Sunday, April 23, 2017

Weekend Update

Congress returns to work on Capitol Hill tomorrow. This week's deadline is April 28 when the current federal resolution funding the federal government expires. The FEHBlog does not foresee a government shutdown when the same party holds the Presidency and control of both Houses of Congress.

Later this week, Thursday and Friday specifically, the popular Health Data Palooza will be held here in Washington DC.  The registration information is here.

The FEHBlog's eye was caught by this Health Affairs study finding a "Small Decline In Low-Value Back Imaging Associated With The ‘Choosing Wisely’ Campaign, 2012–14."   The Choosing Wisely campaign which was launched five years ago is an intiative that encourages patients to question a doctor when he or she recommends a service or supply that Choosing Wisely describes as questionable / low value based on medical society recommendations. The problem here, in the FEHBlog's view, rests with the doctors who should know better, not the patients.

The FEHBlog's eye also was caught by the Society for Resource Management article pointing out that the 2017 graduating class is composed of Generation Z, the generation that follows the Millenial Generation.  The FEHBlog's youngest kid is member of the graduating class of 2017. He had no idea that his youngest kid was in a different generation from his older sisters and brother. You learn something new everyday. Anyway, Modern Healthcare featured an article last week about the health care demands of the Millenial Generation.
[The] millennial generation *** wants instant access to healthcare. They're also looking for a healthcare encounter that is frictionless, convenient and defined by good customer service. The younger generation—and many tech-savvy older Americans—are no longer willing to put up with the long wait times and inconvenient access points traditionally offered by large hospital systems and office-based physician networks.
And that is presenting a big challenge to major health providers such as Advocate, a Chicago-based healthcare system with a dozen hospitals and 1,500 employed physicians. It is among the many major players now looking to establish new access points for younger healthcare consumers, who give less weight to name brands or personal referrals than previous generations.
But many are late to the game. When it comes to meeting the new consumer expectation for speed and convenience, traditional players such as Advocate face mounting competition from stand-alone urgent-care centers, in-pharmacy health clinics and telehealth consultations. In some cities, there's even a return of on-demand home visits.
Interesting.

Friday, April 21, 2017

TGIF

Well, Congress is nearing the end of its two week long home district work session. The continuing resolution funding the federal government expires on Thursday April 28 which is the 99th day of the Trump administration. UPI reports that the House leadership has worked up another amendment to the American Health Care Act in a continuing effort to obtain majority support for the bill. Of course, funding the government must be addressed first.

In an interesting development, the big health insurer United Healthcare made executive leadership changes according to this Twins Cities Business Journal article. The FEHBlog's attention was caught by the following paragraph from the article --
In a conference call with investors, [a UHC executive] said the company changes up its leadership team every two to three years. “I think it provides fresh new focus, a lot of energy,” he said. “In many respects … we move [executives] from one spot to another to broaden experience as well.”
 Here are few closing tidbits:

  • HHS Office for Civil Rights sanctioned a healthcare provider because it was unable to produce a written HIPAA business associate agreement for a particular vendor. It's good practice for covered entities and business associates to routinely inventory those agreements. 
  • Walgreen Co. agreed with the Justice Department to settle False Claims Act charges based on its alleged failure to comply with Medi-Cal's billing policies for off-label drugs. Off label drug coverage is a delightfully complex issue. A doctor can prescribe a prescription drug for a purpose that is not on the FDA approved label, but that does not mean that the health plan must cover it.  In this case, Medi-Cal, California Medicaid, added hoops for off-label drug coverage. And of course, the drug company is prohibited from marketing a drug for off-label uses. 
  • Federal News Radio offers a two part report on its interview with Linda Springer about government reorganization. Ms. Springer is a senior advisor to the Director of the Office of Management and Budget. She was one of the OPM directors during the George W. Bush administration. 

Tuesday, April 18, 2017

Pleasant surprise

Nearly eleven years ago, U.S. Supreme Court Justice Ruth Bader Ginsburg authored a 5-4 decision in Empire Healthchoice v. McVeigh. The case concerned a federal court jurisdiction issue but in the course of the opinion, the FEHB Act's state law preemption provision (5 U.S.C. Sec. 8902(m)(1)) was placed under a cloud. This provision allows for uniform nationwide administration of FEHB plans. The court's decision lead to a lot of costly litigation.

