Hit the brakes on Partners HealthCare deal
Before gobbling up South Shore and Hallmark, the medical behemoth must prove it can contain costs and return savings to Commonwealth
By Donald M. Berwick
| OCTOBER 19, 2014
The Partners Healthcare deal to acquire two Eastern Massachusetts health care systems — South Shore Hospital and Hallmark Health — is a very bad idea. It would make a behemoth even larger. You don’t have to be an antitrust lawyer to predict the consequences of even more market power: higher prices, less competition, and the squeezing out of smaller players.
Even without this merger, Partners accounts for about one-third of all hospital revenue and one-fourth of all physician revenue in the state. Partners’ prices hover around 30 percent higher than the state average, and its “total medical expenditures” — adjusted for the severity of the patients it cares for — are nearly 10 percent higher than the average.
So why then would the government let the acquisition happen?
The proposed terms negotiated by the Attorney General’s office, recently open for public comment and now under review in Suffolk Superior Court, purport to offer safeguards. The main ones are these: Partners agrees not to raise prices over a six-year period at a rate higher than general inflation, and it agrees that health plans can pick and chose components of the system to contract with, rather than having to take all of Partners or none.
So, the argument goes, the deal would offer more options for insurers and patients, and will slow the growth of health care costs. And, proponents say, the deal will stabilize two key Massachusetts systems that are vulnerable to failure if left on their own while also elevating the quality of care because Partners is so good at what it does.
The Health Policy Commission — the nearly toothless but highly competent independent oversight body established by the 2012 state health care cost containment law — does not concur. The commission has studied historical data from the Massachusetts Center for Health Information and Analysis, also known as CHIA, which is charged to monitor the costs and quality of care. From it, the commission predicts that the acquisitions will lead to higher prices and raise total costs to individuals and businesses in the state by tens of millions of dollars per year. What’s more, although quality metrics are limited, CHIA so far finds no objective evidence that Partners hospitals or physicians offer overall better care than the average. Finally, it suggests that neither South Shore nor Hallmark is anywhere near the brink of failure — they don’t need to be rescued by a deep-pocketed player like Partners.
The antitrust community consistently opposes as ineffective the kind of remedy that this deal proposes. Agreements such as promising to keep prices down or to permit selective contracting are called “conduct remedies,” as opposed to “structural remedies.” Federal Trade Commission official Deborah Feinstein reiterated in June that her agency “generally rejects” conduct remedies because they are “an inferior substitute for allowing competition along separately owned providers to determine market behavior,” are difficult to enforce, and “nearly always focus on price. . . denying consumers the benefit of non-price competition.”
Now let’s be clear: Partners is a fabulous medical organization in many ways. It’s where the first successful kidney transplant was done. Doctors and patients come there from all over the world to learn about and receive the latest in high-tech care. Among its hospitals are some of the most highly admired teaching and research institutions on the planet. We need to keep it healthy.
But we also need to keep Massachusetts healthy — medically but also with respect to total community well-being. Between 2001 and 2014, nearly every category in our state budget has been reduced in real terms — by a lot. Public higher education: down 26 percent. Early childhood education and care: down 28 percent. Local aid: down 44 percent. Parks and recreation: down 43 percent.
Best state in America: Maine, for its hospitals
The media frenzy over two nurses who contracted the Ebola virus at a Dallas hospital has Americans nervous. Almost two-thirds of Americans said in a Washington Post-ABC News pollthis past week that they are concerned about a widespread epidemic in the United States, despite assurances from President Obama and the head of the Centers for Disease Control and Prevention that such an outbreak is highly unlikely.
To set us even more on edge, the Ebola virus causes flu-like symptoms, and flu season is around the corner. The flu is a much greater threat than the Ebola virus is likely to become: Every year, the flu virus, which is transmitted much more easily than Ebola, kills tens of thousands of Americans.
When it comes to the facilities that deal with our health, residents in Maine should feel a little less anxious: A recent study found that the state has a higher percentage of top-notch hospitals, as measured by patient safety, than anywhere else in the country.
The Hospital Safety Score, conducted by the Leapfrog Group, a nonprofit funded by top employers and health-care providers that measures hospital performance, ranks more than 2,600 hospitals around the country using 28 metrics, from the number of physicians staffing an intensive-care unit to the types of antibiotics prescribed and patient health after an operation. Those metrics come from groups such as the CDC and the Centers for Medicare and Medicaid Services (CMS), as well as self-reported data from the hospitals.
Hospitals that scored highest received an A in the group’s grading system, and 14 of Maine’s 19 graded hospitals qualified for top marks. Maine was one of only four states — along with Massachusetts, South Dakota and Illinois — where more than half the graded hospitals received an A.
