I am continuing my series on the costs of cancer I wanted to write about medical waste. But let's back up a minute, why am I pretending I am scholarly and writing about these 'big' topics in my little tiny blog? Because I think they are important. The medical costs a cancer patient incurs are amazingly high compared to other ailments - particularly in the first year after diagnosis and the last year of their life.
Cancer is becoming more treatable but is also becoming more expensive at alarming rates. The idea that a single chemotherapy infusion can cost over $10,000 is crazy. And unfortunately it is common place. Then if you take the infusion style chemo out of the hospital it becomes a pill that is covered by the pharmacy benefit which means it can costs hundreds of dollars per daily pill. So it may be physically easier on the patient to take a pill instead of receiving an infusion but is much more damaging on their wallet.
But I digress. Today I am writing about the broader spectrum of all medical costs. When I think of medical waste, I think of these big sterilized packages which are used to protect an IV kit and what isn't used is dumped in the trash. All those individually sterilized and sealed items where wrappers larger than the tool are thrown in the trash. By health standards, if a package is unsealed, anything that is not used is no longer sterile and goes in the trash. There are lots of single use items which make their way to the incinerators and landfills.
Unfortunately medical waste is also defined as a much larger problem. Medical waste often happens when there is a patchwork of care.
"Manhattan in New York City is a good example. Because healthcare
utilization there is among the nation’s highest, Manhattan is seen as
wasteful and inefficient. But it is a patch-quilt of wealth and poverty.
Utilization in the low-income Bowery is double the rate of the affluent
Upper East Side and Upper West Side, and utilization in Harlem, the
poorest area, is more than triple (unpublished data). Without either,
Manhattan’s utilization is among the lowest in the nation, lower even
than Grand Junction, Colorado, whose healthcare system was held out by
President Obama as a model for the nation. But like Grand Junction, the
Upper East Side and Upper West Side of Manhattan have few African
Americans and no poverty ghettos.
How much does the extra
care in poor neighborhoods add to overall utilization costs within a
region? The best estimate is 20% to 25%.[17] Yet, tragically, this fact
is ignored—indeed, denied. For example, Dartmouth researchers mock the
fact that “some physicians believe their hospitals or regions spend more
because their patients are sicker and poorer” and declare, “regional
differences in poverty explain almost none of the variation.”[19] In a
similar manner, Nicholas Kristof, a columnist for The New York Times and
an advocate for the poor globally, labeled as “opponents of health care
reform” those who attributed poor outcomes to “America’s large
underclass.”[20] In fact, poverty explains virtually all of the regional
differences in utilization, and “America’s large underclass” accounts
for virtually all of the differences in outcomes between the US and
other nations.
Real healthcare reform would address these
socioeconomic realities. Instead, the US is waging a regulatory “war” on
exaggerated measures of waste, one that shows little promise of
reducing costs or increasing quality but will assuredly crush “needed
innovation by practicing physicians, who best understand the delivery of
care.”[1] Moreover, because there are no risk adjusters for poverty,
physicians whose low-income patients fail to meet federal utilization
and quality norms will suffer financially, and hospitals whose poor
patients have high readmission rates will be penalized. All the while,
the “war on waste” will distract policymakers from building the social
infrastructure that could lower the high healthcare costs of poverty.
These are no ordinary times. For the first time, physicians and their
patients are caught in the crosshairs of the “war on waste.”'
So where does this all leave us? The Republicans believe that market forces will help reduce costs and waste while the Democrats look for answers in the Affordable Care Act. What this tells me is that the system is flawed and needs changes which is nothing new. We can't look to politicians for reform as our sole solution. We need to look at the health care system to resolve this.
Showing posts with label lives vs. dollars. Show all posts
Showing posts with label lives vs. dollars. Show all posts
Tuesday, November 27, 2012
Monday, November 26, 2012
The Cost of Cancer Care, Part 3
The next topic I will cover is controlling costs in cancer care based on the next article availabe from CancerNetwork.com. Here's a little factoid:
"Cancer patients under active treatment comprise 1% of a payer’s patients but as much as 10% of costs."
Or 'Ouch!'.
Cancer care is expensive. How can the costs be controlled by still providing the patients with the optimal level of care in what is largely still a guessing game? Initial chemotherapy doses are often based on body weight. Then if a patient reacts, the doses can be adjusted down. If one treatmetn doesn't work or has adverse results, then a new treatment is tried. All of which may be very expensive.
Here's a 'brilliant' idea. Have physicians take cost into consideration when prescribing treatment. Well whoop de doo. What about the patient who is the center of all this? They should be the primary consideration.
So then why is cost a consideration? Because costs of treatment are too high and insurance companies are dictating treatment based on their perception of need vs. costs.