Today, Justice Ginsburg righted the ship by authoring a unanimous opinion strongly upholding the FEHBA's state law preemption provision. The Court held in Coventry Health Care v. Nevils that the FEHBA preempts a Missouri state law prohibiting health insurers from recovering benefit payments from the responsible party, e.g., the person who caused the auto accident. As Congress directed, where FEHBA contract terms “relate to the nature, provision, or extent of coverage or benefits (including payments with respect to benefits),” § 8902(m)(1) ensures that those terms will be uniformly enforceable nationwide, free from state interference." Amen.

Thank you Justice Ginsburg , the other members of the Court, and Miguel Estrada, the Gibson Dunn lawyer who argued the case for Coventry, for this outcome which will simplify FEHBP administration.

Sunday, April 16, 2017

Weekend update

Happy Easter.

Members of Congress and Senators remain in their home districts / States for another week.

Last Friday, the Centers for Medicare and Medicare Services proposed to give hospitals a "total increase in inpatient operating prospective payments of 2.9 percent in fiscal year 2018," which begins October 1, 2018.  CMS explains that
CMS is committed to transforming the health care delivery system – and the Medicare program – by putting a strong focus on patient-centered care, so providers can direct their time and resources to patients and improve outcomes. In addition to the payment and policy proposals, CMS is releasing a Request for Information to solicit ideas for regulatory, policy, practice and procedural changes to better achieve transparency, flexibility, program simplification and innovation. This will inform the discussion on future regulatory action related to inpatient and long-term hospitals.
Fresh approach.

Also last week, Drug Channels provided on outlook on specialty drug prices.  Drug Channels predicts that specialty drugs will represent 42% of the prescription drug market in 2021.
Here are [Drug Channels'] three key factors behind the projections: 
    Pharmacy industry revenues have been shifting from traditional brand-name drugs to specialty drugs. We estimate that in 2016, specialty drugs accounted for 28% of the pharmacy industry’s prescription dispensing revenues, up from 17% of revenues in 2011. This shift will continue, because the next-generation pharmaceutical blockbusters will primarily be specialty products aimed at smaller patient populations than were the mass-market blockbusters of yesteryear. Consequently, most of the industry’s best-selling drugs by revenue will be specialty drugs, not traditional drugs. 
    The generic wave is ending, which means that the growth rate of generic substitution will slow in coming years. Over the past five years, the generic dispensing rate (GDR)—the percentage of prescriptions dispensed with a generic drug instead of a branded drug—grew by 26 percentage points, from 63% in 2006 to 89% in 2016. We project that by 2021, GDR will have grown by only 3 percentage points, to 92%. 
    From 2009 to 2016, brand-name drugs with about $167 billion in retail sales faced generic competition. Annual brand sales facing generic competition averaged $21 billion annually. From 2016 to 2019, however, brand-name drugs with total sales of $19 billion will lose patent protection—an annual average of about $6 billion. Since generic drugs have much lower prices than do brand-name drugs, revenues from traditional drugs will grow slowly.





Friday, April 14, 2017

TGIF

Yesterday, the Centers for Medicare and Medicaid Service finalized their recently proposed rule intended to help stabilize the individual health insurance market. The rule floats the FEHBlog's boat because it simplifies the system yet sensibly enforce the important rules.

In contrast, Accord reports on a Treasury audit finding that the IRS has not been able to impose employer mandate penalties on its any "applicable large employer" because of, among other reasons, "several major issues with the technology being used to assist the IRS enforce the employer mandate."   The ACA simply can be too complicated to enforce.

Employee Benefit News tells us about trade association recommendations on controlling prescription drug costs. According to the PBM trade association's (PCMA) president the wave of the future is narrow pharmacy networks.  "The aim is to determine which drugstores are most convenient for employees and then negotiate substantial discounts where there are competing drugstores in those areas."

Earlier this week, HHS's Office for Civil Rights announced another HIPAA security rule violation settlement with a health care provider. The investigation that lead to the settlement was triggered by a large data breach (> 500 affected patients).

Finally the FEHBlog got a kick out of this Wall Street Journal article reporting that
Plaintiffs’ lawyers have long solicited clients through television advertisements that warn of a drug’s potentially harmful side effects.
Now, a powerful congressman, backed by the leading doctors’ group and some drug companies, is pushing back, saying the ads are to blame for patients suffering harm or even dying after dropping treatment. Rep. Bob Goodlatte (R., Va.), chairman of the House Judiciary Committee, wants the ads to include a warning that patients should talk with their doctors before adjusting medication.
What's good for the goose, etc.

