November 1, 2007
Health IT, leadership key to patient-centered care
Health care facilities and providers that want to implement patient-centered care need to use health IT and effective leadership, according to a report from the Commonwealth Fund. One expert says health IT must be easy to adopt for patients and clinicians, and applications must be implemented gradually to avoid fears about quality of care. Healthcare IT News (10/29)
June 20, 2007
Medical Spending Growth Expected to Decline
June 19, 2007From: http://www.workforce.com/section/00/article/24/96/57.html
Lower spending on prescription drugs and increased cost sharing with employees are expected to lower the growth rate of medical spending in 2008, a sign that premium increases may decline as well, according to data released Tuesday by PricewaterhouseCoopers.
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Medical Spending Growth Expected to Decline
Lower spending on prescription drugs and increased cost-sharing with employees are expected to lower the growth rate of medical spending in 2008, a sign that premium increases may decline as well, according to data released Tuesday, June 19, by PricewaterhouseCoopers.
The driving force behind the drop is patients’ increased sensitivity to price. Employers have achieved this by sharing more of the cost of medical care with employees. They have also focused on managing the health of employees to prevent disease and encourage healthy lifestyles through health coaches and disease management.
“The causes for the current deceleration are complex,” according to the report’s authors, “but it’s clear that the movement into consumerism is real and is affecting medical costs.”
Though still in its infancy, the use of electronic medical records is partially responsible for the slowing of medical cost increases.
Though a drop in medical cost growth does not necessarily mean a decline in premium growth, the past few years have seen just that.
This year, medical costs at health maintenance organizations, for example, are expected to increase 9.9 percent, compared with an increase of 11.8 percent last year. Consumer-directed plan costs increased 7.4 percent, compared with 10.7 percent a year earlier.
Premium growth rate, meanwhile, has dropped every year since 2003, when premiums rose 13.9 percent nationally. In 2006 and 2007, premiums increased 7.7 percent.
Medical cost trends for employers are a combination of factors: how much medical care costs; how much medical care patients seek; and how much of the cost employers shift to employers.
—Jeremy Smerd
Quotation
“No task is so humble that it does not offer an outlet for individuality.” -William FeatherMedicare's Drug Benefit Tough to Navigate
From; http://www.forbes.com/forbeslife/health/feeds/hscout/2007/06/19/hscout605671.html06.19.07
TUESDAY, June 19 (HealthDay News) -- Medicare's new Part D drug benefit is widening patients' access to drugs, a new study says. The real problem, experts say, lies in finding out if your particular plan covers the medication you need.
That's because more than 1,800 different private health plans across the United States now participate in Part D -- each carrying its own formularies, or drug-coverage charts.
"Technically, it is possible for physicians to look up every drug for every patient, but in practicality, this study says they aren't doing it because it's just too hard," said lead researcher Dr. Chien-Wen Tseng, a generalist physician faculty scholar at the University of Hawaii School of Medicine.
The result, according to Tseng, is that "12 percent of patients said that they had left the pharmacy empty-handed, because the drug was either too expensive or was not covered."
And a recent survey of U.S. doctors found that 59 percent said their Medicare patients had encountered trouble getting prescriptions filled under Part D, which took effect last year, Tseng said.
"The whole point of Part D is to expand access," she added. "But if people can't figure out which drug is actually paid for in Part D, then we're back to where we were before the drug benefit."
The study, which was funded by the nonprofit Robert Wood Johnson Foundation, is published in the June 20 issue of the Journal of the American Medical Association.
Despite encountering some bumps along the way, Medicare's new drug benefit is widening access to medications for the average older American, most experts now agree.
"Part D benefits provide a lot of coverage for people who didn't have it before," said Tseng, who is also affiliated with the Pacific Health Research Institute in Honolulu.
In their study, Tseng and the study's senior author, Dr. R. Adams Dudley, of the University of California, San Francisco, used data from Medicare's Web site to track the availability of 75 widely used medications for older patients in California and Hawaii. The drugs were drawn from eight classes, including ACE inhibitors, beta-blockers, calcium channel blockers, diuretics, SSRI antidepressants and statins.
The good news was that, in the vast majority of cases, patients could expect to find at least one drug from each of the eight classes that would be covered by their plan, with the exception of heart drugs called angiotensin II receptor blockers.
The real problem came in figuring out -- in the short amount of time allowed by most doctor's office visits -- whether a particular drug was or was not covered by a patient's participating health plan.
"In California, for example, we looked at people who were potentially faced with over 70 plans" to sort through, Tseng said. "That means that you'd have to have hard copies [of each plan's formulary] and look that up each time, or have Internet access and navigate through the Medicare Web site."
