Dec
18

Opioid deaths up…Perdue family completely blameless

Two members of the Perdue family, the folks who made tens of billions of dollars addicting patients to dangerous drugs, testified before Congress yesterday.  Both averred there was nothing they could have done to avoid/prevent the damage their company did.

Yesterday the CDC reported 81,230 drug overdose deaths occurred in the United States in the 12-months ending in May 2020.

Quoting the CDC:

This represents a worsening of the drug overdose epidemic in the United States and is the largest number of drug overdoses for a 12-month period ever recorded.

The Perdue family’s complicity in this national disaster is obvious and damning to everyone but the billionaires who’ve parked more than $10 billion of their profits from drug dealing offshore, safe from recovery efforts by American law enforcement and Perdue’s victims.

This from Kathe Perdue:

“I have tried to figure out, was there anything that I could have done differently? Knowing what I knew then — not what I know now?” said Dr. Sackler, who served on the board from 1990 to 2018. “There’s nothing that I can find that I would have done differently based on what I believed and understood then.”

Perdue on the Board through 2018, many years after Perdue Pharma’s criminal sales practices had been prosecuted, fines paid, settlements authorized. She was on the Board in 2007 when it authorized a $600 million settlement to resolve just one set of charges.

Oh, that represented 1/50th of the family’s net worth.

Two conclusions are possible – and only two.

Either Ms Perdue really couldn’t think of anything she could have “done differently” to stop her company’s ongoing, continuous and highly effective efforts to addict people, or she’s a bald-faced liar.

In the first instance, she’s a psychopath.

In the second, she lied to Congress.

What does this mean for you?

When are you going to sue these bastards for what they’ve done to your customers, employees, members, and organization?

Thanks to Steve Feinberg MD for the heads up on the CDC data.


Nov
12

COVID facts and implications

This is getting real.

I woke this morning to the news that COVID has infected well over 10 million of us and killed almost a quarter million of our mothers, fathers, daughters, siblings, and grandparents.

Worse, the infection rate in the Midwest and Great Plains is exploding

As is the overall US infection rate…

If anything, the trend line is worse than it appears, as it is an average of the last 7 days. With daily new case counts rising rapidly (Wednesday’s count was 142,755), this third wave is looking more like a tsunami.

Latest research

The CDC is finally putting on its big boy pants…

CDC recommends community use of masks, specifically non-valved multi-layer cloth masks, to prevent transmission of SARS-CoV-2.

Wow…who would’ve thunk it??

Research determined that wearing masks protects the wearer as well as those around them. From CDC:

An investigation of a high-exposure event, in which 2 symptomatically ill hair stylists interacted for an average of 15 minutes with each of 139 clients during an 8-day period, found that none of the 67 clients who subsequently consented to an interview and testing developed infection. The stylists and all clients universally wore masks in the salon as required by local ordinance and company policy at the time.

Make sure your masks:

  • have multiple cloth layers and/or
  • are made of silk or
  • polypropylene.

Vaccine progress

The NYTimes’ excellent – and constantly updated – vaccine progress tracker reports there are:

  • no vaccines currently approved for wide use;
  • 6 vaccines approved for early or limited use; and
  • 11 more in large scale efficacy (does it work?) testing.

Pfizer’s vaccine shows a lot of promise, with early results from a large study indicating it was 90%+ effective in “preventing the disease in individuals with no prior history of the disease.”

The vaccine has some significant logistical challenges which will make distribution tricky indeed; it:

Notably, Pfizer did not take any taxpayer money to fund its research, and its executives specifically stated the company is not participating in “Operation Warp Speed.”

Hospitals in ten high-infection states are at or beyond capacity.  From the Atlantic;

According to local news reports, hospitals are already on the brink of being overwhelmed in IowaKansasMinnesotaMissouriMontanaNorth DakotaTexasUtah, and Wisconsin,

Implications

Expect a return to limited availability of facility-based medical services. Hospitals are going to have to cut back on elective services to maintain capacity.

More states will mandate restrictions on group gatherings and business operations. New York has already done so, along with North Dakota and I’m sure several others.

There will be significant economic effects.

What does this mean for you?

If everything goes well, by spring 2021 – that’s late March – there may be enough of us vaccinated to slow the virus’ spread.

Be responsible. Wear a mask.

 

 

 

 


Oct
30

It’s not a good time to be a hospital.

