Global Pricing Plan Added To Trump’s Attack On Drug Prices, But Doubts Persist

The proposal would have Medicare base what it pays for some expensive drugs on the average prices in other industrialized countries.

Sarah Jane Tribble, Kaiser Health News

President Donald Trump’s new pledge to crack down on “the global freeloading” in prescription drugs had a sense of déjà vu.

Five months ago, Trump unveiled a blueprint to address prohibitive drug prices, and his administration has been feverishly rolling out ideas ranging from posting drug prices on television ads to changing the rebates that flow between drugmakers and industry middlemen.

Thursday, Trump proposed having Medicare base what it pays for some expensive drugs on the average prices in other industrialized countries, such as France and Germany, where prices are much lower. The proposal is in the early stages of rule-making and awaiting public comments.

The U.S., Trump said, will “confront one of the most unfair practices, almost unimaginable that it hasn’t been taken care of long before this.”

The proposal was met with hope and skepticism, with several experts saying they were happy the administration was taking on Medicare Part B’s rising drug prices but questioning its approach.

Walid Gellad, director of the Center for Pharmaceutical Policy and Prescribing at the University of Pittsburgh, said in an online post that the administration’s proposed solutions were unclear. And, he said, they would “face insurmountable challenges.”

While some industry watchers pointed to the announcement as a political move, Wells Fargo pharmaceutical analyst David Maris said that this is a broader effort by the president and his administration to attack the root causes of high drug prices.

“The reality is he could very easily not take this on and do what other administrations have done and let the prices keep rising.”

Trump, too, promised more to come and said he will soon announce “some things that will really be tremendous.” On Friday, Health and Human Services Secretary Alex Azar said that, as promised in the blueprint, there would be more changes to Medicare Part D, which covers most prescriptions. Ian Spatz, a public policy expert and senior adviser at Manatt Health, said the overall blueprint was “unprecedented in terms of how many different ideas and areas of ideas that it contained.”

Nothing would happen overnight. The proposal to require drug prices in TV ads could be delayed by litigation and notably, if implemented, does not include any penalties for companies who fail to post their prices.

The proposed rebate rule was delivered to the Office of Management and Budget in July. Matt Brow, president of industry consulting firm Avalere Health, said he expects the administration to publish the rule for comment by year’s end.

Trump’s international pricing plan is not as far along as the rebate proposal. Rather, it is an “advanced notice of proposed rule-making.” The proposed rule could come in spring 2019, and Azar said the new model could begin in late 2019 or early 2020.

Yet, on Friday, Azar signaled the proposal could change, telling an audience at the Brookings Institution that the administration is “open to any number of alternative ideas.”

Avalere’s Brow said there is a good chance the proposal will change significantly.

“The sweeping nature of the proposal makes the stakes higher and makes it harder to implement,” Brow said.

If the administration moves forward, it would bypass Congress and implement a pilot under the Center for Medicare & Medicaid Innovation’s purview. The pilot would phase in over five years and apply to 50 percent of the country. Azar said there would be no changes to Medicare benefits and no restrictions on patient access.

The proposal focuses on drugs covered under Medicare Part B, which are administered in hospitals, clinics and doctors’ offices. It also would alter the reimbursement formula for doctors and providers and would allow private-sector vendors to purchase drugs and then sell them to doctors and hospitals. Medicare would reimburse those vendors at the international pricing level.

Currently, doctors and hospitals administering Part B drugs are reimbursed the average price of a drug plus 6 percent. President Barack Obama’s administration attempted to alter Part B as well but drew intense lobbying opposition and eventually withdrew a proposed pilot project.

Allan Coukell, senior director for health programs at Pew Charitable Trusts, said removing incentives that reward doctors for purchasing costlier drugs and bringing in a new way to control prices “makes a lot of sense.” Drug spending within Medicare Part B reached $22 billion in 2015, and drug costs have increased by an average of 8.6 percent annually since 2007.

Stephen Ubl, president of the industry trade group Pharmaceutical Research and Manufacturers of America, or PhRMA, said imposing foreign price controls from countries with socialized health care systems would harm patients and hinder drug discovery and development.

Azar, a former executive at pharmaceutical manufacturer Eli Lilly, told reporters Thursday that “you may hear the tired talking points” that this will affect innovation. He disputed that idea, concluding that “less than 1 percent of pharma [research and development] could potentially be impacted by this change.”

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.

What PTs Need to Know About Medicare Plans

Our friends at WebPT offer a thorough, but easy-to-follow breakdown of everything PTs need to know related to Medicare plans.

from WebPT

Generally speaking, Medicare is a federally funded health insurance program that provides benefits for people who are 65 or older; people with disabilities; and people with end-stage renal disease. Each part of Medicare—A, B, C, and D—covers a distinct set of services and benefits. Then, there are Supplement Plans that fill in some of the gaps. Not sure how Part C differs from Part A—or what gaps a Supplement Plan could possibly fill? How about Original Medicare versus Medicare Advantage? Keep reading, because we’ve compiled a breakdown of each.

