Author: Admin

Pharma Sales Growth Tied to Price Hikes

Of the roughly $23.3 billion in sales growth seen by 45 top pharmaceutical products, $14.3 billion of that has been tied to price increases, not demand.

61% of the pharma industry’s recent sales growth was apparently, at least in part, a byproduct of price increases on top-selling drugs, according to a new report from investment firm Leerink.

From 2014 through 2017, sales for 45 top pharmaceutical products, including AbbVie’s Humira, Amgen’s Neulasta and Enbrel, and Pfizer’s Lyrica, increased by 28% (roughly $23.3 billion) in the United States. However, more than $14.3 billion of those sales was the result of price increases.

Continued price hikes from pharma companies have faced backlash and much scrutiny in recent years, including at the government level, with the Trump Administration releasing a plan to tackle the rising costs in May.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

PT Supported Opioid Bill Ready for President’s Signature

Landmark legislation to fight the opioid epidemic, supported by the APTA, is headed to the President’s desk to be signed into law.

Last week, the U.S. Senate passed legislation that aims to combat the staggering opioid epidemic that has been impacting this country at an alarming rate by a 98-1 margin, and it will now head to the White House for Donald Trump’s signature, making it law.

Being hailed as “landmark” legislation by Senate Majority Leader Mitch McConnell, it includes provisions aimed at promoting research to find alternative, less addictive medications for pain management, as well as covering treatment for opioid addiction and use disorder, and efforts to prevent foreign shipments of illegal opioids.

The legislation is supported by the APTA, as well as scores of physical therapists. “The bill now on its way to the White House represents a significant step in the right direction,” APTA congressional affairs senior specialist, Kristina Weger, is quoted as saying. “But there’s much more work to be done—there are many provisions that direct agencies to begin reviews and studies on potential changes that we may not see for years. We need to continue our advocacy and outreach to help fight this crisis.”

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

How to Ask for Referrals Without Freaking Out

Asking for referrals is a necessity to grow your practice and make it thrive, but some therapists are uncomfortable doing so.

from Evidence in Motion

Some therapists may have a little anxiety or feel uncomfortable about asking for referrals in an effort to grow their practice. However, as your practice needs clients to thrive, asking for referrals is a necessary evil. Learn how to do it right in this handy breakdown of three principles that work from Evidence in Motion.

Read More →

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Congress Bans Pharmacist ‘Gag Orders’ On Drug Prices

Pharmacists will no longer have to keep it a secret when the cash price for a prescription is less than what someone would pay using their insurance plan.

By Susan Jaffe

For years, most pharmacists couldn’t give customers even a clue about an easy way to save money on prescription drugs. But the restraints are coming off.

When the cash price for a prescription is less than what you would pay using your insurance plan, pharmacists will no longer have to keep that a secret.

President Donald Trump was expected to sign two bills Wednesday that ban “gag order” clauses in contracts between pharmacies and insurance companies or pharmacy benefit managers — those firms that negotiate prices for employers and insurers with drugstores and drugmakers. Such provisions prohibit pharmacists from telling customers when they can save money by paying the pharmacy’s lower cash price instead of the price negotiated by their insurance plan.

The bills — one for Medicare and Medicare Advantage beneficiaries and another for commercial employer-based and individual policies— were passed by Congress in nearly unanimous votes last month. A spokesman for Sen. Susan Collins (R-Maine) said her office had been told the president would sign the bills Wednesday. The White House declined to comment.

“Americans deserve to know the lowest drug price at their pharmacy, but ‘gag clauses’ prevent your pharmacist from telling you!” Trump wrote on Twitter three weeks ago, shortly before the Senate voted on the bills. “I support legislation that will remove gag clauses.” The change was one of the proposals included in Trump’s blueprint to cut prescription drug prices issued in May.

Ronna Hauser, vice president of payment policy and regulatory affairs at the National Community Pharmacists Association, said many members of her group “say a pharmacy benefit manager will call them with a warning if they are telling patients it’s less expensive” without insurance. She said pharmacists could be fined for violating their contracts and even dropped from insurance networks.

