“President Joe Biden signed a short-term spending bill to avert a partial government shutdown starting Sunday after a dramatic turn of events Saturday that saw the House quickly pivot to bipartisanship.
“Hours before the midnight deadline, the Senate voted 88-9 to clear the House-passed, 48-day funding patch, which generally mirrors the Senate version except for one major omission: There’s no military or economic aid for Ukraine, unlike the Senate bill, which had $6 billion.
“Democrats grumbled about that and called on the House to bring a separate Ukraine aid bill to the floor. But ultimately, there was no stomach to allow a government shutdown over the lack of Ukraine money, which lawmakers on both sides of the aisle said would be forthcoming in a separate package.”
The new deadline is November 17, the Friday before Thanksgiving. Bear in mind that the debt ceiling act incentivizes passing all twelve appropriations bills by the end of the calendar year.
Rep. Matt Gaetz (R-Fla.) wants to remove House Speaker Kevin McCarthy (R-Calif.) for working across the aisle to stop a government shutdown — but some Democrats are not on board.
Why it matters: As Axios has previously reported, Gaetz will likely need the vast majority of Democrats to vote with him, barring an unprecedented GOP uprising against McCarthy.
Driving the news: Gaetz said during an appearance on CNN’s “State of the Union” on Sunday that he planned to file a motion to vacate against McCarthy this week.
McCarthy responded in a CBS News interview that he will “survive,” calling Gaetz’s effort “personal.”
What they’re saying: “I’m not going to follow Matt Gaetz to Peter Luger’s Steakhouse,” said Rep. Steve Cohen (D-Tenn.), a member of the Progressive Caucus.
Cohen said McCarthy “shouldn’t be put out” for putting a bipartisan stopgap funding bill on the floor: “He did the right thing … and I’ll definitely vote not to vacate. I expect a good number of Democrats will as well.”
“Every time we work together, he loses his mind,” Rep. Greg Landsman (D-Ohio) said of Gaetz in a statement, adding: “This is all about TV appearances for him … just let us govern.”
“I see almost no way that Matt gets most of the Dems,” said one senior House Democrat, speaking on the condition of anonymity. “Many will vote present if they don’t vote No on [House Minority Leader Hakeem Jeffries’] recommendation.”
“Hundreds of children die or are left severely injured around the country each year after they are rushed to hospital emergency rooms that are poorly prepared to treat them.
“Only about 14% of emergency departments nationwide have been certified as ready to treat kids, or are children’s hospitals specializing in treating young patients, The Wall Street Journal found.
“Many emergency doctors don’t treat enough children to be able to spot life-threatening illnesses obscured by run-of-the-mill symptoms, or conditions more common in kids. Some E.R. staff default to drug doses and protocols meant for adults and either don’t have or don’t know where to find child-size gear in a crisis.
“Doctors, health authorities and policy makers have known—and warned—of these failures for decades. Research in recent years has quantified the lack of readiness and number of child deaths that could have been avoided, and pointed to basic steps for solving the problem.
“Yet most hospitals haven’t taken action, according to the Journal’s investigation of certification levels in all 50 states, reviews of medical records and interviews with doctors, health officials and researchers.”
The Journal helpfully “put together the first comprehensive list of hospitals nationwide that have received state certification of some level of readiness for pediatric emergencies. The tally also includes certain children’s hospitals and certain pediatric trauma centers, which specialize in caring for kids.”
“Speaking to reporters on Thursday morning, McCarthy said concerns among both Democrats and Republicans about the pace of migrants crossing the U.S.-Mexican border could provide enough common ground for them to work out a short-term deal to keep the government open past Sept. 30, when the fiscal year ends.
“He said he had spoken with some Democratic senators about border enforcement as recently as Thursday morning.“They want something on the border. They’re working on it,” he said of Democrat senators. “And so I think there’s an opportunity here. We know we have to keep the government funded. We know we have a concern about the border—both sides.” Asked directly by a reporter if he expects a shutdown, McCarthy said: “No, I’m saying we work through this and get it done.”
Following a Senate Finance Committee markup hearing in July, where members voted 26-1 in favor of the Modernizing and Ensuring PBM Accountability (MEPA) Act, Senators Ron Wyden, D-Oregon, and Mike Crapo, R-Idaho, formally introduced the bill on Thursday.
Designed to curb the power of pharmacy benefit managers, the bill would prohibit PBM compensation in Medicare from being tied to the price, increase audit and enforcement measures and aid independent community pharmacies that have struggled because of PBM practices, according to a news release.
Following reports of some patients having difficulties accessing new COVID-19 boosters without cost sharing, Alliance of Community Health Plans, Association for Community Affiliated Plans, AHIP, and Blue Cross Blue Shield Association came together in a letter to Xavier Becerra, Secretary of the Department of Health & Human Services, to reiterate their commitment to providing access, swiftly addressing any challenges, and continuing to partner with HHS and others across the health care system.”
Good to hear.
STAT News offers six approaches to resolving the drug shortages confronting our country.
“A panel of independent advisers to the Food and Drug Administration voted overwhelmingly against a polarizing potential treatment for ALS on Wednesday, concluding that the medicine’s messy supporting data did not meet the standard for approval.
“After a day-long meeting that included impassioned testimony from ALS patients, the agency’s expert advisers voted 17-1 with one abstention that the case for NurOwn, a treatment from BrainStorm Cell Therapeutics, was based too heavily on convoluted clinical trial results and compelling but unreliable anecdotal evidence.”
“The label for Novo Nordisk’s weight loss drug Ozempic now acknowledges some users’ reports of ileus or intestinal blockage.
“In its update, however, the FDA said it’s difficult to confirm a causal relationship between the side effect and the drug.
“Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure,” the label says.
“Wegovy and Mounjaro, also GLP-1 agonist medications, already acknowledge reports of ileus on their labels. Novo Nordisk is the maker of both Ozempic and Wegovy, which both use an injection of semaglutide.”
The Affordable Care Act regulators released ACA FAQ 61, which updates interested parties on transparency in coverage and RxDc reporting issues.
The U.S. Office of Personnel Management announced “issuing an interim final rule today to extend the eligibility date for noncompetitive appointment of military spouses married to a member of the armed forces on active duty through December 31, 2028, as called for by enactment of the Fiscal Year (FY) 2023 National Defense Authorization Act (NDAA) (P.L. 117-263).”
“[A 36-year-old woman living in San Francisco was told her kidneys would heal. But they didn’t; dialysis became a regular routine. She moved to UCSF Medical Center, seeking better care and a place that would allow her parents to visit. There, she met Chi-yuan Hsu, UCSF’s chief of nephrology, who was looking to study patients who might be successfully weaned from dialysis. He believed many patients with acute kidney injury like Lawson stayed on dialysis for longer than they needed.
“The results of a new study by Hsu, published Thursday in the Journal of the American Society of Nephrology, validate his suspicions. The study of nearly 8,000 patients, nearly 2,000 with acute kidney injury, found 40% of patients with acute kidney injury recovered their kidney function. But of these patients, just 18% were weaned from dialysis through having fewer sessions, and 9% by having shorter sessions.
“More than 70% of these patients ended up eventually stopping dialysis without any weaning — “cold turkey” as Hsu puts it — suggesting they could have been having fewer, or shorter treatments earlier. This is important, he said, because dialysis not only impacts quality of life, as it did for Lawson, it can also lead to infection and heart damage, and possibly — this is still under debate — to additional kidney injury that could inhibit recovery and lead to a need for permanent dialysis.”
Health Leaders Media explains how to address the relationship between patient safety and health equity.
Employee Benefit News points out the need for mental health benefits to cover suicide prevention.
From the U.S. healthcare business front,
Forbes reports that CVS, Walgreens And Rite Aid are closing nearly 1,500 stores across the U.S.
“All three drug chains have different reasons for closing stores, but the downsizing prescription is the same. Chain drugstores cost a lot to operate, and they don’t have sufficient differentiation to attract customers feeling the economic pinch.”
