Thursday Miscellany

COVID-19

Person using a laptop

Thursday Miscellany

David Ermer–ACA, COVID-19–

Today the Department of Health and Human Services finalized it major annual ACA notice — the 2021 notice of benefit and payment parameters. Here is a link to the fact sheet. Of note to all FEHB plan carriers —

  • The finalized 2021 maximum annual limitation on cost sharing [for in-network care] is $8,550 for self-only coverage and $17,100 for other than self-only coverage. This represents an approximately 4.9 percent increase above the 2020 parameters of $8,150 for self-only coverage and $16,300 for other than self-only coverage.
  • We finalized changes to the policy regarding how direct drug manufacturer support, including coupons, may accrue towards the annual limitation on cost sharing in response to stakeholder feedback indicating confusion about the regulatory requirement finalized in the 2020 Payment Notice. This new policy provides that, to the extent consistent with State law, issuers will be permitted, but not required, to count toward the annual limitation on cost sharing amounts paid toward reducing out-of-pocket costs using any form of direct support offered by drug manufacturers to enrollees for specific prescription drugs.

The notice also makes changes to the medical loss ratio rules applicable to health insurers. The entire annual notice is available at this link.

The Government Accountability Office today released a timely report titled “Congressional Action Is Essential to Enable a Sustainable Business Model.” In pertinent part —

Regarding USPS, reassessing its business model should start with the level of required postal services. For example, delivery is USPS’s most costly operation; USPS officials estimate annual savings of $1.4 billion to $1.8 billion if delivery of mail were reduced to 5 days rather than 6 days per week. Second, USPS is to function as a financially self-sustaining entity; however, it does not. A reassessment could include determining whether some of USPS’s costs and liabilities should be borne by taxpayers. Third, alternative institutional structures for USPS range from a federal agency to a private company. A bankruptcy proceeding is not an effective or appropriate means to address the issues associated with a potential USPS restructuring, according to the National Bankruptcy Conference [whose report is an appendix to the GAO report].

The Wall Street Journal in its story on the GAO report noted that “The Postal Service’s governance board said Wednesday it would tap Louis DeJoy, the chief executive of a North Carolina consulting and project-management firm, to be the next postmaster general.” He is “expected to take over as postmaster general on June 15” at which point the current Postmaster General Megan Brennan will begin her well deserved retirement.

Also today UnitedHealth Group announced the large health insurer

will provide more than $1.5 billion in initial assistance, including customer premium credits, to its UnitedHealthcare customers as many people have been unable to access routine or planned care due to the COVID-19 pandemic. Consequently, UnitedHealthcare has seen a lower volume of medical care being delivered than was anticipated when pricing was initially established.

For UnitedHealthcare commercial fully insured individual and employer customers, credits ranging from 5% to 20% — depending upon the specific plan — will be applied to premium billings in June.

For people served by UnitedHealthcare Medicare Advantage plans, all specialist and primary physician cost sharing will be waived at least through the end of September, helping remove barriers for seniors needing to access care.

The FEHBlog is quite proud to represent health insurers and plans for the way that they have stepped up in this crisis for their members.

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.

Tuesday Tidbits

David Ermer–Congress, COVID-19, Medicare–

Theme for Cinco de Mayo — Ball of confusion that’s what the world is today. The Temptations (1970)

The American Hospital Association reported today that hospitals are losing $50.7 billion monthly from March through June due of course to the COVID-19 emergency. That’s a lot more than the $175 billion that Congress has appropriated so far for grants to hospitals and other healthcare providers. The FEHBlog doubts that most hospitals have strong balance sheets. No wonder health plans are stepping up to offer support as noted on Sunday.

Healthcare Dive discusses a study that reminds us about the large extent to which private payers including FEHB plans subsidize hospitals and other providers due to the insufficient payments from Medicare. “It’s unlikely Washington would take concrete measures to shrink hospitals’ toplines during the pandemic.”

Fierce Healthcare informs us that after reaching out to 500,000 Medicare Advantage members Humana has decided to waive Medicare Advantage member cost sharing for primary and behavioral healthcare this year whether the care is delivered in office or virtually. “William Shrank, M.D., chief medical officer at Humana, told FierceHealthcare that the insurer is tracking member behavior in this area and has gathered plenty of anecdotal evidence that patients are deferring potentially necessary care due to the pandemic.”

