Congress remains out on the campaign trail until November 13.

The FEHBlog described the U.S. Justice Department’s approval of the CVS Health / Aetna and Cigna / Express Scripts mergers as a big step but not the final step because the companies still have to deal with state approval. The Hartford Courant reports that New York State is considering blocking parts of the CVS Health / Aetna merger. A final decision is due no earlier than October 26.

Medcity News offers an interesting report on how Blue Cross plans are addressing social determinants of health. For example Blue Cross Blue Shield of Kansas City is using Healthify’s platform.  Healthify claims that it can “help healthcare organizations find community services, track social needs, and coordinate referrals with community partners to radically improve the health of the people we serve.” Interesting.

Healthcare Dive reports that

•     A new Harvard University study casts doubt on the benefits of U.S. hospital accreditation by independent organizations.
•     Researchers looked at patient outcomes at 4,400 U.S. hospitals, 3,337 of which were accredited by the Joint Commission and 1,063 that underwent state-based review between 2014 and 2017. The study included about 4.2 million patients aged 65 and older who were admitted for 15 common medical and six common surgical conditions, as well as patients who completed the HCAHPS patient satisfaction survey.
•     While patients treated at accredited hospitals had slightly lower 30-day mortality rates than patients at state-reviewed hospitals (10.2% versus 10.6%), mortality rates for the surgical conditions were identical (2.4% versus 2.4%). Readmission rates for the medical conditions were significantly lower at accredited hospitals (22.4% versus 23.2%), but were slightly higher for the surgical conditions (15.9% versus 15.6%). The study was published online by BMJ.

Yesterday, the Office of Management and Budget (“OMB”) released the Fall 2018 semi annual regulatory “and deregulatory” agenda. Here are a link to the Office of Personnel Management’s (OPM) current regulatory plan which is not strong on de-regulation in the FEHBlog’s view and a link to OPM’s list of projected regulatory actions.

Govexec.com and Federal News Radio seek to read the tea leaves on the status of the Trump Administration’s federal government reorganization plan as it impacts OPM. In the FEHBlog’s view, an important factor is that OPM’s acting director remains in charge of implementing the White House’s government reorganization plan at OMB. The FEHBlog advises against underestimating Margaret Weichert.

The FEHBlog calls his readers attention to this wide ranging Medpage Today interview with Barbara McAneny, MD, American Medical Association president, and a practicing oncologist/hematologist in New Mexico. Very illuminating.

In other views

• Fidelity Investments offers ideas about how to use health savings accounts over the years. People need education about how to use HSAs.
• Employee Benefit News discusses the current state of implementing bundled payments.
• Healthcare Dive reports on a recent AHIP conference discussing the role of government in healthcare.  
• Health Data Management talks about the importance of personalized incentives in healthcare. 

Washington Post columnist Joe Davidson had an interesting column yesterday on OPM acting director Margaret Weichert’s first week in office.

Also yesterday, the HHS Secretary Alex Azar unveiled a proposed rule that would require televised prescription drug advertisements to include a textual description of the drug’s list price. Health Payer Intelligence offers a useful overview of the healthcare industry’s mixed reaction to the proposal. The FEHBlog thinks that it would be a win for the consumer if the price posting requirement reduces the number of prescription drug ads on TV.

Speaking of advertising, the FEHBlog read a Wall Street Journal article early last month about a California government public nuisance action against Sherwin Williams and other companies that had manufactured lead paint. Part of the evidence was advertising from over a century ago. The defendants had asked the U.S. Supreme Court to review the adverse California state court judgement against them. On Monday the Supreme Court declined to review the judgment.  Governing discusses the Supreme Court’s action here. The lawyers suing the prescription opioid drug manufacturers under this public nuisance doctrine were invigorated by the Supreme Court’s action.

In other litigation news, the U.S. Justice Department announced that it is prosecuting a $1 billion healthcare fraud case the involves compound drug manufacturers and a rogue telemedicine company. Blue Cross of Tennessee allegedly got whacked for $174 million by the fraud.

Healthcare Dive reports that Anthem wrapped up the litigation over a 2015 data breach by agreeing with settle with the HHS Office for Civil Rights for a $16 million HIPAA privacy and security rule fine. On Friday November 2, a panel of the U.S. Court of Appeals for the D.C. Circuit will hear over argument concerning an appeal of the district court’ decision in OPM’s favor in a case seeking to hold OPM accountable for its 2015 data breach.

