President nominates an OPM Director

President nominates an OPM Director

OPM Headquarters a/k/a the Theodore Roosevelt Building

The Federal Times, Govexec, and Federal News Network all report on today’s announcement that the President is nominating Kiran Ahuja to be OPM Director. Ms. Ahuja led the President’s transition review team lead for the agency. “Ahuja has over 20 years of public service and philanthropy experience. She’s currently the CEO of Philanthropy Northwest, and she spent several years as a career civil rights attorney at the Justice Department.” Her nomination is subject to Senate confirmation. In due course, the President also is expected to nominate an OPM Deputy Director and an OPM Inspector General.

Healthcare Dive reports on the first confirmation hearing for the President’s nominee for Secretary of Health and Human Services, Xavier Becerra. Mr. Becerra “told senators on the health committee Tuesday morning he would continue work he did as California attorney general to combat anticompetitive practices in healthcare and go after providers that ‘unfairly jack up prices on patients.'” According to the report, Mr. “Becerra will be back in the hot seat Wednesday for his second confirmation hearing, this one in front of the Senate Finance Committee. That will be the committee voting on whether to send his nomination to the full Senate for a vote.”

Tomorrow, the Senate Homeland Security and Governmental Affairs Committee at 10 am and the Senate Budget Committee at noon each will hold a business meeting on whether to advance to the Senate floor the President’s nomination of Neera Tanden to be Director of the Office of Management and Budget.

Tomorrow at 10 AM, the House Oversight and Reform Committee will hold a hearing on “Legislative Proposals to Put the Postal Service on Sustainable Financial Footing.” The Committee Staff explains in a memorandum,

the Committee will hold a hybrid hearing to review legislative proposals to place the Postal Service on a more sustainable financial footing. The Committee will consider a discussion draft that includes several provisions to relieve the financial burdens under which the Postal Service is currently operating and to enhance transparency regarding performance. That draft is being circulated with this memo. The discussion draft includes provisions on Medicare integration [for Postal annuitants participating along with Postal employees in a separate program within the FEHB] , repealing a requirement for the Postal Service to pre-fund retiree health care, and service performance standards.”

Earlier today, the Oversight and Investigations Subcommittee of the House Energy and Commerce Committee held a hearing on the availability of COVID-19 vaccinations. The hearing featured testimony from executives at the companies manufacturing those vaccines. Fierce Healthcare reports that “Pfizer, Moderna and Johnson & Johnson execs say [at the hearing] they’re working all the angles on increasing COVID-19 vaccine production and expect to amp up weekly deliveries by tens of millions by the end of March.”  

In that regard, a friend of the FEHBlog pointed him to this NIH Director’s blog entry released today

For the millions of Americans now eligible to receive the Pfizer or Moderna COVID-19 vaccines, it’s recommended that everyone get two shots. The first dose of these mRNA vaccines trains the immune system to recognize and attack the spike protein on the surface of SARS-CoV-2, the virus that causes COVID-19. The second dose, administered a few weeks later, boosts antibody levels to afford even better protection. People who’ve recovered from COVID-19 also should definitely get vaccinated to maximize protection against possible re-infection. But, because they already have some natural immunity, would just one shot do the trick? Or do they still need two?

A small, NIH-supported study, published as a pre-print on medRxiv, offers some early data on this important question [1]. The findings show that immune response to the first vaccine dose in a person who’s already had COVID-19 is equal to, or in some cases better, than the response to the second dose in a person who hasn’t had COVID-19. While much more research is needed—and I am definitely not suggesting a change in the current recommendations right now—the results raise the possibility that one dose might be enough for someone who’s been infected with SARS-CoV-2 and already generated antibodies against the virus.

Encouraging news.

Friday Stats and More

Based on the Centers for Disease Control’s COVID-19 Case Tracker website, here is the FEHBlog’s chart of new weekly COVID-19 cases and deaths over the 14th week of 2020 through the 7th week of this year (beginning April 2, 2020 and ending February 17, 2021; using Thursday as the first day of the week in order to facilitate this weekly update):

and here is the CDC’s latest overall weekly hospitalization rate chart for COVID-19:

The FEHBlog has noticed that the new cases and deaths chart shows a flat line for new weekly deaths  because new cases greatly exceed new deaths. Accordingly here is a chart of new COVID-19 deaths, which is a lagging indicator, over the period (April 2, 2020 through February 17, 2021):

Finally here is a COVID-19 vaccinations chart for the past month which also uses Thursday as the first day of the week:

The Wall Street Journal reports tonight that

Efforts to vaccinate the world’s population against Covid-19 got a boost Friday after research showed that some vaccines provide strong, one-dose protection, and that one of the vaccines can now be stored in normal freezers instead of ultra-cold ones.

