FEHBlog

Congress has left town for the holidays.  The 114th Congress’s work is done. Here’s a link to the Week in Congress’s account of last week’s actions on Capitol Hill.  The new 115th Congress takes office on January 3, 2017.

Tomorrow is the last day of the current Federal Benefits Open Season.

The FEHBlog overlooked mentioning last Sunday an interim OPM rule released on December 2 that permits federal employers, with OPM’s permission, to extend FEHBP and FEDVIP to the children of same sex domestic partners of federal employees who work outside the United States, where same sex marriage may not be legal. The FEHBlog recalls reading a related OPM letter explaining that currently the State Department is single federal employer who has elected this expansion of coverage.

The Washington Post continued today its series of articles on the Nation’s opioid epidemic. This article is worth reading because it explains that a lot of people need these drugs but doctors need to do a much better job monitoring their patients use of these additive painkillers.

Thanks to friends of the FEHBlog he can suggest that his readers take a look at guest commentators article on prescription drugs — here and here.  Useful perspectives.

Finally, Healthcare IT News updates us on the HHS Office for Civil Rights plans for HIPAA privacy and security rule enforcement audits in 2017.

The FEHBlog projected no government shutdown this year and Politico reports tonight that the FEHBlog’s projection turned out to be correct. Thank Heavens.

Federal News Radio brings up up to date on Capitol Hill actions. Congress has passed the 21st Century Cures Act and the National Defense Authorization Act (“NDAA”) for the current fiscal year.  The House passed a continuing resolution that funds the Federal government until April 28, 2017. The House has left town for the holidays. The Senate is considering the measure now.

The lame duck session of Congress hurtles toward its impending conclusion. Three important bills remain in play — the National Defense Authorization Act, the 21st Century Cures Act, and the resolution continuing funding for the federal government. The House has passed the first two bills and the Senate is expected to act on them today or tomorrow. The House leadership unveiled the new continuing resolution last evening.

• Here’s the Wall Street Journal’s latest report on the NDAA.  
• The Boston Globe’s STAT provides an overview of the Cures Act under the guise of listing winners and losers.  
• The Hill reports on the proposed continuing resolution which would fund the federal government through April 28, 2017.  

This is the last full week for the Federal Benefits Open Season, which ends on December 12.

Congress continues at work on Capitol Hill this week. We can expect that Congress will extend the continuing resolution funding the federal government which expires this coming Friday.  The FEHBlog thinks it’s safe to say that there is no chance of a government shutdown due to a funding lapse. The question on the table is how long to extend the resolution. Here is a link to The Week in Congress’s report on last week’s actions.

Following up on the Congressional hearing on federal long term care insurance premiums discussed in last Thursday’s post, the FEHBlog is offering a link to the NARFE testimony which includes a laundry list of possible reforms.  The federal long term care insurance act was developed and enacted at the turn of the century as they say. The Wall Street Journal points out in this article that the long term care market launched in the 1990s based on key pricing errors and peaking right at the time that the law was passed, the year 2000.  Bad mojo.

The Hartford Courant brings us up to date on the trial over the federal government’s effort to block the Anthem-Cigna merger.  The trial over the government’s effort to block other big health insurer merger – Aetna and Humana — starts today also in the federal district court here in Washington, D.C. Both cases are tried to a federal district judge, not to a jury.

On the innovation front,

• Medcity News discusses three telehealth approaches “which show how the sector is diversifying.” One of then is the American Well / Tyto Care approach that the FEHBlog noted on Friday. Check out the article to read about the other two.
• The Wall Street Journal reported on Saturday about Aspire Health, a start up company lead by former Senate Majority Leader Bill Frist, who is an MD.  Aspire Health’s objective is to use claims data to identify plan members who are expect to die in the next year and “lower their medical costs by providing palliative care in their homes.”  “The Nashville-based company, which recently won $32 million in funding from GV (formerly called Google Ventures), has managed the care of more than 20,000 Medicare Advantage patients in 19 states in exchange for a monthly fee. It estimates that it can save health plans $8,000 to $12,000 per patient.” Interesting. 

Also the Centers for Medicare and Medicaid Services released the 2015 National Healthcare Expenditures study. Cost curve up.

Nothing frosts the FEHBlog’s cake more than the fact that taxpayers paid over $30 billion for government approved electronic health records systems that weren’t designed to communicate with each other. Health Data Management reports that the 21st Century Cures Act which likely will become law next week includes provisions intended to boost EHR interoperability.

