Friday, May 24, 2019

TGIF

Ah it's the end of the great annual federal three day weekend drought. 

Today, the Department of Health and Human Services proposed revisions to the complicated Obama era Affordable Care Act Section 1557 non-discrimination rule. The rule change will be controversial but I doubt that few will oppose this sensible change:
The proposed revisions would eliminate $3.2 billion in unneeded paperwork burdens imposed by the 2016 rule. Covered entities report that the 2016 rule requires them to send billions of “tagline” notices each year informing patients and customers of their ability to have “significant documents” translated in at least 15 languages. When HHS adopted the 2016 rule, it projected notice and taglines costs of about $7.2 million in the first five years. Because the 2016 rule did not fully account for printing and mailing costs associated with these notices and taglines, it underestimated the burden of these requirements by over three billion dollars over five years. Instead of requiring regulated health companies to mail billions of paper taglines to mostly English speakers, the money saved could be used to more effectively address individual needs of non-English speakers such as by providing increased access for translators and interpreters.
The above HHS link provides links to the text of, and a fact sheet on, the proposed rule. The proposal will be open for public comment for sixty days after publication in the Federal Register.

The Wall Street Journal reported this morning that
President Trump is expected to release an executive order as early as next week to mandate the disclosure of prices in the health-care industry, according to people familiar with the discussion. The order could direct federal agencies to pursue actions to force a host of players in the industry to divulge cost data, the people said. The administration is also looking at using agencies such as the Justice Department to tackle regional monopolies of hospitals and health-insurance plans over concerns they are driving up the cost of care, according to two people familiar with the discussions. The White House declined to comment on its plans.
Time will tell.

Following up on yesterday's announcement of a HIPAA Privacy and Security Rule alleged violation settlement with a business associate, HHS issued a new Fact Sheet on Direct Liability of Business Associates under HIPAA, a law that was enacted in 2009. Reminders are helpful. Health Data Management discusses implications of the settlement here.

Health Data Management also calls attention to an HHS Office of Inspector General report finding that Medicare accountable care organizations with robust health information technology tools provide better patient care.
“ACOs that used a single electronic health record system across their provider networks were able to share data in real time,” states the OIG’s report. “A small number of ACOs had access to robust health information exchanges, which gave ACOs access to patient data even when patients saw providers outside the ACOs’ networks. Most of the ACOs we visited use data analytics to inform their care coordination by identifying and grouping patients according to the potential severity and cost of their health conditions.”
In a good news / bad news story, the Boston Globe's STAT reports this afternoon that
the Food and Drug Administration on Friday approved the first gene therapy for a type of spinal muscular atrophy, a lifesaving treatment for infants that will also be the most expensive drug in the world. Known as Zolgensma, the gene therapy treats children under 2 years of age with spinal muscular atrophy, an inherited neuromuscular disease that causes progressive loss of muscle function. The most severe form of SMA causes infants to die or rely on permanent breathing support by the age of 2. The disease is caused by a defect in a gene that makes SMN, a protein necessary for the survival of motor neurons. Zolgensma uses a re-engineered virus to deliver a functional copy of the defective gene so that SMN protein can be produced. Novartis is pricing Zolgensma at $2.125 million, or an annualized cost of $425,000 per year for five years, the company said.
This is another reason why it makes sense for small and even mid-sized health plans to consider purchasing specific risk stop loss insurance.

Becker's reports that the measles outbreak has spread to 25 states in the United States for a total of 880 cases. The Health Affairs Blog offers an article explaining why linking adult vaccines and quality is a public health imperative. 
There are currently 13 recommended vaccines on the adult immunization schedule and many additional adult vaccine candidates in the pipeline. Despite proven efficacy and favorable recommendations from the Advisory Committee on Immunization Practices, availability and accessibility of vaccines alone are insufficient to encourage uptake. 
Traditional policy levers such as school-entry requirements and the Vaccines for Children program have successfully improved vaccination rates in pediatric populations. For adult populations, however, complex challenges have driven the need for stakeholders to explore alternative solutions. As the country innovates in the areas of health care payment and delivery, quality measurement tied to payment presents a promising lever to drive adult immunization uptake and achieve national population health targets. 