Ophthalmologists who accepted payments from drug companies were less likely to prescribe a cheaper medicine to treat an eye disease that causes blindness in older people, rather than a pair of more expensive alternatives, according to a new study. This led Medicare to spend an additional $643 million during a recent six-year period.
Specifically, physicians who received money prescribed Avastin, an older cancer medicine, 28% of the time for combating age-related macular degeneration. And they prescribed two costlier treatments, which have approved specifically to treat the eye disease, 72% of the time. Physicians who did not accept payments prescribed Avastin 46% of the time, nearly twice as often as those who accepted payments.
“As a result, Medicare shelled out an estimated $642.8 million from 2013 to 2019, presumably due to the company payments, according to the study, which was published in JAMA Health Forum. The researchers examined Medicare Part B data that encompassed nearly 21,600 ophthalmologists who accepted money from Roche and Regeneron Pharmaceuticals, which sell the pricier eye treatments.”
“Members of Generation Y, who were born between 1977 and 1994, and Generation Z, born between 1995 and 2004, report a satisfaction score of 714 out of 1,000. But Baby Boomers, born between 1946 and and 1964, and people born earlier had a significantly lower score of 671.
“The satisfaction gap between older and younger generations is widest when it comes to digital channels and appointment scheduling, which could mean older users are struggling to use telehealth providers’ digital interfaces, the study argues.”
“Medicare Advantage provides health coverage to more than half of the nation’s seniors, but a growing number of hospitals and health systems nationwide are pushing back and dropping the private plans altogether.
“Among the most commonly cited reasons are excessive prior authorization denial rates and slow payments from insurers. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over their high denial rates.
“It’s become a game of delay, deny and not pay,” Chris Van Gorder, president and CEO of San Diego-based Scripps Health, told Becker’s. “Providers are going to have to get out of full-risk capitation because it just doesn’t work — we’re the bottom of the food chain, and the food chain is not being fed.”
“In late September, Scripps began notifying patients that it is terminating Medicare Advantage contracts for its integrated medical groups, a move that will affect more than 30,000 seniors in the region. The medical groups, Scripps Clinic and Scripps Coastal, employ more than 1,000 physicians, including advanced practitioners.”
interviews an Aetna executive about successful value based care.
The Wall Street Journal reports about employer groups that are successfully advocating for lower hospital prices in their states. The flagbearer is Gloria Sachdev, who is chief executive officer of the Employers’ Forum of Indiana. Good luck.
Here are the highlights from the related Federal News Network article:
“Starting in January, federal employees and retirees will pay an average of 7.7% more toward their health premiums, according to data the Office of Personnel Management released Wednesday. * * *
“The government will contribute 5% more toward FEHB premiums in 2024.”
The government contribution is 72% of the enrollment weighted average premium capped at 75% of the selected plan’s premium per 5 U.S.C. Sec. 8906.
OPM always emphasizes that the average increase can be lowered by enrollees selecting lower-priced plans during the Open Season, which runs from November 13 to December 11, 2023.
This is the last Open Season before the Postal Service Health Service Health Benefits Program launches on January 1, 2025/
The surprising number to the FEHBlog is the following:
“FEHB participants will see a total of 159 plan options in 2024, offered across 69 health carriers. That’s far fewer than this year’s total of 271 plan options.
“The roughly 41% decrease in plan options is mainly due to the exit of health carrier Humana from the FEHB program. Humana is exiting the program over the next two years.”
OPM also posted 2024 FEDVIP premiums today. Per Federal News Network, “Premiums will rise for FEDVIP dental plans by 1.4% on average, while vision plans will go up by 1.1%, OPM said.”
Here are links to the Govexec and Federal Times articles on this OPM announcement.
The Department of Health and Human Services provided a readout from HHS Secretary Xavier Becerra’s meeting with national health insurance leaders about the current Covid vaccine campaign.
“House Speaker Kevin McCarthy (R., Calif.) rebuffed a bipartisan short-term funding bill from the Senate in favor of a House Republican plan driven by conservatives, as dim prospects for a deal raised the likelihood of a partial government shutdown starting this weekend.
“Many lawmakers now anticipate that Congress will fail to fund the government past Sept. 30, a lapse that will partially close federal agencies and temporarily withhold pay for federal workers and active duty-military personnel.”
From the public health front,
Here is a link to the National Cancer Institute’s latest bulletin of research highlights.
The National Institutes of Health informs us about its decision to fund
“a first-of-its-kind community-led research program to study ways to address the underlying structural factors within communities that affect health, such as access to safe spaces, healthy food, employment opportunities, transportation, and quality health care. Through the NIH Common Fund Community Partnerships to Advance Science for Society (ComPASS) program, NIH made 26 awards to community organizations and a coordinating center, totaling approximately $171 million over five years, pending the availability of funds. Through these awards, ComPASS will enable research into sustainable solutions that promote health equity to create lasting change in communities across the nation.”
“Yet another retailer is making moves in healthcare. This time it’s Costco, which announced Monday that it is partnering with virtual health marketplace Sesameto provide Costco members with discount pricing for medical care. But its move is a little different from other retailers like Walgreens and CVS Health, one expert said.
“Sesame’s platform provides access to thousands of independent clinicians across all 50 states. Through the partnership, Costco members will have access to $29 per virtual primary care visit and $79 per virtual mental health therapy visit. They’ll also have access to health checkups — which include a standard lab panel and a virtual follow-up consultation — for $72. In addition, they’ll receive 10% off on other Sesame services, including in-person care. Sesame’s usual prices (for those accessing the company outside of Costco) vary, but a primary care visit can often be around $45, said Michael Botta, co-founder and president of Sesame.
“Sesame does not accept insurance, so all of the services are offered via cash pay, meaning the partnership will mostly benefit patients who are uninsured or enrolled in high-deductible health plans.”
Amazon announced this week that it would invest up to $4 billion in artificial intelligence company Anthropic as the AI arms race heats up.
The two companies are forming a strategic collaboration to advance generative AI, and the startup selected AWS as its primary cloud provider. Along with the hefty investment, Amazon also took minority ownership in the two-year-old start-up.
“As new primary care models, including retail health clinics, continue to scale, the national supply of clinical providers will become even more constrained. For health systems, hospitals and medical groups, competition for the shrinking pool of nurses and doctors will intensify, according to a new analysis.
“Patients have more choices than before with the increasing supply of new entrants like CVS, Amazon and Walmart, and this is also leading to care becoming more fragmented and disintermediated from the traditional care journey, said Sanjula Jain, Ph.D., chief research officer and senior vice president of market strategy at healthcare analytics company Trilliant Health.
“Patient panel sizes for new primary care entrants—like Walgreens’ VillageMD, CVS’ Oak Street Health and Amazon’s One Medical —average 584 patients per provider, which is far lower than the current patient-to-provider ratio of 944. These ratios suggest that the U.S. would need an additional 218,000 primary care providers to meet the needs of every American under the new entrant primary care model, according to Trilliant Health’s “2023 Trends Shaping the Health Economy” report.”
“Centene is laying off 2,000 employees — a little over 3% of its workforce — as the health insurer struggles with headwinds from Medicaid redeterminations and Medicare Advantage star ratings.
“The layoffs were confirmed to Healthcare Dive by a company spokesperson. Centene has recently sold off assets, including AI platform Apixio and UK
“Senate Democratic and Republican leaders unveiled their plan to avoid a government shutdown, releasing legislation to extend funding through Nov. 17 while also providing about $6 billion apiece for Ukraine and for disaster relief.
“The proposal—the only bipartisan approach currently being pursued by congressional leaders—marks a contrast with House Speaker Kevin McCarthy’s plan to extend government funding on the condition that Congress also enact strict border-security measures. The Senate plan was released as the chamber prepared a vote to open debate on the measure, while the House was preparing to vote to advance four full-year funding bills.”
