Monday, September 18, 2017


Yesterday, the FEHBlog said that Congress is out of town this week. My bad. The House is out of town this week but the Senate is here for a few days. The Washington Examiner reports that the Senate passed an FY 2018 defense authorization bill which will now go to a conference committee with the House. It's interesting to watch the Graham - Cassidy ACA replacement bill gather steam. Fortune reports that the bill may be one vote away from Senate passage. It's unfortunate that this bill does not include a repeal of the health insurer tax which punishes the FEHBP. The Washington Examiner reports that
[House Speaker Paul] Ryan, who had previously spoken positively about the legislation, noted that the House would not have time to amend the bill if the Senate did clear it. Instead, it would face having to simply approve the Senate measure.
"A conference committee is probably not possible," he noted.
Republicans in the House "acknowledge and understand" that they wouldn't have time before the end of the month for anything other than a vote to approve the Senate legislation, he added.

Sunday, September 17, 2017

Weekend update

Congress is out of town this week. Here's a link to the Week in Congress report on last week's activities there.  Of note is the fact that the House of Representatives completed passing all twelve appropriations bills for fiscal year 2018. Here are links to the Federal Times and Federal News Radio reports on this action. Federal News Raadio explains that
The Senate is much further behind the House in its appropriations and budget process. The chamber hasn’t passed any of the 12 appropriations bills, and Senate appropriators have yet to move all spending packages out of committee. Lawmakers have until Dec. 8 now to pass some sort of spending bill before the current continuing resolution expires.
Modern Healthcare has a very upbeat article about a CMS's Comprehensive Primary Care initiative.
Unlike most of the CMS' models, CPC had the agency team up with commercial payers and managed-care plans to lower healthcare costs for all patient populations in a particular region. 
Each payer doled out a monthly fee to practices of around $20 in order to encourage better care coordination by primary-care providers. Each practice on average received $175,775 from the CMS and other payers—equaling $51,286 per clinician or 12.5% of practice revenue—for CPC participants by the third year of the experiment in 2015, which is the last year full data are available. 
By the end of 2015, payers invested over $370 million to transform primary care and 445 practice sites in seven regions participated in the program. In all, about 327,000 Medicare beneficiaries and nearly 3 million patients nationwide saw their care affected by the CPC model.
The vast majority of healthcare providers who participated in the CPC have transitioned over to the current stage known as CPC Plus. Intriguing. A non fee for service payment model that providers appreciate.

Speaking of CMS,  the agency unveiled the new SSN free Medicare beneficary card on Friday.
CMS will begin mailing the new cards to people with Medicare benefits in April 2018 to meet the statutory deadline for replacing all existing Medicare cards by April 2019. In addition to today’s announcement, people with Medicare will also be able to see the design of the new Medicare card in the 2018 Medicare & You Handbook. The handbooks are being mailed and will arrive throughout September.
This is also a big transition for FEHB carriers whose enrollment includes a large cadre of Medicare beneficiaries.

Friday, September 15, 2017


Sen. Bill Cassidy (R Lousiana) according to the Hill, "is predicting he will win enough votes to pass his last ditch ObamaCare repeal-and-replace bill [discussed in last Wednesday's FEHBlog] through the Senate, despite the long odds he seems to be facing."

In 1993, the FEHBlog nearly fell out of breakfast nook when he read that Hillary Clinton's health care plan would end the FEHBP. The FEHBlog was much more chill when he read on the Health Affairs Blog that Sen. Bernie Sanders' (D Vermont) Medicare for All bill will end the FEHBP as well as all other employer sponsored healthcare. Needless to say, AHIP is upset, but this bill is not going anywhere for the time being.

The single payer issue boils down to this - Medicare survives by cost shifting onto employer sponsored healthcare. If employer sponsored healthcare disappears, Medicare spending, which already is high, would go through the roof.  If the medical community supports this initiative, it will be killing the golden goose. There is no such thing as a free lunch.

