February 20th, 2009 by Dr. Val Jones in Health Policy
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In a provocative analysis of a 30-year old Medicare coverage loophole, John Schall explained the following (at the Medicare Policy Summit event):
1. Medicare covers kidney transplants for patients with end stage renal disease (ESRD). Transplant patients, of course, require life-long immunosupressive drugs to keep their bodies from rejecting the new kidney.
2. Medicare only covers immunosupressive drugs for 36 months total. These drugs are too expensive for most patients to afford out-of-pocket.
3. Many kidney transplant patients covered by Medicare are unable to continue their immunosupression regimen after 36 months, and slowly go into organ rejection.
4. Once they have rejected their transplanted kidney, they are eligible to receive a new one, fully covered by Medicare, with (you guessed it) 36 months of immunosuppresive drug coverage to follow.
Wouldn’t it just be cheaper to cover immunosuppresive drugs for the lifetime of the patient who receives an organ transplant? Yes, and that’s what lobbyists have been arguing for 30 years now, without a change in the rules.
Government-run healthcare can have its challenges… and this is only the beginning.
February 19th, 2009 by Dr. Val Jones in True Stories, Uncategorized
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Shaun Donovan
Bob Schieffer may be dipping his toe into the micro-blogging phenomenon that is Twitter. I can only imagine how little time he has for this kind of thing, being that when I last interviewed him, he had about 500 emails/day to triage.
But he tried an interesting experiment today – asking the Twitterverse what they’d like him to ask HUD Secretary Shaun Donovan on Face The Nation this Sunday. I suggested that most Americans were probably curious to know who qualifies for federal assistance with their mortgages.
What would you like Bob to ask Shaun? You can make suggestions or follow Bob on Twitter: @bobschieffer
And for a bit of trivia – it’s a small world after all – Shaun Donovan’s younger sister went to medical school with me. She has kindly hosted me at her apartment in New York City on numerous occasions – so it seems that her whole family is directly involved with housing people of all walks of life – even bloggers.
February 19th, 2009 by Dr. Val Jones in Health Policy
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Dan Todd, Senior Manager of Reimbursement for Amgen Pharmaceuticals, recently presented a candid view of how current healthcare reform initiatives may negatively impact his industry. Here are the highlights from the Medicare Policy Summit in Washington, DC:
1. Comparative Effectiveness Research: while the Obama administration’s new emphasis on comparative effectiveness research is not supposed to influence coverage decisions or draw conclusions about “cost effectiveness” – there is no current policy to prevent that from happening. Pharmaceutical companies are nervous about coverage being denied for their products that don’t fare well in head-to-head studies with alternative treatments.
2. Physician Payment Reform: as payment mechanisms move away from fee-for-service and towards episodic care compensation, physicians will no longer be directly influenced by price differences between drugs. Specialist physicians who used to purchase drugs (such as in-office administered chemotherapy agents) under a competitive acquisition program from pharmaceutical companies (and then seek reimbursement from Medicare), will now have less incentive to select one drug over another based on price. Physician compensation will not be dependent on the price difference between drugs – but on the overall bundled services for an episode of care for each patient.
3. The Rise Of Primary Care: as more emphasis is placed on improving compensation to primary care physicians, specialist services will likely receive lower reimbursements to cover the higher payments for PCPs. Since specialists are more likely to prescribe more expensive drugs that have more generous margins (under Medicare Part B), the pharmaceutical industry will be negatively impacted by the improvements in primary care reimbursements for cognitive services.
4. Stifling Innovation: perhaps the most compelling argument made by Mr. Todd is the potential stifling of innovation that a comparative effectiveness regime could impose. Blockbuster drugs are rarely discovered in a vacuum. They are the result of incremental steps in understanding the biology of disease, with an ever improving ability to target the offending pathophysiologic process. The first few therapies may offer marginally improved outcomes, but can lead to discoveries that substantially improve their efficacy. If an early drug is found to be only marginally better than the standard of care, an unfavorable comparative effectiveness rating could kill the drug’s sale. Without sales to recoup the R&D losses and reinvestment in the next generation of the drug, development may cease for financial reasons, and the breakthrough drug that could cure patients would never exist.
