Every “Free” Sample (a Doctor Accepts) Comes with a Price.

Do drug company reps influence doctor prescribing practices?

A NPR article noted “Dermatologists who accept free tubes and bottles of brand-name drugs are likelier to prescribe expensive medications for acne than doctors who are prohibited from taking samples, a study reports…”

“The difference isn’t chump change. When patients see a dermatologist who gets and gives free samples, the average cost of medicines prescribed is $465 per office visit. That cost drops to about $200 when patients see a doctor who can’t hand out freebies, a team at Stanford University found.”

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“Medical Errors Are a Quiet and Largely Unseen Tragedy.”

“Every year between 210,000 and 440,000 Americans die as a result of medical errors and other preventable harm at hospitals, according to researchers.”

These numbers are equivalent to a jumbo jet crashing every day with no survivors. Based on these figures, medical errors could be considered the third-leading cause of death in America, behind heart disease (more than 590,000 a year) and cancer (more than 570,000 a year).

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“Doctors Overlook Lucrative Procedures When Naming Unwise Treatments”

It is always a good idea to talk to your primary care practitioner, the clinician who knows you best, about procedures suggested consulting physicians.

A Kaiser Health News article noted: “The medical profession has historically been reluctant to condemn unwarranted but often lucrative tests and treatments that can rack up costs to patients but not improve their health and can sometimes hurt them. But in 2012, medical specialty societies began publishing lists of at least five services that both doctors and patients should consider skeptically. So far, 54 specialty societies have each offered recommendations and distributed them to more than a half-million doctors.”

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“More than 5% … of U.S. Adults, Could Be Misdiagnosed during an Outpatient Visit …, and about One-Half of These Errors Had the Potential to Lead to Worse Outcomes for the Patients.”

A Modern Healthcare article reported on a studies which defined misdiagnoses as “missed opportunities to make a timely or correct diagnosis based on the available evidence.”

“One of the studies used in the analysis, published in March 2013 in JAMA Internal Medicine, identified nearly 70 different conditions for which misdiagnoses occurred in the primary-care setting, like pneumonia, renal failure and urinary tract infections. The other two focused specifically on cancer, including a retrospective study published in BMJ that used electronic health-record data to detect potential delays in prostate and colon cancer diagnoses; and a 2010 study in the Journal of Clinical Oncology, which evaluated whether EHRs could be good predictors of misdiagnoses in lung cancer.”

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“Recommending That Doctors Weigh the Costs, Not Just the Effectiveness of Treatments.”

Have you ever discussed the cost of treatment options with your doctor? Probably not!

The New York Times article noted “The shift, little noticed outside the medical establishment but already controversial inside it, suggests that doctors are starting to redefine their roles, from being concerned exclusively about individual patients to exerting influence on how health care dollars are spent.”

“In practical terms, new guidelines being developed by the medical groups could result in doctors choosing one drug over another for cost reasons or even deciding that a particular treatment — at the end of life, for example — is too expensive. In the extreme, some critics have said that making treatment decisions based on cost is a form of rationing.”

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“Never Events” – Medical Errors That Should Never Happen

“The term “Never Event” was first introduced in 2001 by Ken Kizer, MD, former CEO of the National Quality Forum (NQF), in reference to particularly shocking medical errors (such as wrong-site surgery) that should never occur. Over time, the list has been expanded to signify adverse events that are unambiguous (clearly identifiable and measurable), serious (resulting in death or significant disability), and usually preventable. The NQF initially defined 27 such events in 2002. The list has been revised since then, most recently in 2011, and now consists of 29 events grouped into 6 categories: surgical, product or device, patient protection, care management, environmental, radiologic, and criminal.”

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MSSNY Pushes Doc ID Bill

The Medical Society of the State of New York has hired extra public relations help, signing a three-month agreement with an outside consultant in addition to its regular staff. At the top of its agenda is a pending bill (S5493/A7889) sponsored by state Sen. Joseph Griffo, R-Utica, and Assemblyman Al Stirpe, D-Syracuse. The bill would make it clear to patients when their health care providers are physicians—not less-trained professionals. Known as the Healthcare Professional Transparency Act, the measure would require workers who come in contact with patients to wear an ID tag that specifies what kind of license he or she has. The bill would also cover medical advertising. “Ambiguous provider nomenclature, related advertisements and marketing and the myriad of individuals one encounters in each point of service exacerbate patient uncertainty,” the bill reads in part. According to MSSNY, an AMA survey found that 54% of patients believe optometrists are medical doctors, 35% believe a nurse with a Ph.D. is a physician, and 44% say they have trouble learning which of their caregivers are M.D.s.

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“Many People Will Not Be Able to See the Physicians Who Have Treated Them for Years, Use Facilities Providing the Most Appropriate Treatment, or Access Care within a Reasonable Time and Distance from Their Homes.”

Don’t assume that you can continue to see your doctor…

A City Journal article noted that “… having health insurance is not the same thing as getting good health care, or any health care. In fact, it doesn’t matter how many Americans obtain insurance under the ACA. Most will have difficulty finding a physician.”

“Those who do get coverage through the exchanges and pay their premiums will also struggle to get medical care. The ACA requires insurers to accept every patient regardless of risk, provide expansive benefits packages, and eliminate caps on lifetime benefits. Looking to control costs, most insurers are offering exchange plans that severely limit the number of doctors and hospitals patients can visit. Some state exchanges—including New York’s—don’t offer a single plan that covers visits to out-of-network doctors or hospitals.”

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“Nurse Practitioners Are Worthy Professionals … but They Are Not Doctors.”

The New York Times op-ed noted “EARLIER this month, the New York State Legislature passed a bill granting nurse practitioners the right to provide primary care without physician oversight. New York joins 16 other states and the District of Columbia in awarding such autonomy. (Most states still require nurse practitioners to work with physicians under a written practice agreement.) The bill’s authors contend that mandatory collaboration with a physician “no longer serves a clinical purpose” and reduces much-needed access to primary care.”

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Nurse Practitioners in NY Will No Longer Need to Be Formally Tethered to a Physician

An article in Modern Healthcare explained the change.

“The Nurse Practitioners Modernization Act was introduced last year and was included in the state budget … The law will allow NPs with more than 3,600 hours of experience to practice without a written practice agreement with a supervising physician. It does not expand NPs’ scope of practice or allow them to provide additional services, according to the 3,500-member Nurse Practitioner Association New York State.”

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