Misuse of ICDs?

From the JAMA article "Non–Evidence-Based ICD Implantations in the United States":

Conclusion Among patients with ICD implants in this registry, 22.5% did not meet evidence-based criteria for implantation.

Click here to access the article abstract.

To stent or not to stent or if I could turn back time...

From the New York Times article "Doctor Faces Suits Over Cardiac Stents":

The Senate Finance Committee, which oversees Medicare, started investigating Dr. Midei in February after a series of articles in The Baltimore Sun said that Dr. Midei at St. Joseph Medical Center, in Towson, Md., had inserted stents in patients who did not need them, reaping high reimbursements from Medicare and private insurance.

The senators solicited 10,000 documents from Abbott and St. Joseph. Their report, provided in advance to The New York Times, concludes that Dr. Midei “may have implanted 585 stents which were medically unnecessary” from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for those procedures.

Click here to access the NYT article.

U.S. physicians on the defensive?

Interesting data from the latest on the series of national physician surveys conducted by Jackson Healthcare on the impact of defensive medicine; some key findings:

• 76 percent of respondents reported that defensive medicine decreases patients’ access to healthcare.
• 72 percent of respondents reported that the practice of defensive medicine negatively impacts patient care.
• 71 percent of respondents reported that defensive medicine has had a negative effect on the way they view patients.
• 67 percent of respondents reported that defensive medicine comes between the doctor and patient.
• 57 percent of respondents reported that defensive medicine hampers their decisionmaking ability. 
• Patients most likely affected by defensive medicine are 1) those requiring surgery, 2) women and 3) those visiting emergency rooms.
• Defensive medicine is now being taught as standard medical practice. The survey found that 87 percent of current residents and fellows reported being taught to avoid lawsuits, compared with 48 percent of total respondents.

Click here to access add'l information on this survey as well as other surveys conducted by Jackson Healthcare.

Billing for health care

Health Affairs has just published a great article on the administrative burden of billing for health care. From the article abstract:

The U.S. system of billing third parties for health care services is complex, expensive, and inefficient. Physicians end up using nearly 12 percent of their net patient service revenue to cover the costs of excessive administrative complexity. A single transparent set of payment rules for multiple payers, a single claim form, and standard rules of submission, among other innovations, would reduce the burden on the billing offices of physician organizations. On a national scale, our hypothetical modeling of these changes would translate into $7 billion of savings annually for physician and clinical services.

Click here to access the HA article (free full text!).

Thoughts from physicians on how to control health care costs

From the New York Times article "Doctors Offer Thoughts on Cutting Health Care Costs":

How can the country reduce health care costs while not compromising quality?

During the health care debate, government officials, insurers, drug companies and medical associations all weighed in with their opinions. But what about the people who receive so much of our out-of-pocket health care payments: the doctors on the medical front lines? What do they think the country — in other words, you and me — should do to help moderate costs?

To read the physicians' answers, click here.

"FDA Alert: New USP Standards for Heparin Products

Adjustments may be needed to achieve desired anticoagulant effect in some patients New Heparin to Ship Starting October 8" Click here to access the FDA news release.

Ghostbusting

From the New York Times article "Medical Editors Push for Ghostwriting Crackdown":

As Washington tries to revamp the health care system, concerns about ghostwriting are taking on new urgency. One of the underlying assumptions of the health care overhaul effort is that money can be saved and medical care improved by relying more heavily on research showing which drugs and procedures are the most effective. But experts fear that the process could be corrupted if research articles are skewed by the hidden influence of drug or medical device makers.

Click here to access the NYT article.

Side-by-Side Comparison of Major Health Care Reform Proposals

The Kaiser Family Foundation's has an interactive side-by-side health reform comparison online tool at their website which allows users to compare "any or all of 12 different plans, including the plans approved by the Senate Health, Education, Labor and Pensions Committee and by the three House committees with responsibilities for health reform (H.R. 3200, America's Affordable Health Choices Act of 2009, also known as the House Tri-Committee bill)," and it is current as of today. Click here to access said tool!

Cracking FRAX?

From the New York Times article:

...the World Health Organization has developed an online tool meant to help doctors and patients determine when treatment for deteriorating bones is appropriate.

A preliminary version of the tool, called FRAX, was released last year and can be found at www.shef.ac.uk/FRAX/index.htm. A revised version is to be released later this year.

