Friday, December 13, 2019


Health Payer Intelligence reports that
America’s Health Insurance Plans (AHIP) submitted a statement to the House Energy and Commerce Committee opposing current single-payer proposals in the United States.
“Americans are facing an escalating crisis of affordability across our health care system. Cost pressures are becoming more intense for all who pay the tab for health care in the United States, whether they be consumers, employers, or governments,” the organization explained. “AHIP and our members believe that the best way to bring down costs is to improve what’s working and fix what’s not, so that everyone has affordable coverage, access to high-quality care, and control over their health care choices.”
Amen to that.

On the prescription benefit manager front --
  • Per Fierce Heathcare, Express Scripts has unveiled the first apps to be added to its curated digital health formulary.  The idea behind the formulary, which other PBMs are adopting, is to "make it easier for health insurers [and self funded employers] to vet the tools for their members, especially as the number of solutions available in the market continues to grow." The list of ESI approved apps may be found here.   
  • Healthcare Dive informs us that CVS Health "unveiled a precision medicine program for oncology patients Thursday designed to increase access to broad-panel gene sequencing tests for patients with specific advanced stage cancers."
The Department of Health and Human Services' Office for Civil Rights, which enforces the HIPAA Privacy and Security Rules announced its second settlement with a healthcare provider, Krounda Medical of Florida, over allegations that the provider had not complied with the Privacy Rule's requirement on individual access to medical records. The provided agreed to pay a $85,000 penalty and take remedial actions.

The Boston Globes STAT reports that
In this week’s New England Journal of Medicine, we report that home has become the most common place of death among Americans dying of natural causes for the first time since the early 20th century, while deaths in hospitals and nursing facilities have declined. Our analysis of data from the Centers for Disease Control and Prevention and the National Center for Health Statistics also showed striking differences in place of death according to who you are and what you die of: individuals who are nonwhite or those dying from diseases other than cancer are less likely to die at home than those who are white or those who die from cancer.
It appears to be time for health plans to review their in home hospice coverage.  

Thursday, December 12, 2019

Capitol Hill Update

Good news. reports today that the Democrat and Republican leadership in Congress along with the White House have agreed on an omnibus spending bill for the current government fiscal year. Congress has time to pass this legislation before the December 20 deadline provided by the current continuing resolution. Details have not yet been unveiled.

The House of Representatives passed Speaker Pelosi's prescription drug bill (H.R. 3) along party lines. The Health Affairs blog provides a helpful outline of the various prescription drug bills under Congressional consideration including their status.

The Senate approved the President's nomination of Stephen Hahn, MD, to be Food and Drug Commissioner today by a 72-18 vote. Fortune offers background on the good doctor.

Wednesday, December 11, 2019

Midweek update

The House of Representatives passed the current fiscal year defense authorization act today by a wide margin. The Federal News Network reports on provisions beyond the paid parental leave program that affect federal employees, federal annuitants, and federal benefit programs. Specifically the bill addresses FEHBP and FEDVIP problems that arose in the lengthy government shutdown earlier this year. It would be better if Congress banned those shutdowns.

The bipartisan leadership of the powerful House Ways and Means Committee announced a legislative plan to end surprise billing. It is starting to look that we will be stuck with some form of arbitration to resolve surprise billing disputes. The following provision from the new plan plows new ground as far as the FEHBlog can recall:
The party that loses the decision will pay a reconciliation process fee. In addition, a surcharge will be applied to providers and plans that use the process in excess of certain pre-determined thresholds. Annual reporting of the decisions rendered through the process will also be required.
These aspects of the new plan's dispute resolution process strike the FEHBlog as good ideas.

Kaiser Permanente announced that Gregory Adams has been named as its new CEO following the untimely passing of Bernard Tyson. "Since 2016, he has served as Executive Vice President and Group President, with direct responsibility for health plan and hospital operations in all 8 Kaiser Permanente regions."

Healthcare Dive reports that
Amazon's at-home prescription drug delivery company PillPack unveiled its first direct integration with a payer's app Tuesday. PillPack by Amazon Pharmacy is now directly available on not-for-profit Blue Cross Blue Shield of Massachusetts' member app, MyBlue, and the Boston-based insurers' beneficiaries can order, pay for and receive medications to their home for no extra fee. All BCBSM members are eligible for PillPack, but the payer is starting with its fully-insured commercial members and is targeting the product toward those taking multiple medications.
The FEHBlog is a fan of PillPack as it simplifies peoples's lives and encourages adherence.

