Over-Prescribing, Under-Prescribing, And The Fee-For-Service Catch 22

The federal government has granted itself potent new authority to expel physicians from Medicare if they are found to prescribe drugs in abusive ways, following through on a proposal issued earlier this year.

Excellent news! Now fee-for-service doctors can exist like Heller-esque protgaonists, trapped by the possibility of losing funding for over-prescribing, or losing funding by under-prescribing.

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Oregon Spends Over $1,000 Per Cover Oregon Enrollee — Then Bails On Their Broken Website

Oregon went “all in” on health reform, firmly embracing the Affordable Care Act. They launched a very successful Medicaid expansion — a $2 billion federal experiment to prove the state could save money by managing patients’ care better, and, of course, the state’s own online marketplace to sell Obamacare insurance.

But that last point has been a huge problem.

The Cover Oregon board decided on Friday to ditch its troubled website and join up with the federal HealthCare.gov exchange instead.

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The Logic Of Obamacare: Small Business, Unintended Consequences

In his Kevin MD post, Stephen C. Schimpff asks, “Is this affordable health care or is it is the law of unintended consequences?”

Schimpff is former CEO, University of Maryland Medical Center; chair, advisory committee, Sanovas, Inc.; and the author of The Future of Medicine – Megatrends in Healthcare and The Future of Healthcare Delivery- Why It Must Change and How It Will Affect You. He’s got plenty of clout behind him. And he says, “The Affordable Care Act is not so affordable if you own or if you are an employee of a small business.” Read his full explanation of what he believes will happen to small businesses in 2014 and 2015 based on the ACA.

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Posted by: AtlasMD

December 23, 2013

Is The ACA Deadline Update A Publicity Stunt?

NPR reports that the administration has granted a one-day extension on Obamacare sign-ups. According to NPR, “The deadline that had been midnight on Dec. 23 has been pushed to Christmas Eve at midnight.” So why the update? Apparently the government realized that there were issues with time zones, and that more time should be allotted to compensate.


It’s a good thing the federal government isn’t an actual person. We’d be concerned that their head is attached to their shoulders.


Posted by: AtlasMD

November 22, 2013

Food For Thought – Dutch Healthcare

It feels like the sky is perpetually falling on the American healthcare system. And yes, the first part of solving a problem is admitting you have one. But, we came across an NPR article discussing some things the Dutch do differently than we do. Really, it isn’t a question of whether one of us is doing it better than the other. Instead it’s that these differences could suggest our different value systems.

Take this quote, for example: “The Dutch like their health care system and feel comfortable with it, polls show, even when things don’t go exactly as they want.” This aligns with the Dutch’s values of pragmatism and stoicism.

In the Netherlands, many women try to have their babies at home. NPR claims that is because “[Dutch women] view giving birth as something that should be natural, not medical.” And services across the country align with this idea. In Amsterdam there’s a center for pregnant women that combines a spa, shopping center and school — not something we’ve heard of here in the States.

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NPR Breaks Down Obamacare’s Effect on Insurance Rates

NPR published an article reviewing introductory rates on policies offered through state-run insurance exchanges. The report examined 36 different states. So what’s the verdict? A resounding “it depends.” In Oklahoma, premiums are going for as low as $96/month. Meanwhile, in Wisconsin, the lowest rate on a bronze plan is well over $300. The reporter echoed our direct care mantra, saying, “Competition equals lower prices.” They explained how in regions with only one insurance company selling through the subsidized exchange, the average monthly premium for a 21-year-old buying the lowest cost bronze policy is $186, before any subsidies are applied. However, in regions with 10 or more rival carriers, the average cost is $132 or less.

How will Obamacare’s varying premium rates affect direct care practices?

Actually, there are two wins happening. If you’re a doctor looking to move to open a cash-only clinic, you’ll bode well in regions with only one insurance plan offered through the exchange. Lower competition tends towards higher insurance rates, meaning that wrap-around plans and your direct care offering can add tremendous value. Secondly, in areas with fewer insurance plans offered on the exchange, there is another effect: increased premiums for existing subscribers. In this case, because of the lack of competition, and the fact that Obamacare is forcing insurance companies to expand their offerings, rates might reach an exorbitant level for the subscriber. This is another patient who would benefit greatly from switching to a wrap around plan (remember, Obamacare means that insurance plans can’t raise their rates for pre-existing conditions) and enrolling in your direct care clinic.

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NPR Exposes Top Medicare Prescribers Who Rake In Speaking Fees From Drugmakers

The blood pressure drug Bystolic hit the market in 2008. It faced a slew of cheap generics, so its maker, Forest Laboratories, needed to devise a plan. They launched a promotional assault targeted straight at the people scribbling on the pads: prescribing doctors. “It flooded the offices of health professionals with drug reps, and it hired doctors to persuade their peers to choose Bystolic — even though the drug hadn’t proved more effective than competitors,” says NPR in a damning exposé that includes some shocking numbers.

According to the article, at least 17 of the top 20 Bystolic prescribers in Medicare’s prescription drug program in 2010 have been paid by Forest to deliver promotional talks. And they together received $284,700 for speeches and more than $20,000 in meals in 2012. And it’s not just us over here at Atlas MD going, hmmm, I bet they prescribed a lot of the beta blocker Bystolic. NPR reports that in the 2012 fiscal year, sales of Bystolic reached $348 million, almost double its total from two years earlier.

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