VIDEO
This segment was originally broadcast by "60 Minutes" on March 29, 2007. The amount of money spent on lobbying and political contributions by the pharmaceutical industry has continued to increase since. Check out this case study by the New York Times for a more recent update on the skyrocketing cost of prescription drugs in the United States.
Under The Influence
60 Minutes' Steve Kroft Reports On Drug Lobbyists' Role in Passing Bill That Keeps Drug Prices High
2007 Mar 29
Correspondent Michelle Singer
This segment was originally broadcast on April 1, 2007. It was updated on July 23, 2007.
If you have ever wondered why the cost of prescription drugs in the United States are the highest in the world or why it's illegal to import cheaper drugs from Canada or Mexico, you need look no further than the pharmaceutical lobby and its influence in Washington, D.C.
According to a report by the Center for Public Integrity, congressmen are outnumbered two to one by lobbyists for an industry that spends roughly $100 million a year in campaign contributions and lobbying expenses to protect its profits.
One reason those profits have exceeded Wall Street expectations is the Medicare prescription drug bill. It was passed more than three-and-a-half years ago, but as 60 Minutes correspondent Steve Kroft reports, its effects are still reverberating through the halls of Congress, providing a window into how the lobby works.
The unorthodox roll call on one of the most expensive bills ever placed before the House of Representatives began in the middle of the night, long after most people in Washington had switched off C-SPAN and gone to sleep.
The only witnesses were congressional staffers, hundreds of lobbyists, and U.S. representatives, like Dan Burton, R-Ind., and Walter Jones, R-N.C.
"The pharmaceutical lobbyists wrote the bill," says Jones. "The bill was over 1,000 pages. And it got to the members of the House that morning, and we voted for it at about 3 a.m. in the morning," remembers Jones.
Why did the vote finally take place at 3 a.m.?
"Well, I think a lot of the shenanigans that were going on that night, they didn't want on national television in primetime," according to Burton.
"I've been in politics for 22 years," says Jones, "and it was the ugliest night I have ever seen in 22 years."
The legislation was the cornerstone of Republican's domestic agenda and would extend limited prescription drugs coverage under Medicare to 41 million Americans, including 13 million who had never been covered before.
At an estimated cost of just under $400 billion over 10 years, it was the largest entitlement program in more than 40 years, and the debate broke down along party lines.
But when it came time to cast ballots, the Republican leadership discovered that a number of key Republican congressmen had defected and joined the Democrats, arguing that the bill was too expensive and a sellout to the drug companies. Burton and Jones were among them.
"They're suppose to have 15 minutes to leave the voting machines open and it was open for almost three hours," Burton explains. "The votes were there to defeat the bill for two hours and 45 minutes and we had leaders going around and gathering around individuals, trying to twist their arms to get them to change their votes."
Jones says the arm-twisting was horrible.
"We had a good friend from Michigan, Nick Smith, and they threatened to work against his son who wanted to run for his seat when he retired," he recalls. "I saw a woman, a member of the House, a lady, crying when they came around her, trying to get her to change her votes. It was ugly."
When the prescription drug bill finally passed shortly before dawn, in the longest roll call in the history of the House of Representatives, much of the credit went to former Congressman Billy Tauzin, R-La., who steered it through the house.
"It's just a messy process," Tauzin says. "I mean, the old adage about if you like sausage or laws, you should not watch either one of them being made is true. It's a messy process."
Tauzin says that the voting machines were open for three hours "because the vote wasn't finished."
As for arms being twisted? "People were being talked to," he says.
And of Walter Jones' comment that it was the "ugliest night" he had "ever seen in politics in 22 years?"
"Well, he's a young member," counters Tauzin with a laugh. "Had he been around for 25 years, he'd have seen some uglier nights."
It certainly wasn't ugly for the drug lobby which invested more than $10 million in campaign contributions during the last election and has been a source of lucrative employment opportunities for congressmen when they leave office.
Former senators Dennis Deconcini, D-Ariz., and Steve Symms, R-Idaho, and former congressmen like Tom Downey, D-N.Y.; Vic Fazio, D-Calif.; Bill Paxon, R-N.Y., and former House Minority Leader Robert Michel, R-Ill., all registered as lobbyists for the drug industry and worked on the prescription drug bill.
"I can tell you that when the bill passed, there were better than 1,000 pharmaceutical lobbyists working on this," says Rep. John Dingell, D-Mich.
Dingell has been in Congress for 52 years and is the chairman of the House Energy and Commerce Committee, which shares jurisdiction over Medicare. He says the bill would not have passed without the efforts of the drug lobby.
"There is probably a lotta truth in it that the bill was stacked in their benefit. And it's probably also true that it was written by their lobbyists," he says.
Says Jones: "You couldn't even walk to the steps of the Capitol without having somebody, maybe one or two, coming up to you to say, 'Can't you change your vote? Can't you vote for this bill?' "
Why was the drug lobby was so interested in this bill and what did it have to gain? Ron Pollack, the executive director of Families USA, a nonpartisan health care watchdog group, says it all boiled down to a key provision in the legislation.
It prohibited Medicare and the federal government from using its vast purchasing power to negotiate lower prices directly from the drug companies.
"The key goal was to make sure there'd be no interference in the drug companies' abilities to charge high prices and to continue to increase those prices," says Pollack.
Pollack says there's no question that this was prompted by the pharmaceutical lobby.
"They were the ones who wanted to make sure Medicare could charge high prices and to continue to increase those prices," he says.
The drug industry says that competition among private insurance plans that service the Medicare program help keep prices low. But Families USA reported in a January study that Medicare patients are being charged nearly 60 percent more for the top 20 drugs than veterans pay under a program run by the U.S. Department of Veterans Affairs.
For example, Lipitor, a popular cholesterol drug, the cheapest Medicare price is $785 for a year's supply — 50 percent more than the VA's price of $520.
For Zocor, another cholesterol drug, the best Medicare price is $1,485 for a year's supply. The same drug only costs $127 a year under the VA's plan.
Read the full Families USA report
Pollack says the VA successfully negotiates with the drug companies on price.
"Medicare could do the same thing," he says, "but Medicare is prohibited from doing that as a result of this new Medicare legislation."
"What was the logic? Or what was the idea, the rationale behind not giving the government the ability to negotiate drug prices?" Kroft asks Rep. Dan Burton.
Burton says it was simply that the drug companies didn't want it. "They wanted to make as much as money as possible. And if there's negotiation, like there is in other countries around the world, then they're gonna have their profit margin reduced," he says.
Before the vote, Congress was told the program would cost a whopping $395 billion over the first 10 years. In fact, Medicare officials already knew it was going to cost a lot more.
Burton said he and others were misled. "Within two weeks after the bill was passed, everybody knew it was gonna cost well over $500 billion," he says. "And many members of the Congress [who] had voted for it said, 'I would never have voted for it had I known that.' "
Medicare Chief Actuary Richard Foster later told Congress that he revised the cost estimate to $534 billion before the vote, but was told to withhold the new numbers if he wanted to keep his job.
During a Congressional hearing, Foster stated: "It struck me there was a political basis for making that decision. I considered that inappropriate and, in fact, unethical."
Foster said the person who told him to withhold Congress from getting the revised estimates was Medicare boss Tom Scully.
Scully was the administration's lead negotiator on the prescription drug bill, and at the time was also negotiating a job for himself with a high-powered Washington law firm, where he became a lobbyist with the pharmaceutical industry.
"He was negotiating for his job at the same time that the Medicare legislation was being considered. He wound up taking this job 10 days after the president signed this legislation," says Pollack.
It is but one example of the incestuous relationship between Congress and the industry, and just one of the reasons the pharmaceutical lobby almost never loses a political battle that affects its bottom line.
Former Congressman Billy Tauzin, who helped push the prescription drug bill through the House, didn't disagree.
Has the bill been good for the drug industry?
"It's been good for the patients whom the drug industry represents …" Tauzin says. "In terms of profits — [for the drug companies] and volumes, yes."
Says Kroft: "Your old friend, John Dingell, says that of the 1,500 bills over the last eight years dealing with pharmaceutical issues, the drug companies almost, without exception, have gotten what they wanted."
"Yeah … I would think he's correct. They've done fairly well," replies Tauzin.
Why has this lobby been so successful? The former congressman says he believes it's because they stood for the right things.
If Tauzin sounds a lot like a lobbyist for the drug industry, that's because now he is.
Just a few months after the prescription drug bill passed, Tauzin began discussions with the pharmaceutical industry to become its chief lobbyist in Washington. He says it was one of several lucrative offers he's received just before he got some very bad news.
"I got a call from a doctor in Bethesda who said, 'You got cancer. And it's extremely rare. And it could kill ya.' And then everything changed," Tauzin says.
Tauzin had a cancerous tumor removed from his intestines and was treated with a new medicine, called Avastin, that had never been used before on that form of cancer.
The treatment was successful, and as a result Tauzin says he felt he owed his life to the drug industry. After serving out his congressional term, he accepted a $2 million-a-year job as president of PhRMA — Pharmaceutical Research and Manufacturers of America.
"There was an extraordinary moment when my wife literally looked me in the eye and said, 'Look, you're gonna do well wherever you go, Billy … You got a lot a great offers … And maybe you oughta think about working for the people that struggle everyday to try to invent the medicines that save lives like yours.'
"And that was a pretty important moment in my life," Tauzin says. "And it was the moment I decided that this was the work I wanted to do — headaches and all."
Jones and Burton agree that the perception of Tauzin's move is not good.
"I mean, when you're pushing so hard for a bill that's controversial and you have to keep the machine open for three hours to get the one vote necessary to pass it, and then, within a matter of months you go to work for the industry that's gonna benefit from it, it does cause you some concern," says Burton.
They are not the only ones cynical about the decision.
"You push this bill through that produces a windfall for the drug companies. And then a short time later, you go to work for the drug lobby at a salary of $2 million. That doesn't look good," Kroft tells Tauzin.
"There was nothing I could've done in my life after leaving Congress that wouldn't have had — I didn't have some impact on in 25 years in Congress … If that looks bad to you, have at it," Tauzin says. "That's the truth."
In fairness to Tauzin and former Medicare chief Tom Scully, they weren't the only public officials involved with the prescription drug bill who later went to work for the pharmaceutical industry.
Just before the vote, Tauzin cited the people who had been most helpful in getting it passed. Among them:
John McManus, the staff director of the Ways and Means subcommittee on Health. Within a few months, he left Congress and started his own lobbying firm. Among his new clients was PhRMA, Pfizer, Eli Lilly and Merck.
Linda Fishman, from the majority side of the Finance Committee, left to become a lobbyist with the drug manufacturer Amgen.
Pat Morrisey, chief of staff of the Energy and Commerce Committee, took a job lobbying for drug companies Novartis and Hoffman-La Roche.
Jeremy Allen went to Johnson and Johnson.
Kathleen Weldon went to lobby for Biogen, a Bio-tech company.
Jim Barnette left to lobby for Hoffman-La Roche.
In all, at least 15 congressional staffers, congressmen and federal officials left to go to work for the pharmaceutical industry, whose profits were increased by several billion dollars.
"I mean, they — they have unlimited resources. Unlimited," Burton says. "And when they push real hard to get something accomplished in the Congress of the United States, they can get it done."
In January, one of the first things the new Democratic House of Representatives did was to make it mandatory for Medicare to negotiate lower prices with the drug companies.
