Congress is in session on Capitol Hill this coming week.  On Wednesday, the House Oversight and Government Reform Committee is holding a hearing on reforming the Postal Service and the House Energy and Commerce Committee’s health subcommittee is holding a hearing on “Health Care Solutions: Increasing Patient Choice and Plan Innovation.”  

Millions of people are on opioids — most of them over 45 — and that means some are at risk of overdose. Bratberg said we should be educating patients and doctors.
“We’re really making a push nationally and regionally to educate prescribers about those risks, and to use tools available to warn folks about that.” [according to University of Rhode Island pharmacy professor Jeffrey Bratberg]
Tools that help lower the risk include naloxone, the overdose rescue drug. There’s also medication, such as buprenorphine or methadone, to assist people who have become addicted to painkillers to stop their use safely. In essence, those drugs keep a low level of opioids in the system to keep someone from going into withdrawal without getting them high.

Congress is poised to pass a bevy of laws on this issue.

The FEHBlog for many years has been looking forward to savings generated by unbranded versions of specialty drugs, so-called biosimilar drugs. However, the Wall Street Journal reports today that

Generic drugs have long delivered huge savings over their brand-name counterparts. That isn’t likely to happen, though, with knockoff versions of some of the expensive drugs on the market today.
Rival versions of so-called biotech drugs, called biosimilars, are just starting to be released, and health insurers and drug-benefit managers say they expect them to cost nearly as much as the brand-name originals did for years.
One big reason: Pharmaceutical companies have been raising prices on biotech drugs about to lose patent protection to squeeze out more revenue before competition arrives, according to insurers, drug-benefit managers and pharmaceutical-industry consultants. And makers of the knockoffs are setting their prices just below those marked-up ones.

Quelle domage.

Hospitals and Health Networks reports that

The cost to hospitalize those with opioid abuse or dependence problems has more than tripled in a decade, up to nearly $15 billion in 2012, according to a new study published in Health Affairs this week. Similarly, the number of patients hospitalized for the effects of these drugs has surged by more than 72 percent, reaching 520,000 in 2012 (the year with the most recent available data), researchers with Harvard and the Veteran’s Health Administration found. Overall hospitalizations during that time, meanwhile, stayed relatively flat.

 Wow.  Cost curve up.

In that regard, Fierce Health Finance tells us that “Expanding healthcare price transparency didn’t prompt lower outpatient spending, according to a study published in the Journal of the American Medical Association” and that 

[Health Affairs] researchers call for increased education to raise awareness of the tools insurers have made available, saying payers should do more to engage consumers in shopping for the best price option.  While that may be easier said than done, the solution may lie in using providers as navigators for price shopping.

Modern Healthcare reports that the Centers for Medicare and Medicaid Services has performed its annual data dump on Medicare payments to doctors. Here’s a link to the CMS press release that may be more accessible.

To show that the FEHBlog is not a one trick pony focused on costs, he also points out Healthcare IT News reports on a Brookings Institution analysis offering cybersecurity tips to healthcare organizations.

The media is chock full of studies. Here are a few that caught the FEHBlog’s eye today:

• The Washington Post reports tonight on a Johns Hopkins study suggesting that medical errors are the third leading cause of death in the U.S.  From a practical standpoint the FEHBlog simply does not believe that medical errors cause “nearly 700 deaths a day — about 9.5 percent of all deaths annually in the United States.”  But this eye-popping study will garner a lot of attention. 
• The Washington Post reported yesterday about a Health Affairs study finding that “Seven of the top 10 most profitable hospitals in the United States are nonprofit facilities that each netted more than $150 million from caring for patients in 2013.”  For non-profit read tax-exempt.  
• The Wall Street Journal reports today that “Retiring after age 65 may help people live longer, says a study published online in the Journal of Epidemiology & Community Health. The risk of dying from any cause over the study period was 11% lower among people who delayed retirement for one year—until age 66—and fell further among people who retired between the ages of 66 and 72, the study found.” The FEHBlog hopes to work beyond 65 but based his life experience, he’s not sure about this study either.  

The Washington Post yesterday put on its front page an article headlined “Hospital discharge: It’s one of the most dangerous periods for patients.” This is not news. The FEHBlog is certain that hospitalized patients do better — during and after hospitalization — if they have active support from family and friends. Patients without that support likely stay in the hospital longer and are readmitted more frequently.  The question is how to provide better support for these unsupported patients. Perhaps telehealth will help.

Bloomberg reports that the large prescription benefits manager Express Script is focusing attention on overcoming “Valenant style” drug price hikes.

Customers, such as employers or insurance plans, that sign up for the new program will give Express Scripts advance permission to try to shift patients to cheaper alternative medicines when an old drug jumps suddenly in price, [Express Scripts Chief Medical Officer Steve] Miller said. Express Scripts also will be able to steer patients away from pharmacies that the benefit manager judges are working with a drugmaker to push an expensive treatment or circumvent rules designed to encourage use of cheaper treatments.

Good luck with that.

