The College of Healthcare Information Management Executives has submitted comments to the Office of the National Coordinator on the proposed federal health information technology strategic plan.
CHIME supports the plan's goals but wants to see refinements that will increase the likelihood for effective and widespread adoption of IT by healthcare providers.
The comments are contained in an April 18 letter to Farzad Mostashari, MD, ScM, the National Coordinator for Health Information Technology. The letter is signed by Richard A. Correll, president and CEO, and Lynn Vogel, MD, who chairs the CHIME board of trustees.
Ann Arbor-based CHIME has asked the ONC to provide standardized approaches and to allow sufficient time to encourage the adoption of electronic health records systems and supporting technologies by providers.
CHIME's comments in the letter to Mostashari focus on four areas of concern:
Confidence and trust in HIT. To make sure patient information is shared responsibly, CHIME requests that ONC "further define how consent management should be handled…stored and transmitted through health information exchanges. The consent process must also support exchange with personal health records so that information between patients and their providers – no matter the source – is accurate, secure and furthers the goal of improved care."
Performance measures. While CHIME supports ONC's approach in quantifying hospital and physician performance in achieving meaningful use objectives, it reiterates its request that the second stage of meaningful use objectives not be implemented before 30 percent of eligible hospitals and eligible professionals have achieved the objectives in the first stage.
Patient-accessed and patient-added health information. CHIME wants to see more alignment among HHS regulations affecting the timeliness of patient access to information. In its letter the executive organization notes that the timeliness standard under the HIPAA provisions "is significantly different from that under the electronic health record meaningful use regulations recently adopted by HHS (30 days for information maintained onsite vs. three business days). CHIME considers the three business day standard unreasonable and is also troubled by the failure to adopt more consistent timeliness standards across HHS regulations."
EHR evolution. While CHIME supports the development of EHR capabilities, it suggests "caution should be exercised when expecting EHRs to do too much, too fast – such as accommodate multiple languages and disabilities."
"Our comments touch on a number of issues and challenges we're facing while working with ONC to advance and standardize the adoption of health information technology and health information exchange," Indranil "Neal" Ganguly, vice president and CIO of CentraState Healthcare System and a member of CHIME's policy steering committee explained in a statement. "From data safety and integrity to continued evolution in EHR usability, hospital CIOs are at the forefront of this transformation, and we are pleased to offer guidance on how ONC can move forward.
The deadline for public comments has been to May 6.
Compared to insured patients, the hospitalizations of uninsured patients are typically shorter and have a lower cost per stay, an April statistical brief from the Agency for Healthcare Research and Quality (AHRQ) and the Healthcare Cost and Utilization Project (HCUP) has found.
Uninsured patients are typically hospitalized for 3.8 days vs. 4.7 days for insured patients and have a lower cost per stay ($7,300 vs. $9,200).
The AHRQ brief looks at characteristics of uninsured hospitalizations, such as utilization, diagnosis, cost and geographic location. Uninsured stays are compared with the characteristics of insured hospital stays, which include private insurance and government programs such as Medicaid and Medicare. The data analyzed is from HCUP's nationwide inpatient sample on uninsured hospital stays in 1998, 2003 and 2008.
In 2008, the uninsured accounted for 2.1 million inpatient hospitalizations, or 5.3% of all U.S. community hospital stays, researchers found.
After remaining fairly constant between 1998 and 2003, number of uninsured hospital stays increased by 21% from 2003 to 2008. Although the authors provide no reason for the increase it probably reflects the increase in the number of uninsured as employers have dropped coverage and nonemployee-sponsored premiums have increased beyond what is affordable for a growing segment of the U.S. population.
Because most patients age 65 and older are covered by Medicare, uninsured stays are predominantly for patients younger than 65 years of age. In a telephone interview, P. Hannah Davis, MS, one of the authors, said that the age differential could account at least in part for the shorter hospital stay as well as the primary reason for the hospital stay among the uninsured: childbirth, which account for 11% of those hospitalizations.
From 2003 to 2008 uninsured hospitalizations for skin infections increased by 55% while hospital stays for gallbladder disease posted a 43% increase and diabetes complications increased by 40%. Uninsured alcohol-related hospitalizations, which posted a significant 18% decline from 1998 to 2003, increased by 35% from 2003 to 2008.
Davis noted that in general the severity of illness was lower for uninsured versus insured hospitalizations. For example, the uninsured had fewer chronic conditions per patient (2.5 vs. 3.5).
