Comments on: Drug Company Detailing http://www.letstalkhealthcare.org/transparency/drug-company-detailing/ Sat, 22 Nov 2008 05:10:18 +0000 http://wordpress.org/?v=2.5.1 By: sean grady http://www.letstalkhealthcare.org/transparency/drug-company-detailing/#comment-5560 sean grady Thu, 03 Jul 2008 15:27:34 +0000 http://www.letstalkhealthcare.org/?p=233#comment-5560 Charlie - To control healthcare costs I think you have to make some really difficult decisions and stick to them. Nibbling around the edges by prohibiting drug reps to hand out free pens is just not a serious step forward in controlling costs. First, like it or not physicians need to be put back in a form of capitation so they are responsible for managing the care of their patients. Give physicians the real ability to manage the care, a fair budget with the opportunity for some profit and a strong stop/loss reinsurance policy to cover potential losses. Pay for performance incentives are nice but if employers can't afford the policies who really cares how many diabetics are in good control? Put physicians and hospitals back in control of caring for their patients within budgets as opposed to the fee for service environment of today that encourages more tests, more admissions to hospitals and more high cost imaging. Providers are ordering and doing more because that is how they make more money and there is no downside to them Second, we have to cut the free hand-outs such as the free care pool still in existence and paying $450 million to Boston Medical Center and Cambridge Health Alliance. The free care pool was supposed to go away as people were enrolled in Connector plans but here we are still paying hundreds of millions to politically connected facilities. The feds are right to hold up the state waiver until Mass gets rid of the free care pool hand-outs that were supposed to go away. Third, the health plans need to stop being held hostage by Partners Healthcare who give them a take it or leave it rate demand. They get paid far more than others while not showing they deliver care any better. They drive up the cost of insurance for everyone because of their high demands and they are really a monopolistic force driving the cost of care ever higher. If questioned they threaten to take their network and leave.... someone should let them and set up a low cost alternative network. People would be stunned how much lower premiums would be without Partners included in it. Fourth, people have to pay more. I would love a Lexus too but if I can't afford it I have to settle for a Camry. People can't expect to have the best of everything in healthcare for a $5 co-payment. If you use the system expect to pay more of the cost. A small percentage of the people drive most of the costs so maybe they should be expected to pay more. Fifth, Medicare has to be reformed. We all pay into Medicare via payroll taxes and right now it looks like it won't be there for us when we reach the age of eligibility. I think higher eligibility age, fewer covered benefits and higher member payments should all be on the table. Medicare Advantage plans are another opportunity for the feds to pass the risk on to private plans that offer enhance benefits and have better ways of controlling costs. No they are not perfect but they are better than the federal government running healthcare (with them in control we have Medicare heading off a cliff in a few years). These are difficult decisions and all have flaws but we need to get serious here and not think that stopping a drug rep bringing in a free lunch is what is driving the cost of healthcare higher. Have a happy holiday and look forward to your response on my proposals. Charlie - To control healthcare costs I think you have to make some really difficult decisions and stick to them. Nibbling around the edges by prohibiting drug reps to hand out free pens is just not a serious step forward in controlling costs. First, like it or not physicians need to be put back in a form of capitation so they are responsible for managing the care of their patients. Give physicians the real ability to manage the care, a fair budget with the opportunity for some profit and a strong stop/loss reinsurance policy to cover potential losses. Pay for performance incentives are nice but if employers can’t afford the policies who really cares how many diabetics are in good control? Put physicians and hospitals back in control of caring for their patients within budgets as opposed to the fee for service environment of today that encourages more tests, more admissions to hospitals and more high cost imaging. Providers are ordering and doing more because that is how they make more money and there is no downside to them Second, we have to cut the free hand-outs such as the free care pool still in existence and paying $450 million to Boston Medical Center and Cambridge Health Alliance. The free care pool was supposed to go away as people were enrolled in Connector plans but here we are still paying hundreds of millions to politically connected facilities. The feds are right to hold up the state waiver until Mass gets rid of the free care pool hand-outs that were supposed to go away. Third, the health plans need to stop being held hostage by Partners Healthcare who give them a take it or leave it rate demand. They get paid far more than others while not showing they deliver care any better. They drive up the cost of insurance for everyone because of their high demands and they are really a monopolistic force driving the cost of care ever higher. If questioned they threaten to take their network and leave…. someone should let them and set up a low cost alternative network. People would be stunned how much lower premiums would be without Partners included in it. Fourth, people have to pay more. I would love a Lexus too but if I can’t afford it I have to settle for a Camry. People can’t expect to have the best of everything in healthcare for a $5 co-payment. If you use the system expect to pay more of the cost. A small percentage of the people drive most of the costs so maybe they should be expected to pay more. Fifth, Medicare has to be reformed. We all pay into Medicare via payroll taxes and right now it looks like it won’t be there for us when we reach the age of eligibility. I think higher eligibility age, fewer covered benefits and higher member payments should all be on the table. Medicare Advantage plans are another opportunity for the feds to pass the risk on to private plans that offer enhance benefits and have better ways of controlling costs. No they are not perfect but they are better than the federal government running healthcare (with them in control we have Medicare heading off a cliff in a few years). These are difficult decisions and all have flaws but we need to get serious here and not think that stopping a drug rep bringing in a free lunch is what is driving the cost of healthcare higher. Have a happy holiday and look forward to your response on my proposals.