“House Republicans finally paved the way for consideration of more fiscal 2024 appropriations bills, setting up a busy week in which the chamber is set to consider four separate spending measures. And that’s not counting the one bill they have to pass this week in order to stop a partial government shutdown.
After several tries to get the Defense bill on the floor, the House adopted a rule to take up that legislation plus three others — Homeland Security, Agriculture and State-Foreign Operations.”
The Centers for Medicare and Medicaid Services announced
“that average premiums, benefits, and plan choices for Medicare Advantage and the Medicare Part D prescription drug program will remain stable in 2024. Improvements adopted in the 2024 Rate Announcement, as well as the 2024 Medicare Advantage and Part D Final Rule, such as increased beneficiary protections around marketing and prior authorization and increased access to behavioral health, support this stability. CMS is committed to ensuring these programs work for people enrolled in Medicare, that benefits remain strong and stable, and that payments to plans are accurate.
“Additionally, thanks to the Inflation Reduction Act, people with Medicare Part D prescription drug coverage will continue to have improved and more affordable benefits, including a $35 cost-sharing limit on a month’s supply of each covered insulin product, recommended adult vaccines at no cost, and additional savings on their Medicare Part D drug coverage costs in 2024. These savings include the expansion of the Low-Income Subsidy (LIS) program, also called Extra Help, which helps eligible enrollees afford their premiums and cost-sharing, as well as a cap on out-of-pocket costs for millions of people with very high drug costs in the catastrophic phase of the Part D benefit.
“CMS is releasing this key information, including 2024 premiums and deductibles for Medicare Advantage and Medicare Part D prescription drug plans, ahead of the upcoming Medicare Open Enrollment, beginning October 15, 2023, to help people with Medicare determine the best Medicare coverage option for their health care needs.”
The National Institutes of Health announced its Targeted Challenge to revolutionize technology to treat genetic diseases.
NIH also “designated people with disabilities as a population with health disparities for research supported by the National Institutes of Health.”
The Centers for Disease Control called attention to its quick Pre-Diabetes Test.
“More than three years into the pandemic, the millions of people who have suffered from long Covid finally have scientific proof that their condition is real.
“Scientists have found clear differences in the blood of people with long Covid — a key first step in the development of a test to diagnose the illness.
“The findings, published Monday in the journal Nature, also offer clues into what could be causing the elusive condition that has perplexed doctors worldwide and left millions with ongoing fatigue, trouble with memory and other debilitating symptoms.”
“Long COVID in the U.S. is rare among children and has affected roughly one in 14 adults, according to a pair of data briefs from the CDC’s National Center for Health Statistics (NCHS).
“Overall, in 2022, an estimated 1.3% of children in the U.S. ever had long COVID, and 0.5% currently had long COVID, reported Anjel Vahratian, PhD, MPH, of the NCHS, and colleagues.
“As for adults, an estimated 6.9% ever had long COVID, and 3.4% currently had long COVID that year, said Dzifa Adjaye-Gbewonyo, Ph.D., MPH, of the NCHS, and colleagues.
“Out-of-pocket health care costs for employed women in the United States are estimated to be $15 billion higher per year than for employed men, exacerbating gender wage disparities. And this financial burden on women persists even when excluding maternity-related services.”
The report offers possible remedies to employers and health plans.
“In the aftermath of a devastating summer tornado at Pfizer’s Rocky Mount injectables plant in North Carolina, manufacturing has largely resumed. Still, the company expects supply shortfalls for some drugs produced at the plant to stretch into next year.
“The “majority” of the Rocky Mount facility’s manufacturing lines have restarted, Pfizer said in a Monday release. What’s more, Pfizer has launched an additional line in the site’s new sterile injectable manufacturing area, dubbed R3, the company added.
“The “expedited restart” comes ahead of Pfizer’s previously stated timeline. Late last month, Pfizer said it intended to restart manufacturing at the plant the fourth quarter of 2023.
“Pfizer is restarting production in phases, with full production across the site’s three manufacturing suites expected to come back online by the end of the year.”
“As the supply of two staple cancer drugs rebounds after months of scarcity, two medications used in pediatric cancer patients have fallen into shortage, NBC News reported Sept. 25.
“The shortages of cisplatin and carboplatin are easing, but methotrexate access remains in flux, and supply levels of vinblastine and dacarbazine are worsening.
“Vinblastine is approved to treat Hodgkin lymphoma, non-Hodgkin lymphoma, Kaposi sarcoma, and breast and testicular cancer; dacarbazine is used for melanoma and Hodgkin lymphoma. Both are in shortage, and pediatric providers are worried because there are few alternatives.”
“Elevance Health and Blue Cross Blue Shield of Louisiana have paused their $2.5 billion merger following criticism from state regulators that it could reduce competition and raise healthcare costs in the state.
“Elevance and BCBSLA said they’re withdrawing the merger to “provide more time for key stakeholders to understand the benefits this transaction will provide” in a statement to Healthcare Dive.”
Axios shares private employer ideas on how to improve health benefits for their employees.
“Senate Majority Leader Chuck Schumer (D-N.Y.) is ramping up the pressure on Speaker Kevin McCarthy (R-Calif.) to avoid a government shutdown by moving first on a stopgap funding bill that will pass the Senate this week, a few days before the Sept. 30 deadline.
“The Senate’s plan is to send the bill to the House and put pressure on McCarthy to bring it to the floor for a vote it would pass with bipartisan support if given the chance, said senators who are calculating how the endgame will play out.”
The Department of Health and Human Services released a letter from Secretary Xavier Becerra to “the health payer community.” This is the paragraph that grabbed the FEHBlog’s attention:
“I also know that, with the end of the public health emergency, the requirement to cover COVID-19 vaccinations furnished by out-of-network providers generally has ended. However, if a plan or issuer does not have a provider in its network who can provide a qualifying coronavirus preventive service, the plan or issuer must cover the item or service when furnished by an out-of-network provider and may not impose cost-sharing with respect to the item or service. We want to underscore the public health importance of reducing barriers to coverage however possible and urge you to consider any and all ways to reduce these barriers. It is critical to help your members navigate your network, particularly to help people understand the differences between your medical and pharmacy network as appropriate. We know you are already looking for ways to smooth these issues and hope that will continue. In the meantime, we will do our part to urge consumers to seek in-network providers when possible.”
Fierce Healthcare tells us about a D.C. conference at which attendees encouraged the Centers for Medicare and Medicaid Services to offer Medicare coverage for the new generation of anti-obesity drugs.
“Healthcare organizations are continuing to push the Centers for Medicare & Medicaid Services (CMS) to rethink its coverage policy for anti-obesity medications.
“These medicines are not covered by Medicare Part D, because existing statutory exclusion is in place for these drugs that do not cover “agents when used for anorexia, weight loss or weight gain,” according to a press release. In a joint press conference hosted by health experts at Manatt, Phelps & Phillips and the Obesity Action Coalition, advocates laid out a legal basis in support of covering GLP-1s, stating that they can target obesity rather than describing the drugs solely in terms of their effects on weight.
“Obesity is a disease that has multiple causes and consequences not limited to weight,” said Michael Kolber, a healthcare partner at Manatt Health, to reporters. “There are many drugs that cause weight loss or weight gain, even if that’s not why they’re being prescribed.”
“As the Biden administration pushes to make insurers cover mental health care on par with physical care, there’s a similar push from lawmakers and advocates for electronic health records, Ben reports.
“Mental health and substance-use providers weren’t allowed to get billions in federal subsidies for adopting EHRs in the 2009 HITECH Act, which advocates argue has led to significant disparities in uptake between behavioral and physical health providers. While data varies, one recent federal estimate found that 49 percent of psychiatric hospitals have certified electronic health records compared to 96 percent of general and surgical hospitals.
“Without the funding, the behavioral health industry didn’t invest in robust behavioral health-specific electronic health systems, said Alisa Chestler, a Baker Donelson attorney with digital health expertise.