According to research published in JAMA in March, people with Medicare Part D drug insurance overpaid for prescriptions by $135 million in 2013. Copayments in those plans were higher than the cash price for nearly 1 in 4 drugs purchased in 2013. For 12 of the 20 most commonly prescribed drugs, patients overpaid by more than 33 percent.

Yet some critics say eliminating gag orders doesn’t address the causes of high drug prices. “As a country, we’re spending about $450 billion on prescription drugs annually,” said Steven Knievel, who works on drug price issues for Public Citizen, a consumer advocacy group. The modest savings gained by paying the cash price “is far short of what needs to happen to actually deliver the relief people need.”

After the president signs the legislation affecting commercial insurance contracts, gag order provisions will immediately be prohibited, said a spokesman for Collins, who co-authored the bill. The bill affecting Medicare beneficiaries wouldn’t take effect until Jan. 1, 2020.

But there’s a catch: Under the new legislation, pharmacists will not be required to tell patients about the lower cost option. If they don’t, it’s up to the customer to ask.

The Pharmaceutical Care Management Association, a trade group representing pharmacy benefit managers, said gag orders are increasingly rare. The association supported the legislation. Some insurers have also said their contracts don’t include these provisions. Yet two members of Congress have encountered them at the pharmacy counter.

At a hearing on the gag order ban, Collins said she watched a couple leave a Bangor, Maine, pharmacy without their prescription because they couldn’t afford the $111 copayment and the pharmacist did not advise them about saving money by paying directly for the medicine. When she asked him how often that happens, he said every day.

“Banning gag clauses will make it easier for more Americans to afford their prescription drugs because pharmacists will be able to proactively notify consumers if a less expensive option may be available,” she said last week.

When Rep. Debbie Dingell (D-Mich.) went to a Michigan pharmacy to pick up a prescription recently, she was told it would cost $1,300. “After you peeled me off the ceiling, I called the doctor and screamed and talked to the pharmacist,” she recalled during a hearing last month. “I’m much more aggressive than many in asking questions,” she admitted, and ended up saving $1,260 after she learned she could get an equivalent drug for $40.

While the legislation removes gag orders, it doesn’t address how patients who pay the cash price outside their insurance plan can apply that expense toward meeting their policy’s deductible.

But for Medicare beneficiaries there is a little-known rule — not found in the “Medicare & You” handbook or on its website —that helps people with Medicare Part D or Medicare Advantage coverage. If they pay the lower cash price for a covered drug at a pharmacy that participates in their insurance plan and then submit the proper documentation to their plan, insurers must count it toward patients’ out-of-pocket expenses.

The total of those expenses are important because that amount affects the drug coverage gap commonly called the “doughnut hole.” (This year, the gap begins after the plan and beneficiary spend $3,750 and ends once the beneficiary has spent a total of $5,000.)

And beneficiaries don’t have to wait until the gag order ban takes effect in two years.

The Medicare rule also says that if a senior asks about a lower price for a prescription, the pharmacist can answer.

Rep. Buddy Carter (R-Ga.), a pharmacist who sponsored the Medicare gag order bill, said he wasn’t surprised by the bipartisan support for the legislation. “High prescription drug costs affect everyone,” he said.

KHN’s coverage of prescription drug development, costs and pricing is supported in part by the Laura and John Arnold Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation which is not affiliated with Kaiser Permanente.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Healthcare Continues Adding Jobs; Unemployment Hits 49 Year Low

The unemployment rate is at a 49 year low, and healthcare’s steady and consistent job growth is one factor as to why.

Healthcare added 26,000 jobs in September, including 12,000 in hospitals, 10,300 in ambulatory care, and 3,400 in nursing care facilities, according to numbers released by the U.S. Bureau of Labor Statistics on Friday.

The constant and steady growth of jobs in the healthcare sector has contributed to what is now the lowest unemployment rate (3.7%) in 49 years.

