Weekend update

Weekend update

Happy Groundhog Day! USA Today reports that “On Groundhog Day 2020, Punxsutawney Phil could not find his shadow. And as the legend goes, this means we’re in for an early spring.” Oh, there’s also a big pro football game this evening in Miami. Go Chiefs.

Congress is in session this week on Capitol Hill. Federal News Network reports

The House will vote [this coming] week on a bill to repeal the Postal Service’s mandate to pre-fund health benefits for future retirees. The USPS Fairness Act (HR 2382) if passed, would undo one of the central provisions in the 2006 Postal Accountability and Enhancement Act. The bill, introduced by Congressman Peter DeFazio (D-Ore.), now has more than 300 co-sponsors and the support of the postal unions.

If Congress could get together to kill the three highly controversial Affordable Care Act taxes, Congress should be able to repeal this misguided mandate too.

Kaiser Health News reports on the Affordable Care Act penalties on Medicare payments that the Centers for Medicare and Medical has imposed on hospitals for certain adverse events affecting patients.

Now in their sixth year, the punishments, known as HAC penalties, remain awash in criticism from all sides. Hospitals say they are arbitrary and unfair, and some patient advocates believe they are too small to make a difference. Research has shown that while hospital infections are decreasing overall, it is hard to attribute that trend to the penalties.

This HAC penalty is in addition to the readmission penalty on Medicare payments that the ACA also created.

Fierce Healthcare warns

Payers better be prepared for orphan drugs.

The Food and Drug Administration (FDA) will evaluate more than 150 new approvals this year, OptumRx officials said in their latest quarterly report on the drug pipeline.

Already, there are 64 applications submitted to the agency with likely approval in 2020, the pharmacy benefit manager said. At least 11 of those drugs are set to be “blockbuster” products with over $1 billion in U.S. sales, Optum said in the report.

Optum has seen similar development activities over the past several years.

“It’s a little more than just an aberration—seeing three years in a row of high outputs is a trend, and something we think is going to continue at least for the foreseeable future,” Bill Dreitlein, senior director of pipeline and drug surveillance at OptumRx, told FierceHealthcare.

Weekend update

Both Houses of Congress are in session this week on Capitol Hill. The FEHBlog has signed up for Congress.gov alerts for S. 1895, Senator Lamar Alexander’s bipartisan bill to lower health care cost. The FEHBlog received his first alert this morning — the addition of a summary of key bill provisions:

Among other things, the bill

applies in-network cost-sharing requirements to certain emergency and related nonemergency services that are provided out-of-network, and prohibits health care facilities and practitioners from billing above the applicable in-network cost-sharing rate for such services; 

revises certain requirements in order to expedite the approval of generics and biosimilars, including requirements relating to citizen petitions, application effective dates, and labeling; 

requires health care facilities and practitioners to give patients a list of provided services upon discharge and to bill for such services within 45 days; 

limits prices that pharmacy benefit managers (PBMs) may charge health insurers or enrollees for prescription drugs, based on prices paid by PBMs to pharmacies; 

establishes grant programs to support vaccinations and data modernization; and 

requires health insurers to make certain information, including estimated out-of-pocket costs, accessible to enrollees through specified technology (e.g., mobile applications).

The Hill reports that the Centers for Disease Control will begin to publish Wuhan coronavirus updates on Mondays, Wednesdays and Fridays. There are now five confirmed cases in the U.S., all of whom are hospitalized. One hundred other people under being watched for the virus.

Chicago’s Crain Business informs us about the merger for four southside Chicago hospitals.

The combination [Advocate Trinity Hospital, Mercy Hospital & Medical Center, South Shore Hospital and St. Bernard Hospital] aims to bolster the precarious finances of the safety-net hospitals that treat large numbers of low-income patients on Medicaid, which pays less than Medicare and commercial insurance.

With an estimated $1.1 billion investment—including private donations and government dollars intended for hospital transformation—the plan is to build at least one new hospital and open up to six new community health centers that would expand access to preventive services and address social determinants of health, such as food insecurity, the four hospital leaders said today.

That’s a hopeful twist on such deals.

The Wall Street Journal reports today that

Hundreds of regional grocery stores in cities from Minneapolis to Seattle are closing or selling pharmacy counters, which have been struggling as consumers make fewer trips to fill prescriptions and big drugstore chains tighten their grip on the U.S. market. * * *

Grocery pharmacies are the latest casualty of industry consolidation that has for years been forcing mom-and-pop drugstores to close. Even some big players have rethought the market. Target Corp. sold off its pharmacy business to CVS Health Corp. five years ago. * * *

The tougher conditions come as the entire drugstore industry copes with a shift to online shopping and shrinking profits in prescription medicines, which often disproportionately affect smaller players.

And so it goes.

Weekend update

OPM directs us to the National & Community Service website for ideas on how to celebrate tomorrow’s Martin Luther King Jr. holiday. The FEHBlog believes that our country is indebted to Dr. King for his bold, essential leadership.

The House of Representatives has a district work period this week, while the Senate will be holding a trial on the House’s impeachment of the President.

Last Friday, the Centers for Disease Control announced updates to its vaping restriction recommendations in light of the subsiding vaping-related lung injury known as EVALI crisis. The FEHBlog appreciates the caution that the CDC has shown in handling this crisis.

Fierce Healthcare recently announced its Fierce 15 of 2019.

Big and small, high-tech and not, we’re honoring this collection of companies across the U.S. that are trying to change the world by changing the healthcare industry. 

The FEHBlog is not familiar with any of these companies but in time?

Healthcare Dive helpfully summarizes five key trends fo providers and payers. The FEHBlog is familiar with all of these.

Kaiser Health News discuss the latest hot item in wellness programs — helping employees sleep.