I\u2019m not quite sure where to go with this. Each week I flip through dozens of medical articles in an attempt to find one or two interesting health care developments you may not have read about. This week, I found myself tossing one article after another into a stack I mentally labeled \u201cgreed and its consequences.\u201d<\/p>\n\n\n\n
Now no one, whether person or corporation (rendered equivalent by the Supreme Court), wants to be labeled greedy. Neither is simple greed a criminal offense. In fact, greedy people and corporations are generally adept at morally (or, in the case of health care, scientifically) justifying their actions. A surgeon caught doing unnecessary procedures and a hospital CEO awash in fraudulent billing charges would be shocked and offended if someone accused them of anything as base as greed.<\/p>\n\n\n\n
And yet my Greed Pile continues to grow.<\/p>\n\n\n\n
I was most surprised to learn about the widespread abuses throughout the hospice industry. About 25 years ago when I was doing a lot of geriatric medicine, hospices for patients with terminal illnesses began to open, usually in a converted floor or wing of a not-for-profit hospital owned by a Catholic order of nuns. The family doctor would visit, the patient kept comfortable, sipping soup proffered by an elderly nun, until the end quietly came. No heroics, no last minute saves, just death.<\/p>\n\n\n\n
It may interest you to know that currently half of Medicare patients will die in hospice, and since Medicare picks up most of the hospice bill we\u2019re now talking serious money. Hundreds of hospices are scattered across the US, most operated by large corporations collecting more than $15 billion a year, all in your tax dollars. So what\u2019s the problem? Medicare fraud and abuse. Investigators found that hospices were billing for charges as if they were hospitals, but without supplying hospital services. In fact, much of the care appears to be mediocre. In addition, unlike nursing homes, which are inspected every 15 months or more frequently, hospices can go years without anybody taking a peek.<\/p>\n\n\n\n
Currently all the major hospice chains are undergoing fraud and abuse investigations and the picture being painted is not pretty. In the interim, these same chains have sent their sales force out in droves, trying to get hospitals, physicians, and families to consider hospice for their loved ones. One of the biggest complaints is inappropriate admissions, meaning expensive \u201cterminal care\u201d for the not-particularly-terminal. You can read more about all this here<\/a>.<\/p>\n\n\n\n Everyone\u2019s favorite greedy pair, the pharmaceutical and health insurance industries, are engaged in a major battle these days and unfortunately you, the patient, are the battlefield. Drug prices have become obscenely high. I recently overheard a pharmacist tell a customer that the small tube of ointment she needed was not covered by her plan and would cost $750. Thinking she\u2019d misheard, she kept asking him to repeat it. He was extremely patient, but finally said, \u201cYes, it\u2019s insane. Completely insane.\u201d<\/p>\n\n\n\n How this tube of ointment, a drug that\u2019s been around for almost 30 years, got priced in the stratosphere is an interesting study in simple greed and you can expect more like it.<\/p>\n\n\n\n Here\u2019s how it goes: A group of big-money investors with absolutely no pharmaceutical expertise learns that an older generic drug has gone off the market, either due to lack of sales or because it\u2019s been replaced by better drugs. Now it\u2019s called an \u201corphan drug.\u201d They buy the rights to this drug, and if anyone else is manufacturing it they\u2019ll buy those rights too. Now the orphan is theirs, not unlike orphan girls in Victorian times who were promptly sold into prostitution. The drug is renamed and manufactured\/packaged either here in the US or somewhere overseas. The orphan gets new clothes and a new identity. Its owners hire a sales force and spend a fortune pimping her out. Clearly the biggest savings for investors is that the drug has already been FDA approved. No testing, no expensive clinical trials.<\/p>\n\n\n\n A quick example of this is the migraine drug Midrin, discontinued in 2009 when the FDA classified it as \u201cpossibly effective\u201d and in any case being left in the dust by the triptans (Imitrex, et al.). Midrin went generic and, because it didn\u2019t work particularly well, was very inexpensive. Enter the Big Money Boys. Midrin received a new name, Nodular, marketed as \u201canother migraine choice.\u201d It is quite<\/em> expensive. When I commented to the drug rep that the FDA says it\u2019s not a very good drug, she answered, \u201cWell, some people like it.\u201d<\/p>\n\n\n\n The health insurance companies are pushing back on this greed and denying coverage for expensive drugs like these. But in the process they\u2019ve learned there\u2019s big money to be made by denying prescription drugs. If you\u2019re a regular user of prescription drugs, you\u2019ve likely seen a medication you\u2019ve long taken suddenly being denied, or you\u2019ve been told you must switch to a generic–and not just any generic, but the one that\u2019s listed in your insurance company\u2019s formulary. You might even be forced to use a drug you\u2019ve tried in the past and know doesn\u2019t work. Too bad for you.<\/p>\n\n\n\n Some of these denials are the result of sweetheart deals between drug company and insurance company. The asthma inhaler ADVAIR saw its market share plummet when it couldn\u2019t match the price of its competitor, Symbicort. Most denials involve new drugs. Your insurance company insists your doctor must prescribe two or more drugs of the same class even if your doc knows the drugs won\u2019t work for you\u2026or aren\u2019t even FDA approved for your condition. This is called \u201cfirst fail\u201d and compels patients to take ineffective drugs (and endure side effects) for the sole purpose of enhancing corporate profits.<\/p>\n\n\n\n Hospitals and physicians are right there with the rest when it comes to self-justifying greedy behavior. I\u2019ve already written about the egregious billing techniques of hospitals to cover the multi-million dollar salaries of healthcare \u201cexecutives.\u201d<\/p>\n\n\n\n An all too frequent topic in hospital board rooms is not \u201cHow can we do better?\u201d but rather \u201cHow can we do more\u2026\u201d (cardiac catheterizations, colonoscopies, cataract extractions). \u201cWe need more referrals to cover that new\u2026\u201d (gamma knife, PET scan). \u201cMore patients to fill our new\u201d\u2026.wing, nursing home, and yes, hospice.<\/p>\n\n\n\n As a primary care provider, I\u2019m seeing more and more unnecessary diagnostic and surgical procedures being performed on patients. This has been confirmed by data collection and record review. This article shows<\/a> that 30% of total knee replacements were probably unnecessary. This one discusses<\/a> the booming sleep apnea business. The diagnosis of obstructive sleep apnea can be iffy, and recommendations for a CPAP machine<\/a> or corrective surgery come long before any advice on lifestyle changes (like weight loss or sleeping on your side).<\/p>\n\n\n\n How long before you find yourself wheeled into an operating room if your nasal septum is a bit crooked, you complain of back pain, or you\u2019re constipated?<\/p>\n\n\n\nBig Pharma and health insurers<\/strong><\/h3>\n\n\n\n
Hospitals and doctors too<\/strong><\/h3>\n\n\n\n