Over the year, healthcare has added 302,000 jobs.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Nursing Jobs, Cost of Living, & Where to Hang Your Hat

Making decisions about your work-style and lifestyle can be fraught with anxiety and concern about the future—let’s unpack that conundrum.

From Nurse Keith’s Digital Doorway

In my work as a career coach for nurses and healthcare professionals, I frequently witness those who work in nursing struggling with decisions related to finding work and the relative cost of living in terms of where they live or where they might move.

Making decisions about your work-style and lifestyle can be fraught with anxiety and concern about the future — let’s unpack that conundrum.

Workstyle and Lifestyle

Figuring out where to live and work can be a difficult choice. On the one hand, you want to earn up to your potential and receive the highest possible wage according to your level of experience and expertise. On the other hand, the highest salaries are generally in large popular metropolitan areas where the cost of living is through the roof and the relatively high salary will just barely (if at all) make up the difference when compared to more moderately priced cities or towns.

A single working professional may have much more freedom of movement than one who is married, but finding a way to afford single life in more expensive areas can be a challenge.

Choosing a new domicile becomes even more complicated when children are in the picture. Whereas a single person may simply look at nightlife, cultural amenities, cost of living, safety, etc, the nursing professional with children must also consider school quality and everything that comes with the needs of growing children.

Choosing an underserved rural area may offer a quiet place to live and low cost of living for someone who loves the outdoors, but for a nurse with a regular habit of going out to movies, theater, and other nightlife activities, the flip side will be discovering how to have those amenities in the city without breaking the bank.

Your chosen lifestyle and workstyle need to be fairly aligned; if you have a spouse and kids, these decisions are more complex but not impossible to overcome. And while work can sometimes take up a third or more of your life, it can’t always be the sole factor that determines where you rest your head at night.

The Best Places to Live

Here in the United States, there is a wide diversity of choices related to climate, safety, way of life, economics, diversity, educational opportunities, housing costs, crime, and culture. And we all know that one person’s paradise can be another’s purgatory.

Money Magazine and Realtor.com crunched the numbers for 2018, creating a list of the 50 best places to live in the United States. The communities were examined using a methodology that looked at areas with populations over 50,000; the rankings were compiled based on the examination of over 70 types of data, including those mentioned in the preceding paragraph.

Somewhat surprisingly (or not), the 50 winners aren’t all household names like San Francisco, Boulder, or Dallas. Here are the top 10:

  1. Frisco, Texas
  2. Ashburn, Virginia
  3. Carmel, Indiana
  4. Ellicott City, Maryland
  5. Cary, North Carolina
  6. Franklin, Tennessee
  7. Dublin, California
  8. Highlands Ranch, Colorado
  9. Sammamish, Washington
  10. Woodbury, Minnesota

Two small cities within the metropolitan halo of Boston made the cut: Newton and Brookline. In relation to the New York City region, only Union and Parsipanny/Troy Hills, NJ were on the list. Near Atlanta, we find the suburb of Alpharetta as a highly prized location (my mother lived there very happily in the last few years of her life). And the only selections in the entire state of California are Dublin, a city of 60,000 located 30 miles east of Oakland, and Eastvale, a city an hour east of downtown LA. Sorry, Hawaii and Alaska — you didn’t even make the top 50.

Anyway, here’s Money Magazine’s list of the best places to live in each state.

We can’t entirely live our lives according to the results from this kind of research, but such information can serve as a jumping off point for further exploration and can support us in doing our due diligence and making prudent choices.

Now For the Jobs per U.S. News

When considering relocation and where to settle down, other tools also come in handy. U.S. News & World Report’s “The 25 Best Jobs of 2018” can help us to piece the puzzle together. While software developer clinched the #1 spot for 2018, rest assured that healthcare jobs dominate the list, with the following health-related careers making appearances:

#2: Dentist
#3: Physician Assistant
#4: Nurse Practitioner
#5: Orthodontist
#7: Pediatrician
#8: A tie between Obstetrician/Gynecologist; Oral and Maxillofacial Surgeon; & Physician
#11: Occupational Therapist
#12: Physical Therapist
#13: A tie between Anesthesiologist & Surgeon
#15: Psychiatrist
#16: Prosthodontist
#17: Dental Hygienist
#18: Registered Nurse
#20: Physical Therapy Assistant
#21: Respiratory Therapist
#22: Nurse Anesthetist
#23: Optometrist

If you’re thinking of switching out of healthcare entirely, see the list for the details, but rest assured that you’d do well as an actuary, marketing manager, statistician, or mathematician.

