Yes, Abraham Lincoln was born today in 1809. The FEHBlog recently watched an interesting PBS documentary on the last President to have grown up in a log cabin, James Garfield. How many Presidents other than Lincoln, William Henry Harrison, and Garfield grew up in a log cabin?

On the good news front, Drug Channels reports that the Food and Drug Administration is working through its backlog of generic drug approval applications which means that manufacturers and wholesalers are losing pricing leverage. “The unprecedented generic inflation of 2013-2014 is fading.”

Modern Healthcare reports that

Embedded within President Barack Obama’s 2017 budget for HHS (PDF) is a provision to “eliminate surprise out-of-network healthcare charges for privately insured patients.” Details are scant, but the administration would try to solve the problem by requiring physicians who “regularly provide services in hospitals” to accept in-network rates, even if they aren’t in the insurer’s network. Hospitals would also have to “take reasonable steps” to ensure patients see in-network physicians.

This idea could attract bipartisan approval.

The IRS provides some guidance / “Tax Tips” on the array of new ACA-related tax forms that taxpayers will be receiving this calendar quarter. Worth sharing.

Modern Medicine reports on the five forces driving the expansion of telemedicine in 2016.  “The global telemedicine market is expected to expand at a compound annual growth rate of 14.3% over the next five years, eventually reaching $36.2 billion, compared to $14.3 billion in 2014.” Whoa nelly!

On the puzzling front, the Wall Street Journal reports that “The healthier you are, the more money you need to save for health care in retirement.”  The underlying reason is that healthier people incur more health expenses because they live longer lives. Nevertheless, it’s an interesting story.

Finally on the bad news front, Healthcare Dive reports why achieving interoperability in electronic medical records is a stretch goal. It certainly frosts the FEHBlog’s cake that HHS did not build interoperability into its EMR standards when it started throwing around $31 billion in funding.

The Senate Homeland Security and Governmental Affairs Committee took the following action at a business meeting this morning:

Nomination of Hon. Beth F. Cobert to be Director, Office of Personnel Management
Results: Ordered reported favorably by voice vote.
Senators present: Johnson, McCain, Portman, Paul, Lankford, Ayotte, Ernst, Sasse, Carper, McCaskill, Tester, Baldwin, Heitkamp, Booker, and Peters.

Now the nomination moves to the Senate floor assuming that Sen. Vitter removes his block. More details on the business meeting can be found in this Federal News Radio article.

Federal News Radio provides a comprehensive overview of the President’s budget proposals affecting federal employment. While the President’s budget as a whole is a dead letter, some of his ideas will be picked up in appropriations bills over the course of the year. Time will identify which ones.

Reuters reports that Aetna and Cigna each reach pay for performance deals with the drug maker Novartis for its new heart drug Entresto. Bloomberg provides more details on the deals which give us hope for a new trend.

The Labor Department issued a hefty report to Congress concerning health plan compliance with the federal mental health parity law. “This report includes examples of situations where EBSA was able to intervene on behalf of participants and ensure that participants received coverage for the healthcare they needed. These results will no doubt be replicated and built upon in coming years as the agency continues to identify, respond to, and correct MHPAEA violations and minimize the opportunity for future violations through effective outreach and regulation.”

The President released his FY 2017 budget today. The House and Senate budget committee chairs are not even asking the OMB Director to present the budget at formal hearings per NBC News. Here’s a link to OPM’s press release on its FY 2017 budget proposal. These are OPM’s legislative proposals for our beloved FEHBP:

The President’s 2017 Budget proposes five changes to modernize and strengthen the Federal Employees Health Benefits Program (FEHBP): 1) Streamline pharmacy benefit contracting to allow the Office of Personnel Management (OPM) to contract separately for pharmaceutical benefits; 2) Allow OPM to enter into contracts with a greater variety of health plan types; 3) Permit OPM to adjust plan premiums based on wellness program participation and tobacco use; 4) Extend temporary health benefit coverage to infants born to dependent daughters of FEHBP participants for 30 days; and 5) add FEHBP to the list of Federal Health Programs in the Anti- Kickback statute. If enacted and implemented, these changes could be reflected in carrier contracts issued for 2018.

Proposals 1), 3) and 5) have been offered for three or four years in a row without Congressional action. These proposals, if enacted, would unnecessarily disrupt a program that is working.  For example, the FEHBlog has explained time and again (with links to studies) that separating prescription coverage from medical coverage raises premiums by denying plans the opportunity to coordinate care. If it were such a great idea, why didn’t Congress take that approach with the Affordable Care Act plans? TRICARE is structured with separate medical and prescription drug coverage but reformers are urging that TRICARE be restructured to look like the FEHBP.  Leave well enough alone.

The FEHBlog will post OPM’s budget justification to Congress when it becomes available.

Both Houses of Congress are in session this coming week. The President is expected to release his final budget on Tuesday.  The President is expected to propose a 1.6% raise for federal employees and military personnel in 2017 according to Reuters. He also is expected to propose a tweak or two the 40% excise tax on high cost employer sponsored plans. The FEHBlog sides with the critics who believe that the tax should be repealed.

Mike Causey on Federal News Radio reminds us that the limited open enrollment period that allows federal employees to switch from self and family and self plus one coverage is ongoing. The period ends on February 29. Annuitants can drop down at any time because unlike employees annuitants pay their premiums wiht after tax income.

Healthcare Payers News reports that “twenty major companies, including American Express, Verizon, Coca-Cola and HCA have joined the newly-launched Health Transformation Alliance to combine data on the population health of their employees, and potentially flex their muscle with insurance companies and big pharma, according to Tevi Troy, president of the American Health Policy Institute.”  Good luck with that, and go Broncos.

OPM reminds us that today is dedicated to efforts to improve heart health. The FEHBlog had no idea.

Yesterday, OPM acting director Beth Cobert had her confirmation hearing before the Senate Homeland Security and Governmental Affairs Committee. Everyone on the Committee and the FEHBlog agrees that Ms. Cobert is well qualified for this position. Nevertheless, the Federal Times explains that there are five issues hounding her nomination to serve as permanent OPM direction. The FEHBP is not one of them.

Also the House Government Reform and Oversight Committee held a hearing on prescription drug pricing. Health Data Management offers this interesting perspective on the causes of rising prescription drug spending.  The article identifies electronic prescription devices, which Congress mandated, as one cause.

In other legislative news  –

• The Hill suggests that Sen. Tom Carper’s Postal reform bill called iPOST may get enacted this year. The bill would create a Postal Service Health Program within the FEHBP.  
• Healthcare Dive reports on a bipartisan bill to expand coverage of everyone’s darling, telehealth. 
• The Week in Congress provides its look back on this week’s activities on Capitol Hill. 

Tomorrow at 10 am the Senate Homeland Security and Governmental Affairs Committee will hold a hearing on the President’s nomination of Beth Cobert to serve as permanent OPM Director. Ms. Cobert currently is the acting Director.  Roll Call is reporting that Sen. David Vitter (R MI) may exercise his privilege to place a hold on Ms. Cobert’s nomination until the agency furnishes him requested information about the OPM rule permitting members of Congress and their staffs to enroll for DC SHOP coverage with a government contribution.

Federal News Radio reports that yesterday OPM’s long standing Inspector General Patrick McFarland announced his retirement as of February 19.  His deputy Norbert Vint will serve as acting OPM Inspector General after that date.  Inspector Generals are nominated by the President.

Yesterday as the Hill reports the House of Representatives was unable to achieve the 2/3s majority vote required to override the President’s veto of the reconciliation measure repealing key parts of the ACA.  Repeal now becomes an issue for the Presidential election.

On the health care cost front, the Altarum Institute released its monthly health care sector report for January 2016

Health care prices grew by 1.1% in 2015, the slowest annual rate ever in our historical series going back to 1990
• The historically low 1.1% growth in health care prices in 2015 was heavily influenced by physician prices, which actually fell by 1%; and more generally by economy-wide inflation, which, at 1.0% in 2015 (as measured by the gross domestic product deflator), barely exceeds the 0.8% rate seen in 2009, the last year of the recession.
• Prescription drug prices grew by 4.6% overall in 2015, but the rate of growth declined over the course of the year, from a peak of 5.5% in Q1 to a low of 3.2% in Q4 2015.

As part of the FEHBlog’s ongoing efforts to place the Zika virus in perspective, here’s a link to an article about the particular mosquito which spreads the virus as well as Yellow Fever and dengue fever. It’s a bad mammer jammer. Just don’t leave any standing water if you live along the Eastern Seaboard (up to NYC or so).