Geographically, a larger share of hospital stays in the South were uninsured (7.6 percent) compared to 4.9 percent in the Midwest, 3.6 percent in the West and 3.2 percent in the Northeast, the data showed.
Uninsured hospitalizations accounted for 8.3 percent of stays in public hospitals but only 4.7% of stays in private, nonprofit hospitals.
There is room for improvement in the nation's emergency departments, where 10 percent of all ambulatory care in the U.S is administered. The Premier Healthcare Alliance has announced a plan to identify where and how improvements can be made.
A two-year collaborative between Premier and emergency departments at 14 hospitals aims to reduce clinical practice variation, improve care quality, increase patient satisfaction, and improve patient outcomes.
The Emergency Department Safety Initiative focuses on improving patient care and satisfaction in the ED through consistent, accurate and timely diagnosis and treatment of high-risk ED patients. Topics covered include best practices in the ED, and promoting effective teamwork and communication in the ED.
Premier teams have made on-site assessments at each hospital, said Dan Fineran, assistant vice president of operations and quality at Premier in an interview. "We are looking at all aspects of the emergency department and speaking with physicians, nurses, and patients to get an idea of how the ED operates in a particular hospital.”
The primary focus is to identify areas where there might be room for improvement, provide follow-up support, and to communicate best practices to each participating ED. Among the targets is to improve patient safety metrics to the 90th percentile.
The 14 participating hospitals represent more than 730,000 annual ED visits. The EDSI will initially target patients presenting in EDs with chest and abdominal pain, two of the most difficult and nonspecific diagnoses. These conditions are most commonly associated with more severe outcomes such as heart attacks, appendicitis, meningitis, and pancreatitis.
According to the Agency for Healthcare Research and Quality, abdominal pain is the fourth highest principal reason for all ED visits in the country, with 4.6 million visits in 2007. Nonspecific chest pain is the fifth highest principal reason for all ED visits in the country, with 3.8 million visits in 2007.
The collaborative will look at avoidable and unplanned ED readmissions to help understand the components and outcomes related to patient flow. Fineran explained that when looking at chest pain patients “we’ll work with the ED to identify the process for treatment, especially the time it takes for these patients to get from door to doctor and door to EKG.” Problem areas and their impact will be identified and then the ED will decide what improvements it wants to make to eliminate those problems.
Participating hospitals are:
Eisenhower Medical Center; Rancho Mirage, Calif.
Kuakini Medical Center; Honolulu, Hawaii
·Methodist Medical Center of Illinois; Peoria, Ill.
·Baptist Hospital East; Louisville, Ky.
·Baptist Hospital Northeast; LaGrange, Ky.
·Baptist Regional Medical Center; Corbin, Ky.
·Central Baptist Hospital; Lexington, Ky.
·Western Baptist Hospital; Paducah, Ky.
·Baystate Medical Center; Springfield, Mass.
·Fairview Southdale Hospital; Edina, Minn.
·Presbyterian Hospital; Albuquerque, N.M.
·Summa Akron City Hospital; Akron, Ohio
·Johnson City Medical Center; Johnson City, Tenn.
·Texas Health Presbyterian Hospital of Dallas; Dallas, Texas
Because the participating hospitals are located in nine states, Web conferences and e-mail alerts will be regularly presented to the group by emergency department and risk management experts addressing ED-specific patient safety topics.
Healthcare stakeholders are beginning to respond to President Obama's plan to reduce the federal deficit by $4 trillion over the next 12 years.
With healthcare on the hook to deliver $480 billion in savings by 2023 and another $1 trillion in savings by 2033, Medicare and Medicaid are among the most visible programs slated for changes that the administration hopes will reduce the cost of care but not the quality.
Changes would also come to the Independent Payment Advisory Board, a 15-member commission of doctors, nurses, medical experts, and consumers who recommend ways to reduce spending, was mentioned three times in the president's speech. Mr. Obama proposed to strengthen IPAB, provide it with additional enforcement measures, and to give the board additional tools to improve the quality of care such as promoting value-based benefit designs.
IPAB is a sticking point across the board. Physicians groups such as the American Medical Association, the American College of Cardiology, and the American Hospital Association, have long voiced their concerns about the board, which was created by the Affordable Care Act, and has the power to analyze the drivers of Medicare cost growth and then recommend to Congress policies to reduce that growth.
