Congress is out of town. Healthcare Dive reports that a Senate hearing held last week, CMS Acting Director Andy Slavitt floated the popular idea of delaying the January 1, 2017 start date for the new MACRA system for compensating doctors under Medicare Part B.  The nub of the problem is that

As things stand, the final rules for MACRA [enacted in 2015] are slated to be published November 1, with implementation on January 1, 2017, giving providers just two months to learn and implement the rules.

CMS’s failure to address the problem could drive more doctors out of Medicare Part B.

Robert Pear from the New York Times brought us up to date on government oversight of health insurance premiums in the ACA marketplaces.   (OPM currently is reviewing FEHB plan benefit and rate proposals for 2017.)

Pear’s article reminds us that the ACA converted health insurers into public utilities which also are subject to heavy government oversight. Meanwhile, Modern Healthcare reports that doctor compensation generally is rising above the rate of inflation, which as health insurers have pointed out is a cause of rising health insurance premiums along with prescription drug costs, etc.

Travis Singleton, senior vice president at recruiter Merritt Hawkins, has been in the business 17 years and the year-over-year pay increases in the firm’s survey this year were the largest he’s seen. “It’s clearly showing a healthcare system at capacity,” Singleton said. “We’re now in year three of this sort of employment dominated model.”

Volume still rules in reimbursement to provider organizations, despite a movement toward value-based payment schemes by the government and private payers, Singleton said. Consolidation of physician practices into larger groups and groups joining hospital systems have helped push up physician pay as well, Singleton said. 

The FEHBlog wishes Congress well under they return to Capitol Hill on September 6.  Here’s a link to the Week in Congress’s report on the current week’s activities on Capitol Hill, which included, as reported in NPR Shots, the passage of a bill to combat opioid abuse in our country.

Two more ACA health benefits co-ops bit the dust this week — one in Oregon and the other in Illinois. That leaves less than half of the original 24 co-ops in operation. Kaiser Health News reports on survival efforts being undertaken by the remaining co-ops.  What a foreseeable and colossal waste of taxpayer funds.

The Wall Street Journal reports this morning the prescription drugmakers power to raise prices remains strong (as the FEHBlog has previously noted). “More than two-thirds of the 20 largest​pharmaceutical companies said price increases boosted sales of some or most of their biggest ​products in the first quarter, according to a Wall Street Journal review of corporate filings and conference-call transcripts.”  David Howard, MD wisely suggests in the Health Affairs blog that policymakers need to back off and let insurers and PBMs to do their jobs.

Speaking of the Health Affairs blog, Dr. Timothy Jost writes about a recently proposed Labor Department rule that would impose a new ERISA reporting obligation on small employers and expand ERISA reporting for all group health plans (but not FEHB plans which already do plenty of reporting.)

Also on the reporting front, Thomson Reuters announces that the Internal Revenue Service has released draft 2016 1095-B and – C forms for public comment. These are the forms that health plans and employers use to document compliance with the ACA’s individual and employer shared responsibility mandates.

CMS came out with its annual projection of health care costs over the next decade.  This projection covers 2015-2025.  Fierce Healthcare cheerfully adds that

Healthcare spending will comprise 20 percent of the U.S. economy by the middle of next decade, according to new data from the Office of the Actuary of the Centers for Medicare & Medicaid Services and published in Health Affairs.
Expenditures on healthcare services will grow at an average rate of 5.8 percent per year between 2015 and 2025, about 1.3 percent higher than projected annual growth in the U.S. gross domestic product, CMS concluded. By 2025, healthcare spending will comprise 20.1 percent of the U.S. economy, up from 17.5 percent in 2014. Expenditures totaled $3.2 trillion last year.

A commenter expressed concern about the Postal reform bill’s Medicare integration provisions discussed in the mid-week post. FedSmith offers a rather bleak view here. On the bright side, the bill would subsidize Part B premiums for a few years. The FEHBlog does expect that full Medicare integration will control Postal Service Health Benefit plan premiums, and that PSHB plans may offer health reimbursement accounts that would help pay for Medicare Part B premiums. The full integration will help the Postal Service.

The House Oversight and Government Reform Committee yesterday approved without opposition its bipartisan postal reform bill (HR 5714).  This bill would create a new Postal Service Health Benefits Program within the FEHBP.  Unlike the FEHBP, the PSHBP would be fully integrated with Medicare for annuitants over age 65.

The bill now can be scored by the Congressional Budget Office. The House Ways and Means Committee also must give its blessing to the Medicare integration feature.  The entire Committee is pushing to get a bill enacted this year.  Here is a link to the govexec.com article.

The President wrote an article in the Journal of the American Medical Association suggesting improvements to his signature healthcare law.  Those improvements such as adding public option in the ACA marketplaces and  prescription drug control would further strengthen government control over the health care sector.  That’s not a sensible approach in the FEHBlog’s view.