The vaccine developed by Pfizer Inc. and BioNTech SE generates robust immunity after one dose, according to new research out of Israel, and further data showed that the University of Oxford and AstraZeneca PLC vaccine similarly prevented Covid-19 when doses were spaced three months apart.

The findings could boost arguments in favor of delaying the second dose of the two-shot vaccine, as the U.K. has done. They could also have substantial implications on vaccine policy and distribution around the world, simplifying the logistics of distribution.

Pfizer and BioNTech said they have asked U.S. regulators to allow their vaccine to be stored and transported at temperatures consistent with standard freezing, around minus 20 Celsius, following successful internal stability testing. Similar filings were being prepared in other countries. 

Should Pfizer’s request be granted by regulators, it would mean its vaccine would vastly expand access in rural regions around the world, as well as pharmacies and physician offices, according to industry experts and officials.

The New York Times has a great article on combatting COVID-19 alarmism and the Society for Human Resource Management discusses the uncertain legal state of employer offers of COVID-19 vaccination incentives to their employees in an effort to overcome vaccine reluctance.

In federal personnel news –

  • OPM announced to FEHB carriers today the promotion of Laurie Bodenheimer to Associate Director, Healthcare and Insurance. Ms. Bodenheimer has served as acting Director of Healthcare and Insurance for the past two and half years. The FEHBlog notes that under federal law, 5 U.S.C. § 1102(d)

There may be within the Office of Personnel Management not more than 5 Associate Directors, as determined from time to time by the Director. Each Associate Director shall be appointed by the Director.

So congratulations Laurie for your well deserved appointment.

  • Fierce Healthcare reports that “President Joe Biden has chosen Obama administration veteran Liz Fowler to lead the Center for Medicare and Medicaid Innovation (CMMI), which has authority to shape key payment models, according to a report in Politico.” This powerful position does not require Senate confirmation.

OPM Call Letter Released

OPM Headquarters a/k/a the Theodore Roosevelt Building

Happy OPM Call Letter Day. The call letter is OPM’s call for 2022 benefit and rate proposals from FEHB carriers. Here’s the letter’s summary:

OPM maintains its focus on improving quality and affordability in the FEHB Program, as well as supporting the Biden Administration’s priority focus on health care access and equity. We expect FEHB Carriers to continueto offer forward-thinking proposals that focus onthe strategicprioritiesdescribed in this Call Letter. Our quality initiatives for the 2022 plan year relate to the COVID-19 pandemic, mental health and substance use disorder services, opioids, and prior authorizations for prescription drugs. We also remain focused on enhancements to price and quality transparency, as well as addressing surprise billing and low-value care. We are encouraging FEHB Carriers to expand coverage of certain medical foods for those affected by Inborn Errors of Metabolism (IEM), and to cover fertility preservation related to infertility caused by medical treatment (iatrogenic infertility).

The FEHBlog has provided links to topics that he does not routinely cover. The proposals are due on May 31, 2021. Good luck carriers.

On the COVID-19 front, MedScape encouragingly reports that

Researchers know by now the available COVID-19 vaccines prevent people from getting COVID around 95% of the time. But the million-dollar question remains: Are people less likely to spread the illness after they get the vaccine? According to preliminary data, the odds are good.

“The looming question is, if the person who’s been vaccinated gets infected, does that person have the capability to transmit it to another person,” Anthony Fauci, MD, the White House COVID-19 Response Team’s chief medical adviser, said during a White House briefing Wednesday. “Some studies are pointing in a very favorable direction.”

Fauci cited studies from Spain and Israel published this month, showing the amount of viral load — or the amount of the COVID-19 virus in someone’s body — is significantly lower if someone gets infected after they’ve been vaccinated, compared with people who get infected and didn’t have the vaccine. Lower viral load means much lower chances of passing the virus to someone else, Fauci says.

“There’s a direct correlation with viral load and transmission,” he says. “In other words, higher viral load, higher transmissibility; lower viral load, very low transmissibility.”

Also, the Department of Health and Human Services announced today “new actions to expand COVID-19 testing capacity across the country. These actions will improve the availability of tests, including for schools and underserved populations; increase domestic manufacturing of tests and testing supplies; and better prepare the nation for the threat of variants by rapidly increasing virus genome sequencing.”

