The Role Of Sales Representatives In Driving Physicians’ Off-Label Prescription Habits – Health Affairs Blog

 

Off-label prescribing is widespread in Canada and the United States. One in nine prescriptions for Canadian adults are for off-label uses with the highest percentages coming from anticonvulsants (66.6 percent), antipsychotics (43.8 percent), and antidepressants (33.4 percent). Overall, 79 percent of the off-label prescriptions lacked strong scientific evidence for their use.

For 160 drugs commonly prescribed to U.S. adults and children, 21 percent were for off-label indications totaling 150 million prescriptions. In this case, 73 percent had little to no scientific backing and once again psychoactive drugs such as gabapentin had the highest level of off-label use.

Moreover, doctors do not seem to know what are and are not approved FDA use for many of the drugs that they prescribe. Now an article published in the June issue of Health Affairs by Ian Larkin and colleagues points to active promotion by sales representatives as one reason for the widespread off-label use of antipsychotics and antidepressants in children.

The Role Of Sales Representatives In Driving Physicians’ Off-Label Prescription Habits – Health Affairs Blog

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JAMA Network | JAMA Internal Medicine | The Political Polarization of Physicians in the United States: An Analysis of Campaign Contributions to Federal Elections, 1991 Through 2012

 

Conclusions and Relevance Between 1991 and 2012, the political alignment of US physicians shifted from predominantly Republican toward the Democrats. The variables driving this change, including the increasing percentage of female physicians and the decreasing percentage of physicians in solo and small practices, are likely to drive further changes.

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Figures in this Article

Although few systematic analyses have been conducted on the political behavior of physicians in the United States, it is often assumed that they sit to the right on the political spectrum. Generalizing from the American Medical Association’s strong opposition to the 1965 passage of Medicare, the belief is that physicians share the wariness of Republicans about government interventions, particularly in health care.^1,2 Ostensibly, this outlook persists today.³

Given the scarcity of data and alert to the many changes in the composition and organization of the physician workforce, we examined physician contributions to presidential and congressional political campaigns from 1991 to 2012. Information on campaign contributions to federal elections is publicly available. The data illuminate patterns of support of physicians for Democratic and Republican candidates and how these patterns compare to those for all donors.

Between 1991 and 2012, campaign contributions in the United States increased substantially. Inflation-adjusted to 2012 dollars, contributions from all individuals increased from $716 million in 1991 to 1992 to $4.64 billion in 2011 to 2012, a 6.5-fold increase. Contributions from physicians increased at a greater rate, from $20 million to $189 million, or by nearly 9.5 fold.

We grouped contributions by the 2-year congressional election cycles. There are important differences in voter participation between midterm election years and presidential election years; for example, people with low incomes are less likely to vote in midterm elections.^4(pp130-133) Contributions also varied between midterm and presidential years, with greater contributions in presidential years.

Over our 22-year study period, the composition of the medical profession changed—most notably, there were more female physicians and fewer solo practitioners^{5- 7}—and politics in the United States became increasingly polarized.⁴ We hypothesized that the increased number of female physicians and the changes in medical practice altered the patterns of political partisanship within the profession.

JAMA Network | JAMA Internal Medicine | The Political Polarization of Physicians in the United States:  An Analysis of Campaign Contributions to Federal Elections, 1991 Through 2012

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The gift of hospice - Pittsburgh Post-Gazette

An op-ed I wrote about the difficulty of navigating the hospice benefit in these days of increased scrutiny…

There are those who continue to pose the question: If hospice is meant to be end-of-life care, why do some patients get “discharged?”

The answer is two-fold. One reason is ever-changing patients and illnesses.

A growing percentage of hospice patients have illnesses with outcomes that are hard to predict. In the past, cancer was the dominant hospice diagnosis. Now, the portion of hospice patients with cancer — one of the more-predictable diseases — has declined. Today, non-cancer diagnoses (such as dementia or heart disease) account for more than 63 percent of hospice admissions, according to the National Hospice and Palliative Care Organization.

The other reason for discharge is simply that reputable hospice organizations are paying close attention to the new rules. Most hospices are more careful than ever about the patients they admit and the patients they keep in their care.

The gift of hospice - Pittsburgh Post-Gazette

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What Has PAMED Done to Improve Tort Reform in Pennsylvania?

Pennsylvania has made amazing strides in medical liability reform WITHOUT CAPS! Follow the link to see the  summary of opportunities that other states can pursue without damaging victims’ rights.

What Has PAMED Done to Improve Tort Reform in Pennsylvania?

Most Pennsylvania physicians — more than 93 percent according to a 2009 study published in the Journal of the American Medical Association —report that they continue to engage in defensive medicine as a result of the state’s hostile medical liability environment.