]]> By: Charlie Baker http://www.letstalkhealthcare.org/transparency/drug-company-detailing/#comment-5544 Charlie Baker Tue, 01 Jul 2008 15:31:45 +0000 http://www.letstalkhealthcare.org/?p=233#comment-5544 So what do we - Brian and Sean - mean by sustainable funding? Does that mean finding more money from somewhere - probably taxpayers or employers or health plans - or all three - to fund a 10% annual increase in health care spending going forward into the future? Does it mean finally doing something serious and real about rising health care costs - almost all of which are tied to practice pattern and unit price variation? Does it mean both? Does it mean something else? Sean seems to want to limit the growth in health care costs. I'm with him. There is no sustainable funding solution that presumes we can just find the money on the revenue side every year from someone or some group - and not deal with the 10% per year increase in underlying health care service delivery. So what do we - Brian and Sean - mean by sustainable funding? Does that mean finding more money from somewhere - probably taxpayers or employers or health plans - or all three - to fund a 10% annual increase in health care spending going forward into the future? Does it mean finally doing something serious and real about rising health care costs - almost all of which are tied to practice pattern and unit price variation? Does it mean both? Does it mean something else?

Sean seems to want to limit the growth in health care costs. I’m with him. There is no sustainable funding solution that presumes we can just find the money on the revenue side every year from someone or some group - and not deal with the 10% per year increase in underlying health care service delivery.

]]> By: sean grady http://www.letstalkhealthcare.org/transparency/drug-company-detailing/#comment-5533 sean grady Fri, 27 Jun 2008 17:35:59 +0000 http://www.letstalkhealthcare.org/?p=233#comment-5533 I am sure Health Care for All is well intentioned in their efforts but if you are going to be an independent advocacy group you should really avoid taking money from the State of Massachusetts which is so heavily involved in many of the policies you are judging. Further, the fact that your plea for continued state funding made it into the Globe article suggests these amounts are not insignificant to your group. I will agree that the state reform has reduced the uninsured rate but there is nothing "new" going on here... the state simply took hundreds of millions of TAXPAYER money from the feds (and state tax dollars as well) and paid for people's insurance policies. Hardly any of the new covered enrollees are actually paying anything so it was just a massive hand-out of free healthcare insurance by the government and paid for by the taxpayers.... not to mention adding millions more in spending over at the connector to sign people up for their free plans. I just don't see this as any kind of "reform" and with the costs totally out of control I do not think this is affordable or sustainable no matter how nice it would be for everyone to have coverage. I am sure Health Care for All is well intentioned in their efforts but if you are going to be an independent advocacy group you should really avoid taking money from the State of Massachusetts which is so heavily involved in many of the policies you are judging. Further, the fact that your plea for continued state funding made it into the Globe article suggests these amounts are not insignificant to your group. I will agree that the state reform has reduced the uninsured rate but there is nothing “new” going on here… the state simply took hundreds of millions of TAXPAYER money from the feds (and state tax dollars as well) and paid for people’s insurance policies. Hardly any of the new covered enrollees are actually paying anything so it was just a massive hand-out of free healthcare insurance by the government and paid for by the taxpayers…. not to mention adding millions more in spending over at the connector to sign people up for their free plans. I just don’t see this as any kind of “reform” and with the costs totally out of control I do not think this is affordable or sustainable no matter how nice it would be for everyone to have coverage.

