Sunday, December 19, 2004
Medicaid's fee-for-service drug expenditures increased 18% per annum
-
Printer Friendly|#| Trackback
Medicaid’s Reimbursements to Pharmacies for Prescription Drugs (pdf)
This Congressional Budget Office report focuses on the markup paid to pharmacies by Medicaid for buying and dispensing drugs. For example, in 2002 medicaid reimbursed pharmacies an average of $46 per prescription. Of that amount, $14 was for purchase of the drug itself. The $32 difference constitutes the 'markup', which has been increasing at a rate of roughly 10% per year between 1997 and 2002.
" "Between fiscal years 1997 and 2002, Medicaid’s expenditures on prescription drugs in the fee-for-service part of the program increased from $10.2 billion to $23.4 billion. About one-quarter of those amounts went to wholesalers and pharmacies to compensate them for distributing and dispensing the drugs.
Prepared at the request of the House Committee on Energy and Commerce, this paper examines recent trends in that “markup”—or the difference between the total amount that state Medicaid agencies paid to pharmacies and the amount that pharmacies and wholesalers paid to purchase the drugs from manufacturers. In keeping with the Congressional Budget Office’s (CBO’s) mandate to provide objective, impartial analysis, the paper makes no recommendations. " "
and
" "Overall, the largest single factor contributing to the rapid increase in markups was the use of newer generic drugs, with their high markups. Another factor was the use of newer single-source brand-name drugs, which had somewhat higher average markups than did older brand-name drugs." "
Wednesday, December 8, 2004
Two NEJM Articles on the War
-
Printer Friendly|#| Trackback
NEJM: Notes of a Surgeon: Casualties of War — Military Care for the Wounded from Iraq and Afghanistan (free full text)
NEJM: From the War Zone to the United States: Caring for the Wounded in Iraq — A Photo Essay (free full text)
![]()
Tuesday, December 7, 2004
Laparoscopy and Ambulatory Surgery Centers in PA
-
Printer Friendly|#| Trackback
The Pennsylvania Department of Health sent a letter to all Ambulatory Surgery Centers in Pennsylvania reminding them that they are not to perform laparoscopic surgeries which:
" 'require major or prolonged invasion of body cavities.' "
Noting that:
" 'the risk of injury to abdominal and other internal organs and structures is not lessened. In fact, there are some reports that the risk of injury may be increased. (Peter D. Jacobson, Medical Liability and the Culture of Technology, PEW Project on Medical Liability, released 9/22/04). ' "
My reading of the Pew report turns up no data implicating ambulatory surgery centers (ASC's) specifically in injuries from laparoscopic procedures. Nothing to suggest that eliminating most laparoscopic procedures from ASC's will improve patients safety. In an era when 'evidence based medicine' is the watchword for practitioners, this kind of blanket policy by the government is difficult for me to swallow.
I suspect (though cannot prove) that hospitals have brought political pressure to bear on the Governor and/or Department of Health to make this policy change in order to bring a very profitable class of surgery back to the hospital setting. The facility fees collected for laparoscopic surgery are considerable, and hospitals feel they've been missing out.
Another example to suggest hospitals have been active in this area is the requirement by some payors that orthopedic implant surgeries be performed in hospitals rather than free standing ASC's. For example, we used to perform rotator cuff repairs (which use an anchor suture) in the ASC, but they can no longer be done here because the insurance company will only pay for the anchors if placed in a hospital. There is just no reason I can think of for this requirement other than to force surgeries back into hospitals and away from ASC's.
12/8/04 update: it is on the state servers at: http://app2.health.state.pa.us/commonpoc/content/facilityweb/FacMsgBoardDetails.asp?msgid=819&msgindex=2&Selection=ALL
Friday, December 3, 2004
Pennsylvania Has Its First Influenza Case
-
Printer Friendly|#| Trackback
Type A-Fujian influenza has been confirmed in a Philadelphia resident, the first laboratory-confirmed case of influenza in Pennsylvania. Of note, this strain was included in the vaccine.
Merriam-Webster's Word of the Year 2004: Blog
-
Printer Friendly|#| Trackback
Blog noun [short for Weblog] (1999) : a Web site that contains an online personal journal with reflections, comments, and often hyperlinks provided by the writer
Just as interesting to me is number 10 on the list: defenestration: Etymology: de- + Latin fenestra window: a throwing of a person or thing out of a window. I believe its more popular use today is in reference to getting rid of the Microsoft Windows operating system, as described in this book
Monday, November 29, 2004
Cocoa, Flavanols and Cardiovascular Risk
-
Printer Friendly|#| Trackback
Cocoa, Flavanols and Cardiovascular Risk:
""The Kuna Indians in Panama, living in their indigenous island home in the Caribbean, do not show the typical rise in blood pressure with age, and hypertension is very rare.[34] In a study that began with the search for protective genes, the observation that migration to Panama City led to a loss of the protection against hypertension made it clear that an environmental factor was involved. Examination of their diet uncovered the fact that they drank large volumes of a flavanol-rich cocoa.[2] Subsequent in vitro studies suggesting that cocoa extracts can induce endothelium-dependent relaxation[4] led to studies in healthy volunteers,[9] and in patients with vascular risk or disease.[1] In the studies of Heiss et al. ingestion of flavanol-rich cocoa led to an increase in flow-mediated vasodilation of the brachial artery following five minutes of ischaemia, a response that correlated with biochemical evidence of increased nitric oxide bioavailability.[8] In the normal volunteers studied by Fisher et al. flavanol-rich cocoa induced striking dilatation of the vessels of the finger, which was reversed completely by an arginine analogue that blocks nitric oxide synthesis (figure 1).[9]""
and
""Endothelial dysfunction with a consequent reduction in nitric oxide production has achieved a central conceptual role in the pathogenesis of atherosclerosis and coronary artery disease, diabetes mellitus and hypertension. Recent evidence that flavanol-rich cocoa activates vascular nitric oxide synthesis in the intact human raises an interesting possibility of a therapeutic potential.""
