Congress returns to Washington tomorrow.  This Washington Post headline sums it up — “Iran, budget, highways and national debt on tap for Congress.”

Yesterday the Washington Post wrote about government funded efforts to improve patient adherence to taking prescription drugs, which is a public health problem.  One trial that appears to be working involves hospital distribution of “internet of things” pill bottles that issue visual and audible warnings and send messages to loved ones about non-adherence. The patients who timely take the medicine receive nominal cash rewards which is analogized to winning the lottery.

Modern Healthcare reports on a new CMS effort to boost value based coverage in the Medicare Advantage program  “In the Medicare Advantage experiment, [value based] plans can [for example] lower cost-sharing for members who participate in disease-management programs, or provide full coverage for “supplemental benefits,” such as nonemergency transportation to primary-care visits or tobacco-cessation programs.” The trial will begin in 2017 and will last five years.  Medicare Advantage plans in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania and Tennessee can participate.

Historically and currently, the FEHBA prohibited discrimination in enrollment. Section 1557, which is part of the Affordable Care Act, prohibits discrimination in coverage which is a distinction with a difference.  The proposed HHS rule, however, only applies to HHS funded programs.  Therefore, the FEHBP falls outside the scope of this rule.  HHS encourages other agencies to promulgate their own Section 1557 implementing rules.

HHS also took a cautious approach to interpreting Section 1557.  The Washington Post explains that

[T]he proposed rule does not provide specifics on other key protections that advocates have sought, such as including sexual orientation as a form of sexual discrimination. Officials said they are seeking more input during the comment period that ends Nov. 6 on how best to incorporate those protections. Nor does the proposal address something that many AIDS organizations say is discriminatory — when insurance plans make it difficult for HIV/AIDS patients to get access to and afford needed medications.
Under the proposed regulation, women could not be charged more than men for insurance or services because they need prenatal or maternity care. Insurers could no longer categorically exclude coverage for gender transition services, although they would not automatically be required to provide surgery or other care. Health-care providers could not refuse to treat transgender people. Individuals would need to be given access to bathrooms consistent with their gender identity.

A final rule will be published next year.

The FEHBlog is jamming to J.S. Bach’s 3rd Brandenburg Concerto which is playing on Performance Today. It’s a very peppy version so the FEHBlog is in a good mood.

To follow up on the Weekend Update, the FEHBlog overlooked in his list of events that are thirty days out the impending end of the current federal fiscal year on September 30.  The Republicans had hoped to return to the regular order of passing individual appropriation bills,  but the Democrats have another idea. So we are looking at Congress enacting another continuing resolution. The FEHBlog does not anticipate any sort of government shutdown over appropriations, but again he is in a good mood.

The Congressional Research Service recently issued three reports on the high cost plan excise tax a/k/a the Cadillac tax, the Bicycle tax, etc.  One report is a “brief overview” of the tax. Another provides background and economic analysis. The third discusses estimated economic and market effects of the tax. CRS, in the second report, expresses an equity concern that taxing employer sponsored health insurance because large employer sponsored plans have only one rate per family group with each plan.  Therefore the tax would not necessarily be imposed on the value of the health insurance received by the particular taxpayer. Demographic groups could wind up subsidizing other groups. (Hey, CRS that’s the nature of large group health insurance.)  In contrast, under the ACA, individual and small employer plans are priced on the age of the individual employee and family members.  (There’s a battle brewing in Congress now because this pricing approach is supposed to be extended from employers with under 50 employees to employers with under 100 employees next year.)  The FEHBlog’s suggested approach of extending the 50% exclusion on health insurance premiums to all high earners, not just the self employed, may side step part of this problem. But on the other hand, who knows how much tax revenue it would generate.

Also on Sunday, the FEHBlog mentioned the impending ICD-10 coding implementation date, October 1.  Health Data Management reports that while Medicare and the American Medical Association have announced an ICD-10 transition plan,  commercial insurers and State Medicaid Plans have been rather mum on the topic. And why not, it was not their idea to implement the ICD-10.

It’s hard to believe that OPM first announced the data breach three months ago on Friday. How time flies! Yesterday OPM announced that it has selected a breach remediation vendor for the second larger breach affecting security clearance forms.  The lucky vendor is Identity Theft Guard Solutions LLC, doing business as ID Experts. Federal News Radio explains that

unlike the earlier contract to notify 4.2 million former and current feds, ID Experts only will handle identity protection services, not data breach notifications. All notifications to all victims of the second OPM breach will be handled directly by DoD and will come via dot-mil email addresses.

