Health Business Blog

Medicare’s Munchkin Mess

The “donut hole” is here. When the Medicare drug benefit was working its way through Congress, it was such a budget buster that legislators inserted a provision that leaves a gap in coverage: beneficiaries receive benefits until spending reaches $2250, then pay everything themselves until they’ve spent $3600, then receive generous benefits again above that point.

As yesterday’s New York Times points out, beneficiaries are now hitting the donut hole for the first time. Many are surprised. They either didn’t know about the donut hole, thought it started after out-of-pocket (as opposed to total) spending hit $2250, or thought it ended after total (as opposed to out-of-pocket) spending hit $3600. Others thought it was something from Dunkin Donuts.

Seniors are angry and confused. The issue may hurt Republicans, it is said. But let’s keep things in perspective. This non-means tested program for seniors is being subsidized by working people. Plenty of well-off oldsters are getting coverage while there is no equivalent subsidy for those below Medicare age.

Overall, I’m not sympathetic.

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Does anyone else think this is overkill?

From the Wall Street Journal:

Federal Bureau of Investigation agents raided the office of Bristol-Myers Squibb Co. Chief Executive Peter Dolan as part of a criminal investigation into an agreement the pharmaceutical company struck to delay the launch of a generic version of its best-selling drug…

FBI agents, working on behalf of the antitrust division of the Justice Department, showed up at Bristol-Myers’s Manhattan headquarters on Wednesday and left with batches of documents, a person familiar with the matter said.

It’s well known that big pharma has been using aggressive tactics to defang generic competition. Those tactics definitely include paying off generic players. From a public policy standpoint I don’t think that’s so great, but I’d rather see it dealt with through legislation than via PR-oriented busts. Do you really think it’s necessary to bust into BMS headquarters to search for paper documents in the CEO’s office? I don’t.

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A local waiting list

A friend took her one year-old daughter to the pediatrician yesterday. Baby is developing a little slower than normal and the pediatrician suggested having her evaluated for language development at Children’s Hospital in Boston. The mom told me she took the first available appointment –in mid-February, almost seven months away! Keep in mind this is an upper middle class family with private health insurance.

Maybe they should go to the UK or Canada to speed things up?

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Change of Shift #3 is up at Emergiblog

Check out Change of Shift: A Nursing Blog Carnival at Emergiblog.

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Never mind

Pfizer had planned to sell its new heart drug, torcetrapib only in combination with Lipitor as I mentioned last week (Should we share Pfizer’s optimism?) Pfizer complained it would be too expensive to develop the drug any other way. That explanation didn’t pass the straight face test, and now Pfizer has backtracked and will sell the pill as a standalone.

From today’s New York Times:

..Pfizer’s plan angered cardiologists, who said the company appeared to be putting its profits ahead of patients’ health. Not all patients can easily switch from one statin to another, and some patients cannot take statins at all. In June 2005, an article in The New England Journal of Medicine sharply criticized Pfizer’s strategy.

Besides complaints from doctors, Pfizer’s plan faced commercial and legal challenges. Some lawyers questioned whether offering torcetrapib only with Lipitor might violate antitrust laws. Meanwhile, Lipitor, though still the top-selling drug in the United States with sales last year of $7.4 billion, is losing market share to Zocor, whose price has plunged since it lost patent protection last month. As a result, Pfizer risked damaging torcetrapib by tying it to Lipitor, said Richard T. Evans, an analyst at Sanford C. Bernstein & Company.

Now Pfizer says it has changed its strategy.

Good thinking.

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Microsoft sniffs out health care

From the New York Times (Microsoft to Offer Health Care Software)

Microsoft plans to offer software tailored for the health care industry, a change from its usual strategy of encouraging others to create industry-specific products using its operating system and programming tools.

The company’Â’s first step, announced today is to purchase clinical health care software developed by doctors and researchers at a nonprofit hospital in Washington. Microsoft is also hiring two of the three doctors who created the software system and 40 members of the development team at Washington Hospital Center…

““This represents a change in our strategy,”” said Peter Neupert, Microsoft’Â’s vice president for health strategy. ““This is the start for Microsoft. We’re just getting started.”

It’s not hard to see why Microsoft is making this shift. In many industry segments, Microsoft’s market share is huge: 50 percent or more. In health care, it’s really low. With health care at 15 percent of the economy and growing fast it makes all the sense in the world for Microsoft to focus there.

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Don’t close the border just yet

As the Wall St. Journal points out (Who Will Care for U.S. Elderly If Border Closes?), there won’t be enough caregivers for baby boomers if immigration is tightened up as many demand. Not only that, but there won’t be enough people to pay into Medicare and Social Security either.

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How to use a laser to help a smoker quit

From the Wall St. Journal (Lasers to Help Smokers Quit):

A new wave of laser-therapy clinics say treatment with a painless low-intensity laser can help smokers quit. The clinics, which are springing up around the nation, say the laser is used on specific “energy” points of the body to stimulate feel-good hormones called endorphins and curb nicotine cravings.

The only downside? It doesn’t work.

But before we give up on lasers altogether, how about changing the protocol?

• Beaming the laser at the cigarette carton to cause it to ignite before the smoker can get to it
• Turing up the power setting and zapping the smoker in between the eyes whenever he lights up

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The fourth ingredient

FDA approved a new OTC sunscreen yesterday. Anthelios SX –that’s a marketing term meaning ‘use this product to increase your chances of having S[e]X on the beach with a Greek God’– protects against UVA and UVB. It has three active ingredients, including ecamsule, which is new to the market in the US. But despite the novelty of the product, FDA also said:

While this product provides protection from harmful UVA and UVB rays, FDA continues to recommend that in addition to using a sunscreen, consumers protect themselves from sun exposure by limiting time in the sun and wearing protective clothing.

Amen to that.

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Why do people with insurance overuse the Emergency Department?

When I posted recently that it looks like the uninsured aren’t to blame for ED overcrowding, Flea asked in the comments section why people with insurance overuse the ED. (FYI, Flea is really into this topic and even has a post about it today.) I don’t think anyone can really answer that question in a quantitative way, but here are some thought starters with real examples.

1. Patient goes to their doctor for something seemingly minor, then is told to go to the ED. Example: a mother takes her seven year old son to the doc for a cut, expecting the pediatrician can stitch it up, but is sent to the ED. Next time she’ll head straight for the ED.
2. Patient lacks a good relationship with PCP despite having insurance and doesn’t feel comfortable making contact for the first time on an emergent issue. Example: healthy woman who’s recently finished having kids has a PCP selected for HMO registration purposes but hasn’t seen the doc in years and the issue isn’t appropriate for her OB/Gyn. Off to the ED she goes.
3. Problem occurs outside of business hours; patient’s own doc is not on call or hard to reach. Real or perceived barriers to communication are high. Example: A house guest dies of meningitis two days after departure. Parents are worried about whether their kids need to start therapy. Time is of the essence and the on-call pediatrician doesn’t call back right away. Hello, ED.
4. A minor issue escalates over time into something major and by then the ED is the only realistic solution. Example: Older man with mild/moderate chronic conditions has flu-like symptoms during the week but doesn’t want to bother his doctor. Condition worsens over the weekend, wife gets nervous and makes him go to the ED.

I could go on, but those are some of the reasons I see. In another post I’ll talk about some possible solutions.

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