But a similar measure was blocked in the Senate, due in part to the efforts of the drug lobby.
Showing posts with label Health care costs. Show all posts
Showing posts with label Health care costs. Show all posts
Sunday, January 12, 2014
Wednesday, September 11, 2013
Almost One-In-Five Intensive Care Patients May Be Getting Futile Treatment
Are 20% of intensive care dollars being wasted? Why do doctors send older patients to intensive care when nothing can be done for them? Would this money be better used on children whose improved health would benefit society? And wouldn't dying patients prefer the peace and comfort of hospice?
Almost One-In-Five Intensive Care Patients May Be Getting Futile Treatment
Howard Gleckman, Contributor
Forbes
9/11/2013
Almost one of every five patients in the intensive care units of a major teaching hospital got treatment that was futile or “probably” futile, according to the doctors who treated them. And older patients—especially those admitted from a nursing facility—were most likely to get care that does nothing to improve their quality of life, or even keep them alive for more than a brief period of time.
Those are the conclusions of a new study by a group of UCLA researchers published this week in JAMA’s Journal of Internal Medicine. This study will be extremely controversial but should not be ignored. It raises important questions about the hospital care given to very sick older patients.
First, take a look at the results, which were based on a survey of 36 critical care physicians who treated 1136 patients over a three-month period in 2011-2012. Of those ICU patients, 11 percent got care that their doctors deemed futile and another 9 percent received treatment that physicians considered probably futile. These patients accounted for about 7 percent of all ICU patient days. The cost of futile treatment in one hospital’s ICUs: about $2.6 million over 3 months.
While the researchers found that older patients and those admitted from long-term care facilities were more likely to get futile care, they saw no differences by race or ethnicity.
Importantly, the survey was done at the time treatment was being administered and not in retrospect. Thus, the ICU docs couldn’t know for sure what the outcomes would be for these patients.
However, the researchers were able to follow the patients and what they learned seemed to confirm the judgments of the physicians. Almost no patients had what most of us would consider a good quality of life six months after their ICU stay.
More than two-thirds (68 percent) of those receiving what was deemed futile treatment died before they could be discharged. An additional 16 percent died within 6 months. Of the remaining 16 percent, nearly all required ventilators, feeding tubes, or other life-sustaining devices to keep them alive.
Still, as the authors readily admit, some of this gets pretty murky. The researchers did not attempt to set objective criteria for futile or probably futile treatment. Instead, they relied on the subjective judgment of the surveyed doctors. And, of course, if ICUs provide less aggressive treatment to those patients whom doctors think are likely to die, their predictions could become self-fulfilling.
Did the patients or their families think the care was futile? The study did not say. If the intensive care docs thought treatment was a waste of time (or worse), why did they do it? The authors didn’t ask and can only speculate: Lack of agreement on whether to treat by the family or among the care team, or failure to address end-of-life issues (always a good guess). And of course money can’t be ruled out.
This study leaves a lot of important unanswered questions. But it highlights an issue we often prefer to ignore: Hospitals do over-treat patients who are near death. The only real question is how often. Many of these patients needlessly suffer even as the health system spends a significant amount of money that could be put to better use.
We know that at least some of this can be alleviated by good hospice or palliative care. This study helps us understand the consequences of failing to provide that care.
Almost One-In-Five Intensive Care Patients May Be Getting Futile Treatment
Howard Gleckman, Contributor
Forbes
9/11/2013
Almost one of every five patients in the intensive care units of a major teaching hospital got treatment that was futile or “probably” futile, according to the doctors who treated them. And older patients—especially those admitted from a nursing facility—were most likely to get care that does nothing to improve their quality of life, or even keep them alive for more than a brief period of time.
Those are the conclusions of a new study by a group of UCLA researchers published this week in JAMA’s Journal of Internal Medicine. This study will be extremely controversial but should not be ignored. It raises important questions about the hospital care given to very sick older patients.
First, take a look at the results, which were based on a survey of 36 critical care physicians who treated 1136 patients over a three-month period in 2011-2012. Of those ICU patients, 11 percent got care that their doctors deemed futile and another 9 percent received treatment that physicians considered probably futile. These patients accounted for about 7 percent of all ICU patient days. The cost of futile treatment in one hospital’s ICUs: about $2.6 million over 3 months.
While the researchers found that older patients and those admitted from long-term care facilities were more likely to get futile care, they saw no differences by race or ethnicity.
Importantly, the survey was done at the time treatment was being administered and not in retrospect. Thus, the ICU docs couldn’t know for sure what the outcomes would be for these patients.
However, the researchers were able to follow the patients and what they learned seemed to confirm the judgments of the physicians. Almost no patients had what most of us would consider a good quality of life six months after their ICU stay.
More than two-thirds (68 percent) of those receiving what was deemed futile treatment died before they could be discharged. An additional 16 percent died within 6 months. Of the remaining 16 percent, nearly all required ventilators, feeding tubes, or other life-sustaining devices to keep them alive.
Still, as the authors readily admit, some of this gets pretty murky. The researchers did not attempt to set objective criteria for futile or probably futile treatment. Instead, they relied on the subjective judgment of the surveyed doctors. And, of course, if ICUs provide less aggressive treatment to those patients whom doctors think are likely to die, their predictions could become self-fulfilling.
Did the patients or their families think the care was futile? The study did not say. If the intensive care docs thought treatment was a waste of time (or worse), why did they do it? The authors didn’t ask and can only speculate: Lack of agreement on whether to treat by the family or among the care team, or failure to address end-of-life issues (always a good guess). And of course money can’t be ruled out.
This study leaves a lot of important unanswered questions. But it highlights an issue we often prefer to ignore: Hospitals do over-treat patients who are near death. The only real question is how often. Many of these patients needlessly suffer even as the health system spends a significant amount of money that could be put to better use.
We know that at least some of this can be alleviated by good hospice or palliative care. This study helps us understand the consequences of failing to provide that care.
Saturday, August 3, 2013
Health exchange releases new small business rates
"In San Diego County, four companies will offer SHOP plans: Sharp HealthCare, Health Net, Kaiser Permanente and Blue Shield."
Health exchange releases new small business rates
Says San Diego companies with fewer than 50 employees could save 12 percent
By Paul Sisson
Aug. 1, 2013
San Diego County small businesses will be able to save 12 percent on health insurance premiums for their employees if they buy coverage next year from the state’s newly created health exchange, officials announced Thursday.
Covered California, the state agency tasked with creating and running the new health insurance exchanges mandated by the Affordable Care Act of 2010, released selected rates for many California regions that it says are less expensive than those now available to businesses with 50 or fewer employees.
Federal health reform calls for each state to create a Small Business Health Options Program, often called SHOP, which will operate alongside a larger exchange tailored to individuals and families.
Both exchanges must be running by Oct. 1 to provide enough shopping time before Jan. 1, 2014, the date when most uninsured Americans must purchase coverage or pay a small penalty.
Small business rates are separated into 19 different geographical regions. In San Diego County, four companies will offer SHOP plans: Sharp HealthCare, Health Net, Kaiser Permanente and Blue Shield.
Covered California did not provide a full list of potential premiums for each company but instead compared prices for a single 40-year-old employee.
Sharp, the only local company offering its own plan in the health exchange for individuals and families, said in a statement that serving businesses made sense because the health system has “long been active in serving the small group market in San Diego.”
In San Diego County, the average of the three lowest premiums offered in the exchange was $290, a rate that the state claims is 12 percent less than an average of $324 for “comparable” small group plans sold this year.
Scott Hauge, president of Small Business California, a nonprofit advocacy group that lobbies in Sacramento on issues that affect small businesses, lauded the rates as a step toward controlling costs.
“It’s a good first step. It adds competition to the market, and any time you add competition, it’s a positive,” Hauge said.
But not everyone was so impressed. Bill Hammett, a San Diego area insurance broker, said there was no way to tell how the state selected a comparable plan to make its cost comparison. He said that, overall, there is just not much difference in costs between companies offering plans on the exchange and those operating in the open market.v “I have no ax to grind with the SHOP exchange, but I just don’t think it’s going to be the huge splash they were hoping for,” Hammett said.
Dana Howard, deputy director of media and public relations for Covered California, said prices are only one aspect of the SHOP exchange. He said the exchange is designed to allow small companies to act like their bigger competitors by allowing flexibility in the plan selected.
The SHOP exchange, he said, allows a company to “anchor” their coverage on a certain plan and allocate a set amount of money, say 50 percent, that they want to spend on an employee’s premium. But employees can decide on their own to go with a different insurance company offered on the exchange if they don’t like the one their employer selected. That ability [for employees] to move to different plans, Howard said, is usually an expensive option that most small companies can’t afford...
Health exchange releases new small business rates
Says San Diego companies with fewer than 50 employees could save 12 percent
By Paul Sisson
Aug. 1, 2013
San Diego County small businesses will be able to save 12 percent on health insurance premiums for their employees if they buy coverage next year from the state’s newly created health exchange, officials announced Thursday.
Covered California, the state agency tasked with creating and running the new health insurance exchanges mandated by the Affordable Care Act of 2010, released selected rates for many California regions that it says are less expensive than those now available to businesses with 50 or fewer employees.
Federal health reform calls for each state to create a Small Business Health Options Program, often called SHOP, which will operate alongside a larger exchange tailored to individuals and families.
Both exchanges must be running by Oct. 1 to provide enough shopping time before Jan. 1, 2014, the date when most uninsured Americans must purchase coverage or pay a small penalty.
Small business rates are separated into 19 different geographical regions. In San Diego County, four companies will offer SHOP plans: Sharp HealthCare, Health Net, Kaiser Permanente and Blue Shield.
Covered California did not provide a full list of potential premiums for each company but instead compared prices for a single 40-year-old employee.
Sharp, the only local company offering its own plan in the health exchange for individuals and families, said in a statement that serving businesses made sense because the health system has “long been active in serving the small group market in San Diego.”
In San Diego County, the average of the three lowest premiums offered in the exchange was $290, a rate that the state claims is 12 percent less than an average of $324 for “comparable” small group plans sold this year.
Scott Hauge, president of Small Business California, a nonprofit advocacy group that lobbies in Sacramento on issues that affect small businesses, lauded the rates as a step toward controlling costs.
“It’s a good first step. It adds competition to the market, and any time you add competition, it’s a positive,” Hauge said.
But not everyone was so impressed. Bill Hammett, a San Diego area insurance broker, said there was no way to tell how the state selected a comparable plan to make its cost comparison. He said that, overall, there is just not much difference in costs between companies offering plans on the exchange and those operating in the open market.v “I have no ax to grind with the SHOP exchange, but I just don’t think it’s going to be the huge splash they were hoping for,” Hammett said.
Dana Howard, deputy director of media and public relations for Covered California, said prices are only one aspect of the SHOP exchange. He said the exchange is designed to allow small companies to act like their bigger competitors by allowing flexibility in the plan selected.
The SHOP exchange, he said, allows a company to “anchor” their coverage on a certain plan and allocate a set amount of money, say 50 percent, that they want to spend on an employee’s premium. But employees can decide on their own to go with a different insurance company offered on the exchange if they don’t like the one their employer selected. That ability [for employees] to move to different plans, Howard said, is usually an expensive option that most small companies can’t afford...
Montana Experiment Brings NHS-Style Health Care to USA; Saves State Millions, Patients Delighted
"[D]ivision manager Russ Hill says it's actually costing the state $1,500,000 less for healthcare than before the clinic opened."
