The Washington Examiner reports this morning on a leadership summary of the revised bill which will be released at 11:30 am ET today. It’s interesting reading.

The FEHBlog was pleased to read that the Senate leadership has decided to extend the current session for two weeks, thereby reducing the August recess from five weeks to two weeks.  Not only does the Senate have to address the health care bill, but there also is a growing backlog of Trump nominations such as the OPM director and deputy director, that is building up and Congress needs time to resolve deficit ceiling and FY 2018 appropriations issues.

It’s best not to make predictions about Congressional actions. A year ago and six months ago, the FEHBlog was swearing up and down that Congress was poised to pass postal reform. But no dice. Similarly, the FEHBlog wrote last winter about a bill (H.R. 372) that flew through Congress with nearly unanimous support to remove the federal antitrust law exemption from health insurers. This occurred right around the time that Aetna and Anthem were losing their antitrust cases so it was a bit puzzling to the FEHBlog. In any event this morning the FEHBlog heard a radio interview with Rep. Louie Gohmert (R TX) who was troubled by the fact that this bill has not gone anywhere in the Senate. Rep. Gohmert also criticized a tort reform bill (H.R. 1215) that the House passed last month on Tenth Amendment grounds. More practically he was concerned that if Congress set this precedent, the Democrats would seek to undo state tort reform laws when they eventually hold the gavel again. Interesting.

And in straightforward good news —

• Modern Medicine interviews Cigna’s chief medical officer about the company’s successful efforts to reduce opioid prescriptions to their plan members by approximately 12% over the past year.
• Fierce Healthcare interviews Aetna’s chief of medical strategy about the company’s strategic partnership with the U.S. Centers for Disease Control to reduce the overprescription of antibiotics. 

Congress returns to Capitol Hill from its week long Independence Day recess tomorrow.

The Wall Street Journal keeps presenting interesting articles about the Crispr technology. That technology works as follows:

An enzyme called Cas9 can be programmed to latch onto any 20-letter sequence of DNA. Once there, the enzyme cuts the double helix, splitting the DNA strand in two. Scientists supply a snippet of genetic material they want to insert, making sure its ends match up with the cut strands. When the cell’s repair mechanism kicks in to fix the cut, it pastes in the new DNA.

The weekend issue included an interview with “[Professor] Jennifer Doudna, a Crispr pioneer who runs a lab at the University of California, Berkeley.” Ms Doudna states “I frankly have been flabbergasted at the pace of the field.  We’re barely five years out, and it’s already in early clinical trials for cancer. It’s unbelievable.” Ms. Doudna and a colleague just released a book called A Crack in Creation. Both the book and the article look at the related ethic issues created by the technology.

Tonight the Journal reported that “A holder of [22] key patents to the Crispr gene-editing technology [the Broad Institute of MIT and Harvard] is willing to join a world-wide joint patent pool—a development that medical and legal experts think could hasten the development of new human therapies.’

The Boston Globe reported today about a criminal scheme involving drug rehabilitation facilities.

Patient brokers, some of whom are themselves in recovery from drug addiction, are paid by marketers working for treatment centers eager to sign up patients with private insurance plans. 

The brokers use phony addresses to sign up people immediately [on healthcare.gov] — a change of address is an exception to the usual limitation that customers can sign up only during the end-of-year open enrollment period — and to take advantage of the best-paying PPO plans in states in which they don’t live. 

The brokers, patients’ families, or marketers for the treatment centers pay the insurance premium. Within a few weeks, the insurer is billed tens of thousands of dollars for what is often subpar care. 

Smart medicine offers a way [to lower the cost curve], enabling doctors to develop a precise, high-definition understanding of each person in their care. The key tools are cheaper sensors, simpler and more routine imaging, and regular use of now widely available genetic analysis. As for using all this new data, here too a revolution is under way. Algorithms and artificial intelligence are making it possible for doctors to rapidly apply relevant medical literature to their patients’ cases, while “natural language processing” (that is, talking to computers) holds the promise of liberating them from keyboards during office visits.

One obvious practical effect of these developments will be to replace hospital stays with remote monitoring in the patient’s home. The Food and Drug Administration has already approved wearable sensors that can continuously monitor all vital signs: blood pressure, heart rate and rhythm, body temperature, breathing rate and oxygen concentration in the blood. The cost to do this for weeks would be a tiny fraction of the cost for a day in the hospital. Patients will be able to avoid serious hospital-acquired infections and get to sleep in their own beds, surrounded by family.

Other examples are offered. An interesting read as we wait for Congress to get back to town next week.

