Tag Archives: affordable care act

The Cost of a Cure: What’s the Right Price?

Recently, two significant pharmaceutical breakthroughs have resulted in a renewed debate about the costs of drug therapy. In the last year, a new drug class for the treatment of Hepatitis C has been released by two different manufacturers and has been found to cure a once incurable chronic liver disease for nearly 90% of patients who are treated with a full course of therapy. The drug appears to be safe and highly effective—however, the cost of a curative course of therapy is nearly 80K dollars. As you might imaging, there are already barriers to access for many patients including those treated in the Veterans’ Affairs (VA) system as well as those on government based insurance programs such as Medicaid.

In the last several months, another remarkable, potentially “game changing” drug has been approved and released into the market. These drugs, made by Regeneron and Sanofi, are intended for patients who do not achieve adequate cholesterol reduction with standard statin therapy (the current standard of care).   According to some analyses, these drugs, when used in the appropriate patient population, may result in the prevention of thousands of cardiovascular related deaths. However, just as seen with the new hepatitis C drugs, the price tag for therapy is exorbitant—nearly 15K dollars annually. With the Hepatitis C drug, therapy is only required for approximately 12 weeks and then is no longer needed—with the cholesterol drug, the therapy will most likely be lifelong.

This month a study examining the cost effectiveness of these new cholesterol drug has been published and concluded that the drugs are far over-priced (nearly 3 fold) for the benefit that they produce. Based on a pure economic analysis, researchers concluded that the drugs should actually cost between 3K and 4K dollars annually rather than the current 15K price tag.

Did Healthcare Reform Forget Big Pharma?

The purpose of the Affordable Care Act (ACA) (as touted by supporting politicians and its authors) is to make health care accessible and affordable to all Americans. Certainly this is a noble goal and one that we should continue to strive to achieve. However, the legislation has failed to meet this mark. While addressing physician reimbursement and clinical behaviors (and limiting choice and physician autonomy), the ACA has done nothing to regulate the high price of pharmaceuticals. Big pharma is allowed to charge exorbitant prices (whatever the market will bear) without regulation. It is clear that pharmaceuticals must reclaim their research and development investments and make a profit—however, many of these drugs are far overpriced and pricetags are simply designed to exploit the system and maximize corporate (and CEO profits). IN addition, many of the most expensive drugs in the US are sold overseas and in Canada at a fraction of the cost. This seems to me to be clear evidence of the pharmaceutical industry taking full advantage of the inherent wealth in the US today.

However, Would it not follow that if we placed limits on the prices of new drugs and paid “fair and equitable” charges, that healthcare costs would significantly decline?

It seems our politicians have sought to attack the problem from a few angles and have failed to address other significant sources of excessive healthcare spending. While reimbursement for physicians and physician groups are set clearly in the crosshairs of the ACA, it appears industry and litigators are not even on the radar. There is hope—legislation is being introduced that will allow legal purchase of drugs from Canada for Americans. In addition, pharmaceutical companies would be required to disclose what they charge for the same drugs in other countries. I believe this is a step in the right direction. Lets continue to innovate and provide new therapies for ALL Americans. But lets do it in a way that is cost effective. The latest studies make it clear that these drugs are overpriced. We must find a way to negotiate a fair and reasonable price that promotes and rewards innovation BUT also provides access to the newest and most effective therapies for all who need it.

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Sharing Bad News or Keeping Secrets—How Physician Communication Impacts Patients and Families

Doctors and Patients bond over time. Information exchange, education and sharing of expertise are critical activities that add to the effective practice of medicine. Delivering bad news is unfortunately an unpleasant part of a physician’s job. Honesty, empathy and clear communication are essential to delivering news to patients and their families—even when the news is unpleasant or unexpected. While communication is an integral part of the practice of medicine, not all healthcare providers are able to relay information or test results in a way that is easily digested and processed by patients. Some physicians may avoid delivering bad news altogether—often keeping patients in the dark. While a paternalistic approach to medicine was accepted as the status quo for physician behavior in the 1950s, patients now expect to play a more active role in their own care. Patients have a right to demand data and understand why their healthcare providers make particular diagnostic and treatment decisions.