End of the week tidbits --

  • The large Blue Cross health insurer, Anthem, is helping to control medical costs by sharing population health data with healthcare providers and vice versa according to Healthcare Finance
  • The AMA brings us up to date on litigation and regulatory doings relating to the zany and complex PHSA § 1557 non-discrimination rule added by the ACA.  Now there's a rule that could be simplified.
  • The FEHBlog found a useful, detailed bio of Jeff T. H. Pon, the President's nominee for OPM Director, on

Wednesday, September 13, 2017

Mid week update

The Washington Post reports that  four Republican Senators (Lindsey Graham (SC), Ron Johnson (WI), Bill Cassidy (LA) and Dean Heller (NV) have introduced an ACA reform bill that "would leave in place most of the financial props that support the ACA, eliminating only a tax on medical devices. At the same time, it does not attempt to replace the current law’s policies with more conservative federal approaches, instead allowing each state to define its own rules for health plans that may be sold to residents and the help consumers should receive to afford that insurance." The bill would repeal the ACA's individual and employer mandates, but not the ACA's taxes, other than the medical device tax. Here's a link to the gang of four's explanation of the bill, including its text.

The Chattanoogan reports on its Senator Lamar Alexander's effort to craft a bipartisan ACA reform bill. Sen. Alexander who chairs the Senate Health Education Labor and Pensions Committee will hear from a state insurance commissioner, doctors, and patient advocates tomorrow.  He expects to release legislative language next week. Time is running short on both bills for a variety of reasons.

The Senate Finance Committee held a hearing on the individual health insurance market yesterday which featured the FEHBlog's go to guy, Avik Roy's testimony. It's worth reading.

Here a few tidbits:

  • Healthcare Dive reports on a recent study concluding that "77% of healthcare consumers say it’s important or very important to know costs before treatment and 53% want to discuss financing options before care."
The survey results show a gap in what patients expect and what hospitals, medical groups and healthcare providers are delivering to patients, said KaLynn Gates, president and corporate counsel of HealthFirst Financial.

Gates suggested providers that offer financial guidance, as well as meet clinical needs of their patients, are “much more likely to thrive in this era of rising out-of-pocket costs and growing competition for patients among traditional and non-traditional providers.”

  • McKnight's Long Term Care News tells us that according to a MedPAC and common sense directing hospital patients to higher quality nursing homes can reduce unnecessary readmissions. 

But discharge planners currently are limited by rule as to how they can educate or steer patients on their post-acute options, critics complain. MedPAC recommended modifying discharge planning rules to allow hospitals to recommend specific nursing home and home health providers — a practice that's already allowed in the Comprehensive Care for Joint Replacement program. The group also discussed the possibility of having discharge planners openly consider post-acute providers' quality ratings when developing discharge plans, and offering quality data to patients prior to discharge.
Perhaps in the meantime health plan case managers can fill the gap.

  •  Epic, which is the largest electronic health records vendor, announced new software that "will allow patients to grant access to their data to any providers who have internet access, even if they don’t have EHRs. In addition, using Share Everywhere, a provider granted access can send a progress note back to the patient’s healthcare organization for improved continuity of care." The software will be embedded in Epic's EHR and also will be available to patients as a cell phone app later this year. 

Sunday, September 10, 2017

Weekend update

Congress is session this week, but the House of Representatives will not be holding votes tomorrow due to Hurricane Irma. Here's a link to OPM's FEHBP hurricane-related guidance. 

The FEHBlog read three eye-opening stories in the Wall Street Journal this weekend:
  • The Journal credibly reports that the Joint Commission which accredits hospitals is not forthcoming about hospital safety violations. "This certifier of hospital quality, however, typically takes no action to revoke or modify accreditation when state inspectors find serious safety violations, according to a Wall Street Journal database analysis of hundreds of inspection reports from 2014 through 2016."  In the words of Curb Your Enthusiasm, is a big bowl of wrong. 
  • The Journal further reports in an article about the major prescription drug manufacturer Eli Lilly that
The pharmaceutical sector still enjoys some of the biggest profit margins of any industry, and continues to charge high prices for many brands. At the same time, a conflux of issues presents challenges: health insurers and politicians have stepped up pressure on prices; R&D is often expensive and unsuccessful; and competition from low-cost generics remains a threat. That has left companies leaning on cost cuts and efficiency improvements to drive profit growth. The result is a dramatically shrinking workforce.
Drug companies have cut more than 269,000 U.S. workers since the beginning of 2007, according to job-outplacement firm Challenger, Gray & Christmas Inc., though the annual number of industry job losses has declined over the past five years. “When the pressure gets heavy, the scrutiny turns to the size of a company’s payroll,” Challenger, Gray CEO John Challenger said in an interview.
  • Finally, the Journal reports in an article about large health insurer Cigna that
health insurance has been a magnificent investment in recent years. The five largest publicly traded health insurers by market value— Aetna , Anthem, Cigna, Humana , and UnitedHealth Group —have all performed exceptionally. The share prices have nearly quintupled on average since the Affordable Care Act became law in 2010. The S&P 500 is up just 116% over that period. 
The FEHBlog should add that he is pro-profit-making. 

