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The Researching Paralegal

Category Archives: Health Reform

Could Lawyers Fix The Rising Cost of Medicine?

01 Thursday Oct 2015

Posted by Celia C. Elwell, RP in Drug Promotion, Government, Health Law, Health Reform, Intellectual Property, Patent Law, U.S. Department of Health and Human Services

≈ Comments Off on Could Lawyers Fix The Rising Cost of Medicine?

Tags

Cancer, FDA, Litigation & Trial, Max Kennerly, Medicaid, Medicare, Pfizer, Prescription Drugs, RICO, Schering–Plough

Send In The Lawyers: A Partial Fix For America’s Dystopian Prescription Drug Market, by Max Kennerly, Esq., Litigation & Trial Blog

http://tinyurl.com/nb82ky8

It’s hard to read any news about prescription drugs these days without wondering if you’ve somehow fallen into a Philip K. Dick novel. Just look at some of these titles over the past week:

  • ‘2 new studies show the FDA is rushing more drugs to market based on shoddy evidence’
  • ‘The True Cost of an Expensive Medication’
  • ‘U.S. drug company sues Canada for trying to lower cost of $700K-a-year drug’
  • ‘Outrage could lead to lowering price of high-cost drugs’

All of these stories are about different drugs, but the common theme among all of the stories is, of course, money. The Mayo Clinical Proceedings recently found ‘In the United States, the average price of cancer drugs for about a year of therapy increased from $5000 to $10,000 before 2000 to more than $100,000 by 2012, while the average household income has decreased by about 8% in the past decade. Further, although 85% of cancer basic research is funded through taxpayers’ money, Americans with cancer pay 50% to 100% more for the same patented drug than patients in other countries.’ . . .

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Kentucky’s Bill To Prevent “Frivolous” Nursing Home And Other Medical Abuse Claims, But Is That The Problem?

21 Saturday Mar 2015

Posted by Celia C. Elwell, RP in Elder Abuse, Elder Law, Health Law, Health Reform, Litigation, Medical Malpractice, Negligence, Nursing Home Abuse, Personal Injury, Skilled Nursing Facilities, Wrongful Death

≈ Comments Off on Kentucky’s Bill To Prevent “Frivolous” Nursing Home And Other Medical Abuse Claims, But Is That The Problem?

Tags

Elder Abuse, Frivolous Litigation, Health Care Provider, Kentucky, Medical Malpractice, Nursing Homes

Senate OKs Bill For Review Panels In Medical Lawsuits After Lively Debate Between Doctors, Lawyers, Others, by Melissa Patrick, Kentucky Health News

http://kyhealthnews.blogspot.com/2015/02/senate-committee-oks-bill-for-review.html

The Senate has approved a bill that advocates say will help weed out ‘frivolous’ medical malpractice lawsuits and speed up litigation for legitimate suits.

‘Right now, Kentucky has one of the nations most litigation-friendly environments, making our commonwealth a prime and profitable target for personal injury lawyers preying upon our health care providers,’ Sen. Ralph Alvarado, R-Winchester, a physician and sponsor of Senate Bill 6, told the Senate Health and Welfare Committee. Opponents disputed that claim.

The Senate passed the bill Thursday 24-12. It is not expected to pass the House.

The bill would establish panels of three medical experts, two chosen by each side and the third chosen by the other two, to review suits against health-care providers to determine if the case has merit before the lawsuit can proceed. Panel findings would be admissible in court but not legally binding.

The Republican-controlled Senate passed a very similar bill last year but it got nowhere in the Democrat-controlled House, and its prospects are similar this time. However, Wednesday’s committee meeting provided a detailed and lively explication of the issue, lasing almost two hours.

Vanessa Cantley, a Louisville personal injury attorney, told the committee that most medical malpractice cases are legitimate. She cited a Harvard University study published in the New England Journal of Medicine that concluded ‘portraits of a malpractice system that is stricken with frivolous litigation are overblown’ and reported that 97 percent of claims for medical injury evaluated over a decade were deemed to be meritorious.

However, Michael Sutton of Louisville, a civil defense attorney, said defendants win 80 per cent of medical malpractice suits.

Cantley said there are 2,700 deaths in Kentucky each year due to purely preventable medical error, but, according to the state Department of Insurance, fewer than 500 lawsuits a year are filed by abuse and neglect victims. . . .

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Insurers Using Generic Drugs To Shift Costs To Sick?