For example, Medicare always has had a public option (traditional Medicare) which has shifted overall costs to the private sector plans including the FEHBP.  If a public option is added to the ACA marketplaces there are fewer places left for those costs to shift.  A large cost shifting target would be the FEHBP.  Kaiser Health News offers readers an assortment of news articles about the piece.

In other news,

• The HHS Office for Civil Rights has offered ransomware guidance to HIPAA covered entities, including FEHB plans, and their business associates.  Here is Health Data Management’s take on that guidance. 
• CCIIO has issued FAQs on the proper timing for implementing the recently revised ACA summary of benefits and coverage.  
• The American Health Policy Institute has released a study examining different approaches to high cost health plan members. 

The FEHBlog is safely ensconced within the Capital Beltway again after a weekend in New York City. Congress will be in session on Capitol Hill this week before a long break.  On Tuesday July 12, at 2 pm, the House Oversight and Government Reform Committee will mark up several bills, including its bipartisan Postal reform bill.

Last week, The Centers for Medicare and Medicaid Services proposed a host of 2017 changes to its rules for Medicare Part B payments to doctors and its rules for its outpatient hospital prospective payment system (“OPPS”). “CMS estimates that the updates in the proposed rule would increase OPPS payments by 1.6 percent and [ambulatory surgical center] payments by 1.2 percent in 2017.”

The Wall Street Journal reports that “surprise” medical bills create battles between providers and insurers.  This problem arises when doctors who work in insurer network hospitals, such as emergency room doctors, anesthesiogists, pathologists, etc., are out of network.  The Journal’s lead places blame on narrow insurer networks. But the FEHBlog is aware that this problem exists in all types of insurer networks.  Hospitals should be making a better effort to bring all of their doctors into the insurer networks in which they participate.

The FEHBlog is up in New York City. Down in DC, according to the Washington Post, the House of Representatives passed by a wide bipartisan margin a bill intended to combat the opioid abuse crisis.  Here is a link to The Week in Congress’s report on this past week’s other actions on Capitol Hill.

The Hartford Courant reports that Connecticut’s ACA co-op HealthyCT is under state supervision. Ironically, the co-op is in hot water because HHS is requiring the non-profit to pay $13.4 million to the ACA’s risk adjustment program because it’s population is too healthy.  WSOC TV adds that Illinois’s ACA co-op is sueing HHS in response for HHS’s demand for $72 million for the same risk corridor program.  As the FEHBlog noted many years back, the co-ops are indeed the ACA’s Solyndras.

The National Diabetes Education Program has refreshed its website. It’s good link for health plans to use.

Healthcare IT News reports on a $650,000 HIPAA data breach settlement between a HIPAA business associate and HHS’s Office for Civil Rights. This marks the first settlement with a business associate, rather than, a covered entity (a health care provider, a health plan, or a healthcare clearinghouse).  For over five year, business associates who perform services for covered entities became subject to these penalties over five years ago.

My this workweek has been moving along rapidly. The House of Representatives did pass a significant mental health reform bill yesterday by a wide bipartisan margin as reported in the Pittsburgh Post Gazette.  In this regard, the FEHBlog notes this Modern Healthcare article reporting that the Medicaid program has begun to cover short term stays for adults at mental health institutions. Since its enactment in 1965, Medicaid has excluded this coverage because at that time the States provided this mental healthcare. Why it took fifty years to make this change is mystifying.

Employee Benefits News reports that according to an ADP Research Institute study employer-sponsored health benefit plan costs have been stable since the ACA marketplace opened in 2014.

Here are several tidbits:

• Hospitals are adding experienced nocturnal doctors to their ranks according to FierceHealthcare 
• Stat reports on a U.S. Court of Appeals decision that a biosimilar manufacturer cannot sell its new less costly specialty drugs for 180 days after receiving FDA marketing approval.
• Home Health News reports that False Claims Act penalties are nearly doubling on August 1.
• The New York Times Upshot compares the dietitian and public opinions on whether particular foods are healthy or unhealthy. 

Happy 4th of July!  Congress returns to Capitol Hill this week. Congress will be in session there for the next two weeks.  According to the calendars for the House and Senate,  the legislative bodies will be busy attending to party convention and reelection campaigns until following Labor Day.  Congress then will return for the remainder of September and then be off until after the election on November 8 (assuming a lame duck session is held).

Health Data Management reports on the status of efforts to make electronic medical records communicate with one another or in one word interoperable.  It’s not encouraging and that’s discouraging because the federal government hurled $34 billion at the electronic medical records industry without first requiring interoperability.  “The lack of interoperability is one of the major reasons why the
promise of electronic health records has not been fulfilled,” said [immediate past] AMA
President Steven J. Stack, MD. “Vendors have been incentivized to meet
the flawed benchmarks under the Meaningful Use program. We need to
replace those benchmarks with ones that focus on better coordinated
care.”

Pharmalot reports that the major pharmaceutical manufacturers, including Pfizer and Gilead, continue to engage in routine product price increases. “To avoid a torrent of public criticism, some makers are raising prices only by modest amounts, but in some cases doing that multiple times a year.”