Friday, September 08, 2017


Congress today passed a bill (H.R. 601) that provides for, according to the Wall Street Journal, $15.25 billion in relief for victims of Hurricanes Harvey and Irma as well as a three-month extension of the government’s funding and borrowing limit" to December 8, 2017.  

The Senate Health Education Labor and Pensions Committee held two hearings this week on bipartisan ACA reform. Once was with State insurance commissions and the other was with State governors. The Committee has two more hearings scheduled for next week. The Wall Street Journal reports that
Senate Health Committee Chairman Lamar Alexander (R., Tenn.) said he hoped to reach an agreement with Democrats by the end of next week on the insurer payments, which offset subsidies they provide low-income consumers.
At a hearing Thursday, Mr. Alexander suggested he would be willing to authorize the subsidy payments for multiple years, as Democrats are demanding, in exchange for “structural changes” to the ACA, also called Obamacare.
Mr. Alexander, who is crafting the package jointly with Sen. Patty Murray (D., Wash.), aims to win Congress’s final approval before the end of the month, when insurers will sign their ACA contracts for 2018. The urgency was underlined Thursday when two insurers announced they would pare back coverage in Virginia and Maine because of uncertainty surrounding the payments.
At the same time, Sen. Bill Cassidy (R., La.), an architect of a competing plan that would repeal large parts of the ACA, said he would formally introduce his own plan on Monday, raising the possibility of a clash between the two Republican-led efforts.
Here's a link to the Week in Congress's report on other doings on Capitol Hill.

Health Care Dive tells us that

  • From 2010 to 2016, healthcare markets continued to concentrate, according to new research published in Health Affairs.
  • In 2016, 90% of metropolitan statistical areas (MSAs) had a high concentration of hospitals.
  • Primary care physician concentration increased the most, in part due to such providers being acquired by larger care delivery systems. "From 2010 to 2016, the share of primary care physicians working in organizations owned by a hospital or health care system increased from 28% to 44% — a dramatic increase of 57% — while the shares in independent solo practices or organizations owned by a medical group decreased," wrote author Brent Fulton, assistant adjunct professor at Petris Center in the School of Public Health, University of California, Berkeley. 
Cost curve up as usual thanks to the ACA (in the FEHBlog's view).

The Government Accountability Office issued a report suggesting IRS adjustments to the ACA's high cost plan excise tax a/k/a the Cadillac tax.  That tax is scheduled to kick in in 2020 and it's bound to impact FEHBP self and family coverage. The GAO website on the report displays some interesting demographic statistics about the Blue Cross Federal Employees Plan which was to be a yardstick for Cadillac tax adjustments. 

Let's wrap up the short work week (and the beginning of the NFL season) with a couple tidbits:
  • Employee Benefit News has an opinion piece suggesting that millennial workers may be interested in using telemedicine for mental health care. 
  • Modern Healthcare reports that the Experian credit bureau (not to be confused with Equifax which just suffered a massive data breach) is interested in advancing a practical patient identifier based on its Universal Identity Manager. Experian said that
whether the Universal Identity Manager catches on depends in part on who the early adopters are. The National Council for Prescription Drug Programs works with Experian, and the implementation pipeline now includes more than 
100 health systems, some payers and pharmacies. “Some of the big pharmacy chains are looking to adopt it,” Johnson said, “and if that happens, and if Epic adopts it, then I think it will accelerate.”

Monday, September 04, 2017

Happy Labor Day!

Congress returns from its August recess tomorrow, and according to the Hill, its agenda is overflowing with pressing issues this month which, of course, is the month in which the current federal fiscal year ends. The FEHBlog will keep tracking activities on the Hill.