17 Wednesday Sep 2014

Posted by Celia C. Elwell, RP in Affordable Care Act, Drug Promotion, Health Care Benefits, Health Law, Health Reform

≈ Comments Off on Insurers Using Generic Drugs To Shift Costs To Sick?

Tags

Affordable Care Act, Charles Ornstein, Co-Payments, Generic Drugs, Health Insurance, Insurers, Pre-Existing Conditions, ProPublica

A New Way Insurers are Shifting Costs to the Sick, by Charles Ornstein, ProPublica (This story was co-published with The New York Times’ The Upshot.)

http://tinyurl.com/kaaelvg

By charging higher prices for generic drugs that treat certain illness, health insurers may be violating the spirit of the Affordable Care Act, which bans discrimination against those with pre-existing conditions.

Health insurance companies are no longer allowed to turn away patients because of their pre-existing conditions or charge them more because of those conditions. But some health policy experts say insurers may be doing so in a more subtle way: by forcing people with a variety of illnesses — including Parkinson’s disease, diabetes and epilepsy — to pay more for their drugs.

Insurers have long tried to steer their members away from more expensive brand name drugs, labeling them as ‘non-preferred’ and charging higher co-payments. But according to an editorial published Wednesday in the American Journal of Managed Care, several prominent health plans have taken it a step further, applying that same concept even to generic drugs.

The Affordable Care Act bans insurance companies from discriminating against patients with health problems, but that hasn’t stopped them from seeking new and creative ways to shift costs to consumers. In the process, the plans effectively may be rendering a variety of ailments ‘non-preferred,’ according to the editorial.

‘It is sometimes argued that patients should have ‘skin in the game’ to motivate them to become more prudent consumers,’ the editorial says. ‘One must ask, however, what sort of consumer behavior is encouraged when all generic medicines for particular diseases are ‘non-preferred’ and subject to higher co-pays.’ . . .

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Will Insurers Win Battle Against Rising Cancer Treatment Costs?

17 Tuesday Jun 2014

Posted by Celia C. Elwell, RP in Drug Promotion, Health Law, Health Reform, Insurance Coverage, Insurance Law

≈ Comments Off on Will Insurers Win Battle Against Rising Cancer Treatment Costs?

Tags

Cancer, Chemotherapy, Drug Prices, Health Plans, Highmark, Insurers, Oncologists, Outpatient

Insurers Take Up Fight Against Rising Chemotherapy Costs, by Julie Appleby, Kaiser Health News 

http://tinyurl.com/no6clm6

Some cancer patients and their insurers are seeing their bills for chemotherapy jump sharply, reflecting increased drug prices and hospitals’ push to buy oncologists’ practices and then bill at higher rates.

Patients say, ‘I’ve been treated with Herceptin for breast cancer for several years and it was always $5,000 for the drug and suddenly it’s $16,000 — and I was in the same room with the same doctor same nurse and the same length of time,’ said Dr. Donald Fischer, chief medical officer for Highmark, the largest health plan in Pennsylvania.

Like other insurers, Highmark found that when hospital systems bought doctors’ practices, chemotherapy costs rose because physicians’ offices were then deemed ‘hospital outpatient centers’ and could charge more for overhead.

Now insurers are pushing back. In what may be the first move of its kind, Highmark in April stopped paying higher fees for chemotherapy drugs given to patients whose doctors work for hospitals, instead paying the same price they would have had the doctor remained independent. . . .

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Must Health Plans Cover Costs of Suicide?

18 Tuesday Feb 2014

Posted by Celia C. Elwell, RP in Health Law, Health Reform

≈ Comments Off on Must Health Plans Cover Costs of Suicide?

Tags

Ann Doucette, Attempted Suicide, Bi-Polar Disorder, Employees, Health Insurance, Health Insurance Portability and Accountability Act, Health Plans, Medical Costs, Sara Rosenbaum, Source-Of-Injury Exclusions, Suicide

Despite Law, Health Plans Refuse Medical Claims Related To Suicide, by Michelle Andrews, NPR Health News

http://tinyurl.com/lxowwyu

Dealing with the aftermath of a suicide or attempted suicide is stressful enough. But some health plans make a harrowing experience worse by refusing to cover medical costs for injuries that are related to suicide, even though the federal health law doesn’t allow such exclusions, legal and government analysts say.

Yet patients or their loved ones often don’t realize that.