Let’s wrap up for the week with a couple of innovations:

• Telehealth vendor American Well announced yesterday “a new partnership [with Tyto Care] to combine video telehealth visits with comprehensive remote examinations. Together the companies will offer the tools needed to conduct the most complete virtual visit in telemedicine, significantly expanding the scope and safety of care delivered to consumers via telehealth.”

• The Wall Street Journal reports that 

There are more than 120,000 people in the U.S. waiting for an organ transplant and not enough donors. The dire shortage has led some researchers to consider an unusual solution: They are breeding genetically modified pigs whose organs could be compatible for human transplant.

Researchers have been trying for decades to make animal-to-human transplants work, a process known as xenotransplantation. Pigs are a particularly promising source of organs. They produce big litters. Organs such as the kidney and liver are similar in size to those of humans. “Nobody has come up with a better animal,” says Joseph Tector, a professor of surgery who runs the xenotransplantation program at the University of Alabama at Birmingham.

Then last year, a group led by George Church of Harvard University published a paper describing their use of a new gene-editing technology called Crispr-Cas9. Unlike previous gene-editing systems, Crispr allowed the researchers to make multiple changes simultaneously to inactivate viral remnants in the pigs’ genes.

Crispr has helped renew enthusiasm for xenotransplantation.

Luhan Yang, one of the authors of the paper and now president and chief scientific officer of EGenesis Bio, which she and Dr. Church co-founded, says the company has used Crispr to create pig embryos designed to keep human immune systems from rejecting them. They have also used Crispr to inactivate pig retroviruses. The researchers are gathering data and hope to have pigs next year whose organs can be tested in trials with animals.

Here’s another article on the use of this new gene editing technology in humans if your interest has been whetted. 

Here’s a link to yesterday’s House Oversight and Government Reform Committee hearing on Federal Long Term Care Insurance premium hikes. Govexec and Federal News Radio have reported on the hearing. Nothing much apparently happened, but it was the beginning of the conversation not the end.  The FLTIC statute needs updating.

The Washington Post reports that the House of Representatives this evening passed by a wide margin the 21st Century Cures bill.  The bill is focused on drug and device development and mental health reform.  The Post explains that “The final bill, running at close to 1,000 pages, contains a cornucopia of health-related provisions, including $1 billion for opioid abuse prevention.” The Senate is expected to approve the bill next  week and the President then is expect to sign it into law.

Federal News Radio reports that Congress continues to work on the National Defense Authorization Act which is a piece of must past legislation for the lame duck session. According to Federal News Radio, the conference report will include a 2.1% pay increase for the military and TRICARE reforms.

Congress also must pass an extension of the continuing resolution funding the federal government. The current continuing resolution expires Friday December 9. The FEHBlog has been reading that the debate concerns whether to extend funding to the end of March or May.  The FEHBlog anticipates that the lame duck session will end once that matter has been resolved.

OPM will be releasing two proposed rules in tomorrow’s Federal Register.  One creates a procedure for removing ineligible family members from a self and family or self plus one enrollment.  This rule sets the stage for implementing OPM’s long standing plan to conduct dependent eligibility audits in the FEHBP. The other, which surprised the FEHBlog, creates a procedure for cancelling the self and family enrollment of spouses and adult children who are financially independent of the enrollee.  “This proposed rule is in response to [presumably an avalanche of] enrollee requests to remove family members from
existing enrollments.”  The public comment period for both proposed rules will end on January 31, 2017.


Finally, in an interesting development, the Drug Channels blog discusses a recently announced deal between the OptumRx prescription benefit management company and CVS Pharmacies. Drug Channels explains that

The surprise announcement echoes the arrangement that OptumRx established with Walgreens. The new deal signals that CVS is starting to counter Walgreens’ aggressive partnering strategies. OptumRx customers also get to choose which chain will be their preferred 90-day at retail provider.

In contrast, customers of CVS’s own PBM, Caremark, only have a choice between CVS pharmacies and Caremark mail service for 90 day scripts of maintenance medications.  Drug Channels provides more background if you are interested.

We are now about halfway through the lame duck session of Congress and the Federal Benefits Open Season.

