When a doctor takes a call or responds to an email from a patient, or when a medical assistant reminds a patient about an overdue exam or unfilled prescription, the medical practice typically doesn't get paid for its time. Anthem Blue Cross and Blue Shield in Wisconsin is taking a small step to change that. The health insurer is creating contracts that will pay primary care physicians a monthly fee to help cover the time-consuming tasks that keep people healthy. "Care coordination doesn't just happen," said John Foley, a regional vice president who oversees contracting for Anthem Blue Cross. The contracts also will reward physicians who meet certain quality and performance goals and who provide care at a lower cost.
Last year, federal health care reform brought about $3.2 million in savings for Aspirus Wausau Hospital. "This has been the one biggest changes we've seen so far," said Sid Sczygelski, senior vice president of finance and the chief financial officer for Aspirus Inc., about the federal Affordable Care Act's effect on the hospital's bottom line. The Affordable Care Act, also known as Obamacare, helped reduce the number of people without health insurance, which meant hospitals saw less bad debt and charity cases last year. In 2014, taxpayers were required for the first time to get insurance or pay a fine.
Angel Torres hasn't been to the doctor since coming to the United States illegally more than two decades ago. But now, his vision is getting blurry and he frequently feels tired. Torres, 51, worries he might have diabetes like his brothers. "Time is passing," he said in Spanish. "I need to get checked out." Torres is in luck. He lives in California, which has a dramatically different approach to health care for undocumented immigrants than most other states. Several counties — including Los Angeles, where Torres lives — offer these immigrants free coverage at local clinics. In addition, as many as 500,000 low-income immigrant parents eligible for President Obama's new deportation relief likely will qualify for Medi-Cal, California's version of Medicaid.
Walk around near a hospital, and you'll see healthcare workers out and about, wearing their scrubs. It's the colorful, pajama-like uniform donned by anyone from hospital cafeteria employees to nurses and surgeons. Scrubs are on the move, in coffee shops, restaurants, on the subway - not exactly a fashion statement, but some experts are concerned that it also poses a health risk - since germs can travel in and out of hospitals on these uniforms. "You're really not supposed to wear scrubs outside of the hospital," explained one employee from a Philadelphia hospital who asked to remain unnamed. He added that he'd never been questioned by his employers about wearing scrubs outside.
The database provides some details on $3.5 billion in drug- and device-related payments to doctors for consulting, research, and other purposes during the last five months of 2013. CMS initially withheld data on about a third of the payments submitted because of inconsistencies. From MedPage Today
The Open Payments database created under the Physician Payments Sunshine Act (PPSA) is much improved from its rocky start, several speakers said at a briefing here sponsored by the National Coalition on Health Care.
"To CMS' [the Centers for Medicare and Medicaid Services] credit, they have made consistent improvements in what is out there," Rodney Whitlock, PhD, health policy director for Sen. Chuck Grassley (R-Iowa), said at the briefing Wednesday. "Our office is very pleased with what CMS has done." "The PPSA is definitely a success," agreed Adriane Fugh-Berman, MD, associate professor of pharmacology and physiology at the Georgetown University Medical Center. "The fact of its existence is really positive." Berman is also the director of PharmedOut, an organization whose goals are to document the influence of the pharmaceutical industry on drug prescribing and foster access to unbiased information about drugs.
The database, which the Centers for Medicare and Medicaid Services (CMS) opened to the public on Oct. 1, provides some details on $3.5 billion in drug- and device-related payments to doctors. The payments, which span only the last 5 months of 2013, are for consulting, research, travel expenses, and other purposes.
However, CMS initially withheld data on about a third of the payments submitted because of inconsistencies such as payments to one doctor being attributed to another physician with a similar name. Once the problems are alleviated, that data is expected to be included in the next release of information from the database, which is scheduled for June.
As good as the PPSA is, it doesn't include everything, and that's why it's a good idea for states to have their own additional laws regarding disclosure of relationships between providers and healthcare companies, Fugh-Berman added.
For example, the District of Columbia's AccessRx Act requires pharmaceutical companies to report marketing expenditures to all healthcare providers; only 20% of what's required under the District's law is included in the PPSA, she said.
In 2012, D.C.-based organizations received $19.6 million from pharmaceutical companies, and 31% of the entities that received more than $25,000 from drugmakers in 2012 failed to disclose that fact on their websites or in their annual reports, according to Fugh-Berman.
Allan Coukell, senior director for health at the Pew Charitable Trusts, in Washington, made three predictions about the PPSA:
The process of submitting data will continue to be refined.
CMS probably will continue to refine how it presents that data; the agency is currently revising its search base and data tools.
The current variation in how drug and device companies attribute payments to various categories -- for example, which payments are classified under "marketing" and which to "meals" -- may be lessened. "Stakeholders will have to sit down and say, 'What do we mean by X?'" he said.
William Jordan, MD, MPH, president-elect of the National Physicians Alliance, a group that aims to help physicians practice free of conflicts of interest and financial entanglements, noted that 1,300 teaching hospitals have appeared in the PPSA database. "That speaks to the point of formularies for hospitals being influenced by pharmaceutical companies," he said.
During the question-and-answer portion of the briefing, one audience member complained about CMS setting $10 as the minimum payment to a physician that needed to be reported to the database, arguing that amount was too low. But Fugh-Berman said she didn't think that was low enough.
"I think it should be $1," she said. "Social psychology research shows us that small gifts actually have a bigger import than large gifts" in terms of influencing people.
Although the PPSA targets pharmaceutical and device firms' payments to physicians, these companies have actually expanded their marketing targets beyond doctors to include nurse practitioners, physician assistants, and payers, Fugh-Berman said, adding that one-fourth of all prescriptions today are written by advanced practice nurses and physician assistants; drug company payments to those providers are not included in the Open Payments database.
In addition, drug companies are also marketing to social workers, because they "often are making diagnoses and deciding what medications a person will be on" even if they're not actually writing scrips, she said.
Fugh-Berman also criticized drug companies' use of free drug samples to market their medications. "Samples are the most effective marketing tools pharmaceutical companies have," she said, urging that patients offered samples of newer drugs should ask instead for older drugs that work better.
John Murphy, assistant general counsel for the Pharmaceutical Research and Manufacturers of America, a Washington-based trade group for the pharmaceutical industry, said in a phone interview that Fugh-Berman's suggestion "is a serious disservice to patients who have unmet medical needs or are in the rare disease space ... you can look at the industry over past 10 years and see a wave of innovation that's helped a lot of patients." Murphy attended the briefing but was not one of the speakers.
He noted that in the first 5 months of data released from the Open Payments database, payments to physicians for meals and for expenses related to sales visits comprised less than 10% of what was included. "That shows you how much more went to research and education, medical journal authorship, consulting, and the like," Murphy said. "I think that tells a compelling story, that this is industry making sure research and development gets conducted in the U.S., and physicians have an opportunity if they so choose to keep themselves up to date on the latest treatments that come up."
This article is published under agreement with MedPage Today.
U.S. healthcare executives say Obamacare is likely here to stay, despite repeated calls from Republican lawmakers for repeal of the 2010 law aimed at providing health coverage for millions of uninsured Americans. Top executives who gathered in San Francisco this week for the annual J.P. Morgan Healthcare conference, say that while President Obama's signature domestic policy achievement may well be tweaked, it is too entrenched to be removed. The Obama administration said in November that it aims to have over 9 million people enrolled in government-backed federal and state health insurance marketplaces in 2015, their second year of operation.