Wednesday, April 12, 2017

Midweek update

Today, the Office of Management and Budget ("OMB") ended the temporary federal hiring freeze implemented upon the President's inauguration. Federal News Radio reports that OMB has replaced the hiring freeze with a detailed structure for reorganizing government agencies.

Last week, OMB issued in depth guidance on the President's one rule in, two rules out Executive Order 13,771.  The FEHBlog is suprised that to date he has not noticed any HHS roll back of ACA rules, such as the onerous Public Health Service Act Sec. 1557 rule, or sub-regulatory guidance, such as the ACA FAQs. that would loosen the choke chain that the ACA placed on health plans. That is the third leg of the Republican House leadership's health care reform strategy. The FEHBlog must remain patient.

Federal News Radio also reflects on the fact that it's been nearly two years since OPM announced its large data breaches.  The article observes that
the biggest harm from the OPM breaches has been the public’s erosion of trust in the agency and in government at large to protect personal data, said Charlie Phalen, director of the National Background Investigation Bureau (NBIB).
“It’s a big deal in the sense that we need to renew the faith of the American public that we can protect that information,” he said during an Apr. 10 discussion of the long-term impacts of the OPM data breaches at the Intelligence and National Security Alliance’s Counterintelligence Threats Summit in Arlington, Virginia. “By and large, that’s the biggest piece. It is less of a big deal holistically in terms of dangers to people. The problems that will be encountered will be individuals in the wrong place at the wrong time if this is exploited in some shape or form.”
AHRQ posted the results of study which supports ongoing Congressional efforts to reduce the state law malpractice burden on physicians, e.g., H.R. 1215. In sum,
Medical malpractice law is intended to foster high quality care and discourage negligence among health care providers. This observational study took advantage of differing malpractice laws by state and examined the extent to which the malpractice environment is associated with hospital quality. Investigators assessed quality using several measures: validated processes-of-care measures, such as whether evidence-based actions were appropriately taken for common conditions like myocardial infarction, pneumonia, heart failure, and surgical care; patient experience as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems; imaging efficiency as reported by Medicare's Hospital Compare website; AHRQ Patient Safety Indicators; and 30-day readmission and hospital mortality rates. There were no associations between any of these quality outcomes and the rate of paid claims per 100 physicians. Areas with a higher malpractice geographic cost index had lower 30-day mortality but higher readmission rates, and higher malpractice costs were correlated with more inefficiency in some types of imaging. The authors conclude that malpractice environment does not appear to be associated with quality, but higher malpractice costs may lead to overtreatment.

Sunday, April 09, 2017

Weekend update

Congress is on a home work period for two weeks.  Judge Neil Gorsuch was confirmed as a U.S. Supreme Court justice on Friday.  Judge Gorsuch will be sworn in tomorrow.  Here's a link to the Week in Congress's report on last week's activities on Capitol Hill.

The Hill reported that the President has nominated "Neomi Rao, an associate law professor at George Mason University, was nominated to run the White House’s Office of Information and Regulatory Affairs (OIRA)." The appointment requires Senate confirmation. Ms. Rao will play an important role in the President's administrative reform efforts. GWU Law Professor Jonathan Adler comments in the Washington Post's Volokh Conspiracy blog that
Trump’s selection of Rao suggests the administration is serious about regulatory reform, not merely reducing high-profile regulatory burdens. The selection of a well-respected administrative law expert further suggests the administration recognizes the need to be attentive to legal constraints on administrative action and that meaningful reforms require more than issuing a few executive orders. 
Healthcare IT News discusses an AHIMA Journal article asking whether HIPAA should be re-evaluated. HIPAA is now over 20 years old. The FEHBlog's advice would be to repeal the electronic transactions standard and code sets requirements in favor of industry oversight which works in banking and refocus HIPAA on privacy and security which are two appropriate topics for government regulation.



Friday, April 07, 2017

TGIF

Reports of the demise of the American Health Care Act were premature. The House of Representatives continues to work on the bill. Yesterday, the House Rules Committee cleared for floor consideration an amendment to the bill (H.R. 1628) which would create an invisible high risk pool to help insurers cover the cost of expensive members in the individual market.  The FEHBlog listened to the Speaker's press conference announcing this change. One of his colleagues explained that the concept was successfully tested in the State of Maine. Here's a link to a Health Affairs blog article about this experiment.