Health Payer Intelligence reports on a PriceWaterhouseCoopers study's findings:
“In 2020, organizations will make strategic deals not to just grow larger but instead to expand into new identities with platforms anchored in value, innovation, customer experience and population health,” the report stated. “As they weigh their options, health companies will need to ensure that the deals they pursue pass the sniff test of employers and consumers seeking more affordable care.”

Tuesday, December 10, 2019

More on S. 1895 and then some

Thanks to Healthcare Dive, the FEHBlog found the section by section summary of the revised S. 1895 bill reference in yesterday[s post. The Healthcare Dive article notes that "The latest details emerging on legislation to ban surprise medical billing includes nuggets [found in the summary] meant to pacify payers and providers, but is not pleasing either."

Those nuggets certainly disturb the FEHBlog who knows that the surprise billing / flying the pirate flag issue cannot be solved with any sort of provider / health plan arbitration. That outcome will only increase overall costs and encourage providers to leave health plan networks. Ill advised.  The weeks Econtalk podcast episode concerns the strength of vested interests and you certainly see that weight being thrown around in the surprise billing and prescription drug cost legislative efforts.

In other news, reports that the Congressional conference report on the FY 2020 defense authorization bill, so-call must pass legislation, would block any further dismantlement of OPM at least until the National Academy of Public Administration submits to Congress a study on the OPM-GSA merger (Section 1112).  Title 76 of the conference report would create a 12 week long paid parental leave plan for federal employees effective October 1, 2020. The House is expected to consider the conference report before the Senate.

Monday, December 09, 2019

S. 1895, H,R, 19, and Rankings / Awards

"Senate Health Committee Chairman Lamar Alexander (R-Tenn.) and House Energy and Commerce Committee Chairman Frank Pallone Jr. (D-N.J.) along with Ranking Member Greg Walden (R-Ore.) yesterday announced they have reached a bipartisan, bicameral agreement on legislation to lower what Americans pay out of pocket for their health care."  This is a revised version of S. 1895, the bill to lower healthcare costs act. The FEHBlog as yet has not been able to lay his hands on the text or section by section summary of the revised bill.

Nevertheless, the American Hospital Association reports that according to the section by section summary, that "Insurers would be required to, at a minimum, reimburse providers for all claims subject to the balance billing prohibition at the median in-network negotiated rate for the service in that geographic area where the service was delivered. Both providers and insurers would have the right to contest claims paid at or above $750 ($25,000 for air ambulance services) using baseball-style, binding arbitration."

Bloomberg Government reports that the House minority leadership has introduced its own bill to lower drug costs without affecting the number of new drugs, H.R. 19. "The package, unveiled Monday, would create a $3,100 out-of-pocket cap in Medicare’s prescription drug benefit program. It would also take steps to spur new generic drugs and includes a laundry list of changes to Medicare and Medicaid. The legislation includes more than 40 provisions that Democrats and Republicans have previously agreed to support, Republicans say."

Modern Healthcare has released its 2019 list of most influential people on U.S. healthcare. CMS Administrator Seema Verma captured the top spot.

Healthcare Dive announced its 2019 awards. CVS CEO was named top executive.  Mr. Merlo was number 5 on the Modern Healthcare list. It's worth noting that Mr. Merlo's deputy CVS Executive VP Karen Lynch was number 6 on the Modern Healthcare list.

The United Health Foundation issued its 2019 American Health Rankings. Vermont holds the top spot and Mississippi holds the lowest. The FEHBlog's state Maryland ranks 18th.

Sunday, December 08, 2019

Weekend Update

The Federal Benefits Open Season's last day is tomorrow.

