It’s football season again. Spain whipped Germany in Euro 2008 futbol. In America, summer training camps are under way. And in Washington, DC, Congress can’t figure out what to do with the football that is the Medicare physician fee fix bill.
The bill passed by Congress last year which would avoid a drop in payments to physicians will expire tomorrow (June 30, 2008). Last week, Congress took their July 4th recess without passing a bill to overturn the impending 10.6% reduction in physician payments. The reductions are schedule to begin on July 1.
The two weeks brought serious of fourth quarter, action-packed series of votes in both houses of Congress, not to mention a dizzying amount of back-room deal-making. Last week, the Senate failed by one vote to get the 60 votes needed to cut off debate and move to final passage of HR 6331, the House-passed version of the fee fix bill. In a move of unity, Senators Clinton and Obama were rushed to the Senate to participate in voting, but it did not impact the outcome.
Senate Democratic leadership were emboldened by a stunning vote earlier last week, where the House passed the bill by a veto-proof margin of 355-59. House Democrats picked up many Republicans who are running in close elections, as well as Republicans who will be retiring, thereby defying the President’s veto threat.
HR 6331 is largely the Senate Democratic measure developed by Finance Chairman Max Baucus (D-MT). House Democratic leaders decided to abandon the Medicare sections they passed last year under the Child Health and Medicare Protection Act in favor of this overtly political move to force the Senate to defy the White House. Congressional members also wanted to politically capitalize on a General Accountability Office (GAO) report released this week showing that insurance companies offering Medicare Advantage plans are overpaid. President Bush has repeatedly threatened to veto any legislation from Congress that includes cuts to Medicare Advantage plans as part of the physician fee fix legislation.
Last Tuesday, the House Democrats brought HR 6331 to the floor, just as Chairman Baucus and Finance Ranking Republican Charles Grassley (R-IA) had reached a compromise on the Medicare physician fix bill which the President was expected to sign. This measure would provide a smaller update for physicians, but still extend the fix for 18 months, but would not include cuts to Medicare Advantage plans opposed by George Bush’s administration. With the overwhelming vote in the House, Senate Democratic leadership decided to scuttle the bipartisan bill and take up the House-passed bill. But because the Senate could not gather the 60 votes needed to proceed to HR 6331, nothing will happen and the pay cut will go into effect on July 1. So, Congress will be heading into overtime when it returns.
The Senate will likely overturn the cuts when they return…and make them retroactive to July 1. But it’s completely unclear if the Senate will move forward with the partisan HR 6331, or take up the scuttled bipartisan bill when they return. My vote is on the bipartisan bill.
Watch for 4th of July fireworks on Independence Day…and when Congress returns. It’s gridiron gridlock in Congress for a little while longer.
Sunday, June 29, 2008
Saturday, June 28, 2008
Prescription Information Battle Re-emerges
Pharmalot has a new article up on Is Data Mining Protected Commercial Speech? To which, I have to ask the question, aren’t we done with this issue yet ? Several states have passed laws and IMS Health and others have sued back. Several federal judges have struck this down and even the most ardent opponents of data mining have thrown in the towel. Why ?
Ed Silverman’s article cites only one source : American University academic Sean Flynn. Now, Flynn knows a lot about the law. He just doesn’t know much about the law in the United States (Flynn is from Africa). His failed understanding of the U.S. Constitution is the reason why New Hampshire and Maine’s bids to ban the practice were unsuccessful. Sean Flynn and his boss Sharon Treat may have hit on a loathsome practice, but Flynn's ignorance of the American legal system has led this to be an entirely academic exercise. It’s no longer about actually defeating the practice of pharmaceutical information, it’s a self esteem exercise for Flynn.
In the Silverman piece, Sean Flynn is quoted as saying : “the commercial speech doctrine serves consumer interests in being fully informed of products and services on the market by providing limited protection to advertisements and other speech to consumers proposing a commercial transaction.” This is precisely why these laws haven’t gone anywhere.