On other fronts —

• The Centers for Disease Control has a new director— Brenda Fitzgerald, MD who “has been the commissioner of the Georgia Department of Public Health (DPH) and state health officer for the past six years.”
• Yesterday the CDC issued a report on opioid prescription trends in U.S. counties over the ten year period ending with 2015.  “The amount of opioids being prescribed in the United States varies county by county. Half of US counties have seen a decrease in the amount of opioids prescribed from 2010-2015, but the highest prescribing counties still prescribe six times more than the amounts of the lowest prescribing counties.” The CDC encourages doctors to follow the CDC’s guidance on prescribing those drugs. 
• MHealth Intelligence reports that 25 states have adopted an enhanced interstate nursing licensure compact.  “The eNLC, an enhanced version of the Nurse Licensure Compact originally introduced in 1997 and implemented in 2000, allows for registered nurses (RNs) and licensed practical/vocational nurses (LPN/VNs) to practice in any member state under one license. Licensing standards are aligned in member states so that nurses applying for a multistate license are required to meet the same standards, which include a federal and state criminal background check.” Of course, this law facilitates the use of nurses in telehealth programs. 
• Employee Benefit News reports that employers and investment advisors are encouraging workers to see and take advantage of the relationship between 401(k) retirement accounts and health savings accounts, e.g., it’s important to build balances in both types of accounts for retirement. That’s an interesting angle for FEHBP carriers of consumer driven plans to explore.
• Health IT Security reports that the  “The National Health Information Sharing and Analysis Center (NH-ISAC) announced that it had a Petya ransomware vaccine, and also discussed mitigation tactics that organizations can follow to minimize the potential risk of infection.”

The FEHBlog trusts that his readers had an enjoyable Independence Day holiday. The FEHBlog certainly did.

The Wall Street Journal reports tonight that the Senate Majority Leader Mitch McConnell has asked the Congressional Budget Office to evaluate a BRCA amendment from Sen. Ted Cruz (R Tex.) that would allow insurers that offer ACA-compliant coverage to also offer non-ACA compliant coverage, most likely lower cost catastrophic protection against illness or injury.  “The action unfolded as Mr. McConnell continued to reach out to various senators while Congress is on recess. Mr. McConnell was forced to delay a vote before the recess amid defections from both conservatives and centrists. He is working to assemble a revised version the Senate can consider shortly after it returns to Washington.”  This amendment meets the FEHBlog’s criteria of allowing greater consumer choice. The FEHBlog thinks that allowing more choice will encourage people to pay more attention the exchanges.  The Journal adds that “Tweaks to the original Senate bill are likely to include more funding for opioid addiction treatment and possibly beefed-up funding for tax credits that help low-income people buy insurance.”

Speaking of opioid addiction, the Boston Globe’s STAT service offers an interesting perspective on the importance of crime lab and public heath official cooperation to stay on top of the massive problem.

Healthcare Dive reports that a new tranche of data has been added to the federal government’s Open Payments website. “Open Payments is a federal program, required by the Affordable Care Act, that collects information about the payments drug and device companies make to physicians and teaching hospitals for things like travel, research, gifts, speaking fees, and meals. It also includes ownership interests that physicians or their immediate family members have in these companies.” The payments totalled over $8 billion in both 2015 and 2016. You can look at gross data or individual provider data. The FEHBlog’s own internist reported $62 in payments which is about $3200 below the national mean. Be reassured. Have some fun!

On the bright side of pharmceuticals,  genomeweb tells us about small clinical studies “pointing to the potential of personalized anti-cancer vaccine strategies in individuals with advanced melanoma,” which is a very deadly disease.

Congress is out of town for the Independence Day holiday this week. Here’s a link to the Week in Congress’s report on last week’s actions on Capitol Hill.

Fierce Healthcare is offering a series of articles on a worthy topic — provider / payer cooperation.  For example,

Payers can monitor patients’ adherence rate by how often they fill their medications. But just because the patient fills a prescription doesn’t mean they’ll take it.
“That’s where your care management programs help to fill in the gaps,” one attendee said. “Collaboration is about how you create the right incentives so everyone is moving in the right direction. It’s easy to agree to in theory—it’s hard to do.”

Here are a few quick hits on prescription drug costs:

• Fierce Healthcare tells us about two recent studies on opioid use. 
• The Wall Street Journal reports on unexpected shortages of “simple” prescription drugs. 
• The Food and Drug Administration last week announced ‘two new, important steps to increase competition in the market for prescription drugs and facilitate entry of lower-cost alternatives. The agency published a list of off-patent, off-exclusivity branded drugs without approved generics, and also implemented, for the first time, a new policy to expedite the review of generic drug applications where competition is limited.”

The House Appropriations Financial Services and General Government Subcommittee passed its 2018 appropriations bill through a voice vote Thursday afternoon. The draft does not offer an alternative to the president’s proposal of 1.9 percent raise.
Trump proposed a 2.1 percent pay raise for members of the military. The Senate agrees with the president’s proposal, but the House Armed Services Committee suggested a 2.4 percent raise for troops next year.

The bill contains the three traditional FEHBP-related appropriations provisions — an abortion coverage restriction (which is noted in the Committee announcement), a female contraception coverage mandate, and a prohibition on applying full Cost Accounting Standards coverage to the FEHBP.  This is only the start of the formal legislative process.

Following up on yesterday’s Drug Store News, the Drug Channels blog offers its observations on the modified Walgreen’s deal with Rite Aid.