Meanwhile the Wall Street Journal reports that

Despite a growing outcry over the rising cost of cancer treatments, drugmakers are placing multibillion-dollar bets on new [cancer] medicines they expect will command premium prices and generate big sales.
France’s Sanofi SA said Thursday it made an unsolicited, $9.3 billion offer to purchase San Francisco-based Medivation Inc., which sells a prostate-cancer drug that recently drew criticism from members of Congress over its price tag. It is Sanofi’s latest effort to expand its cancer-treatment business as sales of its older drugs decline. Medivation’s board was scheduled to meet Thursday to review the offer.
Separately, AbbVie Inc. of North Chicago, Ill., agreed to pay $5.8 billion to acquire a privately held cancer-drug developer, Stemcentrx Inc., of South San Francisco, Calif., continuing AbbVie’s aggressive push to build an oncology business. Stemcentrx’s investors include a venture-capital fund founded by Peter Thiel, a co-founder of PayPal Holdings Inc. and an early investor in Facebook Inc. 

Rur roh.

The Centers for Medicare and Medicaid Services issued two massive rules this week — the first discussed at this Morning Consult link made changes to the Medicaid and CHIP programs and the other discussed at this Diagnostic Imaging link  proposed to implement the MACRA law that created a Medicare Part B pricing system to replaced the physician detested sustainable rate of growth formula. MACRA along with the ACA is the law that generated all of the excitement at the LAN Summit earlier this week. The Diagnostic Imaging article which requires registration is the best overview that the FEHBlog ran across. Plus it’s headlined “MACRA to hit small practices hard.” The FEHBlog is concerned that the new law will continue to drive doctors out of Medicare.

In follow up to a much earlier post, the FEHBlog notes that the New York Attorney General reached a settlement earlier this week with seven insurance companies over the timing of coverage of the new Hepatitis B drugs. “As a result of these agreements, nearly all commercial health insurance plans in New York State will cover treatment for chronic Hepatitis C without requiring members to develop advanced disease, such as liver scarring, and will not deny coverage because the member uses alcohol or drugs, or because the authorizing physician is not a specialist.”

The Washington Post reported yesterday on the skyrocketing costs of emergency surgeries.

In a paper published in JAMA Surgery on Wednesday, researchers found a surprising pattern. In an analysis of 421,476 patient records from a national database of hospital inpatients, they discovered that a mere seven procedures accounted for approximately 80 percent of all admissions, deaths, complications and inpatient costs related to emergency surgeries. The sample included only adults who underwent a procedure within two days of admission from 2008 to 2011.
The seven dangerous and costly procedures are mostly related to the organs of the digestive system: removing part of the colon, small-bowel resection, removing the gallbladder, operations related to peptic ulcer disease, removing abdominal adhesions, appendectomy and other operations to open the abdomen.

Hmmm.

Finally, the Health Care Cost Institute confirmed with a new study that the prices of medical procedures vary.

The FEHBlog attended the federal government’s collaborative Health Care Payment Learning and Action Network (LAN) summit in Tyson’s Corner Virginia on and off for the past two days.  The event was very well attended.  The speakers were enthusiastic.  The LAN’s objective is to achieve the HHS’s Secretary’s “moonshot” objective of paying 50% of healthcare providers using alternative payment methods (“APMs) by 2018.

HHS already has reached the Secretary’s low hanging fruit objective of a 30% APM payment level by this year. This initiative is begin driven by both the ACA and the major Medicare law passed last year that requires HHS to replace the current Medicare Part B payment methodology by the end of the decade (or so).

APMs come in two flavors — population based payments and episodic based payments.  Population based payments are similar to ACO or PCMH approaches (as the FEHBlog understands them) — pay a facility or medical group on a fee for service basis for a determined period subject to a quality and risk adjusted global budget with gain and loss sharing.  An example of the episodic approach is the Medicare pilot to pay bundled prices (including payments for both facilities and doctors) for elective joint replacements. The LAN is developing “specs” for three episodic bundles that providers and payers can template — elective joint replacements, maternity, and cardiac care. Details can be found at the LAN website linked above.

The FEHBlog found the maternity care bundle interesting because obstetricians always have billed on a case rate basis — one price for the entire maternity and live birth — and hospitals have always included the baby’s bassinet charges with the mother’s bill. The trick is to  contractuallyknit together the two bills — assign one payment recipient — create quality metrics etc.

The FEHBlog is certain that this change is happening.  He has been reading about switching from fee for service to value based payments for about thirty years. Whether the change will lower costs remains to be seen. Stay tuned.

Both Houses of Congress are again in session this coming week. Here is a link to the Week in Congress’s review of last week’s actions on the Hill.

Tomorrow and Tuesday, the FEHBlog is going to check out the Healthcare Payment and Learning Action Network’s summit in beautiful Tyson’s Corner Virginia.  Why not? There’s no admission charge.

Tomorrow Truven Health Analytics announces the top 15 health systems for 2016. The FEHBlog can hardly contain his excitement.  The list will be posted here tomorrow.  Earlier this month, IBM closed on its $2.6 billion purchase of Truven. There’s no minimum loss ratio requirement on selling consulting services.

HHS Office for Civil Rights announced two substantial HIPAA privacy / security rule violation settlements with health care providers here and here.

