Heated And Deep-Pocketed Battle Erupts Over 340B Drug Discount Program – Kaiser Health News

This is an ugly story from both sides of the issue. The big Pharma companies are looking to claw back some of their profits, and some hospital districts, such as Jefferson County Healthcare, may be using the system in a way it was not intended, meaning that it is unclear that the patients who were intended to benefit from this, actually are seeing benefits. JHC has a relationship to somehow share these discounts with Safeway, where they send patients for filling the discounted drug.  Is the patient actually seeing a discounted price or is the hospital somehow using this to generate more profits? I am under the impression that Kitsap County is using the program more as it was originally intended, meaning that the monies are passed directly to the consumer who benefits from the discount. Is that not true here? It appears not to be.

The program, known as 340B, requires pharmaceutical companies to give steep discounts to hospitals and clinics that serve high volumes of low-income patients.

Under 340B, named after the section of the Public Health Service Act that authorizes it, eligible hospitals buy drugs at a discount from the pharmaceutical companies and then are reimbursed for those purchases from Medicare. The drugs are purchased under the Part B program, which covers expensive chemotherapy and other treatments in a hospital, doctor’s office and clinics.

Heated And Deep-Pocketed Battle Erupts Over 340B Drug Discount Program

First Digital Pill Approved to Worries About Biomedical ‘Big Brother’ – NY Times

The medicine, an antipsychotic drug, has a sensor that will show doctors whether and when patients are taking it. Other medicines will follow, experts say. Feedback from a medical professional was, “This is all about performance markers and doctors being able to “divorce” non compliant patients, so their reimbursement doesn’t go down. Patients who don’t/ can’t understand or cannot afford medications, or have other barriers are once again the disenfranchised group.”

New York Times Article

Groundbreaking option in Washington state could let dementia patients refuse spoon-feeding – Seattle Times

Anyone who has watched a terminally ill loved one who refuses to eat, will appreciate this new option. We need to continue to press for death with dignity. If you don’t think this is important you may not have experienced what some homes for the elderly who are mentally not in control will do when they decide that they will keep the patient alive at all costs. This is not a pretty picture of care for the terminally ill, but is all to real today.

A Washington state agency that advocates for medical aid-in-dying has created guidelines for dementia patients who fear losing control not only of their faculties but of their free will to live and die on their terms.

https://www.seattletimes.com/seattle-news/health/new-groundbreaking-instructions-out-of-washington-state-could-let-dementia-patients-refuse-spoon-feeding/

Health care mergers often driven by patient access – Kitsap Sun

Good short article detailing the problems facing independent medical practitioners today. This is the state of medicine we are in. Jennifer Hanscom is the CEO and executive director of the Washington State Medical Association.

When I began my career at the Washington State Medical Association in 1996, 38 percent of physicians were in solo practice; today that number has plummeted to less than four percent. For comparison, during that same period only 18 percent of physicians were in practices of 100 or more physicians and a good percent of those practices were large independent clinics. Today, over 61 percent of physicians practice in groups of more than 100 physicians, with most employed by integrated systems.

http://www.kitsapsun.com/story/opinion/columnists/2017/09/07/my-turn-health-care-mergers-often-driven-patient-access/639402001/

Now we know…

The Republicans have just floored their health care reform bill. You can read the details all over the internet. But it’s a disaster for rural hospital districts like ours. We have the oldest population of any county in the State and  rely heavily on Medicare reimbursement. We also have a huge poor population, which relies on Medicaid. Let’s just set aside the number of people who come to the food bank weekly.

Our reliance on  Medicare and Medicaid patients being reimbursed from the federal government at rates that make it worthwhile to do the work of caring for them, make it important not to lose what ground has been gained. Before Obamacare we were running a deficit that the taxpayers of this county paid for. Since Obamacare we are running a surplus. Not much, but not in the red. Now this. Who’s going to pay?The general attitude that I hear all the time from acquaintances and on the Internet is that they don’t want more taxes. The poor will come into the emergency rooms regardless if they are covered or not. But if the Feds don’t pay for them, it will be on us. You and I. Or the hospital could eventually close. Just ponder the words of a Kaiser Family Foundation study published in 2016 (JHC is  a 25 bed hospital):

In 2012-2013, rural hospitals had an average of 50 beds and a median of 25 beds. They had an average daily census of 7 patients and 321 employees, and they were 10 years old on average. Compared to urban hospitals, rural hospitals are more likely to be in counties with an elderly and poor population.9 According to The North Carolina Rural Health Research Program (NC RHRP) at the Cecil G. Sheps Center for Health Services Research, which tracks rural hospital closures, there were 72 rural hospital closures between January 2010 and April 2016, compared to 42 closures between 2005 and 2009, and since the 2008-2009 recession, the annual number of closures has increased each year.10 More than half of all rural hospital closures since 2010 were in the South and few Southern states have expanded Medicaid under the ACA.

http://www.kff.org/report-section/a-look-at-rural-hospital-closures-and-implications-for-access-to-care-three-case-studies-issue-brief/

The expectations are that we are in for some very hard times in the years ahead. It will take a lot of effort to keep our hospital running efficiently and staffed appropriately. Even now, we are having a hard time retaining quality medical staff even though we offer competitive salaries to Seattle, according to the hospital administration. Unfortunately, we have not done a great job at looking at foreign trained medical professionals, which are in wide spread use at Harrison and other nearby medical facilities. We also are behind the curve in the use of less expensive mid-levels, ARNPs and PAs. To the hospital district’s credit, the number of those mid-levels is up recently, probably due more to federal requirements and an inability to retain physicians, more  than anything else.