Over the weekend, the Wall Street Journal had an interesting article about using negotiation strategies in doctor-patient discussions.  In 2013, a Harvard Business School professor and an emergency room physician, who happen to be brothers, wrote an article on this topic. The article is worth reading because applying negotiating approaches to difficult discussions obviously is templatable to many professional situations.  The article explains that the approach has been successfully used with prostate cancer patients.
The Harvard Business School pointers have brought “more clarity and definition and concise thinking” to how doctors discuss these risks with patients, Dr. Scardino said.
In a report published in June in the journal European Urology, the Sloan Kettering team, along with Professor Malhotra, analyzed the decisions of 1,003 prostate-cancer patients eligible for active surveillance. When they compared 761 patients in a two-year period before the doctors were taught the Harvard methods, with 242 patients who were counseled with the business-school pointers, they found the percentage that chose active surveillance rose to 81% from 69%. In other words, there was a decrease of 30% in “the risk of unnecessary curative treatment.” Even a “minimal intervention can decrease overtreatment,” the paper concluded. 

Here's an update on a couple of major data breach lawsuits that the FEHBlog has been following:

  • Bank Info Security reports that  "A federal judge [sitting in the Northern District of California] has granted preliminary approval for an amended $115 million settlement in the consolidated class action lawsuit against health insurer Anthem over a 2015 cyberattack that impacted nearly 79 million individuals. The case is now slated to be wrapped up next February."
  • Law360 reports that a federal judge sitting the the District Court for the District of Columbia has reactivated the multi-district class action against OPM stemming from the 2015 cyberattack against the agency. Late last year, the Court heard oral argument on the government's motion to dismiss the case for lack of standing. Federal courts will not hear a case unless plaintiff presents a justiciable dispute. For the past decade, federal courts have been reluctant to recognize standing in data breach cases because they considered the damages to be ephemeral. On August 1, the U.S. Court of Appeals for the D.C. Circuit issued an opinion in Attias v. Carefirst which bucks this trend. This was not the first court to do so but it is the appellate court that governs the OPM case. The federal district judge immediately asked the parties to brief the  application of the Attias decision to the OPM case. In the FEHBlog's opinion, OPM has the tougher row to how here. Attias was a game changer in the D.C. Circuit.

Sunday, September 03, 2017

President announces new OPM Director nominee

Yesterday, the White House website included a press release listing 42 nominations recently sent to the Senate for confirmation. The nominees included
Jeff Tien Han Pon of Virginia to be Director of the Office of Personnel Management. Dr. Pon most recently served as the Chief Human Resources and Strategy Officer for the non-profit professional membership organization, the Society for Human Resource Management as well as the Chief Operating Officer for Futures Inc., an organization dedicated to helping transitioning military explore careers, find jobs, and transition to civilian jobs. Dr. Pon previously served as a Principal at Booz Allen Hamilton, Inc. in the consulting service areas of Human Resources, IT, and Change Management and as the U.S. Department of Energy’s Chief Human Capital Officer. He also was the Deputy Director of eGovernment at the U. S. Office of Personnel Management where he and his teams brought about HR Shared Service Centers, Payroll Modernization, and the stand-up of USAJobs. Dr. Pon is a graduate of the University of Southern California, and holds a Ph. D. and Masters of Science degree from the California School of Professional Psychology. 
Mr. Pon appears to go by Jeff or Jeff T. H. Pon professionally based on his SHRM listing and Linked In. Here are links to interviews that Mr. Pon gave to while he was a principal at Booz Allen in 2011 and that he gave more recently to SHRM. Good luck to him.

Friday, September 01, 2017


Federal News Radio reports that yesterday, the President exercised "his authority to give federal civilian employees and uniformed service members a pay raise effective Jan. 1, 2018.Most civilian federal employees will receive an average raise of 1.4 percent, with an additional 0.5 percent adjusted in locality pay for a total of a 1.9 percent." The military will receive a 2.1% increase.

The Robert Woods Johnson Foundation has updated its state of obesity map for the U.S. The Foundation reports that
According to the most recent data, adult obesity rates now exceed 35 percent in five states, 30 percent in 25 states, and 25 percent in 46 states. West Virginia has the highest adult obesity rate at 37.7 percent and Colorado has the lowest at 22.3 percent. The adult obesity rate decreased in Kansas between 2015 and 2016, increased in Colorado, Minnesota, Washington, and West Virginia, and remained stable in the rest of states. This supports trends that have shown overall leveling off of obesity rates in recent years.
The obesity designation is based on a body mass index of 30 or over which is a widely accepted standard. Here's a link to their fast facts on obesity in our country.