From Capitol Hill, this Congressional Budget Office report to the House Ways and Means Committee on the COVID-19 budget reconciliation bill provides a useful overview of the healthcare and employee benefit proposals in the bill. The Speaker intends to pass the $1.9 trillion relief measure by the end of this month.

Health Payer Intelligence discusses a recent Health Affairs article positing that “whether care is affordable for members depends on more than just pricing; affordability is also tied to how clustered healthcare events—and, by extension, healthcare spending—are in a single year.”

The conclusion of this study has clear implications for payers. When members skip care due to affordability, they miss key preventive care services which can result in higher healthcare spending downstream in the members’ healthcare journeys. During the pandemic, payers have waived primary care costs in order to incentivize members to continue receiving care for this very reason. The researchers called on payers, employers, and lawmakers to explore methods for spreading members’ healthcare costs out over time [e.g. monthly deductibles rather than annual deductibles, low copays for essential medicines like insulin].

As we reach the end of the 4th Quarter 2020 financial reporting season, Healthcare Dive summarizes the reports from major health insurers.

Tuesday Tidbits

Photo by Patrick Fore on Unsplash

Happy Mardi Gras!

As the FEHBlog has noted, the FEHB Program has unique demographics compared to other employer sponsored health plans because the federal government offers generous FEHB annuitant coverage to its employees. FEHB enrollment is roughly 52% active employees and 48% annuitants. The average age of federal and postal employees is late forties and the FEHBlog understands that average age of an FEHB enrollee is sixty. (OPM offers detailed demographic statistics on its workforce but not on its retirement system members. No complaints, just stating a fact.)

Today HHS’s Agency of Healthcare Research and Quality issued a fascinating report titled “Concentration of Healthcare Expenditures and Selected Characteristics of High Spenders, U.S. Civilian Noninstitutionalized Population, 2018.” Here are the report’s highlights:

  • In 2018, the top 1 percent of persons ranked by their healthcare expenditures accounted for about 21 percent of total healthcare expenditures, while the bottom 50 percent accounted for only about 3 percent.
  • Persons ages 65 and older and whites were disproportionately represented in the top spending tiers.
  • Inpatient hospital care accounted for 36 percent of spending for persons in the top 5 percent of the spending distribution.
  • About three-quarters of aggregate expenses for persons in the top 5 percent of spenders were paid for by private insurance or Medicare.

In 2018, the top 1 percent of persons ranked by their healthcare expenditures accounted for 21 percent of total healthcare expenditures (100 minus 79 percent; figure 1), with an annual mean expenditure of $127,284 (figure 2). The group within the top 1 percent is defined as persons who spent $72,212 or more during the year. Cut points for additional percentile groups are shown in table 1 [immediately below]. The top 5 percent of the population accounted for 48.3 percent of total expenditures (100 minus 51.7 percent), with an annual mean expenditure of $58,609. The bottom 50 percent accounted for only 3.2 percent of total healthcare expenditures. Every person in this group spent less than $1,317 during the year (table 1), with an average annual expenditure of $384 (figure 2).

Percentile of population2018 Expenditure
Top 1%$72,212 or more
Top 5%$26,355 or more
Top 10%$14,651 or more
Top 30%$3,776 or more
Bottom 50% Less than $1,317

But given the FEHB’s demographics, this figure particularly caught the FEHBlog’s eye:

Figure 4: Percentage of persons by age group and percentile of spending, 2018

Age groupOverall percentageBottom 50%Top 50%Top 10%Top 5%
0–1722.630.614.56.45.8
18–4435.243.227.320.818.9
45–6425.420.130.733.436.3
65+16.86.027.539.439.0

It is a credit to OPM and the FEHB carriers that they are able to hold premiums rather stable.

On the COVID-19 vaccination front —

  • NPR updates us with encouraging COVID-19 vaccination distribution statistics.
  • Federal News Network tells us that “The Biden administration’s Safer Federal Workforce Task Force has new details on how agencies should handle [COVID-19 vaccination] leave, labor unions and mask mandates during the ongoing pandemic.”
  • The Centers for Disease Control now offers guidance on how to arrange COVID-19 vaccinations for home-bound individuals.

Healthcare Dive reports on CVS Health’s fourth quarter 2020 earnings report. The headline is that CVS Health’s payer arm Aetna plans to return to the Affordable Care Act marketplace for 2022.