HealthInsight, another nonprofit, which ranks hospitals based on patient well-being, cast a wider net and found that 13 of Maine’s 37 hospitals scored in the 90th percentile or higher for patient care.
In Maine, it pays to be a better hospital: The state government waives a $250 deductible for employees who use certain top-rated hospitals, said Leah Binder, chief executive of the Leapfrog Group. “The employers in Maine have worked closely with the hospitals to really try to push them to improve their quality, and you’ve really seen results over the past few years,” Binder said. “It’s driven a lot of healthy competition to meet [the state’s] standards.”
In the Leapfrog study, 28 of Virginia’s 64 graded hospitals — 44 percent — snagged an A rating. But in four states and the District, none of the ranked hospitals qualified for the top grade. Maryland’s hospitals were not included in the survey because they do not participate in a CMS inpatient survey.
So remember the basics this flu season: Cover your mouth when you cough. Wash your hands frequently. And move to Maine to find some of the nation’s best hospitals.
Cuba’s Impressive Role on Ebola
Cuba is an impoverished island that remains largely cut off from the world and lies about 4,500 miles from the West African nations where Ebola is spreading at an alarming rate. Yet, having pledged to deploy hundreds of medical professionals to the front lines of the pandemic, Cuba stands to play the most robust role among the nations seeking to contain the virus.
Cuba’s contribution is doubtlessly meant at least in part to bolster its beleaguered international standing. Nonetheless, it should be lauded and emulated.
The global panic over Ebola has not brought forth an adequate response from the nations with the most to offer. While the United States and several other wealthy countries have been happy to pledge funds, only Cuba and a few nongovernmental organizations are offering what is most needed: medical professionals in the field.
Doctors in West Africa desperately need support to establish isolation facilities and mechanisms to detect cases early. More than 400 medical personnel have been infected and about 4,500 patients have died. The virus has shown up in the United States and Europe, raising fears that the epidemic could soon become a global menace.
It is a shame that Washington, the chief donor in the fight against Ebola, is diplomatically estranged from Havana, the boldest contributor. In this case the schism has life-or-death consequences, because American and Cuban officials are not equipped to coordinate global efforts at a high level. This should serve as an urgent reminder to the Obama administration that the benefits of moving swiftly to restore diplomatic relations with Cuba far outweigh the drawbacks.
The Cuban health care workers will be among the most exposed foreigners, and some could very well contract the virus. The World Health Organization is directing the team of Cuban doctors, but it remains unclear how it would treat and evacuate Cubans who become sick. Transporting quarantined patients requires sophisticated teams and specially configured aircraft. Most insurance companies that provide medical evacuation services have said they will not be flying Ebola patients.
Foreign pharmacy marketing to Mainers is illegal, unsafe — and not a better deal
By Curtis Picard and Kenneth McCall, Special to the BDN
Posted Oct. 13, 2014, at 11:11 a.m.
We are disappointed to hear of another foreign entity trying to skirt U.S. federal law and market prescription drugs to Maine residents.
As the BDN reported in an Oct. 7 article, Great British Drug Store will begin offering online drugs. We have asserted from the beginning that Maine’s law that circumvents federal regulations regarding the importation of pharmaceuticals is not only illegal, but also unsafe.
Maine pharmacies adhere to strict state and federal regulations regarding their operations, and the online foreign entities, like Great British Drug Store, are not held to any oversight from state or federal regulators. It’s hard to believe in the 21st century that any state would allow foreign entities to provide health care products without verifying their credentials and without requiring licensing and ongoing oversight to ensure public safety. Unregulated drug importation is just another form of drug diversion.
Furthermore, according to the U.K. National Health Service, “It is illegal for [UK] pharmacists to supply medicines based on prescriptions issued outside the U.K., the EEA [European Economic Area] or Switzerland. This includes prescriptions by doctors in the U.S. and Canada.” Great British Drug Store is violating both U.S. and U.K. laws.
Maine’s new law has absolutely no reasonable measures in place to protect the public. If a medication imported from Great British Drug Store causes an adverse reaction in a patient, who does the patient turn to for help? Who is liable and responsible? The Great British Drug Store is clear in its terms and conditions that the customer is the importer and is on the hook if U.S. law enforcement seizes the shipment.
The terms and conditions state that customers must agree that “Great British Drug Store take[s] no responsibility for any order stopped or held by any international or domestic customs or security organization,” and that “the risk in the goods shall remain with us until they arrive at the point of entry into the USA or your country of import. You contract to us that you are personally importing the goods.”
Lastly, Maine-licensed pharmacists help patients find safe and affordable medication options every day. In fact, according to the IMS Institute for Healthcare Informatics, 84 percent of all prescriptions dispensed by U.S.-licensed pharmacists are generics. For example, the Hannaford Healthy Saver price for a 90-day supply of FDA-approved generic Lipitor (atorvastatin) 40 mg is $9.99. Great British Drug Store advertises a 28 count of 40 mg pills of “Lipitor” at $108.40, before shipping.