Finally closing a loop on the opioid crisis response bill, Willis Towers Watson reports that the conference report that both Houses of Congress passed last month did not extend (from 30 to 33 months) the period of time during which primary private sector health plan responsibility for end stage renal disease is primary to Medicare. That hideously expensive pay go was included as a pay-go in the House version of H.R. 6.

The Week in Congress reports that both houses of Congress have left Capitol Hill for the campaign trail. A lame duck session will begin on November 13. 

Govexec.com reports on the federal annuitant cola of living adjustment announcement made today.

The 2.8 percent increase applies to retirees under the Civil Service Retirement System. Those under the Federal Employees Retirement System will receive 2 percent. FERS employees only receive the full percentage increase if it is less than 2 percent. If the change is 2 percent to 3 percent, FERS retirees get 2 percent. And if the increase is 3 percent or higher, FERS retirees receive 1 percentage point less than the full increase.

The new COLAs will take effect starting with federal retirees’ December 2018 benefits.

Federal News Radio reports that OMB Deputy Director Margaret Weichert is taking on her new part time job as OPM acting director with gusto. Govexec.com adds that

Weichert said OPM is moving forward on its reorganization plan, and has already taken steps on the administration’s proposal to consolidate background checks within the Defense Department and to move many of OPM’s transactional functions to the General Services Administration. She pledged to push forward the plan to fold what remains of OPM into the Executive Office of the President in the White House, a key point of tension between the administration and Pon [according to Govexec.com]

“Independence [of OPM] if it’s not delivering the actual mission, isn’t of the primary concern,” Weichert said, adding that there is “no better place” for the strategic direction of federal personnel issues than the White House. She explained that Trump asked her to serve as acting director in part because she has “a lot of experience in delivering complex, large organizational change.”  

That reorganization plan also would move the FEHBP and other federal benefit operations to GSA.

The FEHBlog was taken by this Weichert observation from the Federal News Radio article:

Though Weichert said she and OPM were celebrating and acknowledging the 40th anniversary of the civil service reform law, today’s federal workforce has outgrown the statutes and provisions that informed the 1978 act. * * *

“Although incredibly well-intended, all of the original components of Title 5 and updates to it since then were well-intentioned, but layers and years of statute and added regulation have made it very complex and very cumbersome to operate nimbly and agilely in the 21st century,” Weichert said.

Amen to that. In the FEHBlog’s view, the same problem afflicts the FEHBP even though the nearly sixty year old original law was the model of simplicity.

Govexec.com has offered its version of the backstory on OPM Director Pon’s departure from the agency last Friday. His departure, in stark contrast to U.N Ambassador Nicki Haley’s departure yesterday, was not graceful. The Govexec.com article notes that “Multiple individuals confirmed that senior aides to Pon were also removed from OPM, including his chief of staff and his confidential assistant.” In support of this assertion, the FEHBlog found that the online OPM organization chart is “under maintenance.”    

OPM today posted on its homepage an October 4 statement from then Director Pon applauding “No Time to Wait: Part 2”, a report recently released by the National Academy of Public Administration.”

In Part 2 builds on the framework of Part 1 with a more-detailed plan of action to transform the public service:

• Build flexibility in the pursuit of mission.
• Replace the over-defined job specifications of the current system with a competency-based, talent-management model.
• Reinforce the pursuit of merit-system principles.
• Lead from the center.
• Transform the federal government’s human capital backbone.

Federal News Radio reports on a speech by OMB Deputy Director and OPM acting Director Margaret Weichert made earlier today.  In the course of this speech, Director Weichert

outlined some of her top priorities in the new role [at OPM]. “There’s a lot that I need to get from a baseline perspective, but what I did tell the team yesterday is I have two primary areas of focus,” the President’s Management Agenda — particularly building the  workforce of the future — and general management * * *.

Not much difference between the Pon and Weichert messages. The FEHBlog suspects that the Administration wants speedier implementation.

Also today, the U.S. Justice Department announced that

it is requiring CVS Health Corporation (CVS) and Aetna Inc. (Aetna) to divest Aetna’s Medicare Part D prescription drug plan business for individuals in order to proceed with their $69 billion merger.  The proposed divestiture to WellCare Health Plans, Inc. (WellCare), an experienced health insurer focused on government-sponsored health plans, including Medicare Part D individual prescription drug plans, would fully resolve the Department’s competition concerns.

