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

Oct 19, 2010• 6

By NAOMI FREUNDLICH

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.

Although the problem of so-called “polypharmacy” among seniors results in significant economic and public health costs, little has been done to remedy the problem. In fact, in a recent commentary in the Journal of the American Medical Association, Jerry Avorn, associate professor of medicine at Harvard Medical School and author of the book “Powerful Medicines,” says that “many aspects of the US health care system act to discourage optimal prescribing” for the elderly.

For example, elderly Americans are highly underrepresented in the clinical trials for many of the drugs that doctors commonly prescribe for them. Seniors may metabolize these medications differently and they are often more sensitive to side effects and counter-indications with other drugs than younger people. They also take many more drugs (often all at the same time) than any subjects who take part in controlled clinical trials. Disturbingly, doctors sometimes end up prescribing a new medication to treat the adverse effects of a pill the elderly patient has been taking for years.

San Francisco 2010: Qpid.me Demonstration

Oct 19, 2010• 1

By Bianca Grogan

At the Health 2.0 Fall Conference, October 7-8, 2010, in San Francisco, Ca, during the much talked about Behavior Change, Health 2.0 & The Unmentionables session, Ramin Bastani, Founder of Qpid.me spoke about one of the most difficult, but important, conversations you should have with your partner. Ramin drew from his past experiences while introducing a service which he called "a mordern, flirtatious, I'll show you mine, if you show me yours." Take a look at this demonstration and discover a new and easy way to mention one of the biggest unmentionables of them all.

PBM Industry Reforms can Reduce Wasteful Health Care Spending, Protect Patient Choice of Pharmacy

Oct 19, 2010• 3

By CSS

American businessman Victor Kiam best described the small business owners’ mindset by declaring, “An entrepreneur assumes the risk and is dedicated and committed to the success of whatever he or she undertakes.” However, external forces can occasionally constrain even the most astute entrepreneur, as is the case with independent community pharmacy owners. These same forces needlessly inflate prescription drug costs for employers and health plan sponsors, while undermining patient choice and health outcomes.

Pharmacy benefit managers (PBMs) are hired by employers, government agencies, health insurance plans and unions to administer prescription drug plans. They morphed over time from simple claim adjudicators to gigantic drug middlemen operating a byzantine drug delivery system that benefits them at the expense of others. They reap windfall profits simply for processing claims and operating mail order pharmacies. In 2009, the three largest PBMs – CVS Caremark (which includes the CVS pharmacy retail chain), Medco Health Solutions, and Express Scripts – made $6.4 billion, $1.1 billion and $776 million respectively in profits. By contrast, independent pharmacies operate off of slim profit margins that are driven by prescription drug reimbursement. Despite the rising cost of many medicines, these rates have been declining for years.

Local pharmacists have a Hobson’s choice: accept onerous, non-negotiable contract terms dictated by PBMs or lose access to both new and long-term patients. When the contracts are signed community pharmacies are dragged into a profit-draining, bureaucratic abyss. If they have the temerity to complain, PBMs can often freely void the contract. U.S. Representatives Anthony Weiner (D-NY) and Jerry Moran (R-KS) introduced H.R. 5234, the PBM Audit Reform and Transparency Act of 2010; a bipartisan-supported bill designed to tackle some of the most egregious practices of the PBM industry. Its passage is a must.

Doctors, Hospitals and the Yankees

Oct 19, 2010• 5

By ROB LAMBERTS, MD

Joe Boyd hated the Yankees.

“Those damn Yankees. Why can’t we beat ‘em?”

Then he got the opportunity to save his beloved Washington Senators by making a deal with the devil – giving up his soul in exchange for being transformed into “Shoeless Joe” to propel his team to win the World Series.

Interesting. I think a lot of doctors are making their deal with the devil. They are looking for a small gain in comparison to a long-term of misery. True, Joe Boyd made out in the end; but that will only happen if someone from Hollywood writes our script.

Here’s the problem: at the core of our problems with healthcare is the total lack of cohesive communication. Doctors have no idea what other doctors have done with a patient. Tests get ordered, medications get changed, procedures, hospitalizations, even surgeries are done without communication to other doctors who would benefit from this information. The conduit of communication is this:

Doctor: “So, how have you been doing over the past few months?”

Patient: “Didn’t you get the notes from the hospital? I was in for two weeks. I had a heart attack and a stroke and now I am in rehab for both of these.”

Doctor: (checks chart uncomfortably) “No, I didn’t hear about it. Why don’t you tell me about it….”

Situations like this happen daily at my office. Patients are started on medications by specialists without my knowledge. Lab tests are done that I have no access to. Huge changes happen in the lives of the patients for whom I have cared for over a decade, and I get nothing. Even consults I order are done without any communication back to me. On the other side of things, my patients are hospitalized without any consideration of the care I have been giving over the past decade. Patients are treated as if their care starts from scratch every time they enter a new venue.

San Francisco 2010: Launch of ShareCare

Oct 18, 2010

By Bianca Grogan

WebMD founder Jeff Arnold launched ShareCare at this year’s Health 2.0. ShareCare recruits industry experts to answer health and wellness questions, providing consumers with the necessary tools to make smart health choices and live healthier lives. ShareCare simplifies the search for health information, allows consumers to find high quality answers from multiple points of view, and drives healthcare to the local level by allowing consumers to hear from physicians close to home. With partners such as Sony, Harpo (Oprah’s production company), Discovery, Dr. Mehmet Oz, and multiple major content providers, the launch of ShareCare has been highly anticipated.

The Health Reform (Almost) Everyone Loves

Oct 18, 2010• 32

By MICHAEL MILLENSON

Come with me to the land of happy health reform. It is a place where Republicans and Democrats find common ground, a place where physicians, hospitals and health insurers sit together as partners, a place where criticism is respectful, not rancorous. It is the world of Accountable Care Organizations (ACOs).

What are ACOs, and why have they escaped the general onslaught of opprobrium from Obamacare opponents?

The term Accountable Care Organization was originated by Elliott Fisher of the Dartmouth Center for the Evaluative Clinical Sciences, picked up by the Medicare Payment Advisory Commission and then enshrined in Section 3022 of the Patient Protection and Affordable Care Act (otherwise known as health care reform). The language is explicitly designed to use financial incentives to change the health care delivery system.

ACOs are defined less by form than by function. A group of physicians, possibly with a hospital, agrees to manage the full spectrum of care for a defined population of at least 5,000 Medicare beneficiaries for a minimum of three years. If the ACO meets certain targets for quality and cost-effectiveness, it gets to keep part of the savings.

HIE Guide for the Perplexed

Oct 18, 2010• 23

By MARGALIT GUR-ARIE

HIE stands for Health Information Exchange. Sometimes the term HIE is used to describe the act of exchanging health information, sometimes HIE is used to describe the infrastructure which enables the exchange to occur and sometimes HIE is used to describe an organization that owns the infrastructure which enables the act of health information exchange. HIE (the act) is supposedly the holy grail of Health Information Technology (HIT) and the enabler of “an EHR for every American by 2014”, which in turn, will bring about better health care at lower costs and, by leveling the playing field, will reduce disparities in care.

The Government, through ONC, has awarded over $547 million to various States to create regional HIE (organizations). The fledgling new State HIEs (the organizations) are busy screening and purchasing HIEs (the platforms) and defining the rules of their local HIE (the act). There are several HIE (platform) vendors, notably Medicity and Axolotl (recently acquired by Ingenix), but even Microsoft and IBM are trying to make inroads into this fairly new market. In a parallel process, ONC is busy defining national standards and regulations for HIE (the act).

There are two basic models for any information exchange and HIE (the act) is no different.

The Centralized Model – All information creators/editors/contributors push their content to a centralized repository, preferably in real time, and all users/readers pull the information on demand from said centralized repository. This is the infamous “database in the sky” which houses every American’s medical records. Conceptually, this is the simplest model to understand. The Government will buy enough hardware to set up clusters upon clusters of databases, define the exact data elements and documents to be stored, assign a national identifier to all of us (physicians too) and finally publish specifications for pushing and pulling data securely. Every EHR vendor and medical information supplier (such as labs and pharmacies) will build the necessary web services and integrate them in their technology and we will all live happily ever after. However, other than the obvious monumental technology challenges involved in maintaining such infrastructure, Americans tend to experience significant discomfort with the concept of Uncle Sam having unfettered access to so much personal information and the obvious privacy issues it raises.

San Francisco 2010: iWantGreatCare Demonstration

Oct 17, 2010• 2

By Bianca Grogan

In the US, a growing number of doctor rating sites offer helpful – and unfortunately sometimes less than helpful – background information on physician performance. Healthgrades, Angie’s List, Vitals.com and a long list of start ups use a range of approaches and methodologies to provide comparative information on physicians, theoretically allowing users to make informed choices between providers, comparison shop for the best prices and avoid doctors with poor track records. In the UK, the independent iWantGreatcare.com takes a different approach, offering a stats driven glimpse into the performance of doctors working for the National Health Service (NHS). We like the site’s clean lines and ease of use, something we can’t always say about all its U.S. based competitors. In this presentation from October’s Health 2.0 Conference in San Francisco, iWantGreatCare’s Managing Director Neil Bacon talks about his firm’s approach and why nearly as many doctors as patients are using the site.

A Prescription For Doctors

Oct 16, 2010• 21

By THOMAS GOETZ

Enough about patients: What is a doctor to do?

In the past few months, since The Decision Tree book came out, I’ve had the privilege to talk with many doctors about the opportunity and challenge of engaging patients in their own health. Some physicians, not surprisingly, have been suspicious, and even hostile to the idea that patients have a role to play. But thankfully, those have been rare exceptions. Most doctors I’ve spent time with have been eager to hear about new tools that might engage their patients, and they’ve been eager to share well-earned advice on where there’s work to be done. It has been a delight and an education to talk about the potential of healthcare with these physicians who are, after all, doing the hard work of providing medical care every day.

A high point in my continuing education came a couple weeks ago, when I was invited to speak at the Minneapolis Heart Institute Foundation‘s Fall Nursing Conference, where I met a number of nurses who are eager to help patients gain some control over their health. A few days later I gave a lecture on patient engagement at the University of Minnesota Medical Center. The invitation came from Dr. David Rothenberger, an esteemed surgeon who has consistently emphasized the importance of innovative thinking in medicine. Dr. Rothenberger also runs a program for physicians with promising leadership potential, and part of my day involved talking with them about the changing nature of clinical medicine, and the challenge of engaging patients in their healthcare.

These were good doctors, deeply motivated to help their patients, and there was scant resistance to the notion of an empowered patient who might seek to engage in their care and treatment. Indeed, they seemed to relish the opportunity to work with such patients.

San Francisco 2010: Regina Holliday Presents her Painting

Oct 15, 2010• 11

By Bianca Grogan

On the last day of the Health 2.0 Fall Conference in San Francisco, October 7-8, 2010, Regina Holliday presented the painting that she worked on for the full two days of the conference. She titled her painting Bridging the Great Divide, in reference to how we communicate, bridge communities, and combine left and right brain thinking.