Happy Memorial Day

Congress is out of town this week.  FEHBP carriers must submit their 2017 benefit and rate proposals to OPM tomorrow.  

The Washington Post offered a follow-up report on the antiobiotic-resistant e. coli superbug that first appeared in the U.S last week last Friday's post].  Significantly the infectious disease doctor who is interviewed in the story concludes that

Q: How likely is it for someone to pick up this antibiotic-resistant strain of E. coli from food?
A: Even if you ingest some resistant E. coli, most of it would be dead as it goes through the stomach because the stomach is highly acidic and designed to sterilize what we ingest. Most of it is gone by the time it comes out of the stomach. Even if some of it makes it through, it can hang out in your gut for a while and disappear. Only a very small portion of those people may become sick. So to summarize, you are starting at a very low risk in food, and then it goes through the stomach, and most will disappear in the digestive tract. I don’t think there is anything to be super worried about.

He advises cooking meat thoroughly and washing your hands when you cook.  This is the same maternal advice that everyone receives.  The point remains that doctors and hospitals need to curb utilization of antibiotics. As the expert explains

Q: Should doctors and hospitals be doing anything differently now that we know this resistance gene has been found in the United States?
A: It’s always prudent for doctors, when treating a bacterial infection with colistin, to make sure it works against the bacteria in a test tube when they need to give this antibiotic to their patients, instead of assuming that it should work. Many hospitals already do this, including ours [the University of Pittsburgh Hospital].

Last week, HHS's Office for Civil Rights clarified its recent rule on maximum charges for providing copies of health records to individuals under HIPAA.  Health IT Security reports that "as the healthcare industry becomes more digitized, more patients are requesting electronic copies of PHI [("ePHI")]. For  [HIPAA] covered entities that do not wish to calculate the labor and supply costs for providing ePHI, organizations can charge a flat fee of $6.50 or lower, which includes labor, supplies, and postage fees."

TGIF

As we approach the end of the annual federal holiday drought, Congress is leaving town for a week. Here is a link to the Week in Congress's report on past week's activities on Capitol Hill. 

The New York Times reports today that the number of opioid prescriptions is finally dropping nationwide.

For much of the past two decades, doctors were writing so many prescriptions for the powerful opioid painkillers that, in recent years, there have been enough for every American adult to have a bottle. But for each of the past three years — 2013, 2014 and 2015 — prescriptions have declined, a review of several sources of data shows.
Experts say the drop is an important early signal that the long-running prescription opioid epidemic may be peaking, that doctors have begun heeding a drumbeat of warnings about the highly addictive nature of the drugs and that federal and state efforts to curb them are having an effect.

Experts have been worried about over-prescription of antibiotics for years.  Modern Healthcare reports that

A little more than one-third of acute care hospitals in the U.S. adhere to best practices to promote appropriate use of antibiotics, according to a new report. An analysis of more than 4,100 U.S. acute-care hospitals recently published in the journal Clinical Infectious Diseases found that 39% had an antibiotics stewardship program that met all seven of the core elements recommended by the Centers for Disease Control and Prevention.   

This is not a tsk tsk situation.  We have reached a true "ruh-roh" moment on the antibiotic over-usage front.  According to Reuters

U.S. health officials on Thursday reported the first case in the country of a patient with an infection resistant to a last-resort antibiotic, and expressed grave concern that the superbug could pose serious danger for routine infections if it spreads.
"We risk being in a post-antibiotic world," said Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, referring to the urinary tract infection of a 49-year-old Pennsylvania woman who had not traveled within the prior five months.
Frieden, speaking at a National Press Club luncheon in Washington, D.C., said the bacteria was resistant to colistin, an antibiotic that is reserved for use against "nightmare bacteria.

Let's wrap up this post with a few tidbits on topics that the FEHBlog has been following --

• Drug Channels digs into the CALPers PBM contract recently awarded to OptumRx. 
• The OPM Inspector General issued another report on OPM's efforts to better secure its computer systems. Here's a link to the Washington Post's report thereon. 
• Beckers Hospital Review reports that Ohio's health insurance co-op, Coordinated Health Mutual, has failed. The Hill adds that "Just 10 of the original 23 [ACA creations] will now remain.

Mid-week update

This morning, a House appropriations subcommittee approved the committee's leadership's version of the financial services and general government appropriations bill by voice vote along party lines. No FEHBP surprises. The next step is the full committee.