The FEHBlog wants to correct one Tuesday tidbit which read "HHS's Office for Civil Rights, which is responsible for enforcing the HIPAA Privacy and Security Rules, has a new feedback form, which is capable of accepting many categories of feedback." The feedback form in fact was posted by the Office of National Coordinator for Health Information Technology within HHS. The HHS OCR complaint forms can be found at this link. Lo siento.

Enjoy the long weekend and the start of the college football season.

Thursday, August 31, 2017

Thursday update

Following up on Tuesday's post on Hurricane Harvey, the Washington Post reports that Houston's medical world mostly has withstood the hurricane due to significant disaster preparatory steps taken in the wake of a strong tropical storm in 2000.

Tuesday's post also noted that Gilead Sciences had acquired a company called Kite which specializes in develop CAR-T cancer treatments. Stat News reports that yesterday the Food and Drug Administration approved a Novartis CAR-T treatment called Kymriah for marketing. "Novartis’s product is the first CAR-T therapy to come before the FDA, leading a pack of novel treatments that promise to change the standard of care for certain aggressive blood cancers."  Novartis plans to charge $475,000 for a course of treatment which is lower than the $700,000 charge approved by the British health system.

How about some FEHB plan news?
  • The Kansas City Star tells the impressive story of the largest employee organization carrier in the FEHBP, GEHA
  • Blue Cross FEP announced that its rolling out telehealth services to its FEHB plan members next year under a contract with Teladoc. In a related story, Healthcare Dive reports that utilization of  telehealth services is building in the Medicare program.
And let's wrap it up with some tidbits
  • Take a look at Healthcare Dive's article on what's happening with the 21st Century Cures Act which Congress passed late last year. 
  • Healthcare Finance News informs us that "Healthcare spending growth slowed in 2016, and the trend appears to be continuing, according to the August 2017 Altarum Institute Center Health Sector Trend report."
  • The ACA's employer mandate requires that a large employer offer coverage with a minimum actuarial value of 60% and an affordable employee contribution not to exceed 9.5% of W-2 income which percentage is annually adjusted. Since the mandate was implemented in 2015, the percentage has crept up slightly. However, Accord consultants tells us that 
In 2015 the affordability threshold was adjusted to 9.56 percent. Then in 2016 the affordability threshold increased again to 9.66 percent and again in 2017 to 9.69 percent. However, for the first time, the affordability threshold has decreased in 2018 all the way back to 9.56 percent. The significant drop in the affordability threshold compared to 2017 places employers who are toeing the line of the affordability threshold in danger of being subject to a potential section 4980H(b) penalty if the price of coverage is not reduced for self-only coverage.
In programs like the FEHBP the employer can select a benchmark plan that is open to all employees for compliance purposes, instead of testing each plan offered to employees. 

Tuesday, August 29, 2017

Tuesday Tidbits

The FEHBlog returns to DC tonight following a tour of duty watching over his grandson. It's raining here in NYC but the rain is nothing like the rain that's fallen on Houston. Becker's Hospital Review reports on Hurricane Harvey's impact on healthcare in Houston.  Here's a link to OPM's FEHB related hurricane guidance.

Healthcare Dive reports that Anthem is implementing a new policy under which it will cover outpatient MRIs and CT scans in free standing imaging centers but not at hospitals.  Healthcare Dive observes that
Hospitals are continuing to increase the outpatient care they perform for a number of reasons. Patients often find it more convenient, and payment rates are usually higher than for services performed at a physician's office. Imaging done at a stand alone clinic can be drastically cheaper, and Anthem is looking to cut costs its deems unnecessary.
The largest payer in the country is as well. The CMS has a proposal to make costs more site neutral by paying services at off-campus hospital outpatient departments at 25% of regular outpatients rates. The same proposal also includes a small increase (1.75%) for outpatient payments. The American Hospitals Association generally opposes site-neutral regulations, arguing the change could reduce patient access to care. But other healthcare organizations, including the American Medical Association, say it levels the playing field and helps smaller practices stay afloat.
In the mergers and acquistions arena --

  • The Financial Times muses about a recent Gilead Science's acquisition. Gilead made a boatload of money by acquiring Pharmasset, a company that developed a Hepatitis C cure known as Solvadi. Gilead yesterday acquired Kite for about $12 billion. Kite is "one of the leading companies in the pioneering field of chimeric antigen receptor therapy or Car-T, a one-time treatment that involves re-engineering a patient’s blood cells so they can identify and attack cancer."  
  • Reuters reports that "Advisory Board Co said it would sell its healthcare business to UnitedHealth Group Inc’s Optum unit and education business to private equity firm Vista Equity Partners, for a total deal value of $2.58 billion."
The Health Affairs Blog discusses a recent National Academy of Medicine study on how to reduce healthcare costs by redesigning care for high need patients. The study principally provides advice to health care providers but it also explains the role for payers and the government. 

