Are two big #hospital groups better than one? #consolidation

At Wednesday’s meeting, the  Massachusetts Health Policy Commission heard a staff report on the proposed merger of Beth Israel Deaconess Medical Center

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From the report. AMC= academic medical center

 In summary, we find that these transactions are anticipated to increase market concentration, solidify BIDCO’s position as the second largest hospital network in the state, and could strengthen BIDCO’s ability to leverage higher prices and other favorable contract terms. However, BIDCO’s market share will remain far smaller than the dominant system in the state for most services.

Member of the commission pondered the impact of having two large hospital systems, instead of just one giant one — Partners. Their conclusion — no one really knows, but it would be worth finding out.  We’ll see where that goes.

From the Globe:

“… commissioners noted that the growth of Beth Israel Deaconess Medical Center and Beth Israel Deaconess Care Organization, or BIDCO, could be a good thing. BIDCO is a network of affiliated doctors and hospitals that negotiates contracts with insurers and gives its members set budgets under which to manage patient care.

“To me, big is not necessarily bad,” said Marylou Sudders, the state secretary of health and human services, who sits on the commission. “Shouldn’t Massachusetts have… a strong competitor to what is the largest and most expensive health system?”

The commission said that by adding MetroWest and the Baptist to its network, BIDCO will solidify its place as the state’s second largest provider network. But it will remain much smaller than Partners, with about 13 percent of all hospital discharges, compared to 29 percent for Partners.

 

The persistence of low-value services

CaptureAnalysis from Health Leaders Media:

Turns out, it’s not so easy to make wise choices about healthcare. Several new studies find that, even with urging, doctors and patients are having a hard time passing on low-value services, including many identified in the Choosing Wisely campaign.  

Not that it should be a surprise. You don’t need an MD to know that change is difficult.

The specialty societies of the Choosing Wisely campaign have offered up a menu of low-value services they suggest patients can live (well) without. The trick is to convince providers and patients to abandon superfluous old-reliables and “might-as-well” tests. They waste money and can do more harm than good.

Somehow, the message isn’t getting through…

And this release today on the ACOG meeting mentioned in the story:


Breast Cancer Screening Conference Addressed Mammography Guidelines

Washington, DC – More than 50 stakeholders in women’s health convened on the 28th and 29th of January, 2016, at the headquarters of the American College of Obstetricians and Gynecologists (ACOG) to discuss recommendations on mammography for breast cancer screening. Participants reviewed current data and provided perspective on the interpretation of the data and resultant recommendations for breast cancer screening.

 

The primary issues addressed at this conference included when screening should be initiated, how frequently mammography should be performed, and if there is a point in a women’s life at which mammographic screening may no longer be beneficial. Although clearly important, other aspects of breast cancer screening – including the role of clinical breast exam and screening for high-risk women or those with dense breasts – were determined to be beyond the scope of this conference.

 

Participants in the conference included representatives from the United States Preventive Services Task Force (USPSTF), the American Cancer Society, the National Comprehensive Cancer Network (NCCN), the American College of Radiology, the American College of Surgeons, the American Academy of Family Physicians, the American College of Physicians, and ACOG. In addition, representatives from more than 22 other organizations representing women’s health care providers, radiologists, patient advocate organizations, and allied women’s health professional communities participated in the conference. Furthermore, patient representatives also provided valuable input.

 

The participants will continue the efforts at addressing breast cancer screening recommendations. It is hoped that the outcome of these conversations will help to improve informed decision-making among women and their health care providers.

 

 

 

 

 

Lown Institute seek trainees’ stories of dangerous “medical overuse”

From Lown:

The first author must be a trainee who is a professional student, intern, resident, fellow, masters or doctoral student, or post-doctoral student.logo

More here

 We are seeking clinical vignettes written by trainees that describe harm or near harm caused by medical overuse. In particular, we want to hear about medical interventions that are commonly performed and seem acceptable, rather than errors or obvious malpractice.

Applications should include a clinical vignette that provides an engaging story with pertinent clinical and historical findings. Vignettes must also include a succinct summary of the clinical issues that describes the evidence for medical overuse and suggests an alternative approach going forward.

The top two vignettes will be eligible for scholarships to participate in the fourth annual Lown Institute Conference, April 16-17, 2016 in Chicago. 

Health care in Massachusetts: Affordable or not?

Not affordable: From this week’s paper

Rising health care costs have outpaced the incomes of Massachusetts families over the past decade, despite efforts by the state to control medical expenses, according to a report released Wednesday.

Affordable: Two weeks ago.

Despite concerns about rising health care costs, the head of the state’s largest and most expensive network of doctors and hospitals said Thursday that health care is “very affordable” in Massachusetts.partners

Partners HealthCare chief executive Dr. David Torchiana, in remarks to the Greater Boston Chamber of Commerce, acknowledged that health care costs are higher here than in other parts of the country, largely because Massachusetts is home to several large teaching hospitals whose training and research programs make them expensive to run.

But considering the high incomes in Massachusetts, it’s not so bad, Torchiana said: “Health care is very affordable in Massachusetts.”

To help make sense of this and other health policy debates, check out the latest Health Wonk Review.

