Waste in Medicare

[Aragorn]

This story from NYT is a good example of how increased costs occur. My question is - is it intentional? In the state I practiced, the company which got the bid to supply Medicaid drugs was run by the biggest contributor to a former governor's campaign. Surely no one thinks that was an accident? Then said firm initiated rules whereby they sold higher-priced brand-name meds in preference to cheaper generics - in my specialty this was almost universal.

http://www.nytimes.com/2009/10/02/business/02avastin.html?hpw

For several years, eye doctors have been using Avastin off-label as a treatment for retinal diseases, particularly age-related macular degeneration, the leading cause of blindness in the elderly.

Avastin is similar in its mechanism of action to Lucentis, a drug approved to treat macular degeneration. Both drugs are made by Genentech, a subsidiary of Roche.

But Lucentis costs about $2,000 per injection — with an injection needed as often as every month. Although Avastin can cost thousands of dollars a month as a cancer treatment, when used in the tiny portions required for eye-disease injections, it costs only about $30 to $50 per shot.

(snip)

But Medicare has now introduced a special reimbursement code just for the smaller doses of Avastin. And starting Thursday, the reimbursement of Avastin dropped to about $7.20 for the dose typically used in the eye.

What this means is doctors can either lose money using the much cheaper drug, or waste taxpayer money but make a profit by using the much more expensive drug. And there can be no argument about off-label use as a factor - after all, Medicare introduced a new reimbursement code. They did not STOP reimbursement.

This is no different from patients who request much more expensive drugs (usually after TV ads) and when confronted with the watse, reply "I don't care, my insurance covers it." Very few change their request even when told that increased costs will lead to higher insurance payments.

I've been thinking about writing a guide for patients about how to avoid this. Anyone thin kit would be helpful in the HC reform thingie?

[NYC_SKP]

1. Medicare recipeints could receive much better care for half the cost if it was run well.

It's a good program in theory, but as the medicine is actually practiced, as the services are actually practiced, it is a costly mess.

Both of my parents are in their eighties. In fact, both are in hospitals right now.

They each have too many doctors who don't communicate, take way too many meds (and incorrectly), and make use of ambulances and ERs far more often than they should.

If they received proper care, if their providers communicated, and if their data was shared efficiently, I dare say they would have cost the system 25% of what this past year has cost the program.

Medicare needs an overhaul.

[rubberducky]

3. I find the same thing with my mom`s care.

Just recently she received 66 ex rays for various "hurts" on just one side of her body in a 5 week period. I took her to the doc just a couple of days ago for a sore back. Doc said she had to have more xrays, I objected on the grounds that my mother would soon start glowing if this continued, so she ordered and MRI instead! Mom was happy with this decision because it seemed to prove to that "something was really wrong with her back", after all doc wouldn`t order and MRI unless it was really necessary would she? Usually by the time the xrays come back whatever was xrayed doesn`t hurt anymore, but something else does. Hardly a week goes by without her having a doc appointment with some kind of doc constantly ordering more tests of some sort. It`s very frustrating.

[Aragorn]

4. nurses laughed

but they were teasing. "You're the only doctor who ever calls other doctors!" Your story is way too frequent. I also did a lot of consults in older (65+) people and reduced their medications as well as improving their health. My main complaint about that was the number of times the doctor who asked for my help went and changed everything back.

Medicare itself is not the problem IMO. The amount of greed and inventiveness of those looking to rake in money is the problem. I include a majority of doctors in this statement.

Medicare itself could use improvement, but it is the drive for profit that is the major problem.

[rubberducky]

5. You are so right.

[sinkingfeeling]

2. My 90 year old mother has been getting Lucentis injections under Medicare Advantage for years.