Unfortunately, the study found that, in most doctor-patient encounters, that's just not happening. "This information is not currently easily available to physicians, and physicians don't have the time to look up every drug for every patient," Tseng said.
There were some helpful -- but not foolproof -- rules of thumb, however, the study found. For example, about three-quarters (73 percent) of generic drugs were widely available across plans. "So, physicians might think 'Great, that gives me a shortcut -- just prescribe the generic,' " Tseng said.
However, since one-quarter of generic medications aren't widely covered by plans, that could leave a large minority of patients frustrated as they run into roadblocks at their local drug store.
And those frustrations aren't just an inconvenience, Tseng said.
"These things have real consequences for patients," she noted. In fact, 17 percent of doctors who said their patients had failed to get a prescription filled explained that those bureaucratic mix-ups had led to "a serious medical consequence" for the patient involved.
Robert Hayes is president of the Medicare Rights Center in New York City, a consumer watchdog group. He said these types of incidents are still all too common for Part D participants.
"The key message here is that the variety of plans confounds people's ability to get the drugs that they need," Hayes said. "Very often, people leave the doctor's office with a prescription that they cannot and do not fill."
The solution, he said, lies in a renewed commitment by Medicare to streamline drug-coverage information for both doctors and patients.
"In three words: Simplify, simplify, simplify," Hayes said. "With the amount of money that we are putting into this program, people in Medicare and the American taxpayer should be getting far better health care. That's the frustration."
Tseng agreed. "Ideally, we should be making this all very easily accessible," she said. "Part D benefits provide a lot of coverage for people who didn't have it before. We're just saying, let's find a way to help providers find out what's actually covered and paid for by Part D."
More information
There's much more on navigating Part D at Medicare.
June 19, 2007
Study: Coffee protects against eye twitches
This is just strange. Who thought of why someone would want to research this. Drinking coffee may reduce the risk of the neurological disorder blepharospasm, a twitching of the eyelid that can lead to temporary blindness, researchers say. BBC http://news.bbc.co.uk/2/hi/health/6757825.stm(6/19)OxyContin marketing penalty consumes 90% of profits
The fines assessed against Purdue Pharma and some of its executives over false advertising charges amounted to 90% of the company's profits from the OxyContin drug at issue. The $634.5 million penalty was one of the largest ever paid by a drugmaker in similar cases, but this one was settled in part because of the involvement of GOP presidential candidate Rudolph Giuliani on behalf of the company. The New York Times http://www.nytimes.com/2007/06/19/business/19drug.html?_r=1&oref=slogin (6/19)June 18, 2007
The Perverted Ethics of "Conscience Clauses"
http://www.ethicsscoreboard.com/list/pharmacists.htmlAccessed on 06/18/07.
This is an Opinion (NOT MINE!)from the above referenced site.
Posting Date: 4/15/2005
A Wisconsin pharmacist named Neil Noesen refused to fill University of Wisconsin student Amanda Phiede's birth control prescription on religious grounds, and now faces discipline from the state Pharmacy Examination Board. He also managed to call attention to a growing call for so-called "conscience clauses" in state laws that would permit pharmacists to withhold professional services that they found morally objectionable.
"Conscience clauses" came into being in the wake of the Supreme Court's Roe v. Wade opinion legalizing abortion. Obviously that right to privacy ruling put Catholic hospitals in a difficult position, so the U.S. Congress passed the Church amendment (named after Sen. Frank Church of Idaho) in 1973. This provision allowed individual health care providers and institutions such as hospitals to refuse to provide abortion and sterilization services, based on moral or religious convictions. Most states adopted their own "conscience clause" laws by 1978.
Let us begin by saying that if a national consensus on an issue with moral and ethical content is so far from settled that certain institutions can demand a special legislative exemption from abiding by a Supreme Court ruling, that is a strong, if not conclusive, indication that the ruling itself may have been premature.
That aside, conscience clauses are a terrible idea that encourage arbitrary professional misconduct. It is an example of how morally based action can lead to unethical conduct.
An especially wrong-headed "commentary" that appeared a while back in the Los Angeles Times argued otherwise. In it, Crispin Sartwell, who teaches political philosophy at Dickinson College in Carlisle, Pa. stated his opinion that:
…I personally am no opponent of birth control of any sort or, for that matter, of abortion rights. But people whose jobs require them to violate their own deeply held convictions ought to refuse to do the job, and any politician who upholds freedom or dignity must uphold their right to do so.
What you should ask yourself in this case is not whether you think people should have access to birth control, but whether you should be required to do things that violate your deepest convictions. Should a soldier be required to torture prisoners, for example? Should he refuse to do so if ordered? Should a liberal corporate peon be required to contribute to the Republican Party? Should a Christian secretary have to assist in the advocacy of man-boy love?