If you’re wondering about the difference between NPs, nurse anesthetists, and RNs, look no further:

Nurse Anesthetist
Median salary: $160,270
Unemployment rate: 2.7 percent

Nurse Practitioner
Median salary: $100,910
Unemployment rate: 0.7 percent

Registered Nurse
Median salary: $68,450
Unemployment rate: 1.2 percent

One thing we have no reliable data on is how much nurses are earning when they reach the PhD or DNP level, so the operative question remains whether pursuing those terminal nursing degrees repay the earnest (and highly indebted) nurse with high salaries and low unemployment.

Similarly, the Bureau of Labor Statistics also does nothing to parse these differences either. Don’t get me wrong, BLS data is a useful resource but doesn’t give us the full breakdown we truly need (likely because those BLS folks have no idea what a DNP is, and it’s even less likely that they even know what DNPs are capable of.)

The 25 Best Nursing Jobs

According to an article posted on TopRNtoBSN.com, nursing jobs of course have their own hierarchy of popularity and career mojo. Unfortunately, no methodology is shared, thus we’re left in the dark as to how they arrived at these conclusions. While the only hard statistics we’re given are median salaries, the list includes:

  1. Ambulatory Care Nurse
  2. Camp Nurse
  3. Case Management Nurse
  4. Correctional Nurse
  5. Flight Nurse
  6. Forensic Nurse
  7. Home Health Nurse
  8. Hospice Nurse
  9. Informatics Nurse
  10. IV Therapy Nurse
  11. International Nurse
  12. Long-Term Care Nurse
  13. Medical Supplies or Pharmaceutical Rep
  14. Nurse Advocate
  15. Nurse Educator
  16. Nurse Manager
  17. Nurse Researcher
  18. Psychiatric Nurse
  19. Public Health Nurse
  20. School Nurse
  21. Substance Abuse Nurse
  22. Telephone Triage Nurse
  23. Transplant Nurse
  24. Travel Nurse
  25. Wound, Ostomy, & Continence Nurse

You likely already noticed that many of the listed nursing jobs are removed from acute care, demonstrating to curious nurses that there is indeed life beyond the hospital (I’ve known this for decades, myself, but so many nurses seem unaware that any potential for work exists outside of the hospital milieu. Don’t get me started about those who say real nurses only work in hospitals!).

And remember that nurse entrepreneurs and other outside-the-box nurses (like myself) never get air time on mainstream healthcare and career websites.

Choose Your Own Adventure

Nursing offers varying entry points into the profession, with some students now choosing an entry-level MSN as their starting place, especially when coming from another professional career. That said, RN and BSN programs are still robust in terms of how many people are clamoring for admission, as are the many types of MSN and NP programs.

In essence, nursing is a “choose your own adventure” undertaking, with as yet many unknowns for each individual. Those unknowns may include the twists and turns of the economy; potential changes in healthcare reform and the Affordable Care Act (ACA) and the number of insured Americans; student loan program changes; as well as cost of living and other factors covered in the first half of this post.

Between cost of living, your family’s needs, potential salaries, and the lifestyle you prefer to lead, your choice of a nursing specialty and a place to put down roots is truly up to you. If you’re single or otherwise able to explore the country as a travel nurse, that could be one way of doing your research. Otherwise, networking, conversations, informational interviews, and deeper research is called for.

The possibilities are endless, nurses — do your due diligence and see what the roulette wheel of life and career hold in store for you.

Keith Carlson, RN, BSN, NC-BC, is the Board Certified Nurse Coach behind NurseKeith.com and the well-known nursing blog, Digital Doorway. Please visit his online platforms and reach out for his support when you need it most.