Catalyst for Health Reform has created a new state by state report card on healthcare price transparency laws. “Sixteen states [including the FEHBlog’s home state of Maryland] received passing grades this year, up from only seven when CPR last graded states in 2017.”

Lincoln Memorial

May the Fourth be with you

David Ermer–Congress, COVID-19–

The FEHBlog saw that line several times today. It’s cute.

Healthcare Dive reports that the Department of Health and Human Services decided last Friday to divvy up $22 billion of CARES Act funding by send $12 billion to hospitals in COVID-19 hot spots and another $10 billion to rural hospitals. The American Hospital Association is happy.

RevCycle Intelligence informs us that “Outpatient visits for more than 50,000 providers declined by nearly 60 percent in mid-March when COVID-19 cases started to rise exponentially, researchers from Harvard University recently reported in a Commonwealth Fund study. The volumes have remained low through mid-April.” Here are a couple more tidbits from the study:

  • The decline in visits was generally larger among surgical and procedural specialties and smaller in other specialties such as adult primary care, obstetrics/gynecology, oncology, and behavioral health.
  • As the number of in-person visits dropped, telehealth visits increased. But the increase in telehealth visits only partially offset the drop in in-person visits.
  • Nearly 30 percent of all visits at these ambulatory practices are now provided via telemedicine.
  • The decline in visits was largest among school-age children and older adults.

Health Payer Intelligence informs us that America’s Health Insurance Plans and AHIP member medical directors have proposed a course for health plans to follow while we come out of the great hunkering down. That course includes continuing expansive coverage of COVID-19 testing and care, promoting telehealth, and engaging members, particularly those in need.

In that regard, Medical Economics provides physicians with advice on best practices for billing health plans for telemedicine services during the COVID-19 emergency. The advice strikes the FEHBlog as a bit complicated. It’s therefore not surprising to the FEHBlog that, according to an mHealth Intelligence report, members of Congress “Reps. Kim Schrier (D-WA) and Phil Rose (R-TN), say they want private payers to operate under the same rules as the Centers for Medicare & Medicaid Services, which last month established telehealth payment and coverage parity for the duration of the emergency.” The two representatives have introduced a bill for this purpose H.R. 6644).

Weekend Update

David Ermer–Congress, COVID-19, OPM, SCOTUS–

The Senate, but not the House of Representatives, returns to Capitol Hill tomorrow. On Wednesday, the Senate Homeland Security and Governmental Affairs Committee is holding a roundtable discussion about how new COVID-19 information should drive policy. On Thursday, the Senate Health Education Labor and Pensions Committee is holding a “Shark Tank” about new tests for COVID-19.

Federal News Network reports that George Nesterczuk who was President Trump’s first nominee to be OPM Director, has become a senior advisor to OPM’s current acting Director Michael Rigas. In 2017, Mr. Nesterczuk asked the President to withdraw the nomination in the face of criticism from federal employee unions.

The Wall Street Journal estimates the revenues that major health insurers will receive at some point due to the Supreme Court’s favorable decision in the Affordable Care Act risk corridor case last Monday. The Supreme Court begins its series of May telephonic oral arguments tomorrow.

The Journal further reports

The promise of new payments comes as the health-insurance industry has seen little financial pressure from the pandemic. In earnings calls over the past few weeks, insurers said they’d seen minimal impact on first-quarter results, and they were benefiting from reduced health-care costs due to the widespread cancellation of elective procedures and patients steering clear of routine care.

But the insurers said they could see costs ramp back up later in the year. Overall, several big companies including UnitedHealth Group Inc., Anthem Inc. and Humana left their financial guidance on earnings for 2020 in place despite the coronavirus impact.

A WSJ article posted today adds that

With fewer claims to pay out, some health insurers are using their improved balance sheets to help struggling providers secure loans, pay claims earlier and, in some cases, underwrite patients’ outstanding bills. And they have good reason to ensure providers survive the pandemic: “There is a risk that there is a smaller provider network after this,” said Brad Ellis, a senior director at Fitch Ratings. “So health insurers are trying to maintain the network.”

Well done.