Recently, a disturbing report indicated that in a database of Medicare patients who were newly diagnosed with Alzheimer’s disease, only 45% were informed of their diagnosis by their physician. While shocking, these statistics mirror the way in which cancer diagnoses were handled in the 1950s with many doctors choosing not to tell patients about a devastating health problem. With the advent of better cancer therapies and improved outcomes, now we see than nearly 95% of all patients are informed of their cancer diagnosis by their physician.

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How can this be? Why would a physician NOT tell a patient about a potentially life changing diagnosis?

I think that there are many reasons for this finding in Alzheimer’s disease and that we must address these issues in order to provide ethical and timely care to our patients.

  1. Time constraints: Electronic documentation requirements and non-clinical duties allow for less time spent with each patient. In order to deliver bad news such as a terminal diagnosis, a responsible physician must not only spend time carefully delivering a clear message but must also be available to handle the reaction and questions that will inevitably follow. Many physicians may avoid discussing difficult issues due to the lack of time available to help the patient and family process a diagnosis. We must create ways to diminish the administrative burden on physicians and free them up to do more of what they do best—care for patients. More reasonable and meaningful documentation requirements must be brought forward. Currently, many physicians spend far more time typing on a computer rather than interacting in a meaningful way with patients during their office visits. Eye contact, human interaction and empathy are becoming more of a rarity in the exam room. This certainly limits the effective delivery of bad (or good) news to patients. Priority MUST be placed on actual care rather than the computer mandated documentation of said “care”.
  2. Dwindling Long-Term Doctor Patient Relationships: Networks of hospitals, providers and healthcare systems have significantly disrupted traditional referral patterns and long-term care plans. Many patients who have been enrolled in the ACA exchanges are now being told that they cannot see their previous providers. Many physicians (even in states such as California) are opting out of the Obamacare insurances due to extremely low reimbursement rates. Patients may be diagnosed with a significant life changing illness such as Alzheimer’s disease early in their relationship with a brand new healthcare provider. When a new physician provides a patient with bad news—of a life-changing diagnosis that will severely limit their life expectancy as well as quality of life—patients often have difficulty interpreting these results. Healthcare providers that have no relationship with a patient or family are at an extreme disadvantage when delivering negative healthcare news. Long-term doctor patient relationships allow physicians to have a better understanding of the patient, their values and their family dynamics. This “insider knowledge” can help facilitate difficult discussions in the exam room.
  3. Lack of effective therapies to treat the disease: No physician likes to deliver bad news. No doctor wants to admit “defeat” at the hands of disease. It is often the case where some healthcare providers will not disclose some aspects of a diagnosis if there are no effective treatments. I firmly disagree with this practice of withholding relevant information as I believe that every patient has the right to know what they may be facing—many will make significant life choices if they know they have a progressively debilitating disease such as Alzheimer’s disease. In the 1950s, many patients were not told about terminal cancer diagnoses due to the lack of effective treatments. However, medicine is no longer paternalistic—we must engage and involve our patients in every decision.
  4. Lack of Physician communication education: As Medical Students we are often overwhelmed with facts to memorize and little attention is given to teaching students how to effectively interact with patients as well as colleagues. Mock interviews with post interview feedback should be a part of pre clinical training for physicians. We must incorporate lectures on grief and the grieving process into the first year of medical school. Making connections with patients must be a priority for physicians in the future—we must equip trainees with the tools they need for success.  Leaders distinguish themselves by the way in which they share bad news.  According to Forbes magazine the critical components of sharing bad news include–accuracy of communication, taking responsibility for the situation, listening, and telling people what you will do next.

What’s next?

