Weekend update
Happy Easter!
From Washington, DC,
- Congress remains on a State/District work break this week. Both Houses of Congress return to Capitol Hill on April 13.
- Govexec reports,
- “President Trump’s fiscal 2027 budget proposal, released Friday morning, would freeze federal civilian employees’ pay in 2027, all while granting a sizeable raise for members of the armed services.
- “An Office of Management and Budget spokesperson told Government Executive that under Trump’s budget, civilian workers would receive no pay increase next January. But under the plan, members of the military would receive between a 5% and 7% pay increase, with the highest raises going to the lowest ranked personnel.”
- The U.S. Office of Personnel Management has released its Fiscal Year 2027 Congressional Budget Justification.
- Worth noting on page 84
- The FEHB Protection Act of 2025 (FPA) requires OPM to strengthen eligibility verification and oversight of the FEHB Program. OPM is directed to issue regulations and implement verification processes by July 4, 2026, conduct a comprehensive family member eligibility audit between July 4, 2026 – July 4, 2029, and establish a process for removal of ineligible individuals (completed in December, 2025 per statutory deadline).
- FEHBlog observation — Any improvement in eligibility verification should begin with adding the HIPAA 820 electronic enrollment roster transaction to OPM’s enrollment system. That transaction would allow carriers to reconcile premium payments to individual enrollments. What is the sense of performing this family member audit if carriers don’t know if the individual with self and family or self and family coverage (or half of the enrollment with self only coverage) is paying the correct premium?
- Worth noting on page 84
- Healthcare Dive reports,
- “Antitrust regulators are warning Tennessee not to terminate an agreement giving its health department oversight of Ballad Health, a hospital monopoly in the state.
- “The Tennessee legislature is considering bills that would allow Ballad’s certificate of public advantage, or COPA, to expire in 2028. Balled was formed in 2018 under the COPA, a controversial mechanism that allows potentially anticompetitive hospital mergers to go through in exchange for increased state oversight for a period of time.
- “Without the COPA, all state supervision of Ballad’s care quality, availability and access, along with population health initiatives, would end.
- “That could have steep consequences for Tennessee patients, including higher healthcare costs and poorer quality of care, the Federal Trade Commission said in the letter sent Wednesday.”
- MedTech Dive relates,
- “The Trump administration is adjusting how Section 232 tariffs on steel, aluminum and copper imports and derivative products are calculated, according to a proclamation President Donald Trump signed Thursday.
- “Under the new rules, which go into effect April 6, goods made almost entirely of aluminum, steel or copper, including steel coils and aluminum sheets, will face a 50% tariff for the value of the item.
- “However, derivative articles “substantially made” of steel, aluminum or copper will incur a 25% levy, per a White House fact sheet. Such goods include steel cooking appliances, silverware, diesel-engine trains and semi-trailer hauling trucks, according to a list provided by the White House.”
From the public health, medical / Rx research front,
- The Washington Post reports,
- “Uri Alon was long puzzled by a textbook statistic: longevity, the thinking went, was about 20 percent in our genes.>” * * *
- “The original studies that were used to estimate how much of lifespan was inherited were studies of Scandinavian twins from the tail-end of the 19th century.
- “During that era, “extrinsic” mortality was high — deaths that aren’t related to the deterioration of aging, such as accidents, violence or deaths from infections that are now uncommon because of better nutrition, therapies and hygiene.
- “His team examined a database of Swedish twins born later, between 1900 and 1935, and found that these extrinsic deaths were masking the inherited component of lifespan. When they applied their model, designed to remove extrinsic deaths, to databases of Scandinavian twins and the siblings of centenarians who lived to at least 100, the heritability of lifespan markedly increased — to about half.” * * *
- “Thomas Perls, a longevity researcher at Boston University and the founding director of the New England Centenarian Study, agrees that genetics play a major role in lifespan, but that it depends on what age you are talking about.
- “At the very extremes of old age — people who live to 105 or even 110 — genetics play a major role in lifespan. But Perls points to a 2018 study in the journal Circulation that suggests that even without winning the genetic lottery, an average person can probably get to about 88 years old as a man, and 93 years old as a woman. That depends on embracing good health-related behaviors. He also notes that socioeconomic advantages contribute — access to health care, education, healthy food.”
- and
- “Joseph Buxbaum was initially unconvinced. When early hints of a connection between autism and Alzheimer’s began to appear in the medical literature a few years ago, they struck him as implausible — one a condition of early brain development, the other driving decline in old age.
- “But the signals kept accumulating, and over time, his skepticism gave way to a new line of inquiry that could transform scientists’ understanding of the two diseases.
- “I came to this kicking and screaming. I didn’t want to believe it,” Buxbaum, a professor of psychiatry, neuroscience, and genetics/genomic sciences at the Icahn School of Medicine at Mount Sinai, said.” * * *
- “The idea that two conditions at opposite ends of life might be biologically linked is beginning to upend long-standing assumptions in brain science, blurring a divide that has shaped the field for decades. Now, some researchers have begun to see the two as intertwined: that understanding Alzheimer’s may require looking back to how the brain develops, and that insights into autism might, in turn, reshape how we understand Alzheimer’s itself.”
- The New York Times explains how a “long stay in intensive care can bring physical, cognitive and mental health challenges that can take months or longer to resolve.”
- “More than five million people annually are admitted to intensive care across about 5,000 American hospitals, and research shows that more than half experience such aftereffects. Older age increases the odds.
- “Patients and families are often startled by these continuing difficulties. “The belief is that they’ll be discharged from the hospital and in two or three weeks, they’ll be back to normal,” said Dr. Brad Butcher, who was Mr. Masterson’s doctor and wrote about PICS recently in the medical journal JAMA. “That doesn’t comport with reality.”
