Hot News About High Costs and Overuse in Hip and Knee Surgery, Maternity Care, and Specialty Pharmacy; MNBTE Photos Online; Another Delay for EHRs?

July 28, 2015

Action Group Purchaser’s Guides

Through its Care Delivery Learning Networks, Action Group employer members take a deep dive on how to increase the value of health care goods and services that are subject to high cost, variability, and overuse or inappropriate use. The following Guides are available through the Member Center.

  • Specialty Pharmacy, Phase I
  • Total Joint Replacement
  • Back Pain and Surgery
  • Maternity and Infertility

Weekly Buzz: Medicare May Make Hospitals Bear Risk for Hip and Knee Surgeries

surgery

Among the most requested Modern Healthcare articles this month features Medicare’s voluntary Bundled Payments for Care Improvement initiative. The Centers for Medicare & Medicaid Services (CMS) is planning to require hospitals in 75 geographic areas to participate in a test of bundled payments for hip and knee replacements.

The procedures are among the most common that Medicare beneficiaries receive, and the price varies significantly. The average Medicare payment for surgery, hospitalization and recovery ranges from $16,500 to $33,000, the CMS said in a news release announcing the initiative.

Although Minnesota is not among the initial CMS test group, The Action Group and its Care Delivery Learning Network participants spent over six months studying variability in total joint replacement cost and quality in our state. Members have access to the resulting Total Joint Replacement Purchaser’s Guide by logging into the Member Center at mnhealthactiongroup.org.


Prenatal Ultrasounds Increase 92% in a Decade

The number of routine prenatal ultrasound procedures increased 92 percent from 2004 to 2014, reaching 5.2 per delivery. While the value of prenatal ultrasound is clear, medical experts warn frequent scans for women with low-risk pregnancies may not be medically justified and could promote certain harms, as reported in the Wall Street Journal. Medical societies recommend only one or two for low-risk women.

Also in the news this week, the cost of having a baby in a hospital varies by over $10,000 across the U.S. Researchers suggest that improving hospital practices, such as increasing care coordination and reducing cesarean deliveries, may help cut costs.

Action Group members have access to the Maternity and Infertility Purchaser’s Guide, created by and for Minnesota Health Action Group member purchasers. Simply log into the Member Center at mnhealthactiongroup.org. .


Carolyn Pare
On the Air

With the work of The Action Group’s Specialty Pharmacy Care Delivery Learning Network gaining national attention, Carolyn Pare, president and CEO, was invited to discuss the high cost of specialty medications on HealthCare Consumerism Radio. In this interview, Carolyn discusses the issue, why it matters, and what employers can and should do to stem the tide.

Specialty Pharmacy: Is the Tipping Point Near?

“Prices for cancer drugs, some of which extend lives by only a couple of months, routinely exceed $100,000 a year, and some new ones exceed $150,000.”

Public outcry over the untenable cost of specialty medications is growing on all fronts. As complaints grow about exorbitant drug prices, purchasers, patients, doctors, and lawmakers are uniting to demand accountability from pharmaceutical companies and that they disclose the development costs and profits of those medicines and the rationale for charging what they do.

The Action Group began facilitating a confidential, peer-to-peer Specialty Pharmacy Care Delivery Learning Network last fall to discuss anxieties and strategies related to managing the burgeoning and increasingly complex specialty pharmaceutical market. The Phase I Specialty Pharmacy Purchaser’s Guide is available to Action Group Members through the online Member Center. Phase II of the Learning Network is underway, with a second guide becoming available in early 2016.

News of the Week:

Drug Prices Soar, Prompting Calls for Justification (New York  Times)
Doctors Object to High Cancer Drug Prices (Wall Street Journal)
The High Price of Low Adherence to Medication (Express Scripts)


bridges-verticalMinnesota Bridges to Excellence Resources Now Available Online!

Well over 400 Achievement and Improvement Awards, representing a payout to rewarded clinics of over $1.5 million, were announced during the annual Minnesota Bridges to Excellence (MNBTE) celebration of improvements in patient care, held July 15, 2015.

To learn more about MNBTE, or to view the press release, a comprehensive list of rewarded clinics, or a slide show of the event click here.


Another Delay in Implementation of Meaningful-use Rules for EHRs?

Sen. Lamar Alexander (R-Tenn), chairman of the Senate Health, Education, Labor, and Pensions (HELP) Committee, is advising the Obama administration to delay the implementation of Stage 3 meaningful-use rules for electronic health records. Alexander is worried that these new requirements could be difficult for providers to fulfill by the current enforcement date of 2017.

The Action Group began addressing this important topic in 2008, issuing a Health Care Purchaser Declaration encouraging all health information “data holders” to join us in increasing the efficiency, cost effectiveness, and value of personal health information management. We will continue to press for EHRs that enable every Minnesotan, regardless of health status, insurance or employment, to have ready access to secure personal health information.


Thought for the Week

“If a prescription drug demands an outrageous price tag, the public, insurers and federal, state and local governments should have access to the information that supposedly justifies the cost.”

Preamble of a bill introduced in the New York State Senate in May