May
16

The VA’s been cooking the books

Richard Eskow of Sentinel Effect reports on the latest revelations about a bit of book-cooking at the VA. Seems the VA has been a bit, or perhaps more than a bit, overly positive about its record.
More troubling than boosterism is the allegation that the VA selectively reported results, and even fabricated conclusions to make the system appear better than it actually is.
As a fan of the VA, I’m concerned about two things.

Continue reading The VA’s been cooking the books


Apr
23

Desperate times, desperate measures

The largest health plan trade group wants to form a new agency to “compare the cost and effectiveness of medical treatments as part of a series of recommendations to reduce health care costs.” (California HealthLine from CongressDaily) At first blush that’s pretty similar to what the Agency for Health Care Research and Quality is doing today.

Continue reading Desperate times, desperate measures


Apr
13

Fee for service drives up surgery rates

Jason Shafrin reports on the link between physician compensation mechanisms and surgery rates.
Here’s the “money quote” –
“When specialists are paid through a fee-for-system (FFS) methodology rather than a capitation or salaried basis, surgery rates increase 155%. There is suggestive evidence that surgery rates fall when primary care physicians are paid on a fee-for-service basis compared to capitation or salaried payments.”
Not addressed is the key question – is the rate of surgery appropriate under either compensation mechanism?


Mar
23

Washington’s smart policy on opioids

The state of Washington is a monopolistic workers comp state; unless an employer is large enough to be self-insured, it has to buy workers comp insurance from the state itself.
As a monopolistic state, the regulators have even more power than in the highly regulated but non-monopolistic states. One area of particular interest is how the state deals with the WC drug formulary, which specifically excludes Actiq and Lyrica.
Washington’s Health Dept. just released new guidelines on the use of narcotic opioids; the guidelines, their development process, and the impact of same should be watched carefully by regulators, insurers, managed care firms and most of all prescribing physicians.

Continue reading Washington’s smart policy on opioids


Feb
27

URAC’s foray into pharmacy benefit management

URAC, the accreditation body that seems to be into every aspect of managed care, is now looking to certify PBMs. In a presentation at the PBMI conference in Phoenix last week, a representative provided an overview of the process, modules, timing and certification levels contemplated by URAC.
While the process is only for health lines today, URAC is seriously looking into accrediting WC PBMs
Brace yourselves.

Continue reading URAC’s foray into pharmacy benefit management


Feb
19

Actiq – the off-label poster child

Actiq is a narcotic taken in lollypop form, a technique that gets the drug to the pain centers quickly. Developed for break-through cancer pain, evidence now suggests that only 10% of Actiq users have cancer.The high-powered narcotic has been the subject of several recent reports and a state attorney general investigation concerning off-label use.

Continue reading Actiq – the off-label poster child