Friday Stats and More

David Ermer–CDC, COVID-19–

At this point, according to the Centers for Disease Control’s COVID-19 cases in the United State website, which the FEHBlog tracks, the number of confirmed cases topped one million on Wednesday and the number of confirmed deaths topped 60,000 on Thursday. Interestingly, the case fatality rate (deaths over cases) has remained between 5 and 6% for the last fourteen days after jumping from 2% on April 1 to 5% on April 17. The case fatality rate (“CFR”) should drop as the number of confirmed cases increases due to antibiotic testing. The American Spectator observes

To put this in perspective: Last winter 250,000 people tested positive for the flu. 25,000 died. If these numbers are right, the CFR for the flu is 10 percent … but that can’t be right.

And, in fact, it isn’t. The Centers for Disease Control and Prevention (CDC) estimates that, although only 250,000 people tested positive for the flu last year, 39 million people actually got it. Generally only those who are older or otherwise unhealthy, or those who have a severe case, go to the doctor and get tested for the flu; everyone else just takes Motrin and Tylenol and stays home. This drives up the CFR dramatically.

Also check out the CDC’s weekly COVIDView.

The Boston Globe’s STAT offers a pessimistic view of the COVID-19 emergency over time. If the STAT’s view is correct, then we have experienced no progress in medical care since 1918-1919 when the flu decimated the world. The FEHBlog has confidence in our healthcare system to pull us through this crisis.

America’s Health Insurance Plans discusses the steps that health insurers take to expand coverage in the face of the COVID-19 emergency. Health benefits did not exist in 1918-19.

For those interested, the American Medical Association reviews advocacy efforts for its membership during the crisis.

The Harvard Business Review called the FEHBlog’s attention to

Kanter’s Law: that everything can look like a failure in the middle. Unexpected obstacles and difficult predicaments can arise in the middle of any human and organizational endeavor. Give up, and by definition it’s a failure. Persist, pivot, and persevere, and there’s hope for finding another successful path.

In closing Happy Law Day. ” Law Day is held on May 1st every year to celebrate the role of law in our society and to cultivate a deeper understanding of the legal profession.”

The Law Day 2020 theme is “Your Vote, Your Voice, Our Democracy: The 19th Amendment at 100.” In 2019-2020, the United States is commemorating the centennial of the transformative constitutional amendment that guaranteed the right of citizens to vote would not be denied or abridged by the United States or any state on account of sex. American women fought for, and won, the vote through their voice and action.

Person using a laptop

Thursday Miscellany

David Ermer–COVID-19, HIPAA Privacy and Security Rules, Medicare–

The Centers for Medicare and Medicaid Services today announced wide ranging Medicare changes to make healthcare more accessible during the COVID-19 emergency. For example,

For the duration of the COVID-19 emergency, CMS is waiving limitations on the types of clinical practitioners that can furnish Medicare telehealth services. Prior to this change, only doctors, nurse practitioners, physician assistants, and certain others could deliver telehealth services. Now, other practitioners are able to provide telehealth services, including physical therapists, occupational therapists, and speech language pathologists.

CMS previously announced that Medicare would pay for certain services conducted by audio-only telephone between beneficiaries and their doctors and other clinicians. Now, CMS is broadening that list to include many behavioral health and patient education services. CMS is also increasing payments for these telephone visits to match payments for similar office and outpatient visits. This would increase payments for these services from a range of about $14-$41 to about $46-$110. The payments are retroactive to March 1, 2020.

It will be interesting to see whether commercial plans adopt these changes (perhaps they already have). Check out the lengthy list. Hopefully many of these changes will be made permanent following the COVID-19 emergency.

As the FEHBlog has listed major COVID-19 testing locations. It occurred that he should also link to the COVID-19 sites for the major actuarial consulting firms, all of which provide useful information for health plans:

These sites are a valuable public service in the FEHBlog’s view.

HHS’s Office for Civil Rights today provided a helpful COVID-19 cyber threat resources. While the FEHBlog could not find a link to the list, he was able to upload the email to Dropbox.

Midweek update

David Ermer–COVID-19, HSA–

Healthcare Dive reports that health plans, health care providers, and the Chamber of Commerce have sent Congress a joint health care wish list for the fourth COVID-19 relief bill.

Becker’s Hospital Review provides an updated list of state by state peak dates for COVID-19 hospital resources from IMHE. According to the chart virtually all of the State have hit their peak by today.

Health Payer Intelligence discusses Oscar Health’s population health oriented approach to connecting with its plan members during the COVID-19 emergency. On a related note, Fierce Healthcare summarizes the steps that the country’s tech giants, Apple, Amazon, and Alphabet/Google, have taken in response to the COVID-19 emergency.