Thursday, May 23, 2019

Thursday Thoughts

The FEHBlog was happy to read about the discussion draft of bipartisan healthcare reform bill released today by the chair, Sen. Lamar Alexander, and ranking minority member, Sen. Patty Murray, of the Senate Health, Education, and Pensions Committee. Kaiser Health News reports that the bill picks up two of the FEHBlog favorite cost saving approaches:
The novel ["surprise bill"] part from Alexander and Murray is the idea of an “in-network guarantee.” It requires that any hospital considered “in-network” for a health plan must promise that everyone working there is also in-network.  This would avoid situations in which patients choose a hospital because they know their insurance company will cover the bill, only to find out that one of the doctors they saw was out-of-network, leaving the patient with a hefty bill.  It also requires that labs and diagnostic tests be in-network, cutting off another avenue of surprise bills, [and]
Instead of regulating drug prices, the package would address patent protections, making it easier for generics to get to market and harder for brand-name drugs to maintain exclusive patents for lengthy periods. 
The Senate HELP committee is requesting comments on the discussion draft. Comments must be submitted to LowerHealthCareCosts@help.senate.gov by 5 PM on Wednesday, June 5, to be considered.

Speaking of surprise bills, Health Payer Intelligence reports on a House Ways and Means Committee hearing on surprise billing held earlier this week.

The Centers for Disease Control issued a report yesterday on Trends in Cancer and Heart Disease Death Rates Among Adults Aged 45–64, 1999–2017."  Here are the top line results:
Cancer death rates for middle-aged adults aged 45–64 declined by 19% from 1999 to 2017 (224.9 deaths per 100,000 to 182.6), whereas heart disease death rates declined by 22% from 1999 (164.3) to 2011 (127.9) and then increased 4% from 2011 to 2017 (133.6). The same trend patterns were observed for both men and women. The cancer death rate was always higher than the heart disease death rate from 1999 to 2017, and was 37% higher in 2017.  
The Health and Human Services Department's Office for Civil Rights ("OCR") announced another settlement of HIPAA privacy and security rule violation allegation today.
On July 23, 2015, [Medical Informatics Engineering (MIE), an Indiana based HIPAA business associate] filed a breach report with OCR following discovery that hackers used a compromised user ID and password to access the electronic protected health information (ePHI) of approximately 3.5 million people. OCR’s investigation revealed that MIE did not conduct a comprehensive risk analysis prior to the breach. The HIPAA Rules require entities to perform an accurate and thorough assessment of the potential risks and vulnerabilities to the confidentiality, integrity, and availability of an entity’s electronic protected health information.
“Entities entrusted with medical records must be on guard against hackers,” said OCR Director Roger Severino. “The failure to identify potential risks and vulnerabilities to ePHI opens the door to breaches and violates HIPAA.”

Wednesday, May 22, 2019

Midweek update

The Federal Times, Govexec, and Federal News Network all reported on the House Oversight and Reform Committee hearing yesterday on the Administration's plan to dismantle OPM. The FEHBlog heard the acting Director Margaret Weichert, who was not combative, explain that she was hoping for a bipartisan legislative solution, but she received no support from the subcommittee members or the other witnesses at the hearing.  Unfortunately watching the hearing was not entertaining.

The Office of Management and Budget posted its Spring 2019 regulatory agenda today.  The FEHBlog regrettably has not seen much deregulation, if any, in the FEHBP. In any event, here's a link to OPM's regulatory agenda.

Health Payer Intelligence reports that "At Health Partners Plans [which is based in Philadelphia], a medically-tailored meal delivery program is improving outcomes and reducing costs for members with chronic disease." It's certainly worth reading.

As price transparency is referenced in OPM's 2020 call letter for benefit and rate proposals, it is worth noting this Modern Healthcare article which explains that ]
The [HHS] Health Information Technology Advisory Committee on Wednesday voted to remove price-transparency requirements from the proposed interoperability rule.  In its second meeting this month hashing out recommendations on how the federal government should address concerns related to information blocking and patient privacy, HITAC cautioned that tying price transparency to the information-blocking proposals would have an "unintended consequence of slowing down the finalization of the current ONC rule." Instead, it recommended ONC create a separate price-transparency task force within HITAC to produce recommendations for future rulemaking.
In other words, slow down.  The proposed interoperability rule is open for public comment until June 3. So far 926 comments have been submitted.


