Analysis | Why are we paying so much for worthless health care?

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Today’s Edition: Federal health officials are releasing thousands of extra doses of a highly sought-after drug to protect babies against RSV. Pregnant women are still handcuffed while in custody despite many states banning the practice. But first

One way to save more money for cool new medical advances: Stop paying for so many useless things

Medical advances are expensive. Take Vegovi, a very successful anti-obesity remedy that we have learned Last week it can also reduce the risk of heart disease. If only 10 percent of Medicare beneficiaries start taking the drug, taxpayers could be on the hook soon 27 billion dollars a year.

So how can a country afford the latest and greatest medicine? One possibility: Stop paying billions of dollars a year for things that don’t help patients and may even harm them. How many 30 percent from the 3 trillion dollars that we spend on health care annually goes to such low-value care, as I reported in the this story.

Some examples: Doctors continue to prescribe unnecessary opiates or antipsychotics, routinely screen for vitamin D deficiency, and order cancer screening tests late in life when they are unlikely to provide much benefit. Treatments like these increase costs, lead to health complications and hinder the provision of more adequate care.

But the fee-for-service health care system in the United States rewards doctors for providing more care rather than real care, and that has made it difficult to stop such waste. Even when physicians have no financial incentive to order additional tests or services, low-value care is difficult to eradicate.

A recent analysis in Coloradofor example, found that patients and private and public payers in the state spent 134 million dollars on unnecessary care in 2021. And despite more than a decade-long campaign of the so-called Choosing wisely to identify unnecessary services, spending on low-value care barely decreased.

In some places, defensive medicine plays a role, as doctors in hotly contested states order extra lab tests or imaging for fear of malpractice suits. And sometimes, low-value services simply become ingrained in the culture and become almost impossible to eliminate.

Like Mark FendrickDirector University of Michigan Value-Based Insurance Design Center, that said, there is a culture of more is better. And more is better is very difficult to overcome.

Some individual institutions have succeeded in reducing low-value care. Children’s Hospital Colorado reduced the number of abdominal CT scans in children by having surgeons come to the emergency room and help assess how likely they were to have appendicitis. And the safety net health system in Los Angeles, which operates on a fixed budget, managed to eliminate it unnecessary testing before cataract surgery. But these efforts are more the exception than the rule.

Fendrick argued that eliminating low-value services is the only viable way to pay for all the advances in medicine, such as new anti-obesity drugs like Vegovi. A provision in the Affordable Care Act already provides the means for this. Buried deep in the law, Article 4105 (which Fendrick jokes only eight people actually know about) gives Secretary of Health and Human Services authority not to cover any service to which US Preventive Services Task Force assigns a D ratingmeaning it offers little or no benefit and is not recommended.

A few years ago, at the request of then-Democratic leadership, Fendrick calculated that Medicare could save 5 billion dollars over 10 years by not paying for the seven most common D-rated services. And that reflects only the services themselves, not the cascade of unnecessary worry they often cause.

Spoiler alert: Medicare still pays for them.

You can cover insulin. You could buy a lot of obesity drugs, Fendrick told me. That’s not enough for maybe a month of anti-obesity meds, but you know what I mean.

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the key operational programs at KFF an independent source of health policy research, polling and journalism.

Federal regulators are seeking to ease the shortage of RSV therapy for babies

The Centers for Disease Control and Prevention issues more than 77,000 additional doses of a recently approved drug designed to protect babies against respiratory syncytial virus amid a national shortage.

Dose of Sanofi and AstraZenecalong-acting monoclonal antibodies, Bayfortus, are distributed to physicians and hospitals through the Vaccines for Children program and commercial channels. CDC, along with For food and medicinewill continue to be in close contact with manufacturers to ensure the availability of the drug by the end of this year and the beginning of 2024, the agency announced in Statement.

Key context: This is the first RSV season in which Beifortus has been available, but the new tool has been hard to come by, fueling fear and frustration among parents who want to protect their young children from the virus, which is the leading cause of hospitalization among infants in the United States. .