Employee Benefit News provides useful COVID-19 emergency tips for sponsors and holders of health savings accounts.

MedCity News reports good news on the cancer detection front:

A test designed for early detection of cancers from a blood sample was able to more than double the number of cancers picked up through screening, including seven cancers that currently do not have any standard-of-care screening methods, according to a new study.

The study, sponsored by Cambridge, Massachusetts-based Thrive Earlier Detection and carried out by Johns Hopkins University and Geisinger Health, was presented Tuesday at the American Association for Cancer Research’s [virtual] annual meeting.

Bravo.

Tuesday Tidbits

David Ermer–ACA, COVID-19, OPM, SCOTUS–

Following up on yesterday’s post on the Supreme Court’s decision in the Affordable Care Act risk corridor case, read Katie Keith’s article in Health Affairs on all of the decision’s reverberations. Fascinating.

The FEHBlog did virtually attend the NCQA Quality Talks 2020 conference today. Two speakers favorably caught the FEHBlog’s attention:

With regard to OPM’s concern about rooting out low value care in the healthcare system, Cardiologist Rita Redberg, MD, has been editing for years a series in the JAMA Internal Medicine Journal titled “Less is More.” Dr. Redberg blasted the medical device industry for promoting artery stents before first obtaining reliable evidence of the device’s safety and efficacy. As it turns out the device is no more effective than a placebo.

The good doctor explained that normally it’s difficult to perform a blinded research study with a new medical device because the research participant usually knows whether or not she received the device (as a opposed to a sugar pill.) In this recent Orbita study, the researchers convinced all of the study participants that they had received a stent. The good doctor also spoke about a friend who unnecessarily received a stent and wound up needing a heart transplant.

The FEHBlog also was quite impressed by Dana Lewis a young go-getter who along with a colleague developed a small closed loop computerized system to control her continuous glucose monitor as she has type 1 diabetes. She then founded an “open source artificial pancreas system movement (#OpenAPS)” to help others. She is not resting on her laurels.

An article in Medical Economics discusses a proposed Labor Department rule intended to protect TRICARE medical networks. However, the rule if finalized would disrupt FEHBP medical networks. The FEHBlog submitted comments to the Labor Department on the proposed rule for the FEHB plan trade association he represents. The comments asked the Labor Department to protect both TRICARE and FEHBP networks. He hopes the Labor Department will pull back the rule given the COVID-19 emergency.

In a bit of good COVID-19 news, the New York Times reported progress being made in two efforts to create a COVID-19 vaccine. Fingers crossed.

Also the Hill reported this afternoon that the House of Representatives has changed its mind about returning to Capitol Hill on May 4. The Senate continues to plan to return to the Capitol next Monday.

Monday Musings

David Ermer–Congress, COVID-19, Electronic health records, SCOTUS–

Here’s a musing for you. The FEHBlog expects that everyone is familiar with the spiritual titled “Sometimes I feel like a motherless child.” Well after reviewing lots of news, the FEHBlog to paraphrase this spiritual sometimes feels like the only person in America who believes that the U.S. healthcare system can pull us through this pandemic.

The House and Senate announced today that each body of Congress will be returning to Capitol Hill next Monday May 4. Welcome back.

In a decision sure to delight health insurers that took the initial plunge with the ACA marketplaces back in 2014, the U.S. Supreme Court ruled today in a virtually unanimous opinion that the U.S. owes many of those insurers a total of roughly $12.3 billion for unappropriated yet mandated risk corridor payments. The only dissenter was Justice Alito who agreed that the government owed the money but questioned whether there was a private right of action under the ACA to sue the government for the money. It’s not a crazy thought because the government is generally protected against lawsuits by a doctrine known as sovereign immunity.

The FEHBlog thought that this would be a good opportunity to update readers on the major commercial COVID-19 testing sites:

Castlight offers a COVID 19 testing directory which organizations can link to their own websites.

Verily Health, which is an affiliate of Alphabet/Google, has “launched COVID-19 Pathfinder— a new set of tools that provide on-demand access to COVID-19 information directly from a hospital or health system website.” Cool.

In a bit of good news for HHS, Fierce Healthcare reports that the EPIC, the electronic health record (“EHR”) giant, has switched from “fiercely” opposing to supporting the HHS EHR interoperability rules. “Epic controls more than a quarter of the hospital EHR market, according to KLAS Research, and, among hospitals with 500 or more beds, Epic has a 58% market share.”