Congress must either vote on IPAB's recommendations or enact policies that achieve equivalent savings.
In a statement released Wednesday in response to the president's speech, AHA president and CEO Rich Umbdenstock made it clear that the organization would prefer to see IPAB repealed rather than given more power. "America's hospitals support the repeal of IPAB because its existence permanently removes Congress from the decision-making process, and threatens the important dialogue between hospitals and their elected officials about the real healthcare needs of their communities. Expanding IPAB adds to that problem.
The White House deficit reduction plan sets a target of Medicare growth per beneficiary as the gross domestic product plus 0.5%.
Ardis D. Hoven, M.D., chair of the AMA said in a statement, "We have strong concerns about the potential for automatic, across-the-board Medicare spending cuts because they are not consistent with meeting the medical needs of patients, which is our primary focus. The AMA urges President Obama and Congress to work with the medical profession on patient-centered reforms.
"Like all Americans, physicians appreciate the urgent need to get the nation's fiscal house in order, and we are willing to do our part. The AMA is actively engaged in developing and promoting new health care payment and delivery models to promote high-quality, cost-effective care for all patients, including those on Medicare."
AHA's Umbdenstock is concerned by what he terms "formula-driven, arbitrary budget targets could result in across-the-board cuts to healthcare. We will continue to oppose the use of this trigger that could impede patients' access to care and further exacerbate the "cost-shift," which would increase healthcare costs to employers and other purchasers of private coverage."
Obama's plan also clamp down on states' use of provider taxes to lower their own spending while not providing additional health services through Medicaid.Once again AHA's Umbdenstock takes issue. "Curtailing this option will result in less funding and even more pressure to cut Medicaid, jeopardizing services to the poor and the disabled."
Another area targeted isspending cuts is prescriptions drugs.President Obama proposes that Medicare leverage its purchasing power to reduce costs. He would also like to implement management of high prescribers and users of prescription drugs, speed up the availability of generic biologics, and prohibit brand-name companies from entering into "pay for delay" agreements with generic companies.
President Obama on Wednesday presented a plan aimed at reducing the federal deficit by $4 trillion over the next 12 years. Healthcare will be expected to contribute its share with changes in the Medicare and Medicaid programs accounting for$480 billion in savings by 2023 and another $1 trillion in savings by 2033.
In a speech delivered at George Washington University, the President outlined in broad strokes the steps his administration will take to reduce healthcare costs. He said passage of the Accountable Care Act will reduce the deficit by $1 trillion and that his deficit reduction proposal will build on that success. He said that savings in the Medicare program will involve reducing wasteful subsidies and erroneous payments, and cutting spending on prescription drugs.
President Obama also proposed capping the growth of Medicare spending per beneficiary and strengthening the Independent Payment Advisory Board, a 15-member commission of doctors, nurses, medical experts, and consumers who recommend ways to reduce spending.
In a nod to the Partnership for Patients program announced by the Department of Human Services on Tuesday, the president said "we will change the way we pay for health care, not by procedure or the number of days spent in a hospital, but with new incentives for doctors and hospitals to prevent injuries and improve results.
The President made it clear that he will oppose efforts by Rep. Paul Ryan(R-WI) to reduce the deficit by recreating Medicare or Medicaid. "Their plan lowers the government's healthcare bills by asking seniors and poor families to pay them instead. Our approach lowers the government's healthcare bills by reducing the cost of healthcare itself."
Obama's defense of the Medicare and Medicaid programs was more emphatic later in the speech: "I will not allow Medicare to become a voucher program that leaves seniors at the mercy of the insurance industry, with a shrinking benefit to pay for rising costs. I will not tell families with children who have disabilities that they have to fend for themselves. We will reform these programs, but we will not abandon the fundamental commitment this country has kept for generations."
President Obama's willingness to reduce Medicare drew the ire of the American Medical Association. In a statement issued by her office, Ardis D. Hoven, MD and AMA chair released a statement expressing "strong concerns about the potential for automatic, across-the-board Medicare spending cuts because they are not consistent with meeting the medical needs of patients, which is our primary focus. The AMA urges President Obama and Congress to work with the medical profession on patient-centered reforms."
A White House fact sheet available here provides additional details of how costs will be reduced and savings achieved. Among the highlights:
Set a new target of Medicare growth per beneficiary as the gross domestic product plus 0.5%. According to the fact sheet this is consistent with the reductions in Medicare spending since ACA passed and the new Medicare proposals included in the president's speech.
