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A pharmaceutical firm's recent decision to hike the cost of a prescription drug that treats foodborne illness from $18 to $750 per tablet outraged millions of Americans.
The move prompted Democratic presidential candidate Hillary Clinton to accuse the Swiss-American company Turing of "price gouging." The following day, Clinton unveiled her national plan to rein in drug prices -- and borrowed an idea from California: cap out-of-pocket costs for some prescriptions to save patients with chronic or serious health conditions thousands of dollars. The Golden State's effort to tackle the issue of skyrocketing drug prices is among the most aggressive in the nation, opening up a wider debate over an industry whose sales account for 10 percent of the nation's $3 trillion in annual health care costs. There seems little doubt that the controversy over rising drug prices will rage on and become a key issue in the presidential race. Though average generic drug prices have fallen by more than half since 2008, costs for the name-brand prescription drugs that treat chronic and life-threatening diseases have more than doubled over that period, up 127 percent, far more than the 11.24 percent inflation rate. Read more at San Jose Mercury News "The CMS says doctors tending to tens of millions of chronically ill Medicare patients aren't taking advantage of federal dollars aimed at improving care and reducing hospital readmissions and overall costs.
This year, Medicare began paying an average of $42 per patient per month for non-face-to-face chronic-care management services, such as consulting with other doctors caring for the same patient who might be dealing with dementia, heart disease or arthritis. The CMS estimates 70% of Medicare beneficiaries—roughly 35 million—would be eligible, but CMS has only received reimbursement requests for 100,000 beneficiaries thus far, Kathy Bryant, a senior technical adviser in the Center for Medicare, said last week at an Advisory Panel on Outreach and Education meeting. She added that even that number may be too high as some could be duplicate claims. One possible reason for the low interest is that doctors have to get permission from patients who are responsible for a 20% copayment each time their provider bills for the services. “Getting bills for things when they haven't seen a doctor is not something they are used to,” Bryant said. Others said the CMS didn't provide enough information on how to properly bill under the codes. “Physicians are leery about using them because they don't know if they are doing so correctly,” said Regina Mixon Bates, founder and CEO of the Physicians Practice S.O.S. Group, a healthcare consulting and education firm. Another reason could be the lengthy process on electronic health-record systems." Read more at Modern Healthcare "When it comes to health care costs, it’s clear: Where you live matters. And in California, the gap is especially sharp between the north and south.
Take, for instance, common procedures like a cesarean section or a total knee replacement. The total average price tag for a typical C-section in the four-county Sacramento area is $28,828; in east Los Angeles County, it’s $17,567, according to a health care comparison tool unveiled last week by state officials and Consumer Reports magazine. And that knee replacement? It’s about $42,488 in the Sacramento Valley but drops to $27,276 in east Los Angeles County." Read more at Sacramento Bee "California public health officials have released a report highlighting how demographic disparities across the state affect physical and mental health, Payers & Providers reports.
Details of Report The 96-page report was released by the California Department of Public Health's Office of Health Equity. Overall, OHE Deputy Director Jahmal Miller said the report demonstrates how health outcomes are affected by:
Read more at California Healthline "Paramedic Jacob Modglin parks on a palm-lined street in Oxnard and jumps out of his ambulance. He is prepared for any kind of emergency.
But his patient is standing in the driveway of a one-story house, holding a thermos, and smiling. It's time for his 8 p.m. appointment. Modglin is part of a new cadre of "community paramedics" working in a dozen pilot programs across California. Their jobs are to treat patients before they get sick enough to need emergency care. The paramedics are still first responders, just deployed to prevent a crisis rather than react to one." Read more at The Los Angeles Times "About half of the nation's primary care doctors expressed concern about quality-of-care metrics commonly used by accountable care organizations, according to the 2015 National Survey of Primary Care Providers released last week by the Kaiser Family Foundation and the Commonwealth Fund.
In that survey, almost half of all primary care physicians surveyed (47% of them) also said that recent trends in health care are leading them to consider an earlier retirement. According to KFF officials, the survey reflects a continuing 20-year pattern of physician dissatisfaction with market trends in health care. That dissatisfaction extends to quality metrics and the financial penalties for not meeting those metrics. Roughly 50% of surveyed physicians said those provider performance metrics have a negative effect on patient care. About 22% said the practice would have a positive effect on patient care." Read more at California Healthline "Traditionally, medical students haven't been taught how to talk with their patients about the costs of treatments and medications. The thinking was that doctors should offer their best advice to all patients, regardless of their insurance or ability to pay.
But in a huge departure from the past, the vast majority of the country's medical schools now integrate discussions of cost, value and effectiveness into their curricula. It's "a dramatic change," says Dr. Janis Orlowski, chief health care officer for the Association of American Medical Colleges, which helps medical schools develop curricula." Find more at KPCC |
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March 2016
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