Lots happening this week, much of which was lost in the pre-election madness.

From Becker’s, a list of the 16 rural hospitals that shut their doors this year; over the last decade 133 have closed.  Most are in the South.

States that didn’t expand Medicaid figure prominently, accounting for 12 of the 16 closures. More than two dozen hospitals in Kentucky are at risk; the state’s decision to expand Medicaid took effect in June of this year, but the years of financial hardship will prove to be too much of a burden for some.

Expect more closures in the coming months.

One small contributor; now that PPE manufacturing is moving stateside, facilities’ costs will increase. That adds another straw to the camel’s back.

What does this mean for you?

Longer drives to get care if you live in a rural area, and hospitals looking everywhere for revenue to make up for losses.


Oct
27

More hospital consolidation = higher prices

The only demonstrable impact of facility consolidation is higher prices.

There’s also solid evidence that more concentrated health care markets are associated with lower health care quality.

While the number of deals dropped by about 21% in the first half of this year as everyone’s attention focused on COVID and the impact thereof, a number of transactions still took place.  Conversely, several deals in process totaling around $23 billion were abandoned, victims of a variety of challenges.

Consolidation may actually accelerate as facilities hammered by the financial impact of COVID19 seek safe harbors.

The latest consolidation is in the north-central part of the nation, with 2 not for profit systems working on an a deal driven in large part of a desire to help the systems expand their footprint.

I’d expect more, although the increasing number of facility closures may well put a damper on deals as some run out of time.

This is particularly damaging in rural areas, where over a hundred hospitals have shut their doors over the last decade.

From Bob Shepard, UAB

What does this mean for you?

There will be fewer hospitals tomorrow than today, which likely means higher prices.


Oct
22

COVID update – where we are today v2

Had a posting issue yesterday; email notifications did not go out to all subscribers – reposting this  – apologies if you already received this.

A big increase in coronavirus infections is here, one that may eclipse the first two waves that struck the country, swamping schools, businesses, governments…all of us.

from JHU, based on Covid tracking project data

In some ways, we are in a far better position to manage this wave than we were back in March.

We know that masks and physical distancing (way better term than “social distancing”, which, frankly, is awful) work.

Medical professionals know a lot more about treating people with COVID. This knowledge was hard-won indeed, the price incalculable at 212,000 dead moms, dads, kids, brothers, sisters, dear friends, grandparents, and colleagues.

We know effective contact tracing and quarantine limit the spread, AND make societal shut-downs unnecessary.

In other ways we are little better off than we were in March. Back then the hot spots were limited to a few metro areas in a handful of states; now the biggest spread is in North and South Dakota, Montana (!), Wisconsin, Idaho and Nebraska, with local hot spots in many other states.

It hasn’t helped that COVID has become politicized and science ignored or denigrated.

We are still woefully lacking in the number of tests administered, how fast results come back, and how accurate tests are.

We’re averaging about a million tests a day, which sounds great, until you realize we need more than 6.5 million tests a day.  Worse still, many tests are all but useless as it takes far too long to get results, and there are too many false positives and false negatives.

And the burden isn’t equally shared. We have lost at least 41,583 Black lives to COVID-19 to date. Black people account for 20% of COVID-19 deaths where race is known. (13% of the population) The death rate for minorities – Hispanics and Native Americans in particular – are much higher than it is for Whites.

What does this mean for you?

Wear a mask. Physically distance.


Oct
21

COVID update – where are we today.

A big increase in coronavirus infections is here, one that may eclipse the first two waves that struck the country, swamping schools, businesses, governments…all of us.

from JHU, based on Covid tracking project data

In some ways, we are in a far better position to manage this wave than we were back in March.

We know that masks and physical distancing (way better term than “social distancing”, which, frankly, is awful) work.

Medical professionals know a lot more about treating people with COVID. This knowledge was hard-won indeed, the price incalculable at 212,000 dead moms, dads, kids, brothers, sisters, dear friends, grandparents, and colleagues.

We know effective contact tracing and quarantine limit the spread, AND make societal shut-downs unnecessary.

In other ways we are little better off than we were in March. Back then the hot spots were limited to a few metro areas in a handful of states; now the biggest spread is in North and South Dakota, Montana (!), Wisconsin, Idaho and Nebraska, with local hot spots in many other states.

It hasn’t helped that COVID has become politicized and science ignored or denigrated.

