Ron Davis, MD, immediate past president of the American Medical Association, died yesterday. I was impressed by his courage in carrying out the responsibilities of his office while undergoing treatment for pancreatic cancer. He educated the public about his treatment through the Carepages website. He was clearly a man of character.
As far as I can recall FEHB plan brochures generally have defined a covered hospital as one accredited by JCAHO (“the Joint Commission”). Until recently, the Joint Commission was the only CMS approved vendor that could accredit hospitals for Medicare participation. The AMA News reports that CMS in May 2008 approved a second vendor, DNV Healthcare. DNV’s program is known as NIAHO. What’s more, on October 24, CMS placed one of the Joint Commission’s programs on probation, which the Joint Commission must resolve by May 2009.
Big reasons for the savings:• Generic drugs. The use of generic drugs has grown sharply, especially among seniors. Norvasc, for high blood pressure, and Fosamax, for osteoporosis, are among expensive drugs now available in generic form. Generics account for 64% of Medicare prescriptions compared with 61% in the private sector, Medicare says. • Fewer enrollees. The program has 2 million fewer participants than originally forecast. Some seniors decided to keep existing drug coverage, Medicare says. Also, fewer poor people enrolled than expected. • Doughnut hole. Seniors have cut costs to avoid falling into the “doughnut hole” — a coverage gap in which drug expenses between $2,510 and $4,050 a year are not insured.
Physicians and other eligible professionals who adopt and use qualified electronic prescribing (e-prescribing) systems to transmit prescriptions to pharmacies may earn an incentive payment of 2.0 percent of their total Medicare allowed charges during 2009. This incentive is in addition to a 2.0 percent incentive payment for 2009 for physicians who successfully report measures under the Physician Quality Reporting Initiative (PQRI), and both incentive payments are in addition to the 1.1 percent fee schedule update required by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA). Thus, a physician who successfully reports under both the e-prescribing and PQRI initiatives could receive up to a 5.1 percent pay boost for 2009.
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.”
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.
• 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).
Look at what’s happened in baseball. For decades, executives, managers and scouts built their teams and managed games based on their personal experiences and a handful of dubious statistics. This romantic approach has been replaced with a statistics-based creed called sabermetrics. . . . Similarly, a health care system that is driven by robust comparative clinical evidence will save lives and money. . . . Working closely with doctors, the federal government and the private sector should create a new institute for evidence-based medicine.
Interesting analogy.
Treatment with placebos is far more common than you might think, according to a new national survey in which 46 percent to 58 percent of U.S. physicians admitted using placebos regularly. . . . Only 5 percent said they tell patients explicitly that they are doing so. the physicians surveyed were far more likely to use active agents as placebos, including over-the-counter painkillers, vitamins, sedatives and antibiotics. . . . . What classifies them as placebos is the context. If the recommended treatment hasn’t been shown, physiologically, to work for the condition in question, that’s a placebo.
No wonder health care costs are high.