Monday, September 16, 2019

OPM's New Director Takes the Reins

OPM hsa announced 
Director Dale Cabaniss officially begins her tenure as Director of the U.S. Office of Personnel Management (OPM) today [September 16] following her Senate confirmation on Sept. 11, 2019.
“I’m honored by the opportunity to serve as the Director of OPM. I look forward to delivering effective and efficient government solutions and taking on the challenges facing Federal employees and their agencies as we work together on behalf of the American people,” said Director Cabaniss.
Good luck Director Cabaniss, and thanks OMB Deputy Director Margaret Weichert for your service as acting OPM Director for nearly the past year. 

Sunday, September 15, 2019

Weekend update

Congress remains in session on Capitol Hill this week. On Tuesday afternoon, September 17, the Senate Financial Services and General Government Subcommittee of the Committee on Appropriations will mark up the fiscal year 2020 appropriations bill for its jurisdiction which includes OPM appropriations.  The full Committee will consider the Subcommittee's marked up bill on Thursday morning, September 19.

The Wall Street Journal's Numbers columnist offered an interesting piece this weekend on suicides in our country.
According to researchers at Harvard University, nine out of 10 people who attempt suicide and survive won’t go on to die by suicide at a later date. Because of that, blocking access to methods of suicide—such as bridges or firearms—can be a powerful deterrent.
In 2017, the most recent year available, 47,173 people died from suicide, up from 29,350 in 2000, according to the American Foundation for Suicide Prevention and the Centers for Disease Control and Prevention.  It is the 10th leading cause of death, according to the CDC, and the focus of efforts to reduce the rate by 20% over the next five years.
The American Medical Association's Twitter feed today called attention to a related 2017 AMA article

Also this weekend, the Wall Street Journal reported on the data manipulation issues surrounding the blockbuster genetic therapy drug, Zolgensma,  This drug cures spinal muscular atrophy in children under two years old. The most virulent form of this disease Type 1 is fatal at a very young age. Novartis charges $2,1 million for a course of treatment.

The WSJ article explains that the data manipulation was attributable to a company that Novartis had purchased. The acquired company AveXis and thus Novartis are in hot water for not promptly notifying the Food and Drug Administration about the issue.  The article further explains that the FDA deserves credit for quickly determining that the data manipulation although serious from a legal standpoint did not require pulling the life saving drug off the market.

Friday, September 13, 2019


As far as the FEHBlog can tell, Dale Cabaniss has not yet taken the reins at OPM following her Senate confirmation on Wednesday. Yesterday, OPM acting Director Margaret Weichert, who deserves a lot of credit for handling two big government jobs for nearly one year, stated yesterday
I am pleased to announce that Ms. Dale Cabaniss received Senate confirmation yesterday to serve as the next Director of OPM. I want to extend my congratulations and best wishes to her as she begins her appointment here, and I have no doubt that she has the qualifications and vision to lead this agency into the future.
The OPM website still lists Ms. Weichert as the director. Perhaps the swearing in is happening this afternoon and if not it should happen early next week.

Mike Causey from the Federal News Network posted about the 2020 cost of living allowance ("COLA") for federal annuitants. 
COLAs are based on the increase, if any, of urban living costs from the third quarter of the current year (July, August, September) over the Consumer Price index-W for the previous year’s third quarter, if any.With two months to go in the countdown the potential COLA now stands at around 1.6%. The August COLA will be announced later this month. The COLA for September will be made public Oct. 10.
The full and exact amount of the COLA depends on the increase or decrease in the CPI-W for the months of September and August. Millions of American retirees — Social Security, civil service and military — get a catch-up-with-inflation increase each January. In 2018 the COLA was 2.8% for retirees under the Civil Service Retirement System (CSRS) and 2.0% for those retired under the Federal Employees Retirement System (FERS) which replaced it.
FERS annuitants may be eligible for Medicare's hold harmless rule  while CSRS annuitants cannot as their Medicare premiums are paid from their Federal annuity benefits, not from Social Security benefits.