As with most things in medicine, change often occurs “around” healthcare providers without direct physician input. Physicians are appropriately focused on providing excellent care and connecting with patients while politicians and economists craft the future of medicine. The issues with lack of communication of negative findings with patients MUST be addressed. Patients have a right to their own data and have a right to know both significant and insignificant findings. In order to avoid situations where patients are not fully informed about their medical condition, we must continue to remain focused on the patient—even if it means that other clerical obligations are left unattended.

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Buyer Beware: How Patients are Negatively Impacted by the Changing Landscape of the Affordable Care Act (ACA)

As the Obamacare machine continues to grind forward, many patients have re enrolled in a second year of coverage. While most have not had to use their insurance (the young and healthy crowd) others have found their newly minted coverage to be far less than promised. High deductibles, and up front out of pocket expenses, forced many covered by the exchanges to avoid seeking regular preventative care—Prevention was one of then tenets of the ACA plan. Many have found choices limited and have been forced into healthcare systems that are not their first choice.

Now, as the second year of enrollment (and re-enrollment) has concluded, many of us are concerned about the likelihood of rate hikes and changes in coverage. The Obama administration continues to tout the fact that enrollment numbers remain high and that there have been no substantial increases in premiums. However, this is not necessarily the case. Many exchange insurers have cleverly disguised rate hikes through changes in other aspects of the plans. While some advertise that there are absolutely no significant premium increases, customers who shopped carefully on the exchange site were able to find higher prices for Emergency Room visits, and higher charges for non generic drugs. For some plans this means that rather than pay a $250 co-pay for an Emergency Room visit, the customer must pay up to the yearly deductible for the same ER visit before the co-pay rules go into affect. For many, this may be a non-starter. ER visits can be very expensive and can amount to thousands of dollars in just a few hours. Many patients will find themselves having to pay a 3-6 thousand dollar deductible early in the insured year before any of the benefits begin to contribute to reduce individual out of pocket costs. In some plans, the co-payment for a routine physician visit will go down by an average of 20 dollars and many generic drugs will be covered for free. However, specialty visit co-pays will increase and the prices for specialty medications will increase by 40-50%

In an effort to promote re-enrollment in 2015, the government implemented an automatic re-enrollment system. However, this has left many patients with increasing out of pocket costs due to the fact that multiple changes have been made—such as those described above. Many patients were unaware of the need to shop around for re enrollment and are now increasingly unhappy with their plans. Ultimately the ACA and its supporters in Washington have placed statistics and politics ahead of the patient. While the delivery of quality care to the patients who need it SHOULD be the goal, it appears that politics remains the top priority. Increasing out of pocket costs and higher deductibles—many requiring payment in the first half of the year—are having the opposite affect. One of the central tenets of the ACA is to focus on prevention through promoting regular access to primary care physicians for prevention of chronic disease and its complications.   However, rather than promoting and environment where patients are engaged and actively seek preventative care, many are using the insurance simply as a “disaster plan” simply due to the overwhelming costs. While out of pocket limits and guaranteed care consume the healthcare reform talking points of the Obama administration, the reality is that the way in which the ACA is structured and implemented has actually increased personal financial burden for many.

What Can Patients Do?

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Unfortunately, much of the burden of navigating the new healthcare landscape falls to the patient. The Law itself remains a moving target—with changes certain on the horizon. We must remember that insurers are for profit entities and will ultimately find a way to make a profit—often at the taxpayer and patient expense. While many have been encouraged by the Obama administration to continue to offer affordable premiums, most have found other ways to improve their revenue streams. Whether it is thru juggling co-payments and charges, shifting cost, denying procedure approval or limiting choice, all of these changes will–in the end—negatively impact patients. As a healthcare provider, my job is to educate patients about behaviors that may improve their overall health. Now with the implementation of the Affordable Care Act, this responsibility now extends to helping my patients manage their insurance choices. While this is not necessarily a traditional role of a physician, it is important that we make sure that our patients continue to have access to the care they need—without incurring a life altering expense.