CVS’ fourth quarter revenue of $69.6 billion, up 4% year over year, was mostly due to growth in the benefits segment. Healthcare benefits reported quarterly revenue of $19.1 billion, up 11% year over year, driven primarily by membership growth in Medicaid and Medicare products and partially offset by a drop in commercial membership and COVID-19 costs.

As of the end of 2020, CVS covered 23.4 million lives. Despite fluctuating membership and utilization due to COVID-19 over the course of last year, overall utilization in the fourth quarter was generally back to normal, executives said. The company’s medical loss ratio, a marker of how much it’s reinvesting in patient care, was 86.7% in the quarter, compared to 85.7% same time last year.

JDSupra includes this employment law article titled “Employees Starting to Receive the COVID-19 Vaccine – Now What?” which is worth a gander in the FEHBlog’s opinion.

Monday Roundup

Photo by Sven Read on Unsplash

The FEHBlog ran across this Health and Human Services letter to U.S. Governors thanks to the American Hospital Association’s daily email. It states in pertinent part

We are writing to you today to share more details regarding the public health emergency (PHE) for COVID-19, as declared by the Secretary of Health and Human Services (HHS) under section 319 of the Public Health Service Act (42 U.S.C. §247d). The current public health emergency was renewed effective January 21, 2021, and will be in effect for 90 days. To assure you of our commitment to the ongoing response, we have determined that the PHE will likely remain in place for the entirety of 2021, and when a decision is made to terminate the declaration or let it expire, HHS will provide states with 60 days’ notice prior to termination.

All right then.

FCW reports that President Biden “announced a raft of senior officials to help lead the Office of Personnel Management on Jan. 25. The positions are for appointments that don’t require Senate confirmation.” Consequently the lengthy list does not include the OPM Director and Deputy Director nominees. The acting Director remains Chief Management Officer Kathleen McGettigan.

The Washington Post reports that 50-50 Senate Minority Leader Mitch McConnell is ready to approve the “clean” power sharing agreement offered by Senate Majority Leader Chuck Schumer. Why? Two Democratic Senators strongly voiced opposition to repealing the legislative filibuster.

On the COVID-19 vaccination front

  • President Biden answering press questions yesterday (more detail at the link and the FEHBlog points this out because for what it’s worth it’s his sense too.)

Q   [Josh from Bloomberg] Well, my question was at what date — or, roughly, when do you think anyone who wants [a COVID-19 vaccination] would be able to get it?  Summer? 

THE PRESIDENT:  Oh, I — no, I think it’ll be this spring.  I think we’ll be able to do that this spring.  And — but it’s going to be a logistical challenge that exceeds anything we’ve ever tried in this country, but I think we can do that.

I feel confident that, by summer, we’re going to be well on our way to heading toward herd immunity and increasing the access for people who aren’t on the first — aren’t on the list, all the way going down to children and how we deal with that.  But I feel good about where we’re going, and I think we can get it done. 

  • Govexec.com reports on efforts by the Department of Veterans Affairs and the Postal Service to arrange for vaccinating their essential workforce members.
  • Stat News informs us that “Moderna is studying adding booster doses to its vaccine regimen after finding its Covid-19 vaccine was less potent against a coronavirus variant that was first identified in South Africa, the company said Monday. * * * Nevertheless, [b]oth the Moderna vaccine and the immunization from Pfizer-BioNTech produce such powerful levels of immune protection — generating higher levels of antibodies on average than people who recover from a Covid-19 infection have — that they should be able to withstand some drop in their potency without really losing their ability to guard people from getting sick.”
  • NPR News discloses that “Merck is halting development of its two COVID-19 vaccine candidates, saying that while the drugs seemed to be safe, they didn’t generate enough of an immune response to effectively protect people against the coronavirus. * * * While Merck is shelving both of its vaccine candidates, the company says it will keep working on two therapeutic drugs, including one that aims to protect the body’s respiratory system from the coronavirus’s ravaging effects. Last month, the company signed a deal with the U.S. government agreeing to supply up to 100,000 doses of one of those drugs for about $356 million.