The House also passed this week by a wide bipartisan margin a bill that would clarify that employers may use stop loss insurance to help them control similar costs in self-funded arrangements without losing the benefits of ERISA preemption of state mandates and related laws. Employee Benefits News discusses the bill here.

On the disease front:

  • NPR provides an update on the Zika virus's impact on expectant mothers in our country. 
  • Health Day reports that "Overall cancer death rates in the United States continue to fall, but racial gaps persist, a new report says."  Take a look. 
Finally, a couple of tidbits:
  • Magellan Rx, a prescription benefit manager, released its seventh annual pharmacy trend report. 
  • Health Data Management reports that  "Nashville is home to a new 16,000-square-foot Center for Medical Interoperability that will be focused on simplifying and advancing health data sharing across technologies and systems."  Here's a link to the non-profit organization's website.  Good luck to them. 

Wednesday, April 05, 2017

Midweek update

On the prescription drug front,

  • The Wall Street Journal reports tonight that Walgreen's CEO is optimistic that his company's planned merger with Rite Aid will close by the end of July. 
  • The Journal also reports that President Trump's nominee for Food and Drug Commissioner Scott Gottlieb had a smooth confirmation hearing before the Senate Health, Education, Labor and Pensions Committee today. 
He said his first priority will be tackling the opioid epidemic which he said was a serious public health issue on par with infectious diseases like Ebola or Zika. He said solutions will "require dramatic action," including finding ways to spur development of non-addictive alternative painkillers as well as addiction treatments.
A committee vote on Gottlieb's nomination is expected after the Easter recess Alexander said.

  • Drug Channels has a report on hospital's scalping health plans with high pricing on specialty drugs.   
The National Center for Business Journalism writes about five healthcare trends involving the millenial generation.  Here's number one:

According to a survey conducted by Communispace, only 56 percent of millennials reported that they had visited a primary care physician in the last year, compared to 74 percent of non-millennials. Efficiency and convenience are at the heart of the millennial shopping experience. According to HIT Consultant, millennials are going to retail clinics (34 percent) and acute care clinics (24 percent) to save time. In response, the number of retail and urgent care locations is exploding. According to the Convenient Care Association, the number of retail care clinics has risen by 127 percent since 2010.
Interesting. Good news for telehealth vendors.

Fierce Healthcare informs us that
A new study shows the value of integrating caregivers into the discharge process for elderly patients: far fewer readmissions.
Researchers from the University of Pittsburgh Health Policy Institute found hospitals that involved family members or unpaid caregivers in the discharge planning process had a 25% reduction in risk of elderly patients being readmitted to the hospitals within 90 days and a 24% reduction in risk of being readmitted within 180 days.
The study was published Monday in the Journal of the American Geriatrics Society. It is the first to quantify the post-discharge impact of caregiver integration into discharge planning on healthcare costs and resource utilization. 
Well duh. The FEHBlog thinks that this advice should be followed for all hospital admissions.

Finally here's encouraging news from AHRQ:
Prior research has demonstrated that hospital accreditation by The Joint Commission is associated with improved hospital performance on certain quality of care measures. However, it has not been established whether the survey periods themselves are associated with a change in patient outcomes. Researchers analyzed Medicare admissions at 1984 hospitals surveyed by The Joint Commission between 2008 and 2012 from 3 weeks prior to a survey up to 3 weeks afterward. They compared patient outcomes between survey periods and the surrounding weeks. For the primary outcome—30-day mortality—they found that patients admitted to the hospital during survey periods had significantly lower mortality than those admitted during nonsurvey weeks. The authors conclude that heightened vigilance during survey weeks and resultant changes in practice may explain this finding. 
The upshot is plan your hospital admission around your hospital's Joint Commission accreditation survey. The FEHBlog understands that accrediting bodies generally require advance public notice of accreditation surveys. Perhaps health plan case managers should take this into account. (jk)


Sunday, April 02, 2017

Weekend update

Congress remains in session again on Capitol Hill this week. The Supreme Court is likely to be back to nine justices later this week when the Senate confirms Judge Neil Gorsuch. The vote is scheduled for Friday.