There are a few things that I think that patients can do to actively advocate for themselves and others:

  1. Stay Informed: Make sure that you ask questions of your insurer—are their changes to my coverage? How are out of pocket expenses handled? Can I see my doctor and my specialist when I want or need to without incurring a penalty or increased cost?
  2. Shop Around: Just because you have had coverage with a particular company in the past does not mean that you have to remain locked in with them. Make sure you explore all of the options that are available to you through the exchanges. Carefully question insurance company representatives so that you completely understand policies BEFORE you agree to a contract
  3. Demand Transparency: If you are unable to get a clear answer from an insurer about costs and coverage BEFORE you sign up, it is very unlikely that you will get a clear answer once you are a customer. Once you are a customer, make sure that you have a clear idea of the costs involved prior to scheduling a procedure or test. A recent survey sponsored by the Robert Wood Johnson foundation found that nearly 56% of Americans get out of pocket cost information before accessing healthcare services.

As with most things that have occurred with the Affordable Care Act, it is the patient who ultimately suffers. Insurers continue to profit, as do drug makers and hospital systems and administrators. Physicians have seen reimbursement cut to levels that have forced integration with large hospital systems. Most tragically, however, patients tend to be caught in the middle and have seen their healthcare suffer. Surveys indicate that patients are now inquiring as to cost prior to office visits, tests and procedures. Many find that they must put off necessary preventative activities and even more opt not to have needed tests and therapeutic procedures due to cost. It is clear that the ACA has missed its mark. While insuring large numbers of Americans is a noble goal, this insurance must also provide value rather than meaningless statistics to be utilized at a White House press briefing. As my research mentors at Duke University taught me during my training–with any data analysis, it remains that garbage will equal garbage out. WE must find a better way to provide affordable care to our patients. For now, insurers, hospital systems and politicians are using patients as nothing more than a “Profit Center”. As reenrollment continues through this year and the next we must make sure that our patients are armed with the old adage—“Buyer Beware”

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Attending a Funeral: Mourning the Loss of a Friend AND Learning More About the Art of Medicine

(Please note that this blog is based on real people and actual events.  I am grateful to Ed’s family for granting me permission to use his real first name in this blog)

One of the best things about the practice of medicine is the ability to develop long-term relationships with patients and their families.  As physicians, we have the unique privilege of meeting and interacting with thousands of people throughout our careers.  Every once in a while, there are certain people who really make a lasting impact and forever change us as caregivers and as human beings.  Ed was one of those patients.

This week, I said goodbye to one of my long time patients and dearest friends.  Ed, a Korean War veteran, was an amazing man.  He was a dedicated father, a devoted spouse and lived a life that was an example of faith and service to others.  I met Ed through his daughter years ago.  He had moved locally to live near his children and needed a new cardiologist. Fortunately for me, his daughter asked me to take him on as a patient.

Ed had an ischemic cardiomyopathy and suffered from complications of congestive heart failure (CHF).  He was fairly well compensated on medical therapy but continued to have worsening CHF.  During the course of his illness, we eventually  implanted a Biventricular ICD and his symptoms improved significantly.  As with most patients with CHF, over the years, he began to have more frequent hospitalizations for CHF exacerbations.

Through it all, Ed was always cheerful and never complained–in fact it was sometimes difficult to monitor his symptoms due to his demeanor.  Ed always put others before himself.  His wife, suffering from her own chronic illness, was the focus of his final days.  He loved her deeply and wanted to be sure that she was comfortable and well cared for.  Because of my relationship with Ed and his family, I have been made a better cardiologist, and most importantly, a better man.