This is a big step forward but not the final step as CVS and Aetna are working on wrapping up loose ends with state regulators as discussed in this Healthcare Dive story.  The FEHBlog expects that both the CVS – Aetna and Cigna – Express Scripts mergers will close as planned later this year.

OPM and the Department of Health and Human Services are encouraging federal employees and annuitants and their family members to get a flu shot this fall as FedWeek reports. Here’s a link to HHS’s website with details on the flu shot and how to get the vaccination.

In Affordable Care Act news:

• Fierce Healthcare reports that insurers and trade associations are rolling out association health plans. 
• Politico reports that the Senate rejected an effort to overrule the Trump Administration’s shot term health plan rule. The rule still faces court challenges.

The Federal Times, Govexec.com and Federal News Radio have articles on OPM Director Pon’s surprise departure from the agency last Friday.  Federal News Radio provided a link to the White House announcement which reads as follows:

President Donald J. Trump today announced his intent to designate the following individual to a key position in his Administration: 

Margaret Weichert of Georgia, to be the Acting Director of the Office of Personnel Management.  Ms. Weichert currently serves as the Senate-confirmed Deputy Director for Management at the Office of Management and Budget in the Executive Office of the President.  She will assume the Office of Personnel Management duties in addition to her current duties at the Office of Management and Budget.

Earlier this decade, when the Obama Administration and Congress forced out the OPM Director Archuleta in the wake of the massive OPM data breach, President Obama reassigned Beth Cobert from OMB to serve as acting OPM Director. It was the first time that the Administration had filled an OPM Director vacancy with an OMB official. However, in the case of Ms. Cobert’s appointment, OPM lacked a deputy director who would be the logical person to serve as acting director. In the case of Ms. Weichert, the Administration went to OMB rather than designate the sitting OPM Deputy Director Michael Rigas. The FEHBlog here is making an observation, not seeking to draw any conclusion.

Happy Columbus Day, all.

If the FEHBlog had a Drudge like siren, he would use it here. According to FedScoop, the White House announced that “The Trump administration designated [OPM Deputy Director] Margaret Weichert to take the helm of the Office of Personnel Management as acting director, replacing Jeff Pon after just seven months.” Ms. Weichert will bold both positions for the near future. The Washington Post adds that “people close to Pon said he was at odds with the administration over its planned revamp of the personnel agency, which would have diminished his role and authority.”

Medpage reports that the Senate today easily passed the bipartisan opioid crisis response bill (H.R. 6)  thereby sending bill to the President to be signed into law.

Some of the provisions in the bill, which the House passed last week, include:

• Giving Medicare beneficiaries more information on alternative pain treatments, and expanding treatment options for enrollees who are addicted to opioids, while expanding treatment options for opioid-addicted beneficiaries.
• Partially repealing the the Medicaid Institutions for Mental Diseases (IMD) exclusion, which will allow state Medicaid programs to cover inpatient treatment in residential facilities.
• Allowing mothers undergoing addiction treatment to have their young children stay with them, and increasing accessibility of family residential treatment programs, which allows more parents to get help while still caring for their children in a supervised setting.
• Requiring state Medicaid programs to have safety edits in place for opioid refills, to monitor concurrent prescribing of opioids and certain other drugs, and to monitor antipsychotic prescribing for children.
• Directing the Centers for Medicare & Medicaid Services to issue guidance to states on options for providing services via telehealth that address substance use disorders under Medicaid.
• Accelerating the development and use of drug management programs for at-risk beneficiaries within the Medicare program by mandating that all prescription drug plans use such a program by 2022.
• Requiring FDA to develop evidence-based opioid analgesic prescribing guidelines for the indication-specific treatment of acute pain.

Readers may have noticed that according to press reports, that the average government contribution toward FEHBP coverage increased by 1.2% for 2019. The FEHBlog noted yesterday that the maximum government contribution increased by 0.3% for self plus one coverage and 0.7% for self and family coverage. The increase for self only coverage was 0.4%. So the maximum government contribution increase was under 1%. How then is the government contribution increasing by 1.2%? The government contribution toward FEHB coverage is 72% of the enrollment weighted average capped at 75% of the selected plan’s premium. Consequently, if a plan’s premium is below the maximum government contribution (and many are), the federal government picks up 75% of the any increase in the premium of an under the max plan. Those under the max plan increases account for the average 1.2% increase in the government contribution.