• Today CMS finalized a rule allowing the agency to sell Medicare data to qualified entites in an effort to improve health care quality. CMS has approved 15 qualified entities. Modern Healthcare explains that 

four of the 15 have nationwide reach. They include two for-profit companies, Amino, a startup based in San Francisco and funded by venture capital and OptumLabs, a collaborative led by Optum, the health information technology, data mining and analytics arm of health insurance giant UnitedHealth Group based in Minnetonka, Minn. 

Also serving the entire nation is the Health Care Cost Institute, a not-for-profit that is funded in part by for-profit insurers UnitedHealth Group and Aetna, as well as not-for-profit giant Kaiser Permanente. The other national organization is FairHealth, a not-for-profit insurance claims data miner  . . . .

• Yesterday, CMS’s Medicare Innovation Center launched its Oncology Care Model which engages oncologists and healthcare payers in an experiment with episodic payments for cancer care. Becker’s Hospital Review provides nine interesting details about the effort here.

• Also yesterday, CMS updated its Open Payments Program database with 2015 data.  “The Open Payments program (sometimes called the “Sunshine Act”) requires that transfers of value by manufacturers of drugs, devices, biologicals, and medical supplies that are paid to physicians and teaching hospitals will be published on a public website.” There certainly is a lot of money circulating in the health care industry.  Fierce Healthcare has more details here. 

The Hartford Courant has the latest news on the state of the Anthem-Cigna merger here.

In the weekend update, the FEHBlog noted a report that hospitals like health plans are focused on expanding the use of telemedicine.  The FEHBlog wondered why. The Wall Street Journal provided the answer in this article published on Monday.   The article looks at hospital use of telemedicine from several angles including

In the woods outside St. Louis, shifts of doctors and nurses work around the clock in Mercy health system’s new Virtual Care Center—a “hospital without beds” that provides remote support for intensive-care units, emergency rooms and other programs in 38 smaller hospitals from North Carolina to Oklahoma. Many of them don’t have a physician on-site 24/7.

and

The Cleveland Clinic is working to create a “Cleveland Clinic in the Cloud” that would allow patients across the country to access its physicians without going to Ohio. Dr. [Peter] Rasmussen [from the Cleveland Clinic] also foresees joining with local pharmacy clinics, labs and imaging centers to provide in-person exams as needed. “This will open up a world of relationships across a spectrum of health-care providers that we haven’t seen to date,” he says. 

The Centers for Disease Control released 2016 ICD-10 changes last week according to this ICD-10 Monitor report.  “There are 1,974 additions, 311 deletions, and 425 revisions. The resulting total for diagnosis codes is 71,486.”

Health Data Management reports that the federal government is encouraging the use of ethical hacking by healthcare organizations. “Ethical hackers are computer and networking experts who attempt to penetrate information systems on behalf of its owners to find security vulnerabilities that a malicious hacker could potentially exploit.” What next?

Finally, Employee Benefit News reports on a survey finds that a majority of employees cannot define common health insurance cost sharing terms.  The FEHBlog finds that hard to believe. In any event, employees should be concerned with those terms because according to this International Foundation of Employee Benefit Plans website, “The International Foundation’s new report, 2016 Employer-Sponsored Health Care: ACA’s Impact, finds that about one-third of organizations have increased out-of-pocket limits, in-network deductibles or employees’ share of premium costs in response to ACA.”

It’s also worth noting that the U.S. Supreme Court wraps up its October 2015 term tomorrow.  The Hill provides a summary here.

Avik Roy offers his useful insights into the Republican’s alternative approach to health care reform that Speaker Paul Ryan released last week.

OPM provided details on the transition of the flexible spending account administrator role from ADP to WageWorks on September 1.

Healthcare IT News reports that according to a recent KMPG survey “nearly half of responding healthcare [system] executives expect that the [government mandated] move from volume to value will adversely impact revenue, which makes investing in technologies  [e.g., telemedicine] even more critical to competing in the market.”

Louisville Business First reports that Aetna and Humana have agreed to extend the deadline for completing their merger to December 31, 2016, which is consistent with previous management projections for a second half of 2016 close.

Kaiser Health News reports on the demise of the nasal flu vaccine — FluMist — that until recently had been favored for use by young children.

On Wednesday [June 22, 2016], an advisory panel to the Centers for Disease Control and Prevention voted that — though it continues to be important to be vaccinated against the flu — the spray version was so ineffective that it should not be used by anyone during the 2016-2017 flu season.
Just two years ago, that same Advisory Committee on Immunization Practices recommended FluMist as the preferred alternative for most kids ages 2-8, after reviewing several studies from 2006-2007 that suggested the spray was more effective in kids than the injectable forms of the vaccine.
What changed to make the spray so much less effective than studies had shown it to be in the past? The bottom line is that right now “we don’t understand what it is,” said David Kimberlin, a professor of pediatrics at the University of Alabama at Birmingham, who said academic researchers and those at MedImmune, a subsidiary of Astra Zeneca that makes the vaccine, are working to get answers.