Address the drivers of Medicare cost growth by providing the Independent Payment Advisory Board with additional enforcement measures. The IPAB, which was created by the Affordable Care Act, analyzes the drivers of excessive and unnecessary Medicare cost growth and recommends to Congress policies to reduce the rate of growth.
Replace the patchwork of federal matching formulas with a single matching rate that rewards efficiency for the Medicaid and the Children's Health Insurance e Plan program.
Work with the National Governors Association to develop recommendations to reform and strengthen Medicaid.
Incentivize more efficient, higher quality care for high-cost Medicaid beneficiaries, including those who are eligible for both Medicaid and Medicare.
Improve patient safety through the Partnership for Patients, a public-private partnership focused on preventing patients from getting injured or sicker while they are in the hospital and helping patients heal without complication. Achieving the initiative's goals means more than 1.6 million patients will recover from illness without a preventable complication and costs will be reduced by up to $50 billion in Medicare and billions more in Medicaid over the next 10 years.
Cut unnecessary prescription drug spending by leveraging Medicare's purchasing power and by implementing management of high prescribers and users of prescription drugs.
Reduce abuse and increase accountability in Medicaid and Medicare, recover erroneous payments from Medicare Advantage, and establish upper limits on Medicaid payments for durable medical equipment.
In addition to the healthcare cuts, the president proposed a reduction in domestic spending to save $750 million; additional efforts to identify waste in the defense department budget; and to reduce spending in the tax code by not renewing the tax cuts for the wealthiest Americans.
In the overheated rhetoric surrounding the state of healthcare in America, there is one concept nearly everyone can agree on: Costs are too high. The trouble, of course, comes in finding a way to get those costs to come down.
I'm convinced we've been looking in the wrong places. Real relief from the pain of high healthcare costs won't come from financial juggling. Rather, it will come from improving health, reducing hospital-based harm, and delivering better quality care.
Department of Health and Human Services Secretary Kathleen Sebelius announced Tuesday a $1 billion patient safety initiative aimed at doing just that. The Partnership for Patients program aims to save lives and reduce hospital readmissions by 20% over the next three years. It also has a goal of reducing hospital-based harm by 40%. Along the way the program could save as much as $35 billion in healthcare costs.
During the rollout of PFP, Donald Berwick, MD, who heads the Centers for Medicare & Medicaid Services, talked about the systemic change in hospital processes that will be necessary to achieve these goals. He noted that the effort will require the clinicians, physicians, nurses, and hospital leadership to work together to reduce medical errors.
What struck me about PFP is how program announcements often exist in a parallel universe in Washington, D.C. While Berwick and Sebelius were touting PFP as a program made possible by the Accountable Care Act, congressional staffers were back in their offices reviewing yet another proposal to defund the ACA.
Paul Ryan, (R- WI) who chairs the House budget committee, has presented a budget proposal to reduce the federal deficit by trillions of dollars. His plan would privatize Medicare, convert Medicaid to a community block grant program, and eliminate any funding for the implementation of healthcare reform.
I'm not going to dissect his proposal here because that has already been done by others, but I will make this suggestion to Rep. Ryan: Stop focusing on the money and think about the care.
Improving health, lowering cost, and saving lives is Donald Berwick's mantra. He contends that we won't improve medical care by cutting costs, but we will get there by improving the process of delivering care.
That message seems lost in all of the political posturing that regularly takes place around the federal budget debates.
Among the suggestions bandied about to reduce Medicare costs is to increase the beneficiary share of the Medicare Part B premium, which covers doctor visits and other outpatient services. Some think it might be a good idea to add copayments for home health services or for the first 20 days of a stay in a skilled nursing facility.
I'm sure the people who support these ideas can throw around some impressive numbers about how much this or that change will save taxpayers. But are these "savings" a Bandaid or a cure? How does increasing the cost of seeing a doctor help make someone healthier? And what is accomplished by adding copays to home healthcare or stays at an SNF?
I am beginning to agree with Berwick that we are looking in all the wrong places for healthcare cost relief. Our politicians seem to focus on a quick fix that can be touted in a media sound bite along the lines of "implementing these changes will save the American taxpayer money without affecting the delivery of healthcare services."
