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Who’s Your Doctor?

Over at Forbes, Bruce Japsen reports that the Affordable Care Act is boosting demand for primary care providers. As we’ve said before, Obamacare does nothing to boost physician supply. The millions of newly insured will increase their demand for medical care — and someone has to provide it. This has caused a Gold Rush of sorts among medical practices and hospitals scrambling for primary care providers.

Physician staffing firm, MerrittHawkins reports primary care providers — family physicians and internists tops the list. The number of requests for nurse practitioners and physicians’ assistants it’s been ask to recruits is up more than three times (i.e. 320 %). Advance practice nurses and physicians’ assistants didn’t even make the top 20 of most recruited medical practitioners three years ago. Here’s the current list.

In many cases, increased use of nurse practitioners and physician assistants can provide high quality care at reduced costs. I have long advocated increasing these professionals’ scope of practice as an important part of innovation in delivering medical care. On the other hand, this should happen as a consequence of increased consumer-direction of healthcare spending, not as a response to increased government control, as imposed by Obamacare.

Jul 10, 2014 | 14 comments | by

Hits and Misses

electronic-medical-recordCall your doctor: CMS says telehealth services should cover annual wellness visits, psychotherapy and psychoanalysis.

A remote control for your birth control.

A simple blood test for Alzheimer’s.

Weight loss: The best medicine for osteoarthritis.

And you thought you were a hoarder: CDC finds smallpox vials from 1950s in FDA storage room.

Poop in a pill: Fecal transplant drug nearing Phase 3 clinical trials.

A problem that self-identifies: Microwave oven that counts calories as it nukes.

Jul 10, 2014 | 14 comments | by

Hits and Misses

chopsticks-6What you shouldn’t eat: Instant noodles drive metabolic syndrome (at least in Korean women).

Who would have thought this was the case: Some bee pollen weight loss products are a…scam.

Don’t watch what your workers eat: Non-diet approach to weight management more effective in worksite wellness programs.

However, you can lose weight eating sour milk: Yogurt intake over long term linked to lower risk of becoming overweight.

Less exercise, not more calories, responsible for expanding waistlines.

Should a pharmacist run your corporate fitness program? Sure, it’s yet another job they are infinitely overqualified to perform.

Jul 08, 2014 | 12 comments | by

Insurers Propose Adding a Copper Plan to the Health Insurance Marketplace

health-insuranceAHIP, the trade association for insurers and some Members of Congress are proposing to allow consumers another insurance option in the health insurance Marketplaces. The proposed Copper Plans would pay half of medical expenses (actuarial value of 50%), compared to 60% for the Bronze Plans and 70% for the benchmark Silver Plans. My only concern about adding another tiered plan is that still does not provide insurers with enough flexibility. Insurers need the flexibility to experiment with value-based insurance design, Health Savings Accounts, selective-contracting (i.e. narrow networks) and cost-sharing arrangements not currently allowed under the PPACA. But, the busybodies who think they know what’s in consumers’ best interests are critical of the proposal. According to Kaiser Health News:

Insurers and some U.S. senators have proposed offering cheaper, skimpier “copper” plans on the health insurance marketplaces to encourage uninsured stragglers to buy. But consumer advocates and some policy experts say that focusing on reducing costs on the front end exposes consumers to unacceptably high out-of-pocket costs if they get sick. The trade-off, they say, may not be worth it.

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Jul 07, 2014 | 23 comments | by

Hits and Misses

The real paleo diet: We know what Neanderthals ate by examining their poop!

Slate: Why you still cannot email your doctor.

Nearsightedness linked to higher education levels.

Attributes correlated with falling in love.

EPA employees asked to stop pooping in the hallway.

Jun 27, 2014 | 12 comments | by

The Whac-A-Mole Pharmacy Regulation

seniors-and-prescriptionsIt seems you can whack one bad pharmacy regulation down and it pops right up somewhere else. Earlier this year the Centers for Medicare and Medicaid Services issued a proposed rule that would have effectively banned preferred pharmacy networks in Medicare drug plans. Preferred networks are a common strategy drug plans use to negotiate lower prices with drugstores competing to be included in the exclusive network. Seniors who patronize the preferred network pharmacies when filling prescriptions are generally rewarded with lower cost-sharing — sometimes copays as low as $0! Who wouldn’t love that?