Plan Sponsor reports that
U.S. employer-provided medical benefit costs are forecasted to rise 6.5% in 2020, outpacing general inflation by 3.8%, according to the 2020 Global Medical Trend Rates Report released by Aon plc.  The increase for U.S. employer-sponsored medical plans expected next year is due to a combination of higher costs for specialty drugs, moderate price increases for care and flat or decreasing health utilization.
OPM should be announcing the 2020 government contribution toward FEHB coverage later this month along with all of the FEHB plan premiums for 2020. 

Finally, on the public health front,

  • Route 50 discusses a Centers for Disease Control (CDC) report on obesity rates in the U.S. 
The nine states where more than 35% of adults are obese are Alabama, Arkansas, Iowa, Kentucky, Louisiana, Mississippi, Missouri, North Dakota, and West Virginia. Higher obesity levels are more concentrated in the South and Midwest, according to the CDC.

  • Last night, the CDC released its latest weekly report on the vaping disease crisis. 


Wednesday, September 11, 2019

Breaking News -- Senate approves President's nomination of Dale Cabaniss to OPM Director

About 30 minutes ago, the FEHBlog watched the Senate television channel as the Senate President pro tempore announced a 54 to 38 vote in favor of confirming the President's nominee Dale Cabaniss to be OPM Director. The next step is for Ms. Cabaniss to be sworn in. 

Tuesday, September 10, 2019

Tuesday Tidbits

The Senate this afternoon approved by a 53-41 vote a cloture motion on Dale Cabaniss's nomination to be OPM Director. According to the Senate's latest Executive Calendar, the Senate will vote on Ms. Cabaniss's nomination tomorrow. It appears that there will be a new OPM Director tomorrow.

The Agency for Healthcare Research and Quality has issued its 2018 National Healthcare Quality and Disparities Report. The Report
assesses the performance of our healthcare system and identifies areas of strengths and weaknesses, as well as disparities, for access to healthcare and quality of healthcare. Quality is described in terms of six priorities: patient safety, person-centered care, care coordination, effective treatment, healthy living, and care affordability. The report is based on more than 250 measures of quality and disparities covering a broad array of healthcare services and settings.
Check it out.

The Kaiser Family Foundation has issued an analysis of 2019 medical loss ratio refunds under the Affordable Care Act that health insurers are obligated to pay.  
Using data reported by insurers to CMS, we estimate insurers will be issuing a total of at least $1.3 billion across all markets – exceeding the previous record high of $1.1 billion in 2012 (based on 2011 experience). The amount varies by market, with insurers reporting at least $743 million in the individual market, $250 million in the small group market, and $284 million in the large group market.
The insurers tend to get tripped up on the state by state approach that the ACA uses.

Mhealth Intelligence reports that the American Medical Association ("AMA") which controls the medical procedure code set used in claim transactions has added several important new codes to the 2020 CPT 4.
Among the 248 new codes added to the list for the coming year, the AMA has created six for online digital evaluation services, or e-visits, in which care providers can connect with patients at home to exchange information. Three codes – 99421, 99422 and 99423 – relate to patient-initiated digital communication provided by a physician or other qualified healthcare professional, while three others – 98970, 98971 and 98972 – focus on communications with a “non-physician healthcare professional.”

Monday, September 09, 2019

Monday Musings

The Senate did take up this afternoon the cloture motion on the President's nomination to be United Nations ambassador, Kelly Craft.  The roll call vote was 54 in favor of cloture and 38 against. The Senate's president pro tempore announced that the motion had carried. How could the motion pass without sixteenths votes? The FEHBlog consulted the CRS report on this topic which explains (p. 9) that "pursuant to precedents established by the Senate on November 21, 2013, and April 6, 2017, the Senate can invoke cloture on a nominationby a majority of Senators voting (a quorum being present), The Senate will vote on the UN ambassador's nomination tomorrow morning and then will take a cloture motion vote on the President's nomination of Elizabeth Darling, of Texas, to be Commissioner on Children, Youth, and Families, Department of Health and Human Services. If that motion is approved the vote on Ms. Darling's nomination would occur after 2:15 pm tomorrow afternoon. Thereafter, the Senate will consider the cloture motions for the nominations of six other nominations, including Dale Cabaniss's nomination to be OPM Director. Ms. Cabaniss is list fourth on this cloture motion list. A vote on Ms. Cabaniss's nomination is likely this week.