The FEHBlog realized today that he should have provided links to Prof. Tim Jost's accounts of the HHS final rule implementing PHSA Sec. 1557 and the EEOC's final rules concerning application of Americans with Disabilities Act and the Genetic Information Non-Discrimination Act, assuming readers what more information.  HHS's PHSA Sec. 1557 rule is a particularly complex and burdensome rule which the FEHBlog has heard described as "catnip to the plaintiff's bar."  The FEHBlog looks forward to reading OPM's take on the extent to which this rule applies to the FEHBP. The underlying law applies to the FEHBP and HHS encourage its fellow agencies to promulgate implementing rules for their own health programs and activities.

Beckers Hospital Review reports on a Centers for Disease Control population survey of health information technology use.  The survey highlight is that" the gap between how much the over 65 crowd uses health IT compared to younger generations isn't so large — 33 percent, compared to 54.8 percent."

The consulting firm Milliman issued its 2016 Medical Index which concludes that in 2016, the cost of healthcare for a typical American family of four covered by an average employer-sponsored preferred provider organization (PPO) plan is $25,826." There always are many interesting tidbits to be found in the report. In that regard, it's worth noting that FEHB plan carriers are putting the finishing touches on their 2017 benefit and rate proposals which must be submitted to OPM by next Tuesday May 31.

Following up on Sunday's FEHBlog post, Fierce Healthpayer reports that Anthem's CEO Joseph Swedish, [s]peaking at the UBS Global Healthcare Conference on Tuesday, acknowledged [that his company and its merger partner Cigna] have experienced an expected degree of 'dynamic tension,' noting that 'quite frankly, along the way you hit these bumps, but we're going to overcome this.' Swedish said the companies are collaborating closely as they go through the regulatory process, which he described as having 'a very, very long tail to it.'"

Weekend update

Congress remains in session this coming week on Capitol Hill. Of note is the House Appropriations Subcommittee mark-up of the Financial Services and General Government appropriations bill for FY 2017. That session is scheduled for May 25 at 9:30 am. This is the appropriations bill that funds the FEHBP.  

Last week, the Obama Administration posted its semi-annual regulatory agenda for Spring 2016. Here is a link to OPM's agenda.  Several FEHBP tweaks  are found therein. Bear in mind that the preamble advises that "This publication does not impose a binding obligation on OPM with regard to any specific item on the agenda. Regulatory action in addition to the items listed is not precluded."

The Wall Street Journal reported this morning that

Quarrels have broken out behind the scenes of Anthem Inc.'s $48 billion proposed acquisition of Cigna Corp. as the health insurers seek regulatory approval for their landmark deal, according to a series of letters reviewed by The Wall Street Journal.
People on both sides say the squabbles could delay or derail antitrust approvals, which are typically harder to obtain if both parties aren't in sync. While neither company has sought to terminate the merger, the people say, and it doesn't appear in danger of imminent collapse, Anthem and Cigna are bickering on several fronts.

It's not a good sign when sensitive information like this leaks out to the press.

Almost Friday

The FEHBlog has been out of town this week.  He wants to fit in the end of week message before heading back to DC tomorrow.  Here's a link to the Week in Congress's report on this week's activities on Capitol Hill.

A commenter asked the FEHBlog for details about the Inovalon study mentioned in the Wall Street Journal article about rural health care costs.  The FEHBlog did discover that Inovalon had acquired the health care consulting firm Avalere but he couldn't find the study in question.  He has written to the article's author. In the meantime, the National Rural Health Care Association offers a litany of rural health care problems.   On the bright side, Health Day reports that

Having a commonplace surgery -- such as a gallbladder removal -- may be safer when done in a rural hospital compared to a suburban or city hospital, a new study finds. "This study gives credence to what rural surgeons long suspected -- that well-done rural surgery is safe and cost-effective," study author Dr. Tyler Hughes said in a University of Michigan news release. Hughes is one of only two surgeons at McPherson Hospital in rural McPherson, Kan., and a director of the American Board of Surgery.

Go figure.

Forbes reports on a new Blue Cross study finding that  "the high cost of specialty drugs like the new hepatitis C pills, saying they contributed another $87 annually in [2013 - 2014] costs per enrollee whether they used the expensive medicines or not." That adds up to a lot of money.

Also on the Rx front, the Minneapolis Star Tribune reports that United Healthcare's PBM OptumRx beat out CVS Caremark and Express Scripts for the enormous CALPers prescription drug benefits contact.  The five year long contract is worth $4.9 billion. That is a lot of money.  It also indicates that OptumRx has formed a big three of PBMs with CVS and Express Scripts.

Stat reports on efforts by naturopaths to get reimbursed by health insurers.  Their efforts are spurred on by the ACA's Public Health Service Act Section 2706(a) and vitamin manufacturers. Everyone wants a piece of the pies.