Massachusetts thread in NYTimes story on drug price rekoning

The New York Times reports:

As complaints grow about exorbitant drug prices, pharmaceutical companies are coming under pressure toHIT DEST disclose the development costs and profits of those medicines and the rationale for charging what they do.

So-called pharmaceutical cost transparency bills have been introduced in at least six state legislatures in the last year, aiming to make drug companies justify their prices, which are often attributed to high research and development costs.

One of them is Massachusetts. Also,Vertex comes up for the price of its CF drug — see recent post .

Finally, Tufts Center for the Study of Drug Development takes a knock for its oft-cited development cost reports.

Pharmaceutical executives do not typically tie the price of any particular drug to its development cost. But they do say that their sales have to recoup their investment in research and development if the companies are to stay in business.

They often cite the Tufts Center for the Study of Drug Development at Tufts University, which last year said companies spent an average of $2.6 billion to bring a drug to market, up from an estimate of $800 million in 2003. That includes the cost of failures. And almost half the figure is opportunity cost, the amount a company might have earned if it had invested money elsewhere rather than spending it on drug development.

Critics are skeptical of that figure, saying that the Tufts center gets funding from the pharmaceutical industry and uses data supplied by the drug companies, but does not disclose which drugs are used as the basis of the estimates.

Here’s what Tufts has to say about that:

Our Approach to Research

The Tufts Center for the Study of Drug Development (Tufts CSDD) conducts its research by working closely with government regulatory authorities and with drug developers and manufacturers of all sizes in the U.S. and abroad. Data are collected from the people who create it — pharmaceutical and biotechnology companies. They cooperate because they know Tufts CSDD will generate a comprehensive and objective picture of the drug development process, while strictly ensuring that individual company data are not disclosed. Adhering to stringent methods of quantitative analysis, Tufts CSDD validates its data and develops findings based on rigorous academic standards.

Worth noting here that not all their research is  from ad industry POV. For example:

Dr. Joshua Cohen utilizes his background in health economics to examine public policy issues that concern prescription drug reimbursement and market access. His areas of research include pharmacy benefits management as it relates to the Medicare prescription drug benefit, formulary regulations established by the Centers for Medicare and Medicaid Services, ethics and the distribution of pharmaceutical care resources, comparative effectiveness research, market access to biopharmaceuticals in the US and Europe, role of clinical and cost-effectiveness in clinical practice guideline development, drug development targeting neglected diseases, and decisions by drug regulatory agencies regarding prescription (Rx) to over-the-counter (OTC) switches.

  • Patient access to newly approved oncology drugs in US and Europe
  • Clinical, regulatory, and economic challenges facing pharmacogenomics
  • Prescription-to-over-the-counter switches in US and Europe
  • Trends in biosimilar market uptake

Why won’t the Cystic Fibrosis Foundation comment on the high price of the new Vertex drug?

Robert Weisman of the Globe reports today:

California scientist Paul M. Quinton learned that he has cystic fibrosis at age 19 and has speVertexLogoSOPnt his long career in his lab working on ways to cure it.

He is, in short, not the kind of person you’d expect to be fighting with Vertex Pharmaceuticals Inc., the company developing a new class of breakthrough drugs for the obstructive lung disease.

But he and a group of prominent cystic fibrosis doctors are doing just that. For the past three years, they have engaged in a private and largely fruitless dialogue with Vertex over their complaints that the Boston biotechnology firm is overcharging for its medicines.

At the end of the story he checks in with the group  that represents the interests of patients. They don’t say much:

ssA spokeswoman for the Cystic Fibrosis Foundation wouldn’t comment specifically on the price of Orkambi. But in a statement, the foundation said that the cost of doctors, hospitals, drugs, and diagnostics together places “a tremendous financial burden on people with the disease and their families.”

Worth noting that the CFF’s so venture philanthropy — non-profit investment in drug development — let to the ultimate development of one of Vertex’s CF drugs the new drug. A Nov. NYTimes story notes the foundation expected to receive $3.3 billion from selling the rights to the royalties to those drugs.

Proponents say it speeds drug development while also providing potential monetary rewards that can pay for even more research.

But there is some concern that a profit motive could divert the organizations from their primary mission — helping patients — and create a conflict of interest. For instance, the price of the main drug developed through Cystic Fibrosis Foundation’s investment is $300,000 a year. Kalydeco treats the underlying cause of cystic fibrosis 

Critics say that perhaps because a higher price means higher royalty payments, the foundation did not do enough to bring the cost down.

“I would like to see them do more to get the price of this drug down to something that is going to be sustainable,” said Paul M. Quinton, a cystic fibrosis researcher at the University of California campuses in Riverside and San Diego, who has the disease himself. “And I have some concern about the possible appearance of a conflict.”

My latest from Health Leaders: disparities, quality & TripleAim

by Nora Valdez. Click for more.

by Nora Valdez. Click for more.

Fueled by the financial incentives built into the healthcare reform law, the Institute for Health Improvement’s concept is generating meaningful changes in the way healthcare is delivered, research finds.

Value-based care brings new urgency to the effort to end disparities in healthcare access and outcomes for minorities.

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