Treatment costs for drug-resistant staph infections were about $38,500 compared with more than $40,700 for MSSA-associated pneumonias.
Drug-resistant staph infections continue to be deadlier than those that are not resistant to antibiotics, but treatment costs surprisingly are the same or less, an analysis shows.
"The lower costs for treating drug-resistant infections were a surprise," said study coauthor Trish Perl, MD, chief of Infectious Diseases at UT Southwestern Medical Center. "The findings are contrary to previous predictions and studies that suggested the treatment costs for drug-resistant infections would be greater."
Across four years of data, researchers found:
Treatment costs for drug-resistant staph infections (MRSA, methicillin-resistant Staphylococcus aureus -related pneumonia) were about $38,500 compared with more than $40,700 for pneumonias (MSSA, methicillin-sensitive Staphylococcus aureus –related pneumonias) in 2014.
Treatments costs for non-pneumonia-related hospitalizations related to staph infections were $15,578 for MSSA-related infections compared with $14,792 for MRSA-related infections.
Similar patterns were observed from 2010 to 2013.
Cost differences between MSSA- and MRSA-related pneumonia hospitalizations rose from 26% in 2010 to 31% in 2014.
Reasons for the lower costs may be due to price differences in drugs used to treat the different types of infections or that MSSA infections were more severe or that less-invasive MSSA infections may not be diagnosed or coded correctly, leaving only costlier MSSA infections in the record, researchers said.
Alternatively, this difference may relate to the fact that care providers failed to change from antibiotics used for MRSA to more appropriate antibiotics in a timely fashion, the researchers said.
The federal government has joined the whistleblower lawsuit leveled against the specialty drug maker, as INSYS puts its minimum liability exposure at $150 million.
INSYS Therapeutics, Inc. says it has become "a completely transformed organization" in the face of stinging federal allegations that it bribed clinicians to push its powerful opioid painkiller, and lied to insurers to get reimbursements.
"INSYS continues to have ongoing dialogue with the DOJ regarding this investigation," the Phoenix-based specialty drug maker said in a media release.
"Today, INSYS is a completely transformed organization, with a promising pipeline, a strong commitment to serving patients as well as an organizational culture of high ethical standards."
The statement was issued this week hours after the Department of Justice announced that it would join a whistleblower lawsuit leveled against the drug maker.
The suit, unsealed this week in a federal court in Los Angeles, alleges that INSYS paid kickbacks to physicians and nurse practitioners to get them to prescribe Subsys, a spray form of fentanyl approved by the FDA in 2012 for the treatment of persistent pain in adult cancer patients.
"Many of these kickbacks took the form of speaker program payments for speeches to physicians that were, in fact, shams; jobs for the prescribers’ relatives and friends; and lavish meals and entertainment," DOJ said in a media release.
Federal prosecutors also allege that INSYS pushed physicians to prescribe Subsys for patients who did not have cancer. In addition, INSYS employees allegedly lied to insurers about patients' diagnoses to obtain reimbursement for Subsys prescriptions that had been written for Medicare and TRICARE beneficiaries.
"Insys allegedly bribed doctors who are more concerned with profits than patients," said Christian J. Schrank, Special Agent in Charge for the Office of Inspector General of the U.S. Department of Health and Human Services.
"Encouraging the inappropriate use of this too-often deadly opioid is intolerable enough, but the abuse is compounded when taxpayers are forced to pick up the bill," Schrank said.
The whistleblower suit was filed in 2013 by former INSYS sales rep, Maria Guzman, who detailed what she said were overt and disguised bribes that INSYS made to doctors to increase prescriptions and dosages of Subsys, and lies used to rationalize the off-label benefits for patients.
"Sex, money, luxury items – nothing was out of bounds in INSYS's efforts to persuade doctors to prescribe Subsys without consideration of what was best for patients," Guzman said. "I could not keep silent, knowing how these off-label prescriptions endangered so many."
In its media release, INSYS said it "has learned from the past and remains committed to significant innovation and investment in R&D, which the company believes will result in improving the lives of many patients."