Wouldn't it be better to take a longer view and resolve the problems that send a patient to a doctor or a SNF in the first place? If reducing surgical site infections or central line-associated bloodstream infections or ventilator-associated pneumonia will mean fewer trips to a doctor or lower readmission rates at a hospital then those are probably the areas where we should be focusing our collective medical expertise and political clout.
Resolving these medical concerns will take time. The Partnership for Patients is looking at a three-year window to implement process changes that will reduce costs and save lives. That's a long-time in the world of politics, but it's a short time for hospitals to put in place policies that will have such a far reaching effect on healthcare costs.
Department of Health and Human Services Secretary Kathleen Sebelius has announced - a $1 billion patient safety initiative aimed at saving lives and reducing hospital readmissions .
Partnership for Patients is public-private collaboration that includes hospitals, employers, health plans, physicians, nurses and patient advocates, Sebelius said Tuesday in a webcast. PFP will focus on hospital safety with the goal of reducing patient care injuries by 40%, saving 60,000 lives, and reducing hospital readmissions by 20% over the next three years
The $1 billion in federal funding for the initiative will be made available under the Affordable Care Act. Today, Effective immediately, $500 million was made available through the Community-based Care Transitions Program. Up to $500 million more will be dedicated from the Centers for Medicare & Medicaid Services Innovation Center to support demonstrations related to reducing hospital-acquired conditions.
In addition to saving lives, Sebelius touted PFP's potential to save up $35 billion in healthcare costs, including up to $10 billion for Medicare alone.
More than 500 hospitals, as well as physicians and nurses groups, consumer groups, and employers have agreed to commit to the new initiative.
"Americans go the hospital to get well, but millions of patients are injured because of preventable complications and accidents," said Sebelius. "Working closely with hospitals, doctors, nurses, patients, families and employers, we will support efforts to help keep patients safe, improve care, and reduce costs. Working together, we can help eliminate preventable harm to patients."
Hospitals will focus on nine types of medical errors and complications where the potential for reductions in harm rates has already been demonstrated by other hospitals and systems. These areas include adverse drug reactions, pressure ulcers, childbirth complications and surgical site infections.
CMS will help hospitals adopt evidence-based care improvements to target preventable patient injuries. Members of the partnership will identify specific steps they will take to reduce preventable injuries and complications in patient care. CMS chief Donald Berwick, MD, said efforts will include an organized method of sharing information on best practices on a national level.
Sebelius and Berwick each noted that incentives to participate in the program will include a payment system that rewards best care.
URAC, an independent healthcare accreditation and education organization, has opened a call for public comment on the performance measures proposed to be added to its accreditation standards for health plans.
The performance measures were developed by several stakeholders, including the Centers for Medicare & Medicaid Services, the Agency for Healthcare Research and Quality, the American Medical Association, and the Pharmacy Quality Alliance.
Alan Spielman, president and CEO of URAC said in a statement that the goal is "to focus on measures that are meaningful and relevant for consumers, health plans, and purchasers."
The performance measures open for comment fall into several domains including:
Care coordination
Effectiveness of care
Efficiency
Healthcare disparities
Health information technology integration/meaningful use
Health plan administration
Patient centeredness
Patient safety
The measures are designated as either mandatory or leading. Mandatory measures must be met in the accreditation process; leading measures are state-of-the-art or cutting edge and don't have an established industry standard to meet.
For the efficiency domain assessing the number of low birth weight infants per 100 births is a mandatory measure while assessing the number of hospital admissions for long-term diabetic complications per 100,000 population is a leading measure.
Consumers, employers, healthcare management organizations, health plans, purchasers, policy makers and others are asked to comment here. The deadline for public comment is May 20, 2011 at 6:00pm.
Comments should focus on the measure classification (leading vs. mandatory), measure specification and whether the measure should be used to evaluate the performance of health plans, health networks or health insurance exchanges.
URAC accredits almost 70 health plans with 120 million lives across the U.S. Its accreditation standards include quality benchmarks for network management, provider credentialing, utilization management, quality management and improvement, and consumer protection.
Healthcare systems have a message for physicians: We want you!
“We are hearing from search consultants that about 20% of their C-suite placements are going to physician executives,” explained Don Hutton, president of MEDI, a Jacksonville-Fla.-based executive placement and leadership development firm.
He says accountable care organizations are a big draw for physicians. “Hospitals and health systems want physician leadership for their ACOs because much of what needs to be accomplished under healthcare reform will need to be physician-driven.”