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Why Doctors Stay Silent When They See Mistakes Made By Other Doctors.

04 Tuesday Feb 2014

Posted by Celia C. Elwell, RP in Health Law, Health Reform, Medical Malpractice

≈ Comments Off on Why Doctors Stay Silent When They See Mistakes Made By Other Doctors.

Tags

Cleanup Surgery, Code of Silence, Doctor, Dr. Brant Mittler, Dr. David Mayer, Dr. Thomas Gallagher, Marshall Allen, Medical Error, Physician, ProPublica, ProPublica Patient Harm Questionnaire, Surgeon, Surgical Mistakes, The New England Journal of Medicine

Why Doctors Stay Mum About Mistakes Their Colleagues Make, by Marshall Allen, ProPublica

http://tinyurl.com/q2tknhf

A video discussion about why doctors stay silent about this problem is at the end of this post. -CCE

Patients don’t always know when their doctor has made a medical error. But other doctors do.

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2014 Employment Law Predictions.

11 Saturday Jan 2014

Posted by Celia C. Elwell, RP in Affirmative Action, Bullying, Criminal History, Employment Law, Gender Discrimination, Health Care Benefits, Health Reform, Internships, Medical Marijuana, Minimum Wage, Pregnancy Discrimination

≈ Comments Off on 2014 Employment Law Predictions.

Tags

Arbitration Fairness Act, Background Checks, Donna Ballman, Employment Law, Family Act, Health Care, Internships, Legalized Marijuana, Minimum Wage, Pregnancy Discrimination, Screw You Guys I’m Going Home Blog

Donna’s Employment Law Predictions for 2014, by Donna Ballman, Screw You Guys, I’m Going Home Blog

http://tinyurl.com/mqokell

Minimum wage, legalized marijuana, health care, internships, background checks, pregnancy discrimination, and more. -CCE

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A Tool to Find Drug Companies’ Payments to Doctors For Drug Promotion.

29 Sunday Dec 2013

Posted by Celia C. Elwell, RP in Drug Promotion, Evidence, Health Law, Health Reform

≈ Comments Off on A Tool to Find Drug Companies’ Payments to Doctors For Drug Promotion.

Tags

Charles Ornstein, Dan Nguyen, Doctors, Drug Companies, Drug Promotion, Health, Jeremy B. Merrill, Pharmaceutical industry, Physicians, ProPublica, Sisi Wei, Tom Carper, Tracy Weber

Dollars for Docs – How Industry Dollars Reach Your Doctors, by Jeremy B. Merrill, Charles Ornstein, Tracy Weber, Sisi Wei, and Dan Nguyen, ProPublica

http://projects.propublica.org/docdollars/

ProPublica’s website provides a wealth of information about the ways the drug companies use medical institutions and physicians to promote their products. -CCE

Drug companies have long kept secret details of the payments they make to doctors and other health professionals for promoting their drugs. But 15 companies have begun publishing the information, some because of legal settlements. Use this tool to search for payments.

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Open Notes Increases Patients’ Access to Physician’s Notes and Encourages Transparency.

13 Friday Dec 2013

Posted by Celia C. Elwell, RP in Health Law, Health Reform

≈ Comments Off on Open Notes Increases Patients’ Access to Physician’s Notes and Encourages Transparency.

Tags

Beth Israel Deaconess Medical Center, EHR Intelligence, Geisinger Health System, Harvard Medical School, Health Reform, Jan Walker, Jennifer Bresnick, New England Journal of Medicine, Open Notes, Progress Notes

NEJM: Open EHR Notes Have A Bright Future As Acceptance Grows, by Jennifer Bresnick, EHR Intelligence

http://tinyurl.com/lwte3yg

Physicians are beginning to understand and accept the value of allowing patients to see the majority of their health information, says a perspective piece in the New England Journal of Medicine, and have fewer worries about what patients will do with that data as they adjust to a new level of transparency.  After a wildly successful OpenNotes pilot program conducted at Beth Israel Deaconess Medical Center and the Geisinger Health System, the idea of sharing progress notes and other EHR data with patients is becoming more mainstream as patient engagement turns into a key piece of healthcare reform.

*     *     *

In the perspective, Jan Walker, a registered nurse and researcher at Beth Israel Deaconess Medical Center and Harvard Medical School, and colleagues wrote, ‘The knowledge that patients (and often their families) will have access to records affects the intent and sometimes the content of clinical documentation.’

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