We don’t recall Michael Leavitt saying anything like this during the 4 years he served as Secretary of HHS under George W. Bush, but now he’s quite forthright in calling Medicare a fiscal disaster, and declaring that health reform proposals built around it would end up just the same.

With surely not a whit of political intent, the former Secretary told the Washington Post today that Medicare provides uncoordinated, expensive, poor quality care because “every incentive in the system is to provide more care, not better care.”

Referring to the Big O’s fading aspiration to create a public option that would compete against Big Insurance, Leavitt scoffed that such an idea would lead to “essentially a bankrupt system.”

Building on Medicare “is the equivalent of trying to solve obesity by prescribing a perpetual regimen of double calories,” Leavitt told the Post.

Then, in a remarkably transparent sleight of hand designed to distance himself from what he just said was the abject failure of a program for which he was responsible, Leavitt pointed a finger at Congress.

It’s too soft, too beholden to the special interests, he deadpanned. 

Planned cuts in Medicare payments to physicians were continually blocked by a Congress that was, he said, in the back pockets of providers. And Congress had OK’d competitive bidding on medical equipment, but backed away from that too, amid pressure from the device industry.

“[I]n a system that’s run by the government, lobbyists and various commercial interests, including doctors, hospitals, nurses, medical equipment dealers and every other part of the system, use the political process to restrict the capacity for change,” Leavitt said, his hands thoroughly washed of the matter.

Let’s hear it for GAVI Alliance partners, the World Bank, the WHO, UNICEF, 5 national governments and the Bill & Melinda Gates Foundation, who announced last week that they have kicked-off the first-ever Advance Market Commitment (AMC) program.

The purpose of the program is to accelerate access to vaccines against pneumococcal disease, which kills 1.6 million people each year, including a million children less than the age of 5.

90% of these deaths occur in developing countries.

Pneumonia, the most common form of serious pneumococcal disease, accounts for one in 4 childhood deaths around the world. The AMC pneumococcal program may prevent up to 7 million childhood deaths by 2030.

Pneumococcal vaccine has been part of regular immunization programs in developed countries since 2000, but there is no affordable vaccine for developing countries.

The vaccine costs $70 per dose in industrialized countries but thanks to the AMC, its price in developing countries will be secured for the long-term at $3.50.

Through an AMC, donors commit money to guarantee the price of vaccines once they have been developed, thus creating the potential for a viable future market.

These commitments provide vaccine makers with proper incentives to conduct R&D and build manufacturing capacity.

“The AMC is an important step towards reducing the health inequities between rich and poor, and a way to protect the lives of the world’s poorest children,” said Julian Lob-Levyt, GAVI’s CEO. “We look forward to pharmaceutical firms applying to the AMC quickly.”

For the pneumococcal AMC program, the governments of Italy, the UK, Canada, Russia, and Norway and the Bill & Melinda Gates Foundation combined to raise $1.5 billion, and GAVI threw in another $1.3 billion. The World Bank provides fiduciary support and the WHO has established technical criteria for a suitable vaccine. UNICEF will procure and distribute it.

Companies that participate in the AMC must commit to supply the vaccines at the low price even after donor funds are gone.

Plans are to introduce the new vaccine to 60 of the world’s poorest countries by 2015.

A CDC report says chicken is the most common source of food poisoning in the US, but vegetable eaters had better beware, too.
 
According to the report, the culprit behind most poultry-related illnesses is Clostridium perfringens, a bacterium that provokes  cramping and diarrhea approximately 10 to 12 hours after the fateful swallow.

Claustridia spores can survive cooking, so maintaining poultry meat at low temperatures during processing and storage ends up being the key preventive measure.

Researchers counted leafy vegetables, root vegetables, vegetables from stalks or vines, fungi and sprouts as separate categories. Had all that produce been combined, vegetable-associated outbreaks would have far exceeded those caused by poultry.

Salmonella is the pathogen responsible for most cases of food-borne illnesses associated with vegetables. It has caused national outbreaks from contaminated peanut butter, spinach and tomatoes in the last few years.

