Midweek update

The press continues to hammer on drug prices.  Kaiser Health News reports that drug price increases hurt the bottom line of hospitals and the Wall Street Journal reports that those increases hurt the bottom line of consumers with high deductible health plans.  The FEHBlog would not be surprised to see Congress eviscerate the current drug pricing system which raises prices on the front end but allows for a volume rebate to third party payers on the back end. Bear in mind that this model is based on Medicaid’s drug program.  Whether Congress would apply such a solution to Medicaid is another question.

Becker’s Healthcare tells us about the growing practice of doctors de-prescribing medicines for older patients.  Becker’s identifies the following five things to know:

1. Of patients in their 60s, almost 40 percent are taking more than five medications.
2. To lower this figure, physicians conduct comprehensive medication reviews to determine which drugs they can decrease the dosage or de-prescribe if they do not benefit a patient’s overall health.
3. Alongside pharmacist Barbara Farrell, Cara Tannenbaum, MD, created the website, deprescribing.org, which allows physicians in the Untied States and Canada to obtain information to help them assess if a patient should cease taking certain medications that are unnecessary or even harmful. Canadian Deprescribing Network maintains the site.
4. In 2015, The American Geriatric Society updated its Beers Criteria, which features a list of 40 medications or classes of drugs that the society deems as possibly inappropriate for older adults. The American Geriatric Society added three new drugs and two new classes of medications to its warning lists for older adults or people with certain health concerns last year. Currently, an expert panel is working on an update for that list for 2018.
5. Physicians have issued warnings about using sedatives in older adults and recently, there have been warnings about proton pump inhibitors. WSJ reports new studies show an association between these pumps and a higher risk for bone loss, fractures and serious bacterial infections.

Here’s a cost reduction effort that health plans should support.

In a bit of good news for the human team,  Healthcare Dive reports on a study finding that human doctors perform signficantly better than computerized algorithms when making initial diagnoses.

Researchers from Harvard Medical School, Brigham & Women’s Hospital and The Human Diagnosis Project used 45 clinical vignettes to compare the diagnostic accuracy of 23 online or app-based symptom checkers with that of 234 physicians.  The results show 72.1% of doctors listed the right diagnosis first, versus 34% of the algorithms. 

However, the doctors misdiagnosed about 15% of the simulated cases acccording to the article. To err is human, etc. 

One of the many tortured ACA provisions is the requirement to cover with no enrollee cost sharing preventives services with A or B reecommendations from the National Preventive Services Task Force when provided in-network. The basic problem is that the NPSTF recommendations provide medical not insurance coverage advice. Moreover, NPR reports that “The former chairmen of the U.S. Preventive Services Task Force say the link between medical recommendations and insurance coverage leads to financial incentives that can corrupt the process and distort people’s health care decisions.”  If you build it, they will come.

Health IT Security reinforces the burning need for HIPAA patient identifiers in order to get the full bang for the buck out of the $32 billion that the federal government has spend on electronic medical records.

Finally, OPM last week “released the detailed government-wide Federal Employee Viewpoint Survey (FEVS) results for 2016. The complete governmentwide results for 2016 contain scores from indices such as Employee Engagement, Global Satisfaction, and the New IQ. Also included are promising practices on employee engagement, very practical advice on what works to help improve engagement and performance. The 2016 FEVS provides government employees with the opportunity to candidly share their perceptions of their workplace, their agencies, and their leaders. This year, 407,789 employees responded to the survey out of the 889,590 to whom it was sent, for a response rate of 45.8%.”

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