“Legislation from Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) and Sens. Markwayne Mullin (R-Okla.) and Catherine Cortez Masto (D-Nev.) would add $20 million in annual grant funding through ONC for behavioral health EHR adoption. Advocates hope it will get into the final SUPPORT Act reauthorization package aimed at addressing the opioid epidemic. The package expires Sept. 30 without Congressional action.
“Al Guida, a lobbyist speaking on behalf of the Behavioral Health IT Coalition, said the lack of EHR adoption in behavioral health prevents such care from being integrated into primary care. David Bucciferro, chair of the HIMSS Electronic Health Record Association, added that it hurts care coordination.”
From the public health front,
In a surprise to the FEHBlog, MedPage Today informs us
“Both nirmatrelvir-ritonavir (Paxlovid) and molnupiravir (Lagevrio) were associated with a reduction in death during the COVID-19 Omicron era, a large retrospective study of electronic health records from the Cleveland Clinic showed.
“Compared with not receiving any treatment, nonhospitalized COVID patients who received nirmatrelvir-ritonavir saw an 84% reduction in mortality (adjusted hazard ratio 0.16, 95% CI 0.11-0.23) and those who took molnupiravir saw a 77% reduction in death (adjusted HR 0.23, 95% CI 0.16-0.34), according to Danyu Lin, PhD, of the University of North Carolina in Chapel Hill, and colleagues. * * *
“We show that these two drugs work very similarly,” Lin told MedPage Today. “The fact that molnupiravir works as well as Paxlovid is an interesting finding, and I would say this finding is not inconsistent with existing literature.”
“Indeed, earlier this week, the American College of Physicians (ACP) issued an updated version of its practice guidelines for outpatient management of COVID in the Omicron era and continued to recommend both antivirals equally.”
That’s very good news.
Precision Vaccinations discusses the four vaccinations now available to pregnant people in their third trimester.
The Institute for Clinical and Economic Research issued “a Draft Evidence Report assessing the comparative clinical effectiveness and value of sotatercept (Merck & Co) for pulmonary arterial hypertension. This preliminary draft marks the midpoint of ICER’s eight-month process of assessing these treatments, and the findings within this document should not be interpreted to be ICER’s final conclusions. * * * On October 5, 2023, as part of ICER’sEarly Insights Webinar Series, ICER’s Chief Medical Officer, David Rind, MD will present the initial findings of this draft report.”
“The declines in body weight that patients experience with injectables like semaglutide (Ozempic, Wegovy) and tirzepatide (Mounjaro) are no exception to the concept that nothing lasts forever.
“Eventually, everybody reaches a “plateau,” even on newer GLP-1 receptor agonists. It’s a phase at which the body reaches a new “settling point,” specialists said, and weight, along with other metabolic markers like blood pressure and HBA1c stabilize, or fluctuate only slightly. For some, this may mean a gradual increase in appetite or “food noise”; others may be able to maintain their current state.
“Studies have shown that, on average, this plateau happens at a little over a year with semaglutide. Even so, physicians say some patients are surprised to learn that there’s a limit to what these medications can do.
“Everyone will plateau, of course. No one on my watch has disappeared. No one has vanished,” Jody Dushay, MD, an endocrinologist at Beth Israel Deaconess Medical Center in Boston, told MedPage Today. “It’s alarming to me that people find that surprising, but everyone will reach a plateau and there’s no way to know when you start the medication what that will be, what percent weight loss that will be, and how quickly they will reach it.”
“Rite Aid proposed closing nearly a fourth of its 2,100 pharmacies and declaring bankruptcy, people familiar with the matter told The Wall Street Journal in a Sept. 22 story.
“The outlet recently reported the pharmacy chain is preparing to file for Chapter 11 bankruptcy as it faces $3.3 billion in debt and numerous lawsuits over its alleged role in the opioid epidemic. Chapter 11 bankruptcies are commonly used to reorganize a company’s structure to continue its business while paying creditors over time.
“The bankruptcy discussions include a plan to close between 400 and 500 of its stores while either having creditors take the remaining pharmacies or selling them. Rite Aid is also considering an auction to sell sections of the business, such as its Elixir pharmacy unit.”
“investing $1 million in national and community-based organizations this fall to address food insecurity among older Americans. Collectively, the funds are expected to provide more than 3 million meals to people in need, increase access to 1.88 million pounds of fresh produce, and save 21 million gallons of water and 2.89 tons of CO2e emissions in responsible food distribution, supporting better health and positively impacting the environment.”
“Fifty-six innovative programs spanning 12 states received critical financial support enabling them to reach thousands of seniors who face food insecurity. The organizations range from local Meals on Wheels chapters and food banks to senior- and veteran-focused coalitions and centers. The sponsorships will also fund food- and nutrition-based programs, such as food pantries, mobile food deliveries, and nutritional meal boxes.”
In a random note, the Washington Post shares opinions on current telephone etiquette which the FEHBlog found illuminating.
“Congress heads into a make-or-break week for avoiding a government shutdown, with leaders of the Republican-controlled House hoping they can persuade GOP holdouts to get on board with four full-year bills and a short-term funding patch.
“With a shutdown set for Oct. 1, unless Congress acts, the plan marks a last-ditch effort by Republicans to find a way forward. If no deal is reached, hundreds of thousands of federal workers are set to be furloughed.
“When it gets crunch time, people that have been holding off all this time blaming everybody else will finally hopefully move,” House Speaker Kevin McCarthy (R., Calif.) told reporters Saturday.
“McCarthy laid out the path forward in a GOP conference call. The House is expected on Tuesday to vote on a rule establishing the parameters for debate on a defense-spending bill, a bill funding the Homeland Security Department, one funding the State Department and another funding agricultural priorities.
“After that, McCarthy is expected to focus on a short-term spending deal ranging from two weeks to two months to keep the government funded while negotiations continue.”
The U.S. Supreme Court has posted its October 2023 Term calendar. The opening conference will be held on Tuesday, September 26. The first oral arguments will be held on October 2, 2023.
If history can be a guide, OPM will announce the 2024 FEHB premiums this week, along with the government contribution change.
“The drug colchicine has been used for more than 2,000 years to treat the fiery joint-pain ailment called gout. It also is a remedy for a genetic disorder called familial Mediterranean fever and for pericarditis, an inflammation of the sac around the heart.
“Now, colchicine may be set for a surprising new role. In June, the Food and Drug Administration approved a new low-dose version of the drug as the first-ever medicine to treat cardiovascular inflammation, marking a new approach to heart attack prevention.
“Several things could limit the adoption of colchicine by cardiologists, at least at first, including side-effect concerns and the emergence of several other new options for reducing the risk of heart attacks. But the drug’s approval provides fresh validation for a concept that has been gaining momentum in cardiology over the past 25 years—that inflammation is a key culprit in atherosclerosis, the artery-clogging disease, and that treating it can reduce the risk of a heart attack.
T”he bedrock strategy for heart-attack prevention has long been lowering LDL cholesterol with drugs called statins. Adding low-dose colchicine—which in one study reduced cardiovascular risk by 31% in patients already treated with statins and other preventive medicines—would enable doctors to simultaneously hit two biological targets that cause heart attacks.
“This is about combining therapies” that are both effective ways to reduce risk, says Dr. Paul Ridker, director of the Center for Cardiovascular Disease Prevention at Harvard-affiliated Brigham and Women’s Hospital, Boston. “They’re not in conflict; they’re synergistic.”
Cardiovascular Business identifies the best heart hospitals using a Newsweek survey. The top five are the following:
NPR Shots considers whether Ozempic causes mental health side effects.
The NY Times discusses the synthetic opioid epidemic plaguing many of the Nation’s large cities, like New York. This article focuses on “collateral damage.”
“The rising death toll comes as the city and the state have turned away from the aggressive law enforcement of low-level street drug activity that was common in the late 1990s. The shift has happened gradually over time, as a broader movement has pushed to reframe drug use as a public health crisis rather than as primarily a criminal issue.”
In Medicare news, Fortune Well tells us about 2024 Medicare changes and other relevant matters as we approach the Medicare open enrollment period, which begins on October 15, 2023.