Tuesday, May 21, 2019

Tuesday's Tidbits

Here's a link to House Oversight and Reform subcommittee hearing on the OPM reorganization held this afternoon. At the link, you can find witness testimony and a video recording of the hearing.

Things are looking up for judicial affirmation of the CVS - Aetna merger settlement with Justice Department as a combination of red and blue states who originally opposed the settlement have not filed a brief supporting it, according to Healthcare Dive.  The hearing will be held beginning June 4 in the federal district court in Washington DC.

Fierce Healthcare reports on a study concluding that "there was little variation among primary care physicians when it comes to hospital readmission rates, leaving the researchers questioning whether policies that hold these doctors accountable for reducing readmissions may miss the mark." If doctors shouldn't be held responsible for hospital readmissions then why should health plans which has several more degrees of separation from the event be held responsible?

The Kaiser Family Foundation published an interesting study on third party reimbursement of prescription drug costs.
Highlights from this analysis include:

  • Private health insurance, Medicare, and Medicaid accounted for 82% of total retail prescription drug spending in the U.S. in 2017, while patients paid 14% of the total as out-of-pocket payments.
  • For spending on specific drug products, the top five drug products with the highest total spending alone account for at least 10% of total prescription drug spending in large employer plans, Medicare Part D, and Medicaid.
  • While some of the same drug products appear among the top 10 drug products with the highest total spending in large employer plans, Medicare Part D, and Medicaid, there is also variation that reflects differing covered populations.
  • Out-of-pocket drug spending per user among people in large employer plans and Medicare Part D is highest for drugs to treat cancer, multiple sclerosis and rheumatoid arthritis.
  • Antidiabetic agents, antivirals and psychotherapeutics are among the top therapeutic classes by total spending in large employer plans, Medicare Part D, and Medicaid.

Monday, May 20, 2019

Monday Musings

No one in the private sector would blink if corporate management decided to merge two related overhead departments like human resources and internal services. Nevertheless, it appears from the House Oversight and Reform Committee meeting notice and this Federal News Network article that tomorrow's Congressional hearing on the Trump Administration's plan to take a similar approach with OPM is going to be a real three ring circus. Get the popcorn ready.

Kaiser Health News reports that
Walmart Inc., the nation’s largest private employer, is worried that too many of its workers are having health conditions misdiagnosed, leading to unnecessary surgery and wasted health spending.
The issue crystallized for Walmart officials when they discovered about half of the company’s workers who went to the Mayo Clinic and other specialized hospitals for back surgery in the past few years turned out not to need those operations. They were either misdiagnosed by their doctor or needed only non-surgical treatment.
A key issue: Their diagnostic imaging, such as CT scans and MRIs, had high error rates, said Lisa Woods, senior director of benefits design for Walmart.
So the company, whose health plans cover 1.1 million U.S. employees and dependents, has recommended since March that workers use one of 800 imaging centers identified as providing high-quality care. That list was developed for Walmart by Covera Health, a New York City-based health analytics company that uses data to help spot facilities likely to provide accurate imaging for a wide variety of conditions, from cancer to torn knee ligaments.
Walmart will enforce this policy with increased cost sharing on those who fail to follow this policy. The FEHBlog hopes that Walmart will evaluate, and share with the public, whether this policy delivers results.  

A healthcare quality pal of the FEHBlog's called his attention to this Joint Commission announcement about a sea change in hospital quality reporting. The Joint Commission is the principal accrediting body for hospitals.
The Joint Commission is shepherding in the next generation of clinical quality by expanding the capabilities of its quality measure program to provide accredited hospitals with year-round, real-time access to quality measures. Over the last two years, The Joint Commission has transformed its electronic clinical quality measure (eCQM) reporting process to increase value and reduce burden for thousands of their 4,500 accredited hospitals with a Direct Data Submission Platform (DDSP). The Joint Commission is now continuing that digital transformation by making the platform and quality measure results continuously available, allowing providers to measure and improve performance in near real-time without additional outside vendors.
In today's Econtalk podcast, the host Russ Roberts, who has a Ph.D. in economics, spoke with Mary Hirschfeld, who has Ph.Ds in economics and theology. It was interesting conversation between Mr. Roberts who is a fan of Adam Smith and Ms. Hirschfeld who is a fan of St. Thomas Aquinas. In any event this Russ Roberts quote gave the FEHBlog a knowing smile:
"[Economic] incentives have problems * * * when you use incentives only for the things * * * that are measurable. * * * And you ignore the things that aren't measurable.