Congress remains in session this coming week. The Wall Street Journal reports that
Congress struck a tentative bipartisan agreement that would authorize 12 weeks of paid parental leave for all federal workers, in a potentially historic deal negotiated with the White House.
Draft language for a must-pass annual defense policy bill includes a provision that would allow 2.1 million civilians who work for the U.S. government across the country to take paid leave to care for a new baby after birth, adoption or the initiation of foster care, according to multiple people familiar with the agreement.
Healthcare Dive informs us
More than half of all commercial plan payments to hospitals in 2017 were earmarked toward some form of value-oriented care or alternative payments intended to reduce waste, according to the latest scorecard from Catalyst for Payment Reform (CPR) — up from just 10.2% in 2012. However, a large chunk of the value-oriented payment (90%) was built off of the fee-for-service infrastructure. meaning the overwhelming majority of these payments had no downside risk. The chairman of CPR, a nonprofit that works with employers and other large purchasers, called the results "disappointing." Bundled payment adoption remained flat between 2012 and 2017, despite various studies showing their promise in holding down costs. They made up only 2% of all value-based payments in 2017.
Rome was not built in a day.

Health Payer Intelligence provides a list of the top 10 most costly chronic illnesses in the U.S.  Cariocasular disease, smoking related health issues, and alcohol related health issues rank one, two, and three.

The Econtalk podcast, the FEHBlog's favorite, offered an interesting interview on decision making in last week's epsode. Check it out. Learn about the  Learn about fast and frugal tree decision making.

Friday, December 06, 2019


Yesterday, the CMS Actuary issued its report on 2018 National Healthcare Expenditures.
Total national healthcare spending in 2018 grew 4.6 percent, which was slower than the 5.4 percent overall economic growth as measured by Gross Domestic Product (GDP), according to a study conducted by the Office of the Actuary at the Centers for Medicare & Medicaid Services (CMS) and published today ahead of print by Health Affairs.
According to the report, private health insurance, Medicare, and Medicaid experienced faster growth in 2018.  The faster growth for these payers was influenced by the reinstatement of the health insurance tax which was applied to private health insurance, 
The health insurance tax was suspended for 2019 but it is poised from reinstatement next year / month. 

Healthcare Dive reports that "More than 1,000 employers [including insurers and trade associations] wrote to Senate leadership Thursday pleading for it to take up legislation to repeal a controversial excise tax on high-cost employer-based health plans [a/k/a the Cadillac tax] slated to go into effect in 2022."  The letter is referring to the House enacted bill HR 748 providing for a clean repeal of the Cadillac tax. Wouldn't it be wonderful if Congress repealed all three senseless ACA taxes, the Cadillac tax, the Health Insurance Tax, and the Cadillac Tax. Congress could treat the lower healthcare spending as an offset against the lost federal revenue.

Adding some perspective to the Becker's Hospital Review report on vaping illnesses having spread across the country which the FEHBlog noted yesterday, the Wall Street Journal encouragingly reports today that
The rate of new hospital admissions for vaping-related illnesses has dropped in the past several weeks, according to data from the Centers for Disease Control and Prevention, suggesting that the outbreak is on the decline.
Doctors, cannabis-industry analysts and other experts say the trend is most likely explained by wider awareness, changing consumer habits and a potential shift in the illicit market.
“The national picture seems to be trending in the right direction,” said Peter Briss, the medical director at the CDC’s National Center for Chronic Disease Prevention and Health Promotion, who is managing the outbreak investigation. “I’m cautiously optimistic that all of the information sharing and communication may have helped.”
The HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules has issued its Fall 2019 Cybersecurity Newsletter. which focuses on ramsonware. 

How time flies, CVS Health issued a press release yesterday on the one year anniversary of its acquisition of health insurer, Aetna. Maazal tov.

Thursday, December 05, 2019

Midweek update

CNBC reports that on Tuesday December 4, the Senate Health Education Labor and Pensions Committee approved for Senate floor consideration the nomination of Stephen Hahn, MD, to be Food and Drug Administration commissioner. The vote was 18-5. The Senate leadership intends to hold a confirmation vote this month. provides an update on the 2020 federal employee pay increase.
The House-passed version of the [FY 2020 appropriations] bill [for OPM] includes an average 3.1% pay raise for federal civilians, which includes a 2.6% across-the-board raise and an average 0.5% increase in locality pay. The Senate, by contrast, did not include any language on compensation in its iteration of the measure, effectively endorsing President Trump’s alternative pay plan to provide a 2.6% across-the-board raise but no increase in locality pay.  If Congress does not act on its own to override Trump’s plan, he still will need to issue an executive order finalizing the 2.6% across the board raise by the end of the year.
Last month, CMS issued final price transparency rule for hospitals, effective January 1, 2021, and a proposed out of pocket cost transparency rule for health plans. This week a group of hospital associations and individual hospitals challenged the final rule in federal court here in the District of Columbia, and two major health plan associations requested an addition 90 days to comment on the proposed rule according to Fierce Healthcare reports.