5. Timing The Release Of Drugs: Navigating the complexities of Medicare reimbursement, with its separately funded Part B and Part D, is a pharmaceutical company nightmare. With the additional scrutiny on comparative effectiveness and functional equivalency proposed in reform measures – timing of drug releases make a big difference in reimbursement. Take a subcutaneous (SQ) versus an intravenous (IV) version of a given drug for example. The market for the SQ administration is much larger than that of the IV route, but if the drug company releases the SQ version too soon, denial of payment for the more expensive IV version will begin to eat away at profitability. As Dan summarizes, “there’s a fine line between expanding your market and cannibalizing it.”
February 19th, 2009 by Stacy Stryer, M.D. in News, Opinion
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By Stacy Beller Stryer, M.D.
Bristol Palin hasn’t said anything new or different than the other teen moms I have met. When asked, every teen mom I have spoken with has said that she loves her child but it has been very difficult and, if given another chance, she would never have had a baby as a teen. All would have waited until they were much older. Bristol Palin says 10 years older. When I worked on the Navajo reservation, I did a program at a local high school where I invited teen moms to come in and speak to the students. They spent quite a long time talking about how difficult it was to have a child and how their lives, as they knew it, were gone forever. These teen moms advised every student to wait as long as possible.
During her recent interview, Bristol commented on how she is no longer living for herself and how her new life is not “glamorous” at all. And, although her son is not even two months old yet, Bristol has decided that she wants to become a spokesperson for the prevention of teen pregnancy. This teen mom thinks that merely telling a teen to be abstinent is not realistic.
Although the teen birth rate had been decreasing steadily for over a decade, the most recent national data, compiled in 2005 and 2006, documented a 3% increase in teen births from 40.5 to 41.9 births per 1,000 girls ages 15 to 19. This increase was seen in almost every age and racial group. During a similar time period, teens surveyed in schools nationwide more frequently reported being sexually active and less frequently used contraception, when compared to the previous decade. Experts in the field have speculated as to why these numbers have begun to increase again. Possible reasons include societal changes, recent high profile teen pregnancies (such as Jamie Lynn Spears and, yes, Bristol Palin), positive display and lack of consequences when sex and teen pregnancy occur in the media, fewer educational programs available, and changing policies within the nation (such as teaching abstinence only as the only alternative).
Bristol is lucky because she has a lot of family support, both emotionally and financially. However, most teen moms don’t have much help, and they face extreme financial difficulties. Teens, who are used to following their own schedule and thinking mainly about themselves, must deal with being awakened multiple times a night and basically being at their baby’s beckon call. They can no longer shower when they want, sleep when they are tired, and eat on their own schedules. Teen moms must also deal with the increased risk of medical problems in themselves and their children. They are less likely to have adequate prenatal care, their babies are more likely to be born early, at a lower birth weight, and to die in the first year of life.
In terms of education, it becomes difficult for teen moms to even finish high school. Only 40% of teen moms graduate from high school, compared to 75% of those who don’t have kids. Plus, teens are more likely to live in poverty, as greater than 75% of unmarried teen moms go on welfare within 5 years of having a baby. Their children also suffer. About 78% of them live in poverty, compared to 9% born to married, women over age 20 who have graduated from high school. These children are also more likely to do poorly in school and drop out before graduating high school.
Unlike other high profile teen parents, Bristol is speaking out. She is telling teens to wait to have kids. And she is telling adults that teaching abstinence is not enough. We need to be discussing these topics at school AND at home. We need to know where our teens are when we’re not home. And they need to know about sexually transmitted diseases, teen pregnancy and contraception before they have a sexual relationship. They must be prepared.
