The Wall Street Journal reports today that “U.S. drug sales this year are expected to rise just 1% to 2%, to as much as $297 billion, according to IMS Health Inc.”  This is described as a “dramatic slowdown.”

Insurers also are hurting sales by not quickly covering new drugs and by pushing consumers and doctors toward low-cost generic drugs, Murray Aitken, senior vice president of Healthcare Insight at IMS said. Novartis’s Tekturna for high blood pressure, for example, has been a weak starter because there are many good generic drugs for hypertension on the market. That said, IMS also expects a slowdown in generic drug sales. Intense competition among generic-drug makers in the U.S. and Europe is driving down prices. IMS predicted the global generic market will grow by 5% to 7% next year, to more than $68 billion, down from double-digit growth in the past.

Similarly, Michelle Andrews from U.S. News and World Report noted today

How fitting that in these cost-conscious times, some experts are questioning whether pricey new diabetes drugs like Actos and Byetta actually provide more bang for the buck than older, cheaper ones. Their research dovetails nicely with new diabetes treatment guidelines that support trying less expensive drugs to lower blood sugar levels first and only moving on to more expensive drugs if the cheaper ones don’t do the trick.

AFP reports that “The cost of diabetes treatments rose from 6.7 billion dollars in 2001 to 12.5 billion dollars in 2007.”

According to an announcement made yesterday,

The American Academy of Actuaries honored Nancy Kichak with the 2008 Robert J. Myers Award for Public Service yesterday during its annual meeting. Kichak, the associate director for the Strategic Human Resources Policy Division of the U.S. Office of Personnel Management (OPM), was selected in recognition of her major contributions to the common good through service to government. * * *The annual award is named after Robert J. Myers, who helped structure and fund the nation’s largest social insurance program in history during his tenure as the chief actuary of the Social Security Administration from 1947 to 1970.

The award is certainly well deserved.

OPM has posted on the web its 2008 report on health information technology and transparency initiatives in the FEHB Program. These are the findings:

• 95 percent of FEHB plans have taken steps to educate their members on the value of HIT.• 75 percent of plans, representing 96 percent of total FEHB enrollment, will have PHRs available for their members in 2009. In 2007, only 51 percent of plans reported offering PHRs.
• Although the majority of FEHB plans continue to report that less the 5 percent of their members have actually used their PHRs to conduct one or more sessions, 16 percent of plans reported over 75% of their members used PHRs.
• Types of personal health records vary; 22 percent of plans report their PHRs are populated by members; 30 percent report they are populated with health plan claims data with the option for members to add personal information; 8 percent are populated by electronic medical records, with the ability to add information, and 15 percent allow members to view their personal health information with no ability for the member to up-date the information.
• 69 percent of plans report they have online physician or hospital cost estimators or comparison tools on their web sites.
• 77 percent of plans report they have online tools which compare physician or hospital quality.
• 26 percent of health plans state they provide financial incentives to providers for e-Prescribing.
• All FEHB plans are required to comply with Federal law and policy requirements to protect the privacy of individually identifiable health information. All indicate they provide members with access to privacy policies describing their compliance with the Health Insurance Portability and Accountability Act (HIPAA).

OPM has posted online its notices of significant plan changes in the FEHBP and the FEDVIP. OPM also posted online 2009 Open Season guidance and announced an upcoming redesign of its benefits program website. The 2009 Open Season will be conducted from November 10, 2008 through December 8, 2008.

The Robert Wood Johnson Foundation recently issued a study concerning “Demystifying U.S. Health Care Spending.” According this study,

Technology—not demographics or medical malpractice—is the key driver of health spending, accounting for an estimated half to two-thirds of spending growth.

Other important drivers of health care spending include health status (particularly obesity) and low productivity gains in the health care sector.

The Wall Street Journal offered its take on health care technology in today’s paper, suggesting that healthcare technology has been an investment that soon may pay dividends:

IT security will eventually meet the expectations of the health-care industry, just as has happened in other sectors, like banking. And when it does, powerful IT networks crisscrossing the globe will change the way much of health care is delivered: Outsourcing and offshoring of medical and nonmedical services will increase, providing more efficient health care at the most cost-effective rates; systems integrations will allow more medical records to be transferred swiftly and securely; efforts to monitor the safety of medicines will gain global access to data; and professionals and patients will find authoritative and up-to-date information on every specialty online.

The Center for Studying Health Policy Change published a report on patient activation or rather the level of patient involvement in their own health care. According to the Center,

“[b]ecause activation levels are linked to important outcomes, such as seeking care, seeking information and health behaviors, and because it is a changeable attribute, it is a potentially important lever for change. * * * Because activation is changeable and provider support appears to be a factor, incentivizing or holding health care delivery systems and providers accountable for patient gains in activation is a possible policy direction.”

In this regard, it’s worth noting a Kaiser Family Foundation poll surprisingly finding that

three in 10 (30%) Americans say they have seen health care quality comparisons of health insurance plans, hospitals, or doctors in the past year. Not all people make health care choices or decisions in a given year that would call for the use of quality information, but this is a downward trend from surveys in 2006 (36%) and 2004 (35%) and roughly equivalent to the level in 2000 (27%). Further, just one in seven (14%) Americans report that they “saw” and “used” comparative health quality information for health insurance plans, hospitals, or doctors in the past year, again down from roughly one in five in both 2006 (20%) and 2004 (19%).