Interestingly, viruses—which can end up on food when restaurant workers fail to wash their hands before handling it—topped straight-up food borne illnesses by almost two to one.

These viruses cause most cases of “stomach flu,” a lovely 48-hour run of nausea and vomiting that has nothing to do with the actual flu virus.

“We’re glad that CDC is finally coming out with good attribution data,” Caroline Smith DeWaal told the New York Times. The director of food safety at Science in the Public Interest added, “it shows the need for improvement, not only at FDA but at the USDA’s food safety programs as well.”

The findings were based on an analysis of reports submitted to the CDC by state and local health departments. Unfortunately, most of the roughly 76 million annual cases of food-borne illness are not reported, and most reported cases are not investigated.

A version of this post initially appeared on the Practice Fusion blog.

In the last 2 years alone, Big Pharma has cut its sales force by 10% to 92,000 and some experts predict the number could drop by another 15,000 in the next 2 years.

That will save $3.6 billion for the pharmaceutical companies, who know all too well that results from the investment it has made in its sales force are way down.

In fact, just 37% of drug reps who visit physician offices are able to place drug products in the sample drawer, and a only 20% speak directly with a physician.

Nearly a quarter of all physicians practice within a group that bans reps altogether.

That one reason why Big Pharma has become so excited about ePromotion, a term encompassing 3 relatively new techniques by which drug manufacturers can doctors about their products, even in the absence of Sid the Drug Rep.

The ePromotion troika includes virtual details, which include video and audiotapes, text messages and email (but no live communication), video details, which include live chat or telephone-assisted Internet sessions in which physicians can speak directly with a representative, and virtual events which include CME events, webinars, conference calls and panel discussions.

Big Pharma’s enthusiasm will likely grow as it digests the results of a new survey showing that doctors’ attitudes toward ePromotion are becoming increasingly positive.

SDIHealth concluded this after completing its Annual Study of ePromotion, the 8th such iteration of the poll.

The Study revealed that 67% of physicians expressed a positive attitude toward ePromotion, up 5% from the previous year.

73% of the surveyed physicians felt ePromotion was at least as effective as face-to-face promotion by drug reps, a jump from 68% the year before.

 The average time spent per doctor, per ePromotion activity was a robust 18 minutes.

With each year, “we have seen acceptance toward ePromotion among physicians increase,” said Jason Fox, Associate Director at SDI.

“The results of this survey underscore a growing opportunity for the two groups to interact more regularly.”

Steven Forage, a metro-DC-based software salesman spends 5 hours per day behind the wheel. Like so many others, he’s closing deals on his cell, drinking coffee and checking email, in addition to driving.

One thing he worries about no more, however, is getting nailed by a speed camera.

That’s because Forage tricked-out his Caddy with PhantomAlert, a system that links all known locations of the cameras with his GPS and warns him when he’s approaching one.

“Fuzz alert!” shouts an electronic voice from his dashboard. “Ding, ding. Ding, ding. Fuzz alert!”

PhantomAlert has subscribers all over the country, including more than 2,000 in metro-DC alone according to it’s owner, Joseph Scott.

Scott’s employees access the locations of speed cameras from government and police Web sites, and receive tips from subscribers as well.

Scott believes cops should dig his device, since after all the cameras are there to slow-down drivers and not generate cash from tickets. “Not only should they support us,” Scott told the Washington Post, “but when they mail out citations, on the back they should say, ‘Get PhantomAlert.’ “

Some officials disagree. “If drivers think they only get a ticket when their little device goes off, that could lead them into a false sense of security, which could cause them to speed,” Lisa Sutter, a District employee who runs camera enforcement operations in DC told the Post.

But in fact others see merit in Scott’s device. Corinne Geller, a spokeswoman for the Virginia State Police, thinks PhantomAlert could create a perception that there is more surveillance going on at any time than is actually the case. “If it’s a deterrent, that’s a good thing,” Geller said.

