Friday Stats and More

Friday Stats and More

The CDC’s COVID-19 cases in the U.S. website, which the FEHBlog tracks, added age demographic information this week. The basic infection mortality rate stabilized then dropped slightly then stabilized again over the past two weeks. That has to be good news. The CDC’s weekly COVIDview supports the FEHBlog’s layman analysis.

MedPage Today offers an interesting story about the downswing of the illness from the perspective of New York City clinicians who have been on the front line.

The Centers for Medicare and Medicaid Services finalized today a subset of proposed Medicare Advantage and Part D changes that the agency proposed earlier this year. CMS is releasing the final rule in two installments so that Medicare Advantage and Part D plans are not overwhelmed. That’s considerate.

OPM released additional COVID-19 guidance for federal agencies today. The guidance concerns the Families First Coronavirus Response Act’s paid leave program for employees affected by COVID-19.

Thursday Miscellany

The House of Representatives passed COVID-19 relief bill no. 3.5 (H.R. 266) by a vote of 388-5 this afternoon. The bill restores funding for the Small Business Administration’s relief programs and provides $100 billion in funding for healthcare providers.

OPM issued a new COVID-19 letter to FEHBP carriers today. The FEHBlog was pleased to see that OPM is allowing FEHB high deductible plans with health savings accounts to cover telehealth before the “high deductible” as permitted by the CARES Act (COVID-19 relief bill no. 3).

OPM also announced today that “the Combined Federal Campaign (CFC) will conduct a nationwide special solicitation to support charities serving and affected by COVID-19. This special solicitation will run through June 30.” Good call. Here’s the link to the campaign.

Also over the past two days, OPM has issued FAQs on resuming normal workforce operations at federal facilities and the Families First Coronavirus Response Act’s (COVID-19 relief bill no. 2) paid sick leave program. Meanwhile the U.S. Department of Labor is up to nearly 90 FAQs on that program which also applies to private sector employers with under 500 employees.

Midweek update

Today, the FFCRA Paid COVID-19 Sick Leave Benefit took effect generally for private employers with under 500 employees. The Labor Department which enforces this law published temporary rules on mandated benefit. The informal guidance accompanying the rules explains that

Most employees of the federal government are covered by Title II of the Family and Medical Leave Act, which was not amended by this Act, and are therefore not covered by the expanded family and medical leave provisions of the FFCRA. However, federal employees covered by Title II of the Family and Medical Leave Act are covered by the paid sick leave provision.

Federal News Network discusses the complex impact of COVID-19 on the U.S. Postal Service. The article begins as follows:

With the Postal Service now tracking the deaths of its employees from the coronavirus pandemic, in addition to a growing list of those who have tested positive for the virus, the agency is doing everything it can to continue normal operations — even in the most extraordinary circumstances.

The USPS Board of Governors held a moment of silence Wednesday for postal employees who have died of complications from COVID-19, the illness caused by the current strain of the virus.

Those include Rakkhon Kim, a 50-year old letter carrier in New York City, who died of complications from the virus last week.

Terribly sad.

It’s worth linking to this Wall Street Journal article on nurses working on the COVID-19 front line in the Bronx, New York. The Boston Globe’s STAT discusses how the COVID-19 spreads and creates additional hot spots.

Healthcare Dive reports on a FAIR Health study of consumer use of telehealth and retail clinics relying on data gathered before the current COVID-19 emergency. “Consumer use of telehealth and retail clinics spiked from 2017 to 2018, while use of urgent care centers, ambulatory surgery centers and emergency rooms dropped as consumers increasingly turn to cheaper sites of care for low-acuity medical needs.”

As the article notes, telehealth use has become a necessity in the past month. HIMSS provides a patient guide on how to get the most out of telehealth visits. This may be useful for health plans to share with members.

CARES Act Update

The President and the entire Senate leadership have agreed on a third COVID-19 relief bill known as the CARES Act (H.R. 748). Senator Charles Grassley, the Senate Finance Committee Chair, has released a summary of the bill’s taxation and unemployment insurance provisions and summary of its health provisions. The key health provisions affecting federal employees benefits are the following:

Sec. 3701. Health Savings Accounts for Telehealth Services
This section would allow a high-deductible health plan (HDHP) with a health savings account (HSA) to cover telehealth services prior to a patient reaching the deductible, increasing access for patients who may have the COVID-19 virus and protecting other patients from potential exposure.