Men like Ed are few and far between–I was honored to care for him.  My professional role as his cardiologist is what provided me with the fortunate opportunity to be a part of his life and develop a relationship with he and his wonderful family.  As I have said many times before, Medicine is best practiced when relationships and tight bonds are formed between Doctor and patient.  As I left the chapel where the Catholic Mass celebrating Ed’s life was held, I could only wonder if I would ever have the chance to meet another “Ed”.  Healthcare in the US has become more fragmented than ever and care is no longer contiguous in many cases.  Many patients are experiencing access issues and are being told that they can no longer see their long time physicians because of “network” issues or insurance coverage rules.  Doctors are forced to spend more time typing and glaring at  computer screens and less time actually getting to know the “people” behind the diseases they treat.  Connections like I had with Ed are harder to form and personal bonds are less likely to occur in the current environment.  I fear that medicine is becoming more about the “system” and managing regulation than it is about listening and caring for those who suffer from disease.

Ed taught me many things during the time that I cared for him.  He taught me humility, kindness and selflessness–I have never met anyone quite like him. Most importantly, he taught me the value of relationships and TIME.  Even in death, he inspires me to be more to each of my patients–in spite of increasing government demands on both my time and talents.  Ed never stopped caring for others–he never wavered in his commitments to his God, his wife and his children.  It is my hope that I can stand firm and continue to fight for my patients and their right to receive exceptional care.  While I continue to actively speak out against the Affordable Care Act and the regulation of medicine that separates doctor from patient, I must do so in a way that is constructive and advocates for the patient rather than for the doctor.  That is how Ed would see it–of that I am sure.

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Controlling the Costs of Innovation: Let’s Refocus and Remember The Patient

In a controversial study released this week, Tufts University’s Center for the Study of Drug Development estimates that the cost to bring a new drug to market exceeds nearly 2.6 billion dollars.  The study, which was 40% funded by industry has been criticized for over estimating these costs in favor of industry and misrepresenting some cost estimates.  While we will not know fully the extent of the methodology of the study until later in 2015 when it is published in a peer reviewed journal, these preliminary findings were released in advance and have already begun to spur debate.

However, irrespective of these criticisms, I believe that the study does have merit and brings an important issue forward—is the FDA stifling innovation with excessive fees and paperwork?  Are smaller, less well funded researchers/corporations unable to significantly contribute without partnering with big pharma? Who will ultimately bear the increased cost of drug development?

Innovation is what has always made healthcare in the US great–it is what separates us from the rest of the world.  For decades, the US has been able to attract talent from throughout the world and this has resulted in numerous “game changing” breakthroughs in medicine.  Through continued development of new drugs, new technologies and new ways to better treat disease, we are able to improve outcomes and reduce death from preventable disease.  The US has always been a place where others from around the world have come to incubate and grow ideas.  Now, it appears that innovation must come at a substantial cost–the increasing capital required for drug development as well as taxes on medical device companies only serve to squeeze out the “small guys with big ideas” and limit our ability to continue to produce new, more effective therapies and cures.  In addition, these additional costs to the pharmaceutical industry are not simply added to their bottom line–they are pushed on to the healthcare consumer as well as Federally funded healthcare plans.  Ultimately, the taxpayer bears the brunt of the increased cost.

The process of drug development is long and arduous.  Government regulation, politics and greed have served to make it even more difficult.  Physicians in academic medicine, scientists, pharmacologists and leaders in industry have learned to partner and share ideas in order to bring basic science principles from the bench to the bedside—ultimately translating ideas into cures.  Certainly, big pharma is in place to make profits and increase market share.  But as costs increase, many drug makers are putting less and less profit back into research and development.  Growth can become stagnant and new ideas may never reach the bench or bedside.  Federally funded research–such as NIH grants–face big cuts and budgets are often embroiled in political battles.  Legislators use research dollars as bargaining chips and fund projects that appeal only to a particular interest group or a group of favored donors.  We must find a better way to promote medical innovation and reward research.  We must find better ways to choose the most promising projects for funding.  We must be good stewards of the R & D dollar and make every single investment count.