A version of this post originally appeared in the Practice Fusion Blog.

The US Department of Veterans Affairs will allow clinical investigators to use de-identified patient information contained in its EMR as a means to support clinical research initiatives on subjects ranging from MRSA to posttraumatic stress disorder, heart failure and cancer.

Matthew Samore, an epidemiologist from the VA Salt Lake City will be involved with the project. He opined that the so-called Consortium for Healthcare Informatics Research “will not only inform new guidelines but help resolve some conflicts in current guidelines.”

Only VA-associated investigators will get the keys to the highway.

Samore said he hoped the project would show how data-mining techniques could be used in other EMR systems, but worried that since most EMR systems are so poorly interoperable, it would be quite some time before they could match the VA’s capabilities in this area.

Pam Matthews, a senior director of health care information systems at HIMSS concurred with this prediction. “The VA is a closed system. When you apply (what they are doing) to the commercially available products, their data model, their software model may be different,” she said to AMedNews.

Web-based EMRs eliminate these problems, however, by securely storing patient records in a central repository that is continually available to all health professionals involved with the care of a particular patient. 

The VA begins its initiative under a dark cloud caused by the heist of a laptop containing data on 26 million vets, a bit of a privacy issue that is avoided with Web-based solutions since the data are housed in secure, off-site locations.

Fourteen years ago, Harvard researchers revealed that insurance companies were big-time investors in tobacco companies. The seemingly hypocritical position prompted outrage and calls for them to divest.

But when the same scientists recently re-examined the matter, they found the industry had failed to kick the habit.

By reviewing SEC filings and news reports from 2008, J. Wesley Boyd and colleagues determined that US, UK and Canadian-based insurance companies owned at least $4.4 billion worth of stock in companies whose subsidiaries produce cigarettes, cigars, chewing tobacco and related products.

“Despite calls upon the insurance industry to get out of the tobacco business by physicians and others, insurers continue to put their profits above people’s health,” Boyd told Medical News Today. “It’s clear their top priority is making money, not safeguarding people’s well-being.”

The World Health Organization estimates that tobacco products contribute to 5.4 million deaths per year worldwide.

New Jersey-based Prudential Financial Inc., which markets life and disability insurance, has holdings in tobacco firms like Reynolds American and Philip Morris, that total $264 million.
 
These numbers are dwarfed by Toronto-based Sun Life which sells health, disability, life and long-term care insurance. It owns just north of $1 billion in tobacco company stock.

Meanwhile, London-based Prudential Plc, which offers disability, health and long-term care insurance, holds $1.38 billion in British American Tobacco and other such companies.

“Insurance firms have figured out ways to profit from both… investing in tobacco (and) selling life or health insurance. (They) exclude smokers from coverage or, more commonly, charge them higher premiums. Insurers profit - and smokers lose - twice over,” wrote the authors.

Boyd’s group first reported on the matter in a 1995 Lancet article.

Ever since a 2007 trial of Avandia raised concern that newer generation diabetes-fighters raised cardiovascular risk, sales of the drugs have crashed and investigators have scurried to provide follow-up data one way or the other.

Now, Bristol Meyers Squibb scientists have raised hope that a diabetes drug in the pipeline may actually cut cardiovascular risk.

The drug is saxagliptin, a dipeptidyl peptidase-4 (DPP4) inhibitor.

At the ADA meetings last month, Robert Wolf and colleagues reported the results of a meta-analysis, in which they pooled results from 8 phase II and III trials of the drug.

They found major adverse cardiovascular events to be 55% less common in saxagliptin-treated patients than in those receiving either placebo or metformin.

If confirmed with prospective trials, this cardioprotective effect “would be a very important advance,” Wolf told MedPageToday.

The meta-analysis combined 4,607 adverse events reported during 3,758 patient-years of study in 8 randomized, double-blind trials of saxagliptin in type 2 diabetes.