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.

PTs, OTs Land Spots on List of Highest-Paying Jobs in Healthcare

PTs and OTs are being recognized as top earners in healthcare and are featured on a newly released list of the top ten highest paying careers in the field.

Physical therapists and occupational therapists are being recognized as top earners in healthcare by CNBC, being featured on their newly released list of the top ten highest paying careers in the field.

PTs ranked eighth on the list, with a median annual salary of $86,850, besting OTs in ninth place by only $3,650.

Positions that outrank PTs and OTs in annual earnings include physician assistants, optometrists, nurse anesthetists/midwives/practitioners, pharmacists, podiatrists, dentists, and physicians/surgeons.

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.

In Days Of Data Galore, Patients Have Trouble Getting Own Medical Records

Federal law guarantees that people have a right to see and obtain a copy of their medical records, so why are they so hard for patients to access?

Judith Graham, Kaiser Health News

Medical records can be hard for patients to get, even in this digital information age. But they shouldn’t be: Federal law guarantees that people have a right to see and obtain a copy of their medical records.

New evidence of barriers to exercising this right comes from a study of 83 leading hospitals by researchers at Yale University. Late last year, researchers collected forms that patients use to request records from each hospital. Then, researchers called the hospitals and asked how to get records, the cost of doing so, how long it would take, the format in which information would be sent and whether the entire record would be available.

Researchers didn’t disclose they were conducting an academic study; instead, they posed as a relative asking questions on behalf of a grandmother who needed her records before seeking a second opinion. Family members make such requests on behalf of older relatives every day.

Hospitals’ answers were inconsistent: In many cases, the information on forms didn’t match what researchers were told on the phone. Sometimes their answers violated federal or state legal requirements.

Notably, only 53 percent of hospitals’ forms indicated patients could get their complete records. This right was acknowledged in all the phone calls. Forty-three percent of hospital forms didn’t disclose the estimated cost of obtaining records, as required. In phone calls, all but one hospital disclosed costs, but 59 percent cited a higher-than-government-recommended fee for electronic records.

“The unfortunate truth is that the system doesn’t give patients reliable or consistent responses. And some people who work in medical records departments appear to be ignorant of the law and the rights that patients have,” said Dr. Harlan Krumholz, co-author of the study and professor of medicine, epidemiology and public health at the Yale University School of Medicine.

Under a groundbreaking law, the Health Insurance Portability and Accountability Act of 1996 (HIPAA), patients have a right to get some or all of their medical records upon request. (Psychotherapy notes can be excluded.) Hospitals, medical clinics, physician practices, pharmacies and health insurers are required to make this information available within 30 days (sometimes a 30-day extension can be granted), at a reasonable cost and in the format that patients request (for instance, paper copy, fax, electronic copy or CD), if possible.

Research suggests that reviewing medical records can be beneficial. People are more likely to follow treatment recommendations, remember what happened at medical visits and feel engaged in their care when they have access to this information, studies indicate.
But HIPAA requirements are often misunderstood. Jacqueline O’Doherty, a geriatric care manager with Health Care Connect LLC of Califon, N.J., encountered this last month when she tried to see records for an 80-year-old client who was being transferred from a hospital to a nearby rehabilitation facility after suffering acute respiratory distress.

Although the older woman had signed a form appointing O’Doherty as a “designated representative” — a status that should have allowed O’Doherty access to her clients’ records — a hospital nurse refused to let O’Doherty check the client’s lab results, medication list and discharge summary. It was only when an infectious-disease doctor intervened, citing the need for continuity of care, that O’Doherty was able to review her client’s records.

“It really depends on the institution, what they will and won’t let you do,” O’Doherty said.

After receiving a large volume of complaints about records’ cost and accessibility, the Office for Civil Rights of the U.S. Department of Health and Human Services, issued new guidelines in January 2016. For electronic records, the guidelines prohibit per-page charges and recommend a maximum cost of $6.50 for consumers. They also clarify patients’ right to have records sent to third parties, including family members or professionals advocating on their behalf.

Despite these protections, the forms used to request records aren’t standardized and can be confusing. Often it’s not clear what is being offered. “As a person who works in the health care system, even I had trouble understanding the forms and what I could request based on the options listed,” said Carolyn Lye, a medical and law student at Yale who did much of the legwork for the new study.

Problems may be even more common at physician practices, which often don’t have medical records departments. When GetMyHealthData, a campaign to expand access to digital health information, asked consumers about their experience, people described poorly informed or unhelpful staff, high fees, long waits and frustrating bureaucratic processes, among other barriers.

