Civil War: healthcare edition

The formula for rising healthcare costs in the US is filled with a bunch of pointed fingers lately. One finger is being pointed at drug maker Kaléo (no, not that Kaleo) by pharmacy benefit manager Express Scripts. They’re suing Kaléo over its price hikes on a heroin/painkiller overdose treatment. According to Express Scripts, these hikes triggered price protection rebates owed to Express Scripts, which total around $14 million—most of the lawsuit. The PBM has successfully sued larger drug companies like Horizon, so Kaléo may be at a bit of a disadvantage here. Especially since Express Scripts could use the extra cash to deal with the fingers pointed at it, including one $15B lawsuit by its (soon-to-be former) largest customer, the insurance provider Anthem.

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Protecting access to doctors’ wallets

A bill proposed in the U.S. House of Representatives, the Protecting Access to Care Act of 2017, would cap noneconomic damages in medical malpractice cases to $250,000. Many healthcare organizations are giving this bill a huge thumbs-up since it’ll allow them to focus less on so-called defensive medicine, bringing down healthcare costs. It also proposes protecting health care providers from being affected by product liability lawsuits against products approved by the FDA. However, opponents argue that it will deny plaintiffs the ability to get full repayment for wrongdoings. It hasn’t been put up for a full House vote yet, but this is definitely an interesting bill to watch. No word yet on if it will protect HCPs from relentlessly insulting anesthetized patients.

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Let’s hope that 5th x-ray was necessary…

Newsflash, physicians who spend more on hospitalized patient care saw no improvement in patient outcomes compared to those who spend less. The study, conducted by the Harvard School of Public Health, analyzed Medicare spending across 72,000+ physicians and 3,000+ hospitals, tracking mortality and readmission rates over a 3-year-period. Researchers not only found that spending varied more across individual physicians than across hospitals, but also the cost of tests, imaging studies and other procedures varied up to 10.5% among doctors. More spending with no decrease in patient mortality or hospital readmission rates. The US has long taken the cake for wasteful healthcare spending. Needing what we buy? That’s just crazy.

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2. You can’t have your telecake and eat it too

As we’ve mentioned a couple times in previous InsightCity stories, telemedicine is still trying to get its little telewings off the ground as a means of driving down healthcare costs. The whole idea behind it is patients (particularly rural ones) can use telemedicine to communicate with their healthcare providers without having to visit in-person. Which is a great idea on paper… if those patients aren’t also visiting in-person. Get it? They’re doing both! A study published in HealthAffairs detailed the phenomenon, and explained that this kinda defeats the whole point of telemedicine because it effectively drives healthcare costs up. Telemedicine: providing you the opportunity to space out during your physician’s instructions both in the clinic, and from your own home!

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1. About that new drug you wanted…

Beginning in April of this year, NHS England will have the ability to withhold patient access to select approved medicines, according to The Times. Even if NICE considers a new drug of appropriate value, it may be withheld or rationed if it costs the NHS more than £20 million per year. While this might not be too alarming for those seeking help to lower cholesterol, the prospect of a drug being withheld for a rare disease – even if it is considered good value – is no bueno. Or what if one of the many potential Alzheimer’s drugs in development works? The size of the addressable patient population could make the £20 million threshold look puny. Stay tuned for more unpopular decisions to come.

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5. You’ve got to be kidney me

What’s super-fun, kinda scary and has the potential to save the US almost $4B in healthcare costs a year? Rollercoasters, duh. An interesting discovery by Dr. David Wartinger, a urological surgeon who has dealt with kidney stones for decades, was that upon returning from summer vacations to amusement parks his patients came back with fewer kidney stones. Curious about the possibility, he designed a little study, made a model of a kidney and hit the coasters. When riding in the back of the coaster, the model kidney passed the stone ~64% of the time. Armed with some foundational evidence to prove the concept, Dr. Wartinger has planned out a prospective clinical trial to see if the results can be validated.

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