Generic Manufacturers: The Saviors

Just saw this pop up on my blog reader and couldn't resist having a little fun and making a few edits....


GPhA: Generic drugs will save $931B over 10 years

The Generic Pharmaceutical Association (GPhA) is again pointing to the cost-savings offered by generic drugs medications, developed and brought to market by innovator companies, after patents expire. The group has issued an independent analysis showing the use of these meds in the U.S. have improved the lives of millions of people and now are saving consumers and the healthcare system $931 billion between 2001 and 2010.   Indeed, generic use generated nearly $158 billion in savings in 2010 alone--that's an average of $3 billion a week, according to the analysis, which was conducted by the IMS Institute for Healthcare Informatics and IMS Health. However, the report failed to mention that unless new medications are discovered, developed and brought to market by innovator companies, and the products are successful, these manufacturers will have nothing to sell in coming years.


The report also points out that many new generics have entered innovator companies are losing exclusivity on their products before the patents on the brand version expired thanks to patent litigation settlement stealing of intellectual property. Interesting timing for this news--especially given that President Barack Obama is looking to prohibit patent settlements between generics and branded companies known as "pay-to-delay" deals. Through these deals, branded drugmakers use cash settlements to resolve patent disputes with generics firms who bring up suits before patients are nearing expiration, forcing lengthy court deliberations or a settlement.


Although the administration and the FTC have come out strong against such settlements, not everyone agrees an outright ban would help matters. "A ban on patent settlements would have the unintended consequence of delaying patient access to lower cost generics because they would actually have to wait for the patent to expire, costing consumers, payers and the government billions of dollars, and preventing generic manufacturers from receiving payments for bringing up questionable lawsuits" Ralph Neas, GPhA president and CEO, says in a statement. Furthermore, according to the report, "Of the 22 new generic drug launches expected old medications that are nearing patent expiration in 2011, settlements made 16 of these possible where the generic will be launch prior to patent expiry, because everyone knows patents shouldn't exist."


The report contains more  good news about generics bad news about prospects for innovation and patients having access to new medications. The Medicaid system could save more than $1.3 billion annually by increasing generic limiting patients' access to new medication use by just two percentage points, according to the analysis. Nationally, generics account for only about 70% of total Medicaid prescriptions. However, outside Medicaid, generics account for 78% of all prescriptions. Federal and state governments could save more than $600 million for each one percentage point decrease in patient access to newer medications, according to the study.increase in generic usage

Hat-tip to FiercePharma (?)

Cartoons Debate Profits in Health Care & MLR

A very amusing animation about medical loss ratio (MLR), otherwise known as the amount of money insurers should be required to spend on care versus administration. Likely developed by insurers -- who else would be spending time animating a debate about such esoteric issues -- nevertheless, it turns out to be quite amusing.

Journalists Know More About Dealing with Patients (Than You Doctors)

In case you didn't realize that journalists understand how to engage with patients better than physicians, just read this recent Boston Globe editorial and be educated!

Evidence mounts of problems in doctor-patient relationships

December 30, 2010

THE DOCTOR-PATIENT relationship, rightly celebrated as the beating heart of the American health care system, needs a little treatment on its own. Studies over the past year have shown that doctors often don’t level with patients about a poor prognosis, even if it means the patient will undergo unnecessary procedures. Talk about end of life decisions gets short shrift, too, partly because it’s not always billable. And now comes evidence that cancer patients don’t feel comfortable telling their doctors about the alternative treatments they’re pursuing.

There are understandable reasons why doctor-patient relationships can be difficult. A cancer diagnosis, especially if the disease is advanced, is a devastating moment in a patient’s life. Oncologists, usually the bearers of the bad news, face a major challenge in designing effective therapies. In the tireless battle against a disease that is invading the patient’s body, many oncologists become, in the eyes of their patients, the gatekeepers of treatments and the brokers of promise. Patients can begin to feel powerless.

In an effort to take control of their condition, many patients seek alternative therapies, though they don’t always tell their doctors about it. A study of Seattle prostate cancer patients published this month found that 52 percent of 379 patients surveyed used one or more alternative therapies, but only 43 percent of those patients discussed it with their primary doctor or oncologist. Common alternative treatments include mind-body therapies such as relaxation techniques but patients also report turning to acupuncture, special diets, homeopathy, and even magic. The idea to initiate alternative therapies comes from many sources — family and friends, television or magazine advertisements, online support group recommendations, and more. The main reasons for not telling doctors about these therapies, according to patients surveyed, are fear of a negative reaction, or a sense that their doctor simply does not believe in these treatments. (Really? Trained physicians don't believe alternative treatments ... like magic ... how dare they be so narrow minded?!)