In other healthcare news —

  • Fierce Healthcare reports that Consulting firm ADVI Health reviewed the websites for 20 (PDF) of the largest hospitals in terms of bed size and found that the largest hospitals all posted some type of pricing information online [in response to a federal transparency rule that took effect on January 1, 2021]. But many of the hospitals did not provide healthcare common procedural codes for the services, according to the analysis, which did not list the hospitals. “Many institutions didn’t use the codes, which makes it difficult to make comparisons across facilities,” said Caitlin Sheetz, lead author of the analysis and head of analytics for ADVI.”
  • Fierce Healthcare updates us on that Blue Cross’s new high performance network. “BCBSA said 45 companies have signed on to offer the Blue HPN plan to employees, reaching 55 markets and 340,000 potential members. The plan is the only HPN available in the 10 largest U.S. cities, BCBSA said. Jennifer Atkins, vice president of global network solutions at BCBSA, told Fierce Healthcare that even in its early days, Blue HPN has found success in lowering costs for employers. The HPN plan saved 11% in the total cost of care compared to a traditional PPO, she said.”
  • Fierce Healthcare also informs us that non-profit “Civica Rx announced a plan to build a major manufacturing facility to produce sterile injectable drugs for hospitals, a major step for the organization comprised of health systems such as Mayo and Intermountain. The $124.5 million project is planned for Petersburg, Virginia — just south of Richmond — and is expected to potentially create more than 180 jobs. The 120,000-square-foot manufacturing facility aims to address a major source of shortages for hospitals. Sterile injectable drugs have been a major source of shortages in recent years due in part to fewer companies making the products, according to the Food and Drug Administration.”

Happy Inauguration Day

Mount Rushmore

Joe Biden and Kamala Harris were sworn in as President and Vice President this morning. Good luck to them both on this National Day of Unity.

The President issued fifteen executive orders today. Among the new requirements are the following per the Wall Street Journal

  • The 100-day [COVID-19] mask mandate applies on federal property and on airlines, trains and transit systems traveling between states, though Mr. Biden will direct the government to work with state and local authorities on similar steps.
  • [The establishment of] an office of White House Covid-19 response, headed by Jeffrey Zients, Mr. Biden’s coronavirus czar, which will work with federal agencies and report directly to the president. Goals include securing more protective equipment for workers, increasing testing and vaccinations and reopening schools.
  • Mr. Biden also called for extending the federal eviction moratorium until at least March 31 and the pause on interest and principal payments for direct federal loans until at least Sept. 30.

The President’s chief of staff imposed a regulatory freeze pending review and approval by Biden Administration officials. This order applies, for example, the proposed HIPAA Privacy Rule amendments discussed in yesterday’s post as well as the HHS and CMS rule makings discussed earlier this month. That’s a sensible action.

Govexec.com reports that Kathleen McGettigan is replacing Michael Rigas, who resigned, as acting OPM Director. Ms. McGettigan, who is OPM’s Chief Management Officer, previously served in this position during other transition periods. Govexec.com adds that President “Biden has yet to name a nominee for OPM director.”

In other developments today

  • STAT News reports that “Amazon has reached out to President Joe Biden to offer logistical and technical support for his goal of vaccinating 100 million Americans within his first 100 days in office.”
  • Healthcare Dive informs us that “UnitedHealth Group beat Wall Street expectations for both earnings and revenue in fourth-quarter financial results released Wednesday, as care consumption and prescriptions returned to more normal levels despite fears of renewed deferrals as COVID-19 cases surge.”
  • The Health Affairs Blog identifies five healthcare trends to watch this year.

Tuesday Tidbits

Photo by Patrick Fore on Unsplash

Surprise! The FEHBlog mentioned the other day that he considered the Trump Administration’s proposed HIPAA Privacy Rule amendments to be a dead letter because they had not been scheduled to be published in the Federal Register today, the last day of the Trump Administration’s Federal Register. Well, as it turns out, that proposed rule showed up in the Federal Register public inspection list today with a Federal Register publication date of Thursday January 21. In any event. as the FEHBlog mentioned, the Biden Administration will be decide the fate of this rule making, which for what it’s worth the FEHBlog considers to be a helpful improvement.

Also today, OPM released a preview of the 2020 Federal Employee Viewpoint Survey results. “A preview of the governmentwide results are heartening,” said Acting Director Michael Rigas. “Through the toughest times, employees have been resilient and motivated while supervisors and senior leaders alike have served employees well by embracing their roles to keep employees safe and informed.”  Well done, OPM and federal agency employers and employes.

The FEHBlog is a fan of new health plan designs. Fierce Healthcare reports that

UnitedHealthcare is launching a new, virtual primary care option as part of an effort to expand access to local clinicians in its employer-sponsored plans.

Virtual primary care will be available to members in certain employer plans across 11 states, UnitedHealthcare said in an announcement. The insurer expects to expand the offering to additional states over the course of the year.