Well, Professor Sartwell, since you ask…yes, people who voluntarily undertake the duties of a job should either be prepared to fulfill those duties, take the consequences of not doing so, or not take the job in the first place. That is the ethical duty that one accepts when one agrees to do a job.
Sartwell's examples, by the way, are terrible. U.S. soldiers are, in fact, not only permitted to refuse to obey an illegal order (like being ordered to torture a prisoner) but are required to do so. Contributing to a political party is not a duty of employment, and refusing to obey an order to do so has nothing to do with "conscience." His last bizarre example comes from the beginning of his essay, in which he describes a supposedly true anecdote about a devoutly religious woman who served as a secretary for an executive who had her type letters related to his involvement in the National Man-Boy Love Association. She needed the job, you see, but didn't feel it was right to type his letters.
But she didn't, in Sartwell's terms, "have to assist in the advocacy of man-boy love." Nowhere are typists regarded as active participants in the projects related to the letters they type; it is not as if the letter wasn't going to be typed if she didn't do it. But more importantly, she didn't have to type the letter at all.
She just had to type it if she wanted to keep her job.
This calls to mind a court case of a few years back in which a National Basketball Association player was suspended for refusing to stand when the National Anthem was played before games. He said his religion prohibited doing so, and sued. The NBA pointed out that the standard player contract requires players to follow such team rituals. That was enough for the court, which ruled that the player was free to exercise his conscience, but not if he wanted to continue to play in the NBA.
Exactly. And Professor Sartwell's secretary acquaintance is free to refuse to type her boss's NAMBLA letters. She's just unlikely to be his secretary any more.
The call for conscience clauses is just another chapter in what I sometimes refer to as the ethical "weeny-fication" of America, in which advocates work assiduously to take all risk, danger and courage out of moral stands. Courage is a great and necessary test of conviction, and it must not be removed from ethical decision-making. Professionals should be able to make moral stands in violation of their official duties only if they are willing to take the heat afterwards, and pay the price.
Without this necessary feature, we would all be subjected to paralyzing refusals to fulfill basic duties for moral reasons large, small, eccentric and imaginary. The PETA member check-out clerk who won't allow you to buy steak and eggs; the ecologically minded Home Depot worker who refuses to let you buy pesticide for your peach trees; the religiously teetotalling bar waitress who will only serve you soft drinks; the SUV-hating gas station attendant who won't let a gas-guzzling, global-warming Ford Suburban fill up; the George Bush detesting poll-worker who won't let one of those evil, war-mongering Republicans vote; the Fundamentalist science teacher who refuses to teach Bible-denying evolution…oh, one can come up with endless examples, and, frankly, none are any more absurd than the pharmacist that began this discussion.
He has no professional right to refuse to fill a lawful prescription directed by a physician. He has no right at all to make his customer feel like she is doing something wrong, or to inconvenience her by making her go to another store. His job is to fill prescriptions, not judge them, and if he cannot do that, he shouldn't be a pharmacist.
He is free to make his stand, and indeed, there are times a stand is appropriate. In England, a woman recently exploited the wording of the abortion law to abort a late term fetus because the child would be born with a cleft-palate…a minor birth defect that can be completely corrected with minor surgery. This is creeping awfully close to eugenics, and I would support a doctor's choice to refuse to perform such an abortion on moral grounds. I would also support the medical board's decision to discipline him, which might encourage a public debate about reasonable limitations on late-term abortions. But that's a rare moral stand in an unusual case; it is extremely unwise to pass laws to make moral stands widespread and without consequences. Do I want surgeons free to refuse to operate on criminals, child molesters, adulterers, drug pushers, Michael Moore, Tom DeLay, Paris Hilton, Professor Sartwell's friend's NAMBLA boss or Howard Stern just because they may be morally certain that the world would be better off without them? No, I don't, and neither do you. And, I suspect, neither would Professor Sartwell, if he gave the issue just a bit more thought.
"If you claim the right to behave in accordance with your conscience," he writes at the end of his article, "then you also must accord that right to all others, even pharmacists."
Perhaps. But you do not have the right to avoid all consequences that flow from your exercise of that "right". You have to have the courage to go along with the moral stand, the guts to risk the consequences. The NBA player can refuse to stand for the National Anthem, if he's willing to pick cherries for a living. Neil Noesen can refuse to fill the prescription, if he's game for employment at Blockbuster.
And Crispen Sartwell has every right to express his opinion, but this is one parent who won't be paying tuition to Dickinson as long as their professors teach such perversions of ethics in their Philosophy classes.