Highlights from the Health Wonk Review: Comparative Effectiveness Research; Why Reform Will Mean Fewer, Larger Insurers; Skilled Nursing Facilities; Low-Income Seniors, and Insurers Under Investigation

This week The New Health Dialogue’s Meredith Hughes, Allison Levy and Sam Wainwright host a round-up of some of the best health care posts of the past two week.  Below, just a few highlights. (To read the entire review, click here )

On the Health Business Blog, David Williams asks New England Health Care Institute’s Valerie Fleishman to explain the definition of comparative effectiveness research, describe CER provisions contained in the ARRA and ACA and discuss the challenges in disseminating new information to be used at the point of care.  It’s an excellent interview which tells you everything you need to know about Comparative Effectiveness Research --and how the research will be used at point of care.

Rick Scott and the Florida Gubernatorial Race: “Nurses Are for Sink; Doctors Are for Scott; Voters Still on Mars” Part 1

                                      Rick Scott vs. Alex Sink
 

Source: FlaglerLive.com  

Summary: As regular HealthBeat readers know, Rick Scott, the former CEO of Columbia/HCA, a for-profit hospital chain that was raided by the FBI in 1997, is now in the running to become governor of Florida. (See links below to earlier HealthBeat posts.) As the election approaches, it appears that Scott might well win. Even the Florida Medical Association (FMA) is endorsing him.

“Dollars for Docs” Investigation Provides Insight into Lucrative Pharma-Physician Deals

Are you wondering what kind of information will be gleaned about pharmaceutical company-physician relationships once the Physician’s Payment Sunshine Act takes effect in 2013? That’s the year when drug companies will have to start publicly reporting all payments and gifts they dole out to doctors who conduct “educational” speeches and seminars that promote proprietary pharmaceuticals.

In their recent “Dollars for Docs” project, reporters from the investigative news organization ProPublica offer a sneak preview of what kind of money we’re talking about. Reporters from the group probed the “labyrinthine websites” of seven Big Pharma companies that are already reporting this kind of data and discovered that between 2009 and 2010 these firms paid a whopping $257.8 million to about 17,700 providers for giving “educational” talks and seminars to colleagues about certain medications. Charles Ornstein, a reporter for ProPublica told NPR  “In our database we found that there were 384 doctors who, over the course of just the past 18 months, have received at least $100,000 from the drug companies that have reported so far.”

How Reform Law Funds Itself, Strengthens Medicare, and Cuts the Deficit: Part 1

Summary: Those who oppose health care reform continue to assert that the legislation is unaffordable. The only way to dispute this claim is first, to spell out the specific provisions in the Affordable Care Act (ACA) that trim spending and raise new revenues—without rationing care. These planks in the legislation provide substantial funding for the subsidies, employer tax credits, and Medicaid expansion needed to cover some 32 million Americans who are now uninsured—while simultaneously putting Medicare on the road to fiscal stability.

Here are the highlights. The Affordable Care Act finances reform by:

• collecting  over $100 billion in new fees from the insurers, drug-makers and device-makers who will see their revenues grow as millions of new customers buy their products

•  raising Medicare taxes for the 2% of the population at the very top of the income ladder

•   cutting $132 billion in over-payments to Medicare Advantage insurers

•   collecting penalties from individuals  who choose not to purchase “essential minimal coverage” for themselves or their families

•   collecting fees from employers with at least 50 full-time employees who do not offer insurance to their workers 

•   taxing “Cadillac” insurance plans (costing more than $10,200 for an individual, or $27,600 for a family)

•   reducing government subsidies to hospitals that treat a large number of uninsured patients. (Because there will be fewer uninsured, hospitals will no longer need such large subsidies.)

Medicare Costs Rise, Health Outcomes Suffer When Seniors Are Over-Medicated

The problem of elderly people taking too many medications is not new, but continues to pose a serious risk to health as well as contribute significantly to rising Medicare costs. The fact is that nearly 20% of adults aged 65 years and older who are not hospitalized take 10 or more medications daily. This number is not the result of shoddy care, but rather achieved when doctors simply follow practice guidelines for several common, co-existing conditions like diabetes, high blood pressure and depression, for example. If you look at all seniors (those both in and out of the hospital) the American Society of Consultant Pharmacists reports that the average 65-69 year old takes nearly 14 prescriptions per year; by ages 80-84 that number averages an astounding 18 prescription drugs per year.