As with most things in medicine, we must always pause and remember to focus on the patient.  Advocating for the patient suffering with disease is the reason most of us became involved in medicine in the first place.  Whether the study from Tufts over-estimates the cost of development or not, it should still serve as a wake up call to us all.  We must work to control the cost of developing new therapies—we must limit excessive taxation, we must promote entrepreneurship and begin to fix the current system of FDA approval for new therapies.  We must separate politics from medicine and streamline processes—eliminate paperwork and promote efficiency–if we are to continue to lead the world in medical innovation.  We must continue to make room for the “small guy with the big ideas”–If we do not–ultimately it will be our patients that suffer in the end.

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Big Brother is Watching…And Your Healthcare Privacy Rights May Suffer: More Affordable Care Act Fallout

Data is essential in healthcare delivery and it is often what guides us in improving outcomes.  Utilizing data obtained from large populations helps us better decide what aspects of disease prevention and treatment need more of our attention.  I have shared my concerns about the sanctity and security of these data in a prior blog from July.  These data are important and allow us to evaluate at risk populations and target our interventions.  In the US, participation in surveys is 100% voluntary.  The Centers for Disease Control obtains most of its data from diagnoses reported by healthcare institutions (there are certain disease that are mandated by law to be reported).  However, with the advent of the Affordable Care Act (ACA), some corporations and businesses have taken the acquisition of data a step too far.  In George Orwell’s novel 1984, the author presents a vision of an dystopian society where “Big Brother” watches every move ordinary citizens make in an attempt to maintain order (and advance his own agenda).  We have all seen the recent government abuses within the National Security Administration (NSA) and within the Internal Revenue Service (IRS).  As the ACA is implemented, I am concerned that Big Brother may already be here and working in the US healthcare system today as well.  In medicine, the doctor-patient relationship is sacred–data disclosed for healthcare should be sacred as well.

Although our country has always been based on basic tenets of freedom of choice, right to privacy and other key freedoms, some institutions see Obamacare as a ticket to interfere with the daily lives of American citizens.  For instance as reported in the last several weeks by the New York Times,  Pennsylvania State University now is attempting to require all employees, including senior faculty, to undergo physical exams and answer online health questionnaires that contain very personal and very sensitive health information.  It is obvious that the pressures of the ACA and the need for cost containment is motivating these types of mandates.  From the business standpoint, the university is hoping to reduce risk and liability by modifying at risk behaviors in its insured employees.  However, none of these data will help the faculty do a better job for their employers and I am sure that the Penn State University administration clearly see this as a way to save healthcare dollars.  The next logical step, however, may be to deny or terminate employment based on health risk and potential cost to the system.  Where does the rabbit hole end?  Is this the beginning of health status discrimination in the workplace?

Many senior faculty at Penn State are refusing the mandate based on invasion of privacy–even though the university is planning to levy substantial daily fines for non responders.  Several prominent professors have stated that if they are forced to participate they will simply answer the questionnaires randomly and provide far fetched ridiculous answers–simply play the conscientious objector.  Many other Americans are waiting to see how this pans out–there is concern that this type of activity will begin to spread to other institutions and industries.  Labor unions are already beginning to lobby against these mandates–in the case of Penn State, union employees are exempt.  At what point are our private lives and medical histories private?  What is the separation between workplace and home? Where do we draw the lines and do we allow others (government and employers) to draw the lines for us?

The spirit of risk reduction and working with employees to improve their health status and live better lives makes good sense–however, there are better ways to accomplish this goal.  Health fairs, educational seminars and free health screenings for cholesterol and high blood pressure make good sense–but all of these activities should be voluntary.  Asking highly personal questions such as sexual preference, prior drug or alcohol use and the state of one’s marriage should not be a part of a wellness program at work.  In the case of the Penn State questionnaire there are even questions related to how you get along with others in the workplace–including your boss.  These issues are private and should remain that way. In defense of the institution, the development of these wellness programs are not entirely their fault.  In fact, the ACA provides a 30% discount for the implementation of a comprehensive wellness program–virtually assuring that every business will “voluntarily” submit to these types of invasion of privacy. Although the university administrators claim that the data is secure and is not available to supervisors and those in the administration, it concerns me greatly that this will not be the case– (just ask those Americans who had unlawful wire taps and those that were bullied by the IRS due to their associations with certain political groups).  Big Brother is watching….from your doctors office, from your bedroom and from your back porch.   I am afraid that this particular blog may leave you with far more questions than answers….maybe we should ask Big Brother.

