Mike Whitely of WorkCompCentral reported this morning that the Florida Medical Association has decided that their doctors’ profits are far more important than patient safety.

Sure, they’re hiding behind grand words such as “patient choice” and “return to work”, but those are just code words for “we’ll sock taxpayers and employers for as much as we can as long as we can, and to hell with ethics.”

The president of the FMA, one Miguel Machado, said last year “encouraging patients to comply with prescriptions ensures that they will get back to work sooner.” His legislative lead said:

“The FMA maintains that physician dispensing of medications is one of the most effective means of patient compliance, which means injured workers can return to their jobs sooner.”

There are two issues here; one is the FMA’s inability to support that statement with any research, and two; the fact that physician dispensing is outright dangerous.

Truth is there is not one shred of evidence that dispensing drugs results in faster return to work or better outcomes.  There is NO DATA, no research, no information, no studies, no indication whatsoever that physician dispensing does anything positive; unless you count enriching doctors, repackaging companies, and the firms that enable those practices as positives…

And let’s not forget it enriches investors, specifically ABRY Partners, that own physician dispensing companies.  And yes, that’s the same ABRY that also owns TPA York Claims and MSA firm Gould and Lamb. (Nothing against York, mind you – the people I know there are very good and very committed to doing the right thing for their customers)

There is a plethora of evidence indicating that ending outrageous profiteering on physician dispensed drugs does NOT end the practice of physician dispensing, but it seems Machado’s medical degree did not come with even a basic understanding of science or statistics.  If it did, he would be able to read WCRI’s report on California which showed no significant decrease in physician dispensing after CA tied the price of repackaged physician dispensed drugs to the original manufacturer’s price.

The second issue is even more troubling.

Machado’s doctors don’t have access to pharmacy databases that retail stores use to prevent potentially deadly drug interactions. Pharmacists in retail stores are required to check computerized databases to ensure the drugs they are dispensing don’t conflict with other medications their patients are taking. There’s no such requirement for Machado’s doctors.  And, because most work comp claimants are seen by docs who haven’t seen the patient before, the treating physician doesn’t have a complete medical record – or access to one.

So Machado’s words ring completely, unequivocally, blatantly, hypocritically false.

I don’t know what it will take to convince these hypocrites of the error of their ways; perhaps news of the first – or second, or third – patient death caused by a fatal drug interaction from a physician-dispensed drug. It is horrible indeed to consider, but when one remembers Florida is the same state that refuses to fund its prescription drug monitoring program and waited years before closing pill mills, it may well take multiple deaths before the FMA does the right thing.

Kudos to Sen Alan Hays, DMD for his principled and active commitment to fixing this problem.

If you want to let the FMA know your thoughts on this, their number is 800-762-0233; even better, their twitter handle is @FloridaMedical.

Of course, it’s up to you, but you may want to tweet something like “@FloridaMedical’s drug dispensing position puts #ProfitsBeforePatients”.

Michael Gavin at PRIUM has a somewhat more measured but equally disappointed view…

 

Not directly.

But there’s a wealth of indirect effects.  Here are a few worth contemplating…

But first, I’m not seeing a plunge “off the cliff” as all that big a disaster.  Sure, there will be much consternation among pols and pundits, but that’s as much to  generate readers and viewers as to “report” on reality. The negative impact of the political deadlock has already been baked into the economy, so the economy isn’t going to get any worse over the next month or so.

That said, if we don’t get a resolution by mid-January, the proverbial stuff will hit the fan.

So two scenarios.

One, it gets fixed over the next month.  Some delay in premium payments from governmental entities. Perhaps a holdup on changes to Medicare physician reimbursement and docs hold bills in hopes their reimbursement doesn’t get slashed.  Some employers will hold off on hiring while they wait for the kids in the sandbox to get their $%&(@% together. And delays in starting infrastructure work or continuing existing projects will undoubtedly occur…

That’s about it.

Which leads us to the “oh crap” scenario, the one where DC pols decide to cross the stupid line.

Government spending on infrastructure would all but cease; employers would stop hiring and might well lay off workers; health care providers – especially hospitals – would likely cut staff as well; manufacturing would slow appreciably, state, local, and municipal governments would furlough employees…

You get the picture.  As a result, comp premiums would drop significantly, few employers would look to switch insurers or administrators, and service providers/vendors would likely see a significant decrease in business as well.

So, let’s not go there.

I fully expect our elected officials will fix this before it’s too late.  The political consequences (are there any other?) would be catastrophic if they don’t.

As Winston Churchill said of us: “The Americans will always do the right thing… after they’ve exhausted all the alternatives.”

 

 

Here’s where we are with the implementation of PPACA aka Obamacare.

1.  Several states have either rejected the Medicaid expansion or are waffling. Expect most to decide to take the money; hospitals, physicians, and their lobbyists are working overtime to make sure this happens.  It’s a no-brainer; the feds are paying all of the cost for the first five years, 95 percent for the next five, and 90 percent thereafter.

2. A new tax to subsidize lower-income folks’ Medicaid goes into effect January 1. Most of the new revenue (85 percent) derives from the top 1 percent of taxpayers, with lower-income people getting most of the benefits. for Medicaid and insurance subsidies.

3. The growth of Accountable Care Organizations is quickening – but some are ACOs in name only, while most are ACO 1.0. While there’s much skepticism about the eventual ability of ACOs to control costs/improve outcomes, I’m convinced they will do both.

This from David Harlow:

“…we’re at the leading edge of a significant disruption built around the Affordable Care Act’s provisions on ACOs and related initiatives: a sea change in the way health care is conceptualized, and radical change in delivery and payment systems.  We’re ahead of the curve on these issues in Massachusetts, with a law passed this summer that will move us into ACOs for all — not just Medicare beneficiaries — and away from fee-for-service medicine, and a local Blue Cross-Blue Shield plan known as the Alternative Quality Contract that has been working on this basis — budgeted caps with quality kickers — for several years already. It’s the latest form of pay for performance, or value-based payment.”

4. The feds will charge insurers who go thru Federal Exchanges 3.5% of premiums. This is likely quite a bit more than private insurers were figuring.  If nothing else, it will increase pressure on governors who until now have rejected operating their own Exchange; expect insurers in the 21 states that have rejected exchanges to increase pressure on their governors to set up their own state-run exchanges.

5. There’s much angst in the insurer community over definitions of benefits – which are set by each state – and the cost of providing those benefits.  States with few mandates may well see costs go up significantly, especially for younger folks with individual coverage (who now must more heavily subsidize older members).

Lastly, there’s a whole lot of uncertainty surrounding implementation of Obamacare/PPACA, along with a lot of prognostication about costs, coverage, and impact on providers, employers, and taxpayers.

One thing to remember; if private insurers had controlled costs, we wouldn’t be talking about Obamacare.