Congress is under pressure to pass a resolution by April 28 funding the federal government though the end of the federal fiscal year on September 30.  The FEHBlog cannot imagine a federal shutdown occurring when the same party hold the Presidency and both Houses of Congress.  But as we were once again reminded by the demise of the American Health Care Act earlier this month, we don't have a parliamentary system.

The FEHBlog has been keeping an eye on the House bipartisan postal reform bill (H.R 756).  Any action since the House Oversight and Government Reform Committee approved the bill by voice vote on March 16 has been behind the scenes.  Printing Impressions reports that last week postal customers from the printing, imaging, and mailing industries visited Capitol Hill last week to urge fast approval of the bill.

In a bit of good news, ABC News reports that progress is being made on the development and testing of a vaccination against the Zika virus.  According to the report,
This is a totally new kind of vaccine. Traditionally, vaccines are made using a dead or weakened virus to train the body's immune system to recognize and fight that infection.
In contrast, the DNA vaccine works through trickery: It's made with a circular piece of DNA carrying genes from the Zika virus that, once in the body, make particles that resemble Zika enough to alert the immune system but cannot cause infection.
The NIH also is testing the safety of some more traditional Zika vaccine candidates, but the easier-to-make DNA vaccine was the first ready to advance to this second stage of human testing.
Don't expect a vaccine to be widely available any time soon. If Zika causes lots of illness this year, Fauci said researchers may have clues by early 2018 about how well the shots work — but if natural infections slow, they'll need many more volunteers to get an answer.




Friday, March 31, 2017

TGIF

Here's a link to the Week in Congress's report on the current week's activities on Capitol Hill. Yesterday, the Senate Health Education Labor and Pensions Committee cleared for floor consideration the President's nomination of Alexander Acosta to be Secretary of Labor. "An aide for Senate Majority Leader Mitch McConnell told Bloomberg BNA March 30 that he didn’t have any scheduling announcements about a full floor vote."

Healthcare Dive is reporting this afternoon that "Donald Rucker, who previously served as Siemens Healthcare's vice president and chief medical officer, will serve as the next head of the HHS' Office of National of Coordinator for Health IT (ONC)." "On his LinkedIn biography, Rucker describes himself as a physician leader with national clinical informatics success.” He states he was a co-developer of the first Microsoft Windows-based electronic medical record." That's good news because no doubt he will be leading the charge on electronic medical record interoperability.

Health Data Management tells us about a recent IBM report on the state of health care cybersecurity. "The top types of attacks for monitored security clients in 2016 were injection of malicious data (/ phishing attacks experienced by 42 percent of its clients), manipulation of data structures to gain unauthorized access (32 percent) and collection/analysis of information (9 percent)."  The oversight subcommittee of the House Energy and Commerce Committee will be holding a hearing on strengthening public/private partnerships to guard against cyberattacks in the health care sector next Tuesday.

GAO issued a report on the benefits and limitations of identity theft services for consumers.

Finally, be sure to read this Forbes article in which the CEO of the enormous Permanente Medical Group, Robert Pearl, MDm describes his recent hospital stay following a serious knee injury. The article begins
I’ve spent much of my life in hospitals as a physician and surgeon. Recently I suffered an injury that taught me much about what it’s like to be a patient. It wasn't that I did not understand the problems, but now I recognize the full magnitude. As a result, my perception of being hospitalized has changed forever. And I recognize how delirium, a life-threatening event, can happen to even relatively healthy patients.

Thursday, March 30, 2017

Midweek update

Historically, OPM issues a call letter for benefit and rate proposals in March shortly before the carrier conference. This year, likely due to the impending Administration change, OPM issued the 2018 call letter in early January. In the FEHBlog's view if OPM is going to issue the call letter early then why not issue a draft call letter for carrier comment like Medicare Advantage does? 

The call letter was discussed at the carrier conference last week.  Carriers are assembling their benefit and rate proposals which is not the easiest task because not a lot of 2017 claims experience has developed at this point. Carriers continue to wait for OPM's technical guidance on those proposals which should come out in the next week or so.  

2018 may be a particularly tricky year to set rates because OPM mandated for 2017 that FEHB plans provide coverage for applied behavioral analysis to treat autistic children.  There may have been pent up interest in this costly but important coverage. Also many plans introduced telehealth benefits. It's not a lot of time to figure out what's bending the cost curve up or down.  

What's more, the benefit and rate proposal period now coincides with the HEDIS data collection season. HEDIS is a set of health care quality measures upon which OPM puts a lot of emphasis. Good luck to the carriers with these important efforts. 