Montana Experiment Brings NHS-Style Health Care to USA; Saves State Millions, Patients Delighted
by james321
Daily Kos
Jul 31, 2013
Former Montana Gov. Brian Schweitzer has pledged his support for single-payer health care in the past, but his recent efforts to bring zero-cost sharing primary and preventive care to Montana government employees and retirees may be doing something that most progressives would only dream could happen in America: bringing NHS-style, socialized medicine to Montana.
This is a big deal and -- while currently limited to state employees and retirees -- could be laying the groundwork for America's most socially-just health care system. NPR has the details:
A year ago, Montana opened the nation's first clinic for free primary healthcare services to its state government employees. The Helena, Mont., clinic was pitched as a way to improve overall employee health, but the idea has faced its fair share of political opposition.
A year later, the state says the clinic is already saving money.
Pamela Weitz, a 61-year-old state library technician, was skeptical about the place at first.
"I thought it was just the goofiest idea, but you know, it's really good," she says. In the last year, she's been there for checkups, blood tests and flu shots. She doesn't have to go; she still has her normal health insurance provided by the state. But at the clinic, she has no co-pays, no deductibles. It's free.
That's the case for the Helena area's 11,000 state workers and their dependents. With an appointment, patients wait just a couple minutes to see a doctor. Visitation is more than 75 percent higher than initial estimates.v Yup, nobody is forced to visit this publicly-financed clinic run by a private operator. If they wish, they can take their big-profit, private health insurance and head to any doctor they want, but folks are recognizing that this, err... public option, provides better care. And, when patients do make this choice, both the state and patients save money.
The state contracts with a private company to run the facility and pays for everything — wages of the staff, total costs of all the visits. Those are all new expenses, and they all come from the budget for state employee healthcare.
Even so, division manager Russ Hill says it's actually costing the state $1,500,000 less for healthcare than before the clinic opened.
"Because there's no markup, our cost per visit is lower than in a private fee-for-service environment," Hill says.
Physicians are paid by the hour, not by the number of procedures they prescribe like many in the private sector. The state is able to buy supplies at lower prices.
Bottom line: a patient's visit to the employee health clinic costs the state about half what it would cost if that patient went to a private doctor. And because it's free to patients, hundreds of people have come in who had not seen a doctor for at least two years.
Take a second and let the words above sink in real deep. There you have exactly why the UK, Canada, Australia, Italy, Costa Rica, Cuba and other first-world -- and third-world -- countries are able to secure better health care outcomes than the United States with dramatically lower health care spending. Imagine what -- let's call it the Montana model -- could do for our national debt. And, you know, even more importantly, the health of our people and the wellbeing of our medical professionals.
Hill says the facility is catching a lot, including 600 people who have diabetes, 1,300 people with high cholesterol, 1,600 people with high blood pressure and 2,600 patients diagnosed as obese. Treating these conditions early could avoid heart attacks, amputations, or other expensive hospital visits down the line, saving the state more money.
Clinic operations director and physician's assistant Jimmie Barnwell says this model feels more rewarding to him.
"Having those barriers of time and money taken out of the way are a big part [of what gets] people to come into the clinic. But then, when they come into the clinic, they get a lot of face time with the nurses and the doctors," Barnwell says.v Again, common sense that's not too common in these United States -- with the exception of Montana -- at the moment. High-deductible garbage plans -- promoted by big wigs at Aetna and Cigna who want patients to have more 'skin in the game' -- lead patients to delay putting off that chest pain until it becomes a heart attack...and open-heart surgery. When doctors aren't dealing with private health insurer bureaucracy and any sort of medical billing, the entire resources of the practice go towards taking care of human beings. When doctors are salaried instead of operating with a fee-for-service model, they emphasize quality over quantity. This is how medicine works in the UK, Canada and many other countries where protecting the wealth of hospital and insurance company CEOs is not the primary goal of the health care system.
Even Republicans -- who, you know, are naturally predisposed to hate the idea of patients seeing doctors without cost-sharing -- have a tough time faulting the new clinics.
"For goodness sakes, of course the employees and the retirees like it, it's free," says Republican State Sen. Dave Lewis.
...
Now, Lewis is a retired state employee himself. He says, personally, he does like going there, too.v "They're wonderful people, they do a great job, but as a legislator, I wonder how in the heck we can pay for it very long," Lewis says.
Well, Mr. Republican, they're saving the state millions -- you just won't admit it, but at least you admit you love the socialized medicine.
What's most exciting about these clinics? More are on the way.
Montana recently opened a second state employee health clinic in Billings, the state's largest city. Others are in the works.
And best of all? Schweitzer went right around the backs of Republicans to set up these life- and money-saving clinics. That's bold, progressive leadership. Let's do our best to spread the news far and wide about how the "Montana model" is proving what much of the rest of the world already knows: the ideal primary health care system should be free at point of use.
Montana Experiment Brings NHS-Style Health Care to USA; Saves State Millions, Patients Delighted
by james321
Daily Kos
Jul 31, 2013
Former Montana Gov. Brian Schweitzer has pledged his support for single-payer health care in the past, but his recent efforts to bring zero-cost sharing primary and preventive care to Montana government employees and retirees may be doing something that most progressives would only dream could happen in America: bringing NHS-style, socialized medicine to Montana.
This is a big deal and -- while currently limited to state employees and retirees -- could be laying the groundwork for America's most socially-just health care system. NPR has the details:
A year ago, Montana opened the nation's first clinic for free primary healthcare services to its state government employees. The Helena, Mont., clinic was pitched as a way to improve overall employee health, but the idea has faced its fair share of political opposition.
A year later, the state says the clinic is already saving money.
Pamela Weitz, a 61-year-old state library technician, was skeptical about the place at first.
"I thought it was just the goofiest idea, but you know, it's really good," she says. In the last year, she's been there for checkups, blood tests and flu shots. She doesn't have to go; she still has her normal health insurance provided by the state. But at the clinic, she has no co-pays, no deductibles. It's free.
That's the case for the Helena area's 11,000 state workers and their dependents. With an appointment, patients wait just a couple minutes to see a doctor. Visitation is more than 75 percent higher than initial estimates.v Yup, nobody is forced to visit this publicly-financed clinic run by a private operator. If they wish, they can take their big-profit, private health insurance and head to any doctor they want, but folks are recognizing that this, err... public option, provides better care. And, when patients do make this choice, both the state and patients save money.
The state contracts with a private company to run the facility and pays for everything — wages of the staff, total costs of all the visits. Those are all new expenses, and they all come from the budget for state employee healthcare.
Even so, division manager Russ Hill says it's actually costing the state $1,500,000 less for healthcare than before the clinic opened.
"Because there's no markup, our cost per visit is lower than in a private fee-for-service environment," Hill says.
Physicians are paid by the hour, not by the number of procedures they prescribe like many in the private sector. The state is able to buy supplies at lower prices.
Bottom line: a patient's visit to the employee health clinic costs the state about half what it would cost if that patient went to a private doctor. And because it's free to patients, hundreds of people have come in who had not seen a doctor for at least two years.
Take a second and let the words above sink in real deep. There you have exactly why the UK, Canada, Australia, Italy, Costa Rica, Cuba and other first-world -- and third-world -- countries are able to secure better health care outcomes than the United States with dramatically lower health care spending. Imagine what -- let's call it the Montana model -- could do for our national debt. And, you know, even more importantly, the health of our people and the wellbeing of our medical professionals.
Hill says the facility is catching a lot, including 600 people who have diabetes, 1,300 people with high cholesterol, 1,600 people with high blood pressure and 2,600 patients diagnosed as obese. Treating these conditions early could avoid heart attacks, amputations, or other expensive hospital visits down the line, saving the state more money.
Clinic operations director and physician's assistant Jimmie Barnwell says this model feels more rewarding to him.
"Having those barriers of time and money taken out of the way are a big part [of what gets] people to come into the clinic. But then, when they come into the clinic, they get a lot of face time with the nurses and the doctors," Barnwell says.v Again, common sense that's not too common in these United States -- with the exception of Montana -- at the moment. High-deductible garbage plans -- promoted by big wigs at Aetna and Cigna who want patients to have more 'skin in the game' -- lead patients to delay putting off that chest pain until it becomes a heart attack...and open-heart surgery. When doctors aren't dealing with private health insurer bureaucracy and any sort of medical billing, the entire resources of the practice go towards taking care of human beings. When doctors are salaried instead of operating with a fee-for-service model, they emphasize quality over quantity. This is how medicine works in the UK, Canada and many other countries where protecting the wealth of hospital and insurance company CEOs is not the primary goal of the health care system.
Even Republicans -- who, you know, are naturally predisposed to hate the idea of patients seeing doctors without cost-sharing -- have a tough time faulting the new clinics.
"For goodness sakes, of course the employees and the retirees like it, it's free," says Republican State Sen. Dave Lewis.
...
Now, Lewis is a retired state employee himself. He says, personally, he does like going there, too.v "They're wonderful people, they do a great job, but as a legislator, I wonder how in the heck we can pay for it very long," Lewis says.
Well, Mr. Republican, they're saving the state millions -- you just won't admit it, but at least you admit you love the socialized medicine.
What's most exciting about these clinics? More are on the way.
Montana recently opened a second state employee health clinic in Billings, the state's largest city. Others are in the works.
And best of all? Schweitzer went right around the backs of Republicans to set up these life- and money-saving clinics. That's bold, progressive leadership. Let's do our best to spread the news far and wide about how the "Montana model" is proving what much of the rest of the world already knows: the ideal primary health care system should be free at point of use.
Saturday, May 25, 2013
Hospital Prices No Longer Secret As New Data Reveals Bewildering System, Staggering Cost Differences
Hospital Prices No Longer Secret As New Data Reveals Bewildering System, Staggering Cost Differences
Jeffrey Young
Chris Kirkham
huffingtonpost.com
05/08/2013
When a patient arrives at Bayonne Hospital Center in New Jersey requiring treatment for the respiratory ailment known as COPD, or chronic obstructive pulmonary disease, she faces an official price tag of $99,690.
Less than 30 miles away in the Bronx, N.Y., the Lincoln Medical and Mental Health Center charges only $7,044 for the same treatment, according to a massive federal database of national health care costs made public on Wednesday.
Americans have long become accustomed to bewilderment and anxiety when confronting health care bills. The new database underscores why, revealing the perplexing assortment of prices for medical care, with the details of bills seemingly untethered to any graspable principle.
Even within the same metropolitan area, hospitals charge prices that differ by staggering degrees for the same procedures. People without health insurance pay vastly higher costs for care when less expensive options are often available nearby. Virtually everyone who seeks health care winds up paying inflated prices in one form or another as these stark disparities in price sow inefficiencies throughout the market.
While this basic picture has emerged as the consensus reality among health care experts, their evidence has been primarily anecdotal. Hospitals have protected their price lists -- documents known as charge masters -- as closely guarded secrets.
Their prices are secret no more...
Jeffrey Young
Chris Kirkham
huffingtonpost.com
05/08/2013
When a patient arrives at Bayonne Hospital Center in New Jersey requiring treatment for the respiratory ailment known as COPD, or chronic obstructive pulmonary disease, she faces an official price tag of $99,690.
Less than 30 miles away in the Bronx, N.Y., the Lincoln Medical and Mental Health Center charges only $7,044 for the same treatment, according to a massive federal database of national health care costs made public on Wednesday.
