FEHBlog

All doctors (and Katie Couric) agree on the value of colonoscopy as a medical screening tool for people over 50 . In fact the Columbia University Department of Surgery notes that

“By screening people every five to 10 years, we think we can prevent most cancer formation,” says gastroenterologist Christine L. Frissora, M.D. In fact, having just one colonoscopy decreases your lifetime risk of dying from colorectal cancer by 68 percent.

The Washington Times reports today about a study published in the medical journal Radiology finding that virtual colonoscopy which uses three-dimensional computed tomography produces accurate diagnoses as compared to invasive, optical colonoscopy. The “research found that only 6 percent of the patients who underwent a virtual colonoscopy required a subsequent conventional colonoscopy.” The article reports two especially interesting facts:

In addition, the [virtual] procedure has yielded surprise benefits. It has picked up “clinically important extracolonic findings,” according to a study last year at the San Francisco VA Medical Center. Virtual colonoscopy revealed kidney cancers, abdominal aneurysms and other serious conditions in 45 out of 500 patients who underwent the procedure.

Meanwhile, the American College of Gastroenterology has not yet given its blanket approval of virtual colonoscopy for routine screening. But the Maryland-based group yesterday pronounced capsule colonoscopy — in which the patient swallows a jelly bean-sized video camera that records thousands of images — a “promising new tool for colon cancer screening.” The group will release complete research findings on Monday.

Earlier this month in Tampa, Florida, Walmart and Sam’s Club pharmacies began selling a thirty day supply of about 300 types of generic drugs for $4.00 whether or not the patient is insured. Walmart indicated at the time that it planned to expand the program to all of Florida at the end of the year and beyond Florida in 2007. Walmart almost immediately changed gears and opened the program to all of Florida. Today it announced the immediate expansion of the program to 14 additional states: Alaska, Arizona, Arkansas, Delaware, Illinois, Indiana, Nevada, New Jersey, New Mexico, New York, North Carolina, Oregon, Texas and Vermont.

My colleague, Theresa Defino, has called to my attention this very informative HHS website on healthcare transparency. I’m not sure how long the site’s been up on the web, but it is chock full of healthcare pricing and quality transparency information.

The Journal of the American Medical Association and the U.S. Centers for Disease Control published a report this week estimating that as many as 700,000 Americans wind up in the emergency room every year due to adverse reactions produced by combining prescription drugs with over the counter drugs or herbal supplements. Most of the affect population is over 65. The projection is based on a surveillance project on outpatient drug safety that started in 2004.

The Chicago Tribune reports that

The study’s authors said that in 2004, 82 percent of the U.S. population reported using at least one prescription drug, over-the-counter medication or dietary supplement, and 30 percent reported using five or more drugs. More effort must be made to prevent adverse events, the researchers said.

The study’s database included 63 nationally representative hospitals that reported 21,298 adverse drug reactions among American adults and children treated in emergency rooms during the two-year period.

On September 15, I blogged about two drugs that Merck and Novartis were developing to treat type 2 diabetes. On October 17, the Food and Drug Administration approved the Merck drug Januvia (sitagliptin phosphate), a once a day pill also known as a DPP-4 inhibitor that helps the body lower elevated blood sugar levels. Mayoclinic.com explains that

Controlling your blood sugar is essential to avoiding long-term complications of type 2 diabetes. If you’re struggling to control your blood sugar with diet, exercise and traditional diabetes medications, Januvia may provide a welcome alternative. Ask your doctor if Januvia would be an appropriate addition to your current treatment plan, or if the drug could be used in place of the medications you’re currently taking.

A survey of doctors revealed that physicians intend to prescribe the new drug in lieu of an Eli Lilly drug Byetta that was launched in June 2005. Forbes.com notes that “Merck is expected to charge $4.86 for the pills, which are taken once-a-day [or $146 per month]. Older diabetes drugs can cost as little as 50 cents a day, according to published reports.” Drug manufacturer CFOs love this type of drug because the large population suffering from this disease would take the pills for a long time.

On October 24, the federal district court in Boston will hold a hearing on the motion to approve the tentative settlement of the Prescription Access Litigation Project’s case against the Average Wholesale Price (AWP) publisher, First Databank, discussed in my October 8 post. The settlement agreement, if approved, will require First Databank to stop publishing its AWP listing two years from now, subject to certain exceptions. The AWP is the benchmark for many prescription drug manager pricing arrangements with health plan customers for brand name drugs.

