Family inHome Caregiving Blog
Most pension plans have recovered nicely after the recent stock market boom, however, some analysts are worried because there will be a 52% increase in regulatory costs which will be phased in by 2016. Estimates are that there will be a whopping $150 billion surge in liabilities because retirees are living longer. Morgan Stanley told the Wall Street Journal that the new fees will add $20 billion in costs to their $2 trillion in pension obligations. And that's just for one company! There are more than 60 million Americans who are covered by defined benefit plans currently, but this is likely to significantly decline over time. These new fees will only serve to increase the number of companies that stop offering traditional pension plans to employees because they are getting too expensive to offer.
Many people get way too much salt in their diet via snack and processed foods such as canned vegetables. There is a new source of danger out there according to a recently published study in the British Medical Journal. Anything that you take regularly which fizzles in a glass or dissolves in your mouth is likely to be packed with sodium. Those who take these tonics have a 16% increased risk of heart attack, stroke and vascular death compared with those who got sodium-free versions of the same thing. This is likely due to the fact that having excess sodium in your system increases your blood pressure, which can cause other health problems. Make sure you check the labels of anything dissolvable that you are taking.
There has been quite a bit of press activity regarding the recently released report from the inspector general for the Department of Health and Human Services showing Medicare payments by doctor in 2012, and now local newspapers are starting to pick through the data and single out highly paid physicians. The front page story of the Monterey Herald yesterday focused on two local oncologists (a father and daughter team) who were paid $2.6 million by Medicare in 2012. They were the two highest paid in Monterey County and in a group of 54 doctors who received more than $300,000. One of the oncologists at the top of the list said the high payments were due to chemotherapy drugs which were then billed to patients and he said there was almost no profit margin on them, describing it as a complete wash. After practicing on the Peninsula for 40 years, he said Medicare reimbursement rates had been pushed too low and praised Sam Farr for his efforts in getting reimbursement rates raised, which I wrote about on my blog a few days ago. It's too bad that Medicare can't release reports regarding how much doctors are paid for services rather than goods like pharmaceuticals. It does seem like the margin on the pharmaceuticals would be quite slim.
I wrote yesterday on my blog about the Medicare study of 2012 data showing that the top one third of the highest paid doctors were ophthalmologists. Today, a New York Times article found various explanations for this. First, "There are just these pockets of profitability within the system," Dr. Lisa Bielamowicz, executive director and chief medical officer for research at the Advisory Board Company, referring to the fact that there are a handful of doctors who can do a high volume of very expensive procedures. Since it is such a limited field, quite a bit of business goes to these doctors who do have very lucrative practices. Other ophthalmologists interviewed, however said the results of the study were misleading because many give patients with macular degeneration multiple injections of a very expensive drug on which they make very little margin. Medicare reimbursed doctors $1 billion in 2012 for the most expensive macular degeneration drug called Lucentis. It costs about $2,000 per injection and needs to be given to the patient once per month. One doctor who received $9.5 million in Medicare reimbursements in 2012 said it was largely due to Lucentis injections, on which he makes a profit margin of just 3%. One doctor interviewed said he performed 6,000 injections of Lucentis in 2012 at a cost of about $12 million. There is certain to be a big public debate about this in the coming weeks.
I wrote on my blog yesterday about a Novartis drug for congestive heart failure got two thumbs down from the Food & Drug Administration (FDA), however, it did get good news on another drug which is being developed to treat a rare form of lung cancer. The drug, which is called ceritinib is used to treat ALK-positive lung cancer and has been found to be 20x more effective as the current drug on the market, which is called Xalkori. Both drugs essentially turn off this ALK gene which is causing the cancer. Xalkori has only been on the market since 2011 and, although it's been effective, most patients become resistant to the drug within 12 months and then relapse. The hope is that multiple drugs will be found done to treat this disease, and patients can then be rotated between drugs so they don't gain resistance.
As promised, the inspector general for the Department of Health and Human Services released 2012 data showing Medicare payments by doctor and, as expected, there were a few outliers which are expected to cause quite a bit of public outrage. One ophthalmologist was paid $20.8 million and he had already been in the news last year after it was discovered that a Senator had been using the doctor's personal jet to make trips to the Dominican Republic. The top 1% of the 825,000 medical providers which were paid by Medicare in 2012 accounted for 14% of the $77 billion in billings. Medicare paid 344 physicians and other health care providers more than $3 million each. The 1,000 highest paid Medicare doctors received a total of $3.05 billion. Strangely, one-third of the top earners were ophthalmologists and 10% were oncologists. The inspector general has promised to look into this. This is an interesting moment in time. This data has been available for decades but the American Medical Association (AMA) got an injunction to prohibit the release of the data in 1979. However, in 2011 the Wall Street Journal's parent-company, Dow Jones, fought to have the injunction lifted. It won last year, and so this data will be made public going forward and will call attention to potential fraud. The state with the most top earners was Florida, which has been a hotbed for Medicare fraud. This was followed by California, New Jersey, Texas and New York. Hopefully this data will be used to single out doctors who may be committing fraud.
I see a lot of elder abuse in my line of work and, sadly, it's often done by a family member or someone else that the senior deeply trusts. In one of the more disgusting cases I have read about recently, a police officer in the east bay was arrested after it was discovered that he used his status as a police officer to enter the apartments of seniors as well as an occupational medical facility and steal their prescription pain killers. As if that weren't bad enough, the man was in the K-9 unit so he had a large German Shepard with him which he may have used to scare the senior citizens. Thankfully, he is being held on $480,000 bail.
A wonderful new tool has been used which will reduce the need for some biopsies. Dubbed "liquid biopsies", blood tests can now test for traces of cancer cells or fragments of tumor DNA which are in the blood in just trace amounts. A study which was published in The New England Journal of Medicine showed that in some cases a liquid biopsy could detect the worsening of breast cancer a full five months before it could be seen on a CT scan. Some in the medical community believe that these blood tests could one day be used to screen healthy people for a myriad of different cancers, not just focusing on a single problem such as a PSA test does. Rather, it could be like running a DNA on your whole system to look for abnormalities. There are still many skeptics of this, but hopefully it will be proven to be a useful tool as many biopsies can be very invasive.
Novartis AG suffered a huge set-back when a Food & Drug Administration advisory committee unanimously voted against approving their new drug called Serelaxin (brand name Reasanz). The company believed it was going to be a blockbuster drug, providing treatment for millions of patients with acute heart failure. Currently most drugs on the market for this aren't very impactful. Last June, the FDA had put the drug in an expedited category called "breakthrough therapies" and many believed it would gain approval. Novartis said it would continue to push for approval and that there is sufficiently compelling scientifically and medically relevant to satisfy regulatory requirements.
Physicians are under a full out attack by a number of attorneys which are pushing a California referendum which would throw out the $250,000 cap on malpractice suits that has been in place since 1975. They hope the referendum will gain momentum because it's paired with a popular idea that hospital doctors should undergo routine drug and alcohol testing. "My view is that you can talk about everything else, but the underlying reason (for the ballot measure) is the $250,000 cap. It is going to increase health care costs by several billion dollars and that will have direct adverse consequences," Duane Dauner, chief executive of the California Hospital Association, told the Wall Street Journal. There will be plenty of lobbying on both sides of this issue. The medical industry in California had $31 million in campaign funds ready to fight the effort at the end of last year and will be looking to raise more. The California Medical Association, Planned Parenthood, pharmacists, hospitals and insurance groups are all against it as well.