Cutting Costs by Cutting Pills

According to some disturbing data released yesterday by the CDC, many US adults aren’t following doctor’s orders. And it’s not just the very young or very old, who, it could be claimed,  don’t know any better.

It turns out that adults under the retirement age are twice as likely to skip their prescribed medications in order to save money to save money.

And although spending on drugs is expected to increase an average of 6.6% a year from 2015 through 202, 20% of adults regardless of age, have asked their doctors for a lower cost treatment.

Americans spent $45 billion out-of-pocket on retail prescription drugs in 2011. But, “if you’re not insured or you face high co-payments, you’re going to stretch your prescriptions,” says Steve Morgan, an associate professor at the University of British Columbia’s School of Population and Public Health in Vancouver. “Even among insured populations, there is this invincibility mindset among the very young. Older people are more likely to adhere to chronic therapies over a longer period of time than younger.”

The study also found that 13% of those ages 18 – 64 reported not taking their medications as prescribed to reduce costs compared with 5.8% of those 65 and older.

Strategies that alter the way adults take their medications include skipping doses and consuming less than the prescribed amount. About 11% of those aged 18 – 64 also delayed filling a prescription compared with 4.4% of those 65 and older.

Uninsured adults were more likely to have tried to stretch their medications than those with Medicaid or private insurance.

But are such savings worth it? Failing to take medication as prescribed may actually increase costs to the U.S. health system, particularly if medication non-adherence results in increased hospitalizations, or complications of chronic diseases.

Anytime a patient chooses not to take drugs as prescribed, the pharmaceutical industry pharma loses sales. A recent study estimated that pharma loses $564 billion globally to non-adherence to drugs. Not surprisingly then, the industry is experimenting with reminders, to increase adherence. Nevertheless, a nudge from a text or a talking pill container might not inspire patients who are penny pinching.

I’d love to stay and chat, but I need to run to the pharmacy to refill my blood pressure meds that I ran out of several days ago!

Forgetting Your Cold Sore?

Cold sores. Annoying, embarrassing, uncomfortable. Enough to drive you crazy?

Not quite. However, according to a new study the virus that causes cold sores may be associated with cognitive problems such as difficulties with memory and thinking.

During the study researchers from New York and Miami tested thinking and memory in 1,625 people. Participants gave blood samples that were tested for five common low grade infections: herpes simplex type 1 (oral) and type 2 (genital), cytomegalovirus, chlamydia pneumoniae (a common respiratory infection) and Helicobacter pylori (a bacteria found in the stomach).  The memory and thinking skills were tested every year for an average of eight years.

The results showed that the people who had higher levels of infection had a 25% increase in the risk of a low score on the Mini-Mental State Examination – a 30-point questionnaire that is commonly used to screen for cognitive impairment and dementia.

In other words, those who had higher levels of anti-viral antibodies in their blood, meaning they had been exposed over the years to various pathogens, were more likely to have cognitive problems than people with lower levels of infection in the blood.

“We found the link was greater among women, those with lower levels of education and Medicaid or no health insurance, and most prominently, in people who do not exercise,” said author Mira Katan, MD. “While this association needs to be further studied, the results could lead to ways to identify people at risk of cognitive impairment and eventually lower that risk.”

The authors suggest that exercise and childhood vaccinations against viruses could decrease the risk for memory problems later in life.

Just one more reason for us all to get vaccinated and stay fit!

20/20 on the Vanishing American Hospital

Most Americans are born in hospitals. Hospitals also provide care during many other intimate and extraordinary circumstances in our lives – serious injuries, severe sickness and mental breakdown. Hospitals are also, by and large where we go to die.

As such, hospitals serve as a cornerstone of our communities and our very existence.

According to the American Hospital Association, there are 5,754 registered hospitals in the U.S. In 2011, almost 37 million people were admitted to a hospital in the U.S. – that’s more than 1:10 people.

Yet despite all this history, hospitals are in the midst of massive and disruptive change.

Even knowing this, SRxA’s Word on Health was shocked to read an article suggesting that by 2020 one in three hospitals will close or reorganize into an entirely different type of health care service provider.

Writing on KevinMD.com, a leading physician voice blog, authors David Houle and Jonathan Fleece suggest that that there are four significant forces and factors are driving this inevitable and historical shift.

First, America must bring down its crippling health care costs. The average American worker costs their employer $12,000 annually for health care benefits and this figure is increasing more than 10 percent every year. U.S. businesses cannot compete in a globally competitive market place at this level of spending. Federal and state budgets are getting crushed by the costs of health care entitlement programs, such as Medicare and Medicaid. Given this cost problem, hospitals are vulnerable as they are generally regarded as the most expensive part of the delivery system for health care in America.

Second, statistically speaking hospitals are just about the most dangerous places to be in the United States. Three times as many people die every year due to medical errors in hospitals as die on our highways — 100,000 deaths compared to 34,000.

The Journal of the American Medical Association reports that nearly 100,000 people die annually in hospitals from medical errors. Of this group, 80,000 die from hospital acquired infections, many of which can be prevented. Given the above number of admissions that means that 1 out of every 370 people admitted to a hospital dies due to medical errors.

In other words, hospitals are very dangerous places.  It would take about 200 747 airplanes to crash annually to equal 100,000 preventable deaths. Imagine the American outcry if one 747 crashed every day for 200 consecutive days in the U.S. The airlines would stand before the nation and the world in disgrace.

Currently in our non-transparent health care delivery system, Americans have no way of knowing which hospitals are the most dangerous. We simply take uninformed chances with our lives at stake.