Sunday, May 19, 2019

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 on the Hill.

The Health Subcommittee of the House Ways and Means Committee will hold hearing concerning surprise medical bills on Tuesday afternoon. Fierce Healthcare looks at the differences between the two bipartisan surprise medical bills pending the Senate and the House.

The House Budget Committee will hold a hearing concerning the Congressional Budget Office's recent report on key design considerations and components of establishing a single payer system on Wednesday morning. In this regard, Rep. Rosa DeLauro (D Conn.) re-introduced a Medicare for America bill (HR 2452). This bill would add a super-charged public option to the Affordable Care Act exchanges. In the FEHBlog's view, and as explained in this Wall Street Journal op-ed, this bill is a Trojan horse for the single payer system.

Friday, May 17, 2019

TGIF

Following up on yesterday's leading items, Federal News Radio breaks down the Trump's administration's legislative proposal to dismantle OPM and Avik Roy offers some observations on CMS's Medicare Advantage and Part D drug pricing final rule.

In the examples of how federal law impacts healthcare department --

  • The Boston Globe reports on a recent study finding a substantial increase in mental health are claims over the past decade, a good thing which the FEHBlog attributes to the 2008 federal mental health parity law among other factors, and 
  • The American Medical Association reports that "2018 marked the first year in which there were fewer physician owners (45.9 percent) than employees (47.4 percent), not so good thing for professionals which the FEHBlog attributes to the Affordable Care Act. To that end, "more than half of physicians, 54.0 percent in 2018, continue to work in practices that are wholly owned by physicians, sometimes referred to as “private practice.” This share is statistically lower than that of 2012 (60.1 percent) and 2014 (56.8 percent), but not that of 2016 (55.8 percent). More than half of the 2012 to 2018 shift away from physician- owned practice occurred during the first two years of that period.
The FEHBlog over the past couple months has been learning about APIs. An API is it the part of the [computer] server that receives requests and sends responses. An example of an API is Medicare's Blue Button which allows for Medicare claims data to be transmitted to a beneficiary's phone or table app. Modern Healthcare informs us that Dr. Donald Rucker, the chief of the Office of National Coordinator for Health Information Technology said in an interview that 
If all these [electronic health record interoperability] APIs [such as HL7's Da Vinci] work, the whole reporting of quality measures will, over time, eventually go away"  Dr. Rucker suggested that one day payers could access data from a provider through an API, and apply machine learning to extract quality measures. That would eliminate the need for clinicians to generate these measures "in a one-off kind of way," he said.
A win-win for payers and providers.

Thursday, May 16, 2019

Thursday Thoughts

Today, the Centers for Medicare and Medicaid Services issued their final Medicare Advantage and Part D Drug Pricing rule and it does not include the anxiety inducing provision to lower prescription drug prices by doing away with prescription drug rebates.  Part I.D. to the rule's preamble explains, "We sought comment on the possibility of adopting a new definition of “negotiated price” under which plan sponsors would be required to pass through all pharmacy price concessions at the point of sale. We will carefully review all input received from stakeholders on this issue [nearly 8,000 public comments in total] as we continue our efforts to meaningfully address rising prescription drug costs for beneficiaries."  Here's a link to the CMS fact sheet on the final rule.

Govexec.com this evening shared with the public a May 16, 2019, Office of Management and Budget letter to the heads of Congress proposing legislation to dismantle OPM. In pertinent part,
The primary purpose of the legislative proposal is to authorize the transfer of the vast majority of the current functions and resources of OPM to GSA, including Human Resources Solutions, Information Technology, Retirement, Health and Insurance Services. GSA will create a new Personnel Service to house the human resources and employee lifecycle management shared service offerings. Agencies will benefit from GSA helping them to obtain more strategic and comprehensive support for their needs.
A bi-partisan group of Senators including Sen. Bill Cassidy (R LA), a physician who sits on the Senate Health Education Labor and Pensions Committee, introduced a bill to stop surprise billing. It's a different approach from the House bi-partisan proposal discussed here last week as it covers all surprise situations, not just emergency cases, and it allows for independent dispute resolution.  The bill would apply to the FEHBP. The FEHBlog does expect a bill on this topic to enacted this year.