The goal, UnitedHealth said, is to make it easier for patients to establish and maintain an ongoing relationship with a primary care provider.

“The UnitedHealthcare Virtual Primary Care service and updated policy help expand the use of virtual care from delivering care to people who are sick, to now also focusing on preventing and detecting disease before it starts and, if needed, helping people more conveniently manage certain chronic conditions,” said Anne Docimo, M.D., chief medical officer at UnitedHealthcare,” in a statement.

Creative.

In another creative move, Fierce Healthcare calls our attention to the following:

As healthcare continues to evolve, legacy players are aiming to be the first to gain access to the latest innovations.

At Anthem, that effort has meant launching its own Digital Incubator, which pairs financial backing with mentorship and opportunities for partnerships with universities and corporations.

“Essentially, we are looking to get access to cutting-edge healthcare products,” said Kate Merton, staff vice president and head of Anthem Digital Incubator, in an interview with Fierce Healthcare. “We work with our entrepreneurs early in the cycle to make sure they’re developed with the mindset of the payer, of the consumer and the provider all in one.”

ADI offers a number of pathways for innovators to take and operates in both digital and physical platforms, with its first incubation space opening in Palo Alto, California.

On the mental healthcare front —

  • IFEBP informs us that the Department of Labor’s Employees Benefit Security Administration, which enforces ERISA, “released the Fiscal Year (FY) 2020 Mental Health Parity and Addiction Equity Act (MHPAEA) fact sheet on investigations.”
  • “The U.S. Department of Health and Human Services (HHS) and the Office of the Surgeon General (OSG)—in collaboration with the National Action Alliance for Suicide Prevention (Action Alliance)—released The Surgeon General’s Call to Action to Implement the National Strategy for Suicide Prevention. This new report outlines the actions that communities and individuals can take to reduce the rates of suicide and help improve resilience.”

Catchup Sunday

Happy Martin Luther King, Jr. Day weekend.

HHS issued several final rules on Thursday and Friday last week, none of which apply directly to the FEHBP:

  • The Centers for Medicare and Medicaid Services (CMS”) issued a final rule intended to streamline health plan prior authorization request to providers. America’s Health Insurance Plans, the health insurer trade association, was unimpressed. This rule applies to HHS’s own programs, e.g., Medicare, Medicaid, CHIP, the Qualified Health Plans in the ACA marketplace.
  • CMS also a final Calendar Year (CY) 2022 Medicare Advantage and Part D Rate Announcement, finalizing Medicare Advantage (MA) and Part D payment methodologies for CY 2022. Here’s a link to the fact sheet.
  • HHS also issued part of the final CY 2022 Notice of Benefit and Payments Parameters required by the Affordable Care Act. Katie Keith outlines the notice on the Health Affairs blog, noting

On January 14, 2021, the Centers for Medicare and Medicaid Services (CMS) released its final 2022 Notice of Benefit and Payment Parameters rule, joined in part by the Treasury Department. Historically, the “payment notice” adopts major changes for the next plan year in areas such as the exchanges and the risk adjustment program. Here, however, the final 2022 payment notice adopts only a subset of the policies considered in the proposed 2022 payment notice. This subset of policies includes the most controversial changes that had been included in the proposed rule. The final rule was accompanied by a fact sheet and a press release.

  • A friend of the FEHBlog called to his attention the fact that the Trump Administration HHS never published its proposed HIPAA privacy rule changes, announced December 10, 2020, in the Federal Register. (The HIPAA Privacy Rule does apply to the FEHBP.) What’s more the rule making cannot be found on the Federal Register’s latest public inspection list. The Biden Administration HHS will now have the opportunity to reconsider these “final actions” as well as what to do if anything with the proposed privacy rule changes.

The FEHBlog noticed that on January 7, 2021, the HHS Secretary extended the opioid crisis public health emergency another 90 days into April 2021.

Healthcare Dive informs us that

  • The Federal Trade Commission sent orders to six health insurance companies to obtain patient-level claims data for inpatient, outpatient, and physician services from 2015 to 2020, the agency said Thursday.
  • The FTC wants to figure out how hospitals’ acquisitions of physician practices has affected competition.  
  • The agency sent orders to some of the nation’s largest insurance companies, including UnitedHealthcare, Anthem, Aetna, Cigna, Florida Blue and Health Care Service Corporation.