Modern Healthcare reports that while significant gains were made to reduce in-patient readmissions in the first three years of the government motivated reduction program, little further progress has been made since 2013.  Gathering the low hanging fruit was useful. The second stage is usually more challenging.

As recently as 2011, all-cause readmissions cost the nation $41 billion, according to a 2014 Agency for Healthcare Research and Quality report. Medicare’s tab alone was $26 billion annually, $17 billion of which was attributable to avoidable rehospitalizations. By 2014, Medicare spending on readmissions fell by $9 billion.
While improvements were made during the first three years of the readmissions program, concern is mounting that momentum has stalled. There’s been no more than 0.1% reduction on average between 2013 to mid-2016, according to a December 2016 JAMA study.

That publication also is reporting that hospitals are struggling with collecting patient bills. The FEHBlog was struck by this statistic:

In the past five years, health insurers went from paying 90% of patient-care costs to only about 70% and that’s causing massive headaches for providers.

The FEHBlog doubts this is an issue with FEHB coverage.

Walgreens Boots Alliance, Inc. (Nasdaq: WBA) announced today a new definitive agreement with Rite Aid Corporation under which Walgreens Boots Alliance will purchase 2,186 stores, three distribution centers and related inventory from Rite Aid.

The consideration for the transaction will be $5.175 billion in cash, the assumption by Walgreens Boots Alliance of the related real estate leases and the grant of an option to Rite Aid, exercisable through May 2019 and subject to certain conditions, to become a member of Walgreens Boots Alliance’s group purchasing organization, Walgreens Boots Alliance Development GmbH. Walgreens Boots Alliance will also assume certain limited store-related liabilities as part of the new transaction.

This new agreement replaces the previous merger agreement with Rite Aid, announced in October 2015 and amended in January 2017, and the agreement to divest certain Rite Aid stores to Fred’s, Inc. announced in December 2016. Both of these agreements have been terminated, and Walgreens Boots Alliance will pay Rite Aid the $325 million termination fee with respect to their merger agreement.

The new transaction is subject to the expiration or termination of applicable waiting periods under the Hart-Scott-Rodino Antitrust Improvements Act of 1976, as amended, and other customary closing conditions. The initial closing of the new transaction is expected to occur within the next six months.

Upon the initial closing of the new transaction, Walgreens Boots Alliance will begin acquiring the stores and related assets on a phased basis over a period of approximately six months, and intends to convert acquired stores to the Walgreens brand over time.

According to a chart in the Journal article, Walgreens currently has 13,020 stores in the US; CVS Health has 9676, and Rite Aid has 4,523.  

Postal reform: After many years of trying, the committee under Chaffetz approved legislation to stabilize faltering Postal Service finances. The bipartisan bill was supported by postal management, unions and industry mailers. This major accomplishment, however, turned to frustration when the Republican leadership did not schedule the bill for a House vote.
That leaves him the “most frustrated and just flat-out disappointed … I’m fairly critical of my own leadership because I see no good reason not to move it. It saves money, it’s bipartisan and it’s desperately needed … I’m dumbfounded as to why it hasn’t been brought up.”
Asked why, the offices of House Speaker Paul D. Ryan (R-Wis.) and Republican Majority Leader Kevin McCarthy (Calif.) had no comment.

The FEHBlog also spotted this helpful American Hospital Association cybersecurity page.  The resource leads with information about the sources of the latest ransomware attacks — the Petya and WannaCry viruses.

The Wall Street Journal reports that the Senate Majority Leader Mitch McConnell has postponed a Senate vote on the Better Care Reconciliation Act until sometime after the Senate returns from its Independence Day recess on July 10.  The House of Representatives leadership overcame a similar roadblock to a successful healthcare vote in the Spring.

The Congressional Budget Office issued a report on the Senate bill on Monday. The FEHBlog suggests reading the commentary on that report from Diana Furchgott-Roth of the Manhattan Institute on that report.

Healthcare Dive informs us that the CBO issued a couple of other reports on Monday which confirm that the Medicare program shift massive amounts of cost onto private section insurance programs, including the FEHBP.

Let’s wrap up with a few tidbits:

• U.S. News and World Report issued its children’s hospital rankings which is noteworthy because a DC hospital made the top ten. 
• MedCity News provided a useful analysis of 2017 FDA prescription drug approvals as we approach the mid-point of the year. 
• The Washington Post reports on cell phone apps, like Heal which provide doctors on demand, particularly in urban areas. 

The chief executive of Heal, Nick Desai, co-founded the start-up with his wife, Renee Dua, a physician. Their own parental trip to the emergency room inspired the service, after the couple, unable to contact their regular pediatrician, sat in an emergency room for seven hours with their feverish 3-month-old son.
“My wife turned to me and said, ‘There’s got to be a better way,’ ” Desai recalled. So Heal was born — a service that can work with patients’ insurance. For those without insurance, a visit costs up to $99. “Our number one, main goal is that, five years from now, you won’t have to go to the doctor’s office,” Desai said.

The FEHBlog is not sure how this type of app differs from telehealth app like those offered by American Well and Teladoc.