On Friday, the FEHBlog noted a report that national health care spending increased 5% in 2015. The report attributed the increase largely to health care provider and pharmaceutical price increases.  He described it as bad news. To elaborate, he means that the report illustrates the fact that the Affordable Care Act is failing at its stated objective of lowering the health care cost curve.

This doesn’t surprise the FEHBlog in the least. As the FEHBlog has noted throughout the law’s history the basic problem is that the law encourages health insurance to be used as a price support by for example mandating coverage of low priced items across the board. There’s has to be more flexibility built into the system.

Of course, that’s not the only problem. The Wall Street Journal reports today that drug manufacturers raise their retail prices in lock step. In other words, drug manufacturers see no reason to take advantage of a pricing advantage.

Even when there is competition, prices can continue to climb. That is because patients tend to stick with a drug that works for them, and health insurers and drug-benefit managers sometimes have contracts for drugs that prevent switching to cheaper options.

The odd aspect of the article is while Viagra was given as an example of lock step pricing, insurers only cover that drug in special circumstance.  The inertia in that case must be created by the prescription requirement. Anyway it’s a screwed up market if manufacturers don’t want to compete based on price.

The Hill reported on Friday that the House of Representatives will consider this week a set of health care related bills. The bills concern medical innovation and mental health reform. There’s a good change that this legislation will be enacted in the lame duck session.

Employee Benefit News draws our attention to a recent Mercer Consulting survey of employer sponsored health plan coverage in the United States. The survey points out the rapidly growing coverage of telehealth services which FEHBP enrollees should notice next year. Be sure to sign up for the service before you need to use it.

Finally, Consumer Reports tells us about hospital efforts to reduce central line infections.

Central-line infections account for roughly 5 percent of all hospital-acquired infections, striking more than 27,000 people in 2015, research shows. And they’re a particularly important subset, says Arjun Srinivasan, M.D., associate director for Healthcare Associated Infection Prevention Programs at the CDC.
For one, they are deadly—proving fatal in up to a quarter of cases, in part because people with the IVs are often already frail. They’re costly, too, averaging $46,000 to treat, more than other hospital-acquired infections, according to a 2013 study in the Journal of the American Medical Association. And they’re almost entirely preventable.

Consumer Reports alerts us to which hospitals have been successful in their prevention efforts and which hospitals have more work to do.  It’s a survey that the FEHBlog would check if he need to be hospitalized.

Well, the FEHBlog had a happy Thanksgiving (except for the Redskins loss), and he hopes that his readers are enjoying the holiday too.

The Health Care Cost Institute, a private payer claims data research organization, issued its 2015 healthcare cost and utilization report. The news was not good.

Spending on health care for the privately insured in the United States increased 4.6 percent in 2015, outpacing previous years’ growth, finds a new report from the Health Care Cost Institute (HCCI). Spending grew just 3.0 percent in 2013 and 2.6 percent in 2014. Prices for outpatient, inpatient, professional services, and prescription drugs increased between 3.5-9.0 percent in 2015, a bigger hike than in the prior two years, according to the analysis. Price increases were the primary reason spending grew more quickly in 2015 than in previous years, and were the largest driver of spending growth throughout the four-year study period. * * *

“Using data from four of the nation’s largest health insurers, we’re able to look closely at the changes in health care use and prices over time to understand what is driving costs,” said HCCI Executive Director David Newman. “Year after year in our study period we see that rising prices are leading to spending growth.” 

 Here’s a link to the complete report.

Also Health Data Management reports that the HHS Office for Civil Rights took another healthcare provider scalp — a $650,000 negotiated fine and a corrective action plan against the University of Massachusetts.

The sanctions follow UMass reporting to OCR in June 2013 that a workstation infected with malware resulted in disclosure of protected health information on 1,670 individuals. Malware infected a workstation in the UMass Center for Language, Speech and Hearing because no firewall was in place.
OCR contends that UMass had incorrectly determined that the Center for Language, Speech and Hearing, which was the unit that experienced the breach, was not a covered entity under the HIPAA rules.
Further, OCR determined that while the breach occurred in mid-2013, UMass did not conduct and accurate and through risk analysis until September 2015. In recent years, OCR has increasingly been stringent on the need of HIPAA-covered entities to conduct risk analyses and address vulnerabilities.

Finally, the FEHBlog noticed this afternoon that the House Oversight and Government Reform Committee has scheduled a hearing on Federal Long Term Care Insurance premium spikes for next Wednesday November 30 at 2 pm.