Weekend update

Weekend update

The House of Representatives is engaged in Committee work this week. The Senate is on a State work period for the next two weeks. Meanwhile, according to Fierce Healthcare,

a collection of unions, business groups and policy institutes wrote to congressional leaders Wednesday asking for a provision on surprise medical bills to be included in the next coronavirus stimulus package. “We urge you to end surprise medical billing for all patients through the implementation of fair, market-based payments for out-of-network charges,” the letter said. The American Benefits Council, the AFL-CIO, the Business Group on Health and the American Health Policy Institute were among the groups that signed on to the letter.

That resolution is also the FEHBlog’s preference while provider groups often call for arbitration of some sort.

The U.S. Supreme Court has eight more cases to decide before its summer break. All of these cases were argued virtually in May 2020, and include one PPACA case involving the scope of the contraception mandate. Tomorrow is another decision day. This will be the first time in 24 years that the Supreme Court has released decisions in July. The most famous Supreme Court decision issued in July in the FEHBlog’s memory was the U.S. v. Nixon case decided July 24, 1974, which lead to the President’s resignation early the following month.

The Wall Street Journal brings us up to date on the state of COVID-19 vaccine development. Several candidates are headed into large scale final/phase 3 testing this month.

The U.S. federal government is planning to fund three 30,000-person trials starting this summer: Moderna Inc.’s vaccine starting this month, followed in August by a vaccine co-developed by University of Oxford and AstraZeneca PLC, and in September, a vaccine developed by Johnson & Johnson. Oxford’s vaccine recently began late-stage testing outside the U.S.

The scale is so large it means trials are effectively competing with each other for recruits. “One volunteer cannot be in two different studies. It’s a zero-sum game in that regard,” said Dr. Joseph Kim, chief executive of Inovio Pharmaceuticals Inc., which last week announced positive results in a small study and is preparing for a larger study. PRA Health Sciences Inc., which helps recruit trial patients, is mining busy Covid-19 testing locations, including public-health departments, testing labs and pharmacies, to find healthy volunteers, said Kent Thoelke, PRA’s chief scientific officer.

Fingers remain crossed.

On Friday, the FEHBlog suggested that readers check out last Monday’s Econtalk interview about healthcare reform. The discussion of Iora Health. Iora Health is a multi-state group practice which holds a Medicare Advantage plan contract and is looking to expand to employer groups. Their model is centered on the use of health coaches.

Weekend Update

The House and Senate will be conducting legislative and committee business this week preceding the Fourth of July holiday. Of note, on Tuesday at 10 am the Senate Health Education Labor and Pensions Committee will hold a hearing on ways to return to work and school safely following the great hunkering down.

The Supreme Court has thirteen more opinions to release before its summer break. The Court is expected to release opinions on Monday, Tuesday, and Wednesday this week, all at 10 am.

On the COVID-19 front —

  • Fierce Healthcare discusses how the Walgreen’s Pharmacy chain has leveraged its partnership with Microsoft and other technology companies to better respond to the COVID-19 emergency.
  • A few weeks ago, the Journal podcast offered a fascinating show on the Hertz bankruptcy. It’s worth a 17 minute long listen. The story highlights how a strong balance sheet helps companies weather storms like the COVID-19 emergency. Becker’s Hospital Review identifies 14 well known health systems in this favorable situation, including Kaiser Permanente. It’s not an exclusive list.
  • Healthcare Dive reports on the significant adverse financial impact that the COVID-19 emergency has had on primary care practices in the U.S. Surprisingly that article does not note that these practices have been eligible for Payroll Protection loans and federal grants. The government deserves credit for trying to soften the blow to this critical sector of our health care system. Tuesday June 30 is the deadline for applying for a PPP loan.

On the human nature front, the Wall Street Journal reports that COVID-19 first responders have been relaxing by playing a boardgame called Pandemic.

Weekend Update

Happy Fathers’ Day.

The House and Senate are holding committee hearings and floor votes this week. On Tuesday the Senate Health Education Labor and Pensions Committee will hold a hearing on applying lessons learned from the current COVID-19 emergency to prepare for the next pandemic emergency.