The drug maker, which has lost 85% of its stock value since mid-2015, said it has accrued $150 million, "which represents the company’s current best estimate of the minimum liability exposure which it expects to be paid out over five years in connection with this investigation."
DOJ has been pursuing criminal charges against INSYS founder and majority owner John Kapoor and several former executives and managers, including former CEO Michael Babich and former Vice President of Sales Alec Burlakoff.
Three of the doctors that Guzman's says were top prescribers of Subsys and accepted kickbacks from INSYS – Alabama doctors Xiulu Ruan and John Couch, and Gavin Awerbuch of Michigan – have been convicted of criminal charges and sentenced to prison.
The federal complaint said that Awerbuch wrote 1,283 prescriptions for Medicare patients alone from 2012 until he was arrested in May 2014, costing Medicare nearly $7 million.
While medical schools are reporting solid enrollment and student diversity gains over the past 15 years, the dearth of medical residency slots remains a top concern.
First-year enrollment at U.S. medical schools has increased by 29% since 2002, but school administrators worry that the numbers of medical residency positions available for their graduates aren’t keeping pace.
The Association of American Medical Colleges, in its Results of the 2017 Medical School Enrollment Survey, found that 64% of medical school deans expressed concern about the availability of residency slots in their own state, and 78% expressed concern about the availability nationally.
The survey found that:
Using the baseline of the 2002 first-year enrollment of 16,488 students, a 30% increase corresponds to an increase of 4,946 students. The survey results indicate that the 30% goal will be attained by 2018-2019.
54% of medical schools saw competition for clinical training sites from other healthcare professional programs, an increase from around one-quarter of respondents in 2009.
Nearly all deans (99%) said they had or were planning programs or policies designed to recruit adiverse student body, up from 84% in 2015.
44% of deans reported concerns about their incoming students' ability to find residency positions of their choice after medical school.
A majority of schools are experiencing competitionfor clinical training sites from DO-granting schools and other healthcare professional programs.
46% of deans reported feeling pressure to pay for clinical training slots, though 59% of schools do not pay for clinical training.
Enrollment increases at DO-granting schools continue to accelerate. First-year enrollment at DO-granting schools in 2017–2018 was 8,088, a 163% increase from 3,079 students in 2002–2003.
Combined first-year enrollment at existing MD-granting and DO-granting schools increased by 9,859 students, a 50% increase compared with 2002–2003.
More than $1 billion in Medicare savings projected as CMS and Maryland state officials sign a five-year agreement to expand the state's value-based payment system into non-hospital settings.
The federal government has given the go ahead for a renewal and expansion of the "Maryland Model," which will take Medicare value-based care beyond hospital walls to include long-term and community-based care, and mental health services.
"The new Maryland Model will expand healthcare access and affordability – and ultimately improve quality of life – for Marylanders, especially those with chronic and complex medical conditions,” Maryland Gov. Larry Hogan said in a media release.
With the existing all-payer model up for renewal at the end of 2018, the Centers for Medicare & Medicaid Services required Maryland to build a new model that encompassed all of the healthcare that patients receive, both in the hospital and the community, including long-term care and mental health services.
The five-year contract signed this week by state and federal officials takes effect on January 1, 2019, and is expected to provide an additional $300 million in savings per year by 2023.
The expanded model will:
Invest resources in care that is focused on the patient and enhance primary-care teams to improve individual patient outcomes;
Set a range of quality and care improvement goals and provide incentives for providers to meet them;
Concentrate resources on population health goals to help address opioid use and deaths, diabetes, hypertension, and other chronic conditions;
Encourage and facilitate programs focusing on the needs of Medicare recipients across geographic settings and other key demographics.
The current Maryland All-Payer Model Contract started on January 1, 2014, and was set to expire on December 31, 2018. Maryland officials say the current model has already saved Medicare more than $586 million through 2016, compared to national spending, through reduced readmissions, and lower growth in hospital per capita costs.
The private equity firm says it has heard nothing from leadership at Athenahealth, one week after Elliott made a cash offer to buy the company for $160 per share and take it private in a deal valued at about $7 billion.