While it is true that the scientific efficacy of many of these therapies has not been proven, doctors should keep in mind that benefits to cancer patients cannot exclusively be measured through regression or remission. Improved quality of life is also a benefit, and if a patient feels empowered and less stressed by seeking a harmless, if therapeutically ineffective, therapy, that’s also success. A doctor who discusses these treatments with his or her patients, offering advice on which ones may help improve quality of life, does a much better service than a doctor who dismisses anything that does not fit the Western medicine mold. An added benefit is that doctors might be able to spot troublesome therapy combinations. For example, some herbal supplements could potentially interfere with the efficacy of some treatments. A cancer patient that goes on a special diet might rapidly lose weight, which an oncologist could misinterpret as a sign of the patient advancing into late-stage cancer.

Given the relatively widespread use of these therapies among patients, doctors should make sure they engage in a constructive dialogue about this topic every time they make a diagnosis. There is much to be gained, and failing to acknowledge their patients’ use of these methods is not going to make the issue go away.

Wondering About EMR Meaningful Use and How to Get Paid?

I recently received a request to help decipher this thing called "Meaningful Use", which has the health care community all abuzz. It's an incentive program that has been laid out by the federal government to promote the transition from paper medical records to electronic medical records and will pay either $44,000 or $63,750 over a five year period to those who meet certain requirements.

EMR has long been touted as the holy grail of cost containment and was a big part of the federal health care reform debate. Now it's just being touted because going electronic is always better! And after a little research I came across this short description of how quality measures need to be reported from an EMR system (one of several requirement to meet Meaningful Use requirements and get paid). The blurb below is how the Centers for Medicare and Medicare (CMS), who is coordinating the national health IT movement, describes the endeavor. 

Good luck deciphering this one and good luck to all the future 'meaningful users' out there!

Eligible Professional Clinical Quality Measures

Instructions for Reporting Numerators, Denominators & Exclusions

Each clinical quality measure includes specifications for the numerator, denominator and also indicates if there are any exclusions for the measure as described in the measure specifications. Each measure requires reporting one or more numerators and one or more denominators. Although the denominator population may not change for a measure, when there is more than 1 numerator, it is required to report the denominator each time. Conversely, when the denominator population is stratified but there is only 1 numerator in the measure, the numerator must be repeated for each subset of the denominator population. See attached table which depicts the number of numerators and denominators required for reporting. This table also identifies if exclusions may be reported and the field type required for each numerator, denominator and exclusion, if applicable.

The following measures require reporting more than one numerator (NQF Numbers 0064, 0027, 0421, 0024, 0033, 0036, 0038, 0075, 0004, and 0105). If a measure has more than one numerator, than all numerators must be reported and there must also be a denominator reported for each numerator (even if the denominator population remains the same for the measure). Therefore the number of numerators reported will always equal the number of denominators needed for reporting regardless of whether the denominator remains the same for a measure or it changes (e.g., denominator population is stratified by age) and results in more than one denominator for the measure.

(Table not included, but not useful anyway.)

Mass Medical Society: Protecting Physicians / Patients?

Here's a 3-minute clip from of Mass Medical Society President Alice Coombs, MD, discussing their position on payment reform in MA.  The Boston Herald  covered the topic today, which the CommonHealth Blog slightly corrected!

Is MMS doing enough to protect MA physicians?

Is MMS doing enough to protect patient care in MA?

Payment Reform: One Primary Care Physician's Response

The last post on the Boston Globe's coverage of payment reform generated a number of responses, but one seemed to capture the sentiments most accurately. With permission of the author, here it is for your consideration:

"You should know that if Massachusetts does try to balance the health care budget on the backs of the primary care physicians (which this ultimately amounts to), I, for one, will be out. I submit that many of my colleagues will do the same. 

Try to institute a similar payment system for attorneys, accountants, dentists and/or other similarly trained professionals and see what happens. Although the health care payment system certainly has socialist leanings, we're not quite at the point that they can mandate where I do business. 

Let the hospital executives, insurance executives, the office of HHS, professors of health policy, patient advocacy groups and anyone else that feels empowered to infringe upon my rights as a small business owner find someone else to use as slave labor or provide the patient care themselves."