We are still woefully lacking in the number of tests administered, how fast results come back, and how accurate tests are.

We’re averaging about a million tests a day, which sounds great, until you realize we need more than 6.5 million tests a day.  Worse still, many tests are all but useless as it takes far too long to get results, and there are too many false positives and false negatives.

And the burden isn’t equally shared. We have lost at least 41,583 Black lives to COVID-19 to date. Black people account for 20% of COVID-19 deaths where race is known. (13% of the population) The death rate for minorities – Hispanics and Native Americans in particular – are much higher than it is for Whites.

What does this mean for you?

Wear a mask. Physically distance.


Oct
16

COVID update – statistics, your state, treatment, and misinformation

It’s been a while since we dove into the latest research on COVID. Here’s a summary of where things stand.

“Cures”

Today there are no “cures” for COVID19. More accurately, no drugs or treatments have been proven to “cure” the disease.

A just-released study found that four drugs commonly used to treat hospitalized patients – anti-viral Remdesivir, hydroxychloroquine, Interferon, and Lopinavar:

appeared to have little or no effect on hospitalized COVID-19, as indicated by overall mortality, initiation of ventilation and duration of hospital stay.”

The study was international in scope, used a randomized control format (a rigorous and well-regarded methodology), and enrolled over 11 thousand patients. Note the study has NOT yet been peer-reviewed

Gilead – manufacturer of remdesivir – disputed the study’s findings, which found:

no drug or combination reduced mortality, the chances that mechanical ventilation would be needed, or time spent in the hospital, compared with the patients without drug treatment. (NYTimes)

There are some indications that remdesivir may provide some benefit if administered early in an infection where it can tamp down the body’s immune response – which can be counter-productive.

Data

The US has administered over 119 million tests. About 8 million of us have been infected.  And 210,000 have died.

Black people are dying at more than twice the rate of White people. Other minorities are also dying at a far higher rate.

You can track infections, tests, and deaths in your state here.

The infection rate is climbing – again – especially in the Dakotas, Montana, Nebraska, Wyoming, Rhode Island, and New Mexico. (the darker the color, the higher the infection rate)

Debunking the claim that COVID death rates are “inflated”

Some have claimed that COVID death rates are inflated as many folks that died of COVID had other major health conditions – COVID deniers have been spreading this lie in an attempt to downplay the disastrous effects of COVID.

The CDC’s definition of the underlying cause of death is “the condition that began the chain of events that ultimately led to the person’s death.”

Think of it this way – if a person infected with COVID gets hit by a truck and killed, the cause of death will be listed as Motor Vehicle Accident – NOT COVID.

Similarly, if a person with COVID, hypertension and diabetes falls down the stairs and dies, the cause of death will be listed as “accidental fall”, NOT COVID

So, if a person with COVID, hypertension and diabetes dies after being admitted to the hospital, placed on a ventilator, given remdesivir, and administered oxygen dies, the cause of death will be listed as COVID.

What does this mean for you?

Wear a damn mask. Wash your hands.


Oct
14

Hospitals – it’s not just about the cost

All hospitals are NOT alike – and there’s a quick and highly credible way to identify the facilities highest-rated for quality – and those on the other end of the scale.

The Center for Medicare and Medicaid Services (CMS) has an online tool that allows you to review hospitals’ overall Star ratings. CMS uses a 1-5 star rating metric with the more stars the better.

Here’s how hospitals within 25 miles of Tampa FL stack up.

The overall rating is based on a set of specific ratings that address key measures including:

  • clinical outcomes;
  • patient safety;
  • patient engagement; and
  • cost.

There are a number of “sub-measures” that make up each category, one of particular interest may be facility-associated infections and other safety indicators. Information on timeliness and effectiveness of care is here.

You can download data on each and every hospital reporting to CMS or just pick the facilities of interest; the data is here.

CMS just completed a broad and deep assessment of patient impressions of hospital outpatient services and Ambulatory Surgery Centers; you can find results for individual outpatient facilities here and ASCs here.

For those seeking highly credible data on hospital costs, RAND’s latest research makes data highly accessible.

What does this mean for you?

If you aren’t assessing facilities’ quality, you should be.


Oct
12

What healthcare costs and what you pay

Individuals and families will spend about a trillion dollars on healthcare costs this year. 

Most of those dollars pay for out-of-pocket costs and your share of employer-sponsored health insurance costs.

