Original Story: catalyst.phrma.org
New data raises even more questions about how hospitals are using for-profit pharmacies to expand a little known program called 340B. This program was designed to allow qualifying hospitals and clinics receiving certain federal grants to access deeply discounted pharmaceuticals so they can more easily provide medicines for their uninsured or vulnerable patients. An Oklahoma health care lawyer is reviewing the details of this case.
Unfortunately, there are not sufficient safeguards in place to ensure that hospitals qualifying for the program are true safety net hospitals providing a disproportionate share of charity care to low-income, uninsured patients.[1]
Now, new data shows the majority of hospitals that are aggressively expanding use of this program through for-profit pharmacies are actually providing below average levels of charity care.
For-profit pharmacies became officially involved in the 340B program for the first time in 1996, when the Health Resources and Services Administration (HRSA) allowed hospitals or other 340B entities without an in-house pharmacy to extend their ability to obtain prescriptions at 340B prices through use of a contract with an outside pharmacy. A Charleston health care lawyer assists clients with health care matters involving pharmaceuticals, public health, and health insurance.
These pharmacies are typically traditional retail pharmacies (including some large chain drug stores) and are known as contract pharmacies. In 2010, HRSA dramatically expanded the 340B program by allowing all 340B entities – regardless of whether or not they had a pharmacy on site – to have an unlimited number of contract pharmacies. HRSA also currently allows these pharmacies and hospitals to keep the profit from patients buying medicines at full cost even though the hospitals received steep 340B discounts for the medicines. There is no current requirement for hospitals to reinvest these profits from the 340B program into programs that help uninsured or vulnerable patients access the medicines they need.
Hospitals qualifying for 340B through their disproportionate share percentage (DSH hospitals) account for more than 80 percent of 340B sales volume.[2] This new data shows the majority of these hospitals taking advantage of the contract pharmacy program provide less charity care as a percent of the hospital’s costs than the average for all hospitals—including for-profit hospitals. A New Delhi pharmaceutical attorney is following this story closely.
More specifically, 61 percent of 340B DSH hospitals with more than one contract pharmacy provide charity care that is less than 3.5 percent of costs, which is the national average for all hospitals. And almost one-in-five (18 percent) of these hospitals provide charity care that represents less than one percent of costs. This data suggests that some hospitals may be using contract pharmacy arrangements to benefit the hospital, rather than the uninsured or vulnerable patients the program was intended to help.
In addition to this data, a recent Department of Health and Human Services Office of the Inspector General report found most of the 15 DSH hospitals they sampled did not pass along the 340B discounts to uninsured patients.[3] With the majority of these hospitals providing so little charity care and evidence suggesting hospitals and for-profit pharmacies are using the program to generate profits, it is time to ask whether the current contract pharmacy program is working to improve access to prescription medicines for uninsured or vulnerable patients.
[1] Alliance for Integrity and Reform of 340B, "Unfulfilled Expectations: An analysis of charity care provided by 340B hospitals," Spring 2014 (Available at: http://340breform.org/userfiles/Final%20AIR%20340B%20Charity%20Care%20Paper.pdf)
[2] Data from Apexus Update 2015 – 340B Coalition Winter Meeting.
[3] U.S. Department of Health and Human Services, Office of Inspector General, Memorandum Report: Contract Pharmacy Arrangements in the 340B Program, OEI005—13-00431, February 4, 2014.
Showing posts with label uninsured patients. Show all posts
Showing posts with label uninsured patients. Show all posts
30 July 2015
18 April 2012
Community Health Centers Offer Differing Levels of Care
Story first appeared in USA Today.
At Oakhurst Medical Center in Stone Mountain, GA, just 20% of children have received all their recommended immunizations by age 2.
Adults don't fare much better at this community health center, which provides primary care to 14,000 mostly poor people in a town famous for its granite monolith and "Confederate Mount Rushmore," just east of Atlanta.
Fewer than half of its diabetics and a little more than a third of those with high blood pressure had their conditions under control in 2010 — far below national averages for the U.S. population, according to a Kaiser Health News-USA TODAY analysis of the latest federal data.
But 65 miles east of here in Greensboro in rural central Georgia, it's a different story. At TenderCare Clinic, almost all children get the appropriate immunizations, and eight out 10 diabetics have normal blood sugar levels.
