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Wednesday, November 4, 2015
Medical Marijuana: No snake oil, but it may hold hope for some - AgingCare.com
Growing older is a bit like early childhood. Each day evolves differently. It is a bit like childhood in reverse. As a child matures he gains some ability, in speech, motor activity, cognition and emotional development. The stages are all there.
As we age maturation appears to reverse itself, gradually at first, then more quickly. The process is sensescence. We recognize some of this by cognitive changes, behavioral changes, physical changes, and at times the expression of infantile or emotional reactions of early youth.
Medical Marijuana: No snake oil, but it may hold hope for some - AgingCare.com
As we age maturation appears to reverse itself, gradually at first, then more quickly. The process is sensescence. We recognize some of this by cognitive changes, behavioral changes, physical changes, and at times the expression of infantile or emotional reactions of early youth.
Medical Marijuana: No snake oil, but it may hold hope for some - AgingCare.com
How Doctors Became Subcontractors | THCB
In our healthcare system, the “middleman” is not who you think
Your doctor no longer works for the patient, but to satisfy a payer.
It works like this. You, the patient pay a monthly premium in return for payment coverage to your physician. The requirements for payment are complicated, and if the physician does not meet these inflexible demands he is not paid ("Denied"). Often times there is no explanation.
This has been a gradual shift in doctor-patient relationship which has become the dominant model for reimbursement. What this means essentially is that your doctor works not for you, but your insurer. You pay the premium for the insurer to reimburse a doctor of their choosing (see your provider directory) Often times your doctor is part of a group practice and in a closed network.
It has been a pervasive cancerous expansion of limiting your access to care, and you are paying the insurance company to limit your freedom of access. It is part and parcel of the "Nanny State", one in which someone else is deciding what is good or bad for you, the patient.
It is not the only organization which uses the Nanny state approach. It is the means which Government now controls almost anything.Your freedoms are disappearing.
The Health Care Blog carries the important message from MICHEL ACCAD, MD, who says, In our healthcare system, the “middleman” is not who you think"
How Doctors Became Subcontractors | THCB
Saturday, October 31, 2015
Thursday, October 29, 2015
Universal Payer.....Are we on the way?
Premiums are rising due to the increased risk and utilization. The health system is not yet in equilibrium, and may not be for several more years. The mergers of companies increases their underwriting assets, as well as decreases competition.
On the care delivery side of the equation the additional cost of administering accountable care organizations, meeting HEDIS criteria, and the loss of efficiency of improperly designed HIT (read EHR) is increasing practice overhead driving further mergers of medical practices, and health systems.
The same is true of pharmaceutical retailers and manufacturers.The pricing of drugs is unstable, as well and opportunities exist for profiteering while the going is good. Witness this article taken from the Journal of the American Medical Association,
Options to Promote Competitive Generics Markets in the United States
[-] Author Affiliations
1Warren Alpert Medical School of Brown University, Providence, Rhode Island
2Harvard Business School, Boston, Massachusetts
3Harvard Medical School, Boston, Massachusetts
4Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina
2Harvard Business School, Boston, Massachusetts
3Harvard Medical School, Boston, Massachusetts
4Duke Clinical Research Institute and Department of Medicine, Duke University School of Medicine, Durham, North Carolina
JAMA. Published online October 29, 2015. doi:10.1001/jama.2015.13498
"In August, the price of the 62-year-old drug pyrimethamine (Daraprim), used to treat many potentially fatal parasitic infections, was increased practically overnight from $14 to $750 per tablet. This colossal increase attracted renewed attention to generic pharmaceutical price spikes, prompting public outrage and a new round of proposals to address this issue. Over the past few years, increasing drug shortages and price spikes have affected generic drugs, which now account for 86% of prescriptions and 29% of pharmaceutical spending.1 A stable supply of affordable generic pharmaceuticals is crucial to improve health care access and appropriate utilization for many Americans."
A 2014 report from the US Government Accountability Office found that the number of active drug shortages increased steadily from 154 in 2007 to 456 in 2012, and the majority of the affected drugs were generic.2 According to a recent Senate subcommittee investigation, many generic drugs prices have increased substantially as producers have left the market; for example, the price of albuterol sulfate tablets, used for asthma and other lung diseases, increased 4014% between October 2013 and April 2014 from $11 to $434.3 These generic drug shortages and price spikes are adverse outcomes of a malfunctioning marketplace.
Some solutions have been offered
THREE MARKET-BASED PROPOSALS TO OPTIMIZE GENERIC DRUG COST AND AVAILABILITY
Three potential business strategies—restricted market entry, long-term contracting, and creation of a futures market—could stabilize the generics drug market, but each has strengths and limitations. Paradoxically, for free-market advocates, these proposals all entail efforts that appear to be somewhat anticompetitive. The intent is to create a generics market that is economically viable for several firms to supply each product in the market. This result will likely lead to the most stable market over time.
Two features of the US generic drug market make it more prone to price swings and shortages than other commodity markets. First, entry into the generic drug market is restricted, including financial barriers (the cost of product formulation, quality assurance, and bioequivalence testing) and a time barrier due to the need for abbreviated clinical testing and the uncertainty of the Abbreviated New Drug Application (ANDA) review cycle. Second, again in contrast to more efficient commodity markets, there are barriers to the substitution of other products for a given generic drug molecule.
The economics of the generic drug market are driven by the opportunity for 180 days of market exclusivity for the first generic product on the market. These products are available at prices only slightly reduced from those of the originator products. Generic manufacturers may enter the market after 180 days in the hope of a substantial financial return in the short period of time before the price of the product declines. Firms take a calculated risk in financing bioequivalence studies and in entering the marketplace without knowing how many competitors will enter the market nor how quickly the price of the product will decline. As other firms enter the market and the price of a product approaches its marginal cost, the incentive to remain a supplier diminishes.4 At that time, firms make decisions about exiting the market without knowledge of the actions of other firms. Eventually, exit of enough firms supplying a particular product can lead to substantial price increases as the remaining firms operate with little competition, or drug shortages if remaining firms lack the capacity to supply the entire market. These are the drug shortages and price increases observed by Congress.
