JustCare

Tag: Health outcome

  • Prior authorization in Medicare Advantage harms patients, sometimes severely

    Prior authorization in Medicare Advantage harms patients, sometimes severely

    MedPage Today reports on a poll finding that prior authorization requirements in managed care plans, such as Medicare Advantage, lead to patients needing hospitalization, becoming disabled or dying, according to one in three physicians. Why does Medicare allow prior authorization–with its often unjustified barriers to care–in Medicare Advantage plans?

    No one can deny that sometimes people get care that they don’t need. But, what makes health insurers able to determine what care is needed? On what do they base their decisions?

    As a general rule, health insurers are not held to account for their prior authorization policies. Yet, this AMA survey found that three in ten physicians say that health insurers rarely if ever use prior authorization criteria that is evidence-based. And, 91 percent of physicians say that insurer prior authorization criteria have a negative impact on their patients’ health outcomes.

    Almost one in five physicians (18 percent) said that an insurer’s prior authorization requirement resulted in a life-threatening event for a patient or a health outcome that “required intervention to prevent permanent impairment or damage.” On top of that one in 12 physicians said that their patients became disabled or physically harmed or died as a result of prior authorization requirements.

    Congresswoman Suzan DelBene of Washington State has a bill, Improving Seniors” Timely Access to Care Act, intended to standardize prior authorization programs in Medicare Advantage plans. It would require health plans to disclose their requirements and greater oversight of them.

    Some states limit or have introduced bills to limit insurers from using prior authorization, including New York, Texas, Illinois and Indiana.

    More than 1,000 practicing physicians completed the survey.

    Here’s more from Just Care:

     

  • Which states have hospitals that deliver appropriate care, good patient outcomes and invest in their communities?

    Which states have hospitals that deliver appropriate care, good patient outcomes and invest in their communities?

    Even though health care is often about life and death, and out-of-pocket hospital costs can push many Americans with health insurance into medical bankruptcy, we know a lot more about the best restaurants and the best automobiles than we do about the best hospitals. The Lown Institute ranks states with the best hospitals using measures that most other agencies that rank hospitals do not consider.

    The Lown Institute rankings highlight strikingly different practice patterns and behaviors of hospitals in different parts of the country. They are helpful from a public health perspective and less helpful in helping you choose a hospital. Every hospital in a state is different, so even if you live in a state with good hospitals, it’s important to choose your hospital carefully.

    The Lown Institute defines the best hospitals as the ones that can best save patients’ lives and keep them healthy. They also invest in the communities’ health, have good financial assistance programs, and pay fair and equitable wages. And, they avoid delivering care that people do not need.

    For the Lown Institute, patient outcomes represent 50 percent of a hospital’s grade. Doing right by the community and staff and providing financial assistance to patients, which the Lown Institute calls “civic leadership”, represents 30 percent of a hospital’s grade. And, care value represents 20 percent of the grade.

    Patient outcomes cannot tell the full story about a hospital. Hospitals that treat the poorest patients and patients in the worst health will never have as good patient outcomes as hospitals that treat a relatively healthy and wealthy population, but they might deliver far better care.

    So, how do the states rank?

    Connecticut, Delaware, Hawaii, Massachusetts, Maryland, Ohio, and Rhode Island have hospitals that rank best overall according to the Lown Index. Of note, many of these states are in the northeastern US.

    Colorado, Kentucky, Louisiana, Maryland, New Mexico, West Virginia, and Washington, DC, have higher civic leadership rankings than other states. Of note, none of these states are in the northeastern US. 

    Maine, Minnesota, New Hampshire, and Vermont hospitals received the top rankings for value, meaning they do better at ensuring patients receive appropriate care. Florida, Maryland, New Jersey, and Nevada hospitals received the lowest rankings.

    While the Lown Institute findings overlap somewhat with other rankings, the Lown Institute finds some rural hospitals and safety net hospitals rank in the top 100, unlike other rankings.

    The top hospital in the country, according to the Lown Institute index is JPS Health Network. It is a large public safety net hospital in Fort Worth, TX. It had top rankings  in clinical outcomes, community benefit, inclusivity, and providing the right care. See here for the full list.