The marked differences between Oakhurst and TenderCare underscore the wide variability in how well community health centers are caring for millions of people nationwide.
There is tremendous performance variation within community health centers and also tremendous variation among any health providers, hospitals, nursing homes, doctors. That's the American health system.
Lower-performing centers typically have a higher proportion of uninsured patients and more staff turnover. Most also lack electronic record systems, which makes it harder to track patients.
Oakhurst has many of those challenges. It is one of eight community health centers nationwide whose patients fell below the U.S. average for all six quality care indicators in 2010 — diabetes and blood pressure control, cervical cancer screening, childhood vaccinations, timely prenatal care and low birth-weight babies.
The difficulties he faces include high rates of obese patients; many African immigrants are unaccustomed to seeking preventive care such as vaccinations; and 40% of patients don't have health insurance.
Another issue: Patients who don't follow recommendations. A middle-aged patient is a prime example. She has been coming to the Oakhurst clinic for three years and despite her doctor's urgings, she refuses to take blood pressure medicine after having a bad experience with one drug. The drug in question caused her hair to shed, so she stopped taking it. She is on Medicaid like almost half the center's patients.
The center is doing a number of things to boost care. Staff members now routinely ask parents about getting their children immunized, no matter why they came in. The same goes for women who are due for a Pap test. And an electronic health records system is being installed, which will help monitor patients.
But it is an uphill battle. Last year, Oakhurst identified more than 300 patients as high-risk because they are obese, diabetic or have high blood pressure and asked them to enroll in a free nutrition class. Only 18 signed up.
In rural Georgia, some of those same issues bedevil TenderCare — no-show rates top 30% overall and 70% for Medicaid clients because of transportation difficulties.
But TenderCare uses case managers and counselors to make reminder calls, do in-house counseling and troubleshoot other issues that might interfere with patients' care — efforts that have helped the center achieve some of the best quality scores in Georgia.
A medical assistant plays a starring role. Using a phone in a corner of the room reserved for minor surgical procedures, she calls parents who are late bringing in kids for immunizations, women behind on getting their annual Pap tests and the diabetics who have neglected their monthly checkups.
In a nearby office, the Health Education Coordinator intercepts patients after they meet with doctors to advise them about nutrition, set exercise goals and put them through diabetes school.
Still, it's not unusual for patients to tell him they cannot keep appointments because they couldn't pay a family member for a ride.
The center also has trouble finding specialists and hospitals willing to provide surgery to its uninsured patients. While many health centers have trouble finding specialists and hospitals to do surgery on patients without insurance, TenderCare is in a more precarious spot because it is outside the areas covered by Grady Memorial, the large public hospital in Atlanta, and Medical College of Georgia in Athens.
In the past year, an uninsured man waited more than eight months to find a neurosurgeon to operate on a brain tumor. An uninsured woman died of cervical cancer after waiting a year to find a surgeon.
The clinic's remote location also has some pluses, though. As one of the few health providers in town, TenderCare has been able to attract patients with Medicare and private insurance that pay higher rates than Medicaid. That helped the center privately finance a new $3 million building in 2009.
TenderCare is also more advanced than most rural health centers with its computerized pharmacy dispensing system to reduce errors.
Some patients still struggle. A heavyset woman from nearby Eatonville, Ga., is uninsured. On a recent visit her blood sugar was 456, almost three times normal. Her blood pressure is also high, and her vision has started to blur because of her decade-long struggle with diabetes. She can't seem to avoid the sugars and sweets. She attributes her bad decisions to her bad health.
For more healthcare and medical related news, visit the Healthcare and Medical blog.
For national and worldwide related business news, visit the Peak News Room blog.
For local and Michigan business related news, visit the Michigan Business News blog.
For law related news, visit the Nation of Law blog.
For real estate and home related news, visit the Commercial and Residential Real Estate blog.
For technology and electronics related news, visit the Electronics America blog.
For organic SEO and web optimization related news, visit the SEO Done Right blog.
At Oakhurst Medical Center in Stone Mountain, GA, just 20% of children have received all their recommended immunizations by age 2.
Adults don't fare much better at this community health center, which provides primary care to 14,000 mostly poor people in a town famous for its granite monolith and "Confederate Mount Rushmore," just east of Atlanta.