Option 1: Restrict Market Entry
Option 2: Encourage Long-term Contracts From Wholesalers
Option 3: Create a Futures Market
___________________________________________________________________________
Published Online: October 29, 2015. doi:10.1001/jama.2015.13498.
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. Dr Schulman reports receiving honoraria from McKesson and Cardinal Health; consulting fees from Genentech, Novartis, sanofi-aventis, and Cytokinetics; and holding stock in Alnylam Pharmaceuticals. No other disclosures were reported.
Additional Contributions: This article was developed in collaboration with Aaron S. Kesselheim, MD, JD, MPH (Brigham and Women’s Hospital). He received no compensation for her contribution.
Walgreens to buy rival Rite Aid for $9.4 billion, creating drugstore giant - LA Times
The proposed deal follows a wave of mergers elsewhere in the healthcare industry, with insurers, hospital operators and pharmaceutical companies all combining to gain more leverage with suppliers and cut costs as the Affordable Care Act and other issues roil the outlook for revenues and profits.
In July, for instance, Anthem Inc. reached a $54-billion deal to buy rival Cigna Corp. and create the nation's largest health insurer.
But some observers questioned how much the public is being helped by having fewer players in each of the health industry's major industries.
Companies can make the argument that a larger company is necessary to negotiate better deals, but that might not translate to a boon for consumers, said Carmen Balber, executive director of Consumer Watchdog.
“It's fair to assume that drug prices will increase for consumers because of this merger,” Balber said. “There are less companies negotiating with the pharmacy managers, and there are less companies negotiating with the pharmaceutical companies.”
In downtown Los Angeles, where Walgreens and Rite Aid stores face off across the intersection of 7th and South Hope streets, Jeffrey Portnoy said his only worry about Walgreens buying Rite Aid was the effect on drug prices.He also said there would likely be a review of the stores' overlapping coverage areas and that the Department of Justice would require them to shed some stores in certain regions, including California.
Walgreens overall has about 13,100 stores in 11 countries, and it operates a leading pharmaceutical wholesale and distribution network with sales in 19 countries. The company employs about 370,000 people. Rite Aid has about 89,000 employees.Walgreens to buy rival Rite Aid for $9.4 billion, creating drugstore giant - LA Times
Wednesday, October 28, 2015
Premiums for Health Insurance Bought on Exchanges to Climb in 2016 - WSJ
Consumer Power Report #479:
More than 500,000 Could Lose
Obamacare Subsidies
Premiums for Health Insurance Bought on Exchanges to Climb in 2016 - WSJ
Tuesday, October 27, 2015
Costs for Dementia Care Far Exceeding Other Diseases, Study Finds - The New York Times
Three diseases, leading killers of Americans, often involve long periods of decline before death. Two of them — heart disease and cancer — usually require expensive drugs, surgeries and hospitalizations. The third, dementia, has no effective treatments to slow its course.
So when a group of researchers asked which of these diseases involved the greatest health care costs in the last five years of life, the answer they found might seem surprising. The most expensive, by far, was dementia.
The study looked at patients on Medicare. The average total cost of care for a person with dementia over those five years was $287,038. For a patient who died of heart disease it was $175,136. For a cancer patient it was $173,383. Medicare paid almost the same amount for patients with each of those diseases — close to $100,000 — but dementia patients had many more expenses that were not covered.
On average, the out-of-pocket cost for a patient with dementia was $61,522 — more than 80 percent higher than the cost for someone with heart disease or cancer. The reason is that dementia patients need caregivers to watch them, help with basic activities like eating, dressing and bathing, and provide constant supervision to make sure they do not wander off or harm themselves. None of those costs were covered by Medicare.
For many families, the cost of caring for a dementia patient often “consumed almost their entire household wealth,” said Dr. Amy S. Kelley, a geriatrician at Icahn School of Medicine at Mt. Sinai in New York and the lead author of the paper published on Monday in the Annals of Internal Medicine.
“It’s stunning that people who start out with the least end up with even less,” said Dr. Kenneth Covinsky, a geriatrician at the University of California in San Francisco. “It’s scary. And they haven’t even counted some of the costs, like the daughter who gave up time from work and is losing part of her retirement and her children’s college fund.”
Dr. Diane E. Meier, a professor of geriatrics and palliative care at Mount Sinai Hospital, said most families are unprepared for the financial burden of dementia, assuming Medicare will pick up most costs.
“What patients and their families don’t realize is that they are on their own,” Dr. Meier said.
Everything gets complicated when a person has dementia, noted Dr. Christine K. Cassel, a geriatrician and chief executive of the National Quality Forum.
She described a familiar situation: If a dementia patient in a nursing home gets a fever, the staff members say, “I can’t handle it” and call 911, she said. The patient lands in the hospital. There, patients with dementia tend to have complications — they get delirious and confused, fall out of bed and break a bone, or they choke on their food. Medical costs soar.
Costs for Dementia Care Far Exceeding Other Diseases, Study Finds - The New York Times
Behavioral Medicine in your Community
If you are interested in improving care for homeless individuals or reducing the number of incarcerated people, watch these outstanding presentations
Assisted Outpatient Treatment: The Nevada County Experience from Treatment Advocacy Center on Vimeo.
How can you help in making this a reality ?
Assisted Outpatient Treatment: The Nevada County Experience from Treatment Advocacy Center on Vimeo.
How can you help in making this a reality ?
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