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Cost Containment

What Ever Happened to the 7 Poster Children of Oxycontin?

When Oxycontin was introduced to the world, the public was led to believe that it was some kind of addiction-proof miracle drug. In 1998, Purdue Pharma featured a video of seven chronic pain patients who used Oxycontin and could advocate that the drug had helped them regain normal function and enjoyment of everyday life.

The marketing campaign marked the beginning of the industry’s’ hard push for narcotic painkillers and would convince physicians and the public that opioid use was safe, effective, and normal for people with chronic pain. Now, as addictions to painkillers have skyrocketed and fatal overdoses have more than tripled in the past decade, the U.S. has declared prescription drug abuse as a national epidemic.

So what ever happened to these seven poster children of Oxycontin? A very interesting article by the Milwaukee Journal Sentinel, “Where Are They Now?”, explains what happened to the seven patients who spoke glowingly of their experiences with Oxycontin 14 years ago.

In the 1998 video, one patient, Johnny Sullivan, advocated for Oxycontin saying, “Never a drowsy moment here.” Ten years later after severe addiction to Oxycontin and other opioids, he died in a car crash after falling asleep at the wheel.

“Two of the seven patients were active opioid abusers when they died. A third became addicted, suffered greatly, and quit after realizing she was headed for an overdose. Three patients still say the drug helped them cope with their pain and improved their quality of life. A seventh patient declined to answer questions.” Read More…

Purdue’s marketing campaign was so misleading that they plead guilty in 2007 to a federal criminal count of misbranding the drug “with intent to defraud and mislead the public,” paid $635 million in penalties and remains on probation.

Fortune’s article “Oxycontin: Pursue Pharma’s painful medicine”, provides insight into the $3 billion dollar drug and how new legislation has forced the pharmaceutical industry to take action. Read More…

“Oxycontin’s bad reputation, however, has obscured a significant step. Last year Purdue began selling a reformulated version that should help reduce the worst form of abuse. The original drug had a time-release mechanism that could be defeated by crushing the pill and snorting it, smoking it, or adding water to the powder and injecting it for a heroin-like high. (Purdue’s claims that the time-release process reduced the addiction risk were crucial in making doctors feel comfortable prescribing a powerful addictive drug.) By contrast, the new version breaks into chunks rather than a powder; if water is added, the result is a gelatinous goop.”

While some progress is being made to defeat the Prescription drug epidemic, the story of the seven Oxycontin poster children is a sad example of how a powerful marketing campaign and money out-shined the  harmful consequences  of opioid use throughout the country.

$750 Billion in Health Care Dollars Wasted Annually

By Vanessa Radatus

As we near Election Day, the U.S. health care system continues to fuel fiery debate between President Barack Obama and GOP candidate Mitt Romney. But where will all their assertions and accusations get us in the end?

President Obama’s plan aims to keep Medicare in its current form under the Affordable Care Act, guaranteeing it as the primary option for seniors, while working to cut costs. On the other hand, Romney promises to repeal the health care law and restore the $716 billion to Medicare. But where are the facts, the data, and the real numbers that can prove that America’s most popular and most expensive government entitlement programs can be cost-efficient and still available to future generations?

 The Seattle Times article, “US Health Care System Wastes $750B a Year,” addressed a new report by the Institute of Medicine stating the harsh truth of our current health care system.

“The U.S. health care system squanders $750 billion a year – roughly 30 cents of every medical dollar – through unneeded care, byzantine paperwork, fraud and other waste.”

As if it’s not already difficult to visualize what $750 billion dollars amounts to, it’s even more unfathomable to realize it has all gone to waste. The Seattle Times explains it well, aliking it to business models and costs we can understand.

“If banking worked like health care, ATM transactions would take days…If home building were like health care, carpenters, electricians and plumbers would work from different blueprints and hardly talk to each other.

If shopping were like health care, prices would not be posted and could vary widely within the same store, depending on who was paying. If airline travel were like health care, individual pilots would be free to design their own preflight safety checks – or not perform one at all.”

So just how much is $750 billion? To put it in persepctive, it would provide every living person on Earth (approximately 7 billion) with $107. And while it may not seem like much, 80% of the worlds’ population lives on less than $1 a day. Specifically, this one-year waste on health care is equal to more than 10 years of Medicare cuts in Obama’s health care law.

