September 5th, 2011 by Happy Hospitalist in Health Policy
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One of the worst parts of my job over the years has been to tell patients I was going to bring them into the hospital as an observation status because they did not have any criteria for full inpatient status. There is a huge difference in how CMS pays for hospital care (excluding critical access hospitals) between inpatient versus observation.
Observation is considered outpatient. Medicare will pay for observation hospital services for up to 48 hours to allow physicians a chance to observe the patient and determine if they need to have an inpatient hospital admission. Observation was never intended to be used as a holding pit to help social workers arrange for a nursing home transfer during normal business working hours because it can’t be arranged, on either end, at 10 pm on a Friday night.
What used to be a moral family obligation to care for loved ones too weak to care for themselves has now been relinquished to the role of hospitals and hospitalists. And we all pay for it. Families have abandoned their loved ones for good. It’s really quite sad. Bringing patients into the hospital for the purpose of arranging a nursing home transfer is, in my opinion, a form of Medicare fraud, since these patients have no intention of being fully admitted.
But it’s paid for and will always be paid for, except when Read more »
*This blog post was originally published at The Happy Hospitalist*
September 2nd, 2011 by RyanDuBosar in Research
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Severe shortages for life-saving medications have driven a “gray market” in the wholesale drug supply industry, a watchdog group reports.
And the mark-up on gray market drugs is a budget-buster, reports the Institute for Safe Medication Practices, a Philadelphia-based nonprofit organization devoted entirely to medication error prevention and safe medication use. Purchasing agents and pharmacists at 549 hospitals responded to a survey on gray market activities associated with drug shortages.
The report includes chilling anecdotes from the respondents about pressure from physicians and administrators to ensure drugs are available, and drastic price gouging from the gray market suppliers. Price mark-ups of 10 times or more than the contract price were reported by about a third of respondents from critical access hospitals and community hospitals, and more than half of university hospitals. Examples include a box of calcium gluconate that cost $750 instead of the contract price of $50 (1,400% mark-up), and a supply of propofol that cost $25,000 instead of $1,500 (1,567% mark-up). Oh, and there’s exorbitant shipping and handling fees, too. Read more »
*This blog post was originally published at ACP Hospitalist*
August 18th, 2011 by Paul Auerbach, M.D. in Health Policy
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Sichuan earthquake rescue workers carrying an injured person. In light of the widespread media coverage of natural disasters, such as the earthquake in Haiti and the tsunami in Japan, the public and medical professionals are aware of the anticipated immediate medical needs in these kinds of emergencies. However, it is less well known that after the initial management of life- and limb-threatening injuries, there may be an enormous need to provide care to persons with chronic illnesses. This is because they are displaced from their homes, become exposed to adverse environmental and socioeconomic hardships, lose access to healthcare, are deprived of their sources of medications, and so forth.
Some of my colleagues were allowed to enter Japan after the tsunami, and their observations agree with this assessment, which was also confirmed in a recent paper, “Chronic health needs immediately after natural disasters in middle-income countries: the case of the 2008 Sichuan, China earthquake,” authored by Emily Chan and Jackie Kim (Eur J Emerg Med 2011;18:111-114). The authors considered physical, social and public health preparedness. Read more »
This post, Chronic Health Needs Must Be Addressed After A Natural Disaster, was originally published on
Healthine.com by Paul Auerbach, M.D..
August 10th, 2011 by Michael Kirsch, M.D. in Health Policy, Opinion
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The concept of cost-effectiveness in medicine is elastic. One’s view on this issue depends upon who is paying the cost. Of course, this is true in all spheres of life. When you’re in a fine restaurant, you order differently when the meal will be charged to someone else. Under these circumstances, the foie gras appetizer and the jumbo shrimp cocktail are no longer luxuries, but are considered as essential amino acids that are necessary to maintain life.
In the marketplace, except in the medical universe, goods and services are priced according to what the market will bear. If an item is priced too high, then the seller will have fewer sales and a bloated inventory. Consumers will not pay absurd prices for common items, regardless of supernatural claims of quality.
- Would you pay $100 for an ice cream sundae that boasted it was the best in the world?
- Would you pay $1000 for a tennis racket that promised performance beyond your ability?
- Would you pay $500 for a box of paper clips that never lose their tension? Read more »
*This blog post was originally published at MD Whistleblower*
July 30th, 2011 by Michael Kirsch, M.D. in Health Policy, Opinion
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As a gastroenterologist, I treat hundreds of patients with heartburn. You already know the names of the medicines I prescribe, since they are advertised day and night on television and appear regularly in print newspapers. Pharmaceutical representatives for each one of these drugs come to our office each claiming some unique clinical advantage of their products over the competitors. They have a tough job since the medicines are all excellent, are priced similarly and are safe. On some days we will have 2 or 3 reps visiting us, each one proffering a medical study or two that supports their product. They show us graphs where their drug is superior to the others regarding an event of questionable clinical import. Their goal is to show that the graph line of their drug is going up, while those of their competitors are going down.
Physicians, like me, who do give these folks some time, have mastered the art of the slow head nod as the drug’s virtues are being related. In the past, the relationships they cultivated with us translated directly into prescriptions being written. Not so today, when our prescribing pens are controlled by insurance company formulary requirements. Those drugs that are not on the coveted list not just swimming upstream, they’re trying to scale a waterfall.
Drug companies know a lot more about us than we know about them. They have Read more »
*This blog post was originally published at MD Whistleblower*