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Paying “Dozens of Dollars” for Salt (and water): Early Signs of Cost Shifting in the Affordable Care Act

The cost of medical care in the US is clearly well beyond what it has to be today.  The US leads all industrialized nations in the expenditures per capita for healthcare.  It has been common practice for many years for hospitals to charge a 200-300% markup for inexpensive medicines such as aspirin and tylenol when given to hospitalized patients.  The hospital administrators will tell you (if they actually agree to talk to you beyond “no comment”) that these charges are a way of making up deficits and compensating for costly uninsured patients who are not able to pay their bills.  Private insurers and more affluent individuals are often stuck with paying excessive prices for medicines and medical devices when hospitalized in order to help improve the hospital system’s profit margin and bolster its funds for routine operating expenses.  In addition, there is no standard–costs for identical products and services vary widely in the US from city to city and from institution to institution.  Much of these costs are determined by complex third party contract negotiations and are incredibly difficult to track down and deceifer.  Moreover, interpreting a patient bill for a hospitalization (or even an Emergency Room visit) sometimes requires a degree in forensics.

Today in the New York Times, columnist Nina Bernstein explores the inflated cost of a simple bag of intravenous saline–one of the most common therapies used in hospitals and Emergency Rooms–and how it varies from patient to patient and hospital to hospital.  As Ms Bernstein points out, the cost to manufacture, ship and deliver a bag of saline for medical use is approximately $1.  However, many patients are charged more than 1000 times that amount for the administration of a bag of salt water.  How does this happen?  More importantly why?

In the US today, the medical industry and those that supply medicines, devices and other healthcare products are first and foremost in existence for one reason–to make a profit.  The Affordable Care Act (ACA) is designed to save the US healthcare system money through prevention.  However, for-profit companies who supply medical devices and supplies are naturally still going to work hard to generate revenue.  As hospital systems merge and providers integrate into mega-groups, they have now begun to negotiate through several “middlemen” to procure medical supplies and devices.  These large (and powerful) purchasing and distributing organizations that negotiate pricing and contracts now are able to set pricing points in large accounts.  As competition in the marketplace begins to dwindle due to these complex and often difficult to interpret contracts, prices will ultimately go up (as dictated by the larger mega group contracts).  At each stage in the supply chain, middlemen will be “taking their cut” through further markups and ultimately further inflating costs.  Now that hospitals may be paid less for inpatient care and in turn may be paying less for expensive devices such as implantable defibrillators, companies (and hospitals) will now shift costs by inflating the price of a bag of salt water.

We must begin to place a true “value” on quality care as well as on medical supplies, devices and equipment.  Standards of cost for common items must be created and limits imposed–it should no longer be a market in which the hospital or hospital supplier dictates a 300% increase in cost of salt water in order to continue to generate profit for shareholders under the new ACA.  In addition, hospital charges and billing practices must be made more transparent to patients, government agencies and the individual consumer.  The services provided and medicines and supplies utilized should be clearly delineated and the charges easy to understand.

The Affordable Care Act was intended to protect the consumer and provide quality care.  Unfortunately, it appears that thus far, the ACA rollout has resulted in numerous delays and missed milestones–many of which were designed to protect the consumer from excess cost.  It is a certainty that the ACA will need to be modified in order to become functional–as modifications are made, we must ensure that we are able to control cost and keep the cost of salt water to less than a good bottle of bordeaux.

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