Beckers Hospital Review reports that vaping illnesses now have been detected in all fifty states and the District of Columbia. Alaska was the last state to record a case.  "As of Nov. 20, the CDC has received reports of 2,290 EVALI cases nationwide. Forty-seven deaths have also occurred in 25 states.".

Tuesday, December 03, 2019

Tuesday Tidbits

The Federal Times discusses the one the FEHBP's best features -- the statutory provision allowing federal and postal employees with five years of FEHBP coverage preceding their civil service retirement date to carry their FEHB coverage into retirement with the full government contribution. For that reason, federal and postal employees who have been receiving coverage under a spouse's plan need to consider joining the FEHBP as they approach retirement. Open Season is the time to take this action. The Federal Times points out two exceptions to this rule.

Yesterday, the Internal Revenue Service  ("IRS") issued Notice 2019-63 which resolved an open issue for the FEHBlog. The Affordable Care Act ("ACA") requires health plans and insurers to furnish members and the IRS with Form 1095-B which documents the extent to which the recipient and family members held minimum essential coverage during the last calendar year. The Form 1095-B documents the recipient's compliance with the ACA's individual shared responsibility mandate. When Congress zeroed out that individual shared responsibility penalty for 2019, the FEHBlog expected that the IRS would not require production of the 1095-B for the 2019 tax years. The FEHBlog was wrong (mark the tape). Health plans and insurers must continue to prepare the Form 1095-Bs for 2019 and send them to to the IRS. However, they can furnish them to plan members upon request by placing a notice on their website. Mercer consulting offers a useful article about the intersection of 1095-B reporting and state reporting requirements for their own individual mandates.

A Washington University newsletter discusses a study published by one of its research professors that seeks to draw conslusions about rural health coverage from FEHB premiums offered by local plans in rural areas. Here's a link to the Health Affairs article which is behind a pay wall.

On the Centers for Disease Control front --

  • The CDC reports on its efforts to significantly curb the transmission of HIV over the next decade. Good luck. 
  • Staten Island Live discusses a CDC longitudinal study about the occurrence of pre-diabetes in young Americans. No bueno. 

Sunday, December 01, 2019

Weekend update

Congress is back in town this week. The current continuing resolution funding the federal government expires on Friday December 20.

The Federal Benefits Open Season expires on December 9. OPM has added a note to its Open Season page stating the time at which expiration occurs for each of the programs, e.g., FEHBP at 11:59 pm ET.

Last week, the Centers for Disease Control issued its final 2018 report on the 2018 birth rate in our country
3,791,712 births were registered in the United States in 2018, down 2% from 2017. Compared with rates in 2017, the general fertility rate declined to 59.1 births per 1,000 women aged 15–44. The birth rate for females aged 15–19 fell 7% in 2018. Birth rates declined for women aged 20–34 and increased for women aged 35–44. The total fertility rate declined to 1,729.5 births per 1,000 women in 2018. Birth rates for both married and unmarried women declined from 2017 to 2018. The percentage of women who began prenatal care in the first trimester of pregnancy rose to 77.5% in 2018; the percentage of all women who smoked during pregnancy declined to 6.5%. The cesarean delivery rate decreased to 31.9% in 2018 following an increase in 2017. Medicaid was the source of payment for 42.3% of all 2018 births, down 2% from 2017.
Lots of interesting facts in this report.