Finally on the information technology security front,
  • Beckers Hospital Review offers an Security Scorecard ranking of 18 industries based on their level of cybersecurity protections. The FEHBlog is not sure whether health insurers fall under financial services (ranked fifth) or healthcare (ranked 13th). The FEHBlog guess is the former. 
  • HHS's Office for Civil Rights, which is responsible for enforcing the HIPAA Privacy and Security Rules, has a new feedback form, which is capable of accepting many categories of feedback. 

Sunday, August 27, 2017

Weekend update

Congress remains out of town for another week.  The FEHBlog is in New York City for another two days. The weather in NYC has been spectacular particularly for late August.

In any event, OPM announced that "Rob Leahy will serve as OPM’s Acting Chief Information Officer (CIO), following the departure of David DeVries on September 2, 2017. Mr. Leahy currently serves as OPM’s Deputy CIO. In addition, OPM Chief Information Security Officer (CISO) Cord Chase will transition into the role of Acting Deputy CIO. It's surprising that the President has not nominated a new candidate for OPM Director.

While the FEHBlog has noticed that the ACA regulators have provided regulatory relief to health care providers and insurers in the individual market, the FEHBlog does not recall any efforts to provide regulatory relief to group health plans and insurers. It would not take a federal law or regulation. It would just involve repealing some burdensome ACA FAQs. That's involves as much administrative procedure as tossing a piece of paper into a trash can.

The FEHBlog noticed an odd op-ed in the Wall Street Journal last week.  The op-ed asserts that insurers are continuing to apply pre-existing condition limitations. The ACA like the FEHBP prohibits health plans from limiting coverage at the first time of eligibility. The laws do not limit the use of reasonable medical management techniques like pre-authorization and pre-certification which have in around in the FEHBP and the entire insurance market for decades. Yet the op-ed seeks to redefine those measures as pre-existing condition limitations which is non-sense. The Morning Consult reports that AHIP has come to industry's defense on this point as well.  Health plans will be unable to play their role in controlling healthcare costs if they are deprived of their tools.

Friday, August 25, 2017


The FEHBlog is in Manhattan with Mrs. FEHBlog caring for their grandson while his parents are out of town. It's a lovely late summer afternoon in NYC.

The actuarial consulting firm, Aon, reported that
Total budgeted health care costs per employee (including employer premium, employee premium and employee out-of-pocket) are projected to top $15,000 in 2018, up from $14,266 in 2017.
After plan design changes and vendor negotiations, the average health care rate increase for mid-size and large companies was 3.9% in 2017. Aon is projecting that average health care cost increases for mid-size and large companies will be 4.5% after plan design changes and vendor negotiations in 2018.
The Hill reports that the Federal Bureau of Investigation "has arrested a Chinese national in the United States in connection with malware used in the 2015 breach of the Office of Personnel Management (OPM)."

Healthcare Dive tells us about the steps that health plans and providers are taking to improve the accuracy of health plan provider network directories.  Why not require the doctor to inform his or her patients about the networks in which he or she participates. It strikes the FEHBlog that this step would push the ball forward.

Health Day discusses a recent JAMA study of "the price of anti-cholesterol drugs -- called PCSK9 inhibitors" which concludes that the current price "would have to be slashed by a whopping 71 percent to be deemed cost-effective."
Dr. Kim Allan Williams, who was not involved in the study, is past president of the American College of Cardiology. He said some doctors have a difficult time with such studies because they compare patients' lives and "events" -- such as heart attack and stroke -- versus dollars spent on these medicines.
The new study doesn't change his view of the value of the PCSK9 inhibitor class.
"No one's giving those drugs unless the patient is incapable of getting to the target [level of LDL cholesterol]," said Williams, who is chief of cardiology at Rush University Medical Center in Chicago. "You're only going to use it for a situation where you have no choice."
Because the study is based on list prices, not what patients actually pay, it's also "difficult to analyze the cost-effectiveness when [you] don't know exactly what the cost is," Williams added.