The report identified six major areas of waste (Adjusting for some overlap among the categories, the panel settled on an estimate of $750 billion per year)

  • Unnecessary services ($210 billion annually)
  • Inefficient delivery of care ($130 billion)
  • Excess administrative costs ($190 billion)
  • Inflated prices ($105 billion)
  • Prevention failures ($55 billion)
  • Fraud ($75 billion)

While we won’t see this overbearing number diminish overnight, the future of our health care relies on our nation’s leaders to execute a plan that demands quality, reduces waste and cost for all U.S citizens. The truth is, we simply cannot afford another $750 billion down the drain. Read More…

CMS Drops Coverage for TENS to Treat Chronic Lower Back Pain

After a systematic review of studies, the Centers for Medicare and Medicaid Services (CMS) concluded that it would drop coverage for the use of Transcutaneous Electrical Nerve Stimulation (TENS) for chronic low back pain. In a memo sent out in June, CMS stated, ““TENS is not reasonable and necessary for the treatment of [chronic low back pain].”

Before the decision, Medicare paid for FDA-approved TENS equipment when prescribed by a physician and reimbursed physicians and physical therapists for evaluating patients’ suitability for the treatment. The TENS units are usually small, portable battery operated devices that deliver electrical currents to the skin through electrodes. While TENS treatment is widespread, its efficacy is debated due to inadequate reporting and methodology in early studies.

With CMS nixing the viability of TENS, Medicare will no longer cover most TENS treatments except for patients enrolled in new clinical studies of the treatment.

The move could not ony set a precedent for denial of coverage of non-pharmacologic pain treatments, it might also have a large impact on Workers’ Compensations and Auto Insurance markets. Read More…

New Coupons Make Brand-name Drug Prices as Low as Generic Pills

The smart folks at drug companies have figured out a workaround to subvert the variable prescription pricing in most commercial insurance plans. These pricing schemes reduce the co-pay for brand name drugs to the same much lower level that is paid for generic equivalents.

Trouble is that the insurance company does not get a similar discount and ends up paying far more than it would for the generic, while the consumer is no longer sharing the pain; their own economic disincentive is bought off with the coupons.

By and large, generic prescription drugs are equal to the brand name in efficacy. The patent system amply rewards the innovators with exclusive access to drugs for a period of time, after which the drug is available to others to produce, often cutting the price to a fraction of the prior cost.

The article, “Prefer brand-name drugs? Lipitor, Plavix coupons discount cost to about price for new generics,” quotes an analyst at the end who says: “It’s good for consumers, because they don’t bear the cost and they can stay on the brand.” This is a misguided statement. Our health care costs are driven up by such thinking. The wealth transfer to the drug company is money that could easily be used to lower premiums, deductibles and copays for all.

Managed Care…Is It Coming Back?

As the largest U.S. health insurance companies struggle to cut costs, many are reverting to similar models of managed care. A recent Wall Street Journal article, “Remember Managed Care? It’s Quietly Coming Back,” explains how some health insurers are developing plans with more restricted choices of doctors and hospitals, and weighing new requirements for referrals before patients can see specialists. Insurers argue that the new managed care plans will be very different from the 1990’s version and will help reduce medical expenses.

While both sides of the managed care debate provide valid points, it is also important remember why this kind of plan was implemented within American health care in the first place. The fact is, the U.S. spends substantially more on health per capita than many other developed countries but we don’t have superior health system performance.

In a report by PBS Frontline, “The High Price of Health: A report on the managed care revolution and it’s impact on doctors, nurses and patients,” provides an in-depth look into the pros and cons of managed care and makes the case that whether people are for managed care or not,  creating a model that both cuts cost and provides quality health care is most important. In the report Mark Roberts, a professor of political economy at the Harvard School of Public Health states:

“So the challenge of managed care today is not whether we should be for it or against it. The alternative – totally unmanaged care – comes with a price tag neither the public sector, nor the private sector can afford. Global economic competition and the impending retirement of the baby boom generation means that neither corporations nor tax payers can go back to the old fee-for-service, use-whatever-you-want system. The task is to make sure that we get more of the good kind of managed care and less of the bad. Plans that offer value-for-money and good customer service need to be the ones that succeed in the marketplace.” Read more…

 

The 10 Essentials, Good Judgment and Preparation Will Save More Lives Than Any Technology

When folks in the Northwest learn about outdoor survival, they learn about the “10 essentials”. The list was developed by The Mountaineers as a guide for explorers if they ever need to face these two questions: First, can you respond positively to an accident or emergency? Second, can you safely spend a night—or more—out?