]]> By: Brian Rosman http://www.letstalkhealthcare.org/transparency/drug-company-detailing/#comment-5532 Brian Rosman Fri, 27 Jun 2008 15:56:55 +0000 http://www.letstalkhealthcare.org/?p=233#comment-5532 Health Care For All received a modest grant from the state's outreach program, and we always let reporters and policymakers know that when we talk about this issue. The funds were awarded after a public, competitive process, and are used solely for state-approved outreach activities. We provide detailed monthly activity reports subject to strict accounting and auditing for the funds. The amount received is a small fraction of HCFA's overall budget - less than 3%. HCFA's views on health reform and any other topic are not related to any of the many sources of funds we receive. We think health reform has made real progress, by cutting the uninsurance rate in half, improving the insurance market, and beginning efforts on quality and disparities. But there's still a long way to go, and many challenges ahead, including sustainable financing. Brian Rosman Health Care For All Research Director Health Care For All received a modest grant from the state’s outreach program, and we always let reporters and policymakers know that when we talk about this issue. The funds were awarded after a public, competitive process, and are used solely for state-approved outreach activities. We provide detailed monthly activity reports subject to strict accounting and auditing for the funds.

The amount received is a small fraction of HCFA’s overall budget - less than 3%. HCFA’s views on health reform and any other topic are not related to any of the many sources of funds we receive. We think health reform has made real progress, by cutting the uninsurance rate in half, improving the insurance market, and beginning efforts on quality and disparities. But there’s still a long way to go, and many challenges ahead, including sustainable financing.

Brian Rosman
Health Care For All Research Director

]]> By: Charlie Baker http://www.letstalkhealthcare.org/transparency/drug-company-detailing/#comment-5525 Charlie Baker Thu, 26 Jun 2008 20:47:44 +0000 http://www.letstalkhealthcare.org/?p=233#comment-5525 Sean - I think Health Care For All gets state funding to do outreach for enrollment. I'd prefer to let them speak for themselves on the "conflict" question - but I think Sean's larger point about transparency is a good one. I don't know if HCFA has acknowledged they receive funds from the state to do outreach that's attached to health care reform, which they support. I'm guessing they have, but I don't know. If they haven't acknowledged it, they probably should. Barry - your first point - the disclosure and transparency could go a long way on this issue is a good one - as long as it's real. And your second one about the importance of referencing funding/support that's provided to reviewers and researchers is also a good one. Ironically, I think the research community is coming around on this, which was partly why I wrote the post in the first place. Lisa - I applaud HCFA's efforts on this - and other issues - but don't necessarily believe that the presence of a dinner or a lunch proves a conflict for a physician any more than it does for a public official - or for Health Care For All. Given the topic, Sean's comment is an interesting one. He implies a conflict for HCFA in support for certain state policies if there's direct support for HCFA involved in the outcome. I know HCFA well enough to know that's not the case, but it does make an interesting point about conflict, disclosure, and what's a reasonable business relationship. Sean - I think Health Care For All gets state funding to do outreach for enrollment. I’d prefer to let them speak for themselves on the “conflict” question - but I think Sean’s larger point about transparency is a good one. I don’t know if HCFA has acknowledged they receive funds from the state to do outreach that’s attached to health care reform, which they support. I’m guessing they have, but I don’t know. If they haven’t acknowledged it, they probably should.

Barry - your first point - the disclosure and transparency could go a long way on this issue is a good one - as long as it’s real. And your second one about the importance of referencing funding/support that’s provided to reviewers and researchers is also a good one. Ironically, I think the research community is coming around on this, which was partly why I wrote the post in the first place.

Lisa - I applaud HCFA’s efforts on this - and other issues - but don’t necessarily believe that the presence of a dinner or a lunch proves a conflict for a physician any more than it does for a public official - or for Health Care For All. Given the topic, Sean’s comment is an interesting one. He implies a conflict for HCFA in support for certain state policies if there’s direct support for HCFA involved in the outcome.

I know HCFA well enough to know that’s not the case, but it does make an interesting point about conflict, disclosure, and what’s a reasonable business relationship.

]]> By: sean grady http://www.letstalkhealthcare.org/transparency/drug-company-detailing/#comment-5514 sean grady Tue, 24 Jun 2008 20:25:44 +0000 http://www.letstalkhealthcare.org/?p=233#comment-5514 Charlie - An article in today's Globe re delayed letters to 16,000 Medicaid patients ends with a reference to the fact that the State of Massachusetts provides money to groups like Health Care for All (I think the figure mentioned was $3.5 million in one of the proposed state budgets). Keeping with the issue of transparency, shouldn't Mass taxpayers be aware of the fact that a group like Health Care for All receives state money when they come out in support of state actions? Honestly, I had no idea that taxpayer money was being used to help run these "non profits" that many times come out in strong support of government policies. If the state is funding these groups is it any surprise they come out in support of the state on things like these gift bans or the questionable success of the Mass health reform (yeah we have "enrolled" people but not many are paying for their insurance and the costs are totally out of control) ? Let's make sure transparency is applied to the people who are coming out with strong opinions on these important healthcare issues. Charlie - An article in today’s Globe re delayed letters to 16,000 Medicaid patients ends with a reference to the fact that the State of Massachusetts provides money to groups like Health Care for All (I think the figure mentioned was $3.5 million in one of the proposed state budgets). Keeping with the issue of transparency, shouldn’t Mass taxpayers be aware of the fact that a group like Health Care for All receives state money when they come out in support of state actions? Honestly, I had no idea that taxpayer money was being used to help run these “non profits” that many times come out in strong support of government policies. If the state is funding these groups is it any surprise they come out in support of the state on things like these gift bans or the questionable success of the Mass health reform (yeah we have “enrolled” people but not many are paying for their insurance and the costs are totally out of control) ? Let’s make sure transparency is applied to the people who are coming out with strong opinions on these important healthcare issues.

]]> By: Barry Carol http://www.letstalkhealthcare.org/transparency/drug-company-detailing/#comment-5498 Barry Carol Sat, 21 Jun 2008 09:40:23 +0000 http://www.letstalkhealthcare.org/?p=233#comment-5498 Correction: My reference to a proposed range of values in a financial disclosure form should have read: less than $100, $100 to $1,000, $1001 to $5,000, and greater than $5,000. Apparently, greater than and less than signs are not picked up from the Word document and posted to the blog. Correction: My reference to a proposed range of values in a financial disclosure form should have read: less than $100, $100 to $1,000, $1001 to $5,000, and greater than $5,000. Apparently, greater than and less than signs are not picked up from the Word document and posted to the blog.

]]> By: Barry Carol http://www.letstalkhealthcare.org/transparency/drug-company-detailing/#comment-5494 Barry Carol Sat, 21 Jun 2008 01:35:11 +0000 http://www.letstalkhealthcare.org/?p=233#comment-5494 Frankly, this issue strikes me as much ado about very little. I think it could be adequately addressed by strong disclosure and transparency rules. Doctors and other healthcare professionals could file forms modeled after the financial disclosure forms used by Congress. There could be a listing of general categories of gifts (including cash for speeches, participation in focus groups, conference panels, etc.), a range of value such as $5,000 as well as a listing of the companies that provided the gifts or speaking fees. All of this information could be posted on a public website in a user friendly format that anyone could access. Thorough financial disclosures are even more important for doctors who evaluate research papers, the effectiveness and safety of drugs and devices, and the comparative effectiveness of various medical treatments and procedures. I don’t know why healthcare providers (especially doctors and hospitals) are so resistant to transparency. What are they trying so hard to hide? Frankly, this issue strikes me as much ado about very little. I think it could be adequately addressed by strong disclosure and transparency rules. Doctors and other healthcare professionals could file forms modeled after the financial disclosure forms used by Congress. There could be a listing of general categories of gifts (including cash for speeches, participation in focus groups, conference panels, etc.), a range of value such as $5,000 as well as a listing of the companies that provided the gifts or speaking fees. All of this information could be posted on a public website in a user friendly format that anyone could access.

