Weekend update

Congress

Weekend update

David Ermer–Congress, Rx coverage, SCOTUS, Telehealth–

The Senate is engaged in legislative and committee business this week. Last week the Senate passed by unanimous consent a bill (S. 279) to amend the FEHB and FEGLI Acts for the purpose of extending coverage to employees of Indian tribal grant schools. This bill would close a gap created by the Affordable Care Act which generally extended coverage under these programs to Indian tribal employees. There are 128 tribal grant schools in the U.S.

The House of Representatives is engaged in committee business this week. That body is next scheduled to hold votes over the period June 30 through July 2.

The Supreme Court continues this week to release the remaining opinions from its October 2019 term. The Hill includes an article discussing the seven opinions that are expected to be politically controversial.

In other news Fierce Healthcare reports

  • “A top Department of Health and Human Services (HHS) official acknowledged [last week] that telehealth is here to stay after an explosion of use due to COVID-19 but hedged on whether new regulatory flexibility on reimbursement is going to stick around.” The permanent flexibility depends largely on Congress and state regulators, and
  • “OptumRx researchers are highlighting three more drug products that payers should be keeping an eye on in 2020″ — Roche’s Risdiplam, NS Pharma’s Viltolarsen, and Immunomedic’s Trodelvy.

Friday Stats and More

David Ermer–Congress, COVID-19–

According to the CDC’s COVID-19 cases in the U.S. website, which the FEHBlog tracks, over the past four weeks the numbers of new cases and deaths have taken a downward path

Week ending5/155/225/296/5
New Cases297,581159,546148,210142,829
New Deaths8956816075616353

The basic infection mortality rate (as calculated by the FEHBlog) continues to drop since its peak on May 15.

The Miami Herald features a fascinating article on disease super spreaders — both people and events.

“It’s not just that superspreading events are happening with SARS-CoV-2; they appear to be driving much of the pandemic,” The University of Hong Kong epidemiologists Dillon Adam and Benjamin Cowling wrote in the New York Times.

“This fact is alarming and reassuring at the same time … because it suggests a virus swift and efficient, and so seemingly unstoppable,” and “it also suggests a way to stop SARS-CoV-2 that is both less onerous and more effective than many of the strategies that have been pursued so far.”

”Forget about maintaining … sweeping measures designed to stem the virus’s spread in all forms. Just focus on stopping the superspreading,” the epidemiologists proposed in the newspaper.

In other words, restricting large gatherings could lower transmission rates, but in the U.S., it hasn’t been that easy.

It’s probably not easy anywhere, but it needs to be done in the FEHBlog’s humble opinion.

The International Foundation of Employee Benefit Plans offers a very thoughtful article on steps that health plans should take this year and next in response to the great hunkering down. For example, health plans should

  • Communicate the safety measures that have been put in place at hospitals and clinics. The Centers for Disease Control and Prevention have issued safety guidelines, including limiting visitors and screening patients and employees for the virus.
  • Communicate the importance of seeking urgent and preventive care. “We really want to encourage people to go and seek care that is needed when it is needed,” Baker said. “If we can just share the importance of preventive care from a high-level standpoint, without getting into the employees’ personal business, that may be something really beneficial in order to help manage plan costs,” she said.
  • Tweak wellness programs. Some employees may not have been able to qualify for wellness program incentives, so employers may want to change the guidelines to allow them to qualify.
  • Steps that plans take now could flatten the cost curve for the 2020 plan year. “Just a simple communication may be beneficial as things reopen,” [Dana] Baker [from the Mayo Clinic] said.

In closing, the Wall Street Journal reports that today’s surprisingly strong May employment report “boosted hopes that the economy has moved beyond the worst fallout from the pandemic and may recover more quickly than expected.” Also the President today signed the Payroll Protection Program flexibility act into law today. Here’s a summary of the new law.

Midweek update

David Ermer–Congress, Rx coverage, Telehealth–

NBC News reports that Wednesday evening, the Senate passed by unanimous consent a House passed bill to improve the Payment Protection Program that the CARES Act created to help small businesses with liquidity issues created by the great hunkering down.

UPI provides helpful context around the new Medicare program to control Medicare beneficiary out of pocket costs for insulin.

“Among commercially insured patients, high insulin prices do not necessarily translate to high out-of-pocket costs,” study co-author Dr. Amir Meiri, a research fellow with the Harvard Medical School Department of Population Medicine and a practicing internist, told UPI.

For these patients, “insulin out-of-pocket costs are generally lower than expected and declining, except among patients in high-deductible health plans with health savings accounts, who must pay for the full cost of medications — including insulin — until they reach their deductible,” Meiri said.

The time period for the study was 2007-16. Last year, the Internal Revenue Service pursuant to an executive order issued a ruling permitting coverage of insulin before the high deductible.