Speaking of nominations, Healthcare Dive reports that
  • President Donald Trump is weighing nominating a top executive at the MD Anderson Cancer Center as the next Food and Drug Administration Commissioner, according to multiple reports indicating the Texas oncologist, Stephen Hahn, has become a frontrunner for the post.
  • Picking Hahn, or a third candidate said to be in the running, would be a change of course from acting FDA Commissioner Ned Sharpless, the former National Cancer Institute director who replaced Scott Gottlieb as agency chief in March.
Speaking of drugs, Beckers's Payers' Issues reports that
Shifting specialty drug administration away from hospital settings could reduce expenses by $4 billion annually, according to a new report from United Health Group.  United Health found that administering specialty drugs in independent physician offices and patient homes, instead of hospital outpatient settings, could save insurers between $16,000 to $37,000 per privately insured patient annually.

Finally, the Health and Human Services Office for Civil Rights  ("OCR")today announced 
its first enforcement action and settlement in its Right of Access Initiative.  Earlier this year, OCR announced this initiative promising to vigorously enforce the rights of patients to receive copies of their medical records promptly and without being overcharged.
Bayfront Health St. Petersburg (Bayfront) has paid $85,000 to OCR and has adopted a corrective action plan to settle a potential violation of the right of access provision of the Health Insurance Portability and Accountability Act (HIPAA) Rules after Bayfront failed to provide a mother timely access to records about her unborn child.  Bayfront, based in St. Petersburg, Florida, is a Level II trauma and tertiary care center licensed as a 480-bed hospital with over 550 affiliated physicians.

Sunday, September 08, 2019

Weekend Update

The House of Representatives and the Senate return to work on Capitol Hill tomorrow. The Hill reports that
Lawmakers are returning to Washington on Monday, and they’ll have 16 working days to reach a deal to fund the government by Oct. 1 or pass a spending patch to kick the fight closer to the holidays. 
But the House and Senate are coming back to town with plans to move forward on different tracks. House Democrats are focused on passing a continuing resolution (CR), while Senate Republicans are set to make a late start at moving fiscal 2020 bills. 
The Senate executive calendar informs us that
at 5:30 p.m, notwithstanding the provisions of Rule XXII, the cloture motions on the following nominations ripen: * * *
Dale Cabaniss, of Virginia, to be Director of the Office of Personnel Management for a term of four years;
To recap, on August 1, the Senate Majority Leader Sen. Mitch McConnell "presented a cloture motion that is signed by 16 Senators, proposing “to bring to a close the debate upon” the pending question", to wit, Ms. Cabaniss's nomination." As far as the FEHBlog can tell from this Congressional Research Service report, the Senate will vote on the Cabaniss nomination cloture motion tomorrow evening.  According to Linked In,  Ms Cabaniss served most recently as Chair of the Federal Labor Relatoins Authority and Republican Staff Director of the Senate Appropriations Committee's Financial Services and General Government subcommittee.

Last week the ACA regulators issued the final version of ACA FAQ Part 39 which concerns the non-quantitative treatment limitation provisions of the federal mental health parity law. The ACA regulators issued the draft FAQs in April 2018 and discussed the draft FAQs with stakeholders in January 2019. The ACA regulators explain that
These FAQs are designed to help people understand the law and benefit from it as intended through examples that illustrate the requirements of MHPAEA and its implementing regulations. While some of the fact patterns used as examples may be relatively uncomplicated, they should enable the public to identify and address important MHPAEA issues. These FAQs do not contain any new interpretations of MHPAEA, but instead provide additional examples of how the MHPAEA final regulations apply to different fact patterns to promote compliance.
It's important for health plans to read and understand these FAQs because the NQTL rules are not intuitive.

