Michelle Singletary wrote an interesting piece in today’s Washington Post about tools that are available on the internet to health care consumers, such as Health Grades and my Family Health Budget. Many of these tools are made available by health plans to their participants.

Robert E. Moffitt, the director of the Center for Health Policy Studies at the Heritage Foundation, praised the FEHB Program’s competitive model in an op-ed published today in the Washington Times.

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.