Sunday, March 26, 2017

Weekend update

Congress remains at work on Capitol Hill this week. Here is a link to the Week in Congress's report on last week's activities on Capitol Hill. The FEHBlog did notice that the U.S. Senate has freshenened up its website.

Here are a few tidbits from last week's OPM AHIP FEHBP carrier conference:

  • OPM's medical director, Dr. Christine Hunter, received a prestigious Presidential Rank award from President Obama last December. What's more, OPM's FEHBP tribal coverage desk received a Presidential customer service award.  Mazaal tov! 21,000 Indian tribal employees who work for 100 tribes are covered under the FEHBP. 
  • A National Business Group on Health speaker called attention to his group's issue brief on specialty pharmacy costs. In that regard, a CVS medical director predicted that the biosimilar market will "take off" in three to four year. The FEHBlog certainly hopes so. 
  • OPM's unlocktalent.gov is a data visualization tool that’s available to the public.  The tool includes Federal Employee Viewpoint Survey and the Enterprise Human Resources Integration database.  To see the publicly available information, you need to scroll down the home page.  There's a United States map that shows where federal employees live, for example. Federal employees can register for a deeper dive. 
Modern Healthcare reported last week that two large prescription benefit managers, CVS and Express Scripts, are offering direct to consumer products for folks with high deductible plans, among others. 

A colleague pointed out to me that Govinfo Security reports that

The Trump administration has named Roger Severino as the new director of the Department of Health and Human Services' Office for Civil Rights, which enforces HIPAA['s Privacy and Security rules] and protects patients rights.
An OCR spokesperson confirmed on March 24 that Severino had been named to the position, and his bio has been posted on the office's website.
Meanwhile, former Rep. John Fleming, R-La., has reportedly been selected for the newly created position of deputy assistant secretary for health technology. It's not yet clear whether Fleming would lead HHS' Office of the National Coordinator for Health IT. ONC oversees standards and policies for the HITECH Act electronic health records "meaningful use" financial incentive program, and also carries out various health IT-related provisions in the 21st Century Cures Act, which was signed into law last year.
Finally, Fierce Healthcare reports that last week, the Centers for Medicare and Medicaid Services announced that the agency is delaying at least until October 1, 2017, the mandatory Medicare bundled payment programs that the Obama Administration rolled out last year.  "The latest delay came as welcome news to the Federation of American Hospitals and the American Hospital Association, which expressed concern last year that the accelerated pace of the program."

Friday, March 24, 2017

TGIF

The House never voted on the American Health Care Act. The House leadership with the President's consent pulled the bill from the floor because the Republicans were not able to assemble the necessary votes.  The Wall Street Journal reports this afternoon that the House Speaker Paul Ryan (R WI) conceded that 
We're going to be living with Obamacare for the foreseeable future," though he argues that replacing it would actually have done a favor to Democrats.  He says that tax reform will move forward, even though the plan has been complicated by the Obamacare taxes remaining in place.
The Journal further reports that
Going forward, [President] Trump said he would seek bipartisan support for a bill to overhaul the health-care system, saying that would be “the ultimate” and drawing a contrast with the Affordable Care Act, which he said was “rammed down everyone’s throat” with only Democratic support.
Also today, a three judge panel of the U.S. Court of Appeals for the D.C. Circuit heard oral argument in the Anthem / Cigna appeal of the district court decision blocking their merger agreement from closing. The Wall Street Journal reports
A federal appeals court panel on Friday asked tough questions of health insurer Anthem Inc., which is attempting to salvage its proposed $48 billion acquisition of Cigna Corp. after a trial judge blocked the combination as anticompetitive.
The Anthem appeal, which took place in front of a large crowd at the U.S. Court of Appeals for the District of Columbia Circuit, was surprisingly lively—and lengthy—as three judges said the case presented novel and difficult issues.
“We haven’t had a case like this,” Judge Brett Kavanaugh said.
The session was supposed to last for 40 minutes; the judges instead asked questions for about two hours.
That's an engaged panel. This case was expedited so that the panel could issue its decision before the Anthem - Cigna merger agreement's termination date - April 30, 2017.

Over the weekend, the FEHBlog will share some bon mots from the FEHBP carrier conference. Nothing earthshaking occurred but some useful tidbits were shared by the speakers.