"Care for oncology patients, particularly in the adjuvant setting, is often given over predictable time frames. Instead of paying for each element of care separately, episode-of-care payments either can either pay a flat fee per unit of time or a flat fee for a defined care plan. The availability of accepted guidelines in oncology facilitates this payment approach.
Bach et al proposed such a model for metastatic lung cancer.[9] In this model, oncologists would receive a monthly payment derived from the average cost of caring for all patients with metastatic lung cancer. This payment would bundle the costs of chemotherapy, supportive care medications, and administration. Medicare payments would then be adjusted over time based on claims submitted during prior episodes. Physicians would have to demonstrate that treatment conformed to an accepted standard of care. The intent of the program would be to achieve savings by making physicians discretionary purchasers based on price. The downstream effect would also pressure pharmaceutical manufacturers to adjust drug prices downward in order to be economical within the structure of the payment model."
The crux of the problem is cost is so out of proportion to other medical costs that it must be considered for cancer patients. The problem though is the patient's life can depend on the chosen treatment. I like the end result noted above that pharmaceutical manufacturers would need to adjust their pricing. Which is the real goal - make the treatments less expensive - particularly in the US where patients unevenly absorb the research costs that are less frequently distributed to overseas patients.
Another model being reviewed is the Oncology Model Home:
"The medical home model of oncology care is another critical opportunity in the evolving delivery of oncology care, to both ensure quality and reduce cost.[12] The model emphasizes improved care coordination, recognizing that fragmented care acts as an important cost driver in oncology. This model began with the efforts of Dr. John Sprandio with Consultants in Medical Oncology and Hematology, the first oncology practice to achieve level III recognition from the National Committee for Quality Assurance.
The model employs several elements, with its key strength being its synthesis of multiple separate but important efforts in oncology: care coordination, open access, quality measurement, guideline adherence, and cost savings by preventing emergency department (ED) visits and hospitalization. Patient performance status is a key metric for decision-making, including eligibility for chemotherapy administration. This helps to ensure that patients are appropriate for active treatment vs palliative care. Dr. Sprandio’s practice has achieved reductions in ED visits per chemotherapy patient by 68% and hospitalizations per chemotherapy patient by 51%.[13] These are meaningful accomplishments, since the cost of hospitalization may equal or exceed spending on oncology drugs."
I like this idea better. Coordinating care with patient performance as a significant part of the decision making process. This makes the patient the centerpiece as they should be.
Cost containment should never include rationing of care or so called 'death panels' as they are not humane options. In my mind the two issues are costs of care and the patients treatment/quality of life. Any other suggestions are welcome.
"Cancer patients under active treatment comprise 1% of a payer’s patients but as much as 10% of costs."
Or 'Ouch!'.
Cancer care is expensive. How can the costs be controlled by still providing the patients with the optimal level of care in what is largely still a guessing game? Initial chemotherapy doses are often based on body weight. Then if a patient reacts, the doses can be adjusted down. If one treatmetn doesn't work or has adverse results, then a new treatment is tried. All of which may be very expensive.
Here's a 'brilliant' idea. Have physicians take cost into consideration when prescribing treatment. Well whoop de doo. What about the patient who is the center of all this? They should be the primary consideration.
So then why is cost a consideration? Because costs of treatment are too high and insurance companies are dictating treatment based on their perception of need vs. costs.
"Care for oncology patients, particularly in the adjuvant setting, is often given over predictable time frames. Instead of paying for each element of care separately, episode-of-care payments either can either pay a flat fee per unit of time or a flat fee for a defined care plan. The availability of accepted guidelines in oncology facilitates this payment approach.
Bach et al proposed such a model for metastatic lung cancer.[9] In this model, oncologists would receive a monthly payment derived from the average cost of caring for all patients with metastatic lung cancer. This payment would bundle the costs of chemotherapy, supportive care medications, and administration. Medicare payments would then be adjusted over time based on claims submitted during prior episodes. Physicians would have to demonstrate that treatment conformed to an accepted standard of care. The intent of the program would be to achieve savings by making physicians discretionary purchasers based on price. The downstream effect would also pressure pharmaceutical manufacturers to adjust drug prices downward in order to be economical within the structure of the payment model."
The crux of the problem is cost is so out of proportion to other medical costs that it must be considered for cancer patients. The problem though is the patient's life can depend on the chosen treatment. I like the end result noted above that pharmaceutical manufacturers would need to adjust their pricing. Which is the real goal - make the treatments less expensive - particularly in the US where patients unevenly absorb the research costs that are less frequently distributed to overseas patients.