Tomorrow is the last day of August. This means that public schools open here tomorrow in Montgomery County, MD, that Congress will be back in town next week, and that the Supreme Court and the ICD-10 will make their appearance in about 30 days.  Ihealthbeat reports that the Centers for Medicare and Medicaid Services are showing all green lights for ICD-10 implementation. Time will tell.

On Friday, according to Federal News Radio, the White House announced that federal employees will receive a 1% across the board wage increase on January 1, 2016, plus a .3% locality pay increase for eligible employees.

Forbes reports that exchange plans and employer sponsored plans are eyeing narrow provider networks as a cost saving measure. This statement from the article caught the FEHBlog’s eye — [H]ealth benefits’ analysts say it’s not necessarily a bad thing if health plans and employers cull from their lists of doctors and hospitals those that aren’t achieving whatever quality metrics have been established.”  OPM is putting heavy pressure on FEHB plans to ensure that their providers meet these NCQA quality metrics. That is easier said than done because the current lack of interoperable electronic medical records vastly complicates the data collection process.  There’s no doubt that narrowing the network and limiting out of network coverage can help with this data collection problem.  It’s another example of the proverb be careful what you wish for.  

According to the Federal Times, NARFE is trying to get Congress and/or the Centers for Medicare and Medicaid Services to expand the Medicare Part B hold harmless provision to all Medicare beneficiaries.  Under this provision, if, as expected, there is no Social Security cost of living adjustment for 2016 then there will be no Medicare Part B premium increase for FERS annuitants (this is the hold harmless aspect) but there will be a whopping increase for CSRS annuitants (who in contrast to FERS annuitants did not pay Medicare taxes during employment).  Because a large number of current retirees are under CSRS, the hold harmless exception would  throw a monkey wrench into OPM’s plans to encourage FEHBP annuitants to sign up for Medicare Part B.

The mid-week update has been delayed by the FEHBlog’s cataract surgery which happened yesterday — a miracle of modern medicine.  (The other eye will undergo the procedure right after Labor Day.) Here are a few quick hits:

• The Kaiser Family Foundation reports that many employers will be impacted by the ACA’s 40% high cost excise tax. In fact all employers will be impacted by it because they will have to report on whether or not they owe the tax.  It would make a lot more sense to replace this convoluted tax with a straightforward 50% limit on health plan premiums for all high wage earners, not just self employed individuals.  
• CVS pharmacies plan to expand the use of telemedicine services in its MinuteClinic offices according to Modern Healthcare. This decision follows a successful pilot program. 
• Modern Healthcare also reports that Medicare’s accountable care organization program, another ACA initiative, continues to struggle. The FEHBlog is will to bet that private insurer ACA programs are doing better because they are not bound by complicated laws and regulations. 
• Information Age discusses how healthcare organizations are responding to cyberliability risks.  CSO Online reports on a survey finding not surprisingly that “Just 1 percent of employees are responsible for 75 percent of cloud-related enterprise security risk, and companies can dramatically reduce their exposure at very little additional cost by paying extra attention to these users.”
• Drug Channels reports that the slowdown in generic drug price inflation is “real.” And with that bit of good news it’s time for some eye drops. 

Congress remains out of town until after Labor Day.

Modern Healthcare has listed the 100 most influential people in healthcare for 2015.  The Chief Justice tops the list, followed by the President. The FEHBlog was astonished by the fact that the IRS Commissioner John Koskinen and the Labor Secretary Tom Perez are not listed. Of course the HHS Secretary Sylvia Burwell and the CMS Administrator are listed but the HHS Secretary, the IRS Commissioner and the Labor Secretary are the Three Musketeers of the Affordable Care Act. Independent of the ACA, taxes affect everything and so do labor regulations. For example, on Friday, the DC Circuit upheld the Labor Department’s new protections for home healthcare workers. But quibbles aside, it’s fun to look the chart over.

Speaking of influence, a Wall Street Journal article on pricing pressure that the U.S. and China are placing on the prescription drug industry. To illustrate the U.S. aspect of the story, the Journal’s reporter linked to an earlier story about research into the cost effectiveness of cancer therapies. The Financial Express identifies other approaches under development or already released:

The NCCN, an alliance of 26 cancer centers, envisions the new tool as a supplement to its widely followed guidelines for oncology care, which set out protocols for treating a range of cancers based on diagnosis, disease stage and other factors, such as age.