Finally Health Day reports about health care pricing transparency problems.  

The out-of-pocket price for a standard chest X-ray, CT scan or ultrasound can vary by hundreds of dollars, depending on where the imaging is done, new research reveals.
"The lack of price transparency is certainly not isolated to the field of radiology alone," said study co-author Dr. Mindy Licurse, a diagnostic radiology resident with the University of Pennsylvania Health System. For example, a 2014 analysis by the Health Care Incentives Improvement Institute in Connecticut and Catalyst for Payment Reform in California revealed that most states lack laws making health cost information available to consumers.
"Our study certainly contributes to the underlying hypothesis that pricing information within health care, specifically imaging in this case, may be difficult to obtain depending on the setting, and therefore comparison-shopping by patients is limited," she added.

This is a problem that healthcare providers can and should fix in cooperation with insurers.

Tuesday's Tidbits -- Studies and Rules

The FEHBlog noticed studies on

• Rural health care -- from the Wall Street Journal -- 

Using a health-insurance claims database that includes about two million exchange enrollees, Inovalon found that rural residents racked up significantly higher medical costs than urban enrollees in 2015.  “Individuals in less populated areas tend to be sicker” according to the data, said April Todd, an executive at a consulting unit of Inovalon. But the cost gap was also driven by higher expenses at rural health-care providers, she said.

• Children's health care -- from the Health Care Cost Institute --  

Per capita spending on health care for children covered by employer-sponsored insurance (ESI) grew an annual average of 5.1 percent per year between 2010 and 2014, reaching $2,660 in 2014. At the same time, there was a general decline in the use of health care services between 2012 and 2014. Out-of-pocket spending on children increased an average annual 5.5 percent, to $472 in 2014. This growth was due in part to higher out-of-pocket spending on ER visits, which increased an average annual 11.7 percent or $21 per capita.

• Telemedicine -- again from the Wall Street Journal - which suggests that insurers should give thought to the way in which members are steered toward or away from from telemedicine:

Researchers posing as patients with skin problems sought help from 16 online telemedicine companies—with unsettling results.  *  * * “The services failed to ask simple, relevant questions of patients about their symptoms, leading them to repeatedly miss important diagnoses,” said Jack Resneck, a dermatologist with the University of California, San Francisco, and lead author of the study, published online in JAMA Dermatology on Sunday. Ateev Mehrotra, an associate professor of health-care policy at Harvard Medical School who wasn’t involved with the current study, said it “identifies a number of egregious quality issues that raise significant concern.” 

And of course there are more rules. The Equal Employment Opportunity Commission released a final rule yesterday on employer sponsored wellness programs which will take effect next year.  USA Today indicates that reaction to the rule is mixed.  Professor Timothy Jost in his Health Affairs blog provides more details on the Public Health Service Act Section 1557 rule released last Friday.  He also discusses an HHS rule released a couple weeks ago that loosened the regulatory leash on health care co-ops.

 

Weekend update

Congress remains in session on Capitol Hill this coming week. Here is a link to the Week in Congress's report on last week's activities, which included the passage of 18 House bills concerning opioid abuse.

Last week, the Partnership for Public Service released its annual report on best places to work in the federal government. OPM ranked in the middle for medium sized agencies.

The FEHBlog ran across a Pharmalot post. Pharmalot is a blog that previously appeared on the Wall Street Journal site but now is now on the Boston Globe's Stat site. In any event, Pharmalot reports that "a new study found that Americans spent an extra $73 billion between 2010 and 2012 on pricier brand-name drugs because physicians failed to sufficiently recommend these copycat treatments to their patients. And consumers paid nearly one-third of those additional costs through out-of-pocket payments." Hopefully the implementation of electronic prescription tools is remediating this problem.

Also on the pharmacy front, Walgreen's is adding telemental visits to its app and website and is providing mental health treatment training to its pharmacists. Walgreen's mental health website also provides a link to these mental health screening tools provided by Mental Health America.

Happy Friday the 13th

Sen. David Vitter (R Louisiana) continues to maintain a hold on Beth Cobert's nomination to serve as permanent OPM Director according to this Federal News Radio report.  The Senator "isn’t satisfied with OPM’s response to his questions about a final rule that lets members of Congress and their staff buy health insurance on the Small Business Health Options Plan (SHOP) exchange. And he’s blaming OPM — as well as members of Congress — for being complicit to an exemption in the Affordable Care Act that members shouldn’t have."  This ball properly should be in Congress's court not OPM's.

