DOCTOR PUNDIT

CDC’s Message of Prevention of Infection Remains Consistent

Michael Douglas, MD, MBA — Tue, 09 Mar 2010 14:36:06 +0000

The questions and lingering concerns surrounding the overuse of antibiotics is an age-old and well-worn conundrum for physicians and patients. Even the latter group, well-informed as consumers of healthcare, can agree that most acute upper respiratory infections are most often the result of viral infestations which play themselves out in spite of antimicrobial treatment.The decision to (over)use them in standard medical practice is often the point of debate, as physicians weigh factors such as patient satisfaction and lingering medical and health policy issues surrounding resistance.

Last year, this blog reported on these issues as background for a program in which some retail pharmacy chains were giving away for free antibiotics to patients with prescriptions from their physicians as a way of helping with affordability in the wake of the debate on reform. The CDC offered a statement promoting the responsibilities providers, pharmacists, and patients should consider in taking part in such a program.

Smaller chain pharmacies are trying to compete with the big boys, and in trying to earn store-brand loyalty among their (un- and underinsured) consumers, they are throwing free antiobiotics their way. Last week, the CDC sent out letters those several chain pharmacies that offer no-cost prescription antibiotics to low-income consumers urging them to promote responsible use of antibiotics.

While the program was essentially successful in its efforts to bridge the gap between affordable, accessible healthcare and patient responsibility, no one was really prepared for the massive policy decisions that would have to be made as the June ‘09 H1N1 pandemic loomed — after its initial discovery just one month after this initial Doctor Pundit posting.

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Citing Insurers’ Rate Hikes, Obama Takes Message for Reform to Public Again

Michael Douglas, MD, MBA — Mon, 08 Mar 2010 16:55:04 +0000

Any momentum gained by President Obama when the issue of exorbitant insurance premium hikes was the healthcare topic du jour last month seems to be all but forgotten as Insurance continues to conduct business as usual. In Mass., the Blues in that state face fighting caps on their rates as its governor, Duval Patrick, reviews requests for increases of anywhere from 8 to 32 percent.

In California, the apparent epicenter of the firestorm over rate hikes, insurance companies seem loathe to change as well, citing the “increasing costs of healthcare” as a reason for those hikes. All of this movement by Insurance is forcing Obama to take his message to the public to get support for reform. He’ll begin his week by doing so today in Philadelphia.

Wise move? It’s perhaps his only move. With the GOP urging going back to the drawingboard, moderate Dems uneasy over the pricetag of reform ($1T), and House liberal Dems suspicious of Senate motives once the bill is passed; it appears that Obama is turning to the only group left to fully convince the utility of a healthcare overhaul — the American people. | LINK

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MN Social Healthcare Delivery Program Spared Governor’s Veto

Michael Douglas, MD, MBA — Mon, 08 Mar 2010 11:34:56 +0000

It had all the trappings of a political football; a blue state’s extremely unpopular Republican governor — looking toward a possible presidential run a year after his term ends — used his partisan hardline to threaten veto of one of the most well-funded social programs for healthcare delivery to the state’s working impoverished, all the while setting the stage for a political attack on his character for all of the nation to see at the hands of the opposing party. The apparent newfound conciliatory stance taken by Minnesota governor and 2012 prez hopeful Tim Pawlenty concerning the threatened veto of GAMC headed this scenario at the pass, however, as the healthcare delivery safety net for thousands of the state’s working poor got a last-minute reprieve to continue being funded, albeit scaled back. Of course the negative PR surrounding a pending lawsuit by three beneficiaries of the program didn’t make eating crow any easier for the chief executive.

Though funding for the program was supposed to end on April Fools Day, the brokered change in funding commitment means that service providers will see less in reimbursements. Also,

[u]nder the agreement, hospitals will receive $71 million from the state’s general fund for the year starting July 1 and $131 million the following year. About 12 to 15 hospitals likely can start serving patients in the new program on June 1. For others not yet ready, $20 million will be set aside to pay for uncompensated care for six months.