What’s troubling is that instead of improving the health of seniors, evidence is growing that the more medications an elderly person takes, the more likely he is to experience falls, cognitive decline, loss of mobility, depression and even cardiac problems. These adverse drug effects may be mistaken for Alzheimer’s disease or other dementias too. The bottom line: Experts estimate that up to one-third of the elderly in our communities may be over-medicated and some 20% of their hospital admissions are due to adverse drug events. The costs related to over-medication in the elderly are thought to exceed $80 billion each year.

The Individual Mandate : Gov’t Telling You To Eat Your Spinach “For Your Own Good”? No, Its Aim Is to Protect Others

Summary:  Yesterday, a federal District Court judge in Michigan rejected a constitutional challenge to the Affordable Care Act (ACA)  .This is the first time that a court has gotten to the merits of the case against the ACA.  Below, excepts from analysis by Timothy Jost of the Washington and Lee University School of Law, explaining the decision. Jost’s piece, titled“A Victory for Health Reform and Good Law” appeared on the HealthAffairs blog today.

I’ve added some comments in italics.

Making Sure Prevention Really Does Pay

Prevention is said to be the best medicine, even better than a cure; and as we’ve been told time and again, prevention pays. This is clearly the reasoning behind the health law’s new provision that aims to eliminate financial barriers to preventive services like mammograms and diabetes testing. Health and Human Services Secretary Kathleen Sebelius has said that Americans use preventive services at only about half the recommended rate; studies find that minorities and the poor are far more likely to be barred from these services by high out-of-pocket costs.

The new provision, which went into effect on September 23, requires that insurers provide 45 preventive services to beneficiaries without charging co-pays or deductibles. For now it applies only to new group and individual policies. Many health plans are “grandfathered” in; meaning that that they are exempt from the requirement until they make significant changes to their policies—something that most insurers will likely do before 2013. Medicare and Medicaid plans will have to remove deductibles and co-pays for the designated preventive services by 2011.

HSS estimates that in the coming year some 31 million people in new employer plans and 10 million people in new individual plans will benefit from the prevention provisions under the Affordable Care Act. By 2013, HHS expects some 88 million Americans will see their access to prevention coverage improve.

Swedish Study of Mammograms for Women Under 50

You probably have heard about the new Swedish study of mammograms that appeared in the journal Cancer last week. It seemed to suggest that an average-risk woman in her 40s would benefit from routine mammograms—contrary to the U.S. Preventive Service Task Force’s latest recommendation.
But over at the HealthNewsReviewBlog Gary Schwitzer points to some curious caveats in major news stories about the study. His team reviewed four stories and found that:

“Three of the four stories gave a pretty clear indication that there were methodological concerns about the Swedish research. (Only HealthDay - of the four we reviewed - offered no such hint.)

Tuesday, October 5, I will be speaking at a conference on Fiscal Reform in Washington D.C. titled “America’s Fiscal Choices: Strengthening our Economy and Building for our Future”

The conference is sponsored by the Center on Budget and Policy Priorities, the Century Foundation, Demos and the Economic Policy Institute.

 Speakers and moderators include: Paul Krugman, Karen Davis, John Podesta, Larry Mishell, Robert Greenstein, Robert Reischauer, Robert Kuttner and Ezra Klein.

 The conference is being streamed live from the Newseum; You can also return to this page and view it below the following press release with details

American Cancer Society’s Brawley: “Prostate Cancer Screening Clearly Saves Lives: THAT’S A LIE.”

As regular readers know, I began questioning prostate cancer screening when I launched HealthBeat, back in 2007.  Since then, skepticism about the effectiveness of PSA testing has snowballed.

Over at his HealthNewsReviewBlog  Gary Schwitzer quotes Dr. Otis Brawley, chief medical officer of the American Cancer Society  (ACS)  “taking the gloves off” on prostate cancer screening: