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Evidence of payment-influenced prescribing, pain rises with economic insecurity, and house calls bright spot

March 24, 2016

In order to bring you more of the news you want to read, RightCare Weekly summarizes and interprets three important articles and provides headlines linking to the many other articles and editorials you’ll find interesting. As always, RightCare Weekly presents articles related to moving our healthcare system toward the right care for all patients.

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Features:

recent analysis by ProPublica of the relationship between industry payments and brand-name prescribing revealed that “the more money [doctors] receive, on average, the more brand-name medications they prescribe,” reports NPR. Although this concept is nothing new, this report provides the strongest evidence to date. Ryann Grochowski Jones and Charles Ornstein of ProPublica matched payment records from pharmaceutical companies and medical device makers with doctors’ prescribing choices over the course of one year. Within each of the five specialties examined by Jones and Ornstein (family medicine, internal medicine, cardiology, psychiatry, and ophthalmology), a vast majority of providers received industry payments – between 70.4% (internal medicine) and 89.1% (cardiology). And doctors who received payments were, on average, twice as likely to be high brand-name prescribers as compared to those who did not receive payments. The authors point out that they are not making any claims of causality, but rather are simply reporting the correlation. David W. Parke II, MD, chief executive of the American Academy of Ophthalmology, weighed in on these findings: “In some cases, there are very appropriate and clinically valid reasons for doctors who are outliers in their prescribing… For others, education may very easily result in prescribing change leading to substantive savings for patients, employers and society.” Educating providers about costs to their patients is one way to limit unnecessarily high brand-name prescribing. Check out some of our educational programs in the Right Care Tools suite!

 

The Harvard Business Review explores this month the link between income inequality and physical pain. Eileen Y. Chou, Bidham L. Parmar, and Adam D. Galinsky write, “A growing body of evidence suggests that fiscal pain and physical pain are linked and reinforce each other… Analyses of household consumption data, surveys, and controlled experiments demonstrate a causal link between economic insecurity and pain.” This is especially relevant in the context of opioid pain medication overuse and the resulting addiction crisis; since 2000 rate of deaths from opioid overdoses has increased by 200%, according to the CDC. Chou and her coauthors discuss a number of studies they conducted that examine the impact of economic insecurity on pain. One study found that unemployment is positively associated with spending on over-the-counter (OTC) painkillers, and another that unemployment is correlated with a high level of self-reported physical pain. Randomized experiments yielded consistent results: “When people are in a mental state of economic insecurity, regardless of how it was induced, they experience greater physical pain.” Health and social issues are inextricably linked, and if we are to truly offer patients the best care, both must be addressed.

 

Heal, a start-up in Los Angeles, allows patients to request physician house calls through a smartphone app. According to the LATimesHeal’s founder claims that 60 percent of first-time users of the app would have ended up at the ED for care had the physician not showed up at their door. Thomas Cornwell, MD, featured in an article in AAFP News, has been conducting house calls for more than 20 years. In fact, he estimates he has conducted nearly 32,000 visits for more than 4,000 patients. “You just can’t get more patient-centered than when your patients can’t leave the home and you show them so much dignity and respect by bringing wonderful care to them,” he said. Cornwell is on the front lines of reviving this form of primary care and has recently received a grant “to spread this model of care.” You can hear Cornwell at the 4th Annual Lown Institute Conference next month in Chicago, during a panel discussion, “Bright Spots in the Health Care Landscape that Imagine a Better System.” If you haven’t registered yet, please do so here.

 

Announcement:

 

  • Do you want to help build the Right Care Movement? Come to the organizing workshop on Saturday afternoon at our annual conference. Learn about grassroots community organizing from our own Stephanie Aines, network development and organizing manager at Lown, and Mark Dudzic, national coordinator, Labor Campaign for Single Payer. If you haven’t registered for the 4th Annual Lown Conference, April 15-17 at the JW Marriott Chicago, register here!

 

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RightCare Weekly is made possible through the generous support of the Robert Wood Johnson Foundation.

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