Together with the FAQs the ACA regulators released a final model disclosure request form (p. 16) that can be used to request information from group health plans and health insurance issuers offering group or individual health insurance coverage, including FEHB plans.

The FEHBlog's wife highly recommends reading the New York Times Diagnosis column or each the Netflix show.

Friday, September 06, 2019


The Boston Globe's STAT reports this afternoon that
The Centers for Disease Control and Prevention ["CDC"] reported a rising number of cases of mysterious pneumonias linked to vaping on Friday. Now, the agency reports 450 people from 33 states and one U.S. jurisdiction have been affected. 
Three deaths have been confirmed, authorities said, and another is being investigated. 
The New England Journal of Medicine and CDC’s online journal, Morbidity and Mortality Weekly Report coordinated the release of case reports and case findings from Illinois and Wisconsin, Utah, North Carolina and California. While the descriptions of the cases were remarkably similar, it is not currently clear why young vapers — the majority of cases are young men — are developing severe pneumonias.
Here's a link to the CDC's press release on this investigation.  The CDC recommends
While this investigation is ongoing, people should consider not using e-cigarette products. People who do use e-cigarette products should monitor themselves for symptoms (e.g., cough, shortness of breath, chest pain, nausea, vomiting, abdominal pain, fever) and promptly seek medical attention for any health concerns. Regardless of the ongoing investigation, people who use e-cigarette products should not buy these products off the street and should not modify e-cigarette products or add any substances that are not intended by the manufacturer. E-cigarette products should never be used by youth, young adults, pregnant women, or adults who do not currently use tobacco products.

Thursday, September 05, 2019

Thursday Observations

The Wall Street Journal reports today that
Insurers are scrambling to blunt the expense of new drugs that can carry prices of more than $2 million per treatment, offering new setups aimed at making the cost of gene therapies more manageable for employers.
Cigna Corp. announced Thursday a new program that allows employers and insurers to pay per-month fees for a service that will cover the cost of gene therapies and manage their use. CVS Health Corp. says it plans to offer a new layer of coverage specifically for gene therapies, which would handle employers’ costs above a certain threshold. Anthem Inc. said it is looking at special insurance setups to help employers protect themselves from the financial impact of the drugs.

The Internal Revenue Service announced on Tuesday that the agency plans to collect $15,522,820,037 (yes that's 15 trillion) from health insurers next year based on an Affordable Care Act tax unless Congress acts to further suspend or repeal that levy.  The tax necessarily increases premiums in the FEHBP which the tax heavily impacts. Cost curve up.

Healthcare Dive informs us that
UnitedHealth Group plans to link its network of tens of thousands of physicians in its population health management and care delivery business, OptumHealth, with insights it gleans from its data analytics business, OptumInsights.
  • Patients and providers will be able to access health data in real time as part of this new "digital ecosystem," Optum CEO Andrew Witty, former chief at GlaxoSmithKline, said Thursday at the Wells Fargo Securities Healthcare Conference. It will link all Optum care locations in a particular geography and rely on a risk-based, capitated fee structure to align all participating players together, Witty said.
  • Currently, UnitedHealth has bandwidth in about a dozen U.S. cities to implement the program. It plans to partner with health systems where it doesn't have a strong enough provider presence to advance value-based care and tackle chronic diseases. 

In legal news, the U.S. Justice Department this week petitioned the U.S. Court of Appeals for the D,C, Circuit for a full court rehearing of the recent three judge panel decision to resurrect a federal labor union claim for damages against OPM and its contractor Keystone Government Solutions due to the 2015 data breach. 

Wednesday, September 04, 2019

Midweek Update

U.S. District Judge Richard Leon issued his Tunney Act review decision today approving the antitrust settlement agreement between CVS Health and the Justice Department concerning CVS Health's acquisition of Aetna.  CVS Health observed
CVS Health and Aetna have been one company since November 2018, and today’s action by the district court makes that 100 percent clear.  We remain focused on transforming the consumer health care experience in America.
Healthcare Dive reports on a new prescription benefit manager, Capital Rx, which is touting its pricing transparency model.