The Retail Association of Maine and the Maine Pharmacy Association remain committed plaintiffs in the federal lawsuit to overturn Maine’s foreign drug importation law. Maine’s importation law puts Mainers at risk and violates federal law.
Curtis Picard is executive director of the Retail Association of Maine. Kenneth McCall, BSPharm, PharmD, is immediate past president of the Maine Pharmacy Association and an associate professor in the College of Pharmacy at the University of New England.
By Mary O'Brien, Special to the BDN
Posted Oct. 19, 2014, at 10:07 a.m.
A recent opinion column in the Bangor Daily News shows the extent to which the Maine Pharmacy and Maine Retail associations will go to protect their profits while restricting access to affordable and lifesaving medications for Mainers.
Their self-serving attack is deliberately misleading and contains outright lies about the Great British Drug Store, which two weeks ago began offering safe, quality prescription drugs online at prices up to 70 percent lower than the same drugs in the U.S. Despite the claims of these two organizations, the Great British Drug Store’s pharmacy adheres to the strictest U.K. and European regulations, which are as strong or stronger than the Food and Drug Administration requirements in the U.S.
The prescription medicines we offer online at the Great British Drug Store are the same drugs we offer at our U.K. dispensing business, which owns over 60 bricks-and-mortar pharmacies and which is the largest independent chain of pharmacies in the U.K.
Our medicines are prescribed to people from all walks of life, from the lowest socioeconomic groups to the highest, including politicians and even royalty. We have been approved by PharmacyChecker.com, the only independent company that verifies U.S. and international online pharmacies and compares prescription drug prices. When you buy from the Great British Drug Store, you can be as certain as you are when you visit your local CVS or Walgreens that you are getting genuine, safe medicines.
The opinion article also claims that providing this affordable option to the people of Maine is against the law. This is false. Last year, Maine adopted legislation — sponsored by Sen. Troy Jackson, D-Allagash — to allow the importation of prescription drugs into Maine from certain countries, including the U.K., where quality control and regulations are comparable to the FDA’s. We also have worked for more than a year with U.S., U.K. and Maine officials to ensure that selling prescribed medicines to Maine residents in the manner we do violates no laws.
One of the most misleading accusations is the authors’ contention that there are no measures in place to protect the public should they experience adverse reactions to our medicines. This is a scare tactic. In fact, customers of the Great British Drug Store have the same protections as customers of local pharmacies. The drug manufacturers are liable in the exact same way they are in the U.S.
The most extreme example of the Maine Pharmacy Association’s misleading tactics concerns the claim that prescription drugs are actually cheaper at Maine pharmacies than at the Great British Drug Store. This is laughable. In the authors’ column, the organizations compare the price of a 90-day supply of 40mg generic Lipitor (atorvastatin), which sells for $9.99 at a local Hannaford, to the brand-name Lipitor on our website, which sells for $108.40 for a 28-day supply.
Comparing a 90-day supply of a generic to a 28-day supply of a brand-name drug is apples-and-oranges, and again, a deliberate attempt by the authors to mislead the public.
Here are the facts:
http://bangordailynews.com/2014/10/19/opinion/dont-believe-the-misleading-attacks-aimed-at-keeping-safe-affordable-drugs-from-mainers/print/
On an Antibiotic? You May Be Getting Only a False Sense of Security
The best way to prevent transmission of Ebola in the United States is to identify and quarantine those with the disease as soon as possible. However, the first Ebola patient in this country was, unfortunately, released after going to an emergency room, even though he had symptoms indicative of the disease. He was sent home on antibiotics.
The antibiotics were, of course, of no use in treating Ebola. They’d be of no use for any viral infection, for that matter. Even if the patient had actually had a sinus infection, as his doctors initially believed, antibiotics probably wouldn’t have done much for that either.
Yet antibiotics are regularly prescribed in this manner. Cases like this highlight a real, but often ignored, danger from their overuse: a false sense of security.
As a pediatrician and a parent, I’ve seen many protocols and procedures that require the use of antibiotics for a number of illnesses that may not necessitate them. These plans are in place, ostensibly, to protect other children from getting sick. They rest on the idea that someone on antibiotics is no longer contagious.
This is, tragically, often not the case. If you’ve had a small child with pinkeye, you know that few diseases can get your toddler banned from preschool faster. Most of the time, he will not be able to return to school until he has been on antibiotic drops for 24 hours.