Elliott Management Corp. has sent a second letter to the board at Athenahealth Inc., urging them to prod the medical IT company's leadership to take up the acquisition bid made by the private equity firm.
"Last week, we made public our interest in acquiring Athenahealth, Inc. at a price of $160 per share in cash. Additionally, we made clear that we may be able to raise our offer substantially if given access to diligence," Elliott Partner Jesse Cohn said in the letter sent Monday.
"Since that time, we have heard nothing from the company beyond its cursory, boilerplate press release," Cohn said. "We have received no direct communication despite our emails and messages to Athenahealth offering to discuss next steps or to answer any questions regarding our proposal. None of the company’s advisors has contacted us."
Athenahealth issued a brief statement Monday night reiterating its response last week to the Elliott bid and said it would respond to the proposal "in due course."
Cohn called the silence from Athenahealth's leadership "concerning because, unfortunately, this is the same pattern of behavior we experienced when we tried to get the company to engage in November."
"Athenahealth's board refused to engage with us, despite our repeated offers to make ourselves available for discussion," Cohn said. "Moreover, as far as we are aware, Athenahealth did not even engage an investment bank to evaluate our interest, as no investment back or other third-party advisor contracted us."
The only response that Elliott has received so far from Athenahealth "amounted to nothing more than a one-paragraph letter dismissing our interest," Cohn said.
"This letter was dashed off so quickly that Athenahealth forgot to even sign it. (a signed version was transmitted to us 45 minutes later)," Cohn said. "Though minor, we found this careless oversight illustrative of the broader lack of seriousness with which Athenahealth has treated our efforts to engage."
In the acquisition bid pitched last week, Cohn said that Watertown, Massachusetts-based Athenahealth has a history of underperformance both strategically and operationally.
"Unfortunately, we are faced now with the stark reality that Athenahealth as a public-company investment, despite all of its promise, has not worked for many years, is not working today and will not work in the future," Cohn said.
"Given Athenahealth's potential, this reality is deeply frustrating, but the fact remains that Athenahealth as a public company has not made the changes necessary to enable it to grow as it should and to create the kind of value its shareholders deserve."
Athenahealth Responds
Athenahealth issued the following statement late Monday:
"As stated in our May 7, 2018 press release, consistent with its fiduciary duties and in consultation with its independent financial and legal advisors, the athenahealth Board of Directors is carefully reviewing Elliott Management's proposal to acquire the Company for $160 per share in cash."
"The board will determine the course of action that it believes is in the best interest of the Company and athenahealth shareholders and will respond to Elliott Management's proposal in due course."
The investigation has thus far resulted in 53 convictions – 38 of them doctors – in what is believed to be the largest number of medical professionals ever prosecuted in a bribery case.
A Monmouth County doctor is the latest physician to trade in his white lab coat for a prison-issue orange jumpsuit in a sweeping bribery case that has taken down dozens of medical professionals practicing in New York and New Jersey.
According to federal prosecutors:
Ralph Messo, MD, 56, of Colts Neck, New Jersey, was sentenced this month to two years in prison after pleading guilty to one count of accepting bribes in exchange for test referrals.
The bribe was part of a long-running and elaborate scheme operated by now-defunct Biodiagnostic Laboratory Services LLC, of Parsippany, New Jersey, its president and numerous associates.
Messo admitted he accepted bribes in return for referring patient blood specimens to BLS and was paid approximately $3,000 per month. Messo's referrals generated at least $828,000 in lab business for BLS.
In addition to the prison time, Messo was sentenced to two years of supervised release and fined $4,000.
The investigation has thus far resulted in 53 convictions – 38 of them doctors – in connection with the bribery scheme, which its organizers have admitted involved millions of dollars in bribes and resulted in more than $100 million in payments to BLS from Medicare and private insurance companies.
The investigation has to date recovered more than $13 million through forfeiture. On June 28, 2016, BLS pleaded guilty and forfeited all of its assets. It is believed to be the largest number of medical professionals ever prosecuted in a bribery case.