Americans have long become accustomed to bewilderment and anxiety when confronting health care bills. The new database underscores why, revealing the perplexing assortment of prices for medical care, with the details of bills seemingly untethered to any graspable principle.
Even within the same metropolitan area, hospitals charge prices that differ by staggering degrees for the same procedures. People without health insurance pay vastly higher costs for care when less expensive options are often available nearby. Virtually everyone who seeks health care winds up paying inflated prices in one form or another as these stark disparities in price sow inefficiencies throughout the market.
While this basic picture has emerged as the consensus reality among health care experts, their evidence has been primarily anecdotal. Hospitals have protected their price lists -- documents known as charge masters -- as closely guarded secrets.
Their prices are secret no more...
Monday, November 19, 2012
Anthem Blue Cross Drops Cedars-Sinai, UCLA From Health Plan
Anthem Blue Cross Drops Cedars-Sinai, UCLA From Health Plan
Bob Herman
Becker Hospital Review
September 24, 2012
Anthem Blue Cross in California is shutting out two of the largest healthcare providers in the Los Angeles area — Cedars-Sinai Medical Center and UCLA Health System — from one of its health plans because the health systems are "too expensive," according to a Los Angeles Times report.
All physicians affiliated with Cedars-Sinai and UCLA will be eliminated from Anthem's Select health plan, effective Jan. 1, which is offered to roughly 60,000 employees and dependents in Los Angeles. The city said Anthem's plan would save $7.6 million in annual premiums. It is expected that roughly 2,200 city employees and family members will lose in-network access to their physicians, according to the report.
In response to the move, the health systems said their high costs are associated with their medical research and innovative treatments that "benefit the entire community," according to the report. Cedars-Sinai and UCLA also said Anthem's maneuver will only shift costs onto those who still receive care at the facilities.
Bob Herman
Becker Hospital Review
September 24, 2012
Anthem Blue Cross in California is shutting out two of the largest healthcare providers in the Los Angeles area — Cedars-Sinai Medical Center and UCLA Health System — from one of its health plans because the health systems are "too expensive," according to a Los Angeles Times report.
All physicians affiliated with Cedars-Sinai and UCLA will be eliminated from Anthem's Select health plan, effective Jan. 1, which is offered to roughly 60,000 employees and dependents in Los Angeles. The city said Anthem's plan would save $7.6 million in annual premiums. It is expected that roughly 2,200 city employees and family members will lose in-network access to their physicians, according to the report.
In response to the move, the health systems said their high costs are associated with their medical research and innovative treatments that "benefit the entire community," according to the report. Cedars-Sinai and UCLA also said Anthem's maneuver will only shift costs onto those who still receive care at the facilities.
Wednesday, October 31, 2012
Trouble In Mitt Romney's Socialist Hospital Paradise
In 2010 Romney himself acknowledged the need for Obama's health care law (before he began pursuing the Republican presidential nomination):
"Look, it doesn't make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility, particularly if they are people who have sufficient means to pay their own way."
Trouble In Mitt Romney's Socialist Hospital Paradise
10/27/2012
Arthur Delaney and Jamieson
Huff Post
In the early hours of May 1, D.C. bartender Mike Boone came to the aid of a young woman who was being mugged.
Boone had offered to walk her home from the bar, Trusty's on Capitol Hill, since the immediate neighborhood is not known for having the safest streets at night. A man jumped from behind some bushes and grabbed the woman's purse. Boone also grabbed it, and the two men started fighting.
"We were punching each other pretty hard," Boone recalled. It wasn't until blood gushed from his body and the woman screamed that the bartender realized what had really happened.
"He was punching me with a knife," Boone said.
Boone passed out on the sidewalk. He woke up the next day in a hospital bed, recovering from eight stab wounds and a collapsed lung.
Like nearly 50 million other Americans, Boone lacked health insurance. A pre-existing condition -- in his case, a broken back he suffered in 1993 -- prevented him from obtaining affordable coverage. President Barack Obama's health care law prohibits insurance companies from discriminating against people with pre-existing conditions, but that reform doesn't go into effect for adults until 2014.
Republican presidential nominee Mitt Romney has vowed to repeal the health care law entirely if he's elected. In America, Romney has said, we don't let people die in the street simply because they lack health insurance: Hospitals are there to care for the uninsured.
"We don't have a setting across this country where if you don't have insurance, we just say to you, 'Tough luck, you're going to die when you have your heart attack,'" Romney said in an interview with The Columbus Dispatch on Oct. 11. "No, you go to the hospital, you get treated, you get care, and it's paid for, either by charity, the government or by the hospital."
Indeed, the health care system did not let Boone bleed to death on the sidewalk. But it did bury him in life-altering debt. After four days in the hospital and two surgeries, the 39-year-old -- hailed as a hero on Capitol Hill and beyond for his actions -- is staring at $60,000 in medical bills so far. And they haven't stopped rolling in.
Well-wishers, moved by media reports of his story, have donated $17,000 to help Boone cover his expenses, and he's hoping a public fund for crime victims could defray as much as $25,000 more. But Boone, who said he expects to earn only about $15,000 this year, figures he'll still be looking at nearly $20,000 in debt, all for risking his life for a fellow human being.
His story is one that plays out with troubling regularity in the bar-and-restaurant business, where a high quotient of workers go without health coverage. Post-tragedy fundraisers are common in the industry. The events serve as vivid examples of the private sector's safety net in action.
These fundraisers can defray some of the costs of emergency care, as they have done for Boone, but often they don't provide nearly enough. Paying for health care isn't as efficient or just as Romney suggests. Instead, much of the cost is borne by health care providers and insurers and, ultimately, the insured. We all pay.
"At first, I was like, man, this is really great, this could take care of it," Boone said of the charity he has received. "And then the big bills started coming."
A FORM OF SOCIALISM
Douglas Zehner is the senior vice president and chief financial officer at MedStar Washington Hospital Center in northwest Washington, where Boone was treated. He said Medstar gave $22.1 million worth of care to uninsured or underinsured patients and forgave $85.1 million in debt last year. But that charity isn't free. The only way the hospital can recoup its losses, Zehner said, is by negotiating with private insurance providers for higher prices, a process known as "cost-shifting."
"I have to price my services with insurance carriers because that’s the only group I'm even in the room talking to about how much they're going to pay me for my services," Zehner said. "So the way the cost-shifting works is you basically back into how much [money] you need to run that service [for all patients] and apply it to the expected number of people that are coming in that have insurance to get that service."
The fewer people who have insurance, the greater the burden on those who do have coverage. In order to cover the costs of treating the uninsured, premiums go up. The American Hospital Association estimated that U.S. hospitals performed $39.3 billion worth of uncompensated care in 2010, the most recent year for which numbers are available. That's 5.8 percent of total expenses.
This is a problem that Obama's health care law seeks to address and one that Romney himself has acknowledged in the past, before he began pursuing the Republican presidential nomination.
"Look, it doesn't make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility, particularly if they are people who have sufficient means to pay their own way," he said in 2010.
In 2007, he used even starker language: "When [uninsured people] show up at the hospital, they get care. They get free care paid for by you and me. If that's not a form of socialism, I don't know what is."...
"Look, it doesn't make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility, particularly if they are people who have sufficient means to pay their own way."
Trouble In Mitt Romney's Socialist Hospital Paradise
10/27/2012
Arthur Delaney and Jamieson
Huff Post
In the early hours of May 1, D.C. bartender Mike Boone came to the aid of a young woman who was being mugged.
Boone had offered to walk her home from the bar, Trusty's on Capitol Hill, since the immediate neighborhood is not known for having the safest streets at night. A man jumped from behind some bushes and grabbed the woman's purse. Boone also grabbed it, and the two men started fighting.
"We were punching each other pretty hard," Boone recalled. It wasn't until blood gushed from his body and the woman screamed that the bartender realized what had really happened.
"He was punching me with a knife," Boone said.
Boone passed out on the sidewalk. He woke up the next day in a hospital bed, recovering from eight stab wounds and a collapsed lung.
Like nearly 50 million other Americans, Boone lacked health insurance. A pre-existing condition -- in his case, a broken back he suffered in 1993 -- prevented him from obtaining affordable coverage. President Barack Obama's health care law prohibits insurance companies from discriminating against people with pre-existing conditions, but that reform doesn't go into effect for adults until 2014.
Republican presidential nominee Mitt Romney has vowed to repeal the health care law entirely if he's elected. In America, Romney has said, we don't let people die in the street simply because they lack health insurance: Hospitals are there to care for the uninsured.
"We don't have a setting across this country where if you don't have insurance, we just say to you, 'Tough luck, you're going to die when you have your heart attack,'" Romney said in an interview with The Columbus Dispatch on Oct. 11. "No, you go to the hospital, you get treated, you get care, and it's paid for, either by charity, the government or by the hospital."
Indeed, the health care system did not let Boone bleed to death on the sidewalk. But it did bury him in life-altering debt. After four days in the hospital and two surgeries, the 39-year-old -- hailed as a hero on Capitol Hill and beyond for his actions -- is staring at $60,000 in medical bills so far. And they haven't stopped rolling in.
Well-wishers, moved by media reports of his story, have donated $17,000 to help Boone cover his expenses, and he's hoping a public fund for crime victims could defray as much as $25,000 more. But Boone, who said he expects to earn only about $15,000 this year, figures he'll still be looking at nearly $20,000 in debt, all for risking his life for a fellow human being.
His story is one that plays out with troubling regularity in the bar-and-restaurant business, where a high quotient of workers go without health coverage. Post-tragedy fundraisers are common in the industry. The events serve as vivid examples of the private sector's safety net in action.
These fundraisers can defray some of the costs of emergency care, as they have done for Boone, but often they don't provide nearly enough. Paying for health care isn't as efficient or just as Romney suggests. Instead, much of the cost is borne by health care providers and insurers and, ultimately, the insured. We all pay.
"At first, I was like, man, this is really great, this could take care of it," Boone said of the charity he has received. "And then the big bills started coming."
A FORM OF SOCIALISM
Douglas Zehner is the senior vice president and chief financial officer at MedStar Washington Hospital Center in northwest Washington, where Boone was treated. He said Medstar gave $22.1 million worth of care to uninsured or underinsured patients and forgave $85.1 million in debt last year. But that charity isn't free. The only way the hospital can recoup its losses, Zehner said, is by negotiating with private insurance providers for higher prices, a process known as "cost-shifting."
"I have to price my services with insurance carriers because that’s the only group I'm even in the room talking to about how much they're going to pay me for my services," Zehner said. "So the way the cost-shifting works is you basically back into how much [money] you need to run that service [for all patients] and apply it to the expected number of people that are coming in that have insurance to get that service."
The fewer people who have insurance, the greater the burden on those who do have coverage. In order to cover the costs of treating the uninsured, premiums go up. The American Hospital Association estimated that U.S. hospitals performed $39.3 billion worth of uncompensated care in 2010, the most recent year for which numbers are available. That's 5.8 percent of total expenses.
This is a problem that Obama's health care law seeks to address and one that Romney himself has acknowledged in the past, before he began pursuing the Republican presidential nomination.
"Look, it doesn't make a lot of sense for us to have millions and millions of people who have no health insurance and yet who can go to the emergency room and get entirely free care for which they have no responsibility, particularly if they are people who have sufficient means to pay their own way," he said in 2010.