Hutton pointed to goals such as improving clinical outcomes and lowering medical costs that need strong physician leadership to be achieved.
While demand for physician executives is growing, Hutton said it’s still hard to find physicians who fit the executive mold.
Last year MEDI teamed with researchers in the University of North Florida’s health administration program to try and quantify the core competencies for physician executive leadership. An online survey of 4,000 healthcare executives and physicians across the country produced a list of 12 behavioral characteristics that were deemed most important for a physician executive leader to possess to be successful.
The list includes the usual suspects: integrity; trust and respect; ability to develop relationships; communications skills; and judgment. But it also brings a twist to other competencies that might be difficult for some physicians to fully embrace, including:
Conflict management. Ability to deal with conflict by encouraging the expression of different viewpoints and to collaboratively resolve conflict.
Accountability: Ability to hold leaders and employees accountable for their actions and establish a culture of fair accountability that allows for mistakes when innovating.
Collaborative facilitation. Ability to bring together the right people to transform vision into reality; facilitate groups to articulate and question underlying assumptions; and facilitate team members to make important decisions and set goals.
Motivation: Ability to share knowledge and experience to help motivate others; and demonstrate a clear willingness to address individual needs of employees.
Strategic perspective: Ability to demonstrate flexibility and creativity in meeting new challenges; develop strategy for long?term success; identify efforts that will have the greatest strategic impact; and use the organization's strategies as a guidepost for conducting day?to?day activities.
Adaptability: Ability to adapt to changes in situations/direction/people; and be flexible when considering options/opinions.
Hutton said he sees the list as a resource for physicians who are trying to develop their executive skills as well as a resource for health systems and hospitals looking to hire physician executives. He also sees the core behavioral competencies as a way for existing physician executives to measure their success in the C-suite.
Arizona governor Jan Brewer has generated a lot of press lately and a lot of jokes with her proposal to require some of the state's Medicaid members pay an annual $50 fine for engaging in certain unhealthy behaviors like being obese and smoking.
Google "Arizona + obesity" and more than 6.8 million results from last week appear concerning Brewer's fee proposal along with plenty of references to a so-called flab-and-fat tax.
I have no opinion about the fairness of a flab tax, but it does make me think about how easily our national debate about healthcare can be bogged down and distracted by some nickel-and-dime proposals. If every man, woman and child in Arizona's Medicaid program paid the fine the state's coffers would swell by $50 million, which is a drop in the state's annual $8.9 billion Medicaid budget.
Meanwhile, according to a recent study, three words cost our healthcare system several billion dollars each year. "Dispense as written," or DAW is used by some physicians to avoid the generic equivalent of brand name drugs. Some states allow the patients themselves to request a brand name drug even if the prescribing physician will allow generics.
Researchers at Harvard University, Brigham and Women's Hospital and CVS Caremark studied 5.6 million prescriptions for 2 million patients. Here is what they discovered:
Some 4.7% of the prescriptions were designated as DAW.
For the most part physicians, used DAW when no generic alternatives were available.
In 2% of the prescriptions, patients opted for brand name drugs even when a generic version was available and the physician approved the substitution.
The reaction by insurers is mixed. Some fill the prescriptions and move on while others have policies in place that require preauthorization for DAW medications. At some health plans the enrollee must pay the difference in the cost between an equivalent generic and the requested brand name drug.
With 3.6 billion prescriptions filled in the U.S. each year, researchers estimate that DAW instructions could increase prescription costs by $1.2 billion annually and cost our healthcare system $7.7 billion.
That's a big chunk of the national healthcare bill, but even more worrisome is the idea that some patients aren't even filling DAW prescriptions. Researchers have found that patients who asked their physicians to write brand-only prescription were less likely to fill the prescription when they discovered that a generic version couldn't be substituted.
As you might expect, most of dispense-as-written prescriptions are written by physicians who are older, as are the DAW patients. While it is important for physicians to be able to prescribe the drugs their need, it is possible that generic drug education for both physicians and patients might help reduce the need for DAW. With all of the pharmacy statistics collected by pharmacy benefits managers and health plans, this could be a slam dunk.
'Dispense as written' is not nearly as captivating a term as a 'flab tax.' You are probably not going to hear about it on the nightly news, but with its potential economic wallop, it deserves some attention.