But FRAX is proving almost as controversial as the diagnosis of osteopenia. While some experts applaud it for taking factors besides bone density into account, others say that the formula on which the tool is based is faulty and that the advised threshold for medication is too low.

“FRAX is coming from the same people who came up with osteopenia in the first place,” said Dr. Nelson Watts, director of Bone Health and Osteoporosis Center at the University of Cincinnati, who said the diagnosis unnecessarily frightened women and should be abolished.

Click here to access the NYT article.

Will tort reform happen?

From the Wall Street Journal Opinion Journal (Kimberly A. Strassel):

Tort reform is a policy no-brainer. Experts on left and right agree that defensive medicine—ordering tests and procedures solely to protect against Joe Lawyer—adds enormously to health costs. The estimated dollar benefits of reform range from a conservative $65 billion a year to perhaps $200 billion. In context, Mr. Obama's plan would cost about $100 billion annually. That the president won't embrace even modest change that would do so much, so quickly, to lower costs, has left Americans suspicious of his real ambitions.

It's also a political no-brainer. Americans are on board. Polls routinely show that between 70% and 80% of Americans believe the country suffers from excess litigation. The entire health community is on board. Republicans and swing-state Democrats are on board. State and local governments, which have struggled to clean up their own civil-justice systems, are on board. In a debate defined by flash points, this is a rare area of agreement.

Click here to access (sub. req.).

"Framework for Comprehensive Health Care Reform"

is posted at the website of Senator Baucus. Some excerpts:

Health Insurance Exchange. States would establish an exchange in 2010 to provide easier, more efficient comparison of health insurance plan benefits and premium costs. Information about coverage and cost-sharing would be available in a standard format. So-called “mini-medical” plans with limited benefits and low annual caps would not be offered in the exchange.

Ombudsman. In 2010, states would be required to establish an ombudsman office to act as a consumer advocate for those with private coverage in the individual and small group markets. Policyholders whose health insurers have rejected claims and who have exhausted internal appeals would be able to access the ombudsman office for assistance.

Transparency. Beginning in 2010, to ensure transparency and accountability, health plans would be required to report the proportion of premium dollars that are spent on items other than medical care. Also, beginning in 2010, hospitals would be required to list standard charges for all services and Medicare DRGs.
...
Individual Responsibility. Beginning in 2013, all US citizens and legal residents would be required to purchase health insurance or have health coverage from an employer, through a public program (i.e., Medicare, Medicaid, or CHIP), or through some other source that meets the minimum creditable coverage standard. Exemptions from the requirement would be allowed for religious objections consistent with those allowed under Medicare and for undocumented immigrants. Individuals who choose to keep the plan they have today would be deemed to have satisfied the requirement.
...
Employer Responsibility. Employers would not be required to offer health insurance coverage. However, employers with more than 50 full-time employees (30 hours and above) that do not offer health coverage must pay a fee for each employee who receives the tax credit for health insurance through an exchange. The assessment is based on the amount of the tax credit received by the employee(s), but would be capped at an amount equal to $400 multiplied by the total number of employees at the firm (regardless of how many receive a credit in the exchange). Employees participating in a welfare-to-work program, children in foster care and workers with a disability are exempted from this calculation.
...
Interstate Sale of Insurance. Starting in 2015, states may form “health care choice compacts” to allow for the purchase of non-group health insurance across state lines. Such compacts may exist between two or more states. Once compacts have been formed, insurers would be allowed to sell policies in any state participating in the compact. Insurers selling policies through a compact would only be subject to the laws and regulations of the state where the policy is written or issued.

State Health Insurance Exchanges. State-based “exchanges” will be established to facilitate enrollment for individuals and separately for small group (through a SHOP exchange modeled after S. 979, the “Small Business Health Options Program Act”). The exchange will provide a standardized enrollment application, a standard format for describing insurance options and marketing, call center support and customer service. The exchanges must be self-sustaining after the first year.

Click here to access the posted document.

Pfizer to pay $2.3 Billion in settlement

From the bloomberg.com article:

Pfizer Inc. agreed to a $1.2 billion criminal fine, the largest in U.S. history, and a felony plea by a subsidiary to close an investigation into what government lawyers described as fraudulent marketing of drugs.

The fine, over sales practices for a painkiller since pulled from the market, makes up the biggest single share of a record $2.3 billion settlement, announced today, between the U.S. Justice Department and New York-based Pfizer. The deal includes $1 billion in civil penalties, the largest non-criminal fraud case against a drugmaker, the department said.