In business news,
HR Dive points out, “Employers have 44 days on average to “make or break” a new hire, and first impressions make a lasting impression, according to a Sept. 20 report from BambooHR, a cloud-based human resources platform.”
“Creating a “buddy system” to pair new hires with experienced employees can make the onboarding experience stronger, according to a McLean & Co. report. The tenured employee can personalize the onboarding experience, serve as a contact person and provide advice about team processes or organizational culture.”
The FEHBlog failed to hit publish last night, so Thursday Miscellany was not emailed Friday morning. To correct the problem, Friday Factoids will follow Thursday September 21’s post. Lo siento
“Faced with the House stalemate over a government stopgap funding bill, Senate Majority Leader Chuck Schumer (D-N.Y.) on Thursday set up a path for the Senate to move first on a bill to fund the government beyond Sept. 30.
“Schumer filed cloture on a motion to proceed to H.R. 3935, the House-passed bill to reauthorize the Federal Aviation Administration (FAA), which could serve as a legislative vehicle to pass a continuing resolution to fund the government through the Senate. * * *
“Senators will spend next week debating and voting on the legislation in hopes of sending it to the House by Wednesday or Thursday of next week.”
“The [new] plan [from the House of Representatives] is to ready more of the chamber’s 11 remaining full-year appropriations bills for votes, focusing on passing those to establish a firm negotiating position for talks with the bigger-spending Senate.”
Yesterday, the Affordable Care Act regulators extended the public comment deadline for the proposed mental health parity rule revisions from October 2 to October 17, 2023.
Today, the Centers for Medicare and Medicaid Services posted a new announcement on its No Surprises Act website:
“Effective September 21, 2023, the Departments have directed certified IDR entities to resume processing all single and bundled disputes already submitted to the IDR portal and assigned to a certified IDR entity. The ability to initiate new disputes involving air ambulance items or services as well as batched disputes for air ambulance and non-air ambulance items and services is currently unavailable. IDR portal functionalities related to previously initiated batched disputes are also unavailable. Disputing parties should continue to engage in open negotiation according to the required timeframes.”
CMS also updated its website with No Surprises Act rules and fact sheets.
“The FWCI competencies provide a common language for 214 occupational series. OPM has published 80 occupation-specific competency models representing work governmentwide that may be used for selection, evaluation, and training activities. The FWCI is a resource for agencies to leverage in their skills-based hiring practices.
“OPM will continue to support agencies and collect critical data that strengthens our workforce and enables us to deliver services for the American people,” said OPM Director Kiran Ahuja. “This update to the Federal Workforce Competency Initiative will help agencies hire the talent they need and expand opportunities for positions that do not require certain degrees.”
The Equal Employment Opportunity Commission posted its new strategic enforcement plan for 2024 through 2028.
From the public health front,
The American Medical Association identifies eight things doctors wish their patients knew about the flu shot.
“Poor oral hygiene is associated with an increased risk for myriad health problems, including heart disease, diabetes, cancer, rheumatoid arthritis and early death. The state of our teeth and gums, though, may be vital for our well-being beyond the mouth and body.
“Emerging evidence suggests that what goes on in our mouth can affect what goes on in our brain — and may even potentially affect our risk for dementia.
“People should really be aware that oral health is really important,” said Anita Visser, professor in geriatric dentistry at the University of Groningen in the Netherlands.”
“A recent CVS Health®/Harris Poll survey of Americans 18 years and older found that nearly one in five (18%) U.S. adults say they were plagued with suicidal thoughts in the past year.
“Other key findings from the survey include:
“More than a third of younger adults aged 18-34 (36%) say they had moments in the past year where they contemplated suicide.
“An overwhelming nine in ten (89%) U.S. adults deem suicide prevention efforts a major priority in our society.
“However, less than a third (32%) strongly agree they can recognize the warning signs of someone potentially at risk, and only four in ten (43%) are strongly aware of resources that offer support and information on suicide prevention.
“Nearly eight in ten (77%) U.S. adults believe healthcare providers have a crucial role in suicide prevention, and there is an opportunity for providers to have more discussions about suicide with patients.”
“The Federal Trade Commission is suing anesthesia provider U.S. Anesthesia Partners and private equity firm Welsh, Carson, Anderson and Stowe, alleging the two colluded to consolidate anesthesiology practices in Texas, driving up prices to boost their profits.
“Welsh Carson created USAP in 2012 before acquiring over a dozen anesthesia providers over the next decade to create a single dominant provider in the state, regulators allege. The PE firm and USAP also made price-setting agreements with independent anesthesiology practices while sidelining a potential competitor by striking a deal to keep them out of USAP’s market, the FTC said.
“The complaint filed Thursday in federal district court says the actions have cost Texans “tens of millions of dollars” more each year in anesthesiology services.”
MedCity News offers insights on value-based care from an executive at the HealthPartners HMO in Minnesota. “The commercial market has struggled to adopt value-based care, but HealthPartners has had some success, according to Mark Hansberry, senior vice president and chief marketing officer of the company. During a conference, he shared five rules for scaling value-based care, including creating trust and providing real-time data.”
“Nearly 1,900 U.S. physicians have applied to become certified in obesity medicine — a record number — according to data from the American Board of Obesity Medicine.
“In October, 1,889 physicians will take the exam to become certified in the specialty area. That’s up from 1,001 exam candidates in 2020, marking an 88.7 percent jump. Physicians’ growing interest in the certification comes amid booming patient demand for GLP-1 receptor agonist drugs such as Ozempic and Wegovy. As of August, 2023, sales for Ozempic in the U.S. topped $3 billion.
“More than 6,700 physicians are certified in obesity medicine, a certification that first became available in 2012. For the upcoming exam in October, 38 percent of exam candidates are internal medicine physicians and 30 percent family medicine. To sit for the exam, physicians must have completed a minimum of 60 continuing medical education credits on the topic of obesity.”
The FEHBlog notes that if you build it, they will come.
Fierce Healthcare looks inside Walgreens’ pharmacy and primary care model.
“Novo Nordisk found bacteria in batches of the main ingredient for a diabetes pill that is a cousin to popular diabetes and weight-loss drugs and was made at a North Carolina plant earlier this year, according to a federal inspection report reviewed by The Wall Street Journal.
“The Food and Drug Administration inspected the Clayton, N.C., plant in July and issued a report saying that Novo Nordisk had failed to investigate the cause thoroughly and that the plant’s microbial controls were deficient.
“The plant makes the drug ingredient semaglutide, which is used in the diabetes pill Rybelsus. Semaglutide is also the main ingredient in Novo Nordisk’s popular injections Ozempic and Wegovy, but the company said the semaglutide for those products isn’t made at the same plant.
“The Danish company said the Clayton plant is still running and producing for the market and wouldn’t share details of its interactions with the FDA.
“The agency said Thursday that based on Novo’s responses to its inspection findings, the FDA isn’t aware of ongoing compliance issues that raise any concerns about the quality of drugs made at the plant.”
“A bipartisan bill led by Sens. Chuck Grassley (R-Iowa) and Ron Wyden (D-Ore.) to improve access to lifesaving organ donations became law today. The Securing the U.S. Organ Procurement and Transplantation Network Act will improve the management of the U.S. organ donation system by breaking up the contract for the Organ Procurement and Transplantation Network (OPTN) and encouraging participation from competent and transparent contractors. U.S. Sens. Ben Cardin (D-Md.), Todd Young (R-Ind.) and Bill Cassidy (R-La.) are original cosponsors of the legislation.”
“The lawmakers’ novel approach would aim to ensure Congress completes its work on all 12 appropriations bills needed to fund the government, without the threat of a shutdown that would furlough hundreds of thousands of federal workers and leave government contractors unpaid. Major government functions will stop on Oct. 1 at 12:01 a.m. unless Congress acts.
“The bill, co-sponsored by Sens. James Lankford (R., Okla.) and Maggie Hassan (D., N.H.), would set in motion 14-day continuing resolutions, which keep the government funded at the prior year’s levels, while Congress works exclusively on passing appropriations bills.”