What will replace the AWP? Of course the AWP is no longer the only show in town as other pricing arrangements have been developed. What’s more the the Medicare Modernization Act requires that federal government use an Average Sales Price (“ASP”) methodology (plus 6%) to reimburse the cost of Medicare Part B covered drugs. The HHS Office of Inspector General has recommended that the ASP methodology be extended to Medicaid. Just as the Medicare Part B resource based relative value schedule (RBRVS) has replaced the old California relative value schedule as the primary basis for preferred provider arrangements, I think that we can expect the ASP to be the new wave in PBM pricing.

The Leapfrog Group, an association of large employers and health care purchasing organizations (OPM participates as a liaison) having its objective to improve health care quality and safety, has issued first list of fifty top U.S. hospitals. The Group explained its methodology as follows:

Top Hospitals fully meet Leapfrog’s standard for ICU physician staffing
(IPS) and the Leapfrog Safe Practices Score (SPS). The adult hospitals also
meet Leapfrog’s standards for two or more of the high-risk procedures or
conditions included in the Evidence-Based Hospital Referral (EHR) leap (some
do not apply to children’s hospitals), which were each given equal weight.
Full implementation of Computerized Physician Order Entry (CPOE) was used to
break any ties.Then, if necessary, hospitals’ ranking on overall points for
the Leapfrog Safe Practices Score was used to break any remaining
ties.

I was surprised to find no hospitals in the D.C. metropolitan area on the list (although there are three from Baltimore, Sinai, University of Maryland, and Johns Hopkins). Although Mass General and Brigham and Womens Hospitals which are associated with Harvard Medical School made the list, Yale New Haven did not.

In Benefit Administation Letter 06-035, the U.S. Office of Personnel Management announced that The official Federal Employees Health Benefits (FEHB) withholdings and contribution rates for 2007 are available in a [handy dandy] PDF and Excel file formats on the OPM web site.

Traditional Medicare Part A reimburses hospitals for inpatient care based on a prospective pricing system (PPS) . The Centers for Medicare and Medicaid Services (CMS) updates the PPS annually. CMS issued a notice of the proposed Fiscal Year 2007 PPS updates and rates in August and on October 11 CMS published the final update in the Federal Register. “CMS is continuing to estimate that payments to hospitals will increase by $3.4 billion or an average of 3.5 percent.” CMS is requiring hospitals to report quality data in order to receive the full FY 2007 PPS update. CMS reported last month that

Out of the nation’s 3,490 acute care hospitals eligible to participate, 99 percent of those chose to report quality data. Out of those hospitals eligible to receive a 2 percent annual payment update from Medicare for participating, 171 failed to meet the FY 2007 reporting requirements (143 failed the submission requirements and 28 chose not to participate).

The Robert Wood Johnson Foundation, working with researchers from the GWU University Medical Center and the Massachusetts General Hospital, released a report today that the U.S. Department of Health and Human Services commissioned to establish a baseline for judging the Nation’s progress toward achieving the President’s goal of widespread electronic health record (EHR) use by 2014. The report is sobering.

While 25% of doctors use EHRs to improve patient care, but only “5 percent of hospitals used computerized physician order entry.” Moreover, “less than one in 10 are using what experts define as a “fully operational” system that collects patient information, displays test results, allows providers to enter medical orders and prescriptions, and helps doctors make treatment decisions.”

The Foudation spotlights the following findings from the report:

• Hospital adoption trends are unknown. Assertions to the contrary, there are not enough high-quality, reliable surveys of hospital use of EHRs. The research team reliably estimates, however, that about 5 percent of America’s 6,000 hospitals have adopted computerized physician order entry (CPOE) systems, a component of EHRs, to help reduce medical errors and ease care delivery.
• There is no evidence yet of a digital divide. There remains “considerable uncertainty” about the existence and size of gaps in use of EHRs among physicians who care for vulnerable populations. Tracking the adoption and use of EHRs among these providers, understanding unique barriers to adoption, and identifying policies to close this gap are important steps. The study did find that patient characteristics matter, however. Physicians who treat fewer Medicaid patients are more likely to report using EHRs than those with a larger share of practice revenue from the insurance program.
• A better definition of EHRs is essential. There really is no standard definition of what an EHR is and what adoption means. Consequently, a lot is left to interpretation when surveys are conducted. The report says that the U.S. could more adequately measure EHR adoption trends over time if there was a consistency in terminology and survey methods related to adoption practices.
• Adoption depends on many factors. The report points to four key things that drive adoption: financial incentives and barriers, laws and regulations, the state of the technology and organizational influences such as the size of a practice or hospital or payer mix; and how integrated a health care system is.

There’s a lot of work still to be done.