A friend of the FEHBlog called to his attention this 21st century, FDA approved digital stethoscope that could revolutionize care at home. Fierce Healthcare quotes Cambia Health’s chief medical officer who notes ““Telehealth as always been a benefit,” she said. “I think physicians now know that their patients want to use telehealth.”

OPM IG Confirmation Hearing

David Ermer–Congress, OPM–

This afternoon, the Senate Homeland Security and Government Affairs Committee held a virtual confirmation hearing for the President’s nominee for OPM Inspector General, Craig E. Leen, who currently is the Director of the Labor Department’s Office of Federal Contractor Compliance Programs (“OFCCP”). The FEHBlog caught a good chunk of the hearing online. The Senators’s attention principally was on the other nominee Russell Vought who is the acting Director of the Office of Management and Budget and hopes to be made the permanent director.

Mr. Leen was in no sense ignored though. Each Senator asked him a question or two. His opening testimony is available here. Of note, Mr. Leen stated that

As Inspector General, I would focus on the following immediate priorities:
 Closing open IG recommendations and establishing a public dashboard to track my office’s progress;
 Addressing improper payments and seeking to eliminate them;
 Evaluating OPM’s guidance related to COVID-19 and learn from what went well and what could be improved;
 Increasing the amount of evaluations done by OPM Office of the Inspector General (OIG), and
 Ensuring equal employment opportunity for all protected classes, including ensuring inclusion and accommodations of individuals with disabilities (the federal government should follow the same guidance it gives federal contractors in how to ensure equal employment opportunity)

I would like to take a moment to focus on the first and last priorities. The OPM OIG has over 300 open recommendations going back many years. This is a common issue for IGs. I am concerned about what open IG recommendations does to public trust in government; a problem has been specifically identified, but not corrected. I would make closing these open recommendations a primary focus as Inspector General.

Mr. Leen mentioned during the Q&As that the OPM Inspector General historically has performed one evaluation annually. The next step will be a Committee business meeting to consider sending Mr. Leen’s nomination to the Senate floor.

Weekend update

David Ermer–CDC, Congress, COVID-19, COVID-19 testing, OPM, Rx coverage, SCOTUS–

The House of Representatives and the Senate both will be in session on Capitol Hill this coming week, Of note from an FEHBP perspective is that Senate Homeland Security and Governmental Affairs Committee has scheduled a confirmation hearing for the President’s nominee for OPM Inspection General, Craig E. Leen, for Tuesday June 2 at 2:30 pm. Mr. Leen currently is Director of the Office of Federal Contract Compliance Programs (OFCCP) at the U.S. Department of Labor. The FEHBlog plans to tune in.

The Supreme Court heads into the home stretch of its October 2019 term tomorrow. The Court has 25 decisions left to issue before adjourning for the summer according to the Scotusblog.

OPM released more COVID-19 guidance last Friday. This guidance concerns preparedness for returning to OPM facilities.

Fierce Healthcare brings us up to date on COVID-19 testing at home options. The latest product receiving FDA approval is offered by Quest Diagnostics a/k/a Quest Labs.

The FEHBlog ran across on Twitter today this May 24 column from Reason senior editor Jacob Sillum.

According to the Centers for Disease Control and Prevention (CDC), the current “best estimate” for the fatality rate among Americans with COVID-19 symptoms is 0.4 percent. The CDC also estimates that 35 percent of people infected by the COVID-19 virus never develop symptoms. Those numbers imply that the virus kills less than 0.3 percent of people infected by it.

The FEHBlog also found this reassuring (at least to the FEHBlog) Science News article on COVID-19 mutations.

[C]oronavirus mutations are guaranteed to pop up over the coming months — and experts will continue to track them. “The data will tell us whether we need to worry, and in what way we need to worry,” [Louise] Moncla[, an evolutionary epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle] says. “Everyone should take a deep breath and realize that this is exactly what we’ve always expected to happen, and we don’t necessarily need to be concerned.”

Memorial Day Weekend Update

David Ermer–Congress, COVID-19, OPM–

Congress was scheduled to be out of town this week for State / District work periods. The House however has decided to be in town for votes and a few Committee hearings on Wednesday and Thursday. Congress is considering making some adjustments to the CARES Act’s Payroll Protection Program.

This is a big week for FEHBP carriers because their 2021 benefit and rate proposals are due at OPM by May 31. (Yes, next Sunday.) It is an complicated proposal year because the COVID-19 emergency has disrupted the normal claim payment rhythm.

The Wall Street Journal reports that on a randomized study of hospitalized COVID-19 patients in New York City finding the convalescent plasma (which includes the antibodies created by people who recovered from COVID-19) produced better outcomes. “In the study, the plasma recipients were more likely to remain stable or show improvement in their requirements for supplemental oxygen. They also had improved survival when compared to the control patients.”