“The threat of a massive tax is enough to push drugmakers such as Boehringer Ingelheim Pharmaceuticals, Inc. and Novartis AG to comply with the Biden administration’s landmark drug pricing law and negotiate with Medicare.
“Companies who manufacture the first 10 drugs selected to negotiate prices with Medicare have until Oct. 1 to officially agree to enter price talks. Under the Inflation Reduction Act, those who refuse to comply with the negotiations must pay a tax starting at 65% of the US sales of a product. The fines would increase by 10% every quarter, with a maximum of 95%.”
That’s a lot of leverage.
The Consumer Financial Protection Bureau has “announced it is beginning a rulemaking process to remove medical bills from Americans’ credit reports. The CFPB outlined proposals under consideration that would help families financially recover from medical crises, stop debt collectors from coercing people into paying bills they may not even owe, and ensure that creditors are not relying on data that is often plagued with inaccuracies and mistakes.” In the FEHBlog’s view, this approach is bound to backfire as lenders lose faith in credit reports.
From the public health and medical research front,
“Nearly half of U.S. states had an adult obesity prevalence at or above 35% in 2022, according to CDC.
“The 22 states that met this mark — a small jump from the 19 states just the year prior — included Alabama, Arkansas, Delaware, Georgia, Indiana, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Dakota, Ohio, Oklahoma, South Carolina, South Dakota, Tennessee, Texas, Virginia, West Virginia, and Wisconsin.”
By an 11-1 vote, the Advisory Committee on Immunization Practices (ACIP) recommended that pregnant women receive a single dose of Pfizer’s prefusion F protein (RSVpreF) vaccine (Abrysvo) at 32 to 36 weeks gestation to prevent lower respiratory tract RSV infection in infants.
After decades without an option for protecting most infants against the annual respiratory scourge, providers now have two options: the maternal vaccine and the monoclonal antibody nirsevimab (Beyfortus), which the ACIP last month recommended for all infants younger than 8 months born during or entering their first RSV season.
STAT News adds, “The recommendation was accepted by CDC Director Mandy Cohen shortly after the conclusion of the panel’s meeting.”
“A new cancer drug developed by Daiichi Sankyo and AstraZeneca met one of its two main goals in a breast cancer trial, helping patients who had progressed on earlier-line treatments live longer than those receiving chemotherapy without their disease getting worse, the companies said Friday.
“The trial tested the drug, known as datopotamab deruxtecan, in HER2-low or -negative patients whose tumors were sensitive to hormone treatments before their cancer returned. AstraZeneca and Daiichi didn’t release detailed data and stated that the trial hadn’t gone on long enough to tell if patients given their treatment lived longer overall, the trial’s other main goal.
“The data suggest the companies’ drug could present a threat to Gilead’s similarly acting medicine Trodelvy, which gained approval in a similar setting earlier this year. HR-positive, HER2-negative breast cancer is the most common form of the disease.”
“A combination of cancer drugs from Seagen and Merck & Co. has shown early success in a large clinical trial, results that help confirm the pairing’s ability to treat a wide range of bladder cancer patients.”
“A clinical trial has launched to test whether early intensive immune modulation for hospitalized COVID-19 patients with relatively mild illness is beneficial. The placebo-controlled study, part of the global clinical trials consortium known as Strategies and Treatments for Respiratory Infections and Viral Emergencies (STRIVE), will enroll approximately 1,500 people at research sites around the world. It is supported by the National Institutes of Health’s National Institute of Allergy and Infectious Diseases (NIAID) in partnership with NIH’s National Center for Advancing Translational Sciences (NCATS).
“Immune modulators—treatments for modifying the immune system to better respond to disease or illness—are lifesaving for certain hospitalized COVID-19 patients. However, the optimal timing for administering the medicines to achieve the best outcomes has not been defined.”
The Wall Street Journal poses ten questions about experimental drugs that can be made available to seriously ill patients.
“Catholic healthcare giant CommonSpirit Health has reported a $1.4 billion operating loss (-4.1% operating margin) and a net loss of $259 million for its 2023 fiscal year, which ended June 30, according to financial statements released Thursday.
“The nonprofit, which currently operates 145 hospitals across 24 states, had logged a $1.3 billion operating loss (-3.8% operating margin) and a $1.8 billion deficit of revenues over expenses during its prior fiscal year.
“This time around, the organization enjoyed patient volumes that “reached pre-pandemic levels in many of the health system’s markets” but was dragged by “private and government reimbursements [that] did not keep pace with increased costs of providing care to patients,” CommonSpirit said in a release accompanying the latest financial filings. The most recent year’s operating performance also included a $160 million adverse impact from a fall 2022 cybersecurity breach that affected numerous locations.”
The CMS is poised to crack down further on health insurers in the Medicare Advantage program, according to new comments from a top agency official.
MA plans — which now cover more than half of Medicare beneficiaries — have faced rising criticism over care denials and access, along with improper coding practices that inflate the program’s cost.
“You will see CMS in the future be a much tougher payer and much tougher regulator to ensure that, for every beneficiary and taxpayer who pay more for it, the value is there, the service is there and beneficiaries have full information for the choices that they’re making,” CMS Deputy Administrator Jon Blum said Thursday at the National Association of ACOs’ fall conference in Washington, D.C.
House Republicans appeared to be moving closer to an agreement Wednesday on an opening bid for stopgap funding legislation that would keep the lights on at federal agencies beyond Sept. 30 and pave the way for their chamber to take up its full-year appropriations bills.
At least a handful of conservative holdouts still maintained their opposition as of Wednesday night, which would be enough to sink a revised bill unless GOP leaders are able to change some minds in the next few days. Speaker Kevin McCarthy, R-Calif., is expected to keep the chamber in session on Saturday if necessary.
Even if GOP leaders’ new effort is successful, however, it was starting to look more like a bid to reopen the government after a brief shutdown, given the deadline is 10 days away and the Senate is likely to ping-pong a much different bill back to the House.
The FEHBlog notes that it would not be unusual for Congress to pass a brief continuing resolution next week to allow for the passage of a longer continuing resolution, thereby side stepping the partial government shutdown.
Fierce Healthcare offers details on the House Ways and Means Committee’s No Surprises Act hearing, while Healthcare Dive shares details on the House Oversight and Accountability’s PBM reform hearing. Both hearings were held yesterday.
Speaking of the No Surprises Act, the ACA regulators released a proposed rule increasing the government’s NSA arbitration fee from $50 per party to $150 per party next year. The FEHBlog has no idea why the government doesn’t ladder the fee based on the amount in dispute. The government also increased the maximum fee independent dispute resolution entities can charge the parties.
“FDA Approves GSK Myelofibrosis Med That Has Edge Over Others in Drug Class
“FDA approval of GSK’s Ojjaara in myelofibrosis introduces a new competitor to blockbuster Incyte drug Jakafi. Ojjaara was part of GSK’s $1.9 billion acquisition of Sierra Oncology last year.”
“FDA Rejects ARS Pharma’s Nasal Spray Alternative to Injectable Epinephrine
“ARS Pharmaceuticals frames its intranasal epinephrine spray as a needle-free alternative to products such as EpiPen. Though this spray won the backing of an FDA advisory committee, the agency is now requiring that ARS Pharma run another study to support a regulatory submission.”
From the public health and medical research fronts,
“The federal government is again offering free Covid-19 tests to Americans, providing a fifth round of free tests in part to meet current needs and in part to stimulate a domestic testing industry that has struggled with cratering demand for rapid diagnostics.
“The measure, announced Wednesday, will see rapid tests released from the Strategic National Stockpile. In addition, 12 domestic test manufacturers will receive investments totaling $600 million to help “warm-base” the U.S. capacity for rapid test production, both for Covid and future disease threats. * * *
“Households will be entitled to receive four free rapid tests apiece, with ordering at COVIDtests.gov opening on Sept. 25. O’Connell said test shipments are expected to start on Oct. 2.”