Wednesday, May 15, 2019

Midweek update

At this morning's business meeting of the Senate Homeland Security and Governmental Affairs Committee, the Committee reported favorably Dale Cabaniss's nomination to be OPM Director and Chairman Ron Johnson's (R WI) bill to end the ACA's multi-state program which OPM manages. There is currently only an Arkansas Blue Cross plan participating in that program.  For what it's worth, the FEHBlog expects that Ms. Cabaniss will be confirmed as OPM Director within the month.

Becker's Hospital Review discusses the Leapfrog Group's Spring 2019 hospital patient safety ratings.
For the spring update, Leapfrog contracted with the Johns Hopkins Armstrong Institute for Patient Safety and Quality to update its mortality estimates linked to medical errors, infections and injuries at graded hospitals. Researchers found that patients treated at hospitals given a "D" or "F" safety grade face a 92 percent higher risk of avoidable death, compared to 88 percent for "C" hospitals and a 35 percent for "B" hospitals.
The Wall Street Journal reported today that
About 3.79 million babies were born in the U.S. in 2018, according to provisional data from the Centers for Disease Control and Prevention’s National Center for Health Statistics. That was a 2% decline from the previous year and marked the fourth year in a row that the number fell. The general fertility rate—the number of births per 1,000 women ages 15 to 44—fell to 59.0, the lowest since the start of federal record-keeping.
With the latest decline, births in the U.S. have fallen in 10 of the last 11 years since peaking in 2007, just before the recession. Many demographers believed that births would rebound as the economy recovered, but that trend hasn’t materialized.
The article adds that
“We see these continuing trends: births to older moms increasing, births to younger moms going down,” said Brady Hamilton, a statistician/demographer with NCHS who co-wrote the report.
The trends suggest that a decline in unplanned pregnancies is a big part of America’s lower fertility. Research led by Kasey Buckles, an associate professor of economics at the University of Notre Dame, found that about 35% of the fertility decline from 2007 to 2016 is because of declines in pregnancies that were likely unintended.
“It’s really remarkable, not something that we’ve seen over the last century,” Prof. Buckles said of the changing fertility patterns. 
Also
Abortion doesn’t appear to be responsible for the birth decline. The Guttmacher Institute found that both the total number and the overall rate of abortions have fallen to their lowest levels since around the time that Roe v. Wade legalized the procedure in 1973.

Tuesday, May 14, 2019

Tuesday Tidbits

OPM Acting Director Margaret Weichert held a press roundtable today about the agency reorganization. Govexec and the Federal Times have reported on this event. Moreover, Govexec has shared an OPM document explaining the reorganization and the underlying rationale therefor.  Acting Director Weichert will be presenting her case for reorganization to the House Oversight and Reform Committee next Tuesday May 21.

The Health Affairs blog discusses a bipartisan proposal to fix the surprise billing problem ("with the notable exception of ambulance service") that the House Energy and Commerce Committee unveiled today. "The [proposed] legislation achieves this objective by combining the following three components:

  • Require the health plan to treat the out-of-network service as if it were in-network for purposes of enrollee cost-sharing, deductibles, and out-of-pocket limits;
  • Set a minimum payment amount that the health plan must pay to the out-of-network provider; and
  • Prohibit out-of-network providers from “balance billing” patients -- that is, from billing the patient any amount above the patient’s in-network cost-sharing.
These components would apply to all types of commercial health plans, both insured and self-funded, including FEHB plans.

Fierce Healthcare discusses an American Hospital Association report on how hospitals can save millions by improving patient access to behavioral healthcare.  OPM raised this access issue in its call letter for 2020 benefit and rate proposals. FEHB plans should consider encouraging the use of hospitals that follow the AHA's advice. 