The key is in acute care — often the first and only mode by which this underserved patient population will continue to receive care. With a decrease in monies to provide it — even with a grace period of sorts for charity care — the level of participation of acute hospitals is emblematic of both ongoing problems with funding (providing care) and simply surviving as they continue to operate in a program whose demand will only increase until reform is achieved on the national stage. | LINK

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Obama Signs Bill Delaying Medicare Payment Cuts to Physicians until April 1

Michael Douglas, MD, MBA — Thu, 04 Mar 2010 14:37:43 +0000

Physicians — especially those of the primary care type — are spared the potential problems that come with cuts in Medicare payments. At least for another month. President Obama has delayed the anticipated 21% cut in reimbursements while Congress has to take the matter up yet again.

Sen. Jim Bunning (R-KY) created a legislative frenzy last week when he placed a procedural hold on the bill that would have extended health care benefits to the unemployed for an additional length of time. That measure would have also allowed taxpayer subsidies to be used for premiums. Bunning relinquished his standoff yesterday, allowing this extension on cuts in payments to be avoided for another 30 days.

Polling, as a result, shows just how far cuts in Medicare payments to providers and provider organizations will go in threatening care delivery to a huge segment of the chronic care patient population — the same demographic responsible for the heaviest utilization of pharma, primary care, and acute care. Approximately two-thirds of primary care physicians polled by Medscape said they would cease to care for Medicare beneficiaries as a result of the cut.

An extension only holds off the inevitable, and although Senate Democrats are looking for ways to delay cuts further, there has to be a day of reckoning. That could come October 1, if senate legislators work to pass another bill [PDF] and try to reverse the SGR formula [PDF], which is responsible to establishing pay cut schedules in Medicare provider reimbursements.

With reform, the current band-aid strategy the Obama administration is using continues on its sloppy course.

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New Dementia Drug in Development Fails Initial Study

Michael Douglas, MD, MBA — Thu, 04 Mar 2010 14:16:55 +0000

Pfizer’s current research on a potential blockbuster anti-Alzheimer drug is currently back to drawing-board status. According to the pharma company

[T]he drug, called Dimebon, had shown virtually no effect after six months in treating the cognitive decline or behavioral problems associated with Alzheimer’s when compared with a placebo.

Apparently, Wall Street has been watching the results of this Phase I study; the verdict is still out on whether Pfizer will continue to fund the research for this agent — designed to work better and longer at inhibiting some of the most distressing symptoms related to the disease. | LINK

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Study: Lower Initial Hospital Costs of Care Are Not Necessarily Associated with Poorer Patient Outcomes

Michael Douglas, MD, MBA — Mon, 01 Mar 2010 14:45:46 +0000

Does the higher cost of providing care actually mean better care? In more fiscally flush times, the knee-jerk among patients and providers would probably be a nod toward the affirmative. Today, in the wake of a reform fight which has placed front and center the once-mundane issue of healthcare delivery previously reserved for ivory tower wonkish types; this issue is as bread-and-butter essential to the American public as, say, enormous property tax increases.

Researchers, studying over 3000 hospitals over a two year period (2004-2006), put this question to the test when they compared Medicare beneficiaries who were treated for pneumonia and heart failure. Those treated for the latter condition at “lower-cost” hospitals fared better^[1] chronically with this diagnosis than those treated for the former — essentially calling into question the hypothesis that low-cost hospitals discharge patients earlier but have higher readmission rates (for certain diagnoses) and greater subsequent inpatient care costs. The implications of this trial — no major differences in outcomes between hospitals with longer patient stays and shorter ones — could be far-reaching when setting policy on Medicare reimbursements for acute patient care. | LINK (Study abstract only)

using 30-day mortality rates, readmission and six-month costs of inpatient care among two of the most common Medicare-covered inpatient diagnoses

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March Brings New Perspectives on Fight for Reform

Michael Douglas, MD, MBA — Mon, 01 Mar 2010 14:15:32 +0000

House Speaker Pelosi says she is confident that healthcare reform will pass. This, apparently, is the major mode of thought coming from the Democrats as a result of the flurry of activity and speculation filling the Sunday morning talkfests yesterday. Relying on the sheer numbers of votes in her party, the pronouncement comes a few days ahead of President Obama’s announcement later this week of how he’ll proceed on reform.

Votes are one thing, but how those votes will be cast is quite another — and in the Beltway, perception is everything. The GOP is ready to counter any move by the Dems with criticism they hope to ride all the way to November. If it’s getting the bill through reconciliation (to avoid a filibuster)^[1] or starting over from “scratch” — the GOP’s version of a legislative “gotcha” directed toward Obama — the Democrats seem to be playing a risky game with the nation closely divided on the reform bill as it stands today.