The FEHBlog thinks that the government is fighting the last pandemic. Why not incent the production of the FDA-approved (last February) at-home tests for Covid or the flu, not just Covid?
“Don’t throw out that seemingly outdated at-home rapid Covid-19 test just yet. It may still be good.
“The Food and Drug Administration has been extending expiration dates for some authorized at-home, over-the-counter Covid test kits, meaning some unused tests may still be viable. The agency’s updated list of expiration dates may be useful to those reaching for their stash of Covid-19 tests amid new variants and a recent bump in cases and hospitalizations.”
“A trial of a preventive HIV vaccine candidate has begun enrollment in the United States and South Africa. The Phase 1 trial will evaluate a novel vaccine known as VIR-1388 for its safety and ability to induce an HIV-specific immune response in people. The National Institute of Allergy and Infectious Diseases (NIAID), part of the National Institutes of Health, has provided scientific and financial support throughout the lifecycle of this HIV vaccine concept and is contributing funding for this study.”
“Is morning the best time of day to exercise? Research published Tuesday in the journal Obesity finds that early morning activity — between 7 a.m. and 9 a.m. — could help with weight loss.
“My cautious suggestion from this study is that if we choose to exercise in the early morning before we eat, we can potentially lose more weight compared to exercise at other times of the day,” said lead researcher Tongyu Ma, a research assistant professor at The Hong Kong Polytechnic University.”
“Ochsner Health is launching a pilot program this month that will use generative artificial intelligence to draft “simple” messages to patients.
“About a hundred clinicians across the New Orleans-based health system will participate in the first phase of the program, where AI will prepare responses to patient questions unrelated to diagnoses or clinical judgments. The messages will be reviewed and edited by providers before being sent to patients, according to a news release.
“Ochsner is part of an early adopter group of Microsoft’s Azure OpenAI Service, which integrates with the Epic electronic health record. The health system will test the messaging feature over three phases this fall, and Ochsner will collect patient feedback to improve the system.”
“Making sense of mountains of data continues to be an often elusive goal for most of the healthcare system, but Cambia Health Solutions said it hopes its latest effort will allow it to better corral useable information.
“Cambia and Abacus Insights, a data management company that tacklesthe challenge of making healthcare networks interoperable, launched a new data aggregating system that processes information for about 3.4 million members across four Blues plans.
“According to an Abacus case study (PDF), “Cambia recognized that to deliver care orchestrated around the unique needs of each individual, data must be actionable. To be actionable, case study data must be understandable, usable, timely, and have clinical utility.”
“House Republican leaders worked to salvage a short-term spending bill that sparked angry disagreements among the party’s rank-and-file, but they remained short of the support needed to pass the measure and show the party could unite to avert a government shutdown. * * *
“The effort to pass a short-term deal comes as Congress is working to pass the 12 annual appropriation bills that fund the government. Leaders of both parties in the House and Senate have thrown their support behind reaching a short-term deal that would give both chambers more time to negotiate a full-year spending agreement.
“Both McCarthy and Senate Minority Leader Mitch McConnell (R., Ky.) have warned of the political fallout for the GOP from a shutdown.
“I’ve seen a few of them over the years, they never have produced a policy change, and they’ve always been a loser for Republicans politically,” said McConnell to reporters.”
Govexec offers federal employees a “guide to pay and benefits during a shutdown.”
The House Ways and Means Committee held a No Surprises Act hearing today. Here are a link to the Chairman’s opening statement and a link to the AHIP witness statements.
“Enrollees in the Federal Long-Term Care Insurance Program (FLTCIP) are bracing for another big premium increase starting in 2024.
“The Office of Personnel Management, which runs the federal insurance program, announced plans to hike up premium rates for current enrollees. The changes will take effect on Jan. 1.
“Unlike the averages offered in past years, OPM declined to share an average percentage increase for FLTCIP premiums. An agency spokesperson said the percentage increases for enrollees were too variable for an average to accurately depict how much the rates are rising.
“But anecdotal experiences from program participants who spoke with Federal News Network and who shared their premium notification letters with the National Active and Retired Federal Employees Association (NARFE) show the increases are as large as 86%, if the enrollees choose to stick with their same coverage options. In a few other instances, enrollees received notice from OPM that their premiums will go up 77% and 49%, according to NARFE.”
The U.S. Preventive Services Task Force issued a revised Grade B recommendation today. “The USPSTF recommends screening for hypertensive disorders in [asymptomatic] pregnant persons with blood pressure measurements throughout pregnancy.”
“The recommendation made Tuesday by the U.S. Preventive Services Task Force broadens 2017 guidance to screen regularly only for preeclampsia, a dangerous and increasingly common condition that can arise in pregnancy. It involves high blood pressure along with kidney or liver trouble and other problems and is believed to occur when the placenta develops abnormally because of a problem with the blood vessels that supply it.
“The recommendation applies to other disorders marked by high blood pressure that, like preeclampsia, normally develop in the second half of pregnancy. They include gestational hypertension—high blood pressure without the other signs of preeclampsia—and eclampsia, which involves seizures and is life-threatening.”
Per Healthcare Dive
“Eighty-one percent of nursing home facilities nationwide and 90% of for-profit facilities would need to hire additional registered nurses or nurse aides to meet the minimum nursing staff hours standards proposed by the CMS earlier this month, according to a KFF estimate published Monday.”
“Doctors say they’re finding it increasingly difficult to distinguish Covid from allergies or the common cold, even as hospitalizations tick up.
“The illness’ past hallmarks, such as a dry cough or the loss of sense of taste or smell, have become less common. Instead, doctors are observing milder disease, mostly concentrated in the upper respiratory tract.
“It isn’t the same typical symptoms that we were seeing before. It’s a lot of congestion, sometimes sneezing, usually a mild sore throat,” said Dr. Erick Eiting, vice chair of operations for emergency medicine at Mount Sinai Downtown in New York City.”
The Wall Street Journal offers “A Game Plan for Timing Your Flu, Covid, and RSV Shots This Fall.”
“Doing puzzles, playing memory-boosting games, taking classes, and reading are activities that we often turn to for help keeping our brains sharp. However, research is showing that what you eat, how often you exercise, and the type of exercise you do can help lower your risk of dementia to a greater extent than previously thought.
“Although more studies are needed, “there’s a lot of data that suggests exercise and diet are good for the brain and can prevent or help slow down” cognitive changes, says Jeffrey Burns, co-director of the University of Kansas Alzheimer’s Disease Research Center in Fairway.
“And living a healthy lifestyle can produce brain benefits regardless of age.”
From the healthcare business front,
Fierce Health identifies the most influential minority executives in healthcare for 2023. Maazal tov to those execs.
“Elevance Health’s pharmacy benefit manager, CarelonRx, is launching a new integrated cost savings program to automatically offer members the lowest price for generic prescription drugs at their preferred pharmacy.
“We will automatically compare prices to emulate a comparative shopping experience, similar to when a member would use a discount card,” Michele Paige, vice president of product at CarelonRx, told Becker’s. “But now they don’t have to because it’s integrated within their benefits.”
“The new program, EnsureRx, is set to launch in February and will automatically compare prices for more than 50 generic medications against a variety of cash discount cards, with savings automatically applied. Ms. Paige shared that the list of generic medications covered will be constantly evaluated for potential additions.”
and
“Cigna Healthcare offers employers a supplemental benefit designed to help employees diagnosed with musculoskeletal conditions.
“The payer is adding musculoskeletal conditions to its Supplemental Health Critical Illness plans, according to a Sept. 18 news release. The program provides an annual payment of $3,000 to employees to help them cover out-of-pocket hospital costs or other expenses such as rent, childcare and groceries.
“Cigna offers similar benefits for cancer, heart attack and stroke.”
“House Republicans unveiled a stopgap funding measure Sunday night that would avoid a partial government shutdown next month and provide border security measures sought by conservatives. But passage even in the GOP-controlled House was already in doubt as some hard-liners came out against the measure Sunday night while the ink on it was barely dry.