Click here to access the bloomberg.com article. Also check out the examiner.com article, an excerpt:

In an FBI press release today, the federal government announced that pharmaceutical giant Pfizer will pay $2.3 billion in civil and criminal fines for promoting "off label" uses of three of its big selling drugs by doctors treating patients in the Defense Department and Postal Service health plans. Even the FBI admits in its release that the "fraud" charges result not from injury or illness suffered by any of these patients, but rather from government payment of health insurance claims for "off label" prescriptions to federal employees.

Click here to access the examiner.com article. Click here to read the FBI news release.

ICD-10 implementation

October 1, 2013 is the deadline for implementation of the International Classification of Diseases, 10th Edition, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS). CMS has published a fact sheet which has a number of recommendations for implementation which, big surprise, includes education and training. The fact sheet also lists website resources. FYI, a number of countries have already implemented ICD-10 coding (Britain, Australia, France, Germany, and Canada). Click here to access a free version of ICD-10-CM index, tabular, and GEMS files courtesy of the CDC (and your taxes). Click here to access the HHS Final Rule.

Build it and they will use it (imaging that is)

From the New York Times article:

Federal rules allow physicians to profit from the use of machines they own or lease. But Dr. Harlan M. Krumholz, a cardiologist at Yale and an author of the paper, said financial incentives were only part of the reason the number of tests had risen so fast.

“I think the central driver is more about culture than anything else,” Dr. Krumholz said. “People use imaging instead of examining the patient; they use imaging instead of talking to the patient.

“Patients should be asking the question: ‘Do I really need this test? Is the information in this test going to help in the decision-making process?’ ”

In many cases, there is little evidence that the routine use of scans helps physicians make better decisions, especially in cases where the treatments that follow are also of questionable efficacy.

Click here to access the NYT article. Click here to access the NEJM article on this study (sub. req.). Risk/benefits, folks!

On the right road?

From the Forbes article:

Patrick Soon-Shiong, a self-made billionaire through injectable and breakthrough nanoparticle anticancer technology drug development, is now focusing his philanthropic efforts on creating a national highway for health care.
...
The idea is to create a health grid that empowers the patient and the provider. This should be a public utility, basically what I call a U.S. public health grid.

Click here to read more.

Macy Foundation on "Developing a Strong Primary Care Workforce"

From the publication:

The United States does not have enough health professionals in primary care to meet the anticipated demand. To have any hope of meeting that demand, major changes in the education and reimbursement for primary care professionals will be required. Any effort at healthcare reform must place healthcare workforce issues front and center.

In April 2009, the Josiah Macy, Jr. Foundation convened a meeting in Washington, DC, to discuss the nation’s healthcare workforce. Individuals representing four organizations with expertise in primary care and prevention were in attendance. These professionals work in the trenches of primary care, representing groups that recruit high school and college students into the health professions, nudge medical education toward a greater appreciation of primary care, and guide training for physicians, nurse practitioners, physician assistants, and others on the front lines of healthcare delivery. Their insights are compelling.

To read this publication (which is a summary of the meeting), click here.

Patient (non)compliance

From the PharmaTimes article:

One third to a half of all US patients do not take their medications as prescribed, and this is costing the nation $290 billion - 13% of total health expenditures - every year, says a new report.

Such poor levels of compliance are fuelling - and are fuelled by - the rising tide of chronic disease, says the report, by researchers at the New England Healthcare Institute (NEHI). In general, people with chronic illnesses are worse at taking their medications as prescribed than those with acute conditions, and medication persistence – the length of time a patient continues to take a prescribed drug – tends to be very low among this group.

Click here to access this article.

A voice of reason on health care reform

Please check out Doctor Reece's blog posting on twenty stories of health care reform by clicking here.

The New England Journal Medicine

has a website devoted to articles on health care reform. Click here to access said website.

The importance of data

From the USA Today article:

Data can serve as a tool to identify potential solutions, just as a high blood pressure test not only yields a diagnosis but also points the way to better treatment, says Elliot Fisher, director of the Dartmouth institute, which has pioneered the study of variations in health care by Medicare region.

The goal is to combat rising costs without sacrificing quality, he says.
...
The Dartmouth analysis shows that in 2006, hospitals in higher-performing regions had up to 14% fewer medical admissions, 17% fewer days in the hospital and 36% fewer visits to specialists, and they spent up to 21% less on medical imaging.

Their overall Medicare spending was 12.7% to 16.2% lower than hospitals with poorer performance.

Click here to access.