“People are being told ‘No I can’t give this to you’” because office staff, nurses and doctors “don’t know what they can or cannot do,” said Pamela Lane, vice president of policy and government relations for the American Health Information Management Association.

Electronic patient portals don’t solve the problem yet: Most contain limited information and don’t currently include a way for patients to request records such as the notes physicians take during patient visits. “We’re slowly moving in that direction, but we’re not there yet,” said Catherine DesRoches, executive director of OpenNotes, an organization devoted to making doctors’ and nurses’ notes more readily available to patients.

The government is making improved electronic access to medical records a priority through its new MyHealthEData Initiative, announced earlier this year. Full details of the initiative are not yet available. But Seema Verma, administrator of the Centers for Medicare & Medicaid Services, has repeatedly called for people with Medicare coverage to have better access to their records. In an unusual move, she spoke out on Twitter about the Yale study, calling its findings “not acceptable.”

What can people do if they encounter problems like those documented by the Yale researchers?

If your hospital or doctor’s office declines to make your records available, print out materials about your rights and use them to advocate on your behalf. “Tell staff, ‘I’m entitled to a copy of my records: This is my legal right, as explained here,’” Lane said.

A good resource is a model medical records release form created by the American Health Information Management Association last year, which people can copy and bring with them to help make their case, Lane said. A summary of your right to share medical information with family, friends or other authorized third parties can be found here.

To familiarize yourself with your overall rights, see this “Guide to Getting & Using Your Health Records” published by the government’s Office of the National Coordinator for Health Information Technology. And take a look at the “Get Your Data” section of the GetMyHealthData website, which includes a clear summary of your rights, how to request your medical records, and troubleshooting suggestions if you encounter obstacles. A helpful two-page summary is available here.

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.

Where Healthcare Costs the Most

In Anchorage, AK healthcare prices are nearly 2.5 times higher than in Baltimore, MD. How do other cities costs stack up?

Healthcare costs have rapidly increased across the nation, but focusing on an average amount for the country doesn’t necessarily capture just how high they’ve skyrocketed in some areas.

To give Americans a better picture of price levels and growth rates across the nation, the Health Care Cost Institute analyzed over 1.78 billion commercial healthcare claims and compared the average prices paid for the same services across 112 metro areas.

Here are the top ten cities with the highest healthcare costs and how they compare to the national average, according to HCCI’s Healthy Market Index:

  1. Anchorage, AK — 65% above the national average
  2. San Jose, CA — 65% above the national average
  3. San Francisco, CA — 49% above the national average
  4. Milwaukee, WI — 17% above the national average
  5. Green Bay, WI — 14% above the national average
  6. San Diego, CA — 12% above the national average
  7. Los Angeles, CA — 11% above the national average
  8. Trenton, NJ — 10% above the national average
  9. New York City, NY — 10% above the national average
  10. Portland, OR — 7% above the national average

The city with the lowest comparative cost in the country was Baltimore, MD, which is 33% below the national average.

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.

Nurse’s Post about Vaccines Goes Viral

If you buck vaccinations and Big Pharma, should you be allowed go to the doctor or the hospital when you get sick? This nurse says no in her viral post.

Days before an article was published by the Los Angeles Times stating, “Health authorities in California have more power to insist that a dog is vaccinated against rabies than to ensure that a child enrolled in public school is vaccinated against measles,” a California nurse took to Facebook and made a post about that very topic. In her post, Meggy Doodle, as she’s known on the site, told parents that they may have the “freedom” not to vaccinate their children, but that it comes with a caveat—”The caveat to that is this: then they should NOT be allowed go to the doctor or the hospital when they get sick, looking for treatment,” if they think Big Pharma is “just trying to turn a profit or poison us all.”

Doodle went on to urge those against vaccinations to, “stop being so naïve,” and rattled off a list of live-saving measures which are also compliments of Big Pharma—antibiotics for sepsis, steroids and epinephrine for anaphylaxis, an inhaler for asthma.

“Having a heart attack? Better break out your essential oils and get your affairs in order, because the only thing we have to offer you is medicine and procedures brought to you by the very same people who are responsible for those vaccines you insist are evil,” Doodle continued.

She then said that she personally takes offense to anyone who, “implies that medical professionals, like myself, would ever administer anything to anyone, especially a child, that would intentionally harm them. I take even more offense to anyone that would imply that a college educated professional, like myself, is incapable of “doing the research.””

She signed the post as “a nurse, a mother, a college graduate (with a science based degree), NOT BIG PHARMA.”