On the Rx front --
  • The Wall Street Journal considers a price fixing lawsuit filed by over 40 state attorneys general against various generic drug manufacturers.  "the allegations highlight a basic health-care truth: All companies, including those charged with keeping spending in check, prosper when prices go up." However, "sn industry trade group accurately pointed out Sunday that generic-drug prices have declined overall for years. What is more, total generic-drug spending is a fraction of overall drug costs and a rounding error in the context of total U.S. health spending."
  • Fierce Pharma reports that AbbieVie, which manufactures the wildly successful specialty drug Humira, reached a settlement with the last of the biosimilar manufactuers that was preparing to bring a product to market fairly soon. 
Thanks to the latest settlement, AbbVie’s Humira looks safe in the U.S. until 2023, even as biosimilars have started eating away at the drug’s European sales. After the EU copycats launched last fall, AbbVie reported a 23% decline in first-quarter Humira sales outside of the U.S., to $1.23 billion. The drug's U.S. sales grew 7% to $3.2 billion.
As of now, Amgen will have the first crack at Humira’s lucrative U.S. market. That company was the first to strike a patent settlement with AbbVie and secured a Jan. 31, 2023, launch date. On the other end of the spectrum, Pfizer late last year inked the seventh patent deal with AbbVie, agreeing to a Nov. 20, 2023, biosimilar rollout.  

  • Healthcare Dive reports that U.S. District Judge Richard Leon has ordered three days of hearings beginning June 4, 2019, to hear witnesses testifying about the impact of the CVS acquisition of Aetna on the Medicare Part D market. Judge "Leon is tasked with deciding whether the DOJ settlement is in the public interest under the Tunney Act, which gives courts the power to review DOJ decisions. He can't sink the deal, but he can rule that the settlement didn't go far enough to protect consumers." 
Yesterday, the U.S. Labor Department issued guidance clarifying its March 2019 enforcement relief for so-called pathway 2 association health plans that were engaged in business before a federal district judge struck down pathway 2. That district court decision has been appealed to the U.S. Court of Appeals for the D.C. Circuit. 



Monday, May 13, 2019

Monday Musings

The New York Times offers an extensive article today on stem cell transplants used to treat joint problems.
Dr. Scott A. Rodeo, a surgeon and researcher at the Hospital for Special Surgery in New York, said the treatments were being studied there. So far, he said, “modest data” suggested that platelets might ease pain in arthritic or inflamed knees and elbows. “There’s great potential,” he said. “We are just not there yet. The marketing and use far outpace the science.”
For that reason, as explained in the article, health plans generally exclude these services from coverage.

MedCity News reports on the Food and Drug Administration's biosimilar production guidance that was issued last week.
Knock-off versions of biotech drugs have been on the market for several years now, but one way that the US market for biosimilars has lagged behind its European counterpart is on the question of interchangeability of biosimilars with their reference products.
On Friday, the Food and Drug Administration issued a final guidance on interchangeability, meaning the ability to substitute one product for the other without a prescriber’s involvement, as is the case for generic pharmaceutical drugs. It’s a finalization of a draft guidance issued in January 2017.
Here's a link to the FDA's press release.

Healthcare Dive discusses a recent J.D. Power survey of consumer views on health plans.
The J.D. Power study shows overall health plan member satisfaction up seven points from the prior three years, to 713 on a 1,000-point scale. Fueling the increase is greater satisfaction with coverage and benefits offered.
By contrast, high copays and clunky mobile apps pulled member satisfaction down. "Overall satisfaction scores are 254 points higher when members perceive their plan actively keeps out-of-pocket costs low, helped coordinate care and that there was enough coverage, yet 54% or fewer of health plan members say their plan delivers on each of these criteria," according to the study.
The report also shows people want lower-cost options such as telehealth, urgent care and retail clinics. Nearly half (48%) of respondents said they are very or somewhat likely to consider telehealth, and that share increased to 51% among Gen Y members. Among all members, about a third have used urgent care centers.
If you, like the FEHBlog, want consultant Avik Roy's views on the RAND study on hospital prices that the FEHBlog discussed last week, then click here.  This is the upshot --
Austin Frakt of Boston University, at his blog The Incidental Economist, has for years compiled the research that has shown that “cost-shifting” is a myth:
Indeed, one recent study found that from 1995 to 2009, a 10 percent reduction in Medicare payments was associated with a nearly 8 percent reduction in private prices. Another study found that a $1 reduction in Medicare inpatient revenue was associated with an even larger reduction — $1.55 — in total revenue. This would be impossible if hospitals were compensating for lower Medicare revenue by charging private insurers more.
Private prices go down when Medicare rates go down: not the sort of thing that would happen if cost-shifting is real. What’s actually happening is something much simpler: monopoly exploitation.
The FEHBlog believes that the problem stems from Medicare cost shifting and monopoly exploitation.