Speaking of OPM's Nextgov.com offers an interview with OPM's senior cybersecurity advisor Clifton Triplett. Mr. Triplett "used OPM’s upcoming “unfortunate [data breach announcement] anniversary” to discuss [in the article] the agency’s security posture in the year since the big breach was announced."

HHS issued its final non-discrimination in health programs rule today. The rule applies Public Health Service Act Section 1557 added by the ACA to HHS funded and administered programs. While PHSA Sec. 1557 applies to the FEHBP, it's not clear to what extent this HHS rule applies to the FEHBP. But in any event the rule deserves attention.

The HHS rule takes effect on July 18, 2016. HHS is allowing health plans to make benefit changes required by the rule in time for the next plan year beginning on or after January 1, 2017. The rule unquestionably applies to all ACA marketplace plans which like FEHB plans, are immersed in 2017 benefit design development now (and in some states the horse has left the barn). Here is a link to HHS's related facts heets and the final rule itself.

Midweek update

Here are a few articles to give you a flavor for the Healthcare Datapalooza conference which ends today:

• Health Data Liberation Remains a Political Struggle from Healthcare Informatics. What isn't a political struggle these days?
• HHS endorsed a AARP contest to design a new medical bill.  How about a piece of paper with the Cadusus symbol and the word "Free" written on it?  But seriously anything written for the patient specifically will lack the information that a health insurer needs to process the claim accurately so providers will be stuck with issuing two bills.  
• NPR's story on What Feds Push to Share Data Means for Patients.  The FEHBlog is not sure because we will still need a doctor or other healthcare professional to interpret the data.  Is the level of professional trust really that low? 

Here a two interesting public health pieces:

• Does putting on a couple extra pounds help you avoid death also from NPR. Common sense tells you that it does. A dietician friend told the FEHBlog that the extra pounds (BMI overweight not obese) help older people in particular because if you get seriously ill you can lose weight quickly and it's then hard to put the weight back on.  
• From the Wall Street Journal this morning.  

Following up on [opioid] overdose rescues is “something that we need to figure out how to do better,” said Sharon Stancliff, medical director at the New York City-based Harm Reduction Coalition, an advocacy group for people and communities affected by drugs. “When people have one overdose, they’re at very high risk of having another one.”

Finally, a helpful article from fedsmith.com detailing the Medicare Part B premium mess that confronts us annually.  

Happy Mothers' Day

Congress is in session on Capitol Hill this coming week.  On Wednesday, the House Oversight and Government Reform Committee is holding a hearing on reforming the Postal Service and the House Energy and Commerce Committee's health subcommittee is holding a hearing on "Health Care Solutions: Increasing Patient Choice and Plan Innovation."  

Starting tomorrow, the popular Healthdatapalooza conference will be held here in DC. A Wednesday post conference is dedicated to a day on data security. The FEHBlog will sit this one out. 

Kaiser Health News reports that the opoid overdose crisis is principally afflicting people in the 45 - 64 age group.  

Millions of people are on opioids — most of them over 45 — and that means some are at risk of overdose. Bratberg said we should be educating patients and doctors.
“We’re really making a push nationally and regionally to educate prescribers about those risks, and to use tools available to warn folks about that.” [according to University of Rhode Island pharmacy professor Jeffrey Bratberg]
Tools that help lower the risk include naloxone, the overdose rescue drug. There’s also medication, such as buprenorphine or methadone, to assist people who have become addicted to painkillers to stop their use safely. In essence, those drugs keep a low level of opioids in the system to keep someone from going into withdrawal without getting them high.

Congress is poised to pass a bevy of laws on this issue.

TGIF

Yahoo Finance reports this afternoon that "Health insurer Cigna Corp (CI.N), which announced plans to be bought by larger Anthem Inc 10 months ago, on Friday said the deal may close in 2017 rather than 2016 due to the complexity of the regulatory process, according to a filing with the Securities and Exchange Commission."  The article indicates that an Anthem spokesperson advised that Anthem has not changed its expectations for the close -- 2nd half of this year.  Regulatory review of the deal is ongoing. 

The FEHBlog for many years has been looking forward to savings generated by unbranded versions of specialty drugs, so-called biosimilar drugs. However, the Wall Street Journal reports today that

Generic drugs have long delivered huge savings over their brand-name counterparts. That isn’t likely to happen, though, with knockoff versions of some of the expensive drugs on the market today.
Rival versions of so-called biotech drugs, called biosimilars, are just starting to be released, and health insurers and drug-benefit managers say they expect them to cost nearly as much as the brand-name originals did for years.
One big reason: Pharmaceutical companies have been raising prices on biotech drugs about to lose patent protection to squeeze out more revenue before competition arrives, according to insurers, drug-benefit managers and pharmaceutical-industry consultants. And makers of the knockoffs are setting their prices just below those marked-up ones.