One of the quiet purposes of this data is to monitor physician prescribing behavior to ensure patients are not at risk. In the New Hampshire lawsuit, the goal was as much to create special legislation for a small group of wealthy physicians to shield them from DEA accountability as it was to stop sales reps. One of the architects of New Hampshire legislation had a spouse who is a practicing physician in the State and she didn’t want the government checking up on his writing of prescriptions (including Schedule II narcotics). Pharma sales reps became a convenient excuse. In other states, including Maine, Vermont, New York and West Virginia, the chief supporters of this kind of legislation are doctors with questionable ethical standards. This is like having Rush Limbaugh or Anna Nicole Smith’s physician argue for physician secrecy because they don’t want people to know what they are up to.
Until recently, pharma sales practices were an arms race for the ignorant. More reps meant more hassles for doctors, and the docs contended less time with patients (although, as industry insiders, I think we can all acknowledge that few physicians were actually seeing any of the reps). That’s changed. The number of sales reps is shrinking at more than 10% a year now. And if the doctor’s arguments are true, should mean more time for patients. That hasn’t happened either (but that is a whole separate issue).
In a comment posted on Pharmalot, Dr. Daniel Carlat argues that the government has a compelling interest in restricting the flow of information so as to protect public health. Unfortunately, this buy’s into the Sean Flynn upside-down view of the U.S. legal system. The government does have a strong a compelling interest in protecting public health. Which is why it won’t allow any of these ignorant laws to pass. Passing legislation that creates a cloak of secrecy so a physician’s actions can be shielded from scrutiny is NOT in the interest of public health. Physicians should be subjected to more scrutiny in the interest of public health, not less.
I actually think doctors are shooting themselves in the foot with these secrecy laws. If one of the laws gets passed and is actually held up by the Courts, I think we’ll see the day of the government getting into the business of actively monitoring physicians (compared to the present system of passive monitoring via the health information companies like IMS Health and Verispan). Docs should think about that.
As a patient, I look back 30 or 40 years and think about how it used to be in America. It was the wild, wild west and we had doctors handing out amphetamines like candy. And those were profitable times for a lot of physicians who were running side businesses in “pharmaceutical distribution.”
Sean Flynn and the doctors he represents should just be honest about what their interests really are – unsupervised access to Schedule II narcotics for profit. “Privacy” is just the cover story.
Ed Silverman’s article cites only one source : American University academic Sean Flynn. Now, Flynn knows a lot about the law. He just doesn’t know much about the law in the United States (Flynn is from Africa). His failed understanding of the U.S. Constitution is the reason why New Hampshire and Maine’s bids to ban the practice were unsuccessful. Sean Flynn and his boss Sharon Treat may have hit on a loathsome practice, but Flynn's ignorance of the American legal system has led this to be an entirely academic exercise. It’s no longer about actually defeating the practice of pharmaceutical information, it’s a self esteem exercise for Flynn.
In the Silverman piece, Sean Flynn is quoted as saying : “the commercial speech doctrine serves consumer interests in being fully informed of products and services on the market by providing limited protection to advertisements and other speech to consumers proposing a commercial transaction.” This is precisely why these laws haven’t gone anywhere.
One of the quiet purposes of this data is to monitor physician prescribing behavior to ensure patients are not at risk. In the New Hampshire lawsuit, the goal was as much to create special legislation for a small group of wealthy physicians to shield them from DEA accountability as it was to stop sales reps. One of the architects of New Hampshire legislation had a spouse who is a practicing physician in the State and she didn’t want the government checking up on his writing of prescriptions (including Schedule II narcotics). Pharma sales reps became a convenient excuse. In other states, including Maine, Vermont, New York and West Virginia, the chief supporters of this kind of legislation are doctors with questionable ethical standards. This is like having Rush Limbaugh or Anna Nicole Smith’s physician argue for physician secrecy because they don’t want people to know what they are up to.
Until recently, pharma sales practices were an arms race for the ignorant. More reps meant more hassles for doctors, and the docs contended less time with patients (although, as industry insiders, I think we can all acknowledge that few physicians were actually seeing any of the reps). That’s changed. The number of sales reps is shrinking at more than 10% a year now. And if the doctor’s arguments are true, should mean more time for patients. That hasn’t happened either (but that is a whole separate issue).