Fierce Healthpayer reports on four best practices on value based payment approaches. Kaiser Health News reports on how large employers are paying their employees to travel to other parts of the U.S., e.g., Johns Hopkins, hospital to undergo surgery at bundled or other valued based rates.  This is similar to the center of excellence approach that has been around since the 1980s.  What the FEHBlog found most interesting is that

In addition to cutting the cost of procedures, another chunk of savings to the companies came from avoiding surgeries that probably shouldn’t happen in the first place.
“We’re seeing up to 30 percent — close to 30 percent of cases — who should not be moving forward with the joint replacement,” [Olivia] Ross [from the Pacific Business Group on Health] said.
What typically happens in these cases, she said, is that employees get a recommendation from a local doctor that they should have surgery, only to have physicians at the selected hospitals deem the operation inappropriate.
In some cases that may be because the employee hadn’t first tried less invasive treatments, such as physical therapy, Ross said. Or the employee may need to lose weight first, to make the surgery safer.

Sadly, ABC News reports that the suicide rate in the U.S. is 24% up over the last 15 years.

Sally Curtin, statistician at the NCHS and one of the report’s authors, said that this report may actually underestimate how pervasive suicide attempts are in the U.S. “What we are measuring here is suicide death,” Curtin told ABC News. “We do know that the deaths are the tip of the iceberg for the public health issue. There are many more attempts and hospitalizations.” 

Modern Healthcare digs into the story here.

There were nearly 43,000 U.S. suicides in 2014. More than 14,000 of them were middle-aged whites — twice the combined total for all blacks, Hispanics, Asians, Pacific Islanders, American Indians and Alaska Natives.

On Monday, the Centers for Medicare and Medicaid Services issued their proposed rule describing Medicare Part A reimbursement and policy changes for the federal fiscal year that begins October 1, 2016.  Medicare Part A applies essentially to hospital services.  Per the American Hospital Association’s press release, the rule appears to be a mixed bag for hospitals.

Morning Consult reports on the House hearing held yesterday morning about CMS’s implementation of a new valued based system for paying doctors under Medicare Part B. Heavens to Betsy, Medicare is a complex program.

Health Data Management has an interesting story about how a regional urgent care center chain has integrated telemedicine into its business, thereby boosting patient satisfaction.

Some urgent care providers are wary of telemedicine because they view it as a threat to their businesses, says Alan Ayers, vice president of strategic initiatives for Practice Velocity, a Rockford, Ill.-based vendor that provides technology and billing capabilities for urgent care centers. Telemedicine is not currently taking business from urgent care now, but that could change in the future, he says. “Longer term, we do see urgent care cases increasing in acuity, and if urgent care is going to be an alternative to the emergency room, providers should be treating conditions that are just short of those that need to go to the ER,” Ayers says. “It’s not necessarily a bad thing that telemedicine would take away some of the routine, low-touch care.”

NPR reports on a Journal of the American Medical Association study of U.S. life expectancy patterns.  “The study suggests that the relationship between life expectancy and income is not ironclad, and changes at the local level can make a big difference.”  Intriguing.

Finally, FCW writes about an odd loose end stemming from the OPM data breach, and the St. Louis Business Journal brings us up to date on the early stages of Anthem’s lawsuit against is prescription benefit manager Express Scripts. A busy week so far.

One noteworthy point is that the FEHBlog has been on the web for ten years this month.  The FEHBlog writes the blog to stay up to date for the FEHB plan trade association that he represents.  When the FEHBlog began, the FEHB Act, 5 U.S.C. Ch. 89, governed the FEHB Program. The FEHB Act is a 55 year old of legislative simplicity.  Contract for plans, allow for annual open seasons without pre-existing condition restictions, and let market forces  and consumer choice do their work. The Program was working well.  Four years later, the Affordable Care Act was enacted. The ACA largely trumps market forces with loads of statutory provisions and regulations.  The regulatory maze continues to require the FEHBlog’s attention. He’s not going anywhere.

Congress will be in session this coming week. Congress did not meet its April 15 deadline for enacting a budget resolution.  Space Policy Online reassures us that “Congress has ways around the Budget Resolution process (this wouldn’t be the first year that Congress could not pass one) and since the budget deal worked out last fall between Congress and the White House covers FY2017, the total spending figures exist already.” Here’s a link to the Week in Congress’s account of last week’s activities on the Hill.

On Tuesday, the House Energy and Commerce Committee’s health subcommittee will hold a hearing on Obama Administration initiative to implement new value based Medicare payment methods. Here’s a link to a majority memorandum on the hearing. The Administration is moving fast with these initiatives.  The committee will hear from the medical community.

The FEHBlog noted a few Sundays ago that he had signed AHIMA’s White House petition to remove a long time budget restriction on development of a voluntary patient identifier. (Actually HIPAA calls for a mandatory patient ID – that’s the development initiative that Congress blocked.)  AHIMA needs over 91,000 signatures by Tuesday if it wants a White House response.  AHIMA should develop its own voluntary patient ID.  That may get Congress’s attention.  After all Congress plopped up a good deal of CAQH CORE’s work on HIPAA operating rules right into the ACA.