Today's News and Commentary

About pharma

Speaker Nancy Pelosi To Unveil Plan To Negotiate Prices Of 250 Prescription Drugs: The previously reported proposal to lower drug prices is expected to be released today. One of its lynchpins is the ability of HHS to “negotiate prices for the top 250 most expensive drugs on the market that don't have at least two competitors.”

Estimates of all cause mortality and cause specific mortality associated with proton pump inhibitors [PPIs} among US veterans: cohort study: “Taking PPIs is associated with a small excess of cause specific mortality including death due to cardiovascular disease, chronic kidney disease, and upper gastrointestinal cancer. The burden was also observed in patients without an indication for PPI use. Heightened vigilance in the use of PPI may be warranted.” If it is as effective, H2 blockers may be safer. Except…(see next article)

Novartis halts distribution of its Zantac versions amid probe into impurities: “Novartis AG’s Sandoz unit said on Wednesday it was halting distribution of its versions of the drug commonly known as Zantac in all its markets, including the United States and Canada, after contaminants were found in the heartburn drug. 
The Swiss drugmaker’s steps follow an investigation by U.S. and European regulators into the presence of the impurity, N-nitrosodimethylamine (NDMA), in the drug, ranitidine, and a distribution halt in Canada announced late Tuesday.”
Estimation of Hospital Share of Gross Profits for Physician- Administered Medicines Reimbursed by Commercial Insurers: In addition to being able to bill more for professional services (see yesterday’s blog), research indicates “that commercial payers reimburse hospital clinics at a higher rate than physician offices. Hospital clinics also are eligible for discounts not offered to physician practices, such as the 340B Drug Pricing Program” (see Chapter 6, Payers, section on Medicaid). According to this study, physician offices and hospital clinics “treat similar numbers of patients in the commercial market, but hospitals receive a larger share of the gross profits. Hospitals collect 91% of the gross profit margin while serving 53% of patients receiving physician-administered medicines.” Another skewed advantage for hospitals over independent physician practices.

Why prescription drugs cost so much more in America (Financial Times, subscription required): Not much new here but this article is a good summary of pharma pricing issues in the US and other countries.

About the public’s health

Prevalence of Screening for Food Insecurity, Housing Instability, Utility Needs, Transportation Needs, and Interpersonal Violence by US Physician Practices and Hospitals: “Screening for all 5 social needs was reported by 24.4%…of hospitals and 15.6%… of practices, whereas 33.3%… of practices and 8.0%… of hospitals reported no screening. Screening for interpersonal violence was most common…, and screening for utility needs was least common… among both hospitals and practices…Academic medical centers were more likely than other hospitals to screen.” What programs can be implemented to increase the rate of screening?

Estimating the Health‐Related Costs of 10 Climate‐Sensitive U.S. Events During 2012: One of the arguments against climate change prevention measures is that they cost too much and their implementation would hurt the economy. This study (published two days ago) looked at the total cost of climate-sensitive events in 2012 and estimated the cost was about $10 billion. Wouldn’t climate control measures, then, be cheaper in the long run?

India bans e-cigarettes as global backlash at vaping gathers pace: Yesterday, India banned all e-cigarettes. A great public health measure! However the country still has an immense problem from smoking and chewing tobacco.

Kids’ Share 2019: Report on Federal Expenditures on Children through 2018 and Future Projections: This report is the 13th annual evaluation by the Urban Institute. Among the findings:

  • “In 2018, the federal government spent about $6,200 per child younger than 19, less than in 2017 after adjusting for inflation. This decline is driven by a reduction in federal spending on education and nutrition programs and a temporary reduction in child-related tax credits.

  • As a share of the economy, federal investments in children fell to 1.9 percent of GDP in 2018, the lowest level in a decade [emphasis added]..

  • The share of federal expenditures for children targeted to low-income families has grown over time, reaching 61 percent in 2018…

  • Assuming no changes to current law, the children’s share of the budget is projected to drop from 9.2 percent to 7.5 percent over the next decade, as spending on Social Security, Medicare, Medicaid, and interest payments on the debt consume a growing share of the budget.

  • By 2020, the federal government is projected to spend more on interest payments on the debt than on children” {emphasis added].

Clearly, children are being short changed at the expense of rising deficits and care for older adults. How can we rebalance this funding?

Situations Leading to Reduced Effectiveness of Current Hand Hygiene against Infectious Mucus from Influenza Virus-Infected Patients: As we approach the flu season this article provides some important advice: “the efficacy of AHR [antiseptic hand rubbing] using ethanol-based disinfectant against mucus is greatly reduced until infectious mucus adhering to the hands/fingers has completely dried. If there is insufficient time before treating the next patient (i.e., if the infectious mucus is not completely dry), medical staff should be aware that effectiveness of AHR is reduced. Since AHW [antiseptic hand washing] is effective against both dry and nondry infectious mucus, AHW should be adopted to compensate for these weaknesses of AHR.”

A State-by-State Examination of the Economic Costs of Gun Violence: The U.S. Congress Joint Economic Committee Democratic Staff issued this report yesterday. It needed to come from this party because the Republican administration forbids such research, e.g., by the CDC.
In brief: “In 2017, for the first time, the rate of firearm deaths exceeded the death rate by motor vehicle accidents. That year, nearly 40,000 people were killed in the United States by a gun, including approximately 2,500 school-age children. That is over 100 people per day and more than five children killed each day. Sixty percent of gun deaths each year are firearm suicides…Gun homicides are also associated with fewer jobs, lost businesses and lower home values in local economies and communities across the nation. The latest estimate is that gun violence imposes $229 billion in total annual costs on the United States—1.4 percent of GDP [emphases added].”

Health Drinks, Healthy Kids: These age-specific recommendations from major child health organizations emphasize milk (including breast milk or, if not possible, formula) and water for children. It advocates against juices.

About healthcare IT

Concordance Between Electronic Clinical Documentation and Physicians’ Observed Behavior: “In this case series of 9 licensed emergency physician trainees and 12 observers of 180 patient encounters, 38.5% of the review of systems groups and 53.2% of the physical examination systems documented in the electronic health record were corroborated by direct audiovisual or reviewed audio observation….These findings raise the possibility that some physician documentation may not accurately represent actions taken, but further research is needed to assess this in more detail.” Is this lack of behavior also a case of cut-and-paste that is prevalent in using EMRs? What about the reimbursement implications? The increased, non-performed documentation will cause higher billing codes.

About health insurance

News Reports about a Weakening Economy Impacting How Some Patients Seek Medical Treatment: This report confirms what other studies found in the previous recession- a weak economy causes reduction in health-seeking behavior. Also, anticipation of a weakening will accelerate such activity.

Physician groups call court ruling on site-neutral payments 'bad news': As reported yesterday, the payment site differential between hospitals and independent practitioners was upheld in court. Naturally, physician groups are expressing their dissatisfaction with the decision.