Other medical groups are also trying to address the cost issue, but not as directly as the NCCN. The American Society of Clinical Oncology (ASCO) is developing its own tool for valuing treatments, but says that its “net health benefit” scores will not consider costs, although prices will be noted alongside the scores. In June, New York’s Memorial Sloan Kettering Cancer Center launched an interactive calculator, called “DrugAbacus,” that allows users to decide how much one of 54 newer drugs should cost based on factors like side effects and novelty.  {previously noted by yours truly.]

The NCCN scale, to be launched in mid-October, will employ “evidence blocks” that assign a score of up to five points for each of five measures – price, effectiveness, safety, quality and consistency of clinical data. Initially, it will evaluate drugs used for multiple myeloma and chronic myeloid leukemia. Similar guidelines are expected for most other types of cancer by the end of 2016.

Here are a couple of other articles that caught the FEHBlog’s eye over the weekend:

•  Kaiser Health News reports that “In one of the largest population studies on pain to date, researchers with the National Institutes of Health estimate that nearly 40 million Americans experience severe pain and more than 25 million have pain every day.” American needs more doctors who specialize in treating pain. 
• MedPage proactively asks whether people can deliberately lower their risk of Alzheimers’ disease. In the FEHBlog’s view it’s worth a shot. 

Last Friday, the Food and Drug Administration approved for marketing a female libido drug called Addyi. The effective date of the decision is mid-October which explains why you haven’t seen any commercials for the new drug yet. Yesterday, Sprout Pharmaceuticals, the company which obtained the FDA approval, was bought out by Valeant for about $1 billion according to the New York Times. The Indianapolis Business Journal reports that health plans and prescription benefit managers are not evaluating coverage of the new drug. The article explains that

“I think it’s a mistake for any third-party payer to pay for a medication that doesn’t come with a reasonably solid evidence of value,” said David Juurlink, a physician and professor at the University of Toronto who studies drug safety. “The data for flibanserin [Addyi] make it very clear that the majority of women who take it are not going to experience any meaningful benefit.”
The FDA is requiring doctors to get certified through an online training program to be able to prescribe Addyi, and patients will have to sign a form saying they understand the risks.

We shall see.

Medpage Today reports that “The Federation of State Medical Boards (FSMB) has launched docInfo, a publicly accessible physician search tool containing licensing and state medical board disciplinary information on more than 900,000 physicians and physician assistants nationally.”  Try it — it works.

Several stories have caught the FEHBlog’s eye since his return to the Nation’s Capital on Monday. Reuters is reporting that the  data breach related lawsuits against OPM continue to pile up.  Govexec reports on the government’s ongoing efforts to re-mediate those breaches Health IT security draws lessons from those breaches for the benefit of healthcare organizations. The FEHBlog’s big takeaway was the need to implement multi-factor authentication and vulnerability scanning on IT networks.

In terms of benefit cost saving ideas —

• Fierce Healthcare discusses a survey on hospital readmissions which finds that the strongest predictors of readmissions is previous emergency department visits. “The odds ratio for patients with at least four ED visits in the past six months was 4.65, according to the study.” Other factors with high odds for readmission are patients with cardiovascular or pulmonary disease, patients discharged after a long stay, and patients discharged on a Friday. The article suggests that the hospital pay attention to patients in these risk categories. 
• Fierce Healthpayer considers what health care providers and payers can do collaboratively to increase the use of bundled payments. 
• Life Health Pro reviews state laws that restrict balance billing patients. About a quarter of the states have these laws.  Provider charges in excess of these limits may fall under the standard FEHB exclusion of charges for which the member has no obligation to pay. 
• The FEHBlog’s youngest kid (entering his junior year in college soon) is attending a three week course in basic emergency medical technician skills. The Wall Street Journal reports on a new use of paramedics, who are at the top of the EMT heap, “An initiative, called community paramedicine, is training the fast responders in chronic disease management, medication compliance and home safety. Paramedics are then sent on scheduled house calls to frail and elderly patients or those who have trouble managing chronic conditions like heart failure and diabetes.”  Expanding allied health professional resources can only be helpful.

For the second weekend in a row, the FEHBlog has been traveling on the East Coast. Fortunately there’s not much to update this weekend because it’s mid-August and everyone, including Congress, is out of town, just like the FEHBlog. (But he is returning to DC this afternoon).

A Drug Channels review of CMS’s recent healthcare spending report did catch the FEHBlog’s eye this weekend. Also the Federal Times interviewed the CEO of the contractor who is handling the employee notification services for the first OPM data breach of 2015.  Finally, Benefits Pro discusses a survey concerning the ACA’s impact on hospitals as employers, which is an interesting angle.