The incidence of major adverse cardiovascular events, which include cardiovascular death, nonfatal MI, and nonfatal stroke was 0.7% in saxagliptin-treated patients and 1.4% in the other groups.

Saxagliptin was found to cut CV risk in high-risk subsets as well. For example, among those with a prior history of cardiovascular disease, the incidence of major adverse CV events was 9.2% in saxagliptin-treated patients versus 46.3% in other groups.

Equally impressive reductions were seen in populations with at least one CV risk factor beyond diabetes, at least 2 risk factors in addition to diabetes, in men, and in those at least 65 years old.

The drug’s codevelopers, BMS and AZ, have submitted an NDA to the FDA, which is expected to rule on the matter later this month.

This post first appeared in the Practice Fusion Blog.

Responding to public feedback on a working group’s proposal made last month, the federal HIT Policy Committee has released updated recommendations for defining what is meant by the term “meaningful use” of electronic medical records.

The new recommendations include modifications to the criteria for computerized order entry and a more aggressive implementation time frame for implementing personal health records.

The recommendations now go to the Office of the National Coordinator for Health Information Technology and other branches of HHS, who will use them in developing rules to implement the incentive programs.

The final product should be released beforeyear end.

HITECH legislation states that providers must demonstrate meaningful use of an EMR in order to qualify for bonus payouts under Medicare and Medicaid beginning in 2011.

In an important change designed to ease pressure on providers, the Policy Committee has recommended that its 2011 criteria should apply not just to 2011, but to whatever year a particular provider decides to implement his or her EHR.

Thus if a practitioner decides to go live with an EHR in, say, 2013, he or she will be required to meet 2011 criteria for meaningful use in order to qualify for bonus funding.

The Policy Committee has retained the guideline matrix originally proposed by its working group, while making several modifications to it, most notably with respect to the adoption of CPOE.

Here, the working group’s proposed requirement that providers must use CPOE for “all” orders in 2011 has been diluted to state that 10% of orders “of any type” must be entered by an authorized provider in order to qualify. This will allow pilot CPOE projects and phased implementations to meet the requirement.

The revised criteria also require providers to:
* Implement one clinical decision support rule relevant to a specialty or a high clinical priority;
* Submit claims to payers electronically;
* Check insurance eligibility electronically when possible;
* Provide patients with timely electronic access to their health information;
* Provide patients, upon request, with an electronic copy of their discharge instructions and procedures at the time of discharge; and
* Be able to exchange health information where possible in 2011, and participate in a national health information exchange by 2015. (more…)

The Centers for Medicare and Medicaid Services announced last Wednesday that it was changing its payment rates to providers in 2010.

The new rates will increase payouts to beleaguered primary care practitioners while snubbing radiologists and cardiologists, among others.

Among the perks for PCPs, CMS has proposed a bump in payments for the Initial Preventive Physical Exam, a.k.a. the “Welcome to Medicare” visit to reflect the true complexity of the service.

CMS also proposed to change the way Medicare recognizes professional liability expenses such that Medicare’s support for these costs is redirected to providers experiencing the highest malpractice premiums.

Beyond that, the news was gloomier than Boston’s weather this June. 

CMS is, for example, proposing to remove physician-administered drugs from the definition of “physician services” and to stop paying for consultation codes, which are typically billed by specialists at a rate higher than procedurally similar evaluation and management (E/M) services. 

Overall, the changes would increase payments to GPs, family physicians, internists, and geriatric specialists by 6-8%, according to a CMS press release. The biggest losers will be radiologists, especially interventional radiologists who should see cuts of at least 20% for most imaging tests.

Payments to cardiologists would be cut about 11% overall, with cuts of up to 42% for reading an echocardiogram and 24% for performing cardiac catheterization.

Cuts “like this threaten the successes we have had over the years with reducing heart disease,” ACC president Alfred Bove warned the Wall Street Journal.

Meanwhile Ted Epperly, president of the American Academy of Family Physicians, said the CMS proposal would drive more medical students into primary care, and hailed the pay raise for his constituency as “long overdue.”