Both Houses of Congress are in session this week as the snow continues to melt here in the D.C. metropolitan area.  At 9 a.m. on Thursday February 4 the full House Oversight and Government Reform Committee will hold an oversight hearing on developments in the prescription drug market. An hour later the Senate Homeland Security and Governmental Affairs Commitee will hold a confirmation hearing on the President’s nomination of Beth Cobert to be permanent OPM Director. 

The spotlight has shifted from provider reliability to patient outcomes — the improvement of which is, after all, the real goal of health care. This means the goal of performance analysis is not to judge providers, but instead to assess what is happening to the health of their patients. And if the answer to that question is “Not much,” clinicians have some explaining to do.

Whatever happened to personal responsibility?

The snow continues to melt and a warming trend begins tomorrow.  That’s good news.

On the bad news front, the New York Times ran an investigative piece this morning on drug shortages afflicting hospitals and the Federal Times tells us that the GAO is concerned the the federal government’s multi billion dollar Einstein data protection system is still not up to snuff.

On the too early to tell front, the Centers for Medicare and Medicaid Services announced today

[proposed] rules, as required by the Medicare Access and CHIP Reauthorization Act (MACRA), will allow organizations approved as qualified entities to confidentially share or sell analyses of Medicare and private sector claims data to providers, employers, and other groups who can use the data to support improved care. In addition, qualified entities will be allowed to provide or sell claims data to providers.

The qualified entity program was authorized by Section 10332 of the Affordable Care Act and allows organizations that meet certain qualifications to access to patient-protected Medicare data to produce public reports. Qualified entities must combine the Medicare data with other claims data (e.g., private payer data) to produce quality reports that are representative of how providers and suppliers are performing across multiple payers, for example Medicare, Medicaid, or various commercial payers. Currently, 13 organizations have applied and received approval to be a qualified entity.  Of these organizations, two have completed public reporting while the other 11 are preparing for public reporting. 

Finally the Drug Channels Institute produced a list of the top 15 U.S. pharmacies by dispensing revenues. The top three are CVS/Caremark (22.8%), Walgreen’s (14.9%), and Express Scripts (11%). The top 15 pharmacies generate 73.4% of the total dispensing revenue — $364.1 billion. That’s a lot of dough.

Modern Healthcare published an article yesterday contending that Sen. Tom Carper’s postal reform bill would “push” Postal Service annuitants aged 65 and older into Medicare. Hey Modern Healthcare, those annuitants already are in Medicare for the most part.  Senator Carper’s bill would better integrate FEHBP with Medicare, which is an objective that OPM shares.  It’s not punitive, and the savings would benefit the Postal Service and Postal service employees and annuitants.

Govexec.com is reporting that the Obama Administration is mobilizing to stop the spread of the Zika virus.  The University of Connecticut, the FEHBlog’s alma mater, offered an illuminating article this morning concerning that virus which has “dengue fever like symptoms.

Should people be worried?
Once Brazilian officials learned about the link between Zika virus and microcephaly, they took the unprecedented action of advising women in the most affected areas to avoid or delay pregnancy. The Brazilian outbreak has now spread to a number of countries in South and Central America, including the Caribbean, and more recently, Mexico, and thus cases of microcephaly in these areas are also likely to start rising in the next few months. Even in Brazil, as infected pregnant mothers continue to reach full term, these numbers are expected to increase. That has led the Centers for Disease Control (CDC) to recently issue travel advisories to the countries battling the outbreak. So at this very moment, unless you have traveled or are planning to travel to these areas while pregnant, you should not be worried. 

Do you see Zika becoming widespread in the U.S.? If so, how soon?
In the U.S., a dozen cases of human infection have been reported, but so far they have all been acquired abroad. The potential for what we call autochthonous, or local, transmission exists, because the Aedes mosquitos that are required to transmit the virus are present in the U.S., particularly in the southeast. Locally acquired cases of Zika virus infection have been reported in Mexico and Puerto Rico, so the potential for active transmission in the U.S., particularly as summer approaches, is real. The World Health Organization (WHO) now estimates that all countries in the Americas, with the exception of continental Chile and Canada, where Aedes mosquitos are not found, will likely have outbreaks. As an example, Hawaii is currently battling an outbreak of dengue fever in the Big Island transmitted by Aedes mosquitos. But in general, any outbreaks in the U.S. will be restricted to areas where Aedes mosquitos are found, and careful surveillance, vector control, and other preventive practices such as use of insect repellent, should minimize their effects.

Snowzilla pushed back Beth Cobert’s confirmation hearing before the Senate Homeland and Governmental Affairs Committee to next Thursday February 4 at 10 am.