CT Center for Patient Safety Newsletter

February 2014

In This Issue

Greed...Charles Denham

Legislative Issues

Prescription Drug Factoid

Greed

Charles Denham looks benevolent and patient safety advocates felt that his work over the past few years seemed to indicate a real concern for patients.
What we did not know was that in 2008, as he chaired the Safe Practices Committee at the National Quality Forum, a non-profit that reviews, endorses and recommends standardized healthcare performance measures and practices, Denham pocketed $11.6 million, and in return recommended and promoted a product called ChloraPrep. His advocacy for the product bothered NQF and they began to distance themselves. But what about the public's right to know?

Conflicts of interest are so common and accepted that they are often the norm. The National Physicians Alliance has begun a program - Unbranded Doctors, as they readily acknowledge the problem. "For good reason, the public has steadily lost faith in the medical profession over the last several decades. As the health care system has been yielded to large corporations, a business ethic threatens our foundational ethic of care. Corporate influences have compromised the doctor-patient relationship and medical organizations have unfortunately been complicit in this unraveling. The National Physicians Alliance is founded to restore trust in the medical profession by refocusing medicine on our core values: service, integrity and advocacy. The NPA believes that patients should never have to doubt the motives of their doctors."

But let's put Denham's picture on our wall of shame. What was he thinking? It certainly was not about patients and their right to safe, effective healthcare that is recommended because it is in their interest and not in the financial interest of the doctors.

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Dear Members,

I am always puzzled by doctors who believe that it is OK to practice defensive medicine. Do they think that their rationale meets patients expectations especially when patients are paying a greater share of their healthcare expenses or that patients are willing to take the time to undergo extra tests or even undergo an intervention that is not in their interest?

Defensive medicine is medical practices designed to avert the future possibility of malpractice lawsuits. And defensive medicine is squarely blamed on the fear of medical malpractice litigation.

Gloria Steinem always said we need to name the problem and the problem is money. Far too often conflicts of interest and payment models drive the over-prescribing and overuse that we see. Components of the Affordable Care Act and healthcare reform will be driving change and physicians are insecure in their expectation of their futures. The reaction seems to be that they hold their beliefs more fervently rather than acknowledge the real problem: many of them have financial interests in keeping things the way they are.

Last summer I was a panelist at the annual meeting of the American Board of Radiology Foundation. National leaders discussed the dangers of overuse of CT imagining particularly with young children. At that two day meeting, I listened to the debate and I was puzzled that no one talked about financial interests.

Physicians may own the equipment which has been shown to trigger more testing.
Physicians may own a share of the entity that does the imaging which also drives testing
Physicians are paid to read the tests

Overuse of testing will never end up in a court. How would it be proven that the three CT scans that a seven year old soccer player had is now responsible for his or her brain cancer twenty five years later? Doctors cannot keep saying that it is partially the parents fault for demanding tests. It is not the patients' responsibility to understand the dangers.

Patients will be paying more for their healthcare. As we pay more, we will demand greater transparency of the charges and many of those charges make absolutely no sense. Steven Brill, in his Time Magazine article Bitter Pill: Why Medical Bills Are Killing Us has opened the door to ridicule. Your vet and dentist will tell you the cost of a procedure but not your orthopedic surgeon and definitely not your hospital.

The All Payer Claim Data Base will be aggregating data from all payers. For the first time in Connecticut's history, in just a few years we will be able to find the outliers: for instance, those obstetrical practices that routinely perform early deliveries or the internist who is ordering too many tests or prescribing too many antibiotics. We will be able to see the surgeon whose infection rates are indefensible.

CMS is also stepping up to the plate. Their access to data, and their lethargy to use that data in the past has been discouraging. Going forward, Medicare will be focusing on doctors with the highest Medicare billings because they may well have received improper payments. This scrutiny will be a signal to all physicians that the new willingness of CMS to use data in the patient's interest will increase accountability.

The Affordable Care Act is demanding greater transparency of the financial relationships between the pharmaceutical industry, the medical device industry and the physicians.

Martin Luther King talked about tranquilizing incrementalism. There is no better example than in our attempts to reform the industries so ineffectively providing healthcare. Healthcare has become about the industries and not about the patients. Slowly we are now beginning to focus on the patient. Unfortunately, 20% of our economy needs to shift and I fear that it will not be in my lifetime.

Jean

Surprise Surprise

Have you ever asked a vet how much a procedure will cost? Or a dentist? You were probably given an immediate answer. But if you were to ask a doctor, you would probably be told that they have no idea.

As consumers spend more and more of their income on healthcare, it is about time we shine a light on just how much we will have to pay for a specific procedure.

This year we are trying to get a bill raised in the Public Health Committee that would simply require a physician and hospital to provide information for their patients. The legislation would:

require physicians to prepare a price-list for most commonly performed procedures. This proposal is almost identical to one passed by Maine last year.
require a physician to provide an estimate of the maximum cost of the procedure at the request of a patient.
require hospitals to tell patients and families within 24 hours of admission what their status is (e.g. inpatient or observation status) and explain the potential financial differences. This proposal is necessary because Medicare will not pay for a stay in a skilled nursing facility after hospitalization unless this patient has been classified as inpatient status for at least three days (not including day of discharge). If the patient is classified as observation status, then the patient could face huge, unexpected bills.

The simple purpose of these proposals is to provide reasonable information to patients.

If you have a story about unexpected charges, please contact our office.

Factoid:

In 2010, prescription drugs accounted for 21.4 percent of overall health care expenditures among the U.S. civilian non-institutionalized population. Prescription drug expenses were incurred by 61.3 percent of the population, and among those with expenses, the average annual expense amount was $1,432.
Where do you fit into this picture?