The Wall Street Journal also reports tonight about “early signs the U.S. economy is, ever so slowly, creeping back to life.” “If this is the only wave [of coronavirus], it looks like we’ve bottomed out and the normalization process has begun,” said Beth Ann Bovino, U.S. chief economist at S&P Global Ratings.” Much greater testing, improved treatments, and controls on potentially super spreading events hopefully will place our medical system in a position to handle another wave without another great hunkering down.

Weekend update

David Ermer–Congress, COVID-19, COVID-19 testing, COVID-19 vaccine, Uncategorized–

The House of Representatives returned to Capitol Hill on Friday to pass a resolution (H.R. Res. No. 965) permitting remote Committee hearings and proxy voting during a federal declared emergency like the COVID-19 pandemic. The House also passed a wide-ranging, $3 trillion COVID-19 relief bill known as the HEROES Act (H.R. 6888) by a narrow 208-199 vote. The House thereby laid down its wishlist before the Senate and the President in the looming negotiations over what would be the fourth COVID-19 relief bill.

The FEHBlog’s favorite podcast Econtalk featured a special edition in which the host Stanford economist Russ Roberts interviewed Nobel in Economics laureate Paul Romer about the COVID-19 pandemic. Mr. Romer supports much less hunkering down and a lot more testing. It’s worth the hour or so to listen to the interview.

In other news:

  • The Washington Post reports that “Four months into the U.S. coronavirus epidemic, tests for the virus finally are becoming widely available, a crucial step toward lifting stay-at-home orders and safely returning to normal life. But while many states no longer report crippling supply shortages, a new problem has emerged: too few people lining up to get tested.” This word needs to get out.
  • Healthcare Dive discusses health insurer and tech company efforts to help their employer plan sponsors to safely reopen their businesses.
  • The Wall Street Journal reports on the state of the race to develop a safe and effective COVID-19 vaccine. Eight investigational versions have begun human testing trials. “Testing of early vaccines could show the way for subsequent shots by giving researchers a better idea of the level of immune response needed to provide protection against the virus, Emory’s Dr. Orenstein said.”
  • Fierce Healthcare discusses J.D. Powers 2020 analysis of consumer attitudes toward commercial health plans. “Consumers want a coordinated, integrated experience that their health plan may be unwilling or unable to provide, [James Breen from J.D. Power] said. “Health plan members have an expectation that health insurance companies do that, but I’m not certain whether or not health insurance companies feel that’s part of their major role, so there’s a disconnect there,” Beem said.

Tuesday Tidbits

David Ermer–CDC, Congress, COVID-19–

The Senate Health Education Labor and Pensions Committee held a COVID-19 hearing today featuring a number of federal government healthcare luminaries including Dr. Fauci. Here is a link to the hearing and the submitted testimony. The Wall Street Journal reports

Dr. Fauci said that with some states reopening before seeing a steady decline in cases and deaths, “there is a real risk you could trigger an outbreak…that could set you back rather than going forward.”

Adm. Brett Giroir, who is heading up the administration’s testing efforts, said an increased focus on testing in schools could be used as a means of surveillance to help ensuree students stay healthy.

Other health officials also emphasized the need for widespread testing to get a more accurate picture of how many people have fallen sick and to spot potentially undetected clusters of cases.

Here’s a link to the COVID Tracking Project site which provides a ton of state by state COVID-19 data, including testing data. As previously noted, GoodRx offers a complete, growing list of drive up COVID-19 test sites. Last week, one of the big U.S. lab test companies, LabCorp, began to offer “expanded access to COVID-19 antibody test through LabCorp’s wide network of doctors, healthcare providers, and online. Individuals have the ability to receive the COVID-19 IgG antibody test from their doctor, in person or through a telemedicine program, and now directly using www.LabCorp.com/antibody-testing.“

A friend of the FEHBlog pointed out this National Institutes of Health website which is chock-a-block full of COVID-19 research tidbits. For example, the FEHBlog noticed a NIH study finding “nearly everyone who recovers from COVID-19 makes coronavirus antibodies.” Check it out.

The Hill brings us to date on the four leading U.S. and European COVID-19 vaccine development efforts. “There are more than 100 potential vaccine candidates, according to the World Health Organization, but only eight have entered the crucial clinical trials stage. Four are in the United States and Europe, with the rest in China.”

Healthcare Dive reports that the American Hospital Association flipped out over new price transparency rules in the fiscal year 2021 Medicare Part A hospital PPS changes proposed rule released yesterday.

Weekend update

David Ermer–Congress, COVID-19, HIPAA Privacy and Security Rules, Rx coverage–

Happy Mother’s Day.