Quelle domage.

Hospitals and Health Networks reports that

The cost to hospitalize those with opioid abuse or dependence problems has more than tripled in a decade, up to nearly $15 billion in 2012, according to a new study published in Health Affairs this week. Similarly, the number of patients hospitalized for the effects of these drugs has surged by more than 72 percent, reaching 520,000 in 2012 (the year with the most recent available data), researchers with Harvard and the Veteran’s Health Administration found. Overall hospitalizations during that time, meanwhile, stayed relatively flat.

 Wow.  Cost curve up.

In that regard, Fierce Health Finance tells us that "Expanding healthcare price transparency didn't prompt lower outpatient spending, according to a study published in the Journal of the American Medical Association" and that 

[Health Affairs] researchers call for increased education to raise awareness of the tools insurers have made available, saying payers should do more to engage consumers in shopping for the best price option.  While that may be easier said than done, the solution may lie in using providers as navigators for price shopping.

Modern Healthcare reports that the Centers for Medicare and Medicaid Services has performed its annual data dump on Medicare payments to doctors. Here's a link to the CMS press release that may be more accessible.

To show that the FEHBlog is not a one trick pony focused on costs, he also points out Healthcare IT News reports on a Brookings Institution analysis offering cybersecurity tips to healthcare organizations.

Tuesday Tidbits

The media is chock full of studies. Here are a few that caught the FEHBlog's eye today:

• The Washington Post reports tonight on a Johns Hopkins study suggesting that medical errors are the third leading cause of death in the U.S.  From a practical standpoint the FEHBlog simply does not believe that medical errors cause "nearly 700 deaths a day -- about 9.5 percent of all deaths annually in the United States."  But this eye-popping study will garner a lot of attention. 
• The Washington Post reported yesterday about a Health Affairs study finding that "Seven of the top 10 most profitable hospitals in the United States are nonprofit facilities that each netted more than $150 million from caring for patients in 2013."  For non-profit read tax-exempt.  
• The Wall Street Journal reports today that "Retiring after age 65 may help people live longer, says a study published online in the Journal of Epidemiology & Community Health. The risk of dying from any cause over the study period was 11% lower among people who delayed retirement for one year—until age 66—and fell further among people who retired between the ages of 66 and 72, the study found." The FEHBlog hopes to work beyond 65 but based his life experience, he's not sure about this study either.  

Weekend Update

Congress will be out of town this coming week.  Here is a link to the Week in Congress's report on last week's activities on Capitol Hill. 

The Washington Post yesterday put on its front page an article headlined "Hospital discharge: It’s one of the most dangerous periods for patients." This is not news. The FEHBlog is certain that hospitalized patients do better -- during and after hospitalization -- if they have active support from family and friends. Patients without that support likely stay in the hospital longer and are readmitted more frequently.  The question is how to provide better support for these unsupported patients. Perhaps telehealth will help.

Bloomberg reports that the large prescription benefits manager Express Script is focusing attention on overcoming "Valenant style" drug price hikes.

Customers, such as employers or insurance plans, that sign up for the new program will give Express Scripts advance permission to try to shift patients to cheaper alternative medicines when an old drug jumps suddenly in price, [Express Scripts Chief Medical Officer Steve] Miller said. Express Scripts also will be able to steer patients away from pharmacies that the benefit manager judges are working with a drugmaker to push an expensive treatment or circumvent rules designed to encourage use of cheaper treatments.

Good luck with that.

Meanwhile the Wall Street Journal reports that

Despite a growing outcry over the rising cost of cancer treatments, drugmakers are placing multibillion-dollar bets on new [cancer] medicines they expect will command premium prices and generate big sales.
France’s Sanofi SA said Thursday it made an unsolicited, $9.3 billion offer to purchase San Francisco-based Medivation Inc., which sells a prostate-cancer drug that recently drew criticism from members of Congress over its price tag. It is Sanofi’s latest effort to expand its cancer-treatment business as sales of its older drugs decline. Medivation’s board was scheduled to meet Thursday to review the offer.
Separately, AbbVie Inc. of North Chicago, Ill., agreed to pay $5.8 billion to acquire a privately held cancer-drug developer, Stemcentrx Inc., of South San Francisco, Calif., continuing AbbVie’s aggressive push to build an oncology business. Stemcentrx’s investors include a venture-capital fund founded by Peter Thiel, a co-founder of PayPal Holdings Inc. and an early investor in Facebook Inc. 

Rur roh.