Thorough financial disclosures are even more important for doctors who evaluate research papers, the effectiveness and safety of drugs and devices, and the comparative effectiveness of various medical treatments and procedures. I don’t know why healthcare providers (especially doctors and hospitals) are so resistant to transparency. What are they trying so hard to hide?

]]> By: Lisa Kaplan Howe http://www.letstalkhealthcare.org/transparency/drug-company-detailing/#comment-5492 Lisa Kaplan Howe Fri, 20 Jun 2008 20:48:36 +0000 http://www.letstalkhealthcare.org/?p=233#comment-5492 Thanks for your blog on this important topic. It is great that academic medical centers and other hospitals around the country, including UMass Memorial, Boston Medical Center and others in Massachusetts, have recognized the conflict of interest created by pharmaceutical gifts to providers and are starting to take action. Their actions are an important step forward in eliminating this threat to cost control, access and patient care. In order to fully solve this problem, we must go further. We need a uniform standard across the entire state, which we'll never get with individual institutional policies. Additionally, these policies only apply to doctors that work at hospitals. They do not and cannot apply the the many doctors in private practice. Health Care For All and other members of the MA Prescription Reform Coalition applaud the Senate for passing the pharmaceutical gift ban and we call on the House to do the same. The gift ban is not at odds with the state's recent investment in the life sciences industry. Just the opposite. Precisely because the Commonwealth just pledged $1B of taxpayer money to the biopharma industry, we think it's reasonable for leaders to demand that the industry act ethically in their marketing practices. And, there's no reason why they shouldn't be able to do so and continue to do business in our state. They should be able to market their life-saving products on their merits alone. It also bears mentioning that while the gift ban legislation bans all types of gifts, it bans only gifts. Pharmaceutical and medical device companies will still be permitted to provide samples, pay doctors to conduct research and participate in other types of scientific collaborations with industry and receive infomration from the industry. The ban is not an end to drug company detailing and many other collaborations between industry and health care providers. It's only an end to the excessive marketing that we all pay for. Thanks for your blog on this important topic. It is great that academic medical centers and other hospitals around the country, including UMass Memorial, Boston Medical Center and others in Massachusetts, have recognized the conflict of interest created by pharmaceutical gifts to providers and are starting to take action. Their actions are an important step forward in eliminating this threat to cost control, access and patient care. In order to fully solve this problem, we must go further. We need a uniform standard across the entire state, which we’ll never get with individual institutional policies. Additionally, these policies only apply to doctors that work at hospitals. They do not and cannot apply the the many doctors in private practice.

Health Care For All and other members of the MA Prescription Reform Coalition applaud the Senate for passing the pharmaceutical gift ban and we call on the House to do the same. The gift ban is not at odds with the state’s recent investment in the life sciences industry. Just the opposite. Precisely because the Commonwealth just pledged $1B of taxpayer money to the biopharma industry, we think it’s reasonable for leaders to demand that the industry act ethically in their marketing practices. And, there’s no reason why they shouldn’t be able to do so and continue to do business in our state. They should be able to market their life-saving products on their merits alone.

It also bears mentioning that while the gift ban legislation bans all types of gifts, it bans only gifts. Pharmaceutical and medical device companies will still be permitted to provide samples, pay doctors to conduct research and participate in other types of scientific collaborations with industry and receive infomration from the industry. The ban is not an end to drug company detailing and many other collaborations between industry and health care providers. It’s only an end to the excessive marketing that we all pay for.

]]>