Wednesday, August 23, 2017

Midweek update

OPM should be wrapping up 2018 benefit and rate negotiations with carriers by now. The Washington Post reminds us that the 2018 Federal Benefits Open Season is set to occur from November 13 to December 11, 2017. The Post notes that "Premiums typically are announced earlier, in September. Increases have averaged about 7 percent the past several years — but remember, those are averages, and a given plan’s numbers can be much higher or lower." The government contribution toward FEHBP coverage is 72% of the enrollment weighted average premium capped at 75% of the selected plan's premium.  As a general rule of thumb, if your selected plan is under that cap, then the lion's share of that year's rate changes usually are shielded from the enrollee.  If your plan is over that cap, premium increases and decreases are quite visible. As the FEHBlog has noted, the wild card affecting this year's premiums is whether Congress will continue to suspend or repeal the onerous and really senseless health insurer tax.

In a bit of good news, Senator Charles Grassley (R Iowa) announced that
The Over-the-Counter Hearing Aid Act became law as part of the Food and Drug Administration (FDA) Reauthorization Act.  The bicameral measure requires the FDA to write regulations ensuring that the new category of over-the-counter hearing aids meets the same high standards for safety, consumer labeling and manufacturing protections as all medical devices, providing consumers the option of an FDA-regulated device at lower cost.
This new category once implemented will bring down the cost of hearing aids for consumers.

In other good news, Healthcare Dive reports that the large Blues-licensed health insurer Anthem announced that
It reached its goal of reducing filled opioid prescriptions by 30% earlier than it initially planned. 
The company had originally set the goal among its affiliated health plans with a target of achieving it by 2019. The idea was to limit the quantity of opioid prescriptions in order to prevent accidental addiction and opioid use disorder. 
Anthem had already taken steps such as limiting coverage for newly prescribed short-acting opioids to seven days. That policy, rolled out in October 2016, applied to all individual, employer-sponsored and Medicaid plan members—with the exception of those receiving palliative care or who have sickle cell anemia or cancer. 
It also implemented a prior authorization policy for long-acting opioids starting in September 2016, and has set up a system that alerts providers about members who may be at risk for an opioid use disorder.
In other news,

  • Healthcare Dive also tells us that healthcare provider groups generally were pleased by CMS's proposed Medicare Part B / MACRA payments to doctor rule. Hopefully, CMS's efforts to relieve regulatory pressure on providers will encourage doctors to stay in or even rejoin Medicare Part B.
  • Also on the Medicare front, the Chicago Sun Times reports that nearly 575,000 Medicare beneficiaries used the new end of life counselling benefit in 2016.

Nearly 23,000 providers submitted about $93 million in charges, including more than $43 million covered by the federal program for seniors and the disabled.
Use was much higher than expected, nearly double the 300,000 people the American Medical Association projected would receive the service in the first year.
That's good news to proponents of the sessions, which focus on understanding and documenting treatment preferences for people nearing the end of their lives. Patients and, often, their families discuss with a doctor or other provider what kind of care they want if they're unable to make decisions themselves.

  • One of the few provisions in the ACA that expressly references the FEHBP permits employers to raise premiums by up to 30% for non-compliance with wellness programs and up to 50% for non-compliance with smoking cessation programs.  The Equal Employment Opportunity Committee (EEOC) issued rules implementing this provision.  Fierce Healthcare reports that a federal district judge in DC ruled earlier this week that 

The EEOC has “failed to provide a reasoned explanation” for its decision to adopt the 30% incentive levels in the two rules. “Neither the final rules nor the administrative record contain any concrete data, studies or analysis that would support any particular incentive level as the threshold past which an incentive becomes involuntary in violation of the ADA and GINA,” he added.  
But because vacating the rules would “have significant disruptive consequences” for employers that have already adopted wellness programs that offer participation incentives, Bates ordered the rules remanded to the EEOC for reconsideration.
OPM believes that the government contribution calculation rule in the FEHBA (5 USC Sec. 8909) effectively preempts the agency from allowing carriers to use these brickbat incentives.