Well, apparently the losing pharmacies don’t like that deal. These are the pharmacies who couldn’t offer the lowest prices when competing to be included in the preferred network. Those who can’t (or won’t) compete are cut off from the taxpayer-funded trough since most seniors like lower copays!

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Jun 27, 2014 | 10 comments | by

Hits and Misses

Does food addiction exist? Maybe so.

A breathalyzer for lung cancer.

Don’t wash your chicken!

Sun worshipers may actually be Sun addicts.

Pollution speeds up cognitive decline.

Jun 25, 2014 | 10 comments | by

Hits and Misses

sitting-2Get up and move: Sitting causes cancer!

So-called “Trophy Wives” are mostly a myth.

Facial wrinkles and zip codes may be related.

Adolescent brains process sugar differently than adult brains.

Young mothers who skip college are also likely to skip marriage.

Jun 18, 2014 | 14 comments | by

ObamaCare’s Mandates Are Harming Small Business

The Affordable Care Act’s employer mandate — intended to make employers provide employee health coverage — is having especially large effects on small businesses. Whereas large corporations typically self-insure — paying their employees’ medical bills and hiring insurers to administer health benefits — small businesses purchase group health coverage from insurers. Thus small firms face cost-increasing regulations as they go through the annual ritual of renewing their coverage. As the ACA is fully implemented over the next few years, ObamaCare will negatively affect how businesses operate — including hiring, employee compensation, growth and so forth.  If the early signs are representative of what the future holds, they are not encouraging.

The Mandate on Employers. Though most of the media attention has focused on the number of individuals who have lost health coverage and the rocky start of the federal and state health exchanges, much of the burden of complying with the ACA will actually fall on employers. About six-in-ten Americans with private health coverage get it through an employer. The cost is not trivial: The Congressional Budget Office estimates that the required coverage for an individual will cost the equivalent of an additional $3 an hour “minimum health wage.” Family coverage could cost more than twice that amount.

Employers are also required to limit the amount of premiums most employees pay to a percentage of their wage income. For example, health plans are considered “unaffordable” if workers earning less than 400 percent of the federal poverty level (about $46,680 for an individual) must pay a premium that is more than 9.5 percent of their income. Firms that fail to provide health insurance will be subject to a tax penalty of $2,000 for each uninsured employee beyond the first 30.  Firms that offer “unaffordable” coverage will pay a penalty of $3,000 for each worker who cannot afford coverage.

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Jun 18, 2014 | 19 comments | by

At a Pharmacy Near You: The Specialty Drug Turf War

Drug therapy is the most efficient method to treat most illnesses — often substituting for hospital treatments and even surgery. The pace of scientific advancement in pharmacology is rapid. So-called specialty drugs are displacing traditional drugs as the primary component of drug spending. Only about 10 such drugs were available 20 years ago, but today there are more than 300. Cancer treatments are the most common type of specialty drugs, making up one-third of  the total. Drugs for autoimmune disorders, rheumatoid arthritis and Crohn’s disease, medications for HIV and drugs for multiple sclerosis are responsible for another third of specialty drug spending.

Specialty drugs are expensive. Although comprising only about 1 percent of drugs prescribed, specialty drugs account for more than one-quarter of prescription drug spending — increasing to 50 percent by 2020. These therapies cost anywhere from $15,000 per year to as much as $750,000 per year. Most have no close substitutes, rendering health plans’ traditional efforts to control costs by encouraging generic substitution largely ineffective.

Due to the vast amounts of money involved, a diverse assortment of new and old competitors are jockeying for position and vying to enter the field of specialty pharmacy. These market participants include not just traditional large retail chain drug stores, but also infusion providers (clinics specializing in intravenous therapies), hub vendors (specialized middlemen), therapy-based service providers (clinics specializing in specific diseases), group purchasing organizations and so forth. Small, independent community pharmacies are also teaming up and organizing their own networks in order to break into the market for specialty drugs.

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Jun 11, 2014 | 14 comments | by
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