Federal government personnel moves:

  • The Boston Globe reports that “President-elect Joe Biden on Friday nominated Eric Lander, a pioneer in the study of the human genome and the founding director of the Broad Institute of MIT and Harvard, to be his chief science adviser in a newly created Cabinet position. If confirmed by the Senate, Lander will be the first science adviser to serve in a presidential Cabinet * * *.
  • Medical Design and Resourcing reports that Food and Drug Administration (“FDA”) “veteran Dr. Janet Woodcock has been tapped as interim FDA commissioner by the Biden administration, according to published reports.” Dr. Woodcock currently serves as the FDA’s Director of the Center for Drug Evaluation and Research.
  • Bloomberg Law reports that Dr. “Francis S. Collins will stay on as NIH director under the Biden administration, making him one of the few biomedical agency directors to span three presidents.”
  • Govexec.com reports that “President-elect Joe Biden has named Jason Miller as his government management czar, tapping a former Obama administration economic adviser for the key role in setting the president’s management and federal workforce agenda. * * * Should Miller be confirmed by the Senate, he would serve under OMB Director-designate Neera Tanden if she is confirmed and replace Michael Rigas, who is serving in the OMB management role—and that of Office of Personnel Management director—in an acting capacity. The last Senate-confirmed official to hold the management position was Margaret Weichert, a Trump nominee who served concurrently as acting OPM director. Biden has yet to name a head of OPM.”
  • The Washington Post and the Partnership for Public Service offer a Biden Administration political appointee tracker.

As this is the FEHBlog, it is worth noting that Federal News Network has reported on the OPM’s Inspector General’s report on the impact of COVID-19 on the FEHBP. The OIG’s analysis was found in its September 2020 semi-annual report to Congress. Federal News Network queries “What about 2022, or future years for that matter, when FEHB enrollees flock back to their doctor’s offices again for those checkups and preventative procedures they’ve been putting off?”

Bear in mind that all health U.S. plans including FEHB plans experienced a V shaped drop in claims at the height of the great hunkering down last Spring. Many preventive tests are not required annually. The FEHBlog got his routine physical last summer by a combination of a holding a televisit with the doctor and giving blood etc. at the doctor’s office. Furthermore, prescription drug claims have held steady throughout the pandemic and flu cases remain “unusually low” during this winter. We will get through this together. When we reach the new normal, the healthcare sky will not fall in, at least in the FEHBlog’s view.

Thursday Miscellany

Photo by Juliane Liebermann on Unsplash

In the wake of the Democrat victories in the Georgia Senate elections, Katie Keith in the Health Affairs blog provides her insightful thoughts on what a Democratic Congress means for the Affordable Care Act.

The Robert Wood Johnson Foundation offers for our consideration five experts reflecting on the health equity implications of the COVID-19 public health emergency.

When Medicare pricing changes the healthcare industry takes notice.

  • The American Hospital Association reports today that ” The Centers for Medicare & Medicaid Services has recalculated the Medicare [Part B] Physician Fee Schedule payment rates and conversion factor for calendar year 2021 to reflect changes effective Dec. 27 under the Consolidated Appropriations Act. The new conversion factor is $34.89, which is 3.3% less than the CY 2020 conversion factor of $36.09 but more than the $32.26 conversion factor finalized in the PFS final rule, which would have represented a 10.2% net decrease in PFS payments for CY 2021. This change affects what FEHB plans pay for Medicare prime annuitants. Also where an annuitant over 65 does not pick up Medicare Part B, fee for service FEHB plans pay for doctors services using Medicare Part B payment rates.
  • Beckers Payer Issues reports that “A change in how Medicare pays laboratories for COVID-19 diagnostic tests took effect Jan. 1 * * * Medicare lowered the base payment for COVID-19 tests that use high-throughput technology to $75. Labs can get an additional $25 if they provide results in two days or less.” Medicare testing rates are sound benchmark for out-of-network COVID-19 labs which fail to comply with internet price post requirements.

The Centers for Disease Control yesterday issued an initial report concerning allergic reactions to the COVID-19 vaccines. Here’s the report’s summary:

What is already known about this topic?

Anaphylaxis is a severe, life-threatening allergic reaction that occurs rarely after vaccination.

What is added by this report?

During December 14–23, 2020, monitoring by the Vaccine Adverse Event Reporting System detected 21 cases of anaphylaxis after administration of a reported 1,893,360 first doses of the Pfizer-BioNTech COVID-19 vaccine (11.1 cases per million doses); 71% of these occurred within 15 minutes of vaccination.