Health IT Analytics informs us that "Having [hospital[ staff pharmacists perform post-prescription audits reduced antibiotic use among patients, suggesting that these professionals can help lead antibiotic stewardship interventions, according to a study published in JAMA Network Open."

The Washington Post reports that "former [Food and Drug Administration ("FDA")] agency heads and dozens of health groups urged the White House to nominate acting FDA chief Norman “Ned” Sharpless to become the agency’s permanent commissioner."

Finally, the Federal News Network reports that
Agencies have achieved some middling progress on their efforts to improve and prioritize federal employee health and wellness, according to the Office of Personnel Management. An evidence-based survey of agency health and wellness initiatives shows progress in some areas but gaps in others, particularly in organizations’ efforts to implement nutrition and other support programs for nursing employees, which are required by law.

Tuesday, September 03, 2019

Tuesday Tidbits

CVS Health is celebrating the fifth anniversary of its decision to remove tobacco products from its pharmacies. The FEHBlog frankly is surprised that other pharmacy chains have not followed this lead.

Fierce Healthcare discusses how prescription benefit manager CVS Caremark is carving drugs with "hyper inflated" prices out of its formularies.
The pharmacy benefit manager (PBM) launched its program for “hyperinflation” drug removals in 2017 in which it will take drugs off its template formulary if they have far cheaper equivalents and their high prices aren’t backed by quality metrics. So far, they've identified five drugs to remove as the default option for docs.
The Government Accountability Office reports on the importance of educating consumers about the proper disposal of opioid prescriptions.
Available studies suggest that many patients are unaware of federally recommended disposal methods or choose not to dispose of unused prescription opioids. For example, five studies found that between one-quarter and three-quarters of patients stored unused opioids for future use or had misplaced their unused opioids. Further, federal data indicate that 85 percent of intentional misuse occurs with the patient's knowledge—for example, when a patient sells or gives away unused prescription opioids. To educate and motivate patients to dispose of unused opioids, FDA launched a public awareness campaign called “Remove the Risk” in April 2019. Also, FDA and other stakeholders have created educational materials for patients and providers on safe opioid disposalFina.
Finally, Healthcare Dive informs us that

  • Nonprofit hospitals' operating margins are improving after falling for the last two years, according to an annual report on hospital performance from Fitch Ratings.
  • Smaller hospitals are driving the turnaround and it's a notable trend because they're not able to command higher rates from payers like their peers the "must-have" hospitals, according to the report. 
  • "The fact that [smaller hospitals] saw meaningful improvement is a good indicator that operational strength is returning to the sector, though the highs we saw in 2015 may be an unattainable highwater mark," Kevin Holloran, senior director for Fitch, said in a statement. 

Monday, September 02, 2019

Happy Labor Day!

Last Friday. the President announced a policy change. The Federal Times reports that in lieu of a pay freeze for 2020, the President will support a 2.6 percent base pay increase for federal employees with no locality pay adjustment. Congress can override the President's decision, The Federal Times further observes that "Funding legislation passed by the House would have also increased federal base pay by 2.6 percent, while also granting a 0.5 percent bump on average to locality payments."

Congress remains on a district / State work period for the next week.

Health Payer Intelligence reports that
In the face of uncertain data regarding wellness programs’ efficacy and employees’ utilization, employers are revolutionizing their approach to employee wellness programs with an increased focus on the employee, as opposed to healthcare spending, according to a new Optum study.
“Employers are getting smart, serious and sophisticated in their approach to employee health and well-being,” the Optum study begins. “They are using data, demographics and technology in smart ways to fuel program innovation, relevancy and engagement.”
Beckers Hospital Review informs us that Walmart is dipping its toe in the primary healthcare market.
The new clinic, called Walmart Health, is in Dallas, Ga., and the first appointments are available on Sept. 13. Patients can schedule appointments at The clinic, which is next door to a Walmart store, will offer primary care and a variety of other services, including labs, X-rays, counseling, dental, and audiology, according to CNBC. Depending on the success of the clinic in Georgia, the retailer may open more Walmart Health clinics in the future, sources told CNBC.