Fewer than half of its diabetics and a little more than a third of those with high blood pressure had their conditions under control in 2010 — far below national averages for the U.S. population, according to a Kaiser Health News-USA TODAY analysis of the latest federal data.
But 65 miles east of here in Greensboro in rural central Georgia, it's a different story. At TenderCare Clinic, almost all children get the appropriate immunizations, and eight out 10 diabetics have normal blood sugar levels.
The marked differences between Oakhurst and TenderCare underscore the wide variability in how well community health centers are caring for millions of people nationwide.
There is tremendous performance variation within community health centers and also tremendous variation among any health providers, hospitals, nursing homes, doctors. That's the American health system.
Lower-performing centers typically have a higher proportion of uninsured patients and more staff turnover. Most also lack electronic record systems, which makes it harder to track patients.
Oakhurst has many of those challenges. It is one of eight community health centers nationwide whose patients fell below the U.S. average for all six quality care indicators in 2010 — diabetes and blood pressure control, cervical cancer screening, childhood vaccinations, timely prenatal care and low birth-weight babies.
The difficulties he faces include high rates of obese patients; many African immigrants are unaccustomed to seeking preventive care such as vaccinations; and 40% of patients don't have health insurance.
Another issue: Patients who don't follow recommendations. A middle-aged patient is a prime example. She has been coming to the Oakhurst clinic for three years and despite her doctor's urgings, she refuses to take blood pressure medicine after having a bad experience with one drug. The drug in question caused her hair to shed, so she stopped taking it. She is on Medicaid like almost half the center's patients.
The center is doing a number of things to boost care. Staff members now routinely ask parents about getting their children immunized, no matter why they came in. The same goes for women who are due for a Pap test. And an electronic health records system is being installed, which will help monitor patients.
But it is an uphill battle. Last year, Oakhurst identified more than 300 patients as high-risk because they are obese, diabetic or have high blood pressure and asked them to enroll in a free nutrition class. Only 18 signed up.
In rural Georgia, some of those same issues bedevil TenderCare — no-show rates top 30% overall and 70% for Medicaid clients because of transportation difficulties.
But TenderCare uses case managers and counselors to make reminder calls, do in-house counseling and troubleshoot other issues that might interfere with patients' care — efforts that have helped the center achieve some of the best quality scores in Georgia.
A medical assistant plays a starring role. Using a phone in a corner of the room reserved for minor surgical procedures, she calls parents who are late bringing in kids for immunizations, women behind on getting their annual Pap tests and the diabetics who have neglected their monthly checkups.
In a nearby office, the Health Education Coordinator intercepts patients after they meet with doctors to advise them about nutrition, set exercise goals and put them through diabetes school.
Still, it's not unusual for patients to tell him they cannot keep appointments because they couldn't pay a family member for a ride.
The center also has trouble finding specialists and hospitals willing to provide surgery to its uninsured patients. While many health centers have trouble finding specialists and hospitals to do surgery on patients without insurance, TenderCare is in a more precarious spot because it is outside the areas covered by Grady Memorial, the large public hospital in Atlanta, and Medical College of Georgia in Athens.
In the past year, an uninsured man waited more than eight months to find a neurosurgeon to operate on a brain tumor. An uninsured woman died of cervical cancer after waiting a year to find a surgeon.
The clinic's remote location also has some pluses, though. As one of the few health providers in town, TenderCare has been able to attract patients with Medicare and private insurance that pay higher rates than Medicaid. That helped the center privately finance a new $3 million building in 2009.
TenderCare is also more advanced than most rural health centers with its computerized pharmacy dispensing system to reduce errors.
Some patients still struggle. A heavyset woman from nearby Eatonville, Ga., is uninsured. On a recent visit her blood sugar was 456, almost three times normal. Her blood pressure is also high, and her vision has started to blur because of her decade-long struggle with diabetes. She can't seem to avoid the sugars and sweets. She attributes her bad decisions to her bad health.
For more healthcare and medical related news, visit the Healthcare and Medical blog.
For national and worldwide related business news, visit the Peak News Room blog.
For local and Michigan business related news, visit the Michigan Business News blog.
For law related news, visit the Nation of Law blog.
For real estate and home related news, visit the Commercial and Residential Real Estate blog.
For technology and electronics related news, visit the Electronics America blog.
For organic SEO and web optimization related news, visit the SEO Done Right blog.
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