On the bright side, CNBC reports that
One of the biggest investment opportunities over the next decade will be in companies working to delay human death, a market expected to be worth at least $600 billion by 2025, according to Bank of America analysts. The analysts say companies such as Illumina and Alphabet are on the cusp of “bringing unprecedented increases to the quality and length of human lifespans. 



Sunday, May 12, 2019

Weekend Update

Happy Mothers' Day, readers.

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 on the Hill. As noted last week, the Senate Homeland Security and Governmental Affairs Committee plans to vote on Dale Cabaniss's nomination to be OPM Director during a business meeting on Wednesday morning.

The Federal News Network reports on the state of the Postal Service's effort to create a 10 year business plan as the House Oversight and Reform Committee requested last month. “Ultimately, the question is, what’s the role for your government-sponsored Postal Service in a 21st-century marketplace, and how are you going to fund it? So that’s a broad public policy discussion that we will continue to have with our public officials as well as other postal stakeholders,” [Postmaster General Megan] Brennan said to a group of reporters.  She said to expect the report to be issued in 45 days.

Employee Benefit News reports that Ocean Spray plans to stop charging employees co-payments for mental health care in order to improve access to that care, which is a concern that OPM raised in the 2020 call letter for FEHB benefit and rate proposals. Nothing in the rather complex federal mental health parity law prevents a plan from providing better benefits for mental health vs. medical care.

Willis Towers Watson issued a survey on employer sponsored health care in the U.S. last week.  The FEHBlog took note of the fact that
Nearly four in 10 employers (38%) are considering opening a health center at their workplace location to provide preventive, primary and urgent care by 2020 — a jump from the 26% that offer this today. Further, just over one in four employers (26%) plan to offer near-site health centers by 2020 — an even greater jump from the 8% that offer this today.
Employers are also expanding the types of care offered at health centers, adding mental health services, such as behavioral health counseling, in the next few years. Roughly half indicate they will offer onsite or near-site mental health services through the vendor managing the health center or through a community provider by 2020.
In the FEHBlog's view, one of the major defects in the Affordable Care Act lies its focus on providing highly regulated health insurance, rather than on improving access to health care services. As a result you get stories like the Sunday Washington Post lengthy story today on a struggling hospital in rural Oklahoma. Employers are acting on the problem, why doesn't Congress?  

Thursday, May 09, 2019

Thursday Thoughts

The President released his approach to solving the surprise billing problem today. Principally
The Administration wants to ensure patients are not price gouged in emergency situations by out-of-network providers they could not choose. In emergency situations, balance billing for amounts above the in-network allowed amount should be prohibited. 
The Administration wants to bring transparency to the confusing and opaque pricing system patients face when scheduling care.  Before scheduling their care, patients should be given information about whether the care providers are out of their network and what related costs that may bring.
The FEHBlog's preferred approach to emergency care is having each hospital require their affiliated providers to participate in the same networks in which the hospital participates.

Beckers Hospital Review reports that UniedHeathcare has rolled out a new bundled maternity care package.
The bundled payment program, launched with two healthcare providers in New Jersey and Texas, will reimburse care providers or a hospital for an episode of care — including prenatal, delivery and postpartum services — under a single payment. The bundled payments will link provider reimbursement to care outcomes.  The program, developed in partnership with healthcare provider organization U.S. Women's Health Alliance, is slated to encompass up to 20 provider groups by the end of the year.
 Smart move.

The Senate Health Education Labor and Pensions Committee held a hearing on the 21st Century Cures Act on Tuesday.  Healthcare Dive provides a report on the hearing which considered the proposed HHS interoperability rule. The FEHBlog thinks that there good ideas in these rules which will help implement the President's second no surprises principle stated above. However, HHS proposes to implement these technology driven changes way too fast, to wit, January 1, 2020. The Committee Chairman agrees:
"My major concern is to remind the administration of the advice that my piano teacher used to give me before a recital," committee chairman Lamar Alexander, R-Tenn., said. "She'd say, 'Lamar, play it a little slower than you can play it. You're less likely to make a mistake.'"
Well put, Mr. Chairman. Also don't bite off more than you can chew.

