Friday catch-up

I can’t remember a busier and more portentous week in healthcare in the last thirty years.

Last few weeks, in fact.  A lot happened in the rest of the world while we (at least us wonks) were obsessing over the latest news from Capitol Hill. Here are some of the highlights

When hospitals are going thru inspections by their accrediting agency, fewer patients die. That’s the finding of a study published in JAMA.  (thanks Steve Feinberg MD!) While the percentage reduction was small, the impact was not – if the lower rate prevailed for an entire year across all hospitals, 3,500 fewer Medicare beneficiaries would die – and likely thousands more younger folk. Why?

I’d suggest the Hawthorne Effect is at play: A researcher hypothesized the decrease may be more diligence.

“when docs are being monitored, the focus and attention placed on clinical care goes up. I’d say it was figuring out the diagnosis and matching the treatment correctly, because you’ve been a little more thoughtful.”

Telemedicine prices are going up – from less than $35 per consult in 2009 to around $43 these days.  That’s one of the findings from a research report authored by IBISWorld’s Anna Son.  More details on this in a future post.

The American Chronic Pain Association has just published the updated 2017 ACPA Resource Guide to Chronic Pain Management: An Integrated Guide to Medical, Interventional, Behavioral, Pharmacologic and Rehabilitation Therapies. Another shout-out to Dr Feinberg, Lead Author.

A piece I missed a few weeks back had this striking datapoint – fully 10 percent of claims at the Hartford had at least one psychosocial issue – those claims accounted for 60 percent of claims costs – and claims processes aren’t set up to identify these early on. This from friend and colleague Tom Lynch:

“It takes way too long for adjusters, nurses, and case managers to come to the conclusion that something is going on there. It has been the last thing they look at, and by the time they see it, it’s an iceberg straight ahead and they are about to hit it.”

I’ve been talking about the huge problem of opioids combined with benzos aka sedative hypnotics for some time now.  Mitchell Pharmacy Solutions’ Mitch Freeman PharmD. sent me the latest FDA blackbox warning – and reminded me that this is a much bigger issue than that involving combinations of opioids and certain antidepressants.

Finally, good friend and colleague Sandy Blunt of Medata did his usual incredibly competent assessment of a report, and drew some startling – and terrifying – conclusions.

I am still stuck on the math from an article early this year (“A Charleston Gazette-Mail investigation found drug wholesalers shipped 780 million hydrocodone and oxycodone pills to West Virginia in six years, a period when 1,728 people statewide fatally overdosed.”). The math is staggering on averages. How can anyone with a straight face say they could only recommend a 0.001% suspicion rate to the DEA. 

If the WV state avg pop from Census data during this time was about 1.84m and 780m pills were consumed over six years then each and every man, woman, and child in WV statistically consumed 1.36 pills a week –every citizen, every week of the year, for six years without ceasing. If we consider that 20% of the population was under 18 and adjust our data to exclude this group, then each and every man and woman 18 and up in WV had 1.7 pills a week. 

Even more disturbing is that this was just (“JUST”) for hydrocodone and oxycodone pills and did not include drugs such as codeine, fentanyl, hydromorphone, meperidine, methadone, or morphine …

This from the Gazette-Mail article:

Between 2007 and 2012 — when McKesson, Cardinal Health and AmerisourceBergen collectively shipped 423 million pain pills to West Virginia, according to DEA data analyzed by the Gazette-Mail — the companies earned a combined $17 billion in net income.

Over the past four years, the CEOs of McKesson, Cardinal Health and AmerisourceBergen collectively received salaries and other compensation of more than $450 million.

In 2015, McKesson’s CEO collected compensation worth $89 million — more money than what 2,000 West Virginia families combined earned on average. [emphasis added]

McKesson Corp CEO John Hammergren tees off on the 17th hole during the first round of the Pebble Beach National Pro-Am golf tournament in Pebble Beach, California, February 12, 2015. REUTERS/Michael Fiala (UNITED STATES – Tags: BUSINESS SPORT GOLF)

Thank you, for-profit healthcare system!

2 thoughts on “Friday catch-up

  1. Bernie Sanders recently went to WV, and spoke to a town hall of supporters of Number 45, and they all said the same thing about the opioid problem there. But I don’t know if Sanders explained to them in simple terms why coal is bad, why their jobs are gone and why the coal companies are still mining coal without them. One political figure there (Democrat) even said he voted for Number 45, and yet would do so again. They all said they favor universal health care, but vote for politicians who don’t. And you wonder why they are being dumped on with pills?

  2. I was with you 100% until that last sentence where you blame capitalism, you lost me there, so I can only give 4.5 out of a possible 5 stars. Don’t feel too bad, that’s a pretty good score.

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