Third, hospital customer care is abysmal. Recent studies reveal that the average wait time in American hospital emergency rooms is approximately 4 hours. Name one other business where Americans would tolerate this low level of value and service.

Fourth, health care reform will make connectivity, electronic medical records, and transparency commonplace in health care. This means that in several years, and certainly before 2020, any American considering a hospital stay will simply go on-line to compare hospitals relative to infection rates, degrees of surgical success, and many other metrics. Isn’t this what we do in America, comparison shop? Our health is our greatest and most important asset. Would we not want to compare performance relative to any health and medical care the way we compare roofers or carpet installers? Inevitably when we are able to do this, hospitals will be driven by quality, service, and cost — all of which will be necessary to compete.

So hospitals are about to enter the open competitive marketplace. And as we know there will be winners and losers.  According to Houle and Fleece a third of today’s hospitals will fall into the latter category.

Will your hospital be among them?  Let us know what you think.

e-prescribing: e-fficient, but still e-lusive?

Electronic prescribing or e-prescribing, has multiple potential benefits, including helping to reduce the risk of medication errors caused by illegible or incomplete handwritten prescriptions.  However, according to a study funded by the U.S. Department of Health and Human Services’ (HHS) Agency for Healthcare Research and Quality (AHRQ),  neither prescribers, pharmacists or indeed patients are getting the full benefit of the technology.

The study, published online in the December issue of the Journal of the American Medical Informatics Association focused on a key aspect of e-prescribing: the electronic exchange of prescription data between physician practices and pharmacies. This practice can save time and money by streamlining the way in which new prescriptions and renewals are processed. The study showed that while physician practices and pharmacies were generally positive about electronic transmission of new prescriptions and prescription renewals, connectivity between physician offices and mail-order pharmacies continue to pose problems. Additionally problematic is manual entry of certain prescription information by pharmacists, for example, the drug name, dosage form, quantity, and patient instructions.

“Physicians and pharmacies have come a long way in their use of e-prescribing, and that’s a very positive trend for safer patient care and improved efficiency,” said AHRQ Director Carolyn M. Clancy, M.D. “This study identifies issues that need attention to improve e-prescribing for physicians, pharmacies, and patients.”

Researchers at the Center for Studying Health System Change, conducted 114 interviews with representatives of 24 physician practices, 48 community pharmacies and three mail-order pharmacies using e-prescribing. Physician practices and pharmacies used e-prescribing features for electronic renewals much less often than for new prescriptions. More than a quarter of the community pharmacies reported that they did not send electronic renewal requests to physicians. Similarly, one-third of physician practices had e-prescribing systems that were not set up to receive electronic renewals or only received them infrequently.

Physician practices reported that some pharmacies that sent renewal requests electronically also sent requests via fax or phone, even after the physician had responded electronically. At the same time, pharmacies reported that physicians often approved electronic requests by phone or fax or mistakenly denied the request and sent a new prescription.

The study noted that resolving e-prescribing challenges will become more pressing as increasing numbers of physicians adopt the technology in response to federal incentives. Physicians can qualify for Medicare and Medicaid electronic health record incentive payments by generating and transmitting more than 40% of all prescriptions electronically.

The study concludes that a broad group of public and private stakeholders, including the federal government, e-prescribing standard-setting organizations, vendors and others will need to work together to address these issues.

Do you have any experience, good or bad with e-prescribing?  Let us know.

Hospital readmissions on the rise

Word on Health was shocked to learn that 1 in 10 adult Medicaid patients who were hospitalized in 2007 for a medical condition, other than childbirth, had to be readmitted at least once within 30 days of their initial hospital stay.

The Agency for Healthcare Research and Quality also reported that Medicaid patients are 70% more likely to be readmitted compared with their privately insured counterparts.

The number of underlying health problems appears to correlate with the frequency of readmission. For example, 14% of Medicaid patients with 3 or more underlying health problems were readmitted compared with 10% of those who had no other health problems.

These high hospital readmission rates have been drawing increasing attention from policymakers because they have a significant impact on health care costs. Additionally, they may reflect issues with the standards of health care provided in hospitals as well as a lack of discharge planning and outpatient follow-up.

SRxA has developed a number of innovative disease education and patient management programs specifically designed to:

• improve health
• increase adherence and compliance to medical advice and medications
• decrease the health care burden to society.

Contact us today for further information.

Walgreens tells Washington: No profit – no drugs

Walgreen’s has put the State of Washington on notice.   Because Washington has not adjusted its Medicaid reimbursements, branded script reimbursement does not cover Walgreens’ costs.   Effective April 16, none of the 121 Walgreen’s pharmacies operating in Washington will accept any new Medicaid patients.

“Obviously, we’re disappointed that the alternatives we’ve suggested have failed to achieve a compromise,” said Kermit Crawford, Walgreens Executive VP of Pharmacy. “We intend to continue our commitment to serving our existing patients, but we simply cannot take on additional losses.”

As government intervention and manipulation of the free market continues apace, Word on Health is concerned about the effect this will have on prescription drug manufacturers.

As if the prospect of Government mandated use of generics is not enough to cripple the branded prescription market, if prescription products can be substituted with OTC products paid out of the consumer’s pocket, both third party payers and OTC manufacturers would benefit.

To a large degree major Rx/OTC shifts have already happened for chronic disease therapies, i.e.

• non-sedating anti-histamines (allergy)
• non-steroidal anti-inflammatories (arthritis)
• proton pump inhibitors (reflux)

However, since all chain pharmacies situate the pharmacist at the rear of the store to enhance impulse purchases of OTC products, the decrease in foot traffic from prescriptions could decrease OTC sales too.

Time for another healthcare reform? Word on Health wants to hear from you.