In 2007, he used even starker language: "When [uninsured people] show up at the hospital, they get care. They get free care paid for by you and me. If that's not a form of socialism, I don't know what is."...
Friday, September 14, 2012
Doctor, Hospital Deals Probed, but not Kaiser Permanente, which does the exact same thing
Isn't this exactly what Kaiser Permanente has done? Does Kaiser have the political clout to escape examination?
Doctor, Hospital Deals Probed
September 13, 2012
By ANNA WILDE MATHEWS
The Sacramento Bee/Associated Press
California's attorney general has launched a broad investigation into whether growing consolidation among hospitals and doctor groups is pushing up the price of medical care, reflecting increasing scrutiny by antitrust regulators of medical-provider deals.
The office of the attorney general, Kamala D. Harris, has sent subpoenas, known as civil investigative demands, to several big hospital operators in the state, including San Francisco-based Dignity Health and San Diego's Scripps Health and Sharp HealthCare. Northern California's 24-hospital Sutter Health system has also received one, as has Santa Barbara-based Cottage Health System, according to people with knowledge of the matter. Subpoenas have also gone to major California health insurers, those people said.
The probe, which has been under way for several months, is examining hospital systems' reimbursement from the insurers, according to people with knowledge of the matter. The regulator appears to be focusing on whether the systems' tie-ups with physicians, as well as ownership of hospitals, have given them the market power to boost prices in a way that violates antitrust law, these people said.
Nationally, health-care providers are rapidly merging into bigger health systems, moves that they say will improve efficiency. The number of hospital deals last year, 86, was the biggest since 2000, according to Irving Levin Associates, a research firm that tracks health-care transactions.
Also, nearly a quarter of all specialty physicians who see patients at hospitals are now employed by the hospitals, according to an estimate from the Advisory Board Co. ABCO +0.51% That is more than four times the 5% in 2000. Among primary-care doctors who see patients in hospitals, the employed share has doubled to about 40% in the same time frame.
The American Hospital Association said consolidation doesn't routinely drive up prices; the California Hospital Association referred questions to the national group. Hospitals are merging and employing more doctors in order to streamline and improve care, under pressure from health regulators urging a more integrated approach under the federal health overhaul law, said Melinda Hatton, AHA's general counsel. "The antitrust agencies and national health-care policy don't seem to be really in sync at this point," she said.
Some research suggests that mergers can drive up health-care prices. A 2010 study published in the journal Health Affairs said concentration among health-care providers in California had led to "a definite shift in negotiating strength toward providers, resulting in higher payment rates and premiums."...
Doctor, Hospital Deals Probed
September 13, 2012
By ANNA WILDE MATHEWS
The Sacramento Bee/Associated Press
California's attorney general has launched a broad investigation into whether growing consolidation among hospitals and doctor groups is pushing up the price of medical care, reflecting increasing scrutiny by antitrust regulators of medical-provider deals.
The office of the attorney general, Kamala D. Harris, has sent subpoenas, known as civil investigative demands, to several big hospital operators in the state, including San Francisco-based Dignity Health and San Diego's Scripps Health and Sharp HealthCare. Northern California's 24-hospital Sutter Health system has also received one, as has Santa Barbara-based Cottage Health System, according to people with knowledge of the matter. Subpoenas have also gone to major California health insurers, those people said.
The probe, which has been under way for several months, is examining hospital systems' reimbursement from the insurers, according to people with knowledge of the matter. The regulator appears to be focusing on whether the systems' tie-ups with physicians, as well as ownership of hospitals, have given them the market power to boost prices in a way that violates antitrust law, these people said.
Nationally, health-care providers are rapidly merging into bigger health systems, moves that they say will improve efficiency. The number of hospital deals last year, 86, was the biggest since 2000, according to Irving Levin Associates, a research firm that tracks health-care transactions.
Also, nearly a quarter of all specialty physicians who see patients at hospitals are now employed by the hospitals, according to an estimate from the Advisory Board Co. ABCO +0.51% That is more than four times the 5% in 2000. Among primary-care doctors who see patients in hospitals, the employed share has doubled to about 40% in the same time frame.
The American Hospital Association said consolidation doesn't routinely drive up prices; the California Hospital Association referred questions to the national group. Hospitals are merging and employing more doctors in order to streamline and improve care, under pressure from health regulators urging a more integrated approach under the federal health overhaul law, said Melinda Hatton, AHA's general counsel. "The antitrust agencies and national health-care policy don't seem to be really in sync at this point," she said.
Some research suggests that mergers can drive up health-care prices. A 2010 study published in the journal Health Affairs said concentration among health-care providers in California had led to "a definite shift in negotiating strength toward providers, resulting in higher payment rates and premiums."...
Sunday, August 12, 2012
Inquiry into the spectacularly profitable HCA Hospital Chain cites unnecessary cardiac work
Hospital Chain Inquiry Cited Unnecessary Cardiac Work
By REED ABELSON and JULIE CRESWELL
New York Times
August 6, 2012
GRAPHIC: HCA’s Growing Profit
In the summer of 2010, a troubling letter reached the chief ethics officer of the hospital giant HCA, written by a former nurse at one of the company’s hospitals in Florida.
In a follow-up interview, the nurse said a doctor at the Lawnwood Regional Medical Center, in the small coastal city of Fort Pierce, had been performing heart procedures on patients who did not need them, putting their lives at risk.
“It bothered me,” the nurse, C. T. Tomlinson, said in a telephone interview. “I’m a registered nurse. I care about my patients.”
In less than two months, an internal investigation by HCA concluded the nurse was right.
“The allegations related to unnecessary procedures being performed in the cath lab are substantiated,” according to a confidential memo written by a company ethics officer, Stephen Johnson, and reviewed by The New York Times.
Mr. Tomlinson’s contract was not renewed, a move that Mr. Johnson said in the memo was in retaliation for his complaints.
But the nurse’s complaint was far from the only evidence that unnecessary — even dangerous — procedures were taking place at some HCA hospitals, driving up costs and increasing profits.
HCA, the largest for-profit hospital chain in the United States with 163 facilities, had uncovered evidence as far back as 2002 and as recently as late 2010 showing that some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing. Those hospitals included the Cedars Medical Center in Miami, which the company no longer owns, and the Regional Medical Center Bayonet Point. In some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary, according to internal reports.
Questions about the necessity of medical procedures — especially in the realm of cardiology — are not uncommon. None of the internal documents reviewed calculate just how many such procedures there were or how many patients might have died or been injured as a result. But the documents suggest that the problems at HCA went beyond a rogue doctor or two.
At Lawnwood, where an invasive diagnostic test known as a cardiac catheterization is performed, about half the procedures, or 1,200, were determined to have been done on patients without significant heart disease, according to a confidential 2010 review. HCA countered recently with a different analysis, saying the percentage of patients without disease was much lower and in keeping with national averages.
At Bayonet Point, a 44-year-old man who arrived at the emergency room complaining of chest pain suffered a punctured blood vessel and a near-fatal irregular heartbeat after a doctor performed a procedure that an outside expert later suggested might have been unnecessary, documents show. The man had to be revived. “They shocked him twice and got him back,” according to the testimony of Dr. Aaron Kugelmass in a medical hearing on the case.
In another incident, an outside expert described how a woman with no significant heart disease went into cardiac arrest after a vessel was cut when a Bayonet Point cardiologist inserted a stent, a meshlike device that opens coronary arteries. She remained hospitalized for several days, according to a person who has reviewed internal reports...
In a recent statement, HCA declined to provide evidence that it had alerted Medicare, state Medicaid or private insurers of its findings, or reimbursed them for any of the procedures that the company later deemed unnecessary, as required by law...
Some doctors accused in the reviews of performing unnecessary procedures are still practicing at HCA hospitals...
A Giant Hospital Chain Is Blazing a Profit Trail
By JULIE CRESWELL and REED ABELSON
August 14, 2012
During the Great Recession, when many hospitals across the country were nearly brought to their knees by growing numbers of uninsured patients, one hospital system not only survived — it thrived.
In fact, profits at the health care industry giant HCA, which controls 163 hospitals from New Hampshire to California, have soared, far outpacing those of most of its competitors.
The big winners have been three private equity firms — including Bain Capital, co-founded by Mitt Romney, the Republican presidential candidate — that bought HCA in late 2006.
HCA’s robust profit growth has raised the value of the firms’ holdings to nearly three and a half times their initial investment in the $33 billion deal.
The financial performance has been so impressive that HCA has become a model for the industry. Its success inspired 35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms eager to repeat that windfall.
HCA’s emergence as a powerful leader in the hospital industry is all the more remarkable because only a decade ago the company was badly shaken by a wide-ranging Medicare fraud investigation that it eventually settled for more than $1.7 billion.
Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff, a move that sometimes led to conflicts with doctors and nurses over concerns about patient care.
In late 2008, for instance, HCA changed the billing codes it assigned to sick and injured patients who came into the emergency rooms. Almost overnight, the numbers of patients who HCA said needed more care, which would be paid for at significantly higher levels by Medicare, surged.
HCA, which had lagged the industry for those high-paying categories, jumped ahead of its competitors and was reimbursed accordingly. The change, which HCA’s executives said better reflected the service being provided, increased operating earnings by nearly $100 million in the first quarter of 2009.
To some, HCA successfully pushed the envelope in its interpretation of existing Medicare rules. “If HCA can do it, why can’t we?” asked a hospital consulting firm, the Advisory Board Company, in a presentation to its clients.
In one instance, HCA executives said a private insurer, which it declined to name, questioned the new billing system, forcing it to return some of the money it had collected.
The hospital giant also adopted a policy meant to address an issue that bedevils hospitals nationwide — reducing costs and overcrowding in its emergency rooms. For years, the hospital emergency room has been used by the uninsured as a de facto doctor’s office — a place for even the most minor of ailments. But emergency care is expensive and has become increasingly burdensome to hospitals in the last decade because of the rising number of uninsured patients.
HCA decided not to treat patients who came in with nonurgent conditions, like a cold or the flu or even a sprained wrist, unless those patients paid in advance. In a recent statement, HCA said that of the six million patients treated in its emergency rooms last year, 80,000, or about 1.3 percent, “ chose to seek alternative care options.”
“Many E.R.’s in America, particularly in densely populated urban areas where most HCA-affiliated facilities are located, have adopted a variety of systems to determine whether a patient in fact needs emergency care,” the statement said. “About half our hospitals have done so. Typically, our affiliated hospitals have two caregivers — usually a triage nurse and a physician — make that determination. It should be noted that other non-HCA affiliated hospitals are using similar processes to address E.R. issues.”
As HCA’s profits and influence grew, strains arose with doctors and nurses over whether the chain’s pursuit of profit may have, at times, come at the expense of patient care.
HCA had put in place a flexible staffing system that allowed it to estimate the number of patients it would have each day in its hospitals and alter the number of nurses it needed accordingly.
Several nurses interviewed said they were concerned that the system sometimes had led to inadequate staffing in important areas like critical care. In one measure of adequate staffing — the prevalence of bedsores in patients bedridden for long periods of time — HCA clearly struggled. Some of its hospitals fended off lawsuits over the problem in recent years, and were admonished by regulators over staffing issues more than once.