Also last week, the HHS Office for Civil Rights, which enforces the HIPAA Privacy and Security rules. announced that Sentara Hospitals, which has facilities in Virginia and North Carolina, has agreed to take remedial actions and pay a $2.175 million penalty.  The facts illustrate why it's important to know when to hold them and know when to fold them.
In April of 2017, HHS received a complaint alleging that Sentara had sent a bill to an individual containing another patient’s protected health information (PHI). OCR’s investigation determined that Sentara mailed 577 patients’ PHI to wrong addresses that included patient names, account numbers, and dates of services.  Sentara reported this incident as a breach affecting 8 individuals, because Sentara concluded, incorrectly, that unless the disclosure included patient diagnosis, treatment information or other medical information, no reportable breach of PHI had occurred.  Sentara persisted in its refusal to properly report the breach even after being explicitly advised of their duty to do so by OCR. OCR also determined that Sentara failed to have a business associate agreement in place with Sentara Healthcare, an entity that performed business associate services for Sentara.

Friday, November 29, 2019


The FEHBlog trusts that his readers enjoyed the Thanksgiving holiday. He certainly did.

The Federal Benefits Open Season continues for another ten dats until December 9. Tammy Flanagan in offers Five Open Season Questions and Answers.

Congress returns to Capitol Hill next week. Modern Healthcare reports that Congressional negotiations over surprise billing legislation have resumed making progress.

Becker's Hospital Review points out six trends and issues for hospital and health systems.

Health IT Analytics explains how geographic data can help social determinants of health efforts.  After all isn't all healthcare local?

In that regard, here's an OPM website that profiles the demographic characteristics of federal employees (as of 2017).  Average age -- 47 1/2 years old.

Tuesday, November 26, 2019

Tuesday Tidits

The FEHBlog has heard OPM remark about its interest in adding a FEHBP enrollment tool to its FEHB plan comparison tool. Be careful what you wish for --

  • reports about problems with Medicare's plan finder which recently was redesigned for $11 million. 
  • Federal News Network reports that TRICARE beneficiaries can't use their on-line plan enrollment tool during this open season due to a Defense Department system glitch. "The other two options are to enroll by phone or mail."  

UnitedHealthcare announced yesterday that it will be opening Medicare services centers at 14 Walgreen's stores.
The UnitedHealthcare Medicare services centers will begin to open in January 2020 at Walgreens stores in the Las Vegas, Phoenix, Cleveland, Denver and Memphis markets. Through these centers, Walgreens customers can learn more about Medicare, meet with service advocates to discuss their UnitedHealthcare plan benefits and even enroll in plans. UnitedHealthcare Medicare Advantage members can also make an appointment for an in-store annual wellness visit at the Medicare services center in Walgreens through UnitedHealthcare’s HouseCalls program, helping make it easier to get needed care, tests and treatment. 
Healthcare Dive adds that "CVS Health, which owns its own insurance plan with Aetna, has made a similar move as it plans to open more than 1,500 HealthHUB stores across the country by the end of 2021. The HealthHUB stores earmark about 20% of CVS retail space to health services, with a special focus on preventive care and wellness."  The FEHBlog wonders whether FEHB plans also will be marketed at drug stores.

Healthcare Dive also reports that
Life expectancy in the United States has fallen since 2014 after six decades of increasing. The driving force is in middle-aged deaths from drug overdoses, suicides and organ system diseases, according to a wide-reaching report published Tuesday in JAMA. The findings shows disparities in mortality trends across races and geographic locations. The largest increase in midlife mortality rates from 1959 to 2016 was in New England and the Ohio Valley.
No bueno.  On a related note, the Wall Street Journal headlines today that
Federal prosecutors have opened a criminal investigation into whether pharmaceutical companies intentionally allowed opioid painkillers to flood communities, employing laws normally used to go after drug dealers, according to people familiar with the matter.
The investigation, if it results in criminal charges, could become the largest prosecution yet of drug companies alleged to have contributed to the opioid epidemic, escalating the legal troubles of businesses that already face complex, multibillion-dollar civil litigation in courts across the country. Prosecutors are examining whether the companies violated the federal Controlled Substances Act, a statute that federal prosecutors have begun using against opioid makers and distributors this year.

Sunday, November 24, 2019

Weekend Update

Congress is out of town until December 3. Before leaving town, according to the Hill,
Top negotiators from the House and Senate have reached a long-stalled deal on top-line spending figures for the fiscal 2020 bills.

House Appropriations Committee Chairwoman Nita Lowey (D-N.Y.) and Senate Appropriations Committee Chairman Richard Shelby (R-Ala.) have settled on 302(b)s, which set the top-line number for each of the 12 government funding bills, two sources familiar with the negotiations told The Hill.