What are the implications for public health practice?

Locations administering COVID-19 vaccines should adhere to CDC guidance for use of COVID-19 vaccines, including screening recipients for contraindications and precautions, having the necessary supplies available to manage anaphylaxis, implementing the recommended postvaccination observation periods, and immediately treating suspected cases of anaphylaxis with intramuscular injection of epinephrine.

The Department of Health and Human Services announced today

a national plan to address the serious, preventable public health threat caused by viral hepatitis in the United States. The Viral Hepatitis National Strategic Plan for the United States: A Roadmap to Elimination 2021–2025 sets national goals, objectives, and strategies to respond to viral hepatitis epidemics. Building on three prior National Viral Hepatitis Action Plans over the last 10 years, the Viral Hepatitis National Strategic Plan is the first to aim for elimination of viral hepatitis as a public health threat in the United States by 2030.  This plan serves as a roadmap for stakeholders at all levels and across many sectors, both public and private, to guide development of policies, initiatives, and actions for viral hepatitis prevention, screening, care, treatment, and cure.  

Federal News Network reports that

Federal payroll providers and agencies are beginning to detail exactly how and when federal employees and servicemembers will repay the Social Security taxes that were deferred from their paychecks during the last four months of 2020. The latest omnibus spending package, which the president signed into law last week, allows those subject to the president’s payroll tax deferral to repay the deferred taxes — worth 6.2% of their income — throughout the entire year of 2021, rather than the first four months of the year.

The article provides examples but generally the services are collecting in equal installments over the course of 2021.

Tuesday Tidbits

Photo by Patrick Fore on Unsplash

STAT News reports that “Nancy Messonnier, a top federal health official involved in the distribution of Covid-19 vaccines, predicted on Tuesday [in an interview with STAT] that delays in the administration of the shots would improve soon.” (On the bright side, the CDC has begun to update its COVID-19 vaccinations site daily. Around 275,000 initial doses were administered yesterday.) Furthermore

During the discussion Tuesday, Messonnier said she hoped the supply of vaccine would expand greatly in the spring, a time when the shots could be made more widely available to the general public, not just people with certain jobs or health conditions. But making the vaccine is only one step: successfully inoculating the vast majority of the population will require major efforts to educate the public, to build out accessible sites where people can easily get vaccinated, and to ensure individual people show up when it’s their turn to get the shot.

Health Payer Intelligence updates on how three large payers “extended temporary COVID-19 benefits in 2021.” Technically the COVID-19 public health emergency period expires on January 21, 2021, but unquestionably the federal government will extend that period for another 90 days before then.

Under the Affordable Care Act, effective January 1, U.S. Preventive Services Task Force A and B recommendations made two years earlier become eligible for health plan in-network coverage with no member cost-sharing. If you pick out from the USPSTF list those recommendations that received an A or B grade in 2019, you will find ten recommendations that are eligible for “no additional cost” coverage in 2021. Fierce Healthcare provides insights into how health plan members can take advantage of one of those 2019 recommendations -“The USPSTF recommends that clinicians offer preexposure prophylaxis (PrEP) with effective antiretroviral therapy to persons who are at high risk of HIV acquisition.”

On the OPM front, Federal News Network lets us know that

Federal employees who forfeited vacation time in excess of the usual annual leave carryover limit at the end of 2020 may be able to get some of those days back for use later this year, thanks to a policy in the new annual defense authorization law. The Office of Personnel Management on Tuesday issued detailed guidance covering the new annual leave policy and instructed agencies to implement it.

On the mergers and acquisitions front —

  • Fierce Healthcare reports that “Harvard Pilgrim Health Care and Tufts Health Plan officially combined Jan. 1. The deal, announced in August 2019, comes about a decade after the organizations attempted to merge in 2011. * * * The combined Massachusetts organization will serve 2.4 million members. Both the Tufts and Harvard Pilgrim brands will be in the market for a period of time, the organizations said.”
  • Healthcare Dive reports that health insurer “Centene has entered into a definitive agreement to acquire Phoenix, Arizona-based Magellan Health for $2.2 billion, or $95 per share, the payer said Monday. Magellan will operate independently under the Centene umbrella. Executives said the combination will result in one of the nation’s largest behavioral health platforms as the two will provide behavioral services to about 41 million members in the U.S. The deal also boosts Centene’s already established footprint in government sponsored health plans with the addition of 5.5 million lives and another 2.2 million to add to its pharmacy benefit management platform.