Speaking of the current pandemic:

  • The FEHBlog was wondering about whether there has been an uptick in COVID-19 related hospitalizations to accompany the uptick in COVID-19 cases over this month. The FEHBlog was delighted to find this handy CDC website on COVID-19 related hospitalizations which shows that new hospitalizations have continued to trend down this month.
  • On Friday, OPM released guidance on the relationship paid leave / other time off and COVID-19 work by Federal employees. According to the guidance, OPM plans to issue “regulations [that ] will deem the COVID-19 national emergency to be an exigency of the public business for the purpose of restoring forfeited annual leave. The regulations [among other things] will provide that employees who would forfeit annual leave in excess of the maximum annual leave allowable carryover because of their essential work during the national emergency will have their excess annual leave deemed to have been scheduled in advance and subject to leave restoration.”

The U.S. Supreme Court has 15 decisions left to issue before its summer break. The Court is expected to issue some of those decisions tomorrow at 10 am. The Court is continuing to hold its Thursday conferences so all of 15 of the decisions may not be ready for issuance.

Georgetown Law Professor Katie Keith provided a welcome Health Affairs blog analysis of a complicated topic — federal regulation of employee wellness programs. The key complicating factor is that there are so many different applicable federal laws in play.

Tuesday Tidbits

On the COVID-19 front —

  • The Wall Street Journal reports about the importance of exercising common sense during the COVID-19 emergency:

Six months into the coronavirus crisis, there’s a growing consensus about a central question: How do people become infected?

It’s not common to contract Covid-19 from a contaminated surface, scientists say. And fleeting encounters with people outdoors are unlikely to spread the coronavirus.

Instead, the major culprit is close-up, person-to-person interactions for extended periods. Crowded events, poorly ventilated areas and places where people are talking loudly—or singing, in one famous case—maximize the risk.

  • The Boston Globe reports about a new treatment:

Researchers in England say they have the first evidence that a drug can improve COVID-19 survival: A cheap, widely available steroid called dexamethasone reduced deaths by up to one third in severely ill hospitalized patients.

Results were announced Tuesday and researchers said they would publish them soon. The study is a large, strict test that randomly assigned 2,104 patients to get the drug and compared them with 4,321 patients getting only usual care.

The drug was given either orally or through an IV. After 28 days, it had reduced deaths by 35% in patients who needed treatment with breathing machines and by 20% in those only needing supplemental oxygen. It did not appear to help less ill patients.

  • The Harvard Business Review offers an interesting article concerning the ongoing role of employers and employer sponsored healthcare in addressing the COVID-19 emergency.

In other news

  • The Congressional Budget Office made a presentation on how its factors preventive care savings into federal budget calculations. This could be helpful for health plan actuaries and underwriters.
  • Georgetown University Law Professor Katie Keith discusses the impact of yesterday’s Supreme Court opinion on the Department of Health and Human Service’s revised Section 1557 rule. By the way that rule will be published in the Friday June 19 Federal Register which means that it is currently scheduled to take effect on August 18, 2020. The FEHBlog expects HHS to pull back the final rule for re-evaluation in view of the Supreme Court opinion.
  • Today, the U.S. Court of Appeals for the D.C. Circuit upheld a district court decision striking down a Centers for Medicare and Medicare Services rule that would have required prescription drug manufacturers to disclose the average manufacturer price for their drugs in related television advertisements. The Court held that “the Disclosure Rule’s blunderbuss operation falls beyond any reasonable exercise of the Secretary’s statutorily assigned power.” If you find administrative law interesting, you should read the opinion.

Monday Roundup

Health Payer Intelligence reports that “Major payers and payer organizations objected to the finalized HHS nondiscrimination rule—Affordable Care Act Section 1557—saying that the rule eliminates much of the specific language in the original rule, particularly relating to gender and sexual discrimination.” In that regard, this morning, per the Wall Street Journal, “The Supreme Court ruled that bedrock federal civil-rights law [Title VII of the Civil Rights Act of 1964] prohibits employers from discriminating against workers on the basis of their sexual orientation or gender identity, a decision that for the first time extends federal workplace protections to LGBT employees nationwide.”

The FEHBlog expects that this ground breaking Supreme Court decision will cause the Department of Health and Human Services to reconsider last Friday’s revised final Section 1557 rule either on its own initiative or upon a federal court order. That rule does not take effect until late August 2020.