Keith is co-host of RNFMRadio.com, a wildly popular nursing podcast; he also hosts The Nurse Keith Show, his own podcast focused on career advice and inspiration for nurses.

A widely published nurse writer, Keith is the author of “Savvy Networking For Nurses: Getting Connected and Staying Connected in the 21st Century,” and has contributed chapters to a number of books related to the nursing profession. Keith has written for Nurse.com, Nurse.org, MultiViews News Service, LPNtoBSNOnline, StaffGarden, AusMed, American Sentinel University, the ANA blog, Working Nurse Magazine, and other online publications.

Mr. Carlson brings a plethora of experience as a nurse thought leader, online nurse personality, podcaster, holistic career coach, writer, and well-known successful nurse entrepreneur. He lives in Santa Fe, New Mexico with his lovely and talented wife, Mary Rives.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

$949M: Possible Cost of Mass. Nurse Staffing Ratio Mandate

The debate around the proposed nurse staffing ratio mandate on the ballot in Massachusetts rages on, with new figures estimating it could cost up to $949M.

The total annual costs of a ballot question in Massachusetts that aims to limit the number of patients assigned to each nurse is estimated to cost between $676 million and $949 million, if put into action, according to a new state analysis. The Health Policy Commission, who released the numbers along with other findings on October 4th, also cautioned that it is likely a conservative estimate of the possible cost.

Stuart Altman, Health Policy Commission Chairman, told reporters that passing the initiative could “force a lot of other changes” to health care in Massachusetts in relation to associated costs and the way hospitals choose to respond to the mandate, if it passes.

The Health Policy Commission’s study found that an additional 2,286 to 3,101 full-time nurses would need to be hired to meet the proposed staffing mandates, and that the greatest need would be at community hospitals and for night shifts.

It was also noted by the Health Policy Commission implementing the staffing ratios could save an estimated $34 million to $47 million as a result of shorter hospital stays and fewer adverse events associated with the hiring of a greater number of RNs.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Physicians Say Mandatory Nurse Staffing Ratios Will Hinder ED Care

In an op-ed published last week, three emergency medicine physicians strongly opposed a proposed ballot initiative to mandate nurse-to-patient ratios.

There is a battle brewing in Massachusetts over nurse-to-patient staffing ratios, which will be decided at the ballot box this November. Question 1, also known as the Nurse-Patient Assignment Limits Initiative, was proposed by the Massachusetts Nurses Association, and is part of a larger fight nurses nationwide have been waging for years in an effort to secure safer staffing ratios. However, an op-ed written by three emergency medicine physicians and published last week in SouthCoast Today, says the mandated nurse staffing ratios could hinder quality of care and patient safety efforts.

The physicians—Jennifer Pope, MD, Chair of the Emergency Department at St. Luke’s Hospital, Brian Tsang, MD, Chair of the Emergency Departments at Charlton Memorial Hospital and Tobey Hospital, and Matt Bivens, MD, EMS Medical Director of Southcoast Health hospitals—called the state’s ballot initiative for mandated nurse staffing ratios “a disaster-in-waiting for Massachusetts, especially for emergency departments,” in their op-ed.

“Question One on the November ballot to mandate a government-set nursing-patient ratio invites us to discard what already works, and instead adopt the California model — in fact, a far more extreme version of that model, because of the aggressive proposed timeline. What would happen in the emergency departments?” the op-ed asks.

The physicians postulate what would come next—hospitals will let go of support staff, patients will be rushed in and out of the hospital more aggressively, emergency department waiting room times will soar.

The physicians said, in conclusion, “We worry this will cost jobs of ancillary staff, burden nurses with more low-skilled work, block patients in waiting rooms, rush patients out of the hospitals early, and break systems across the state that are already known for high-quality patient safety and care. We will vote no on Question One.”

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

The Doctor Is in, but Millennials Seem to Be Out

More millennials are shunning the traditional primary care model, in favor of retail clinics, free-standing urgent care centers, and telemedicine.

