late-breaking news from your medical association volume XXII / no. 3 November 2015
Pfizer expands financial assistance to patients Pfizer says it is doubling the income limit for people to receive dozens of its medicines without a co-payment. Pfizer’s move comes amid fierce criticism by patients and politicians, as well as a growing number of government investigations, of six-figure list prices for new mediations and huge price hikes on old ones, with little or no competition. Pfizer’s Pathway program covers co-payments for up to 44 medicines for patients earning up to four times the federal poverty level. The new limits are $47,080 for a single person and $97,000 for a family of four.
Defensive medicine reduces risk of malpractice litigation A new report authored by Dr. Anupam Jena, an associate professor of health care policy at Harvard Medical School, found a significant inverse association between spending by physicians and the probability of a malpractice claim. The doctor and his team claim that defensive medicine—ordering tests and procedures to avoid potential lawsuits, rather than for clear clinical need—is associated with reduced risk of a lawsuit. Even though there has been a considerable effort to reduce overutilization of healthcare resources as part of healthcare reform, the adoption of these efforts has been slow, as many doctors feel they would be exposing themselves to additional liability risk. Dr. Jena examined data from acute care hospitals in Florida from 2000 to 2009.
U.S. death rate drops significantly JAMA recently published an analysis on mortality in the U.S. from 1969 to 2013 that showed that the death rate for all causes decreased by 42.9%. Annual decline for heart disease slowed from 3.9% between 2000 and 2010 to 1.4% between 2010 and 2013. The COPD death rate went from 21.0% to 42.2%, a 100.6% increase. The cancer death rate decreased from by 17.9% between 1969 and 2013.
Consumers influenced by drug advertising According to a recent report by the Kaiser Family Foundation, one in eight patients say they were given a specific drug after asking a doctor about its advertisements, and 67% say drug companies have a lot of influence over what doctors prescribe to their patients. Having the FDA review drug ads for accuracy and clarity before the public sees the ads is favored by 89% of the public.
Percentage of people covered by Medicare The percentage of people in the United States covered by Medicare has risen from 13.5% in 2000 to 16% in 2014.
DMHC fines two insurers for overstating their Obamacare doctor networks The Department of Managed Care has levied fines of $350,000 against Blue Shield and $250,000 against Anthem Blue Cross after the companies went online with error-riddled provider directories that frustrated consumers statewide as they tried to find doctors during the ACA rollout. The DMHC states that the inaccuracies limited enrollee access to care that resulted in an unacceptable consumer experience, and wants enrollees to be reimbursed if they were negatively affected by the misleading information. Blue Shield has already reimbursed more than $38 million to enrollees who incurred out-of-network costs. A year ago, a survey revealed that more than 25% of physicians listed by Anthem and Blue Shield were not taking patients in the Covered California health exchange or had erroneous information in their listings.
$750,000 HIPAA fine offers lesson on security In September the federal Office of Civil Rights (OCR) announced a $750,000 HIPAA settlement with Cancer Care Group, an 18-physician radiation oncology group in Indiana, which was triggered by a stolen laptop bag that contained unencrypted backup media with data on 55,000 patients. The OCR made it clear that the fine was handed out because the group basically ignored the HIPAA Security Rule requirements. In its investigation, OCR found that prior to the breach, the group had been in widespread non-compliance. It had not conducted an enterprise-wide risk analysis when the breach occurred, and it did not have a written policy in place specific to the removal of hardware and electronic media containing ePHI into and out of its facilities.
Majority of consumers underestimate costs of long-term care A study released by Lincoln Financial suggests that nearly three in four consumers significantly underestimate the costs associated with long-term care. Only 22% of consumers believe they are likely to need long-term care. The average cost of a private room in a nursing home can be up to $97,611 a year. A home aide who provides care for eight hours/day, five days a week can cost an average of $42,000 per year.
Medicare agrees to pay doctors for end-of-life consult Six years after legislation to encourage end-of-life planning touched off a furor over “death panels,” Medicare has issued a final rule this month that authorizes the payment to doctors for consultations with patients on how they would like to be cared for as they are dying.
U.S. spends more on healthcare but has worse health and lower life expectancy The Commonwealth Fund released a report noting that the United States spends more per person on healthcare but has lower life expectancy and worse health. Healthcare accounted for 17.1% of the GDP for the U.S. in 2013, about 50% more than any other country. For a copy of the report go to: www.commonwealthfund.org/publications/pressreleases/2015/oct/us-spends-more-on-health-care-than-other-nations.
Applying virtual health tools to annual visits saves time and money A study conducted by Accenture finds that the use of virtual health tools in primary care could save billions annually. Virtual health tools enable healthcare providers to gather patient information, complete the intake survey and consider clinical options prior to the patient visit. This can save each PCP an average of five minutes per doctor visit. It doesn’t sound like a lot, but it can add up to an annual economic savings of over $7 billion annually if 37,000 PCPs utilize this type of virtual health solution.
Lyra Health gets $35 million in Series A funding Lyra Health, a five-month-old Burlingame-based startup led by David Ebersman, a Facebook co-founder and former CFO, has received $35 million in funding. The company aims to help patients find the best available care for mental health and substance abuse issues, using an algorithm to match patients with options that can include “cognitive behavioral therapy from a computer, a pharmaceutical prescription, or a visit with a mental health specialist.”
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Novartis to pay $390M to settle DOJ suit over pharmacy kickbacks Novartis Pharmaceuticals has agreed in principle to pay $390M to settle U.S. allegations that it used kickbacks to specialty pharmacies to push sales of some drugs. The DOJ had sued Novartis in Manhattan federal court, alleging that the world’s biggest seller of prescription drugs sought illegally to boost sales of drugs covered by Medicare and Medicaid. The settlement, together with other one-time charges, knocked Novartis’ third-quarter net income down to $1.8 billion, a 28% decrease year-over-year in constant currencies. Apparently, Novartis offered special deals to pharmacies to boost prescription of its transplant drug Mitotic in a head-to-head competition with Roche’s CellCept. The drug maker set up another scheme to increase refills of its iron chelation drug Exjade.
San Carlos lab slammed for animal abuse San Carlos research company TB Holdings, which performs surgical experiments on dogs and other animals, has been cited by the U.S. Department of Agriculture for six violations of the Animal Welfare Act, including letting animals die in pain and housing animals in enclosures with excessive accumulation of feces and urine. Inspectors also found dogs with open lesions and scabbing (likely caused by poor injection methods), dental problems, and difficulty moving. This company is a repeat offender, including citations in 2014 for testing chemical products and medicine on dogs, especially Beagles because of their size and temperament. They have also been cited for denying euthanasia to a calf breathing abnormally, denying pain relief to a calf after surgery, and allowing so much feces to accumulate that calves were unable to avoid exposure to their excrement. Located on Bing Street, TB Holdings is a contract research organization specializing in medical device testing.
Relypsa get FDA approval for hyperkalemia drug Redwood City’s Relypsa has received FDA approval of its hyperkalemia drug Veltassa, giving it a head start in the race with another Bay Area company to treat the roughly 3 million people with the disease. Hyperkalemia is a buildup of potassium in the blood that places patients at greater risk of heart arrhythmias and is especially severe in chronic kidney disease and heart disease patients. Relypsa stills has a long way to go in its research, development, regulatory and sales process, but it has a six-month head start against a drug in late-stage development by San Mateo-based ZS Pharma.
Genentech to seek regulatory approval for MS Early in 2016 Genentech plans to seek regulatory approval for an experimental drug that in a late-stage trial showed that it could slow progression of a tough-to-treat form of multiple sclerosis. The drug, a humanized monoclonal antibody called Ocrelizumab, could generate $5 billion in annual sales. There currently are no treatments that get out in front of the primary progressive form of MS, as most drugs treat the disease’s debilitating symptoms, including muscle weakness and fatigue. This would be a big win for Genentech and Roche.
Dignity Health is spending $220 million for a facelift of its hospitals Dignity Health says that it will complete a system-wide facelift of its hospitals over a 16-month period. In the Bay Area, most improvements at Sequoia will be completed by June 2016. Dominican Hospital in Santa Cruz, and St. Mary’s and St. Francis in San Francisco are slated to be finished in August 2016. The plans include making the hospitals seemingly to be more comforting, comfortable, and welcoming. The improvements appear to be linked to its advertising campaign, ”Hello Humankindness.” Stanford Health Care excluded from Blue Shield PPO individual and family plans Effective January 1, Blue Shield is excluding Stanford Health Care from its PPO in the region, stating that its rates are among the most expensive in California. It does not affect Blue Shield members in traditional employer group plans. Earlier this year, Blue Shield added UCSF Medical Center and other UC medical centers to its PPO, including the UCSF Benioff Children’s Hospital in Oakland. Other Stanford sites that will become out-of-network for the Blue Shield PPO enrollees include Stanford Medical Group, Lucile Packard Medical Group, and Stanford’s University Healthcare Alliance.
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Choosing wisely: Changing medicine practice is hard The Choosing Wisely initiative, launched in 2012 by the American Board of Internal Medicine (ABIM), challenged specialty societies to produce lists of tests and interventions that are routinely used by doctors in their specialty but are not supported by evidence. The explicit goal of Choosing Wisely is to identify and promote care that is (1) supported by evidence; (2) not duplicative of other tests or procedures already received; (3) free from harm; and (4) truly necessary. In response to this challenge, medical specialty societies asked their members to “choose wisely” by identifying tests or procedures commonly used in their field whose necessity should be questioned and discussed. Now that Choosing Wisely has been around for more than three years, it’s natural to ask, is it working? Has the initiative had an effect on the use and overuse of tests and interventions that don’t benefit patients? This is a difficult question to answer, given the large number of Choosing Wisely lists, and, given how long it takes to do studies, three years is really not enough time for a full assessment. It is, however, sufficient time to get some early indications. Last week, there was a major study published in JAMA Internal Medicine that suggests the answer to that question is, for the most part: Not yet. Indeed, Sanjay Gupta, MD, characterized the results as “disappointing.”
Kaiser and Dignity to jointly run stockton hospital Beginning next summer, Kaiser Permanente and Dignity Health will run the 336-bed St. Joseph’s Medical Center in Stockton, with Dignity retaining an 80% ownership and Kaiser taking a minority 20% ownership position. Kaiser doctors will practice at St. Joseph and admit patients there; Kaiser has 100,000 enrollees in the Stockton market. The partnership will ensure a stable, financially strong hospital. On another note, Kaiser is reportedly in early-stage affiliation talks with Michigan’s nationally known Henry Ford Health System.
Don’t miss the SMCMA physician networking mixer on December 3 SMCMA will hold a holiday social for its members on the evening of Thursday, December 3. Network and catch up with friends over wine and hors des oeuvres at TasteVin, a charming wine bar and bistro in downtown San Carlos. This event is free for SMCMA members and their physician colleagues, but please RSVP by calling (650) 312-1663 or emailing smcma@smcma.org. 4
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