Another model being reviewed is the Oncology Model Home:
"The medical home model of oncology care is another critical opportunity in the evolving delivery of oncology care, to both ensure quality and reduce cost.[12] The model emphasizes improved care coordination, recognizing that fragmented care acts as an important cost driver in oncology. This model began with the efforts of Dr. John Sprandio with Consultants in Medical Oncology and Hematology, the first oncology practice to achieve level III recognition from the National Committee for Quality Assurance.
The model employs several elements, with its key strength being its synthesis of multiple separate but important efforts in oncology: care coordination, open access, quality measurement, guideline adherence, and cost savings by preventing emergency department (ED) visits and hospitalization. Patient performance status is a key metric for decision-making, including eligibility for chemotherapy administration. This helps to ensure that patients are appropriate for active treatment vs palliative care. Dr. Sprandio’s practice has achieved reductions in ED visits per chemotherapy patient by 68% and hospitalizations per chemotherapy patient by 51%.[13] These are meaningful accomplishments, since the cost of hospitalization may equal or exceed spending on oncology drugs."
I like this idea better. Coordinating care with patient performance as a significant part of the decision making process. This makes the patient the centerpiece as they should be.
Cost containment should never include rationing of care or so called 'death panels' as they are not humane options. In my mind the two issues are costs of care and the patients treatment/quality of life. Any other suggestions are welcome.
Sunday, November 25, 2012
The Cost of Cancer Care, Part 2
Cost is now becoming a significant factor in people's cancer treatment decisions - something that should not be happening.
In the past decades, and more significantly in recent years, there have been many developments in cancer treatment. We hear talk about individualized medicine, new treatments which add months to stage IV cancer patients' lives, and more. But we rarely or never hear about the costs. I think of it as the silent side of treatment.
Often these new treatments costs tens of thousands of dollars or more for a single year of treatment with a single dose coming in at the multi-thousand level. What is wrong with this picture? Lots. Why should a patient make a decision on their life because their cancer treatment which could extend their life is out of their price range? Please do not suggest the patients ask for assistance from the pharmaceutical companies because that is not always available.
See this example from an article on CancerNetwork.com, titled "The Cost of Cancer Care, Part I":
"Three years ago, I counseled a patient after a gastrointestinal stromal tumor had been resected from his stomach. I was pleased to be able to tell him that imatinib (Drug information on imatinib) (Gleevec), a drug very well tolerated by most patients, would meaningfully reduce his risk of recurrence. Later, we learned that his out-of-pocket expense under his Medicare Part D plan would be several thousands of dollars for a year of treatment. The patient decided the expense was too onerous and that he would forgo treatment. Patient assistance programs are often limited for Medicare beneficiaries, and none could be secured. I pressed to ascertain whether cost was his sole concern, or if there was another unspoken reason for his resistance to proceed with treatment. There was not; his decision was purely due to cost."
There have been many significant advances in cancer research in recent years including a greater understanding of the biologic side of the disease. The research and FDA approvals can take over a decade to complete. Companies are then offered patent protection for 17 years (or something close to that as my chemo brain fails to recall the exact number) to protect their pricing from competition. Costs in research have escalated creating high drug costs. Other contributing factors are:
The ensuing problem is that costs are high for the patients, insurance companies have high copayments for new non-generic/non-preferred medications. There is a switch to oral treatments which are covered by pharmacy benefits. A chemotherapy infusion may be covered by a $50 copay but an oral chemo in pill form might have a several thousand dollar copay. Its easier on the patient than going to the hospital but much tougher on their wallet. But research has helped saved many lives. There are more gains visible in the coming years as well but at what price?
"These gains have not come without a price. Research and development is expensive. Patients who survive longer under active therapy generally receive more intense overall treatment; this includes not just the therapy itself but also the radiographic and laboratory surveillance necessary to monitor ongoing treatment response and toxicity. While we strive for the development of more effective, less toxic therapies, this progress may be transforming into a painful paradox: the more we advance scientifically, the more constrained we become economically."
So how do we progress and allow advanced treatments, longer lives, and containable costs? That will be part of my next post.
[This is something new for me to have a series looking at a particular issue. As my personal cancer story becomes more of a maintenance factor and a new lifestyle with my other newer ailments, you may see more of these posts in series on differing topics but always ailment related.]
In the past decades, and more significantly in recent years, there have been many developments in cancer treatment. We hear talk about individualized medicine, new treatments which add months to stage IV cancer patients' lives, and more. But we rarely or never hear about the costs. I think of it as the silent side of treatment.
Often these new treatments costs tens of thousands of dollars or more for a single year of treatment with a single dose coming in at the multi-thousand level. What is wrong with this picture? Lots. Why should a patient make a decision on their life because their cancer treatment which could extend their life is out of their price range? Please do not suggest the patients ask for assistance from the pharmaceutical companies because that is not always available.