The Friday night agreement marks a breakthrough for the government funding negotiations. 
Hopefully, the ball will keep rolling and we will have a final omnibus appropriations bill before the latest deadline, December 20.

Healthcare Dive reports on Dr. Stephen Hahn's confirmation hearing as FDA commissioner before the Senate Health Education Labor and Pensions Committee last week.
Hahn told senators he would make it a priority to address drug shortages, examine anti-competitive processes used by brand drug manufacturers to protect biologics from biosimilar competition and protect the United States' drug supply when considering drug importation. Hahn expressed interest in boosting use of patient-focused endpoints in clinical trials for both drugs and devices.
Fierce Healthcare reports that the Stop the Health Insurer Tax coalition has launched a campaign to halt the reimposition of the onerous tax on health insurance premiums for 2020. If history is any guide, a further suspension would apply to 2021 and possibly future years but not 2020 whose premiums already have the HIT payments baked in. offers another perspective on OPM's semi-annual regulatory agenda which was released last week. Thee new OPM regulations concern temporary and seasonal employees.  For example,
[A] forthcoming proposal * * * would make temporary and seasonal employees eligible for dental and vision insurance benefits for the first time. Non-permanent feds only won regular health care under the Federal Employees Health Benefits Program in 2015. OPM said the regulation would bring Federal Employees Dental and Vision Insurance Program eligibility requirements in line with FEHBP.  

Health Payer Intelligence discuses a Milliman study, funded by the Bowman Family Foundation, on the growing discrepancy between health plan payments to primary care providers versus behavioral health providers. A point that caught the FEHBlog's eye is that
Beneficiaries were also 5.2 times more likely to visit an out-of-network hospital for behavioral healthcare needs than they were to visit an out-of-network inpatient provider for medical or surgical care. That statistic spiked 85 percent from 2013.

Friday, November 22, 2019


Tammy Flanagan offers FEHB Open Season tips and secrets in

The Wall Street Journal offers higher income Medicare beneficiaries tips on how to control their Medicare Part B and D premiums.
For 2018, the latest data available, about 7% of 54.6 million total Medicare Part B recipients owed premium surcharges on that coverage, according to Juliette Cubanski, an analyst with the nonprofit, nonpartisan Kaiser Family Foundation.
Next year some people paying surcharges will benefit because inflation adjustments have resumed for the first time since 2011. This change will drop some people into a lower surcharge category, saving them hundreds of dollars.
Healthcare Dive reports that large hospital systems have been contracting with a Nashville based start up called Contessa "to help them deliver at-home hospital care to patients who otherwise would have been admitted."  After all, as the old saw goes, people die in hospitals.

The Health Care Cost Institute has provided a very interesting claims based study on the use of out of network providers, who give rise to the surprise billing problem.
The frequency of out-of-network bills varies by type of service. In 2017, nationally:

  • 16.5% of visits with emergency room services had an out-of-network claim from an emergency medicine specialist.
  • 12.9% of visits with lab/pathology services had an out-of-network claim from a pathologist.
  • 8.3% of visits with anesthesiology services had an out-of-network claim from an anesthesiologist.
  • 6.7% of visits with behavioral health services had an out-of-network claim from a behavioral health provider.
  • 4.2% of visits with radiology services had an out-of-network claim from a radiologist.
  • 2.1% of visits with surgical services had an out-of-network claim from a surgeon.
  • 2.0% of visits with cardiovascular services had an out-of-network claim from a cardiovascular specialist.

Variation across states differs by type of service
  • Pathology and emergency services had the largest variation.
  • Cardiovascular and surgery services had the the smallest variation.
Potential surprise bills for surgery visits are orders of magnitude larger than for other types of service.
  • Nationally, the average potential surprise bill associated with an inpatient surgery was $22,248; outpatient surgery was $8,493.
Celebrations --
  • HHS's Agency for Health Care Quality and Research ("AHRQ") is celebrating its 20th anniversary. 
  • CMS celebrated National Rural Health Day yesterday. 
A friend of the FEHBlog called his attention to this sad story in Vox which illustrates. the confusion still existing over proper treatment of opioid addiction.