The reality is that today most who enter the wilderness bring along technology in the form of a mobile phone, or as the New York Times article, “When GPS Leads to S.O.S” describes, a P.L.B. or personal locator beacon. Such tools are wise, but they are certainly problematic if their possession leads to imprudent decisions to enter the wilderness unprepared for events that are otherwise predictable to experienced outdoor explorers.

These unnecessary and  inappropriate requests for help, or acts of plain rudeness and stupidity towards the wilderness rescue system are wasteful and costly, but also pose a bigger problem. The article states, “While in some countries like Europe,  inexpensive rescue insurance covers the costs of all rescues, while in others, those rescued must pay for the help, especially when “victims” are thought to have been negligent or to have cried wolf. But in the United States, charging hikers or boaters for unnecessary rescues is an option seldom pursued. “We don’t want people not to call for a rescue because they think they can’t afford it. Then they’re likely to get into deeper trouble and trigger a more dangerous rescue,” says Jeff Sparhawk, public information officer for the Rocky Mountain Rescue Group, a search-and-rescue team based in Boulder, Colo.” Read More…

Professional and volunteer rescuers believe in their missions and want to help, but they put their own lives at risk in the process. The 10 essentials, good judgment and prudence, including the willingness to turn back, well short of the summit or goal will save more lives than any technology. Failure is one of the allures of the outdoors. There is always another weekend or another season to try again, and the journey, not the destination ought to be enough.

 

 

Responsible Health Behavior Should Be a Part of Our Societal Structure, Not a Domain of the Health Care System

By Brian L. Grant, MD

This  interview and article, “Health Care’s New Maverick,” with Dr. Ralph de la Torre, CEO of Steward Health Care System, is interesting. Clearly a talented and smart man with a mission, his beliefs may represent some thinking that is far more “in the box” than innovative. A fundamental flaw is that he believes that issues like health behavior and “wellness” ought to be part of a health care system rather than part of our societal structure. We have seen that once the health care system embraces an issue, individuals take a passive role as patients needing care by others, rather than engaging in conduct from birth that reduces or prevents chronic lifestyle illnesses that severely impact individual morbidity and society.

Seriously, is good nutrition and food intake a matter for doctors to dictate and treat than for individuals armed with knowledge and government and social policies that align with the knowledge? Is tobacco use something that could be better curbed by societal and political decisions rather than smoking cessation programs? If prevention, as he rightly highlights as necessary, is effectively achieved, his company’s prospects, along with all others in the health care system, is diminished. His interest as a CEO is at least in part, driving the profits of his company. Profits in health care can be made by doing good, as well as by doing more of what is less than impactful.

U.S. Doctor Shortage Expected to Worsen as More Become Insured

Source: Kaiser Family Foundation

From The New York Times comes this interesting article, “Doctor Shortage Likely to Worsen With Health Law,” stating that increasing access to health care will mean physician shortages in many regions. It would be interesting to understand the assumptions behind these conclusions. Many factors impact these trends. Including the relative low status that primary care specialties hold in medicine, at least economically, the preference for well-educated clinicians for some settings and communities over others, an aging population beset by many chronic conditions, and a care model that may need revision. As we understand many common disorders, other practitioners, including nurses, physician assistants and others may be quite qualified to address and care for them. Read More…

The Los Angeles Times describes one possible solution to the doctor shortage in their article, “In-store Clinics Look to Be a Remedy for Healthcare Law Influx.” With an estimated shortage of 40,000 primary-care doctors by 2020, pharmacy giant CVS Caremark Corp, Target Corp., Walmart and other retailers are preparing to open more walk-in clinics to help address the physician shortage. Read More…

Follow Up: Madigan Commander Reinstated After Army Investigates PTSD diagnoses

Photo Credit: Sgt. Christopher M. Gaylord
Colonel Dallas Homas (far right), commander of Madigan Army Healthcare System at Joint Base Lewis-McChord, Wash., spoke during a press conference addressing the Army’s recent decision to discontinue the use of forensic psychiatry as part of its disability evaluation system.

After two weeks of following the Madigan Army Medical Center investigation, commander Col. Dallas Homas has been reinstated to his position. The investigation started mid-July after soldiers believed their Post Traumatic Stress Disorder (PTSD) diagnoses had been unfairly overturned by Madigan’s team of forensic psychiatrists and psychologists.