In other news

  • The International Foundation of Employee Benefit Plans reports that the Centers for Medicare and Medicaid Services has created flexibilities to allow insurers to advance 2019 medical loss ratio rebates to individual policyholders. The 2019 medical loss ratio report normally would be due on June 30, 2020.
  • The American Hospital Association evaluates whether legislation or regulations can be used to extend various current telehealth flexibilities beyond the end of the COVID-19 emergency.
  • Govexec.com informs us that “Officials at the federal government’s 401(k)-style retirement savings program announced Monday that the Thrift Savings Plan has implemented provisions of the CARES Act coronavirus response package making it easier for participants impacted by the pandemic to access money in their accounts.” Here’s a link to this announcement.

Weekend Update

Happy Flag Day.

Both Houses of Congress will be conducting committee and floor business this week. The House had added floor voting days for Thursday and Friday next week as well as all of the following week (except for next Friday which is the work holiday associated with the Fourth of July.)

The Senate Health Eduction Labor and Pensions Committee is holding a committee hearing of relevance to the FEHBP — Telehealth: Lessons from the COVID-19 Pandemic — on June 17 at 10 am.

The Supreme Court has nineteen more opinions to release before its summer break. This week the Court is releasing opinions tomorrow and Thursday, both days at 10 am ET.

Here are a couple of non-COVID-19 research items that caught the FEHBlog’s attention over the weekend:

  • Precision Vaccinations reports that “With a surprisingly simple approach in which cancer cells are first grown, ruptured and converted into nanoparticles, and then used as a vaccine, Vanderbilt University researchers say they have developed what appears to be a promising treatment for breast cancer metastasis. Metastasis is the last stage of cancer, responsible for about 90 percent of cancer-related deaths.
  • The Wall Street Journal reports that

Scientists may be just a few years away from delivering new treatments for age-related macular degeneration (AMD), the leading cause of irreversible vision loss in people more than 50 years old.

Over the past 15 years there has been only one class of successful AMD drugs, known as anti-VEGF agents, and they have worked for a minority of AMD sufferers. Now researchers are having success fighting AMD from new directions. They include an immune-system inhibitor and stem-cell therapy, which show promise for treating the dry form of AMD in its advanced stage, for which there is currently no treatment approved by the U.S. Food and Drug Administration.

“I’m cautiously optimistic that we will have markedly improved treatments for both wet and dry AMD within two to three years,” says Joshua Dunaief, professor of ophthalmology at the Scheie Eye Institute at the University of Pennsylvania.

Weekend update

The Senate is engaged in legislative and committee business this week. Last week the Senate passed by unanimous consent a bill (S. 279) to amend the FEHB and FEGLI Acts for the purpose of extending coverage to employees of Indian tribal grant schools. This bill would close a gap created by the Affordable Care Act which generally extended coverage under these programs to Indian tribal employees. There are 128 tribal grant schools in the U.S.

The House of Representatives is engaged in committee business this week. That body is next scheduled to hold votes over the period June 30 through July 2.

The Supreme Court continues this week to release the remaining opinions from its October 2019 term. The Hill includes an article discussing the seven opinions that are expected to be politically controversial.

In other news Fierce Healthcare reports

  • “A top Department of Health and Human Services (HHS) official acknowledged [last week] that telehealth is here to stay after an explosion of use due to COVID-19 but hedged on whether new regulatory flexibility on reimbursement is going to stick around.” The permanent flexibility depends largely on Congress and state regulators, and
  • “OptumRx researchers are highlighting three more drug products that payers should be keeping an eye on in 2020″ — Roche’s Risdiplam, NS Pharma’s Viltolarsen, and Immunomedic’s Trodelvy.

Weekend update

The House of Representatives and the Senate both will be in session on Capitol Hill this coming week, Of note from an FEHBP perspective is that Senate Homeland Security and Governmental Affairs Committee has scheduled a confirmation hearing for the President’s nominee for OPM Inspection General, Craig E. Leen, for Tuesday June 2 at 2:30 pm. Mr. Leen currently is Director of the Office of Federal Contract Compliance Programs (OFCCP) at the U.S. Department of Labor. The FEHBlog plans to tune in.

The Supreme Court heads into the home stretch of its October 2019 term tomorrow. The Court has 25 decisions left to issue before adjourning for the summer according to the Scotusblog.

OPM released more COVID-19 guidance last Friday. This guidance concerns preparedness for returning to OPM facilities.

Fierce Healthcare brings us up to date on COVID-19 testing at home options. The latest product receiving FDA approval is offered by Quest Diagnostics a/k/a Quest Labs.

The FEHBlog ran across on Twitter today this May 24 column from Reason senior editor Jacob Sillum.

According to the Centers for Disease Control and Prevention (CDC), the current “best estimate” for the fatality rate among Americans with COVID-19 symptoms is 0.4 percent. The CDC also estimates that 35 percent of people infected by the COVID-19 virus never develop symptoms. Those numbers imply that the virus kills less than 0.3 percent of people infected by it.

The FEHBlog also found this reassuring (at least to the FEHBlog) Science News article on COVID-19 mutations.

[C]oronavirus mutations are guaranteed to pop up over the coming months — and experts will continue to track them. “The data will tell us whether we need to worry, and in what way we need to worry,” [Louise] Moncla[, an evolutionary epidemiologist at the Fred Hutchinson Cancer Research Center in Seattle] says. “Everyone should take a deep breath and realize that this is exactly what we’ve always expected to happen, and we don’t necessarily need to be concerned.”

Friday Stats and More

Per the CDC’s COVID-19 Cases in the U.S. that the FEHBlog tracks, the number of COVID-19 cases crossed the 1.4 million mark and the number of COVID-19 deaths exceeded 85,000 today. The CDC’s COVIDView confirms that the rate of increase continues to slow. For what it’s worth, the FEHBlog-calculated COVID-19 case mortality rate has been pretty stable for the past month. The Wall Street Journal’s Numbers columnist discusses COVID-19 stats her latest column.

Dividing fatalities by the number of confirmed illnesses produces the case fatality rate. [That’s FEHBlog’s approach] A better estimate of lethality divides fatalities by the number of people infected. But no one knows how many people are infected with Covid-19.

“Right now the death rate is a guess,” Dr. [Fred] Brauer said. “I’ve seen ranges from one-tenth of a percentage point to 3%.”

The FEHBlog has been tracking the simple case mortality rate to find a plateau and the FEHBlog thinks we may be there.

Recently, the filing of Supreme Court briefs defending the Affordable Care Act’s constitutionality have lead some press outlets to raise an alarm. The best chill pill is to read this Reason article by Prof. Jonathan Adler who filed on the 38 friends of the Court briefs supporting the statute’s constitutionality. The article’s title says it all — “The Penalty-less Individual Mandate Is Severable from the Rest of the ACA No Matter How You Look at It.” Amen to that.

A friend of the FEHBlog brought to his attention this C-SPAN interview with Dr. David Kimberlin. Dr. Kimberlin is pediatric infectious diseases chair at the University of Alabama at Birmingham. He talked about how the COVID-19 pandemic is impacting children. He expresses concern that the COVID-19 pandemic is discouraging parents from taking their children to pediatrician for routine childhood vaccinations. He encourages parents to contact their pediatrician to learn how the vaccinations can be obtained safely. That’s important advice.

In other news —

  • Becker’s Hospital Review discusses each of the fifteen hospital closures that have occurred in the United State this year.
  • STAT News reports that “fueled by the Covid-19 pandemic, remote heart monitoring could become tech’s next big target.
    • “Both Apple and Alphabet spinout Verily have watches equipped with EKGs that detect the heart abnormality atrial fibrillation, or A-fib. Apple and Amazon have recently hired prominent cardiologists to fill their ranks, while Facebook is hiring for a team overseen by Freddy Abnousi, a cardiologist and the social network’s new head of health technology. Among the new roles: an expert in the same type of technology used to monitor the heart in Fitbits and Apple Watches.”

Friday Stats and More

Per the CDC’s COVID-19 Cases in the U.S. that the FEHBlog tracks, the number of COVID-19 cases crossed the 1.2 million mark and the number of COVID-19 deaths exceeded 70,000 this week. The case mortality rate hit 6% on Thursday after being in the 5 to 6% range for 2 1/2 weeks. Before then the case mortality rate was increasing much faster. So we evidently are plateauing. The Wall Street Journal reports that the leading cause of death in our country remains heart disease. For an even better perspective, check out the CDC’s COVIDView which is released on Fridays.

The Wall Street Journal offers a perspective on State reopening here. The FEHBlog got a kick out of listening too this 20 minute long WSJ podcast on office reopenings titled “Welcome Back to the Office. Your Every Move Will Be Watched.”

The Wall Street Journal also has a regularly updated site on COVID-19 testing and treatments.

Health Payer Intelligence brings us up to date on the Texas v. U.S. case over the Affordable Care Act’s constitutionality. The Supreme Court will hear the case next fall.

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.