“The draft continuing resolution would extend current funding through Oct. 31, while cutting 8.1 percent from all nondefense accounts except for the Department of Veterans Affairs and disaster relief. That extension would give lawmakers an extra month to try to complete fiscal 2024 appropriations that are otherwise needed by Sept. 30. * * *
“The bill is set for floor consideration this week, along with the fiscal 2024 Defense spending bill that stalled last week when conservative detractors threatened to vote against the rule needed to take it up.”
Politico discusses where we stand with the proposed mental health parity rule changes.
“The Biden administration’s proposal substantially expands the law Bush signed. It would mandate that insurers analyze the outcomes of their coverage to ensure there’s equivalent access to mental health care and take action to comply if they’re falling short.
“Insurers respond: AHIP, the lobbying group for insurers, says the situation is more complicated than Biden makes out, and workforce shortages are behind barriers to access.
“For years, health insurance providers have implemented programs and strategies to expand networks and increase access,” AHIP spokesperson Kristine Grow said in a statement.
“The administration has set a deadline for comments on its proposed rules for early October; insurers and their allies are asking for more time to respond.
“The ERISA Industry Committee, which represents large employers’ benefit interests, joined AHIP, among other associations, employers and health plans, in writing to administration officials to ask that the comment period on the proposed rules be extended. They warned that the rules could create “unnecessary burdens” for providers, insurers and patients and “unintentionally” impede access to care.”
The Centers for Medicare and Medicaid Services (CMS) announced on its No Surprises Act website today:
“Federal IDR Process update: Certain functions of the Federal IDR Process are temporarily paused in response to the TMA III Court Order. On September 5, 2023, the Departments directed certified IDR entities to resume making eligibility and conflict of interest determinations and encouraged disputing parties to continue engaging in open negotiations. The Departments expect to direct certified IDR entities to resume issuing payment determinations for some disputes very soon.”
The Office of Management and Budget’s Office of Information and Regulatory Affairs has completed work on a regulation that will affect the FEHB:
AGENCY: HHS-CMS RIN: 0938-AT86 Status: Concluded
TITLE: Medicare Secondary Payer and Certain Civil Money Penalties (CMS-6061) Section 3(f)(1) Significant: No
STAGE: Final Rule Economically Significant: No
RECEIVED DATE: 03/01/2022 LEGAL DEADLINE: Statutory
REVIEW EXTENDED
COMPLETED: 09/11/2023 COMPLETED ACTION: Consistent with Change
The FEHBlog will be watching the Federal Register for this one.
CMS also “finalized a rule to streamline enrollment in the Medicare Savings Programs (MSPs), making coverage more affordable for an estimated 860,000 people.”
From the public health and medical research fronts,
Per Healthcare Dive, “New RSV vaccines can be powerful tools, but rollout poses test; The recently approved shots will slot in alongside vaccines for influenza and COVID-19 this fall, raising communication challenges for public health officials.” The article dives into the details, but health plans can help communicate new vaccines’ benefits to their members with young kids and members who have reached senior citizen status.
“The mixture of stimulants like cocaine and meth with highly potent synthetic opioids is a fast-growing driver of fatal overdoses in the U.S.
“Since 2010, overdoses involving both stimulants and fentanyl have increased 50-fold, and now account for 32% of U.S. overdoses in 2021 and nearly 35,000 deaths, according to a study published Thursday in the scientific journal Addiction.
“We’re now seeing that the use of fentanyl together with stimulants is rapidly becoming the dominant force in the U.S. overdose crisis,” says Joseph Friedman, the lead author of the study and a researcher at UCLA’s David Geffen School of Medicine. “Fentanyl has ushered in a polysubstance overdose crisis, meaning that people are mixing fentanyl with other drugs, like stimulants, but also countless other synthetic substances.”
Healio points out that based on a recent research study,
“Consumption of added sugar, total sugar, total glucose equivalent and fructose from added sugar and juice were linked to a higher risk for coronary heart disease.
“Fructose from vegetables and fruits was not.”
The American Medical Association informs us, “What doctors wish patients knew about social isolation.”
“Chronic acid reflux — also known as GERD — has long been thought to boost a person’s risk of esophageal cancer
“A new study refutes that, finding that only patients with evidence of injury to their esophagus from reflux have a higher cancer risk
“Researchers downplayed a “very moderate” increased risk for women, saying that it remains “extremely low.'”
MedPage Today calls our attention to a different Swedish study,
“Bariatric surgery for obesity was associated with a reduced risk of hematologic cancers in a prospective Swedish study spanning more than three decades.”
“Artificial intelligence (AI) and machine learning (ML) can effectively detect and diagnose Polycystic Ovary Syndrome (PCOS), which is the most common hormone disorder among women, typically between ages 15 and 45, according to a new study by the National Institutes of Health. Researchers systematically reviewed published scientific studies that used AI/ML to analyze data to diagnose and classify PCOS and found that AI/ML based programs were able to successfully detect PCOS.
“Given the large burden of under- and mis-diagnosed PCOS in the community and its potentially serious outcomes, we wanted to identify the utility of AI/ML in the identification of patients that may be at risk for PCOS,” said Janet Hall, M.D., senior investigator and endocrinologist at the National Institute of Environmental Health Sciences (NIEHS), part of NIH, and a study co-author. “The effectiveness of AI and machine learning in detecting PCOS was even more impressive than we had thought.”
From the U.S. healthcare business and quality fronts,
The National Committee for Quality Assurance has named the best-rated health plans of 2023 based on factors that include care quality, patient satisfaction and efforts to keep improving.
The ratings were released Sept. 15 and are based on 2022 data from commercial, Medicare, Medicaid and ACA plans that reported HEDIS and CAHPS results to the NCQA, which cover more than 200 million people. NCQA Accreditation status was also factored in. Plans were rated on a zero- to five-star scale, with five being the highest rating. In total, 1,095 plans received a rating. No Medicaid or Medicare plan received 5-stars this year.
Commercial plans that received a five-star rating:
Independent Health Association (New York)
Kaiser Foundation Health Plan of the Mid-Atlantic States (Washington D.C., Maryland, Virginia)
‘Hospitals have been required to post their prices for shoppable services online since 2021, but costs shared online rarely correlate to prices hospitals share with consumers on the phone, according to a new secret shopper survey.
‘The study found wide variations when comparing hospitals’ online cash prices for childbirth and brain imaging with prices told to consumers who inquire over the phone.
‘For example, researchers found five hospitals with online prices greater than $20,000 for vaginal childbirth but telephone prices less than $10,000. For a brain magnetic resonance imaging scan, two hospitals said the cost was more than $5,000 over the phone, but the price tag was $2,000 online.’
“Novo Nordisk (NOVOb.CO) has hired U.S. private contract manufacturer PCI Pharma Services to handle assembly and packaging of Wegovy, a source familiar with the matter said, as it races to boost output of the weight-loss drug to meet demand.
“Philadelphia-based PCI, which has 15 facilities in North America, Europe and Australia, is putting together the self-injection pens used to administer Wegovy, said the source, who declined to be named because the information is confidential.”
The percentage of asynchronous telehealth claim lines for mental health conditions increased nationwide, with a particularly sharp rise in the Midwest, where it doubled between May and June, according to new telehealth usage data.
The data from FAIR Health’s Monthly Telehealth Regional Tracker represents the privately insured population, including Medicare Advantage and excluding Medicare Fee-for-Service and Medicaid. The tracker, launched in May 2020, uses data from FAIR Health to provide insights into month-to-month changes in the volume of telehealth claim lines and audio-only telehealth usage.
Nationally, telehealth remained stable at 5.4 percent of claim lines in May and June. In three US regions, telehealth use did not change during this period, but usage fell by 2.4 percent in the Midwest.
In general business news, HR Dive offers “A running list of states and localities that require employers to disclose pay or pay ranges.”
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