• Audiologists are licking their chops over the enhanced hearing benefits that FEHB plans are offering in 2009.
• Morpace issued a “study, fielded in September, reveals that 48 percent of American adults
  support creation of a nationwide system of medical records, while 23
  percent oppose such a system.” 29 percent are undecided. The National Health Information Network currently underdevelopment would serve a national electronic patient registry. Unquestionably, privacy protections must be extended to the NHIN and its components. Perhaps a greater issue connected with electronic health records is their longevity. I doubt that anyone could find my childhood medical records but if a child born in the next decade could have cradle to grave medical records accessible through the NHIN. I’m not sure that’s a good idea. Your doctor need to know your relevant medical history. It might be difficult for a doctor to discern that history from all of the records available via the NHIN.
• EBRI issued its 2008 health confidence survey.
• Health Grades issued its 11th annual hospital quality study. “Patients have on average a 70 percent lower chance of dying at the nation’s top-rated hospitals compared with the lowest-rated hospitals across 17 procedures and conditions” analyzed in the study. “The study’s major findings are:
  • The nation’s inhospital risk-adjusted mortality rate improved, on average, 14.17 percent from 2005 to 2007, but the degree of improvement varied widely by procedure and diagnosis studied (range: 6.30% to 20.94%). Five star-rated hospitals’ mortality rates continue to improve at a faster rate (13.18%) than 1- or 3-star hospitals (12.30% and 13.14%, respectively).
  • Large gaps persist between the “best” and the “worst” hospitals across all procedures and
  diagnoses studied. Five star-rated hospitals had significantly lower risk-adjusted mortality across all three years studied. Across all procedures and diagnoses studied, there was an approximate 70 percent lower chance of dying in a 5-star rated hospital compared to a 1-star rated hospital. Across all procedures and diagnoses studied, there was an approximate 50 percent lower chance of dying in a 5-star rated hospital compared to the U.S. hospital average.
  • If all hospitals performed at the level of a 5-star rated hospital across the 17 procedures and diagnoses studied, 237,420 Medicare lives could have potentially been saved from 2005 to 2007.
  • Fifty-four percent (128,749) of the potentially preventable deaths were associated with just four diagnoses: Sepsis, heart failure, pneumonia and respiratory failure.
  • Variation in risk-adjusted mortality exists not only at the national level but also at the state and regional levels. The greatest quality differences between states occurred in hospital death rates for heart failure, pulmonary, stroke and cardiac surgery.
  • The region with the lowest overall risk-adjusted mortality rates was the East North Central region (IL, IN, MI, OH, and WI), while the East South Central region (AL, KY, MS, and TN) had the highest mortality rates.
  • The East North Central region (IL, IN, MI, OH, and WI), had the highest percentage of bestperforming hospitals at 26 percent. Less than seven percent of hospitals within the New England region (CT, MA, ME, NH, RI, and VT) were top-performing hospitals.”

Government Health IT reports today on yesterday’s HHS-sponsored medical ID theft town hall meeting:

Emboldened by the lure of easy money, medical identity thieves have adopted sophisticated ruses, said Gary Cantrell, director of computer forensics investigations in the Health and Human Services Department’s Office of Inspector General.

One scam involves collecting information about health care providers from sources such as the National Provider Identifier registry. Thieves use the data to bill for services never delivered at health care facilities that never existed. In recent years, investigators have recovered several billion dollars in restitution.

That amount is “probably the tip of the iceberg,” Cantrell said.

According to HHS, a “report and roadmap summarizing health IT and medical identity theft issues raised at the town hall will be released in Winter 2008 – 2009 and will set forth possible next steps for the Federal government and other stakeholders in order to work toward prevention, detection, and remediation of medical identify theft.”

HHS has proposed requiring HIPAA covered entities to implement the new X12 5010 transaction standards on April 1, 2010 and the ICD-10 code sets on October 1, 2011. The comment period ends next Tuesday April 21. A broad coalition of industry members advocate adoption of the stretched out timeline recommended by two HHS advisors, NCVHS and WEDI.

The ICD-10 Coalition which is composed of the AMA and other health care provider associations has released a Nachimson Advisors report that finds that

• For a typical small practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as $83,290.
• For a typical medium practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as $285,195
• For a typical large practice, Nachimson Advisors estimates the total cost impact of the ICD-10 mandate as more than $2.7 million.

Accelerating the change will only increase the impact of the cost burden on providers and payors and could lead to a systemic meltdown as BCBSA has warned.

Healthcare IT News reports today that the CMS administrator gave Zen-like advice on this major issue:

“Be serious about the date.”
That’s the advice of Centers for Medicare and Medicaid Service Acting Administrator Kerry Weems, when asked Tuesday about how CMS could help drive the conversion of healthcare diagnostic and billing codes from ICD-9 to ICD-10 code sets.