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 22nd, 2011 by Dr. Val Jones in True Stories
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A strange thing happened to me at a CVS pharmacy two days ago. I was attempting to purchase a protein drink when the girl at the counter asked me to show her my I.D. card. I assumed she meant my CVS savings card and was sincerely confused when she rejected it, saying, “No, your picture I.D.”
I dug through my purse to find my driver’s license while the girl explained,
“You have to be 18 years old to buy this product. I need to type in your date of birth into the computer.”
I wondered if the girl was partially visually impaired – at age 39 I didn’t think anyone would confuse me for a teen (though of course, I would enjoy it if they did), but beyond the amusement of being carded for the first time in over a decade, I was taken aback by the age restriction placed on protein. “I must be really out of the loop,” I thought to myself. “How on earth are teens abusing whey protein? And how did this become so common that CVS instituted a policy against it?”
As it turns out, Read more »
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*
July 15th, 2011 by Peggy Polaneczky, M.D. in Health Tips, Opinion
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If you live in New Hampshire, or some other state that is withdrawing Planned Parenthood funding, you may need to find an alternate source of affordable birth control, at least until the states get their heads screwed back on straight. In the meantime, please, don’t stop your birth control because you think you can’t afford it – the costs of not using it are much, much higher.
But what can you do to make the choice to use birth control even more cost effective?
Birth Control Pills
- Buy them cheap locally. Walmart, Target and Kroger sell very low priced birth control pills – only $4 to $9 a pack. It’s only a few brands (Trinessa, Sprintec and Trisprintec), but ask your doctor if it makes sense to switch if cost is a barrier for you.
*This blog post was originally published at The Blog That Ate Manhattan*