For those with employer-sponsored health insurance, annual premiums in 2020 averaged $7,470 for individuals; $21,342 for families.

Average premiums went up 4% this year, continuing the long-term trend of healthcare inflation significantly exceeding overall inflation.

Over the last five years, premiums increased 22%, more than twice the overall inflation rate (10%).

Then there’s out of pocket costs.

Most families with high deductible plans will have to cough up (no pun intended) more than $4,000 before their insurance plan starts paying.

What does this mean for you?

Every year, more and more of your income goes to healthcare.

 


Sep
10

The Trump Healthcare plan explained – briefly

Yesterday we discussed Presidential candidate Joe Biden’s healthcare plan.

Today we’ll do the same for President Trump’s healthcare plan, which was promised to be ready before the upcoming election…

Five times this year President Trump has promised he will unveil a replacement for “Obamacare”. As of this writing, I have not been able to locate any such replacement plan documentation, web pages, policy statements or plan descriptions other than a couple described below. If you have any details, please share in the comments section below.

It’s not just me – Forbes wasn’t able to locate the President’s plan.

So, if you are looking for a brief explanation – you can stop reading here.

For those who want more detail, here it is.

Unfortunately it appears the White House’s healthcare page has not been updated since 2017 so we will have to rely on public pronouncements and speeches.

Trump’s campaign site does have a list of objectives, but no actual plan, policy description, or details on how these will be met:

This has made it rather difficult to analyze Trump’s plan, so we will have to use the President’s pronouncements to assume what his plan will be. Please note that wherever possible I have cited official White House or Trump Administration sources below.

Pre-existing conditions

The President has repeatedly stated that his plan will require “health insurance companies to cover all preexisting conditions for all customers,” including during a press briefing in early August. In that briefing, Trump stated:

Over the next two weeks, [emphasis added] I’ll be pursuing a major executive order requiring health insurance companies to cover all pre-existing conditions for all customers. That’s a big thing. I’ve always been very strongly in favor — we have to cover pre-existing conditions. So we will be pursuing a major executive order, requiring health insurance companies to cover all pre-existing conditions for all of its customers.

This has never been done before, but it’s time the people of our country are properly represented and properly taken care of.

[note – requiring health insurers to cover pre-ex conditions is imbedded in the ACA (sometimes referred to as Obamacare) and is the law of the land today as that provision of the ACA remains in effect.] source cited is US Dept of Health and Human Services, part of the Trump Administration

Takeaway – taking the President at his word, any new healthcare plan will provide coverage for pre-existing conditions. We do not know if the Trump Healthcare Plan will allow insurers to charge extra for that coverage, or limit coverage to some dollar amount. (that is not allowed under the ACA)

Medicaid changes

Trump has sought to end Medicaid expansion, change funding, and institute work requirements. While these all sound good in sound bites, like many complex issues things sound a lot less good when you peel back the curtain.

Ending the expansion of Medicaid would crush hospital financials, especially in rural, western, midwestern and southern states.  In many areas Medicaid is a critical funding source for facilities; those states that have expanded Medicaid (including deep red Oklahoma) would be in dire straits if the rug was pulled out from under them.

The President has pushed hard to change the way Medicaid is funded to a “block grant” method.  Essentially a block grant is a fixed amount of funding; this would replace part or all of the current funding which is based on a percentage of expenses.

Simple in concept, this is much harder to implement, and completely unsuited to our current situation where Medicaid enrollment is rapidly growing due to the fallout from COVID. We haven’t heard much about block grants of late from the President, so not sure if they are still under consideration.

The same is true for work requirements. Many low income folks don’t have internet access, which is required to submit the detailed documentation required under state Medicaid work requirements. Then they need reliable transportation to get to work – which many don’t have. And there are few jobs available these days in many states due to COVID.

Takeaway – Trump wants to end Medicaid expansion, change its funding mechanism, and require some recipients to work. It is highly doubtful any of this will happen.

Drug prices

The President has authored several executive orders around drug prices, but didn’t follow through on actually implementing those orders.

Trump’s move appeared to be intended to force pharma manufacturers to the bargaining table, but that hasn’t happened. Despite Trump’s statement that he would take unilateral action if pharma didn’t cooperate with him by August 25, he didn’t follow thru on that threat.

More troubling, pharma execs don’t know anything about any meeting or discussion.

Takeaway – no significant action to control drug prices is likely.

What does this mean for you?

It’s really hard to say.