBlog guesses this ties back to the first patient safety concern that the ECRI Institute named.

Finally, here’s a link to an interesting Workforce.com on the effective use of carrots and sticks in employee wellness programs.

The important markup is scheduled for tomorrow at 10 am, not today. In the meantime, the FEHBlog recommends reading Avik Roy’s Forbes article on the CBO report.

This afternoon, the Congressional Budget Office issued its report on the American Health Care Act. Here’s a link to the report. The House Budget Committee meets on Wednesday as noted in yesterday’s post.