In a comment posted on Pharmalot, Dr. Daniel Carlat argues that the government has a compelling interest in restricting the flow of information so as to protect public health. Unfortunately, this buy’s into the Sean Flynn upside-down view of the U.S. legal system. The government does have a strong a compelling interest in protecting public health. Which is why it won’t allow any of these ignorant laws to pass. Passing legislation that creates a cloak of secrecy so a physician’s actions can be shielded from scrutiny is NOT in the interest of public health. Physicians should be subjected to more scrutiny in the interest of public health, not less.
I actually think doctors are shooting themselves in the foot with these secrecy laws. If one of the laws gets passed and is actually held up by the Courts, I think we’ll see the day of the government getting into the business of actively monitoring physicians (compared to the present system of passive monitoring via the health information companies like IMS Health and Verispan). Docs should think about that.
As a patient, I look back 30 or 40 years and think about how it used to be in America. It was the wild, wild west and we had doctors handing out amphetamines like candy. And those were profitable times for a lot of physicians who were running side businesses in “pharmaceutical distribution.”
Sean Flynn and the doctors he represents should just be honest about what their interests really are – unsupervised access to Schedule II narcotics for profit. “Privacy” is just the cover story.
Thursday, June 26, 2008
RFID Poses Serious Risks in Hospitals
A new study in JAMA has found that RFID technology can pose serious, and potentially fatal, risks to patients. In 123 tests performed, 30% produced electromagnetic glitches. Even more concerning, in nearly 20% of the tests, there were serious and hazardous malfunctions that would result in patient harm.
From the study, distance appears to be a significant factor. Most of the interactions were within just a few feet. However, potentially serious events were found over 20 feet.
Wireless radiofrequency identification systems have long been hailed as a panacea for the healthcare system to reduce costs and minimize medical errors. It looks like the promise of RFID technology remains a bit further off.
From the study, distance appears to be a significant factor. Most of the interactions were within just a few feet. However, potentially serious events were found over 20 feet.
Wireless radiofrequency identification systems have long been hailed as a panacea for the healthcare system to reduce costs and minimize medical errors. It looks like the promise of RFID technology remains a bit further off.
Tuesday, June 24, 2008
Prostitutes for Prescriptions
In the United States, everybody is up in arms about sales reps giving doctors a $5 Subway sandwich. It seems a bit ridiculous to me, but the stakes are bit higher in Europe. Let me explain.
Last week, I was at the annual meeting of The European League Against Rheumatism (EULAR) in Paris. It was early one evening and I was standing out front of the hotel near a group of 20 doctors and the Abbott Laboratories bus pulls up. Off the Abbott Labs bus jumps about 20 very hot looking young women with Eastern European accents and dressed in very sexy outfits. The Abbott Labs rep then pairs the hot young companions with the doctors, introduces one to the other, and they stroll off down the street to a restaurant.
Later in the evening, I noticed one of the doctors returning with the young companion and heading straight for the elevator. I wonder what happened next.
So in the U.S., you can’t provide a doctor with a $5 sandwich without drawing scrutiny. In Europe, you have to tone down the branding, but hookers are fair game. So, I guess as long the companions don’t have Humira tattoeed on their body somewhere, then it’s fine.
Last week, I was at the annual meeting of The European League Against Rheumatism (EULAR) in Paris. It was early one evening and I was standing out front of the hotel near a group of 20 doctors and the Abbott Laboratories bus pulls up. Off the Abbott Labs bus jumps about 20 very hot looking young women with Eastern European accents and dressed in very sexy outfits. The Abbott Labs rep then pairs the hot young companions with the doctors, introduces one to the other, and they stroll off down the street to a restaurant.
Later in the evening, I noticed one of the doctors returning with the young companion and heading straight for the elevator. I wonder what happened next.
So in the U.S., you can’t provide a doctor with a $5 sandwich without drawing scrutiny. In Europe, you have to tone down the branding, but hookers are fair game. So, I guess as long the companions don’t have Humira tattoeed on their body somewhere, then it’s fine.
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