Just like last week, the Senate will be in session this week while the House continues to fully hunker down. The Hill discusses five factors influencing when the House will return to Capitol Hill. It’s funny that the article does not list the Presidential election as a sixth factor. (Even the FEHBlog is entitled to have an occasional “DJT” moment. Lo siento.)

The FEHBlog forgot last Thursday to provide a link to the Senate Health Education Labor and Pension Committees “shark tank” on new tests for COVID-19. Here you go. This Committee will be holding a hearing on how to pull out of the great hunkering down on Tuesday.

For the past two months, the FEHBlog has been tracking a simplified infection fatality rate (IFR) for COVID-19 based on the CDC’s statistics. The FEHBlog is not an epidimeologist but he figured things would be looking up if the rate plateaued. The FEHBlog’s statistics do show the IFR increase slowing down over the past month. In any event, here’s a new Health Affairs article on the COVID-19 IFR for your information.

CIGNA’s PBM Express Scripts has created a program called ParachuteRX which offers reasonably priced prescription drugs to the uninsured. Cool.

The FEHBlog has been a fan of genetics-based personalized medicine. It therefore was sobering for the FEHBlog to read in the Wall Street Journal that the popular focus on personalized medicine has detracted from public health efforts. The article explains that

the first national initiative launched to try to treat today’s severely ill patients is the National Covid-19 Convalescent Plasma Project. The project originated with a small nucleus of people who, it turns out, have been prominent critics of personalized medicine over the years, including Arturo Casadevall of Johns Hopkins University, Michael Joyner of the Mayo Clinic and Nigel Paneth of Michigan State University.

The idea of using antibody-rich plasma from recovered patients to try to neutralize a virus in those who are ill was first used more than 100 years ago. The project is designed to buy time and save lives until a vaccine can be developed and deployed or more targeted therapies can be identified and tested. It also offers a real-world test case for ideas that had largely been confined to academic journals and debates between scientists.

Indeed the FEHBlog learned in the Great Influenza book that small scale efforts to use this antibody approach found success in the 1918-19 pandemic. It’s encouraging to read that a large scale effort is underway now. In the aftermath of the great hunkering down, a Goldilocks compromise must be reached between personalized medicine and public health efforts.

Finally, Health IT Security does a good job putting the government’s COVID-19 related flexibilities with regard to enforcing the HIPAA Privacy Rule into focus.

Midweek update

David Ermer–Congress, COVID-19–

Fierce Healthcare and Healthcare Dive report on CVS Health’s positive first quarter 2020 results. According to Fierce Healthcare,

[CVS Health] CEO Larry Merlo said that utilization of telehealth and virtual visits through its MinuteClinic locations was up 600% compared to the first quarter of 2019, while home delivery of prescriptions was up 1000%.

In addition, he said, the company is seeing a fourfold increase in the number of customers adding other items from the front of their stores to home pharmacy deliveries. CVS is also seeing increased engagement with customers and members through its app, Merlo said.

Healthcare Dive adds

Though coronavirus had “minimal impact on the quarter,” CVS does expect a “big impact in April,” CFO Eva Boratto told investors on a Wednesday morning call. Consumers increasingly stayed at home in April, resulting in a sharp reduction in foot traffic to stores, and filed fewer prescriptions due to fewer doctor visits, according to CVS’ preliminary results from the month. Those headwinds could persist throughout the second quarter.

Interesting links —

  • The Senate Health Education Labor and Pensions Roundtable on COVID-19 policy was held today. Among the speaker was the FEHBlog’s favorite health policy expert Avik Roy whose testimony reads in pertinent part as follows:

[T]raffic fatalities is a good mental framework for thinking about how to live with COVID-19. Instead of abolishing cars, we enforce traffic laws and speed limits, and prohibit drunk driving. We set a minimum standard for car safety. But, most of all, we expect individual drivers to be responsible for their own conduct.
Something similar can work for COVID-19. Businesses can deep-clean their surfaces and provide hand sanitizer and masks to their workers and customers. People can wash their hands regularly, and minimize close contact with strangers. This is, in fact, what East Asian countries did after the original SARS outbreak in 2003, and it enabled them to gradually return to normal life, despite the absence of a vaccine or effective treatments.

  • As the FEHBlog aims to be a voice of calm and reason in the FEHBlog storm he notes that PsychHub has created a COVID-19 Mental Resource Hub and that the Atlantic has debunked, to his satisfaction, an unsubstantiated claim that the COVID-19 virus has mutated.
  • The CARES Act created a Pandemic Response Accountability Committee which has its own website. The site’s purpose is “to foster greater accountability and transparency in the use of these [CARES Act relief] funds” totaling $2.3 trillion.