‘Through the Roof’
Many doctors interviewed at various HCA facilities said they had felt increased pressure to focus on profits under the private equity ownership. “Their profits are going through the roof, but, unfortunately, it’s occurring at the expense of patients,” said Dr. Abraham Awwad, a kidney specialist in St. Petersburg, Fla., whose complaints over the safety of the dialysis programs at two HCA-owned hospitals prompted state investigations.
One facility was fined $8,000 in 2008 and $14,000 last year for delaying the start of dialysis in patients, not administering physician-prescribed drugs and not documenting whether ordered tests had been performed.
Claiming he provided poor care, the other hospital did not renew Dr. Awwad’s privileges. Dr. Awwad is suing to have them reinstated. HCA declined to comment. HCA says it stands by its procedures, billing practices and level of care...
By REED ABELSON and JULIE CRESWELL
New York Times
August 6, 2012
GRAPHIC: HCA’s Growing Profit
In the summer of 2010, a troubling letter reached the chief ethics officer of the hospital giant HCA, written by a former nurse at one of the company’s hospitals in Florida.
In a follow-up interview, the nurse said a doctor at the Lawnwood Regional Medical Center, in the small coastal city of Fort Pierce, had been performing heart procedures on patients who did not need them, putting their lives at risk.
“It bothered me,” the nurse, C. T. Tomlinson, said in a telephone interview. “I’m a registered nurse. I care about my patients.”
In less than two months, an internal investigation by HCA concluded the nurse was right.
“The allegations related to unnecessary procedures being performed in the cath lab are substantiated,” according to a confidential memo written by a company ethics officer, Stephen Johnson, and reviewed by The New York Times.
Mr. Tomlinson’s contract was not renewed, a move that Mr. Johnson said in the memo was in retaliation for his complaints.
But the nurse’s complaint was far from the only evidence that unnecessary — even dangerous — procedures were taking place at some HCA hospitals, driving up costs and increasing profits.
HCA, the largest for-profit hospital chain in the United States with 163 facilities, had uncovered evidence as far back as 2002 and as recently as late 2010 showing that some cardiologists at several of its hospitals in Florida were unable to justify many of the procedures they were performing. Those hospitals included the Cedars Medical Center in Miami, which the company no longer owns, and the Regional Medical Center Bayonet Point. In some cases, the doctors made misleading statements in medical records that made it appear the procedures were necessary, according to internal reports.
Questions about the necessity of medical procedures — especially in the realm of cardiology — are not uncommon. None of the internal documents reviewed calculate just how many such procedures there were or how many patients might have died or been injured as a result. But the documents suggest that the problems at HCA went beyond a rogue doctor or two.
At Lawnwood, where an invasive diagnostic test known as a cardiac catheterization is performed, about half the procedures, or 1,200, were determined to have been done on patients without significant heart disease, according to a confidential 2010 review. HCA countered recently with a different analysis, saying the percentage of patients without disease was much lower and in keeping with national averages.
At Bayonet Point, a 44-year-old man who arrived at the emergency room complaining of chest pain suffered a punctured blood vessel and a near-fatal irregular heartbeat after a doctor performed a procedure that an outside expert later suggested might have been unnecessary, documents show. The man had to be revived. “They shocked him twice and got him back,” according to the testimony of Dr. Aaron Kugelmass in a medical hearing on the case.
In another incident, an outside expert described how a woman with no significant heart disease went into cardiac arrest after a vessel was cut when a Bayonet Point cardiologist inserted a stent, a meshlike device that opens coronary arteries. She remained hospitalized for several days, according to a person who has reviewed internal reports...
In a recent statement, HCA declined to provide evidence that it had alerted Medicare, state Medicaid or private insurers of its findings, or reimbursed them for any of the procedures that the company later deemed unnecessary, as required by law...
Some doctors accused in the reviews of performing unnecessary procedures are still practicing at HCA hospitals...
A Giant Hospital Chain Is Blazing a Profit Trail
By JULIE CRESWELL and REED ABELSON
August 14, 2012
During the Great Recession, when many hospitals across the country were nearly brought to their knees by growing numbers of uninsured patients, one hospital system not only survived — it thrived.
In fact, profits at the health care industry giant HCA, which controls 163 hospitals from New Hampshire to California, have soared, far outpacing those of most of its competitors.
The big winners have been three private equity firms — including Bain Capital, co-founded by Mitt Romney, the Republican presidential candidate — that bought HCA in late 2006.
HCA’s robust profit growth has raised the value of the firms’ holdings to nearly three and a half times their initial investment in the $33 billion deal.
The financial performance has been so impressive that HCA has become a model for the industry. Its success inspired 35 buyouts of hospitals or chains of facilities in the last two and a half years by private equity firms eager to repeat that windfall.
HCA’s emergence as a powerful leader in the hospital industry is all the more remarkable because only a decade ago the company was badly shaken by a wide-ranging Medicare fraud investigation that it eventually settled for more than $1.7 billion.
Among the secrets to HCA’s success: It figured out how to get more revenue from private insurance companies, patients and Medicare by billing much more aggressively for its services than ever before; it found ways to reduce emergency room overcrowding and expenses; and it experimented with new ways to reduce the cost of its medical staff, a move that sometimes led to conflicts with doctors and nurses over concerns about patient care.
In late 2008, for instance, HCA changed the billing codes it assigned to sick and injured patients who came into the emergency rooms. Almost overnight, the numbers of patients who HCA said needed more care, which would be paid for at significantly higher levels by Medicare, surged.
HCA, which had lagged the industry for those high-paying categories, jumped ahead of its competitors and was reimbursed accordingly. The change, which HCA’s executives said better reflected the service being provided, increased operating earnings by nearly $100 million in the first quarter of 2009.
To some, HCA successfully pushed the envelope in its interpretation of existing Medicare rules. “If HCA can do it, why can’t we?” asked a hospital consulting firm, the Advisory Board Company, in a presentation to its clients.
In one instance, HCA executives said a private insurer, which it declined to name, questioned the new billing system, forcing it to return some of the money it had collected.
The hospital giant also adopted a policy meant to address an issue that bedevils hospitals nationwide — reducing costs and overcrowding in its emergency rooms. For years, the hospital emergency room has been used by the uninsured as a de facto doctor’s office — a place for even the most minor of ailments. But emergency care is expensive and has become increasingly burdensome to hospitals in the last decade because of the rising number of uninsured patients.
HCA decided not to treat patients who came in with nonurgent conditions, like a cold or the flu or even a sprained wrist, unless those patients paid in advance. In a recent statement, HCA said that of the six million patients treated in its emergency rooms last year, 80,000, or about 1.3 percent, “ chose to seek alternative care options.”
“Many E.R.’s in America, particularly in densely populated urban areas where most HCA-affiliated facilities are located, have adopted a variety of systems to determine whether a patient in fact needs emergency care,” the statement said. “About half our hospitals have done so. Typically, our affiliated hospitals have two caregivers — usually a triage nurse and a physician — make that determination. It should be noted that other non-HCA affiliated hospitals are using similar processes to address E.R. issues.”
As HCA’s profits and influence grew, strains arose with doctors and nurses over whether the chain’s pursuit of profit may have, at times, come at the expense of patient care.
HCA had put in place a flexible staffing system that allowed it to estimate the number of patients it would have each day in its hospitals and alter the number of nurses it needed accordingly.
Several nurses interviewed said they were concerned that the system sometimes had led to inadequate staffing in important areas like critical care. In one measure of adequate staffing — the prevalence of bedsores in patients bedridden for long periods of time — HCA clearly struggled. Some of its hospitals fended off lawsuits over the problem in recent years, and were admonished by regulators over staffing issues more than once.
‘Through the Roof’
Many doctors interviewed at various HCA facilities said they had felt increased pressure to focus on profits under the private equity ownership. “Their profits are going through the roof, but, unfortunately, it’s occurring at the expense of patients,” said Dr. Abraham Awwad, a kidney specialist in St. Petersburg, Fla., whose complaints over the safety of the dialysis programs at two HCA-owned hospitals prompted state investigations.
One facility was fined $8,000 in 2008 and $14,000 last year for delaying the start of dialysis in patients, not administering physician-prescribed drugs and not documenting whether ordered tests had been performed.
Claiming he provided poor care, the other hospital did not renew Dr. Awwad’s privileges. Dr. Awwad is suing to have them reinstated. HCA declined to comment. HCA says it stands by its procedures, billing practices and level of care...
Sunday, April 29, 2012
In Hopeful Sign, Health Spending Is Flattening Out
By ANNIE LOWREY
The New York Times
April 28, 2012
The growth of health spending has slowed substantially in the last few years, surprising experts and offering some fuel for optimism about the federal government’s long-term fiscal performance.
Much of the slowdown is because of the recession, and thus not unexpected, health experts say. But some of it seems to be attributable to changing behavior by consumers and providers of health care — meaning that the lower rates of growth might persist even as the economy picks up.
Because Medicare and Medicaid are two of the largest contributors to the country’s long-term debts, slower growth in health costs could reduce the pressure for enormous spending cuts or tax increases.
In 2009 and 2010, total nationwide health care spending grew less than 4 percent per year, the slowest annual pace in more than five decades, according to the latest numbers from the Centers for Medicaid and Medicare Services. After years of taking up a growing share of economic activity, health spending held steady in 2010, at 17.9 percent of the gross domestic product.
The growth rate mostly slowed as millions of Americans lost insurance coverage along with their jobs. Worried about job security, others may have feared taking time off work for doctor’s visits or surgical procedures, or skipped nonurgent care when money was tight.
Still, the slowdown was sharper than health economists expected, and a broad, bipartisan range of academics, hospital administrators and policy experts has started to wonder if what had seemed impossible might be happening — if doctors and patients have begun to change their behavior in ways that bend the so-called cost curve.
If so, it was happening just as the new health care law was coming into force, and before the Supreme Court could weigh in on it or the voters could pronounce their own verdict at the polls.
“The tectonic plates might be beginning to shift,” said Karen Davis, the president of the Commonwealth Fund, a nonprofit research group in New York. “It’s hard to believe everything that’s been tried over the last decade to slow spending wouldn’t be making a difference.”
Experts were surprised, for instance, at a drop in spending on some hospitalized seniors — people enrolled in Medicare, whose coverage the recession should not affect. They also noted that some of the states where health care spending slowed most rapidly were states that were not hit particularly badly by the recession, suggesting that other factors were at play.
“The recession just doesn’t account for the numbers we’re seeing,” said David Cutler, a Harvard health economist and former adviser to President Obama. “I think there’s much more going on.”
The implications of a bend in the cost curve would be enormous. Policy makers on both sides of the aisle see rising health care costs as the central threat to household budgets and the country’s fiscal health. If the growth in Medicare were to come down to a rate of only 1 percentage point a year faster than the economy’s growth, the projected long-term deficit would fall by more than one-third.
The growth of health costs slowed in the 1990s as health maintenance organizations became more popular. That played a role in both gains in household income — less money on employer-provided health benefits means more money for raises — and in budget surpluses, economists argue.
Some experts caution that there remains too little data to determine whether the current slowdown will become permanent, or whether it is merely a blip caused by the economy’s weakness.
“If there’s something else going on, we don’t know what it is yet,” said Gail Wilensky, a health economist who headed Medicare and Medicaid during the administration of President George Bush. “The most honest thing to say is that, one, the reduction in use is greater than the recession predicts; two, we don’t understand why yet; and, three, you’d be foolhardy to say that we can understand it.”
She argued that the unusual decline in not just income but also wealth during the recession might be one factor cutting down on use of the health care system.
But many other health experts say that there is just enough data to start detecting trends — even if the numbers remain murky, and the vast complexity of the national health care market puts definitive answers out of reach.
Many experts — and the Medicare and Medicaid center itself — point to the explosion of high-deductible plans, in which consumers have lower premiums but pay more out of pocket, as one main factor. The share of employees enrolled in high-deductible plans surged to 13 percent in 2011 from 3 percent in 2006, according to Mercer Consulting.
That means thousands of consumers with an incentive to think twice about heading to the doctor. One study by the RAND Corporation found that health spending among people who shifted into a high-deductible plan dropped 14 percent — though the study also found that enrollees cut back on some care that tended to save money in the long run, like vaccinations.
A second factor is a dearth of expensive, novel drugs coming onto the market, experts said, as well as growing pressure to use generics. “There just aren’t as many blockbusters,” said Professor Cutler, the Harvard economist.
Finally, and most important, health economists point to a shift toward accountable care, in which providers are paid for the quality of care, not the quantity.
There are about 164 “accountable organizations” in the United States, according to research by Leavitt Partners. Hundreds of other insurers and health systems have enacted some of the features of accountable care, like assigning specially trained nurse practitioners to patients with multiple chronic conditions to make sure they take their medications and to prevent hospitalizations...
Tuesday, January 17, 2012
US to Force Drug Firms to Report Money Paid to Doctors
US to Force Drug Firms to Report Money Paid to Doctors
January 17, 2012
by: Robert Pear
The New York Times News Service
To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.
Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices.
Consumer advocates and members of Congress say patients may benefit from the new standards, being issued by the government under the new health care law. Officials said the disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.
Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.
The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.
Under the new standards, if a company has just one product covered by Medicare or Medicaid, it will have to disclose all its payments to doctors other than its own employees. The federal government will post the payment data on a Web site where it will be available to the public.
Manufacturers of prescription drugs and devices will have to report if they pay a doctor to help develop, assess and promote new products — or if, for example, a pharmaceutical sales agent delivers $25 worth of bagels and coffee to a doctor’s office for a meeting. Royalty payments to doctors, for inventions or discoveries, and payments to teaching hospitals for research or other activities will also have to be reported.
The Obama administration estimates that more than 1,100 drug, device and medical supply companies will have to file reports, generating “large amounts of new data.” Federal officials said they would inspect and audit drug company records to make sure the reports were accurate and complete.
Companies will be subject to a penalty up to $10,000 for each payment they fail to report. A company that knowingly fails to report payments will be subject to a penalty up to $100,000 for each violation, up to a total of $1 million a year.
Top executives are potentially liable because a senior official of each company — the chief executive, chief financial officer or chief compliance officer — must attest to the accuracy of each report.
The new requirements, or something very similar, will take effect soon; in fact, they are overdue. Under the new health care law, the administration was supposed to establish payment-reporting procedures by Oct. 1, 2011. The public will have until Feb. 17 to comment on the proposals, which are broadly consistent with the expectations of industry and consumer groups. After considering the comments, Medicare officials will issue final rules with the force of law.
Consumer advocates have long demanded details of the financial ties between doctors and drug and device companies.
Allan J. Coukell, a pharmacist and consumer advocate at the Pew Charitable Trusts, said: “Patients want to know they are getting treatment based on medical evidence, not a lunch or a financial relationship. They want to know if their doctor has a financial relationship with a pharmaceutical company, but they are often uncomfortable asking the doctor directly.”
In an introduction to the proposed rules, the Obama administration says that patients can benefit when doctors and the industry work together to develop life-saving drugs and devices. But, it said, these relationships can also “lead to conflicts of interests that may affect clinical decision-making” and “threaten the underlying integrity of the health care system.”
The administration does not try to define the difference between proper and improper payments. It says simply that public reporting of the financial ties between doctors and drug and device companies “will permit patients to make better-informed decisions when choosing health care professionals and making treatment decisions.”
The new standards carry out legislation championed by Senators Charles E. Grassley, Republican of Iowa, and Herb Kohl, Democrat of Wisconsin. The legislation was included in the 2010 health care overhaul.
“The goal is to let the sun shine in and make information available to foster accountability,” Mr. Grassley said.
Christopher L. White, executive vice president of the Advanced Medical Technology Association, which represents makers of medical devices, said the payment data could be used by federal law enforcement agencies, plaintiffs’ lawyers and whistleblowers.
“Some companies fear that doctors may no longer want to engage in consulting arrangements, and such reluctance could chill innovation,” Mr. White said.
Matthew D. Bennett, a senior vice president of the Pharmaceutical Research and Manufacturers of America, said the industry “supported transparency of physician payment information.” However, he said, it is important that payment data be presented in a proper context, emphasizing that interactions between doctors and drug companies played a critical role in improving care, educating doctors and fostering appropriate use of medicines.
Medicare and Medicaid, the programs for older Americans, the disabled and the poor, spend more than $100 billion a year on drugs and devices.
Although the Congressional Budget Office does not predict immediate savings, it has said that, “over time, disclosure has the potential to reduce spending,” by reducing instances of overprescribing.
The law also requires drug and device companies to report the amount of “any ownership or investment interest” held by doctors or their immediate family members, other than holdings of publicly traded stocks.
The administration intends to apply the same disclosure requirements to doctor-owned companies that distribute medical devices. Such companies allow doctors to benefit financially from sales of devices they use in surgery.
January 17, 2012
by: Robert Pear
The New York Times News Service
To head off medical conflicts of interest, the Obama administration is poised to require drug companies to disclose the payments they make to doctors for research, consulting, speaking, travel and entertainment.
Many researchers have found evidence that such payments can influence doctors’ treatment decisions and contribute to higher costs by encouraging the use of more expensive drugs and medical devices.
Consumer advocates and members of Congress say patients may benefit from the new standards, being issued by the government under the new health care law. Officials said the disclosures increased the likelihood that doctors would make decisions in the best interests of patients, without regard to the doctors’ financial interests.
Large numbers of doctors receive payments from drug and device companies every year — sometimes into the hundreds of thousands or millions of dollars — in exchange for providing advice and giving lectures. Analyses by The New York Times and others have found that about a quarter of doctors take cash payments from drug or device makers and that nearly two-thirds accept routine gifts of food, including lunch for staff members and dinner for themselves.
The Times has found that doctors who take money from drug makers often practice medicine differently from those who do not and that they are more willing to prescribe drugs in risky and unapproved ways, such as prescribing powerful antipsychotic medicines for children.
Under the new standards, if a company has just one product covered by Medicare or Medicaid, it will have to disclose all its payments to doctors other than its own employees. The federal government will post the payment data on a Web site where it will be available to the public.
Manufacturers of prescription drugs and devices will have to report if they pay a doctor to help develop, assess and promote new products — or if, for example, a pharmaceutical sales agent delivers $25 worth of bagels and coffee to a doctor’s office for a meeting. Royalty payments to doctors, for inventions or discoveries, and payments to teaching hospitals for research or other activities will also have to be reported.
The Obama administration estimates that more than 1,100 drug, device and medical supply companies will have to file reports, generating “large amounts of new data.” Federal officials said they would inspect and audit drug company records to make sure the reports were accurate and complete.
Companies will be subject to a penalty up to $10,000 for each payment they fail to report. A company that knowingly fails to report payments will be subject to a penalty up to $100,000 for each violation, up to a total of $1 million a year.
Top executives are potentially liable because a senior official of each company — the chief executive, chief financial officer or chief compliance officer — must attest to the accuracy of each report.
The new requirements, or something very similar, will take effect soon; in fact, they are overdue. Under the new health care law, the administration was supposed to establish payment-reporting procedures by Oct. 1, 2011. The public will have until Feb. 17 to comment on the proposals, which are broadly consistent with the expectations of industry and consumer groups. After considering the comments, Medicare officials will issue final rules with the force of law.
Consumer advocates have long demanded details of the financial ties between doctors and drug and device companies.
Allan J. Coukell, a pharmacist and consumer advocate at the Pew Charitable Trusts, said: “Patients want to know they are getting treatment based on medical evidence, not a lunch or a financial relationship. They want to know if their doctor has a financial relationship with a pharmaceutical company, but they are often uncomfortable asking the doctor directly.”
In an introduction to the proposed rules, the Obama administration says that patients can benefit when doctors and the industry work together to develop life-saving drugs and devices. But, it said, these relationships can also “lead to conflicts of interests that may affect clinical decision-making” and “threaten the underlying integrity of the health care system.”
The administration does not try to define the difference between proper and improper payments. It says simply that public reporting of the financial ties between doctors and drug and device companies “will permit patients to make better-informed decisions when choosing health care professionals and making treatment decisions.”
The new standards carry out legislation championed by Senators Charles E. Grassley, Republican of Iowa, and Herb Kohl, Democrat of Wisconsin. The legislation was included in the 2010 health care overhaul.
“The goal is to let the sun shine in and make information available to foster accountability,” Mr. Grassley said.
Christopher L. White, executive vice president of the Advanced Medical Technology Association, which represents makers of medical devices, said the payment data could be used by federal law enforcement agencies, plaintiffs’ lawyers and whistleblowers.
“Some companies fear that doctors may no longer want to engage in consulting arrangements, and such reluctance could chill innovation,” Mr. White said.
Matthew D. Bennett, a senior vice president of the Pharmaceutical Research and Manufacturers of America, said the industry “supported transparency of physician payment information.” However, he said, it is important that payment data be presented in a proper context, emphasizing that interactions between doctors and drug companies played a critical role in improving care, educating doctors and fostering appropriate use of medicines.
Medicare and Medicaid, the programs for older Americans, the disabled and the poor, spend more than $100 billion a year on drugs and devices.
Although the Congressional Budget Office does not predict immediate savings, it has said that, “over time, disclosure has the potential to reduce spending,” by reducing instances of overprescribing.
The law also requires drug and device companies to report the amount of “any ownership or investment interest” held by doctors or their immediate family members, other than holdings of publicly traded stocks.
The administration intends to apply the same disclosure requirements to doctor-owned companies that distribute medical devices. Such companies allow doctors to benefit financially from sales of devices they use in surgery.
Saturday, November 26, 2011
Lack of record access drives up costs at L.A. hospitals for poor
Lack of record access drives up costs at L.A. hospitals for poor
L.A.'s safety-net hospitals are scrambling to match others nationally that use electronic records and integrated systems to manage care for low-income patients and cut costly hospitalizations.
By Noam N. Levey
Los Angeles Times
November 25, 2011
The emergency room at White Memorial Medical Center on Los Angeles' Eastside was buzzing when paramedics arrived on a Friday night with an elderly man slurring his words and complaining of aching bones.
The nurse in the receiving bay immediately ran through standard triage questions: "Are you diabetic? Do you have high blood pressure? Are you allergic to any medications?" Each drew the same response: "I don't know."
The hospital and doctors had no record of the man or his medical history. And with their only guide a piece of crumpled paper they found tucked into the man's pants that seemed to indicate he might have had cancer, doctors had to order a full diagnostic work-up, including blood tests and an EKG to check his heart.
It was another night of high-priced detective work at one of America's urban hospitals.
"We're mostly flying blind here," said Dr. Brian Johnston, the senior emergency room physician at White Memorial, shaking his head at the high costs generated by the lack of records and unnecessary testing.
Waste bedevils much of America's fragmented healthcare system, driving up already skyrocketing costs. As health spending overwhelms government budgets, the stakes are especially high for safety-net institutions like White Memorial that serve the country's poorest patients, largely at taxpayer expense.
The best safety-net systems — in Denver, Dallas, New York and elsewhere — have found ways to practice medicine more efficiently, using electronic records and integrated systems to manage care for low-income patients and cut costly hospitalizations.
In Los Angeles, Chicago and many other cities, local healthcare officials are now scrambling to catch up.
"There is really no system of care here," said Allen Miller, a Los Angeles consultant who is working with private hospitals, clinics and physicians on a potentially trailblazing initiative to link together medical providers that care for some of Los Angeles County's neediest patients...
L.A.'s safety-net hospitals are scrambling to match others nationally that use electronic records and integrated systems to manage care for low-income patients and cut costly hospitalizations.
By Noam N. Levey
Los Angeles Times
November 25, 2011
The emergency room at White Memorial Medical Center on Los Angeles' Eastside was buzzing when paramedics arrived on a Friday night with an elderly man slurring his words and complaining of aching bones.
The nurse in the receiving bay immediately ran through standard triage questions: "Are you diabetic? Do you have high blood pressure? Are you allergic to any medications?" Each drew the same response: "I don't know."
The hospital and doctors had no record of the man or his medical history. And with their only guide a piece of crumpled paper they found tucked into the man's pants that seemed to indicate he might have had cancer, doctors had to order a full diagnostic work-up, including blood tests and an EKG to check his heart.
It was another night of high-priced detective work at one of America's urban hospitals.
"We're mostly flying blind here," said Dr. Brian Johnston, the senior emergency room physician at White Memorial, shaking his head at the high costs generated by the lack of records and unnecessary testing.
Waste bedevils much of America's fragmented healthcare system, driving up already skyrocketing costs. As health spending overwhelms government budgets, the stakes are especially high for safety-net institutions like White Memorial that serve the country's poorest patients, largely at taxpayer expense.
The best safety-net systems — in Denver, Dallas, New York and elsewhere — have found ways to practice medicine more efficiently, using electronic records and integrated systems to manage care for low-income patients and cut costly hospitalizations.
In Los Angeles, Chicago and many other cities, local healthcare officials are now scrambling to catch up.
"There is really no system of care here," said Allen Miller, a Los Angeles consultant who is working with private hospitals, clinics and physicians on a potentially trailblazing initiative to link together medical providers that care for some of Los Angeles County's neediest patients...
Sunday, October 23, 2011
Employers to continue raising rates, shifting cost to workers
About 31 percent of workers are in so-called high deductible plans this year, up from 10 percent in 2006, according to a Kaiser Family Foundation survey. Such policies are sometimes accompanied by a tax-sheltered savings account that can be used for health expenses.
Employers to continue raising rates, shifting cost to workers
Jim Gallagher
STLtoday.com
October 23, 2011
As open enrollment for health insurance approaches, employees can expect the same-old same-old — paying more for less coverage.
The real cost of health insurance will rise an average of 7.1 percent nationally for 2012, based on early results from a Mercer survey of employers.
That's actually an improvement. Costs have been spiking annually at 9 percent for about five years, said Mercer, the big human resources company.
Companies are responding by cutting benefits, urging employees into lower-cost plans and charging employees a bigger share of premiums. Only 39 percent of companies will not shift costs to employees next year, according to the survey.
Usually starting in November, open enrollment allows workers to choose from a menu of plans offered by their employer. As cost rise, many employees are moving into plans with deductibles of at least $1,000 for single coverage, and higher for families. About 31 percent of workers are in so-called high deductible plans this year, up from 10 percent in 2006, according to a Kaiser Family Foundation survey. Such policies are sometimes accompanied by a tax-sheltered savings account that can be used for health expenses.
Cost-shifting maneuvers are helping companies hold their own cost increase down to an average of 5.4 percent, according to Mercer...
Employer Health Plans Often Omit Part-Timer Workers
Kaiser Health News.org
Oct 23, 2011
Several news outlets this weekend covered work-based insurance issues, including reaction to the Wal-Mart announcement that it would be cutting back coverage for new part-timers and what workers in a number of places should expect as their bosses roll out policies for the coming year.
The Washington Post: Health-Care Coverage Still Eludes Some Part-Time Workers
The news came as a shock: Wal-Mart, the nation’s largest private employer, would not offer health benefits to new part-time employees, the company said Friday. But perhaps it shouldn’t have been so surprising, since the retailer was among a minority of U.S. businesses. Only 16 percent of employers offer health insurance to part-timers, according to the Kaiser Family Foundation’s most recent Employer Health Benefits Survey. The number increases to 42 percent among large employers. ... The health-care law that Congress passed last year is unlikely to change that. While part-time workers will have access to new, subsidized coverage on the individual market, the Obama administration’s signature legislative achievement provides little incentive for employers to cover workers who are not full-time staff (Kliff, 10/22)...
Employers to continue raising rates, shifting cost to workers
Jim Gallagher
STLtoday.com
October 23, 2011
As open enrollment for health insurance approaches, employees can expect the same-old same-old — paying more for less coverage.
The real cost of health insurance will rise an average of 7.1 percent nationally for 2012, based on early results from a Mercer survey of employers.
That's actually an improvement. Costs have been spiking annually at 9 percent for about five years, said Mercer, the big human resources company.
Companies are responding by cutting benefits, urging employees into lower-cost plans and charging employees a bigger share of premiums. Only 39 percent of companies will not shift costs to employees next year, according to the survey.
Usually starting in November, open enrollment allows workers to choose from a menu of plans offered by their employer. As cost rise, many employees are moving into plans with deductibles of at least $1,000 for single coverage, and higher for families. About 31 percent of workers are in so-called high deductible plans this year, up from 10 percent in 2006, according to a Kaiser Family Foundation survey. Such policies are sometimes accompanied by a tax-sheltered savings account that can be used for health expenses.
Cost-shifting maneuvers are helping companies hold their own cost increase down to an average of 5.4 percent, according to Mercer...
Employer Health Plans Often Omit Part-Timer Workers
Kaiser Health News.org
Oct 23, 2011
Several news outlets this weekend covered work-based insurance issues, including reaction to the Wal-Mart announcement that it would be cutting back coverage for new part-timers and what workers in a number of places should expect as their bosses roll out policies for the coming year.
The Washington Post: Health-Care Coverage Still Eludes Some Part-Time Workers
The news came as a shock: Wal-Mart, the nation’s largest private employer, would not offer health benefits to new part-time employees, the company said Friday. But perhaps it shouldn’t have been so surprising, since the retailer was among a minority of U.S. businesses. Only 16 percent of employers offer health insurance to part-timers, according to the Kaiser Family Foundation’s most recent Employer Health Benefits Survey. The number increases to 42 percent among large employers. ... The health-care law that Congress passed last year is unlikely to change that. While part-time workers will have access to new, subsidized coverage on the individual market, the Obama administration’s signature legislative achievement provides little incentive for employers to cover workers who are not full-time staff (Kliff, 10/22)...
Thursday, July 28, 2011
Health bill to approach 20 percent of spending by 2020
Health bill to approach 20 percent of spending by 2020
By Andrew Seaman
Jul 28, 2011
(Reuters) - The U.S. health bill will account for 19.8 percent of the nation's spending by 2020, up from 17.6 percent in 2009, outpacing projected average annual GDP growth, researchers said on Thursday.
The report, published online in the journal Health Affairs, looked at projected U.S. health spending through 2020 and estimated about 30 million people will gain health insurance by the start of the next decade due to President Barack Obama's healthcare overhaul.
According to the report, the average annual growth in national health spending is expected to be 5.8 percent, or 0.1 percentage point higher than it would be without the Affordable Care Act.
"We are projecting a decline in the out-of-pocket share, but that doesn't mean that the consumer's burden is going to be substantially reduced," said Sean Keehan, an economist at the Centers for Medicare and Medicaid Services (CMS) and co-author of the report. "Especially since we're projecting health spending to grow at a faster rate than economic growth and disposable personal incomes."
For 2010, the researchers estimated that health spending grew at a historically low rate of 3.9 percent over the previous year to $2.6 trillion, which they attributed to a weak economy that has led many consumers to delay medical treatment.
But future spending will likely grow at a faster pace, fueling concerns over how to cut the country's deficit, now the subject of fierce debate among lawmakers ahead of a deadline for raising the government's borrowing limit.
The largest increase in healthcare spending in a single year is expected in 2014, when CMS forecasts a rise of 8.3 percent from 2013 as much of the new U.S. health law is implemented. The law's provisions include introducing state-based insurance exchanges and increased access to the government's Medicaid insurance plan for the poor. Spending growth will then average 6.2 percent annually from 2015 through 2020.
According to the report, some large employers with low-wage employees are expected to stop offering health insurance in 2014. An estimated 13 million employees would then likely seek insurance in the new exchanges or by enrolling in Medicaid, according to Rick Foster, CMS's chief actuary.
Increased access to health insurance is another explanation for the high growth rate, because with access comes demand.
The researchers estimated that doctor visits, clinical services and prescription drugs will be some of the largest growth areas, because of the comparably young age of the newly insured population. The report said younger patients tend to require less acute care.
(Editing by Michele Gershberg and Steve Orlofsky)
By Andrew Seaman
Jul 28, 2011
(Reuters) - The U.S. health bill will account for 19.8 percent of the nation's spending by 2020, up from 17.6 percent in 2009, outpacing projected average annual GDP growth, researchers said on Thursday.
The report, published online in the journal Health Affairs, looked at projected U.S. health spending through 2020 and estimated about 30 million people will gain health insurance by the start of the next decade due to President Barack Obama's healthcare overhaul.
According to the report, the average annual growth in national health spending is expected to be 5.8 percent, or 0.1 percentage point higher than it would be without the Affordable Care Act.
"We are projecting a decline in the out-of-pocket share, but that doesn't mean that the consumer's burden is going to be substantially reduced," said Sean Keehan, an economist at the Centers for Medicare and Medicaid Services (CMS) and co-author of the report. "Especially since we're projecting health spending to grow at a faster rate than economic growth and disposable personal incomes."
For 2010, the researchers estimated that health spending grew at a historically low rate of 3.9 percent over the previous year to $2.6 trillion, which they attributed to a weak economy that has led many consumers to delay medical treatment.
But future spending will likely grow at a faster pace, fueling concerns over how to cut the country's deficit, now the subject of fierce debate among lawmakers ahead of a deadline for raising the government's borrowing limit.
The largest increase in healthcare spending in a single year is expected in 2014, when CMS forecasts a rise of 8.3 percent from 2013 as much of the new U.S. health law is implemented. The law's provisions include introducing state-based insurance exchanges and increased access to the government's Medicaid insurance plan for the poor. Spending growth will then average 6.2 percent annually from 2015 through 2020.
According to the report, some large employers with low-wage employees are expected to stop offering health insurance in 2014. An estimated 13 million employees would then likely seek insurance in the new exchanges or by enrolling in Medicaid, according to Rick Foster, CMS's chief actuary.
Increased access to health insurance is another explanation for the high growth rate, because with access comes demand.
The researchers estimated that doctor visits, clinical services and prescription drugs will be some of the largest growth areas, because of the comparably young age of the newly insured population. The report said younger patients tend to require less acute care.
(Editing by Michele Gershberg and Steve Orlofsky)
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