For years, office-based primary care visits have been a staple of American healthcare. However, millennials—the roughly 83 million Americans born between 1981 and 1996—seem to prefer the convenience, speed, connectivity, and price transparency of retail clinics, free-standing urgent care centers, and online telemedicine sites over traditional doctor’s appointments, reports The Washington Post.

In a national poll conducted in July by the Kaiser Family Foundation that surveyed 1,2000 randomly selected adults, it was found that 26% said they did not have a primary care provider. When that percentage was broken down by age groups, there was a staggering difference. 45% of 18- to 29-year-olds had no primary-care provider, compared with 28% of respondents aged 30 to 49, 18% of those 50 to 64, and 12% aged 65+.

A 2017 survey by the Employee Benefit Research Institute and Greenwald and Associates showed similar numbers: 33% of millennials reported not having a regular doctor, compared with 15% of those aged 50 to 64.

“There is a generational shift. These trends are more evident among millennials, but not unique to them. I think people’s expectations have changed. Convenience [is prized] in almost every aspect of our lives, from shopping to online banking,” Ateev Mehrotra, MD, an associate professor at Boston’s Harvard Medical School, is quoted as saying in the article.

This shift is upending the office-based primary care model, with more primary care practices hiring on additional physicians or nurse practitioners in an effort to reduce wait times, as well as embracing digital tools, such as patient portals, in an attempt to woo millennials back to primary care, not only for the practice’s bottom line, but for patient safety.

Some experts warn that straying from the traditional primary care model may be driving up health costs and worsening the problem of unnecessary care, including the dangerous misuse of antibiotics.

“We all need care that is coordinated and longitudinal. Regardless of how healthy you are, you need someone who knows you,” said Michael Munger, MD, President of the American Academy of Family Physicians.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.

Entrepreneurship for Clinicians

Have you ever thought there might be more to your career than clinical practice? Explore the idea of entrepreneurship with Jordan Roberts and Dave Mittman.

By Jordan G Roberts, PA-C

As you may have noticed, the NCCPA and AAPA have teamed up to promote PA’s during PA week 2018 with social media and national public relations campaigns. To add to this, I wanted to share and promote more great work done by PA’s in the business and entrepreneurial space.

Many PAs – clinicians in general even – do not feel they were built for ‘business.’ We like patient care as much as we like leaving the numbers to the administrators and industry folks. I think this comes from our training and our culture. In fact, when I was a PA student, someone told me how “lucky” I was that I wouldn’t have to worry about the business side of healthcare.

However, this made no sense to me, so I started poking around and asking questions. You see, my family is made up of lawyers, accountants, and entrepreneurs. There is a distinct lack of relatives with a medical background. With their backgrounds, they have all taught me valuable lessons that I can directly apply to my role as a clinician, employee, and entrepreneur myself.

To me, dismissing the bottom line means giving up job security and leverage. After all, in today’s corporate healthcare environment, better patient care doesn’t always mean better profits. Therefore, by not knowing your impact on the financial health of your organization, you limit your potential impact on the real health of your patients.

With that in mind, I spoke to a PA who has started multiple successful businesses all the while remaining active as a PA leader and advocate. Dave Mittman and I recorded our conversation for the Clinician1 Podcast, just one of his successful ventures. Please forgive the sound quality in some parts, this was our first episode and there were some technical difficulties.

In this episode, Mittman describes the difference between a non-clinical and non-traditional career, reasons why a clinician might choose this path, and tells us about some examples of successful clinician-run startups.

Listen to the show or read the article by clicking here.

Jordan G Roberts, PA-C helps medical education companies create and distribute the best medical education around. He helps students and clinicians improve their clinical game by using his background in neuroscience to teach simple ways to learn complex medical topics. He is a published researcher, national speaker, and medical writer. He can be found at Modern MedEd where he promotes clinical updates, medical writing, and medical education.

Disclaimer: The viewpoint expressed in this article is the opinion of the author and is not necessarily the viewpoint of the owners or employees at Healthcare Staffing Innovations, LLC.