Physicians who use stigmatizing language in their patients' medical records may negatively affect the care those patients get for years to come.
Be careful what you write, physicians.
Recording disparaging medical notes about your patients could adversely affect the care they receive or how aggressively their pain is managed, according to a study published this month in the Journal of General Internal Medicine.
"This record may be the only source of information a new clinician has about some patients," says Mary Catherine Beach, MD, the study's lead author, said in comments accompanying the study.
"We have to question the assumption that the medical record always represents an objective space," Beach says.
The study gave more than 400 medical students and residents one of two vignettes about a hypothetical patient, a 28-year-old African-American man with sickle cell disease and chronic hip pain.
The vignettes contained medically identical information. However, one used neutral language to describe the patient and his condition, while the other vignette contained nonessential language that implied various value judgements.
For example:
"He has about 8-10 pain crises a year, for which he typically requires opioid pain medication in the ED."
"He is narcotic dependent and in our ED frequently."
For example:
"He spent yesterday afternoon with friends and wheeled himself around more than usual, which caused dehydration due to the heat."
"Yesterday afternoon, he was hanging out with friends outside McDonald's where he wheeled himself around more than usual and got dehydrated due to the heat."
For example:
"His girlfriend is by his side but will need to go home soon."
"His girlfriend is lying on the bed with shoes on and requests a bus token to go home."
The study found that physicians-in-training who read the stigmatizing patient chart notes were significantly more likely to have a negative attitude toward the patient than those who read the chart containing more neutral language.
And not only did their attitudes change—so did their treatment plans. Those physicians-in-training who had read the stigmatizing chart note decided to treat the patient’s pain less.
Even physicians-in-training who recognized the language as stigmatizing were more likely to form more negative opinions about the patient and to treat that patient’s pain less aggressively.
Beach said medical residents had more negative attitudes than medical students toward the hypothetical patient.
"Attitudes seem to become more negative as trainees progress," she says. "It may be that trainees are influenced by negative attitudes and behaviors among their peers and seniors in the clinical setting."
Physicians-in-training who identified as African-American generally had more positive attitudes toward the patient.
"That affirms what some other studies have shown," Beach says, "specifically, that African-American clinicians have more positive attitudes toward patients with sickle cell disease."
The researchers said they were encouraged by one result of the study.
"When prompted, the participants seemed able to reflect on how the words used in the chart notes communicated respect and empathy for the patient," said study co-author Anna Goddu, a Johns Hopkins School of Medicine student. "To us, this seems like a promising point of intervention."
Stakeholders said they appreciate the administration's vow to tackle rising drug costs, but they want to hear the specifics on when, where, and how these initiatives will be implemented.
President Donald Trump received a mixed reaction from various stakeholders Friday after he unveiled a multifaceted—but vaguely outlined—proposal to reduce prescription drug costs for consumers.
Pharmaceutical Research and Manufacturers of America CEO Stephen J. Ubl: "These far-reaching proposals could fundamentally change how patients access medicines and realign incentives across the entire prescription drug supply chain. While some of these proposals could help make medicines more affordable for patients, others would disrupt coverage and limit patients' access to innovative treatments."
"The proposed changes to Medicare Part D could undermine the existing structure of the program that has successfully held down costs and provided seniors with access to comprehensive prescription drug coverage. We also must avoid changes to Medicare Part B that could raise costs for seniors and limit their access to lifesaving treatments."
"Misaligned incentives in the supply chain are resulting in savings for middlemen, but higher costs for patients. After negotiations, medicine prices increased just 1.9% last year, below the rate of inflation, and yet patients' out-of-pocket costs continue to skyrocket. Giving patients access to negotiated discounts at the pharmacy counter and protecting seniors in Medicare Part D from catastrophic costs would help make medicines more affordable."
Rick Pollack, president and CEO of the American Hospital Association: "The AHA appreciates many of the actions that the Administration has proposed, such as incentives to speed up the arrival of generic drugs into the market and reducing out-of-pocket costs for patients. These are good first steps and additional actions are needed. The AHA has specific recommendations to further increase competition, transparency, access and value, while fostering innovation."