The post quickly went viral, amassing more than 12,000 shares and upwards of 13,000 reactions in mere days, with many who shared the post echoing Doodle’s sentiment. “You tell them girl. I agree with you,” said one woman who shared the post. “With flu season approaching… I’ll just leave this here,” said another. “Something to think about,” read comments accompanying quite a few other shares.

As a nurse, do you agree with Doodle’s sentiment? Read her post in full below, then tell us in the comments.

Can’t see the post above? Click here to view it directly on Facebook.

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 Top Yet Another “Highest Paid” List

There’s money in practicing medicine, or so says another top ten list, which ranks physicians and surgeons as top earners in the field.

Physicians and surgeons took the top spot on a new top ten list of high paying jobs in healthcare from CNBC, which indicated they are now earning salaries greater than or equal to $208,000, according to data from the Bureau of Labor Statistics.

Physician and surgeon annual salaries were noted as being $50,000 higher than their not-very-close second place competition, dentists, who ranked in the number two spot with a $158,120 median annual wage, and their salaries were more than $80,000 higher than podiatrists, who earn $127,740 on average, and rounded out the top three.

CNBC ties high wages for those on their list, in part, to high demand and relatively low competition in the job market for healthcare professionals.

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.

72% of Physicians Report Financial Ties to Drug, Device Industry

Since 2003, gifts and payments made to physicians by drug and device companies have been publicly reported–that doesn’t seem to slow them down too much.

Gifts and payments to physicians made by pharmaceutical and medical device companies have been publicly reported since 2003. Despite this breeding controversy among the public—and many changes made by both ends of the relationship as a result of said controversy—a new report by the Dartmouth Institute has found that nearly three quarters of physicians still have a financial tie to industry.

These findings came after physician-researchers Lisa Schwartz and Steven Woloshin conducted a national survey of 1,500 internists and internal medicine specialists. Those surveyed were asked ten yes-or-no style questions regarding “drug, device, or other methodically related company” interactions in the last year. These included receiving or being gifted any of the following: food inside or outside the workplace; free drug samples; pens, notepads, T-shirts; honoraria for speaking; payment for consulting services; payment for service on an advisory board; costs of personal expenses for attending meetings; free tickets to events; subsidized admission to meetings; or conferences for which Continuing Medical Education credits were awarded.

72% of respondents reported a financial tie to the industry, with the most popular benefits received being free drug samples (55%), followed by food and beverage inside (48%) or outside (30%) the workplace.

“What the survey revealed is that while financial industry ties have fallen some over the past decade, a majority of doctors still reported them. This is particularly concerning when you consider that free samples, which are among the most common financial tie reported, have been linked to the prescribing of high-cost brand-name drugs over lower-cost generic alternatives,” Professor Lisa Schwartz, MD, MS, a researcher on the study, is quoted as saying.

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.

New App Connects Patients with Advanced Practitioners, RNs via Text

A new app is taking aim at the telehealth space–not to diagnose, but to triage–and advanced practitioners and RNs are the ones on call.

A new startup has taken aim at the telehealth space. However, unlike other apps, the focus is to connect patients with physician assistants and nurse practitioners, as well as registered nurses, instead of physicians. The app, which offers a 24/7 chat-based model, also aims not to diagnose or prescribe, but to triage and inform.

Developed in the Harvard Innovation Lab and launched earlier this month, Nurse-1-1 is designed to offer patients a better and more reliable resource than being left to their own devices, such as Googling symptoms, to determine whether or not they should seek medical attention. It is HIPPA-compliant and encrypted, and offers patients a low-cost model of $12.50 per chat, with or without insurance—which is undoubtedly cheaper than a wasted co-pay, if medical attention isn’t deemed advisable.

To use the service, patients only need to download the app, answer some simple questions, and then they are paired with either a physician assistant, nurse practitioner, or registered nurse, who can triage their situation through photos and information shared via the chat.

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.

APRNs and PAs Ranked Among Highest Paying Jobs in Healthcare

Advanced practitioners are enjoying advanced wages, and two spots on a new top ten list of the highest paying jobs in healthcare.

Advanced practitioners, such as Physician Assistants, Nurse Practitioners, Certified Registered Nurse Anesthetists, and Certified Nurse Midwives seem to be enjoying advanced salaries, according to a new top ten list of high paying jobs in healthcare from CNBC.

While the average annual wage for healthcare workers clocks in around $65,000—well above the median annual wage for all occupations in the U.S. of $37,690—advanced practitioners are seeing salaries upwards of $100k, landing them prime spots on the CNBC list.

Physician assistants ranked seventh, with a median annual wage of $104,860. Nurse anesthetists, midwives, and practitioners, collectively took fifth place, with a median annual wage of $110,930, and were outranked only by pharmacists, podiatrists, dentists, and physicians/surgeons, which took the top spot with salaries greater than or equal to $208,000.

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.