Perhaps if the Democrats win back the House and Senate and eventually the Presidency we can hope for fixes to this awful proposal which was created by a cabal of men behind closed doors. No women, even of their own party, were asked to work with them. It was despicable back room politics of the worse kind. They have even screwed their own constituents in places like Spokane and Wenatchee, as rural hospitals there are even farther from urban centers.  You have to wonder just who they represent? Or maybe we already know and this next four years will finally drive that home to their supporters in places throughout the rural west and south. Or maybe those voters and non-voters are so tuned into Fox News that they can’t connect the dots anymore.

We can only hope that we will get through the next four years without seeing a collapse of our hospital and the services it is offering, even though prices are already causing people who are aware of the high charges to drive closer into Seattle to seek competitive rates for services.

Now more than ever we need engaged, knowledgeable people in the role of Hospital District Commissioner, which is an election that is happening now. We don’t need a rubber stamp for the hospital district administration, we need deeply knowledgeable people who can roll up their sleeves and help, challenge the administration when needed and go advocate for the hospital district in the State and Federal arenas.

We need leadership from skilled medical professionals who have spent time in the trenches, understanding  both the issues of health care administration and the needs of our neighbors because they have sat in the rooms with these patients as they poured out their hearts to them about their medical conditions and their ability to pay for treatment or drugs. People who held them as they cried. Who may have given them free treatment rather than walked away. Who might have sometimes given them hard news. People who know what we have to fight for and can help guide the hospital district administration and our elected officials forward through this coming dark night.

FTC & FDA Goes Against General Nutrition

TINA reports on GNC regulatory actions and consumer lawsuits

Truth in Advertising, Inc., has published a history of government actions against General Nutrition and its associated companies. The government actions have included three by the U.S. Justice Department actions, three major FTC actions, at least four FTC actions against companies whose products were sold at GNC, more than a dozen false representation actions by the U.S. Postal Service, at least six actions by State agencies, and at least ten actions initiated by the FDA. There also have been more than 100 consumer lawsuits. [GNC: No stranger to regulatory enforcement. TINA.org, May 22, 2017] The takeaway message is that government regulation is limited and consumers need to be very skeptical of claims made about dietary supplements

General Nutrition is one of the largest marketers of vitamins and supplements in the US.

pH Miracle author pleads guilty to practicing medicine without a license

Since Mr. Young was on “Coast to Coast” he likely has some audience here in Jefferson County. I know people tell me they listen to this show frequently.

Robert O. Young expected to do more jail time

Robert O. Young, author of The pH Miracle, has pleaded guilty to two more counts of practicing medicine without a license. In 2014, he was charged with multiple counts of grand theft and conspiring to practice medicine without a license. The San Diego District Attorney’s press release stated that Young accepted patients, including some who were terminally ill, and temporarily housed them at his pH Miracle Center. The charges alleged that Young and associates broke the law when they went beyond advocating dietary changes and administered intravenous treatments to patients, some of whom were terminally ill. In 2016, following a 2-month trial, he was convicted of two counts of practicing medicine without a license. During the trial, Deputy District Attorney Gina Darvas portrayed Young as a charlatan who preyed on the sick and vulnerable—including dying cancer patients—and duped them with bogus science. A few weeks after the trial ended, Darvas announced that Young would be re-tried on the charges for which the jury was unable to reach a verdict. In 2017, faced with this possibility, Young pleaded guilty to two more counts of practicing medicine without a license. The plea agreement calls for a 44-month sentence, some of which has already been served. [Diehl P. Sentencing delayed for pH Miracle author. San Diego Union-Tribune, May 1, 2017] Young, who for many years has represented himself as “Dr. Young,” has a “Ph.D.” from Clayton College of Natural Health, a non-accredited correspondence school that closed in 2010 after Alabama began requiring that all private, degree granting, schools be accredited by a recognized agency or be a candidate for accreditation. [Barrett S. Clayton College of Natural Health: Be wary of the school and its graduates. Quackwatch, Jan 8, 2015] The central premise of Young’s approach—which lacks scientific support—is that health depends primarily on proper balance between an alkaline and acid cellular environment that can be optimized by dietary modification and taking supplements. [Barrett S. A critical look at “Dr.” Robert Young’s theories and credentials. Quackwatch, May 5, 2017]