The United States now sources 80 percent of its intermediate drug chemicals from overseas, a growing number from China. Chinese companies probably suffer worse quality control problems than most of the large Indian companies—but so far no whistleblowers have emerged. I expect many more Ranbaxy-type problems to crop up in the near future, with the likelihood of serious implications for at least some American patients.
Pharmacists responsible for reviewing the medication of patients in California nursing homes routinely allowed inappropriate and potentially lethal prescriptions of antipsychotic medications, and failed to correct other potentially dangerous drug irregularities, according to recent state investigations.
The report reviews the evidence and potential for use of ’emergency readmissions within 28 days of discharge from hospital’ as an indicator within the NHS Outcomes Framework. It draws on a rapid review of systematic reviews, complemented by a synopsis of work in four countries designed to better understand current patterns of readmissions and the interpretation of observed patterns. Reviewed studies suggest that between 5 percent and 59 percent of readmissions may be avoidable. Studies are highly heterogeneous, but based on the evidence reviewed, about 15 percent up to 20 percent may be considered reasonable although previous authors have advised against producing a benchmark figure for the percentage of readmissions that can be avoided. The majority of published studies focus on clinical factors associated with readmission. Studies are needed of NHS organisational factors which are associated with readmission or might be altered to prevent readmission.
The introduction of new performance indicators always has the potential to produce gaming. Observers from the USA cite experience which suggests hospitals might increase income by admitting less serious cases, thus simultaneously increasing their income and reducing their rate of readmission. There is also the possibility that there may be some shift in coding of admissions between ’emergency’ and ‘elective’ depending on the incentives. If hospitals are performance managed on the basis of readmission rates, it would be reasonable to expect that some behaviour of this type would occur.
U.S. GAO – Medicare Advantage: CMS Should Improve the Accuracy of Risk Score Adjustments for Diagnostic Coding PracticesJanuary 29, 2012
Recommendation: To help ensure appropriate payments to MA plans, the Administrator of CMS should take steps to improve the accuracy of the adjustment made for differences in diagnostic coding practices between MA and Medicare FFS. Such steps could include, for example, accounting for additional beneficiary characteristics, including the most current data available, identifying and accounting for all years of coding differences that could affect the payment year for which an adjustment is made, and incorporating the trend of the impact of coding differences on risk scores.
The general public often has a difficult time understanding earnings of large corporations, especially when those corporations are in the medical field. Our natural inclination between the current economic crisis and the undeniably high health care costs is that insurance companies shouldn’t be making huge profits. And, in many cases they are not. But, that is not what it always looks like on paper.
For a better understanding of what these numbers mean, let’s look at the quarterly earnings reports that were released this week by insurance companies across the country.
It is no secret that medical treatment in the US is expensive and costs are only going up. According to experts nearly one-third of the services are wasteful, providing no patient benefit, and in some cases likely proving harmful. While this is discouraging news, the silver lining is that it is therefore possible to dramatically reduce healthcare spending without any harm to quality and access to care. However, it is incredibly difficult to find consensus on just which procedures are unnecessary, and even harder to then convince providers and patients to abandon those services.
Start with Medicare. The trustees who run the program have been telling us for some time that the current benefit and financing system is unsustainable. Indeed, its 2010 report notes that the Medicare “trust fund” will be exhausted five years sooner than previous estimates.
The passage of “Obamacare” has made this deplorable situation worse. This law does increase various Medicare taxes and includes some cost-containment features. However, as Medicare’s own actuary has pointed out, “Obamacare” uses the savings not to strengthen Medicare but to start another unfunded entitlement. The changes — a $500 billion cut in the program — do nothing to shore up the existing Medicare trust fund.