Modern Healthcare reports on a recent RAND study finding that employer sponsored health plans pay hospitals 241% more than Medicare for the same services.
"If you ask hospitals, they will pretty commonly say that 'our prices are high because we lose money on Medicaid patients and barely break even on Medicare.' But if you kind of look at the data, that story doesn't hold up that well empirically," said Christopher Whaley, one of the study's authors. "Sometimes hospitals that can charge higher prices because of market clout, reputation or must-have status do so." 
[Affordable Care Act driven] Consolidation among hospitals across the nation has helped boost their ability to negotiate higher prices from health plans, studies have shown. If employers and health plans participating in the study paid hospitals Medicare rates, they would have paid $7 billion, or about 50%, less over the study period, researchers concluded. 
AIS Health provides a useful article on the annual drug trend reports (including links) for three large prescription benefit managers -- CVS Health / Caremark, Express Scripts and Prime Therapeutics. Check it out.

Wednesday, May 08, 2019

Midweek update

The Senate Homeland Security and Governmental Affairs Committee has scheduled  a vpte on Dale Cabaniss's nomination to become OPM Director for next Wednesday May 15 at 9:30 am. Here's a link to the Federal News Network's article on Ms. Cabaniss's confirmation hearing before that Committee held yesterday afternoon. 

Fierce Healthcare reports that
Kaiser Permanente plans to roll out a new care network to more effectively connect its 12.3 million patients to the community services they need, such as housing, food, or transportation.
The health system is partnering with Unite Us, a social determinants technology and care coordination platform, to build the technology infrastructure that will enable Kaiser Permanente to better address social determinants and  "connect all the dots in a systematic way" for its millions of members, Kaiser Chairman and CEO Bernard Tyson told FierceHealthcare.
The initiative aims to equip all of Kaiser Permanente's healthcare providers with technology tools to better address patients' social determinants of health. The health system plans to start rolling out the network regionally this summer. The goal is to make the network available across its entire system within three years to serve the 68 million people in the communities it serves.
Bravo.

The Department of Health and Human Services finalized a federal rule today generally requiring prescription drug manufacturers to post prices in the consumer advertising shown on television. The accompanying fact sheet explains

  • The rule will require direct-to-consumer television advertisements for prescription drug and biological products covered by Medicare or Medicaid to include the list price – the Wholesale Acquisition Cost – if that price is equal to or greater than $35 for a month’s supply or the usual course of therapy, with the prices updated quarterly.
  • The 10 most commonly advertised drugs have list prices ranging from $488 to $16,938 per month or usual course of therapy. Patients deserve to know what a drug costs as they discuss their options with their doctor.
  • The final rule will go into effect 60 days after it was published in the Federal Register.
  • If a manufacturer simply includes price information in a direct-to-consumer advertisement as required by § 403.1202, that information in the advertisement will not require review by the FDA Office of Prescription Drug Promotion (ODPD). OPDP does not review price information in prescription drug advertisements and does not intend to do so in the future, unless the price information explicitly or implicitly incorporates safety or efficacy information about the drug, or makes express or implied claims about the safety or efficacy of the drug.
We will have to wait and see if the federal courts are asked to weigh in on this rule. 

Kaiser Health News reports on a Senate Judiciary Committee hearing held yesterday on patent laws and drug prices. 

Sen. John Cornyn (R-Texas) offered specific examples of drugs that have benefited from system issues, including Humira, an expensive drug for arthritis and psoriasis that is protected by 136 patents.
That’s called a “patent thicket,” because it prevents a generic alternative from entering the market for more years — in this case, until 2023 for a drug first approved for use in the United States in 2002. “Is there anyone on the panel who’d like to defend the status quo?” he asked.
“There is no way a biosimilar can deal with a hundred patents,” testified Michael Carrier, a professor at Rutgers Law School. “This is an abuse of the system.”
Amen to that.

Celebrated New York Times health policy reporter Robert Pear died yesterday at age 69. Here is a link to his obituary in his newspaper.  RIP.