Thursday Miscellany

Thursday Miscellany

The Centers for Disease Control updated their guidance on how COVID-19 spreads earlier this week. Here’s the main takeaways from the FEHBlog’s standpoint:

COVID-19 is thought to spread mainly through close contact from person-to-person. * * * Some people without symptoms may be able to spread the virus. The virus that causes COVID-19 is spreading very easily and sustainably between people. Information from the ongoing COVID-19 pandemic suggests that this virus is spreading more efficiently than influenza, but not as efficiently as measles, which is highly contagious. In general, the more closely a person interacts with others and the longer that interaction, the higher the risk of COVID-19 spread.

Check it out.

Healthcare Dive reports

The Trump administration on Wednesday proposed changes to how drugmakers can report their prices to Medicaid, seeking to make it easier for pharmaceutical companies and insurers to enter into contracts that tie payment to patient outcomes. Typically, drug contracts are linked to the volume of product sold, providing for larger manufacturer rebates the more a product is prescribed and covered by an insurer. Increasingly, however, drugmakers and insurers have been exploring alternative approaches centered on some measure of a medicine’s value.

Why is this relevant to the FEHBP? “The Medicaid best price policy requires drug manufacturers to give Medicaid programs the best price among nearly all purchasers [Medicare Part D is excepted].” So for example, if a prescription drug manufacturer cuts a deal for value based drug pricing, the VBD pricing cannot drop below the Medicaid price. If the manufacturer can cut the same deal with Medicaid under this proposed rule, then everyone benefits. This is a proposed rule that won’t go into effect until later this year at best.

Fierce Healthcare reports that

Health Care Service Corp., which owns and operates Blue Cross plans in five states, has tapped Epic to develop a data exchange platform between health plans and providers. HCSC health plans will be able to exchange medical information with health providers in its networks that use Epic’s electronic health record (EHR) software. The contract is one of the first of its kind between Epic and a large insurer, according to the companies.

Given the importance of clinical data in government and large employer healthcare quality programs imposed on health plans, including OPM’s Plan Performance Assessment, this certainly won’t be the last such deal.

Monday Musings

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.”

Tuesday Tidbits

Today the Senate passed a bill expanding funding for the Small Business Administration’s COVID-19 relief programs ($370 billion), healthcare providers ($75 billion) and COVID-19 testing ($25 billion). The Wall Street Journal further reports that “the bill now goes to the House, which is expected to vote on it Thursday.” The President has tweeted that he will sign it when both Houses of Congress pass it..

Speaking of COVID-19 testing, Labcorp announced today that “it has received an Emergency Use Authorization (EUA) from the U.S. Food and Drug Administration (FDA). The EUA permits nasal swab specimens to be collected at home using the Pixel by LabCorp™ COVID-19 test home collection kit if recommended by a healthcare provider after completing a COVID-19 questionnaire.” Furthermore, CVS Health announced today that it has opened another large scale drive up COVID testing site in Dearborn Michigan.

As anticipated the Department of Health and Human Services informed the public today about

a policy of enforcement discretion to allow compliance flexibilities regarding the implementation of the interoperability final rules announced on March 9th in response to the coronavirus disease (COVID-19) public health emergency. ONC, CMS, and OIG will continue to monitor the implementation landscape to determine if further action is needed.

Absent this new policy, the rules would have been fully enforceable on January 1, 2021.

Finally the FEHBlog ran across today this long, handy AHIP prepared list of benefit improvements and related actions that its health plan members have made in response to the COVID-19 emergency. Bravo.

Interesting Ideas

Health Payer Intelligence reports that CIGNA and SCAN Health Plan are teaming up to reach out to Medicare Advantage members in an effort to help them with senior loneliness during the great hunkering. SCAN’s “employees are calling on seniors, starting with the most at-risk and isolated. During their birthday and welcome calls, SCAN’s Senior Advocates—individuals who are both members and SCAN Health Plan employees—listen for potential social determinants of health needs.” What a great approach for FEHB plans to follow.

STATNews discusses the value of using chest CT scans to reliably reliably supplement other forms of COVID-19 testing in our country.

STATNews also has developed a new electronic dashboard to gauge the readiness of rural counties in the U.S. to deal with the COVID-19 emergency or other pandemics. The developers are seeking public comment on the dashboard. This dashboard should have benefits beyond the current emergency.

Healthcare Dive reports that

The Centers for Disease Control and Prevention is working to automate generation and transmission of COVID-19 case reports to deliver data put in provider EHRs directly to public health agencies.

For providers that don’t have EHRs with the ability to electronically send case reports, CDC is creating a FHIR-based app [called eCR Now] to connect COVID-19 electronic case reporting (eCR) to existing health IT infrastructure to confirm cases and route the data to appropriate end users. The goal is to give public health officials a more accurate, timely picture of the pandemic.