See this example from an article on CancerNetwork.com, titled "The Cost of Cancer Care, Part I":
"Three years ago, I counseled a patient after a gastrointestinal stromal tumor had been resected from his stomach. I was pleased to be able to tell him that imatinib (Drug information on imatinib) (Gleevec), a drug very well tolerated by most patients, would meaningfully reduce his risk of recurrence. Later, we learned that his out-of-pocket expense under his Medicare Part D plan would be several thousands of dollars for a year of treatment. The patient decided the expense was too onerous and that he would forgo treatment. Patient assistance programs are often limited for Medicare beneficiaries, and none could be secured. I pressed to ascertain whether cost was his sole concern, or if there was another unspoken reason for his resistance to proceed with treatment. There was not; his decision was purely due to cost."
There have been many significant advances in cancer research in recent years including a greater understanding of the biologic side of the disease. The research and FDA approvals can take over a decade to complete. Companies are then offered patent protection for 17 years (or something close to that as my chemo brain fails to recall the exact number) to protect their pricing from competition. Costs in research have escalated creating high drug costs. Other contributing factors are:
The ensuing problem is that costs are high for the patients, insurance companies have high copayments for new non-generic/non-preferred medications. There is a switch to oral treatments which are covered by pharmacy benefits. A chemotherapy infusion may be covered by a $50 copay but an oral chemo in pill form might have a several thousand dollar copay. Its easier on the patient than going to the hospital but much tougher on their wallet. But research has helped saved many lives. There are more gains visible in the coming years as well but at what price?
"These gains have not come without a price. Research and development is expensive. Patients who survive longer under active therapy generally receive more intense overall treatment; this includes not just the therapy itself but also the radiographic and laboratory surveillance necessary to monitor ongoing treatment response and toxicity. While we strive for the development of more effective, less toxic therapies, this progress may be transforming into a painful paradox: the more we advance scientifically, the more constrained we become economically."
So how do we progress and allow advanced treatments, longer lives, and containable costs? That will be part of my next post.
[This is something new for me to have a series looking at a particular issue. As my personal cancer story becomes more of a maintenance factor and a new lifestyle with my other newer ailments, you may see more of these posts in series on differing topics but always ailment related.]
Saturday, August 7, 2010
This is wrong
I find it very wrong that people on life saving medications have to stop taking them for financial reasons. As reported recently in the New England Journal of Medicine, patients were forced to stop taking their life saving medications.
First, I will say the drug in question is relatively expensive - $4500/month. That equals $150/day or $54,000/year. But did the drug company have any ability to provide low cost prescriptions to needy patients? I know some that do (and then the question arises, why can't we all get cheaper drugs - but they need to pay for their overhead, blah, blah, blah. But that will be another post on another day.)
Now the first patient in question had to stop taking the medication due to decreased family income. When it comes to saving the house for all, or saving one person's life, you have to draw the line. But how? Who makes the choices? That would be an awful decision.
The second patient started his own business and couldn't get insurance because of a pre-existing condition. I have lived with a pre-existing condition for 29 years. I have juggled health care plans. (I was very happy when Massachusetts tightened up its consumer protection laws and got rid of the pre-existing loop hole years ago. Its a tough one to juggle. My health is on a need to know basis and if my doctor was telling me you are basically healthy, why should an insurance company say we can't insure you because of your health? But I digress.) This second patient couldn't get health insurance which shows what is wrong with the current system.
The third patient's business failed and he could no longer afford the medication. Again dollars and a human life.
I find it wrong that we are juggling people's lives and dollars. When does a human life get reduced to ability to pay? How wrong is that?
First, I will say the drug in question is relatively expensive - $4500/month. That equals $150/day or $54,000/year. But did the drug company have any ability to provide low cost prescriptions to needy patients? I know some that do (and then the question arises, why can't we all get cheaper drugs - but they need to pay for their overhead, blah, blah, blah. But that will be another post on another day.)
Now the first patient in question had to stop taking the medication due to decreased family income. When it comes to saving the house for all, or saving one person's life, you have to draw the line. But how? Who makes the choices? That would be an awful decision.
The second patient started his own business and couldn't get insurance because of a pre-existing condition. I have lived with a pre-existing condition for 29 years. I have juggled health care plans. (I was very happy when Massachusetts tightened up its consumer protection laws and got rid of the pre-existing loop hole years ago. Its a tough one to juggle. My health is on a need to know basis and if my doctor was telling me you are basically healthy, why should an insurance company say we can't insure you because of your health? But I digress.) This second patient couldn't get health insurance which shows what is wrong with the current system.
The third patient's business failed and he could no longer afford the medication. Again dollars and a human life.
I find it wrong that we are juggling people's lives and dollars. When does a human life get reduced to ability to pay? How wrong is that?
Subscribe to:
Posts (Atom)