This week in Medicine – 12/13/14

Many new items came up this week that I will comment on.
1. Primary care physicians likely to see cut in Medicaid Payments (Congressional Quarterly 12/12). Medicaid (welfare) has not kept up with the overhead costs of a visit. The doctor has to pay to see a medicaid patient – a loosing proposition. So to get doctors to see more medicaid patients, whose ranks have expanded by 300%, the Feds increased the rates to medicare rates, which are also low, but do pay about $10 or so above overhead costs per visit. Each State has to cover the majority of the costs for medicaid, but for the past two years the Federal government paid the “enhanced rate”, but won’t after January 1st and the States budgets are strapped and can’t pick up the extra $25 – $50 million it will cost to keep the rates higher. In the end the doctor who expanded their clinics to take on more medicaid patients are now pushed even closer to the brink of insolvency. Though a good number of doctors saw this coming, and didn’t increase the number of medicaid patients they accepted to protect their solvency.

2. Report: One in five Americans have medical debt on credit reports (New York Times 12/12). This article states that “American consumers -43 million people – have blemishes on their credit reports because of overdue medical bills, while medical debts make up more than half of collection items on credit reports”. Patients are falling ill unexpectedly and getting hammered with hospital bills they can’t afford, and now some hospitals are requiring a significant payment (usually by credit card) for the anticipated patient portion BEFORE being admitted to the hospital. We have a system who’s price tag exceeds its value by an exponential amount, making a good number of people scared to access the system which could quickly bankrupt them.

3. Cost of cancer care forces patients to make difficult choices (new York Times 12/11). “the price of chemotherapy now routinely reaches $100,000 for a full treatment course,” which means that patients must choose between spending savings or refusing to do so in order to “ensure that their families will be provided for after they have died.”. What a terrible position to be put into.

4. Judge: Actavis must keep selling older Namenda. On Thursday, a US District Judge ruled that Actavis Plc must continue to sell the immediate-release version of Namenda (memantine), its Alzheimer’s treatment. New York Attorney General Eric Schneiderman had sued the drugmaker in September, claiming that Actavis was engaging in the practice known as “product hopping” or “forced switch,” in which companies usher patients away from a cheaper drug facing patent expiration and to a more expensive version that still retains intellectual property rights. The Irish pharma had been moving patients from an older, twice-a-day version of Namenda facing the patent cliff next July to its newer XR version, a daily treatment whose patent doesn’t expire for 11 years. The story was covered by at least five print outlets, typically characterizing the ruling as a victory for the New York AG and a setback for Actavis.
Bloomberg News (12/11, Pettersson), for example says the decision was “a win” for Schneiderman, who had alleged in his suit that “the drugmaker was ‘gaming’ the system’” through the switch. Said Schneiderman in a statement, “Today’s decision prevents Actavis from pursuing its scheme to block competition and maintain its high drug prices. Our lawsuit against Actavis sends a clear message: Drug companies cannot illegally prioritize profits over patients.” Actavis vowed an immediate appeal. A great example of the Pharma industry greed and the fleecing of the American Public.

5. Gilead sued over the cost of Hepatitis C Medicine. (CNBC 12/11, Cheng)
reports that the Philadelphia Transportation Authority sued Gilead in Federal court on Tuesday over what it characterized as the “exorbitant” pricing of the biotech’s hep C drug Sovaldi. A release from the plaintiff “said that Gilead has been selling a 12-week dose of Sovaldi in the United States for about $84,000, or $1,000 a pill,” considerably higher than its cost in other countries “and the original projected price.” The release also said that Gilead has generated $8.5 billion in Sovaldi sales through the first three quarters of 2014. In response to the suit, Gilead told CNBC “that it had ‘just received the complaint and therefore [has] no comment at this time.’”

6.HHS awards $36M in ACA grants to health centers. (The Hill 12/10, Ferris). Department of Health and Human Services “is handing out $36.3 million to more than 1,000 health centers across the country that have significantly improved the quality of their patient care.” This money is only available to Federal health centers, not to Private practice clinics who also have significantly improved the quality of their patient care. At our office, we improved our quality in a Cardiac LAN program by the state. It cost us money to do this and we got a certificate in response, no financial award that Federal clinics get.

7.AMA calls for RAC program overhaul.
RAC (Recovery Audit Contractor) auditors are essentially bounty-hunters. The Federal Government, as posted previously, has stated that 43% of all claims (in 2012) to medicare by physicians are in error or fraudulent (“improper Medicare payments”) and they are due $9 Billion. They plan to re-educate doctors, which include penalties and recouping of the fees in error. The government has hired contractors that are paid a sizeable commission for denied claims, but there are no repercussions for inaccuracies. As a result, the number of inaccurate audits, inappropriate claims denials and appeals grow. If doctors want to fight it (60% are overturned eventually since they were inaccurate to begin with), “it takes time away from patient care and often costs physicians more money than they can recoup when the denial is overturned”. The AMA is asking for fairness: The contractors should be subject to financial penalties for inaccurate audit findings, audits should be performed by a physician in the same specialty as the one being reviewed, and physicians should be able to rebill to recoup lost claims. This only makes sense, and I applaud the AMA for pushing this issue, for the Federal Government is strong-arming doctors using heavy handed fear tactics and financial penalties to control them.

8. Study: Health premium hikes outpacing wage growth.
Modern Healthcare (12/9, Subscription Publication) reports that US families with employer-based health insurance aren’t benefiting from the slowdown in national healthcare spending, according to a new Commonwealth Fund report released Tuesday, as “rate hikes of their monthly premiums continue to outpace growth in salaries and wages.” The report found that premiums for families with employer-funded insurance rose 73 percent from 2003 to 2013, while median income grew by just 16 percent over the same period.

9.Survey: Americans on Medicare, Medicaid satisfied with health costs.
Modern Healthcare (12/8, Subscription Publication) reports that 57 percent of adults surveyed by Gallup last month “reported they were generally satisfied with the total cost of their healthcare.” That number is largely unchanged from last year and the years before. Forty-one percent were dissatisfied with the total cost of their healthcare. Perhaps “not surprisingly, adults who are ages 65 or older and eligible for Medicare are far more satisfied than younger adults, Gallup staffer Andrew Dugan reported.” In fact, 77 percent of adults ages 65 or older were satisfied with the cost of their care. Those with Medicare, Medicaid “or other alternatives to private insurance were far more likely to be satisfied with their healthcare costs (74%) than the privately insured (58%) or uninsured (28%), Dugan reported.” Of course Americans on Medicare and Medicaid would be satisfied with the health costs since their care is hugely subsidized by income taxes, which is not the case for the privately insured.

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