Thursday, July 20, 2017

Thursday Tidbits

The Senate Budget Committee posted a July 20 discussion draft of the Better Care Reconciliation Act today. CBO announced that it would be updating its projections for the new draft.

The federal government posted its 2017 updated semi-annual regulatory agenda today.
The Agenda represents ongoing progress toward the goals of more effective and less burdensome regulation and includes the following developments:
  • Agencies withdrew 469 actions proposed in the Fall 2016 Agenda;
  • Agencies reconsidered 391 active actions by reclassifying them as long-term (282) and inactive (109), allowing for further careful review;
  • Economically significant regulations fell to 58, or about 50 percent less than Fall 2016;
  • For the first time, agencies will post and make public their list of "inactive" rules-providing notice to the public of regulations still being reviewed or considered.
Here's a link to OPM's agenda which includes several FEHBP items.

Wednesday, July 19, 2017

Mid-week update

Axios has an interesting report on where the current state of healthcare re-reform after four Senators came out against the Better Care Reconciliation Act on Monday thereby causing Senate Majority Leader McConnell to fall short on the vote count.
All of the Republican senators who oppose the Senate health care bill are meeting tonight to work out their differences — after being told by President Trump this afternoon that they need to work late into the night to get a deal. The holdouts, including moderates and conservatives, are scheduled to meet in Sen. John Barrasso's office at 7:30 pm Eastern with the goal of getting a deal to revive the shelved Affordable Care Act repeal and replacement bill, according to sources with direct knowledge of the discussions.
The Congressional Budget Office reported as the FEHBlog has been typing this out that "Later today, CBO and the Joint Committee on Taxation (JCT) will release estimates of the effects of the [Senate's] Obamacare Repeal Reconciliation Act of 2017.

Meanwhile, the House Budget Committee is working on an FY 2018 budget resolution. A markup hearing was held today.  Federal News Radio reports on the budget resolution's impact on federal employees and annuitants. Modern Healthcare further informs us that
The House Budget Committee on Wednesday agreed [at its markup hearing] to bake in hundreds of billions in Medicaid cuts from its ACA repeal bill to the budget resolution, plus an additional $114 billion in cuts over 10 years.
The committee's Republicans' unanimously approved the decision with no Democrats on board. The budget resolution, which is the foundation for passing tax reform in the Senate without Democratic votes, also assumes Medicare will reduce spending by $487 million from 2018 to 2027.
Some of the additional savings would come from imposing a work requirement on Medicaid adult beneficiaries who are younger than 65 and are not on Social Security disability as a condition of eligibility.
 The resolution now heads to the House floor.

On the disease front, the American Hospital Association tells us that
An estimated 12.2% of U.S. adults had diabetes in 2015, including one in four aged 65 and older, according to the latest national estimates released by the Centers for Disease Control and Prevention. Nearly one-quarter of the 30.2 million adults with diabetes were not aware they had it, based on data from the National Health and Nutrition Examination Survey and Census Bureau. Fasting glucose and hemoglobin A1C levels were used to derive estimates for undiagnosed diabetes and prediabetes. About one-third of adults (84.1 million) had prediabetes, blood glucose levels at risk of progressing to diabetes, including nearly half of adults aged 65 and older. "Consistent with previous trends, our research shows that diabetes cases are still increasing, although not as quickly as in previous years," said Ann Albright, director of CDC's Division of Diabetes Translation. "Diabetes is a contributing factor to so many other serious health conditions. By addressing diabetes, we limit other health problems such as heart disease, stroke, nerve and kidney diseases, and vision loss."
Those are startling numbers.  Meanwhile that Washington Post reports on an ongoing study that is suggesting that the use of PET scans can significantly improve of the accuracy of Alzheimer Disease diagnoses.

Monday, July 17, 2017

Weekend update supplement

The FEHBlog forgot to link to the BNA article about the missing in action Spring 2017 federal semi-annual regulatory agenda. The article notes that the agenda will be posted on reginfo.gov this week and it will reflect the impact of the 2 out in 1 in executive order.  Currently that website will not pull up so the government may be adding the new agenda now. The FEHBlog will check back tomorrow as duty calls.

Sunday, July 16, 2017

Weekend Update

Congress remains in session this week on Capitol Hill. Here's a link to the Week in Congress's report on last week's actions there.

Due to Senator John McCain's unexpected hospitalization, the Senate will not be voting on the Better Care Reconciliation Act this week.  Reuters also reports that the Congressional Budget Office will take a little more time to prepare its report on that bill.

Last week, the Social Security and Medicare trustees issued their annual report. The Associated Press reads the tea leaves to find that Social Security recipients should receive a 2.2% cost of living adjustment for 2018, which surpasses 2017's 0.3% increase and 2016's no COLA.  The trustees also "project that Medicare Part B premiums will remain unchanged — $134 a month for most, though retirees with higher incomes pay more." Federal annuitants receiving CERS benefits and recent annuitants may see higher Part B premiums than others because of the exceptions to the law which generally protects annuitants against sharp increases in Part B premiums. "Both Social Security's cost-of-living adjustment and the Medicare Part B premium are to be announced in the fall."

