Category: Healthcare

How Doctors Die

KEN MURRAY, clinical assistant professor of family medicine at the Keck School of Medicine at USC:

This op-ed was originally published at Zocalo Public Square.

“Years ago, Charlie, a highly respected orthopedist and a mentor of mine, found a lump in his stomach. He had a surgeon explore the area, and the diagnosis was pancreatic cancer. This surgeon was one of the best in the country. He had even invented a new procedure for this exact cancer that could triple a patient’s five-year-survival odds—from 5 percent to 15 percent—albeit with a poor quality of life. Charlie was uninterested. He went home the next day, closed his practice, and never set foot in a hospital again. He focused on spending time with family and feeling as good as possible. Several months later, he died at home. He got no chemotherapy, radiation, or surgical treatment. Medicare didn’t spend much on him.

Mixing Constitutional Apples and Oranges

REBECCA L. BROWN, professor of constitutional law in USC’s Gould School of Law:

This op-ed originally appeared The Times-Picayune.

“The Supreme Court will soon consider the Affordable Care Act. Some argue that the challenge to the individual mandate is about federalism — the allocation of power between federal and state governments in our republic. But a close look at the Constitution shows that this is false.

The Constitution gives Congress power “to regulate commerce … among the several States.” Anything outside this description falls to the states to govern. All prior Commerce Clause challenges to federal laws have claimed that the matter was not “commerce” or not

How Pharmacists Can Help Cut Healthcare Costs

R.PETE VANDERVEEN, dean of USC’s School of Pharmacy:

This article originally appeared at POLITICO.

“How do we get patients – especially those with chronic conditions like diabetes and hypertension — to take their medications faithfully?

Hundreds of billions of dollars are riding on the answer. Spending on prescription medicines in the U.S. annually amounts to $301 billion, about 10 percent of the nation’s total health care tab. But almost as much — $290 billion — is spent each year dealing with the medical effects of Americans not taking their drugs correctly, according to the New England Healthcare Institute.

Getting patients to comply with their prescriptions could significantly cut health care costs.

It won’t be easy. Consider that researchers offered heart-attack survivors a seemingly irresistible incentive to take their medicine: “free” drugs with no co-payments. But the free drugs only modestly improved the survivors’ adherence rates, according to a study published online recently in The New England Journal of Medicine. If free drugs don’t do much, what could make a more significant dent in the problem? Pharmacists could. But the federal government doesn’t recognize them — unlike most other health care professional — as providers, which minimizes their role in helping patients correctly take their medicine and squanders tens of billions of dollars in potential savings.

Research shows that if pharmacists played a treatment role in addition to filling prescriptions, they could considerably lower health care costs. At Kaiser Permanente Colorado, for example, pharmacists set out to help patients with coronary artery disease hit their blood pressure and cholesterol targets.

Working under physician-approved protocols, the pharmacists monitored drug therapies, adjusted dosages, ordered lab tests and added medications when needed. The results? An 89 percent reduction in patients’ overall mortality and a nearly $22,000 annual savings in health care costs per patient, according to a 2007 study.

One of the largest physician-pharmacist collaboration projects is in Asheville, N.C. The city first hired pharmacists to work with its employees who had diabetes in 1997, seeking to improve their health and lower treatment costs.

The results exceeded expectations. From 1997 to 2001, the city reported that annual direct medical costs per worker dropped, on average, by $1,200 to $1,872. The city has since expanded the project to cover other chronic diseases, including hypertension and asthma. It saves an estimated $4 for every $1 invested.

These kinds of improved health outcomes and cost savings could become more widespread if Congress changed provider law to make the expanded services performed by the pharmacists at Kaiser and in Asheville part of standard health insurance coverage.

The training today’s pharmacists undergo qualifies them for provider status. They must complete a four-year postgraduate program focused on managing complex medications – more than 10,000 prescription drugs and counting – that are central to today’s drug treatments.

This knowledge is increasingly in demand. Already, more than half all Americans have one or more chronic diseases, and for 90 percent of them medications are the first-line of treatment. Health experts expect chronic-disease rates to rise as the population grays.

Yes, allowing pharmacists to play a treatment role in patient care, and collect fees for doing it, may initially increase medical costs. But over time, as the Asheville project demonstrates, it saves money.

When you factor in improved patient adherence to prescribed drug regimens because of regular pharmacist oversight, overall savings could be significant.

The Affordable Care Act offers an opportunity to put new pressure on Congress. Under the health care law, every plan sold on the new insurance exchanges will be required to cover a set of “essential health benefits,” like physician services and hospitalizations. The Department of Health and Human Services and the individual states are to decide the definition of those benefits. Making pharmacist-supervised medication management an essential benefit would help bring our health care system into the 21st century.”