Spring break in Congress occurs on 3/26. Will things be wrapped up by them? Will the long road to reform end with votes to secure a bill, any bill? Or will it come down to reconciliation as the line in the sand: for the Dems, it means passing a bill to expand Medicaid, require employer-sponsored coverage, and require people to have coverage; for the GOP, it means fighting against reconciliation and turning Obama’s push for reform into a protracted referendum on the balance of power in Congress come November. | LINK

The House would pass the health bill approved in December by the Senate, and both chambers would approve changes, separately.

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Health Reform Summit: Cooperation or Grandstanding?

Michael Douglas, MD, MBA — Fri, 26 Feb 2010 14:33:36 +0000

President Obama’s healthcare summit has come and gone. The mere fact that this meeting took place in front of cameras was reason enough to discount any potential for real bipartisanship to occur. The upshot? The Republicans stand firm on their ground to rally against any Obama proposal as the party brands itself on this issue ahead of a potentially gratifying November midterm.

Meanwhile, the White House and the Democrats will say that every effort is being made to “forge ahead” amid the apparent obstructionist natures of the GOP. The problem for both parties is that the American public is becoming tired of what it sees as a spectacle. According to a CNN poll [PDF], 86 percent felt that government is broken, with 14 percent saying it isn’t. Of that 86 percent, 81 percent say the government can be fixed, with 5 percent saying it’s beyond repair.

Whatever the ultimate effect this televised meeting had on patients, lawmakers, physicians, insurance companies, and other interested parties; one thing’s for certain: closed-door meetings are the only way anything can get done. Political theater for the world to see accomplishes nothing but shallow grandiosity on the bumpy road to an ultimate reform bill. | LINK

RELATED: The GOP’s proposals. | LINK

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Pharma Company Goes on the Defensive Amid New Avandia Attacks

Michael Douglas, MD, MBA — Fri, 26 Feb 2010 14:05:12 +0000

A safety review of GSK’s Avandia, under fire and intense scrutiny for its role in the possible development of cardiac adverse effects is nearing completion. In spite of the continued negative press, the pharma company has issued a thirty page rebuttal [PDF] of the Senate Finance Committee’s report alleging those safety issues.

The pharma company faces an uphill battle. In the wake of 24-hour, always on news cycles which seemingly filter only stories of negative sensationalism, it should be taking its damage control cues from Toyota these days.

Among the report’s most “glaring omissions” is its lack of discussion about the final results of the ADOPT, DREAM, or RECORD trials, the company said in a release. It said data from these three trials were reviewed by an FDA advisory committee in 2007 that voted overwhelmingly to keep rosiglitazone on the market.

Perhaps, but the issue now is that GSK chose to keep this information from the meta analysis of these trials from prescribers and patients, according to the Cleveland clinic physician responsible for bringing this data to the forefront. | LINK

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Obama’s Reform Summit Begins Amid Hype

Michael Douglas, MD, MBA — Thu, 25 Feb 2010 14:11:39 +0000

Ready…set…yawn? With all of the fanfare surrounding this morning’s healthcare reform summit in Washington, you’d think that its organizers were pulling double duty with producing the upcoming Oscars. We’ve heard the eleventh hour rhetoric from all sides — the potential for bipartisanship at this late stage in the game and how “wonderful” it is to get this forum televised so that the American people can finally acknowledge the transparency President Obama and the White House have always wanted to characterize since he came into power.

But with all of the pomp, circumstance, and…hyperbole surrounding this morning’s summit, it seems the prevailing thought is more of a, well, an afterthought. Although Barack Obama has trumpeted the bipartisan get-together as having the potential to hammer out a last minute deal that will please everyone everywhere, the public seems to have already made up its mind about the state of reform today — and the court of public opinion shows collective ennui over the multiple set-ups for multiple letdowns. Reform fatigue has finally set in.

When the ultimate news item from today’s marathon session will more than likely echo the fact that nothing can be agreed upon of any substance, the public whom Obama so much wanted to convince that reform was within reach has already packed up and moved on. According to one private Medicare exchange’s polling, approximately 1700 of them have already done so. Mr. President, let the latest installment of this drama begin.

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