Friday, August 30, 2019


On this Friday before the last three day weekend of the summer, the FEHBlog offers you a potpourri of information:
  • The HHS Office for Civil Rights which enforces the HIPAA Privacy and Security Rules issued its Summer 2019 Cybersecurity Newsletter on the topic of Managing Malicious Insider Threats. 
  • The Centers for Medicare and Medicaid Services announced its new Market Saturation Tool for use with detecting healthcare fraud, waste, and abuse.
Market saturation, in the present context, refers to the density of providers of a particular service within a defined geographic area relative to the number of beneficiaries receiving that service in the area. The data can be used to reveal the degree to which use of a service is related to the number of providers servicing a geographic region. There are also a number of secondary research uses for these data, but one objective of making these data public is to assist health care providers in making informed decisions about their service locations and the beneficiary population they serve.  
  •  Healthcare Dive reports that telehealth provider American Well survey finding that 
  • Although 66% of consumers reported they're willing to try telehealth, only 8% have actually done it.
  • And, of the people interested in virtual care, 17% weren't sure if their insurance covers it, according to the survey of more than 2,000 adults.
  • Additionally, two-thirds of Americans are using personal health monitoring devices and one-half have health apps.

Wednesday, August 28, 2019

Midweek Update

On Monday August 26, the Affordable Care Act ("ACA")regulators issued ACA FAQ 40.  Prescription benefit managers offer health plans the option of using co-pay accumulators to ensure that prescription drug manufacturer coupons are not counted toward member cost sharing limits. For example, if a member pays $100 out of pocket and uses a manufacturer coupon for the balance, only the $100 payment counts toward, e.g., the plan's annual out of pocket limit.

In the 2020 ACA Notice of Benefit and Payment Parameters, the ACA regulators advised that health plans are permitted to so exclude the value of manufacturer coupons from the ACA's member out-of-pocket spending limits when a generic substitute is available. First the advice created confusion over whether the ACA regulators were requiring health plans to adopt co-pay accumulators. That confusion dissipated because the advice was clearly permissive. However, the health plans engaged in broader use of co-pay accumulators reasonably asked for clarification. In FAQ 40, the ACA regulators advised that they would resolve this ambiguity in the 2021 Notice of Benefit and Payment Parameters. Until that Notice takes effect on January 1, 2021, health plans may continue broader use of co-payment accumulators, e.g., beyond prescription drugs with available generic substitutes.

Fierce Healthcare reports on the results of the American Medical Group Association's annual survey of primary care and specialist physician compensation.  “The 2019 survey shows that physician compensation in 2018 rebounded from a stagnant 2017,” said Fred Horton, AMGA Consulting president. “While productivity also increased, it did not increase enough to surpass the decline we saw in last year’s survey, meaning productivity still has not risen since 2016.”

Modern Healthcare warns that "Physician groups' public relations, advertising and lobbying blitz against Congress' front-line proposals to end surprise medical bills reached such a pitch this month that congressional staff worry the entire effort will collapse."

Forbe's Healthcare Brainstorm columnist sums up a recent JAMA study on heart disease in the U.S. as follows: "diabetes and high blood pressure are still killing millions of people [in the U.S.]. And communities of color continue to be disproportionately affected by this reality."

Medicare's Plan Finder has received an u noteworthy upgrade, according to CMS.
The updated Medicare Plan Finder also provides [Medicare beneficiaries] and their caregivers with a personalized experience through a mobile friendly and easy-to-read design that will help them learn about different options and select coverage that best meets their health needs. The new Plan Finder walks users through the Medicare Advantage and Part D enrollment process from start to finish and allows people to view and compare many of the supplemental benefits that Medicare Advantage plans offer.