The FEHBlog is quite a fan of the FHIR API.

This is the time of the year when the Drug Enforcement Administration (DEA) hold events that allow citizens to safely dispose of unused prescription drugs. Obviously these events are not being held this April. The DEA has creates a website on safe householder disposal of unused prescription drugs. It’s good information for health plans to share with members.

Tuesday Tidbits

The FEHBlog listened to the federal government’s COVID 19 press conference on the drive home from work. The Surgeon General urged listeners to visit When the FEHBlog arrived home, he checked out the website and it turns out to be another url for the Centers for Disease Control’s COVID-19 website that he takes a peak at daily. At least the FEHBlog hasn’t been misdirecting readers. Here is today’s COVID-19 scorecard:

Person-to-person spread36
Under Investigation528
Total cases647

The FEHBlog learned late this afternoon that COVID-19 concerns have caused OPM and AHIP to cancel the annual FEHBP carrier conference which was scheduled to run from April 1 to April 3 in lovely Crystal City Virginia. The FEHBlog while disappointed understands the decision because the event jams hundreds of people together in one hotel ballroom.

Yesterday’s Health and Human Services rules on electronic health record (“EHR”) interoperability and data blocking gave a big boost to HL7’s FHIR specification. “FHIR (Fast Healthcare Interoperability Resources) Specification is a standard for exchanging healthcare information electronically.” The FEHBlog was excited to hear about the FHIR specification early last year because it appeared to be a solution to the nagging EHR interoperability problem. HHS appears to have jumped into the FHIR specification pool with both feet.

This morning the FEHBlog listened to a HIMSS webinar on FHIR accelerators. The four HL7-designated FHIR accelerators are leading the FHIR charge to solve interoperability problems in different spheres:

  • The DaVinci Project is focused using FHIR to fix healthcare business to business exchange issues.
  • The Carin Alliance is focused on using FHIR to fix healthcare business to consumer exchange issues.
  • CodeX is focused on using FHIR to share clinical trial appropriate data found in EHRs with researchers in an effort to find cancer cures.
  • The Gravity Project is focused on sharing social determinant of health data found in EHRs with healthcare businesses for care coordination and SDOH benefit purposes.

Good luck to them all.

Monday Musings

The U.S. Office of Personnel Management issued additional COVID-19 guidance and FAQs on Saturday March 7. The Federal News Network summarizes OPM’s issuances here.

Here are the Centers for Diseases Control’s March 9 COVID-19 statistics for the U.S.

  • Travel-related 72
  • Person-to-person spread 29
  • Under Investigation 322
  • Total cases 423

The CDC has issued guidance for people at risk of contracting serious illness from COVID-19. According to the CDC,

Early information out of China, where COVID-19 first started, shows that some people are at higher risk of getting very sick from this illness. This includes:

  • Older adults
  • People who have serious chronic medical conditions like:
  • Heart disease
  • Diabetes
  • Lung disease

Becker’s Hospital News reports on a study recently published in the Journal of American Medical Association. The study which was conducted in Singapore finds that from a contagion standpoint the COVID-19 virus does not linger in the air but it does contaminate surfaces.

As predicted, the Trump Administration released its final electronic health record interoperability and data blocking rules today. The objective of the rules is to give patients better access to their health records. The rules take effect as early as January 1, 2021. The implementation of the interoperability rule is staged over time.

Here are links to the government fact sheets on the final interoperability rule and the final data blocking rule. WEDI, which an information technology advisor to the HHS Secretary, prepared a helpful comparison of the proposed and final data blocking rules.

Healthcare Dive reports on industry reaction to the final rules. Healthcare Dive explains

The CMS rule requires Medicaid, the Children’s Health Insurance Program, Medicare Advantage plans and Affordable Care Act exchange plans to provide their collective 125 million patients with free electronic access to their personal health data, including medical claims and encounter information including cost, by 2021.

MA plans, state Medicare and CHIP programs, CHIP managed care entities, Medicaid managed care plans and qualified health plans in the federal exchanges now have to “implement, test, and monitor” a Health Level Seven FHIR-compliant API, which the government has selected as the new national standard.

Those plans also have to make their provider directories available to current and potential enrollees through the API technology, too (excepting the federal exchanges, which already do so), by 2021, with the hope insurers will carry over those practices to private plans as well.

Finally it’s worth noting that HHS’s Agency for Healthcare Quality and Research has deemed this to be Patient Safety Awareness Week.

Our firm is closely monitoring the impacts of COVID-19. Effective 6/08/20, Ermer & Suter has reopened its physical offices for business, however for the continued safety of our staff, in-office capacity will not exceed 40%. We remain fully operational and are readily available from both our office and telework locations.