The agency’s announcement comes as RSV level rising suddenly in parts of the country, almost filling hospital emergency departments in Georgia, Texas and some other countries. But based on data so far, experts believe the current RSV season won’t be as severe as last fall, when hospitals were flooded with sick, wheezing children. Mike Stobbe and Kenya Hunter Report Associated Press.

The Department of Health and Social Services is started advisory committee dedicated to the study and treatment of Americans suffering from covid for a long time. Invitations have been sent to prospective members of the commission, which will be made up of independent experts tasked with leading the agency’s investigation into the baffling condition.

HHS Assistant Secretary for Health Rachel Levine:

Many pregnant women report being handcuffed despite the ban

New this is me: At least 37 countries have laws that prohibit or limit the shackling of pregnant women, formerly incarcerated women, and women who have been incarcerated postpartum, but many of these policies do little to monitor compliance or discipline prisons and jails that do not violate the rules, Renuka Raiasam reports for KFF Health News.

Major medical groups widely condemned tying up pregnant women, a practice they consider unethical and unsafe because it increases the risk of falls, complicates medical care and endangers the fetus. Still, advocates say confusion over the law, a lack of sanctions for breaking the law and wide loopholes have allowed pregnant women in custody to continue to be chained, handcuffed or otherwise restrained.

• E.g: It was in Texas 111 instances in which pregnant women reported being restrained last year while in prison, despite a state ban on the practice, he said Texas Commission on Jail Standards the report. In some cases, women were shackled during transport, even though it was then that they were most likely to fall.

It is nearly impossible to get a picture of the prevalence of this practice across the country due to limited data collection and little independent oversight. Strengthening the law will require funding for implementation, such as creating model policies for hospitals and law enforcement personnel, ongoing training, stricter reporting requirements and sanctions for violations, advocates say.

The sudden closure of hospitals means that help is far away for many

Our colleague Scott Wilson took a deep dive into how the sudden closure of an adult-care hospital in one California county exposed the fragility of a system that primarily serves the state’s most vulnerable.

Here’s the video: California’s rural health care system is reeling from a long legacy of the pandemic, a wide swath of unhealthy patients due to higher poverty rates and an imbalance in how the wealthy state focuses its public health resources.

In this case, the disparity comes in the form of often inadequate state insurance reimbursements for rural hospitals, especially community hospitals not affiliated with large health networks, and in medical education opportunities, which are scarce or non-existent in much of the Sierra Nevada and Central Valley. .

Formwork for 106 beds [Madera Community Hospital]that disrupted health services across this region of vast almond groves and grape orchards, is the first of what state lawmakers say could be more rural hospital closures.

In the state with the highest proportion of millionaires in the state, 1 in 5 hospitals they are now at risk of closure, according to a study he published earlier this year California Hospital Association. Many serve the state’s rural strongholds, whose populations are often disproportionately poor and underinsured, and urban neighborhoods such as South-Central Los Angeles.

You can read Scotts full report here.

• In motion: FDA Principal Deputy Commissioner Janet Woodcock he will retire early next year. Having spent nearly four decades in key leadership positions at the federal regulator, her tenure has been marked by significant medical advances and controversies surrounding unproven drugs, Stats John Wilkerson and Ed Silverman the report.
• Rite Aid is being sued to block the Justice Department from proceeding with the lawsuit accusing the bankrupt pharmacy chain of ignoring red flags and illegally filing hundreds of thousands of questionable prescriptions for addictive opioids, Dietrich Knauth reports for Reuters.
• Measles cases and deaths rose at a staggering rate worldwide last year, according to a new report from the CDC and World Health Organization it raises alarm about the widening gap in immunization among children.

Simon Paul, public health officer in Madera, Calif., on how closing the county’s adult care hospital has strained neighboring health systems

Doctors, FDA battle over giving premature babies probiotics (By Liz Ashley White | The Wall Street Journal)

How the Bad River Tribe Flipped the Script on the Native American Opiate Crisis (By Lev Facher | Stat)

Health insurers have been breaking state laws for years (Maya Miller and Robin Fields | ProPublica)

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