    Here’s more from Just Care:

  • To improve health outcomes, physicians need to steer clear of their biases

    To improve health outcomes, physicians need to steer clear of their biases

    Each and every one of us–including our physicians–has a particular perspective through which we see the world. Consequently, we often jump to conclusions—about people, information, products, and services. It’s human nature. To improve health outcomes, physicians need to steer clear of their biases.

    Don’t assume that doctors are somehow different from everyone else. Anupam Jena and Andrew Olenski report for The New York Times on physicians’ biased behavior. They explain that if physicians are to best serve their patients, their myriad biases must be understood and addressed.

    The data show that physicians exhibit racial and other biases that affect the care you get. These biases can mean that you don’t get the care you need. Biases can lead to errors in the physicians’ decision-making

    Like everyone, physicians have confirmation and anchoring biases. Confirmation bias leads them to understand new information in ways that reinforce the information they already believe. Anchoring bias leads them to give greater weight to the first information they learn, for no good reason. With anchoring bias, if you first see one price for a product that’s a lot higher than another, you’ll think the second product is a good buy; but if you had seen an even lower price for the product first, then the second product would appear expensive.

    As a result of these biases, physicians will treat patients inconsistently, sometimes with harmful consequences. For example, if you have a bad side effect from a drug, a doctor might not prescribe that drug again. But, your side effect might be particular to you, and the drug might be beneficial to others.

    Physicians sometimes exhibit gender biases as well. For example, a physician will stop referring patients to female physicians because one patient died who had been treated by a female surgeon.

    On top of these biases, physicians may exhibit left digit bias or bias stemming from the first number the physicians see. Left-digit bias might lead you more often to buy products priced at $3.99 than at 4.00. Left-digit bias might lead physicians to treat 80-year old patients differently than patients 79 and nine months, with significant consequence to their patients’ well-being.

    Left-digit bias has also been shown to lead physicians to interpret test results beginning with a 9 differently than test results beginning with a ten, even when there is no meaningful difference.

    The question becomes how can doctors overcome these biases? Decision-support tools could be helpful in nudging doctors away from their biases and towards evidence-based clinical decisions. You have a role to play as well. You can and should question your doctors’ treatment decisions. For example, if your doctor proposes a particular test for you, you might ask whether she proposes the same test to younger patients and what other tests are available.

    Here’s more from Just Care:
  • In Germany, for patients, new drugs cost the same as older drugs

    In Germany, for patients, new drugs cost the same as older drugs

    Noam Levey reports for the LA Times that, in Germany, people can get the newest cancer treatments for as little as $11. Patients don’t have to think about costs. For patients, new drugs cost the same as older drugs. And, insurers only pay higher prices for drugs proven to improve long-term health outcomes.

    In the US, almost everything having to do with a new drug’s value is cloaked in secrecy. In Germany, pharmaceutical companies are not able to charge high prices for their new drugs unless they can demonstrate to an independent non-governmental agency that the new drugs deliver better long-term outcomes than drugs already on the market. And, the process for determining whether a new drug delivers a better outcome is fully transparent, with everyone–doctors, hospitals and patients alike–getting access to the clinical trial data and other independent assessments of the new drug.

    The evaluation takes three months and ends with a public report. Anyone is free to comment on the report’s findings. More than 40 percent of the time, the evaluators find the drug offers no significant additional value over drugs already on the market.

    Regardless of the findings, the patient’s cost for a drug does not increase. Non-profit insurers, called “sickness funds,” cannot charge a deductible and cannot impose a copay for a drug higher than 10 euros or $11.

    If a new drug is determined to deliver a better outcome than drugs already on the market, pharmaceutical companies negotiate a price with the sickness funds. The sickness funds have leverage both because drugmakers want their drugs on the market in Germany and because they negotiate collectively for the drug’s price. When they fail to reach agreement, about one in five times, the matter goes to arbitration.

    The German government requires sickness funds to pay the list price for a new drug, found to deliver a better health outcome, in its first year. As a result, prescription drug costs in Germany are still higher than in many other wealthy countries, with 2016 per person spending averaging $777 as compared to $1,200 in the US.

    The German government does not regulate prices, but it does limit patient out-of-pocket costs, and it does require the sickness funds to cover all new drugs as they enter the market. An international survey finds that only one in 14 Germans struggle to afford health care as compared to one in three Americans.

    Here’s more from Just Care: