Category: Health Care Access

To Be Governed

elderly-man-worriedA long list of services do qualify as preventive care under the Affordable Care Act, including vaccinations and screenings for diabetes, depression, high blood pressure, high cholesterol and several cancers. Most insurers will cover one such preventive visit per year with no charge to the patient.

But care related to existing health problems, or new issues, is considered “evaluation and monitoring,” not preventive…

Some offices now ask patients to schedule separate annual visits — one for preventive care (with no out-of-pocket cost) and one to discuss problems (with the usual deductible and copay). Medicare also encourages preventive care with its annual free “wellness” visits. But when elderly patients learn they can’t bring up ongoing health issues at such a visit without being charged, many don’t bother, doctors say. (WSJ)

Being Uninsured is Better than Being on Medicaid to Get a Doctor’s Appointment

doc-with-patientPosing as patients, researchers made almost 13,000 calls to doctors’ offices in ten states, seeking appointments for a variety of ailments. For those posing as privately insured patients, they got appointments 85 percent of the time. For those posing as patients on Medicaid, they only got appointments 58 percent of the time. Researchers also posed as uninsured patients who were willing to pay in full at the time of the appointment.

The result? 78 percent were successful (for appointments costing more than $75) — 36 percent better than those posing as Medicaid patients and quite close to those posing as privately insured.

A Mom with a Samsung Smartphone Can Get Her Kids’ Ear & Nose Infections Diagnosed From Home

In the mountains of rural Taiwan, researchers stuck a $50 attachment to a Samsung smartphone that individuals can use at home to take images inside the nose or ear. When those images were transmitted to physicians’ offices, the physicians diagnosed with complete accuracy.

“Overtreatment of ear infections with antibiotics in preschoolers may cause antibiotic resistance and has caused millions of unnecessary visits and prescriptions for antibiotics in the United States,” they write. “…The smartphone-based otorhinoendoscope has the potential to change the doctor’s practice patterns of over utilizing antibiotics for ear infections. Currently, otolaryngologists can wait to see if a child’s infection improves or if antibiotic treatment is warranted after the series of clinical images are obtained from parents.” (More)

Why Do Terminally Ill Patients Have to Ask for Permission to Take a Live-Saving Drug?

Idiopathic pulmonary fibrosis is the scarring of lung tissue over time with no known cause, cure or approved therapy. Patients survive on average for only two to five years after diagnosis, and about 40,000 die of fibrosis-induced respiratory failure every year — roughly the same number as from breast cancer.

A drug called pirfenidone has been shown to delay the decline in lung function and even prolong life. But the FDA refused to approve pirfenidone when it was last reviewed in 2010 because the regulators claimed the evidence was insufficient, and now a new clinical trial shows how careless that decision really was. (WSJ)

Study: Drug Insurance Reduces the Cost of Other Therapies

Results indicate that obtaining prescription drug insurance through Medicare Part D was associated with an 8% decrease in the number of hospital admissions, a 7% decrease in Medicare expenditures, and a 12% decrease in total resource use. Gaining prescription drug insurance through Medicare Part D was not significantly associated with mortality. (NBER)

Waiting List Too Long? Destroy the Records

document-shredding-and-information-destructionPatrick Howley of the Daily Caller reports that Department of Veterans Affairs employees destroyed medical files in a “systematic attempt to eliminate backlogged veteran medical exam requests.” Oliver Mitchell, a former patient services assistant in the VA Greater Los Angeles Medical Center said that the center got about 3,000 requests a month for exams but only had the resources to do 800. Because waiting lists counted against a hospital’s efficiency report, officials began discussing how to make their waiting list look better by destroying records.

ObamaCare Plan Refuses to Cover Cancer Patient Treatment

[S]he bought [a] plan and was approved on Nov. 22. Because by January the plan was still not showing up on her online Humana account, however, she repeatedly called to confirm that it was active. The agents told her not to worry, she was definitely covered.

Then on Feb. 12, just before going into (yet another) surgery, she was informed by Humana that it would not, in fact, cover her Sandostatin, or other cancer-related medications. The cost of the Sandostatin alone, since Jan. 1, was $14,000, and the company was refusing to pay. (WSJ)

A Doctor Describes How She is Adjusting to the New Billing Code

This is Patricia McLaughlin:

Surprise! A chain of unexpected expenses flows from the “simple” ICD-10 change depending upon your billing program company.

icd-10-readyMy billing program was MediSoft Version 17 (a McKesson product). Version 19 (still running into new program glitches) is the one needed for ICD-10. The conversion from Version 17 to 18 took place AFTER we had to purchase 7 new CPUs and 2 new servers. Then a top notch IT team was hired to network everything and found that the new Microsoft Word required several other office programs to change. More expense! The computerized medical record we use was written privately 15 years ago by an ophthalmologist for ophthalmologists. Unfortunately, it never reached a national market and folded. We still like the program (compared to others on the market) and thus needed to locate one of the original programmers to have him do whatever was necessary to allow it to run with the new Word. More dollars flying out! Still waiting patiently for the green light to suffer again through the billing upgrade from MediSoft Version 18 to 19 (once other guinea pigs uncover the glitches of the new program…I’ve had more than my fill, thank you…took me 2 years to force BCBS to pay for over 30 claims lost in cyberspace during the “required” 5010 conversion a few years back)

Besides the software/hardware expense, this all takes time, research, and a great IT team. TIME is the most important component. This ICD-10 conversion is NOT something that will work for procrastinators. All the vendors selling these upgrades are expecting to be overworked at the last minute. Their employees are a limited resource.

I hope this is delayed and would hate like hell to have lost $38,000.00 for all the work done so far to get ready…

FDA Regulations Kill

Paul Howard and Yevgeniy Feyman in Health Affairs:

Meningitis is a terrible disease that can kill its victims in a single day. About 4,100 new cases are diagnosed annually in the U.S., with a mortality rate of more than 10 percent. Even with treatment, survivors are often left with serious side effects that can include brain damage and limb loss…

Swiss drug manufacturer Novartis has developed a vaccine — Bexsero — that specifically targets this strain of meningitis; the drug has already been approved for use by the European Medicines Agency (EMA), the European Union’s equivalent of the Food and Drug Administration (FDA). And within about nine months the FDA allowed Princeton University to offer the vaccine on campus to its students.

But the drug is not available elsewhere in the U.S. And it won’t be until Novartis completes a costly phase III trial. The authors ask:

The natural question to ask is why the FDA shouldn’t just approve a product already approved for the European Union, Canada, and Australia, while monitoring the vaccine (as all vaccines are already monitored — Bexsero is being actively monitored in the E.U.) through postmarket surveillance records? (Indeed, the more than 5,000 patients vaccinated at Princeton are close to the total number of patients tested in the EMA required trials.)

Open Source Comes to Drug Development

It took NIH Director Francis Collins more than two years to wrangle the industry into cooperating. They brought in consultants to structure the $230 million project, which will be jointly funded by companies and the government; several companies and one mental disorder — schizophrenia — fell by the wayside in the process. It ended up being a remarkable arrangement for a sector that’s long been fiercely competitive, jealously guarding its intellectual property against would-be copycats: All the results they come up with will be open source. At the end of the project, which should lock in a basic understanding of how the diseases work, they’ll race to bring new drugs to market as fast as possible. (Lydia DePillis)