Bill Seeks Consent for Off-Label Rx
A bill in the California assembly would require physicians to get informed consent from their patients before “prescribing, administering, or furnishing” a prescription for off-label use. A failure to adhere to the requirement would be considered a violation of the Medical Practice Act, which means physicians could be charged with a crime. The California Medical Association opposes the legislation and said the existing law is enough because physicians can be held liable for not disclosing risks. The bill would require physicians to specify that a medication is not approved by the Food and Drug Administration for the use that the doctor is recommending, and that the risks are unknown and there is not a consensus on the efficacy.
Obesity Linked to 2%–3% of Claims
Obesity accounts for 2%–3% of medical claims dollars, according to a retrospective study in the March issue of the Journal of Occupational and Environmental Medicine. Researchers at Gordian Health Solutions Inc. assessed claims from January 2000 to December 2004 from 61 employers. In 2004 inflation-adjusted dollars, total claims for the study period amounted to $4.55 billion. Obesity was responsible for 2.1% of total claims for male workers ($3.55/member per month) and 2.8% for female workers ($5.71/member per month). The true tally may be higher, said the researchers, noting that their analysis excluded prescription drug costs. Given that the data show a rise in obesity-related costs with increasing age, “childhood obesity may have significant lagged effects.”
IOM on Quality Improvement Groups
An Institute of Medicine committee has released a report on Medicare's Quality Improvement Organizations that describes these groups as spending too much time on reviewing beneficiary complaints and not enough on helping physicians and health care organizations to actually improve care. The panel said there are inherent conflicts when the QIO reviews complaints about organizations it needs to voluntarily participate in quality improvement efforts, and suggested that case reviews should be shifted to regional or national agencies. The 22-member IOM panel spent a year investigating the 41 organizations that are hired by Medicare to improve quality of care, address patient complaints, and review claims to ensure they meet quality benchmarks and reimbursement standards. Stephen M. Shortell, Ph.D., an IOM panel member, said the committee's main finding was that, while the quality of care has improved, “the pace of change is too slow, and gaps in quality persist.” QIOs should be providing more technical assistance to physicians and hospitals, said Dr. Shortell, who is a professor of health policy and management at the University of California, Berkeley. The IOM panel said that QIO boards—which it said are dominated by physicians—should include more consumers, representatives of other health fields, and health information technology experts, and have greater accountability to the public. The American Health Quality Association, a QIO trade group, said it supported most of the recommendations, but said that the organizations should continue to review complaints and appeals because it provided “invaluable opportunities to help providers improve care for all patients.” The AHQA also noted that 30 of 41 QIOs had signed a code of conduct that would make them more accountable.
Many Enrollees Happy With Part D
A new survey of Medicare beneficiaries who are receiving Part D drug benefits finds them to be largely satisfied. The survey—conducted 10 weeks into the new coverage—was paid for by America's Health Insurance Plans, and conducted by Ayres, McHenry & Associates Inc., a Republican polling firm. The poll surveyed 408 of the 5.2 million people over age 65 years who have self-enrolled in Part D, and 401 of the 6.5 million “dual eligibles,” who were automatically enrolled because they had Medicaid drug coverage. Of those who self-enrolled, 66% said it had been worth the time and effort to enroll, and four-fifths (84%) said they had no problem signing up. The majority—85%–90% of both groups—said they had no problem using the new benefit. “This is a dramatic departure from the conventional wisdom about this program,” said Whitfield Ayres, Ph.D., president of the polling firm. But Ron Pollack, executive director of the advocacy group Families USA, said it was not surprising that beneficiaries who went to the trouble to sign up were happy. Shockingly few have signed up, however, Mr. Pollack said. “America's seniors are clearly voting with their feet,” he said.
All Groups at Risk for Poor Care
Although disparities exist in health care among various ethnic and racial groups, those gaps are small compared with the health care everyone receives and what they should be receiving, according to a report from the Rand Corporation. “Differences exist. But they pale in comparison to the chasm between where we are today and where we should be,” said Dr. Steven M. Asch of the University of California, Los Angeles, the study's lead author. “These findings tell us that no one can afford to be complacent, and they underscore that the quality-of-care problem in this country is profound and systemic.” The study assessed preventive services and care for 30 acute and chronic conditions that constitute the leading causes of death and disability. Overall, participants received about 55% of recommended care, despite the fact that the recommendations for the conditions involved were widely known and accepted.