Sec. 3702. Over-the-Counter Medical Products without Prescription
This section would allow patients to use funds in HSAs and Flexible Spending Accounts for the purchase of over-the-counter medical products, including those needed in quarantine and social distancing, without a prescription from a physician.

The FEHBlog mistakenly stated on Sunday that that the House of Representatives would be back on Capitol Hill yesterday. In fact, as the Wall Street Journal explains, House members remain on recess this week. Should the Senate as anticipated pass the CARES Act today, the House leadership is expected to seek approval by a unanimous consent motion. A single member of Congress can block such a motion so a lot rides on entire House leadership support for the bill. According to the Wall Street Journal, House Speaker Nancy Pelosi wants the unanimous consent to clear the House. This motion could be brought to the House floor on tomorrow or Friday. The Journal further reports that the President is ready to sign the bill into law.

The FEHBlog has found a link to a COVID-19 statistics site, The COVID-19 Tracking Project, that displays aggregated lab results from COVID-19 testing, U.S. state by state, where available.

Thursday Thoughts

Fedweek reports that

The largest FEHB carrier, Blue Cross-Blue Shield, has loosened several policies, for those diagnosed with COVID-19, the respiratory condition caused by the COVID-19 virus including waiving:

prior authorization requirements for diagnostic tests and for covered services that are “medically necessary and consistent with CDC guidance”;

any copays or deductibles for diagnostic tests or treatment under that same standard;

early medication refill limits on 30-day prescription maintenance medications and cost sharing for prescriptions for up to a 14-day supply; and

copays for telehealth services related to COVID-19.

The FEHBlog was pleased to see that FEP is waiving telehealth cost sharing related to COVID-19. OPM’s carrier letter mentioned in yesterday’s post overlooked telehealth which is an important tool to mitigate the spread of COVID-19. If your plan offers a telehealth benefit, it is important to pre-register for that benefit before you need to use it. The FEHBlog found his plan’s pre-registration program to be quite efficient.

You will find that FEHBP plans prominently have links to their special COVID-19 coverage features on their websites.

The Wall Street Journal has put its helpful COVID-19 update website outside its general website paywall.

In other news,

  • The Centers for Medicare and Medicaid Services announced earlier this week “the Part D Senior Savings Model, a voluntary model that enables participating Part D enhanced plans to lower Medicare beneficiaries’ out-of-pocket costs for insulin to a maximum $35 copay per thirty-day supply throughout the benefit year. Beneficiaries who take insulin and enroll in a plan participating in the model should save an average of $446 in annual out-of-pocket costs for insulin, or over 66 percent, relative to their average cost-sharing for insulin today.” This program will launch next year. Time will tell whether the prescription benefit plan can extend this discount to FEHBP and other commercial health plans.
  • The National Cancer Institute released the Annual Report to the Nation on the Status of Cancer. The report presents good news
    • Overall cancer incidence rates are leveling off among males and increasing slightly among females.These trends reflect population changes in cancer risk factors, screening test use, diagnostic practices, and treatment advances. 
    • This year’s Special Section focused on progress toward select Healthy People 2020 objectives related to four common cancers (lung, colorectal, female breast, and prostate). The Healthy People 2020 target death rate (161.4 deaths per 100,000 persons) for all cancers combined was met overall and in most sociodemographic groups.
    • During 2007-2017, cancer death rates decreased 15% overall, and the percent improvement target (-10%) was met in many sociodemographic groups.
    • Many of the Healthy People 2020 objectives for death rates, cancer screening, and major risk factors related to lung, colorectal, female breast, and prostate cancer were met.
  • Becker’s Hospital Review provides an overview of seven key dates of the HHS interoperability rule released earlier this week.
  • Healthcare Dive discusses the five additional healthcare apps that CVS/caremark has added to its curated app “formulary” for the benefit of plan sponsors. “Livongo Health, Hinge Health, Hello Heart, Torchlight and Whil are now available for CVS’ PBM clients to use, in addition to Sleepio, a personalized digital sleep program and the first participating program when the service launched in 2019.”

Monday Musings

Today’s U.S. Supreme Court order list from its February 21 conference made no mention of the Texas v. U.S. cases (Nos. 19-840 and 19-841) concerning the Affordable Care Act’s constitutionality, one way or the other. This means that the Court will take up (or continue consideration of) the cases at a later conference. At this stage the Court is deciding whether to review the Fifth Circuit’s decision now or wait for further proceedings in the lower courts. The Court’s docket sheet states that the cases have been re-distributed for the February 28, 2020, conference.

The Federal Employees Dental and Vision Programs’ (“FEDVIP”) laws requires OPM to bid out all of the FEDVIP contracts every seven years. Currently OPM has contracted for 10 FEDVIP dental plans and four FEDVIP vision plans. Last week, OPM released its request for proposals for the next seven year FEDVIP contract cycle which begins on January 1, 2021. OPM states in the RFP document that it has capped the upper limit of dental plans at 12 and vision plans at 5. The deadline for submission of proposals is March 23, 2020. OPM expects to announce the successful contractors in May.

The Washington Post reports that the focal point of the national drug overdose crisis has shifted to the California and other western states. The drugs causing overdose deaths are principally two illicit drugs — fentanyl and methamphetamine.

In California, fatal drug overdoses over the previous 12 months increased 13.4 percent between July 2018 and July 2019, the last month for which the CDC has compiled provisional data — an additional 728 deaths.

Fentanyl delivers an immediate, powerful high but can also render the user unconscious and unbreathing almost instantly. * * * [San Francisco based harm reduction worker Kristen Marshall] noted that thousands of overdoses have been reversed by peers on the street who were supplied with naloxone as part of harm reduction efforts. For many years, San Francisco saw a growing population of drug users but had a strikingly low rate of fatal overdoses. But that was before fentanyl showed up.

In contrast, Illinois’ fatal drug deaths were down 8 percent, Pennsylvania’s down 10 percent, Michigan’s down 13 percent and Maine’s down 20 percent.

Thursday Miscellany

Fedweek noticed another tidbit in the agency’s FY 2021 budget that’s worth noting :

OPM is seeking authority from Congress to offer federal employees what it calls “voluntary benefits” such as short-term disability insurance, prepaid legal plans, emergency short-term childcare, and personal accident insurance.

The purchasing employee or annuitant would be responsible for paying 100% of the premiums for these coverages. What’s more the FEHBlog knows that prepaid legal plans cannot be offered on a pretax basis like FEDVIP can.

In other news,

  • Milliman posted an interesting infographic on various aspects of organ transplantation in the U.S. Average wait times are up and survival rates are down. That’s puzzling.
  • Healthcare Dive reports that “The [federal] Health Information Technology Advisory Committee on Wednesday unanimously approved its second annual report to Congress on the state of health IT landscape, recommending fixes to improve the electronic access, exchange and use of medical information.”
  • The Centers for Disease Control announced today that this year’s flu vaccine is having an efficacy rate of 45%.
  • Health Affairs offers an interesting study on the impact of administrative costs on U.S. healthcare spending.

Big Monday

The U.S. Office of Personnel Management (“OPM”) released its call letter for 2021 FEHBP benefit and rate proposals today. The carrier proposals are due on Sunday May 31, 2020. To prepare the proposals carriers also need OPM’s technical guidance, which is a separate Carrier letter, and to submit their proposals, carriers also must complete OPM’s extensive “ADC” information request. OPM expects a lot from its FEHBP carriers.

The President did transmit his FY 2021 budget proposal to Congress today. The Administration intends to propose to statutory change to the FEHBP government contribution formula (5 USC Sec. 8906):

to base it on a plan’s score from the FEHB Plan Performance Assessment would improve healthcare quality and affordability within the program. The enactment of the proposals in 2021 will not begin to impact program financials until 2023. [Page 1168]✦

This appears to be a retread from the last budget cycle. However, the FEHBlog does not recall reviewing the proposed legislative language for the 2019 proposal. This proposal assuming its the same one didn’t get very far then, and it’s unlikely to get further this year in the FEHBlog’s view. Federal News Network discusses other federal employee compensation found issues in the budget proposal.

