incentives

Study: U.S. chronically ill most likely to go without care

Anne Zieger — Fri, 14 Nov 2008 08:42:46 -0500

In yet another sign of the stresses facing our healthcare system, a recent study found that chronically ill patients in the U.S. are much more likely to go without healthcare because of the cost than patients from the other nations studied. The Commonwealth Fund surveyed 7,500 patients from the U.S. and seven other nations, including Australia, Canada, France, Germany, the Netherlands, New Zealand and the United Kingdom.

In addition to chronically ill patients going without medical care, they also found that the U.S. patients had the worst experience with medical errors, coordination problems, and out-of-pocket expenses. More than 50 percent of chronically ill patients' reports included not filling prescriptions, skipping doses, not visiting physicians, and not getting recommended care.

The researchers also gave recommendations for how to improve these problems, which included using incentives and bundled payments, and engaging patients and communities to focus on prevention and health.

To learn more about the study:
- read this Modern Healthcare piece (reg. req.)

Insurers give doctors 'kickbacks' for prescribing generic drugs

Anne Zieger — Fri, 31 Oct 2008 11:37:08 -0400

We all know how the pharmaceutical industry tries to get doctors to prescribe brand-name drugs even though a generic is available, for their own profit. But what about the flip-side of that problem: when insurers give doctors a portion of their savings from generic drugs?

The AMA has defined these incentives as kickbacks and warned doctors last year that they could face both criminal and civil liability under federal statutes if they accept the incentives. And several states are thinking about passing laws to provide greater scrutiny of these practices by insurers.

However, is it the same problem? Insurers claim that they are not forcing doctors to do anything, but simply encouraging them to keep costs down. They also say that patients sometimes won't take brand-name drugs regularly because of the cost. So who has the right of it? Are these kickbacks, or just incentives?

To learn more about this problem:
- read this Associated Press piece

Jury is still out on WV's patient incentives program

Anne Zieger — Tue, 28 Oct 2008 10:34:30 -0400

Traditionally, Medicaid programs have not been known as hotbeds of innovation. However, West Virginia is instituting a new initiative--possibly the first of its type in the U.S.--that offers a completely new approach to fostering preventive care and wellness among its population. While a few states are offering incentives to patients that cooperate with doctors and go to regular appointments, West Virginia may be the first to bump them to a plan with less coverage if they don't agree to do so.

Whether or not their plan is working is arguable. Only 12 percent of those eligible for the greater coverage actually signed up, with another 3 percent in the process of enrolling. On the other hand, enrollment is higher in the three pilot counties that have had longer to get used to the plan. This suggests that the plan may end up being more successful over time.

Critics, meanwhile, question if people who are being put into the basic plan actually know what they are missing by not getting the enhanced coverage. And some people may simply not see the need for the higher level of coverage, and therefore don't want to commit, they suggest. They also note that some may not have dependable transportation, which makes it difficult for them to attend regular doctor appointments as the plan requires.

Regardless, it seems likely that the plan will produce interesting results whether or not it succeeds. It should be worth watching.

To learn more about the program:
- read this AMNews piece

FDA's medical approval process faces GAO scrutiny

Anne Zieger — Mon, 27 Oct 2008 10:47:30 -0400

The Government Accountability Office is scheduled to release a report next month on the FDA's medical device review process, but the facts that we have available to us already suggest that things are seriously amiss.

The FDA itself admits that it doesn't feel the need to either establish that medical devices are actually beneficial, or compare them to existing treatments. All it does in most medical device reviews is make sure that each device performs the tasks it says it's supposed to (without checking on whether it has a therapeutic effect) and doesn't offer any obvious dangers to the patient.

Meanwhile, Medicare offers incentives to doctors to use new devices; the intention is to help encourage them to take the time to learn about new devices, but the result is that doctors may sometimes overuse medical device treatments that have not been vetted for their effectiveness. For example, some devices go through trials with as few as 25 patients. While the pharmaceutical approval process may have some flaws, at least it never approves a drug with such a scanty review process.

Knowing all of this, the GAO's report next month on medical device approval is likely to be very interesting reading.

To learn more about this problem:
- read this New York Times piece

Suit says Medtronic gave doctors plush gifts

Anne Zieger — Thu, 25 Sep 2008 14:26:40 -0400

Apparently, Medtronic really loves surgeons--so much so that it gave them lots of presents. The medical devicemaker allegedly gave doctors some very plush gifts for using its products, including sexy entertainment, trips to Alaska and patent royalties for inventions in which they had no part, according a lawsuit brought by a former Medtronic lawyer.

The suit targets not only Medtronic, but also 10 doctors, including surgeon Jeffrey Wang, now director of the University of California at Los Angeles's Comprehensive Spine Center.

The allegations are focused on Medtronic's spinal-devices unit, which has $3 billion in annual revenue. Among other things, the suit contends that the unit had sham consulting agreements with more than 100 surgeons who were strictly vehicles to funnel payoffs to them in exchange for their using the unit's products. Medtronic had previously agreed to pay $40 million to the federal government to settle related allegations.

