Taking Another Shot At Lower Drug Prices

The head-spinning experience of navigating the pharmaceutical pricing world came to town Feb. 28, leaving lawmakers and laypeople alike with no greater understanding of why the entire scheme leaves consumers light in the pocket.

The basics are clear. Drug companies set the price for their drugs, but rarely does anyone pay it, Peter Fotos, PhRMA’s Chicago-based regional director for state advocacy told the House Health Policy Committee.

Generally, health insurers go through this relatively new layer of bureaucracy called Pharmacy Benefit Management (PBM) companies to negotiate cheaper rates based on bulk purchases. Then there are other assorted rebates and discounts patients can score. When the smoke clears, about 33 percent of the […]

Taking Another Shot At Lower Drug Prices2019-03-13T18:13:23+00:00

Americans Ready To Crack Down On Drug Prices

By JAY HANCOCK
Large majorities of Americans from both major parties support steps to control prescription drug costs such as showing prices in ads, removing barriers to generics and letting patients get less expensive drugs from Canada, a new poll shows.

By a 9-to-1 ratio, Republicans, Democrats and independents favor making drug companies show list prices in their advertising, says a new survey from the Kaiser Family Foundation. Highly advertised medicines such as Humira, for arthritis, cost tens of thousands of dollars a year, even after discounts.

Although Republicans tend to frown on government control over commerce, 8 in 10 Republican respondents said they support giving negotiating power to the $700 billion Medicare […]

Americans Ready To Crack Down On Drug Prices2019-03-13T18:00:09+00:00

ON POINT WITH POs: Patient Care Organizations

By EWA MATUSZEWSKI
What’s in a name? Sometimes, limitations. A physicians’ organization, for example, is the name given to organizations originally designed to help private practice physicians build and maintain an independent practice. Broadly speaking, the PO handled the foundational business aspects and insurance provider contracts of the practice, while the physicians tended to the needs of their patients and day-to-day operations. The role of POs in the past 10 years, however, has changed dramatically. Yes, we still negotiate contracts, trouble shoot patient registries and implement EHRs, but we also provide in-office care teams and care managers to support the 21st century model of medicine; and we introduce quality initiatives and […]

ON POINT WITH POs: Patient Care Organizations2019-03-13T17:56:58+00:00

COMPLIANCE CORNER: Guidance On Leaves Of Absence

By JESSE MARKOS
The National Practitioner Data Bank has published an article in a recent version of NPDB Insights to help clarify when a hospital privileging action is reportable to the Data Bank. Since a Data Bank report can have significant professional and economic ramifications, it is important for all healthcare providers to understand when a report is required and when one can be avoided.

By way of background, the Data Bank is an alert system that collects and discloses certain adverse information about physicians and other healthcare providers. An adverse report to the Data Bank can significantly impact a health care provider’s reputation and career. State licensing authorities, hospitals and […]

COMPLIANCE CORNER: Guidance On Leaves Of Absence2019-03-13T17:51:51+00:00

LANSING LINES: Lawmakers Push Hospital Staff Ratios

Hospitals would have to hire more nurses to meet staff-to-patient ratios and avoid excessive overtime under a package of bills, known as the Safe Patient Care Act, introduced this in late February in the House and Senate.

The bills would set nurse-staffing levels according to what kind of care they provide. In the intensive care unit (ICU), the ratio would be one-to-one. On a medical-surgical floor, the ratio would be four patients per registered nurse. In post-partum, where baby and mother are fine, the level would be six-to-one, explained sponsor Rep. Jon Hoadley (D-Kalamazoo).

“We think this will encourage hospitals to do what they should be doing, which is to have enough […]

LANSING LINES: Lawmakers Push Hospital Staff Ratios2019-03-13T18:15:04+00:00

Cannabis Advocates Look To End Controlled Substance Tag

A group of Michigan citizens and organizations is suing the Michigan Board of Pharmacy to eliminate marijuana from the Schedule I list of controlled substances.

The state’s Public Health Code, which was enacted in 1978, treats marijuana like opioids and heroin, and that is “unconstitutional under Michigan law,” wrote Michael Komorn, attorney for the residents and organizations in the complaint recently filed in the Court of Claims.

“Even opium, a ‘hard narcotic’ and the root of the opioid epidemic, is a Schedule 5 drug when sold in small concentrations,” he said. “As there is no rational basis to classify marijuana with hard narcotics, it now must be classified below Schedule 5. As […]

Cannabis Advocates Look To End Controlled Substance Tag2019-02-12T22:30:16+00:00

Ads For Short-Term Plans Overwhelm Searches

By STEVEN FINDLAY
Consumers shopping for insurance online last fall — using search terms such as “Obamacare plans,” “ACA enroll” and “cheap health insurance” — were most often directed to websites that promote individual health plans that didn’t meet consumer protections of the Affordable Care Act, according to a new study.

They also failed to get adequate information about those plans’ limitations, according to the analysis by researchers at Georgetown University’s Center on Health Insurance Reforms.

The study probed online marketing practices in eight states.
“It was disturbing, but not unexpected, to find such a high proportion of misleading ads and come-ons,” said Sabrina Corlette, the lead author. “That raises the risk that consumers […]

Ads For Short-Term Plans Overwhelm Searches2019-02-12T22:26:16+00:00

On Point With POs: Community Health Navigators

By  EWA MATUSZEWSKI
Community Health Navigators, Medical Assistants Gain New Respect—And Billing Codes
It’s not unusual for words and phrases to fall in and out of favor in the healthcare space, but it seems once they are assigned a billing code people start to take notice. Such is the case with “community health navigator.” Frequently used in conjunction with the social determinants of health (SDOH), the role of a community health navigator is rightly taking on significance as the go-to solution finder for the web of challenges that can vex consumers, often in the context of primary care, seeking non-medical answers to their quality of life issues.

Community health navigators are used in […]

On Point With POs: Community Health Navigators2019-02-12T22:21:18+00:00

Compliance Corner: Eliminating Kickbacks

By REESA N. BENKOFF & DUSTIN T. WACHLER
Effective Oct. 24, 2018, the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) aims to combat the nationwide opioid and other substance abuse crisis by improving treatment and recovery options, increasing education and prevention, safeguarding communities, and fighting deadly synthetic drugs. The SUPPORT Act is a bipartisan, wide-ranging federal law comprised of over 70 individual bills, including the Eliminating Kickbacks in Recovery Act of 2018 (EKRA). EKRA establishes a new all-payor federal anti-kickback law applicable to recovery homes, clinical treatment facilities, and laboratories. While EKRA was intended to prohibit patient brokers who profit […]

Compliance Corner: Eliminating Kickbacks2019-02-12T22:16:52+00:00

Shirkey Challenges Industry On Uninsured

While the Legislature launches into its latest look into reducing auto insurance rates, Senate Majority Leader Mike Shirkey (R-Clarklake) said he will be asking the insurance industry to come up with “creative solutions” to entice uninsured drivers to come in compliance with the state law requiring drivers to carry insurance.

In Michigan, 19 percent of drivers are tooling around uninsured, the nation’s fourth-highest rate, according to Insurance Research Council. The country’s most insured state is Maine, where 4.5 percent of drivers are uninsured.

If the insurance industry is able to reduce rates for certain populations, possibly to those burdened by a bad credit rating, it may entice more customers to buy the […]

Shirkey Challenges Industry On Uninsured2019-02-12T22:10:50+00:00