Medicare Won’t Pay Hospitals To Remedy Mistakes

[Source: Wall Street Journal: Health Blog, posted by Theo Francis, August 8, 2007]

In one of the darker ironies in American health care, hospitals are often paid extra to treat the problems that arise when they make mistakes. Starting late next year, Medicare won’t pay for treatment for some conditions associated with screw-ups.

Under a little-noticed new rulebook that came down last week, Medicare will return the bill unpaid for care to solve these problems:

• Bed-sores
• Two kinds of catheter-associated infections
• Air embolism, or bubbles of air or gas entering the bloodstream during medical procedures
• Mediastinitis (infection of the area between the lungs) after coronary bypass surgery
• Giving patients the wrong blood type
• Leaving objects inside surgery patients
• In-hospital falls

The government estimates its direct savings at about $20 million a year, and Medicare has said hospitals can’t turn around and stick patients with the tab. Other insurers are likely to follow suit, and hospitals may well do a better job for all patients, not just those on Medicare, say some advocates of the new rules.

Report: Hospitals Employing Physicians in Greater Numbers

Merritt, Hawkins & Associates

(NewsRx.com) -- A growing number of hospitals are employing physicians, according to a new report tracking physician recruiting trends.

The 2007 Review of Physician Recruiting Incentives, prepared by Merritt, Hawkins & Associates, a national physician search and consulting firm, examines over 3,000 recruiting assignments the firm conducted from April 1, 2006 to March 31, 2007. Hospitals offered employment to physicians in 43 percent of the searches the firm conducted during that time, up from just 23 percent the prior year and 19 percent the year before that. Traditionally, executives with the firm note, physicians have practiced as independent contractors or as employees of medical groups that are physician owned. The growing number of hospitals employing physicians signals a shift in this traditional practice paradigm.

"Physicians have long prized their independence," observes Joseph Hawkins, chief executive officer of Merritt, Hawkins & Associates. "But today they are more willing to exchange independence for the security and convenience of hospital employment."

According to Hawkins, physicians are accepting employed positions with hospitals in order to avoid the hassles of private practice, which include high malpractice premiums and struggles for reimbursement. Younger physicians in particular, he notes, are less willing to "hang up a shingle" and practice on their own. Hospitals, which went through a phase of employing mostly primary care physicians in the 1990s, are employing both primary care doctors and specialists today. Employment helps secure physician loyalty to hospitals, Hawkins says, and reduces direct competition between physicians and hospitals for medical procedures and tests.

Merritt, Hawkins & Associates' 2007 Review of Physician Recruiting Incentives also reflects a steady increase in demand for primary care physicians, including general internists, family practitioners and pediatricians. The number of searches the firm conducted for general internists increased by 120 percent from 2003 to 2007. Searches for family practitioners increased by 84 percent in the same time frame while searches for pediatricians increased by 21 percent. Hawkins attributes openings in primary care to the fact that fewer medical students are choosing to practice family medicine and internal medicine, diminishing supply. Meanwhile, a growing and aging population is driving up demand for medical services performed by primary care doctors.

The report indicates that the financial incentives offered to recruit physicians continue to increase, reflecting robust demand for doctors in most specialties. Specialties seeing the greatest increase in income offers over the past year according to the report include urologists, otolaryngologists, cardiologists, orthopedic surgeons, emergency medicine physicians and family practitioners. The report also shows that signing bonuses have become a standard incentive offered in 72 percent of the searches Merritt, Hawkins & Associates conducted last year, up from 46 percent two years ago. Signing bonuses can range from as little as $5,000 to as much as $100,000, the report shows.

Merritt, Hawkins & Associates' 2007 Review of Physician Recruitment Incentives represents the 14th annual report the firm has completed tracking physician recruiting trends. The report may be viewed online by visiting the firm's Web site, www.merritthawkins.com.