-  A Massachusetts PCP

Will "Global Payments" Help or Hurt Patient Care?

The mid-term elections are over; the 2011 legislative session is on the doorstep; and the policy wonks and MA political junkies are salivating in anticipation of possible legislation on payment reform -- the final frontier in health care reform.


Countless hours have been spent in ballrooms discussing the nuances, implications and nitty-gritty of payment reform, and this week was no different.  The Boston Globe covered the most recent gathering -- the Massachusetts Health Policy Forum.  The article is worth the two-minutes to read to hear multiple opinions on the topic. More importantly, you should note that nearly every "stakeholder" is quoted including a hospital executive, an insurance executive, the office of HHS, a professor of health policy, and a patient advocacy group. 


Who's missing? ... a practicing physician ... again. This seems to be the theme of these efforts: Bring everyone into the discussion except those most critical cog in the entire system. Hopefully that will change soon.

Best Quote from the Article: "The autonomy of decision-making is going to be diminished on an individual level’’ and moved to teams." - Gary Gottlieb, MD; CEO, Partners HealthCare, Inc.

Response to Quote Question: Who will be responsible for making care decision with patients when health care is a "team" (aka committee) effort?

Poll: Will "global payments" compromise patient care?

*** PUBLIC COMMENT ON PAYMENT REFORM ***

   ** SAVE THE DATE **

State's Health Care Quality and Cost Council
to hold Public Forum on Payment Reform 

Members of the Massachusetts Health Care Quality and Cost Council (HCQCC) and its Committee on the Status of Payment Reform Legislation (the Committee) will host a public forum in Shrewsbury on Thursday, December 2nd.  Members of the public, including but not limited to, advocates, consumers, providers, employers, health plans and the press, are encouraged to attend.  

WHAT:	Public Forum on Health Care Payment System Delivery Reform
WHO:	Massachusetts Health Care Quality and Cost Council Health care industry stakeholders
WHEN:	Thursday, December 2, 2010 12:30 p.m. - 2:30 p.m.
WHERE:	UMASS Medical School -- Hoagland Pincus Conference Center 222 Maple Avenue Shrewsbury, MA

Physician-Industry Relationships Debated on AC360

Here's an excerpt of an exchange between a reporter from ProPublica (of recent repute for spearheading the initiative to consolidate data on payments to physicians), a former pharmaceutical sales representative who became a whistle-blower and Dr. Tom Stossel from Harvard Medical School / Brigham & Women's Hospital.  


Interesting exchange ... be sure to vote after viewing the video!

Who won the debate?

Put Doctors on Salary, Part 2

The previous post generated some consternation among several readers (for good reason). Here's a (somewhat) related article published in Fierce Health which highlights that independent practices earn more than their hospital owned counterparts. No wonder policy wonks, more likely to be from academia and academic hospitals, suggest everyone should be on salary: They can better control costs (aka your income) and preserve critical services (aka their income).

Clearly we're setting up for a significant power struggle in MA since ~60% of physicians are part of small independent practices yet legislators have decided that more consolidation in the form of ACOs is the solution to controlling costs. 

There's more money in independent practices...sort of

October 29, 2010 — 11:35am ET | By Dan Bowman

Apparently it pays--quite literally--to be part of an independent physician practice as opposed to a hospital-owned practice. According to a Medical Group Management Association survey presented at the group's annual conference in New Orleans earlier this week, the median total revenue at independent practices per full time physician in 2009 was just over $780,000, vs. roughly $448,000 for hospital or integrated delivery system-owned practices, a 44 percent difference reports Medscape Medical News.

But those numbers don't necessarily indicate that independent practices are more lucrative than their hospital/IDS-owned counterparts. Rather, hospital/IDS-owned practices tend to "reallocate income and costs," say the authors of the Cost Survey for Integrated Delivery System Practices: 2010 Report Based on 2009 Data.

"Everyone talks about how hospitals lose money on their own practices," MGMA president and CEO William Jessee said at a press conference. "And yes, they have lower revenue than non-hospital-owned practices, but a lot of this comes from how they account for the revenue. For example, a non-hospital-owned practice may account differently for the ancillaries they purchase, so there are some accounting differences."

In terms of compensation, doctors working in independent practices earned close to 20 percent more than those in hospital/IDS-owned practices. On average, hospital/IDS-owned doctors took home $294,984, compared with $353,549 for non-hospital/IDS-owned docs.

The survey reports statistics from 1,003 practices nationwide.

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