Physicians often ask us, “What has the Pennsylvania Medical Society [PAMED] done to address this problem in the past and what are you doing now to achieve meaningful tort reform in Pennsylvania?”

What Has PAMED Done to Improve Tort Reform in Pennsylvania?

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Navigating Medicare Policy on Physical Therapy and Other Services - NYTimes.com

 

For years, some people on Medicare had difficulty getting insurance coverage approved for physical therapy, occupational therapy and other treatments. The prevailing approach was that if the therapy was not helping to improve a patient’s condition, then it was not eligible for coverage.

“They’d get denied because they weren’t improving, or because they had plateaued,” said Judith Stein, executive director of the Center for Medicare Advocacy, a nonprofit consumer group. The situation was especially difficult, she said, for patients with chronic or degenerative conditions, like Parkinson’s disease or multiple sclerosis.

That is changing, as a result of a 2013 settlement of a lawsuit that the center and others brought against the secretary of the Health and Human Services Department, the parent agency of the Centers for Medicare and Medicaid Services, which oversees Medicare. The suit claimed that Medicare billing contractors were inappropriately denying coverage for “skilled” care by applying an “improvement” standard as a rule of thumb.

Because of the settlement, the agency updated its policy manuals last year. The revisions make clear that if treatment is needed to prevent or slow further deterioration in a patient’s condition, “coverage cannot be denied based on the absence of potential for improvement or restoration.” The update applies to therapy provided in nursing homes, in outpatient clinics and at home. (The agency maintains that the revision was not a change, but was made to “clarify” what had been existing Medicare policy.)

Navigating Medicare Policy on Physical Therapy and Other Services - NYTimes.com

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Hospitals wounded by politics - Opinion - The Times-Tribune

 

Scranton’s three hospitals are among more than one-third of hospitals statewide that lost money in 2013. More than half of the state’s hospitals had profit margins lower than 4 percent for the year, the threshold for sustainability according to the Pennsylvania Health Care Cost Containment Council.

It’s a trend that likely will continue statewide through 2014 and beyond unless the Corbett administration abandons its politically inspired resistance to the Affordable Care Act’s expansion of Medicaid.

The losses have multiple causes, but one key driver is the rising cost of uncompensated care — treatment for patients who have no private or public insurance and cannot pay.

According to the council, known as PHC4, Pennsylvania hospitals provided more than $1 billion in uncompensated care in 2013, a 5 percent increase over 2012.

Gov. Tom Corbett foolishly has rejected a portion of the federal health care law which, in other states that have accepted it, has begun to diminish levels of uncompensated care and provide hospitals with much-needed revenue.

Under the ACA, the federal government pays 100 percent of the cost of Medicaid expansion to cover uninsured low-income workers in the first two years and covers 90 percent of the cost thereafter.

It’s an extraordinary deal for states. In Pennsylvania, it would have pumped about $17 billion into the health care economy through 2019, including about a $1.6 billion direct reduction in the amount of uncompensated care. That reduction likely would be higher because many people now receiving treatment at hospitals would have insurance enabling them to see other providers first.

Hospitals wounded by politics - Opinion - The Times-Tribune

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Medicine’s Top Earners Are Not the M.D.s - NYTimes.com

THOUGH the recent release of Medicare’s physician payments cast a spotlight on the millions of dollars paid to some specialists, there is a startling secret behind America’s health care hierarchy: Physicians, the most highly trained members in the industry’s work force, are on average right in the middle of the compensation pack.
That is because the biggest bucks are currently earned not through the delivery of care, but from overseeing the business of medicine.
The base pay of insurance executives, hospital executives and even hospital administrators often far outstrips doctors’ salaries, according to an analysis performed for The New York Times by Compdata Surveys: $584,000 on average for an insurance chief executive officer, $386,000 for a hospital C.E.O. and $237,000 for a hospital administrator, compared with $306,000 for a surgeon and $185,000 for a general doctor.


And those numbers almost certainly understate the payment gap, since top executives frequently earn the bulk of their income in nonsalary compensation. In a deal that is not unusual in the industry, Mark T. Bertolini, the chief executive of Aetna, earned a salary of about $977,000 in 2012 but a total compensation package of over $36 million, the bulk of it from stocks vested and options he exercised that year. Likewise, Ronald J. Del Mauro, a former president of Barnabas Health, a midsize health system in New Jersey, earned a salary of just $28,000 in 2012, the year he retired, but total compensation of $21.7 million.
The proliferation of high earners in the medical business and administration ranks adds to the United States’ $2.7 trillion health care bill and stands in stark contrast with other developed countries, where top-ranked hospitals have only skeleton administrative staffs and where health care workers are generally paid less. And many experts say it’s bad value for health care dollars.

Medicine’s Top Earners Are Not the M.D.s - NYTimes.com

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