Generics may help curb rising costs of prescription drugs

[Source: Health and Life Sciences Daily, August 8, 2007]

On its front page, the New York Times (8/8, A1, Saul) reports, "A quiet coup is taking place in American medicine cabinets." Although the "nation currently spends $275 billion a year on prescription medicines," analysts forecast that within the five years, Americans will see "a golden era for generic drugs, as patents begin to expire on brand-name medications with more than $60 billion in combined annual sales. That will open the door to copycats that may be 30 percent to 80 percent cheaper." Laizer Kornwasser, an executive for Medco Health Solutions, which manages prescription drug plans, says that America is "just in the beginning of the tidal wave" of generic drugs. While some experts worry that the brand-name companies are suffering "from a systemic decline in productivity," Caroline Loew, senior vice president for scientific and regulatory affairs for the Pharmaceutical Research and Manufacturers of America, said that she didn't think the group "would support the contention that there's a lull" in innovation because of the generics. She said, "The companies are tackling diseases that are extremely complex. The biological mechanisms are very poorly understood. By definition, that sort of science, which is very much emerging science, is going to take longer." The Times notes, "One way the pharmaceutical industry is working to counter the generic trend is through its own generic subsidiaries and contracts for the production of company authorized generics."

See here for additional information from the Wall Street Journal.

D.C. appeals court rules terminally ill lack constitutional right to experimental medicines

[Source: Health and Life Sciences Daily, August 8, 2007]

The New York Times (8/8, A12, Pollack) reports, "A federal appeals court ruled yesterday that patients with terminal illnesses do not have a constitutional right to use medicines that have not yet won regulatory approval. The 8-to-2 decision by the Court of Appeals for the District of Columbia Circuit came in a closely watched and emotional case that pitted desperate patients willing to try unproven, even risky, therapies against those arguing that drugs should be proved safe and effective before they are made available." The case was filed against the FDA "in 2003 by the Abigail Alliance for Better Access to Developmental Drugs," which "argued that forcing patients to wait years for a drug to go through the process of clinical trials deprived dying patients of their right to self-defense, and violated the Fifth Amendment clause stating that people cannot be deprived of life, liberty or property without due process of law." Judge Thomas B. Griffith, writing for the majority, said that "a right to experimental drugs was not deeply rooted in the nation's history and tradition."

The Wall Street Journal /AP (8/8, D2) notes that Judge Griffith also said, "Terminally ill patients desperately need curative treatments," but "their deaths can certainly be hastened by the use of a potentially toxic drug with no proven therapeutic benefit."

The Los Angeles Times (8/8, Savage) adds, "Julie Zawisza, an FDA spokeswoman, said the agency was pleased with the ruling because it upheld the agency's 'role in facilitating appropriate treatment access to investigational therapies while at the same time protecting the public at large by requiring that drugs are proven to be safe and effective before they may be marketed to U.S. consumers.'" She also "said that 'on a limited basis,' some patients and their doctors were permitted to obtain new drugs that were in clinical trials."

On its Web site, USA Today (8/8, Winter) reports, "In a stinging dissent, Judge Judith Rogers called the ruling 'startling.' She said courts have established the right 'to marry, to fornicate, to have children, to control the education and upbringing of children, to perform varied sexual acts in private, and to control one's own body even if it results in one's own death or the death of a fetus. ... But the right to try to save one's life is left out in the cold despite its textual anchor in the right to life." Rogers was joined by Chief Judge Douglas H. Ginsburg.

Bloomberg (8/8, Larson) reports that Frank Burroughs, Abigail Alliance president, said, "The Abigail Alliance is dumbfounded that most of the justices tragically missed the merits of the case." He continued, "We are going to appeal to the Supreme Court." During the past six years, the Abigail Alliance has pushed "for early access to 16 drugs for cancer and other life-threatening illnesses," and each drug "eventually won FDA approval, including ImClone Systems Inc.'s colon cancer drug Erbitux (cetuximab), Novartis AG's leukemia medicine Gleevec (imatinib), and Bayer AG's kidney cancer treatment Nexavar (sorafenib)." The problem, Burroughs said, is that the "FDA and Congress get on the safety issue soap box, and they forget about the people who have a very different risk-benefit perspective."

The case is Abigail Alliance for Better Access to Developmental Drugs, et al. v. U.S. Food and Drug Administration, et al (pdf).