Thursday, April 22, 2010

By Working Together, A Case Study On How To Reduce Health Costs

Think of all the hours we have sat alone in private patient rooms waiting for the doctor to attend our needs. If you are like me, you pass the boredom by reviewing all the medical wall posters. We have all seen them. An artist's rendering of the heart and all its components. Same for lungs. Kidneys. Then the granddaddy of them all -- the body's entire arterial and venus blood highways.

Each and every poster is provided by a drug or medical device manufacturer. They are informative and educational.

Sometimes at the end of the doctor's examination, a brand drug will be prescribed. Oftentimes, the doctor is unaware if it has a generic competitor.

Here's another scenario. While waiting in the reception room, a drop-dead gorgeous young woman dressed in a conservative dark blue suit with hems set seductively an inch below the knees walks into the office with a brief case on wheels. A word with the receptionist and minutes later is talking to the doctor you've been waiting for a half hour.

She's a pharmaceutical sales woman or, in my case, a rep from Medtronic, the largest and most successful insulin pump and medical devise manufacturer in the nation.

You can see where this is headed.

How beholden are our physicians to the drug and medical devise industry. It is true that doctors are held accountable for ethics and medical standards by their peers and in most states by governing boards. But nothing happens unless a peer snitches on another doctor or a patient files a complaint.

Some of the most comical ads on TV is when an agent of Big Pharma says to ask your doctor about prescribing its product and then spends three-quarters of the remaining ad time warning of all the side effects.

Sometimes the ad says call your doctor immediately if those side effects appear. If your doctors are like mine, good luck because those return calls will not set any land speed records. It's not because they consider you a hypochondriac. Usually, they're busy, and equally important, don't get paid for call backs.

It is with some consolation that the Council of Medical Specialty Societies issued new ethics codes Wednesday to limit the influences that drug and device makers have over patient care. It is billed as the most sweeping move ever taken by the group which represents 32 medical societies with 650,000 members.

"We take very seriously the trust that is placed in us by physicians and patients to be authoritative, independent voices in cancer care," said Dr. Allen Lichter, chief of the American Society of Clinical Oncology. He led the panel that developed the code.

The most controversial and strongest rule requires leaders of any medical society and editors of its journals from consulting deals or financial ties to Big Pharma.
The code requires groups to:
  • Publicly post any industry support the group receives, such as money for continuing education sessions.
  • Decline industry funding for developing medical practice guidelines, such as who should get a drug, a test or treatment. Require that most members of a guidelines panel be free of financial ties to industry.
  • Disclose any financial ties that leaders and board members have with companies.
  • Ban company or product names and logos from pens, bags and other giveaways at conferences.
During the recent national debate on health reform, Big Pharma took a hit as one of the bad guys driving health costs up.

What was lost in the hysteria is that the major drug companies offer free or copays ranging as high as $10 for a 30-day prescription to low income patients on Medicaid.

In my case, Medtronic through my endocrinologist implanted at no cost to me an electronic chip that monitored my blood sugars ever five minutes over a 72-hour period. Health Net, my insurance carrier, refused to cover the expensive procedure. 

It was the first time my blood sugars were continuously tracked, finally allowing the doctor and I to adjust the insulin dosages for my diabetes 24/7. My blood glucose has been under control ever since with only sporadic deviations.



For the new health reform legislation to work, this absurd call of resistance led by right wing-nuts of a government takeover must end. Treatment of diabetes is one of the most expensive causes for skyrocketing costs among all the major diseases. In my case, working with my doctors, the insurance carrier, drug and medical devise manufacturers, my cost of treatment has been reduced by about 75% in the past year.

Readers comments are welcome as long as they remain civil. We reserve the right to delete any comments that are vulgar, libelous and totally irrelevant to this posting. -- Jer


chickie said...

Please Prove how the cost of treating your diabetes went down 75% thanks to a medtronic device. Plenty of controlled medical studies have concluded continuous glucose monitors drive up the cost of care. The alternative, having patients check their sugar 4 times a day, adjusting their own insulin or insulin pump, and monitoring their tests works better than these devices. For this reason, medicare and medicaid do not cover the devices, which cose $1400 each and need a $35 sensor every three days.

For this reason, the standard of care in the United States, Canada and England is to use these devices in type 1 patients for short periods of time (72 hrs.) in order to help formulate a care plan. Using it perpetually simply wastes money, no evidence exists this additional $350/month cost prolongs life, reduces days lost from work or reduces long term complications. Did the lady in the skirt who chatted up your doctor mention these facts?

Jerry Remmers said...

The Medtronic chip was used once to track glucose for 72 hours and mark a pattern. Insulin dosages were adjusted to the peaks and meal times. Continued adjustments normalized the sugars in which my A1Cs were lowered from a high of 9.5 at the beginning to average recordings of 6.2 after a year. The results were office visits every six weeks to once every three months. Insulin dosages were reduced by half. Three oral medications for cholesterol, trygliscerides and potassium as well as diruetics were eliminated. Check up with heart, pulmonary and kidney doctors were discontinued. The only costs now are quarterly checkups with primary and endocrinologist, quarterly blood lab tests and test strips for the glucose meter. I also no longer need or use the insulin pump. -- Jer

Jerry Remmers said...

One correction to your inquiry. The 72-hour tracking computer chips would be used once every three months, not every three days. Because my meter readings taken manually and the consistent "normal" A1C averages in the low 6s, there was no need to use Medtronic's chips for repeated tests.

Anonymous said...

I work in healthcare and am astonished you support the incredible waste fostered on patients and the government by "big pharma".

During the recent national debate on health reform, Big Pharma took a hit as one of the bad guys driving health costs up.
What was lost in the hysteria is that the major drug companies offer free or copays ranging as high as $10 for a 30-day prescription to low income patients on Medicaid.

So, you've seen the commercials for a brand name sleeping pill- they're $8 each! the monthly cost to the insurance plan is triple the brand name drug that was being promoted last year. Big pharma seriously raises health care costs with these co-pay coupons that try to drive market share to their more profitable brands.

There's only so much money to go around. In a hospital, they charge you $125 for a generic antibiotic that costs $40, because medicare and medicaid cap the price at $12, so the extra is cost-shifted to the insurance company. When they raise their rates, washington proposes price caps and cost controls, an absurd way to deal with the issue.

Health costs will never be reduced without publishing efficacy and outcomes data. If citizens knew they could get the same restful sleep for 1/3 the cost, they would do the right thing. A nanny-state cannot accomplish this with a top-down bureaucracy, all they'll give us is rationing to fit their budget.

chickie said...

Health Net criteria are available online. To this nutritionist, it sounds like you met the requirements for short term use.

I was questioning perpetual use, which many of my patients want cause it has a cool computer interface (and they want someone else to pay for it) You should appeal the denial!