- “In fact, with greater I.C.U. use and improved treatments — the Society of Critical Care Medicine estimates that 70 to 90 percent of adults now survive their stay — the population likely to encounter the syndrome is growing.
- “Everyone is grateful that the patient has survived,” said Dr. Lauren Ferrante, a pulmonary critical care doctor and researcher at the Yale School of Medicine. “But that’s just the start of a long road to recovery.” In a 2016 study of patients over 70 that she co-authored, by six months after discharge only about half had returned to their pre-I.C.U. functional ability.“
- Medscape tells us,
- “For decades, clinical dietetics has been based on standardized nutritional recommendations for the general population: food pyramids, and Italy’s nutrient reference values, and dietary indications applied uniformly for conditions such as hypercholesterolemia or hypertension.
- “In routine practice, however, physicians have increasingly observed that patients with the same caloric intake and physical activity can show different outcomes in terms of weight change, glycemic control, or lipid profile.
- “This interindividual variability, once considered a clinical anomaly, is now supported by scientific literature. Response to diet does not depend exclusively on energy balance but also on a series of individual biological characteristics that influence nutrient metabolism and the interaction between diet and the body’s physiology.”
- “Precision nutrition frames diet from a simple quantitative tool of nutrients to a personalized metabolic intervention.
- “Applications of precision nutrition extend beyond body weight management. It has potential relevance in numerous clinical conditions, including gastrointestinal disorders such as irritable bowel syndrome, food intolerances, kidney stones, and various cardiometabolic conditions.”
- and
- “Analysis of real-world pharmacovigilance data shows that GLP-1s demonstrate distinct adverse event patterns across indications, primarily related to metabolic, nutritional, gastrointestinal, and psychiatric disorders, with different profiles observed across treatments.” * * *
- “As millions of patients are taking GLP-1s for weight control and obesity treatment worldwide, clinicians should be vigilant in monitoring for unanticipated long-term adverse effects,” the authors of the study wrote.”
- “The study was led by David Stone, Departments of Oncological Sciences and Biomedical Informatics, University of Utah, Salt Lake City. It was published online in Obesity.”
From the U.S. healthcare business and artificial intelligence front,
- Beckers Payer Issues reports,
- “The Blue Cross Blue Shield Association submitted a wide-ranging letter to CMS on March 30 in response to the agency’s information request on its Comprehensive Regulations to Uncover Suspicious Healthcare, or CRUSH, initiative.
- [Three of] Seven BCBSA Recommendations
- “1. CMS should notify Medicare Advantage plans in real time when it suspends payments to a provider over suspected fraud because bad actors are exploiting the current information gap by shifting billing from original Medicare to MA after CMS acted on suspected fraud in fee-for-service.
- “2. CMS should remove any contractual or policy language that requires MA plans to continue paying claims when fraud is suspected, regardless of whether CMS has paid its portion. The association also recommends that suspect claims be tagged with a unique code or priced at zero member liability at the time of a CMS payment suspension, so MA plans can identify those claims before payment.” * * *
- “6. Overall, the association says the independent dispute resolution process under the No Surprises Act is broken and needs structural fixes. BCBSA recommends CMS launch the IDR Gateway as soon as possible, implement baseline eligibility screening before payment or review, establish an upfront eligibility fee to deter bad-faith submissions, and create performance metrics.”
- The Health Care Cost Institute relates,
- “The prevalence of depression and anxiety has increased steadily since 2019. Previous research, including a report from HCCI, has identified a concurrent steady increase in the use of antidepressant and anxiolytic medications. Previous studies have found that most people receive prescriptions for psychotropic medications from their primary care providers. This finding describes national prescribing patterns, but few analyses have examined sub-national patterns and whether there is variation at a state level.” * * *
- “Nationally, approximately three quarters of antidepressant and anxiolytic prescription fills are prescribed by a primary care provider. The remaining quarter of fills are prescribed by psychiatrists and psychiatric NPs, and a small fraction (<1%) are prescribed by other mental health professionals.” * * *
- “At the state level, there is variation in the proportion of antidepressant and anxiolytic fills prescribed by each provider type. The proportion of fills prescribed by a PCP range from 55% in Washington, D.C. to nearly 86% in West Virginia. Likewise, Washington D.C. has the highest proportion of fills prescribed by a psychiatrist or psychiatric NP (44%) while West Virginia has the lowest (14%). The proportion of prescriptions from other mental health providers is highest in Rhode Island (5%) and lowest in Mississippi (0.2%).”
- “At a national level, the proportion of antidepressant and anxiolytics prescribed by a psychiatrist or psychiatric NP increased by about 2 percentage points from 2018-2022.”
- “More research is needed to understand the implications of high levels of PCP prescribing. One study found that patients who are treated by PCPs were less likely to be adherent to antidepressant treatment than patients who are treated by psychiatrists, and that patients treated by multiple providers had lower odds of nonadherence than patients treated by a single provider. Future studies should investigate why patients are receiving antidepressant and anxiolytic prescriptions from PCPs. This phenomenon could be related to mental health provider shortages or could indicate integration of mental health care into primary care, which is an objective of collaborative care models. Additional areas of research should include the role of other mental health providers, including allied health professionals, in prescribing medication, and outcomes associated with these prescribing provider types. Understanding how and why people are prescribed medications to treat mental health conditions is foundational for making informed decisions and effective policy to promote mental health care access.”
- “The Wall Street Journal explains how a consumer can obtain healthcare advice from a AI tool. The journalist does so in consultation with a human doctor.”