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2011 Potpourri XX

By May 13, 2011Commentary

The Wall Street Journal printed a story on the movement from in-person drug company rep visits to physicians to other means of influencing doctors.  Sales and marketing is the largest cost category for most pharmaceutical manufacturers and sales reps are expensive.  Many doctors are less willing to spend time with them, due to ethical concerns and time pressures.  The companies are using interactive websites, iPad apps and other digital tools as a replacement.  Many physicians seem to prefer this form of interaction, although it is not clear it is as effective for the drug companies in increasing prescriptions of their products.   (WSJ Story)

More good news about the positive effects of the Massachusetts health reform–wait times to see physicians have lengthened and the numbers of doctors accepting certain health plans has declined–that is positive, isn’t it?  The wait times increased by several days from last year for most specialists, but wait times for internists shrank by a few days, after very rapid increases in the last 3 years, and pediatric waits stayed the same.  In all cases the waits were from 3 to 6 weeks.  Most primary care physicians are not accepting new patients from the state’s version of Medicaid and other low-income health programs.  We know we must be wrong, but we just keep thinking maybe the solution to health care issues is less government involvement, not more.   (MMS Survey)

A report by the Health & Human Services Office of Inspector General looked at use of atypical antipyschotics for nursing home residents who are Medicare beneficiaries.  These drugs are potent but can have very serious side-effects.  Alarmingly, 88% of the prescriptions were for residents with dementia, where there is an even higher risk of dangerous adverse events.  About 14% of Medicare-covered nursing home residents had a claim for these drugs and the OIG said at least half of those claims should not have been paid because the use was not medically necessary, the use didn’t meet government standards for the prescribing of such drugs for nursing home residents or there wasn’t adequate documentation about the administration of the product.   (HHS IG Report)

Research published in the Archives of Internal Medicine suggests that many Medicare beneficiaries are receiving unnecessary screening colonoscopies.  In the absence of a negative finding, the unanimous recommendation is to wait ten years after a colonoscopy before doing a repeat.  The researchers sampled beneficiaries who had a colonoscopy with no negative findings from 2000-2003 and then looked for repeats.  An amazing 46.2% of these patients had a repeat colonoscopy in less than 7 years, and in almost 43% of this subgroup, there was no reason for it.  There was extensive geographic variation in the rates of unjustified repeats.  Aside from the wasted spending, these colonoscopies are not without risks to the recipients.   (Archives Article)

An American Journal of Managed Care study looks at the relationship between EMRs and productivity during office visits.  The study is based on the national survey on medical care, so results aren’t necessarily robust.  There did not appear to be any association between EMR use and time spent with the provider.  For the same amount of time spent, EMR users were more productive in terms of number of services, number of diagnostic tests and their intensity, particularly for routine visits for chronic care.  It may be that this just reflects greater ease of translating clinical care to billing in an electronic system, or better prompting for certain testing.  It also appears that use of EMRs is probably associated with an uptick in health spending, not a reduction.   (AJMC Article)

A perspective in the New England Journal of Medicine illustrates how government rules sometimes go haywire and cause significant increases in health care spending with no corresponding gain in quality.  Pre-term births have a very large episode cost.  Some of the potential problems can be managed with a drug that until recently was compounded, or made as a final preparation for administration to patients, in the pharmacy.  This practice is legal and regulated by the FDA when there is no manufactured alternative.  The compounded drug has been effective and safe.  Now a drug manufacturer has made a version, Makena, for which it is charging 100 times more than the compounded version, which under FDA rules pharmacies must stop making now that there is a manufactured alternative.  Currently the compounded version has an ROI of 8-12 times.  Using Makena means it will actually add over $3 billion to total health spending.  You have to ask yourself if the FDA is run by lunatics.  The right thing to do is to continue allowing compounding and for payers to tell the manufacturer of Makena that they will pay no more for that product than they would for the compounded one.   (NEJM Article)

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