This assumes, of course, that the pinkeye is caused by bacteria. Often, it is not. Up to 20 percent of conjunctivitis can be caused by adenovirus alone. Pinkeye caused by a virus will be completely unaffected by any antibiotic drops; children will be infectious long after receiving them. Moreover, physicians are pretty much unable to distinguish betweenbacterial and viral conjunctivitis.
Even if we were, there’s little evidence than 24 hours of antibiotic drops do much of anything to render a child noncontagious. Most of the outcomes studied include things like “early microbiological remission,” which means eradicating the infection by Day 2 to 5 of therapy. However, some children still haven’t achieved this outcome even by Day 6 to 10. Drugs simply work differently in different people.
Has Ebola Exposed a Strain of Racism?
Some say that when the deadly Ebola virus traveled from West Africa to the United States, it brought out worrying signs of underlying racism in the American health care system, media coverage, politics and even on United States streets.
Last week, Josephus Weeks, the nephew of Thomas Eric Duncan, the Liberian man who contracted Ebola in his country and died of the disease on a trip to the United States, wrote an op-ed for The Dallas Morning News, in which he blames his uncle’s death on the health care system and prejudice.
Mr. Weeks writes that his uncle came to the Texas Health Presbyterian Hospital in Dallas with a high fever and stomach pain, admitting that he had recently been to Liberia. “But he was a man of color with no health insurance and no means to pay for treatment, so within hours he was released with some antibiotics and Tylenol,” Mr. Weeks says.
Why was he sent back home? That, Mr. Weeks says, is the “biggest unanswered question” about Mr. Duncan’s death. “Thomas Eric Duncan was a victim of a broken system,” Mr. Weeks writes.
Charles D. Ellison at The Root also asks whether Mr. Duncan was initially turned away because he was black and uninsured. “Few want to touch the pointy eggshells of race and class in the frantic discussion over Ebola as it enters the United States,” Mr. Ellison says.
He writes that when white American aid doctors, as well as an NBC cameraman, showed signs of the virus, they were “rushed” back to the United States. “But it’s been rough going for black Ebola sufferers — even when one manages to sneak into the U.S. and access one of the most advanced health care systems in the world.”
Experts told Mr. Ellison that if Mr. Duncan was turned away because of his nationality and lack of insurance, it wouldn’t be inconsistent with what they’ve been observing in the United States health care system.
Lawyers versus doctors in costly Prop. 46 campaign wars
By MELANIE MASON
allot initiative that pits lawyers against doctors has set off one of this year's fiercest campaign wars, a costly clash over increasing state limits on malpractice damages and imposing drug testing on physicians.
Proposition 46 would raise the cap on pain-and-suffering awards in malpractice lawsuits and require that hospitals randomly test their doctors for drug and alcohol use. Backers say the measure would rein in negligent doctors; opponents charge that it's a money grab by the lawyers who helped put it on the ballot.
Supporters have raised only a fraction of the money that opponents have collected for their side of the battle. But the "yes" side is hoping that the attention-grabbing issue of drug testing can help surmount the cash disadvantage.
"We're ringing the alarm bell for the public that there are quacks that like their Jack and smack, and they hurt people," said Jamie Court, president of the advocacy group Consumer Watchdog.
Opponents have built their campaign primarily around the proposal's potential costs — and potential benefits for the other side.
Proposition 46's "greatest weak spot is its price tag," said Jason Kinney, spokesman for the "no" campaign. "Under Prop 46, trial lawyers stand to make a lot of money and everyone else is going to be stuck footing the bill."
In wading into the complex world of healthcare spending, both sides have cherry-picked research and messages that best serve their causes.
The initiative would change California's decades-old $250,000 limit on the non-economic awards people can win in medical negligence cases. That cap dates to 1975, and supporters of the ballot measure say it has become economically unfeasible for lawyers to take many such cases.
The limit would rise to $1.1 million under Proposition 46 and would be indexed to inflation in the future.
One ad the "no" campaign has aired says the measure could cost state and local governments hundreds of millions of dollars annually. That's the high end of an estimate by the nonpartisan Legislative Analyst's Office, which determined that higher malpractice insurance costs for doctors could be passed on to other purchasers, such as the government.
Those costs could range from the low tens of millions of dollars to several hundred million a year, the analysis said.
The ad also says overall total healthcare costs could increase by billions in a few years, raising expenses for an average family of four by more than $1,000 annually.
Those figures come from a study commissioned by supporters of damages caps, which found that healthcare spending would increase by 3.13% due to more "defensive medicine" — additional tests and procedures conducted to ward off lawsuits — if the award limit were raised.
Other studies suggest differently.
A Congressional Budget Office analysis estimated that defensive medicine accounted for 0.3% of national healthcare expenditures. And a Rand Corp. study of hospital emergency departments in three states with strict malpractice limits found the caps had little effect on the cost of care.
No comments:
Post a Comment