"We also urge the Administration and the Congress to oppose any efforts to scale back the 340B drug savings program, which for over 25 years has been critical in helping hospitals stretch scarce federal resources to expand access to healthcare services in communities with a significant number of vulnerable patients. 340B is a critical tool in the toolbox that provides drugs at lower prices to those on the front lines of patient care."
AARP Chief Advocacy & Engagement Officer Nancy LeaMond: "We welcome a broad look across the entire drug supply chain to find ways to help drive down drug prices. AARP also strongly believes that it is critical that any proposals to lower prescription drug costs don’t simply shift the costs around in the health care system without addressing the root problem: the prices set by pharmaceutical companies."
Robert Weissman, president of Public Citizen: "What Trump laid out is policy that Big Pharma can love—and no wonder, because Big Pharma wrote it. Trump abandoned his campaign commitment to Medicare Part D negotiation—which would save $16 billion a year or more—and shamefully aims to beat up on other countries to make them pay more, doing nothing for American consumers but forcing more rationing overseas. Those are the top lines. That’s what matters, and everything else is noise around the margins."
340B Health: "We applaud President Trump’s efforts to rein in the high cost of prescription drugs, but are deeply concerned that his administration’s continued misguided attacks on the 340B drug pricing program will lead to higher drug costs and less access to care for vulnerable patients. The administration’s proposals are based on a faulty understanding of the 340B program and the pharmaceutical market. The notion that 340B discounts are raising drug prices is simply false. Drug companies set the prices for their products and they, alone, decide how high those prices go. The president’s proposal to cut Medicare payments to 340B hospitals violates the Medicare and 340B statutes. It cuts $1.6 billion from the safety net and does nothing to reduce drug prices for seniors and the disabled."
Express Scripts: “President Trump rightly recognizes drug companies charge way too much, and their prices need to come down. In particular, we were pleased that the Administration recognized and endorsed policies that we have advocated for over the years, including increasing access to biosimilars, increasing the number of generic drugs available, and eliminating gag clauses and clawbacks -- anti-patient practices that we do not engage in."
IBM Watson compiles price fluctuation data over the past decade in the wholesale acquisition costs for the 10 most-frequently administered emergency department drugs.
President Donald Trump is scheduled Friday afternoon to outline his administration's plans to control drug prices.
In anticipation of his remarks, IBM Watson Health has provided a breakdown of changes in pharmaceutical wholesale acquisition cost for the top 10 most frequently-administered emergency department drugs within the last 10 years:
In addition, the most-commonly administered non-drug treatment in emergency departments, intravenous sodium chloride, has experienced price increases ranging from 162% to 328% depending on the manufacturer and quantity.
The Cincinnati-based, not-for-profit health system self-disclosed the allegations after an internal audit found that payments to six employed physicians exceeded fair market value for the services provided.
Mercy Health will pay the federal government $14.2 million to settle False Claims Act allegations involving self-disclosed improper financial relationships with referring physicians, the Department of Justice said.
DOJ said Cincinnati-based Mercy provided compensation to six employed physicians—one oncologist and five internal medicine physicians—that exceeded the fair market value of their services.
"During an internal audit, Mercy Health learned that it made errors in the administration of a small number of physician arrangements," the health system told HealthLeaders Media in a statement Friday. "Mercy Health promptly disclosed the administrative errors to the federal government, with which it cooperated fully, and is pleased to have resolved the matter."
"When physicians are rewarded financially for referring patients to hospitals or other healthcare providers, it can affect their medical judgment, resulting in overutilization of services and higher health care costs," said acting Assistant Attorney Chad A. Readler, head of the Justice Department’s Civil Division.
"In addition to yielding a recovery for taxpayers, this settlement should deter similar conduct in the future and help make health care more affordable," Readler said.
"Hospitals should employ their physicians at a compensation level that is consistent with fair market value for the area of practice, and should not attempt to incentivize physicians to refer patients based on anything other than the best clinical interests of the patient," said First Assistant United States Attorney Vipal Patel for the Southern District of Ohio.