Russ Roberts the host of the Econtalk podcast held a fascinating conversation with “physician and author Marty Makary of Johns Hopkins University talks about his book The Price We Pay.” The book concerns fixing our healthcare system. Dr. Makary made a lot of sense to the FEHBlog. He encourages readers to listen to this podcast or read the transcript.

Thursday Miscellany

At last year’s OPM AHIP FEHBP Carrier Conference, a Centers for Disease Control scientist announced that the U.S. Surgeon General soon would be issuing a new comprehensive report on tobacco use in the U.S. That report was issued today. It

  • Examines the effectiveness of various smoking cessation tools and resources;
  • Reviews the health effects of smoking and catalogues the improvements to health that can occur when smokers quit;
  • Highlights important new data on populations in which the prevalence of smoking is high and quit rates are low; and
  • Identifies gaps in the availability and utilization of programs, policies, and resources that can improve cessation rates and help smokers quit.

Here’s a link to OPM’s Quit Smoking website which discusses the FEHBP generous tobacco cessation benefits.

The CDC updated the public on its important antibiotic resistance solutions initiative.

CDC’s AR Solutions Initiative invests in national infrastructure to detect, respond, contain, and prevent resistant infections across healthcare settings, food, and communities. CDC funding supports all 50 state health departments, six local health departments, and Puerto Rico and the U.S. Virgin Islands.  Through these investments, CDC is transforming how the nation and world combat and slow antibiotic resistance at all levels.

Good luck.

The FEHBlog has discussed the relatively new, cooperative effort of hospitals to create a public asset, known as Civica Rx, to help solve drug shortages and lower the cost of generic drugs. Today, Civica Rx and the Blue Cross Blue Shield Association announced

their partnership to create a new subsidiary dedicated to lowering the cost of select generic drugs. The subsidiary is being formed in response to the impact of high drug costs on the health of Americans and the overall affordability of health care. Other health plans, employers, retail partners and health care innovators who share the belief that patients and their needs come first are invited to join the initiative.

The subsidiary will acquire and develop Abbreviated New Drug Applications (ANDAs) for select generic drugs and partner with Civica and manufacturing partners to bring more affordable generic drugs to uncompetitive markets in exchange for aggregated volume and multiyear purchasing commitments. Initially, several generic medications identified as having high potential for savings will be prioritized by the partnership and will evolve into a platform that can be used to enhance competition for additional generic drugs.

The new operation expected to start delivering product in early 2022. Strong move.

The American Hospital Association now offers a webpage with updates and resources concerning the Wuhan coronavirus.

Midweek update

CVS announced the following six health trends for 2020

  1. Continued evolution in kidney care 
  2. Greater consumer scrutiny on wellness products 
  3. The need for data stewardship as digital health rolls on 
  4. Pharmacies as a tool to reach underserved populations 
  5. Efforts to mitigate loneliness 
  6. Increased transparency around drug pricing 

The Centers for Medicare and Medicaid Services has decided to extend Medicare coverage to acupuncture for chronic low back pain as an alternative to opioid based pain killers. The CMS decision ” will cover up to 12 sessions in 90 days with an additional 8 sessions for those patients with chronic low back pain who demonstrate improvement.” Previously Medicare excluded acupuncture from coverage.

Retired OPM official Reg Jones discusses survivor benefits related to federal employment in Fedweek. FEHBP survivor benefits are generous if the prerequisites are met:

If your spouse receives an annuity in any amount and was covered under either the self plus one or self and family option of your FEHB plan, he or she and all eligible children may continue coverage. If the annuity amount is less than the premiums required, your spouse will be able to directly make payments to cover the rest of the cost.

Our firm is closely monitoring the impacts of COVID-19. Effective 3/16/20, Ermer & Suter has implemented telework for all of our staff to encourage social distancing and help contain the virus. We remain fully operational and are readily available from our telework locations with no change in telephone numbers or email addresses.