Last week, the Missouri Supreme Court finally came to its senses and came into line with the U.S. Supreme Court's April 2017 decision holding that the FEHB Act, 5 U.S.C. Sec. 8902(m)(1), preempts  state laws purporting to interfere with the subrogation and reimbursement rights of FEHB plan carriers. The third time was the charm for this court.

Friday, July 14, 2017

Happy Bastille Day!

Hey, France did help us win the Revolutionary War!

It has been a busy week.

Yesterday, the Centers for Medicare and Medicaid Services announced proposed calendar year 2018 payment policies for outpatient hospital / ambulatory surgical care and physician services under Medicare. The CMS administrator, Seema Verma, notes in these announcements that CMS is looking to relieve regulatory burden on providers and help improve the provider / patient relationship among other goals.

Speaking of relieving regulatory burden, Wednesday was the comment deadline on CMS's request for public comment on "Reducing Regulatory Burdens Imposed by the Patient Protection and Affordable
Care Act and Improving Healthcare Choices to Empower Patients."  Here a links to a potpourri of interesting comments -- AHIP, U.S. Chamber of Commerce, American Benefits Council, NCQA, United Health Group, and CVS Health Care.

Healthcare Dive reports on a JAMA study finding that traditional Medicare and Medicare Advantage plans pay doctors just about the same amount. Private sector plans, including FEHB plans, pay more, which illustrates cost shifting from Medicare to everyone else (except Medicaid which also cost shifts).  If we went with a Medicare for All program, there would be no place left to shift costs. The FEHBlog does not understand why providers can't seem to comprehend this fact.

Health Data Management tells us that the Trump Administration wants to improve the utility and interoperability of electronic medical records. Good luck with that

Healthcare Dive reports on "the largest healthcare fraud takedown in history.  The Boston Globe's STAT reports  that Attorney General Jeff Sessions is implementing a crack down on opioid related fraud specifically.

CBS reports that a  form of gene therapy treatment known as CAR-T is working its way through the FDA approval process. This particular treatment is aimed at advanced leukemia in children and young adults.
The therapy could be the first of a wave of treatments custom-made to target a patient's cancer. Called CAR-T, it involves removing immune cells from a patients' blood, reprogramming them to create an army of cells to recognize and destroy cancer and injecting them back into the patient.
The final stage in the new drug approval process should be reached later this year. Yippee.



Thursday, July 13, 2017

Revised BRAC follow-up

Here's a link to a law professor's take in Forbes on the revised BRAC.  The article mentions that Sen. Lindsay Graham (R SC) is submitting his own ACA repeal and replace bill that would repeal the individual and employer mandates and funnel all of the ACA funding to the States for local healthcare use.

According to a Wall Street Journal podcast, the Senate majority will be discussing the revised BRAC over the weekend while they wait for the Congressional Budget Office report. The next step is to hold a floor vote on whether to proceed with consideration of the bill.  That requires 50 votes in this case because it's a reconciliation bill. If that succeeds and the Senate majority can only afford to lose two Republican Senators on any vote, then the bill will be open for consideration of amendments followed by a final vote unless the Senate majority leadership pulls back the bill.

The FEHBlog does not know where this Republican initiative is headed.  The FEHBlog is concerned that if the initiative fails, the ACA health insurer tax may revive for 2018 (unless Congress separately addresses the issue) and thereby drive up FEHBP premiums.  If successful, this initiative, in addition to eliminating these onerous fees, would improve the offerings of consumer driven plans and allow OPM to return the flexible spending account maximum to $5000.  In the FEHBlog's view, it also would be helpful if OPM would allow carriers more flexibility in benefit design but that can be done administratively whether or not the Republican initiative passes.






Revised Senate Better Care Reconciliation Act

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.

Tuesday, July 11, 2017

Tuesday Tidbits

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. 

Sunday, July 09, 2017

Weekend update

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. 




Friday, July 07, 2017

TGIF

 The Wall Street Journal features an essay promoting smart medicine. The author of the essay is a cardiologist and author named Eric Topol. The essay's lead is "Our health-care system won’t be fixed by insurance reform. To contain costs and improve results, we need to move aggressively to adopt the tools of information-age medicine." Good point.  For example,
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."

Wednesday, July 05, 2017

Mid-week update

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.

Sunday, July 02, 2017

Independence Day Weekend Update

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 Wall Street Journal also offered expert advice on reducing anti-biotic overuse by a Johns Hopkins MD executive. As a result of the article, he ran across the author's interesting blog, Voices for Safer Care.  A recent post concerns "Breaking Down the Barriers to Second Opinions. 

Friday, June 30, 2017

TGIF

Yesterday, the Financial Services and General Government subcommittee of the House Appropriations Committee cleared the FY 2018 appropriations bill on the same topic. This is the bill that funds the FEHBP, OPM, etc. Here is a link to the Committee's announcement of the bill. Federal New Radio reports on the subcommittee hearing which was held yesterday afternoon. The report highlights 
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.

Thursday, June 29, 2017

Drug Store News

The FEHBlog learned from the Wall Street Journal this morning that the Walgreens Boots Alliance has a new deal with Rite Aid. According to the WGA press release, 
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.