The spinal-devices unit has already been hit with lawsuits from other former employees. Meanwhile, it's also being investigated by Sen. Charles Grassley (R-IA), who's attempting to find out whether incentives like these have led to what is now common off-label use of Medtronic spine products.

To learn more about the lawsuit:
- read this Wall Street Journal piece (sub. req.)

Related Articles:
Medtronic to disclose gifts to healthcare groups
Medtronic will settle accusations on kickbacks

Healthfirst will pay $35M to NY over Medicaid violations

Anne Zieger — Sun, 07 Sep 2008 20:27:57 -0400

Health plan Healthfirst has reached a $35 million settlement with New York Attorney General Andrew Cuomo over its violation of Medicaid managed-care contract and false-marketing plans filed with state and city officials. The plan, New York's largest Medicaid managed-care provider, violated contract terms by paying inappropriate bonuses and other incentives to sales professionals based on enrollment levels they accomplished between 1999 and September 2003. Healthfirst also failed to disclosed the productivity-based bonuses in the materials it filed with officials. Healthfirst officials noted, in discussing the settlement, that the violations were self-disclosed, and that it has changed its practices completely since that time to conform to regulatory requirements.

While Healthfirst may have changed its ways, it seems likely that we're going to continue to see issues in both Medicaid and Medicare managed care marketing, given the size of the payoff in going for high volume and the relatively vulnerable consumer targeted by each. It seems likely that some reforms are going to be needed going forward to address such issues over the longer term.

To learn more about this case:
- read this Modern Healthcare piece (reg. req.)

Related Articles:
Amerigroup to pay $225M in Medicaid fraud settlement
Illinois doctors fight Medicaid HMO plan
Audit finds that IL Medicaid paid providers late

CMS will pay more than $36M in quality reporting

Anne Zieger — Wed, 16 Jul 2008 13:36:57 -0400

CMS has announced that it will pay out more than $36 million in incentives money to providers who reported data on quality of care delivered between July 2007 and December 2007 as part of its Physician Quality Reporting Initiative. Under the PQRI, health providers who choose to participate get bonuses of 1.5 percent of their total CMS payments during the reporting period in which they reported quality data. Average payments for the most recent period range from $600 for individual physicians to $4,700 for groups. The largest payment CMS plans to make to a practice is more than $205,700. Health professionals in the states of Florida and states with the largest payouts are getting $5 million of the total, the agency said.

To learn more about PQRI payouts:
- read this Kaiser Daily Health Policy Report item

Related Articles:
Bill establishes physician quality reporting system
CMS tightening PQRI measures
MGMA: Medicare quality reporting costly

ALSO NOTED: VA continues to struggle with recruitment, retention; PA releases HAI report; and much more...

Thu, 10 Apr 2008 06:59:50 -0400

> Despite offering bonuses, training and other incentives, the VA is struggling to recruit and keep medical personnel. Article

> Pennsylvania's new report on hospital-acquired infections concluded that about 19 patients in 1,000 got such infections in 2006, running up an average $176,000 bill. Article

> This week, Johns Hopkins set a record. Six kidney patients at Johns Hopkins got new organs from six unrelated living donors in what's considered to be the nation's first six-way swap. Article

> Insurers are increasingly deciding to pay for web visits to physicians, though Medicare hasn't gotten on board. FierceHealthIT

And Finally... Folks, I can't beat this real-life headline: "Bees swarm Mexican police in reverse sting operation." Article

Blue Cross plans push wellness

Thu, 20 Mar 2008 07:59:56 -0400

The nation's fourth largest health insurance company has kicked off an initiative that focuses on using its resources more on patient wellness. Chicago-based Health Care Service Corp., whose subsidiaries include Blue Cross and Blue Shield of Illinois and BCBS plans in Texas, New Mexico and Oklahoma, has more than 12 million members. Health Care Service Corp. has added the word "wellness" to the mission statements of each of these plans, as well as launching initiatives like adding wellness programs to its basic health benefit plans. The health plans are also offering beneficiaries extra incentives to stay well by, for example, earning points for participating in such preventive measures as cholesterol screenings and wellness risk assessments.

Giving consumers--not just providers--direct incentives to stay well seems like a good idea. Let's see, however, if these programs mature into something that goes significantly beyond what U.S. health plans already are doing to meet wellness and preventive goals.

To learn more about the plans:
- read this Chicago Tribune piece

Related Articles:
Congress considers wellness credits for employers. Report
Researcher studies ROI on wellness programs. Report

ALSO NOTED: Prostate cancer vaccine could be five years away; Another LA hospital may be forced to close; and much more...

Wed, 13 Feb 2008 06:59:50 -0500

> Australian researches say they're five years away from a prostate cancer vaccine. FierceVaccines

> Only months after the forced closure Los Angeles-based King-Drew, a second public hospital may close after placing patients in "immediate jeopardy." Article

> Wisconsin may soon change its laws on health data sharing to make it easier for providers to form health data sharing exchanges. FierceHealthIT

> Massachusetts lawmakers expect a $1 billion bill creating incentives for life sciences companies to pass quickly. FierceBiotech

And Finally... I'm sure spacewalks are thrilling, but not when you're under the weather. Article