Potentially very good news for Hershey foods, what, what?
[Via Medscape Headlines]
Friday, November 26, 2004
Common Good Promoting Special Health Courts
-
Printer Friendly|#| Trackback
Common Good is planning a brochure for mass distribution to 'advance the concept of a special health court.' I've written about this organization before. Their proposal, which has some pretty big names behind it, calls for the creation of special health courts. Some of the details include:
- Full-time judges
- Neutral experts
- Speedy processing at lower cost
- Schedule for non-economic damages
- Liberalized standard for patient recovery
Common Good is accepting donations (tax deductible) to help with the mass distribution of their brochures.
![]()
Tuesday, November 23, 2004
New Female Sterilization Technique Quicker, Easier and Cheaper
-
Printer Friendly|#| Trackback
New Female Sterilization Technique Quicker, Easier and Cheaper:
""Mayo Clinic gynecologists have discovered that hysteroscopic sterilization, a new method of plugging the fallopian tubes to prevent conception, will save patients money compared to laparoscopic tubal ligation, the most commonly used method of sterilization for women. This technique involves inserting a nickel-titanium and stainless steel springlike device into the fallopian tubes using a hysteroscope, a tiny, fiberoptic camera. The metal device encapsulates and holds in place white polyester fibers able to cause scarring and thus block the fallopian tubes within 12 weeks, preventing the possibility of future pregnancy.""
Of course, it's still not as easy as a man having a vasectomy, but this technique would not require laparoscopy and would thus be safer for the woman.
[Via Science Blog - Science News Stories]
Tuesday, November 16, 2004
"I'd rather be judged by 12 than carried by 6"
-
Printer Friendly|#| Trackback
Here's a Seal's perspective on all the attention being paid to the issue of a Marine supposedly shooting a wounded terrorist in Fallujah:
""Here is your situation Marine. You just took fire from unlawful combatants shooting from a religious building attempting to use the sanctuary status of their position as protection. But you're in Fallujah now, and the Marine Corps has decided that they're not playing that game this time. That was Najaf. So you set the mosque on fire and you hose down the terrorists with small arms, launch some AT-4s (Rockets), some 40MM grenades into the building and things quiet down. So you run over there, and find some tangos wounded and pretending to be dead. You are aware that suicide martyrdom is like really popular with these kind of idiots, and like taking some Marines with them would be really cool. So you can either risk your life and your fireteam's lives by having them cover you while you bend down and search a guy that you think is pretending to be dead for some reason. Also, you don't know who or what is in the next room, and you're already speaking english to each other and its loud because your hearing is poor from shooting people for several days. So you know that there are many other rooms to enter, and that if anyone is still alive in those rooms, they know that Americans are in the mosque. Meanwhile (3 seconds later), you still have this terrorist that was just shooting at you from a mosque playing possum. What do you do?
You double tap his head, and you go to the next room, that's what."
Sunday, November 14, 2004
45,800,000 American Adults (Still!) Smoke
-
Printer Friendly|#| Trackback
""In 2002, a total of 45,800,000 US adults (22.5%) were current smokers, a decrease from 24.1% in 1998, and an estimated 46 million adults were former smokers (1). For the first time, more adults had quit smoking than were still smoking""
Many more details in the MMWR Report: Great American Smokeout --- November 18, 2004
[Via Medical News Today]
Vioxx Non-Cox2 Effect Demonstrated
-
Printer Friendly|#| Trackback
It's worth pointing out that discussion of a drugs action typically focus on one known effect. That there may be others and that those can be harmful is amply demonstrated by the Vioxx example. An article just published in the journal 'Atherosclerosis' may explain what the second effect is in the case of Vioxx:
Sulfone COX-2 inhibitors increase susceptibility of human LDL and plasma to oxidative modification: comparison to sulfonamide COX-2 inhibitors and NSAIDs
Bottom line: "Abnormal changes in the structure or shape of lipids caused by Vioxx, especially in LDL, may explain why they are more susceptible to oxidative damage, and therefore, contribute to cardiovascular damage. Similar effects on susceptibility of lipids to oxidative damage have been observed with cigarette smoking, diabetes and in patients who have had a recent heart attack."
[Via Medical News Today]
Thursday, November 11, 2004
Veteran's Day
-
Printer Friendly|#| Trackback
It's Veteran's Day. Allow me to point you to a moving tribute to America's fighting men and women: http://www.clermontyellowribbon.com/untilthenflash.htm
| |
1 |
2 |
3
|
4 |
| 5 |
6 |
7
|
8
|
9 |
10 |
11 |
| 12 |
13 |
14 |
15 |
16 |
17 |
18 |
| 19 |
20 |
21 |
22 |
23 |
24 |
25 |
|
26
|
27 |
28 |
29
|
30 |
31 |
|
|
Nov Jan
|