At an August 2nd press conference, the Army Vice Chief of Staff Gen. Lloyd Austin announced that forensic teams would no longer screen PTSD patients and reinstated Col. Dallas Homas to his position as commander, stating “he had not exerted any undue influence on the diagnostic process.”

In relation to our previous blog post “Military Psychiatrists Under Fire for Doing Their Jobs,” written by MCN’s Medical Director Brian Grant, MD, the Seattle Times featured him in an article last week. Here is an excerpt from the Seattle Times article “Reinstated Madigan Chief Happy to Be Back”:

Homas spoke to reporters along with Maj Gen. Richard Thomas, commander of the Western Regional Medical Command and Lt. Gen. Robert Brown, I Corps commander.

In his remarks, Homas confirmed before his removal he met with an ombudsman to discuss the forensic-screening team. At the time, Homas said he thought the forensic team was executing the accepted standard of care. “Now we have been given a new policy, and we’re going to execute that,” he said.

The Army’s decision to abandon the use of forensic screening has raised concerns among some doctors who practice forensic psychiatry. “I am baffled as to why making a psychiatric diagnosis in a military context should have different criteria from the civilian sector,” said Dr. Brian Grant, a Seattle-based forensic psychiatrist. “The matter deserves further study, hopefully including input from medical experts outside the military system.”

Read More…

Ohio Workers’ Comp Agency Battles Painkiller Epidemic

By Vanessa Radatus

Prescription painkiller overdoses killed nearly 15,000 people in the US in 2008. In 2010, about 12 million Americans (age 12 or older) reported nonmedical use of prescription painkillers in the past year, according to the CDC. Illustration by Bryan Christie.

Though prescription drug abuse is not a new problem, it is one that deserves renewed attention. In 2010,  12 million Americans reported using prescription drugs non-medically. Among the most abused painkillers, Oxycontin, Vicodin, and Xanax, are so powerful that even when those with injury or disability are prescribed medically, a staggering number of them become addicted. It goes without saying that prescription drugs can be indispensable allies to those who really need it, but they also pose serious health risks such as lifetime addiction and death.

Fortunately, several states are taking initiative to control this problem and have even managed to find appropriate and safer treatment options given to injured workers. The Ohio Bureau of Workers’ Compensation (BWC) is effectively reducing painkiller abuse trends through formulary and pharmacy management initiatives in an effort to address Ohio’s opiate epidemic. Read More…
From February to April, the number of patients who received powerful narcotic painkillers saw a 12 percent drop as the agency strictly regulates the drugs that physicians can prescribe for the initial pain of  injured workers. In a WorkCompWire article,  BWC Administrator and CEO Steve Buehrer, said, “Ohio’s new formulary is proving an effective way to help manage care and ensure we are getting injured workers the right prescriptions for the right conditions at the right time. While narcotics can be a legitimate part of the treatment process, we owe it to Ohio’s workers to ensure their road to recovery doesn’t descend down the dark path of addiction.”
The initiative has driven down the number of narcotics prescribed to injured workers by 12 percent, or 1.1 million doses. This equals a 12-percent reduction in the number of doses and a 15-percent, or $2.1 million, reduction in costs, according to the BWC. It’s initiatives like these that will help ensure injured workers are receiving the right prescriptions for the right conditions at the right time,” said Steve Buehrer.
The painkiller epidemic  is an issue that must be addressed wisely. While it is a life saver to those who need it for short-term pain or legitimate reasons, it is also the silent killer of thousands of people who abuse it. The Ohio BWC initiative is step in the right direction but a collective effort from the U.S. government, our state legislature, health insurers, healthcare providers and patients must be made to end this nationwide epidemic.
Here are some key findings from the Center for Disease Control and Prevention (CDC):
  • Overdoses from prescription painkillers — including oxycodone, methadone and hydrocodone (Vicodin) — killed 15,000 people last year. That’s more than 40 per day.
  • In fact, painkillers now cause more deaths in America than cocaine and heroin combined. And if the numbers keep rising, they’ll soon outpace car crashes as the nation’s leading cause of fatal injury.
  • In 2010, 1 in 20 people in the United States (age 12 or older) reported using prescription painkillers for non-medical reasons in the past year.
  • Enough prescription painkillers were prescribed in 2010 to medicate every American adult around-the-clock for a month.
  • Nonmedical use of prescription painkillers costs health insurers up to $72.5 billion annually in direct health care costs.