People Are Suing Hospitals for Malpractice More Frequently, Report Finds

The pace of malpractice claims against hospitals is picking up, according to a recent report from Aon Risk Solutions and the American Society for Healthcare Risk Management.

Earlier in the decade, growth in the frequency of claims declined for several years in a row, down to a 1.81% increase for incidents occurring in 2006. The pace has now ticked up for the past three years, to 1.95% for incidents occurring last year, the report says.

It estimates the cost of the 44,000-odd claims arising from incidents occurring last year will top $8.6 billion (that covers hospitals only, not physicians or long-term care facilities.) Obstetrics-related claims alone will run an estimated $1.4 billion.

Erik Johnson, health care practice leader for Aon Risk Solutions’ Actuarial and Analytics Practice, tells the Health Blog it’s not clear why the frequency of claims against hospitals is edging up. Possibilities include a weakening of tort reforms in some states and the recession — he says hard times may make people more likely to file a claim.

Health-care overhaul legislation didn’t affect the forecast, Johnson says. While hospitals may be focused on how that law will impact their business, “they should focus at least one eye on this [liability] expense,” he says.

It’s also possible that as community hospitals increasingly employ physicians, some liability costs may be shifting from doctors to hospitals, he says.

The average loss per claim (including expenses) is rising at a steady 4% annual rate, the report says. It’s expected to be $153,000 for incidents that occurred last year. That stat covers only losses up to $2 million, which is to limit the influence of rare large awards and also to reflect the expenses likely to be borne directly by the hospital — Johnson says most hospitals have a significant deductible and that insurance doesn’t kick in until a payout hits a certain amount.

A full 23% of hospital professional liability costs are associated with health-care acquired infections, health-care acquired injuries, medication errors, objects left in surgery and pressure ulcers, the report says.

Further reading:

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FDA Sniffing Around Pfizer’s Doggy Weight-Loss Drug Slentrol

Not only have we in the U.S. made ourselves fat, we’ve dragged our dogs along with us. Hence, Slentrol, Pfizer’s FDA-approved drug to help pudgy pugs lose a neck roll or three.

But the FDA says a preliminary analysis suggests a “potential correlation” between the breed of the dog and certain side effects of the drug, Dow Jones Newswires reports, citing an agency document. The FDA is planning to study genetic data on dogs that have taken Slentrol to see if certain breeds are more susceptible to problems. It didn’t specify which adverse events it’s tracking.

Pfizer disagrees with this plan, DJN reports. The company says side effects listed on the label, including vomiting, diarrhea and lethargy, are usually mild, and that specific breeds don’t seem to be disproportionately affected.

The breeds most commonly associated with adverse events with Slentrol — Labrador retriever, beagle, golden retriever, dachshund, pug and Chihuahua — are also very common, and some are predisposed to obesity, Pfizer says.

Meantime, there’s been lots of action on the diet-drugs-for-humans front. Last week Abbott pulled Meridia from the market at the FDA’s behest, on concerns of cardiovascular side effects. Three experimental drugs are up for FDA consideration; an advisory panel has voted not to recommend two of them, Arena’s lorcaserin and Vivus’s Qnexa. Orexigen’s Contrave comes before the panel late this year. (The FDA doesn’t have to follow the advice of its advisory panel, though it often does.)

Humans on the hunt for new options shouldn’t steal Fido’s Slentrol, however. The FDA has said that Pfizer tested the drug in a small number of people and it produced swollen abdomens, stomach pain, diarrhea, flatulence, nausea and vomiting.

Further reading:

Photo by dboy via Flickr

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XMRV On Everyone’s Mind at a Chronic Fatigue Syndrome Meeting

The Chronic Fatigue Syndrome Advisory Committee — which advises the head of HHS on policy and scientific issues related to CFS — just wrapped up its latest meeting. During three days of presentations and debate (you can watch it all here), it was hard to avoid talking or thinking about XMRV.

That?s the retrovirus that was linked to CFS in a study published last year in the journal Science. Scientists have been debating the finding ever since, with some labs finding the virus in a majority of CFS patients and other labs not finding XMRV in a single case.

At the meeting’s public comment period, CFS patients pressed for more funding to study XMRV and to launch clinical trials. Many of the patients wore shirts with “NIH: What have you done for ME/CFS today?” emblazoned on the front. And some held up “Act Now” placards. (”ME” refers to myalgic encephalomyelitis/encephalopathy, another term used to describe the condition.)

For the first time, an extra day was added to the advisory committee meeting to focus solely on scientific developments; XMRV got prominent billing. In its final recommendations to HHS, the committee called for the creation of a national clinical trials network. “When [the science behind] XMRV gets sorted out, we?ll be ready to jump,” advisory committee member Nancy Klimas, a University of Miami professor who runs a CFS clinic and researches the condition, tells the Health Blog.

The idea, Klimas says, is to set up a network of at least five centers to serve as a kind of hub for research, clinical care and education. Doctors would start collecting standardized clinical and research data from patients at the sites, and teams of investigators would work together to develop common clinical trial protocols to start pushing drug development for CFS.

Yet a number of scientists at the meeting expressed caution about XMRV. Stuart LeGrice, who has helped lead XMRV efforts at NCI, gave the scientific talk on the virus and urged patients to wait until more is known before taking anti-retroviral medications. (Some are already taking the meds, as the WSJ reported recently.) “We?re not far from a controlled clinical trial,” he told participants during a Q&A session.

And while XMRV is a hot topic, Christopher Snell, the chair of the advisory committee, said at the meeting that research on XMRV has “overshadowed” other possible CFS research avenues. Klimas tells the Health Blog that research in CFS is finally yielding a number of possible therapeutic strategies that spring from other hypotheses unrelated to XMRV.

However, for patients like Robert Miller — who testified at the meeting — it’s clear what’s providing the momentum in CFS research. “This all started because of XMRV,” he said.

Image: iStockphoto

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CVS Will Pay $75 Million After ‘Smurfers’ Bought Meth Ingredients

If you’d been in a CVS in Los Angeles during 2008, you might have witnessed people coming into the store and clearing the store’s shelves of cough and cold medicines. It also might have occurred to you that they weren’t just facing a bad case of the sniffles.

According to federal prosecutors in L.A., those folks were “smurfing”: making “multiple purchases of pseudoephedrine in small amounts with the intent to aggregate the purchases for use in the illegal production of methamphetamine.” And CVS became smurfing central as those folks discovered that those stores, “unlike other large chain retail pharmacies, allowed customers to make repeated purchases of pseudoephedrine that exceeded federal daily and monthly sales limits,” the U.S. Attorney’s Office for the Central District of California says.

That big whoopsy-daisy is costing CVS $75 million in civil fines (and the estimated $2.6 million it made on the medications).

As the Associated Press reports, CVS was supposed to be monitoring and limiting how much pseudoephedrine its customers purchased. It had an automated “Meth Tracker” electronic logbook to record purchases, but did nothing to stop the smurfers (we can’t stop saying that word!) from making multiple purchases in a day.

CVS Caremark CEO Thomas Ryan said that the chain violated its own policies. “To make certain this kind of lapse never takes place again, we have strengthened our internal controls and compliance measures and made substantial investments to improve our handling and monitoring of [pseudoephedrine] by implementing enhanced technology and making other improvements in our stores and distribution centers,” he said in a statement.

The AP says CVS declined to comment on the government’s allegation that the company failed to follow up on reports from employees and store managers about the repeat purchases.

Prosecutors say the violations occurred in Nevada and elsewhere, too; this settlement covers liability in 25 states. As part of the deal, the government won’t seek criminal charges against CVS.

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Before You Increase That Dose, Check Past Use: Medco Study

Before upping the dose of an antidepressant, doctors may want to ask how often patients actually take their current prescriptions.

That?s the suggestion of a new study from big pharmacy-benefit manager Medco Health Solutions, presented Thursday at an American Psychiatric Association meeting. Researchers from the company’s research affiliate, the Cleveland Clinic and the Scottsdale Center for the Advancement of Neuroscience looked at 53,530 patients in Medco?s prescription database who had gotten their antidepressant doses increased. Then they examined how consistently those people had been taking their earlier, lower dose of the medication in the six months before the boost.

The upshot was that 29.7% of the folks hadn’t been taking their earlier, lower dose regularly. (The study defined “adequate adherence” as filling a prescription often enough to have the pills on hand at least 80% of the time.) Around 7.4% of the patients studied had their earlier dose on hand less than half the time.

David Muzina, national practice leader for neuroscience at Medco, suggests that patients may be suffering from side effects or feel some stigma from being on an antidepressant. They may also simply not see any difference in symptoms if they skip a few doses. Still, he tells the Health Blog, as a psychiatrist he was “flabbergasted” by the number who weren?t taking their meds regularly, since patients are “generally really eager for help and want help” with conditions like depression.

The study also found that 65 or older were generally much more likely to be taking their antidepressants regularly, while those who were 18 or younger were much less reliable. Men were a bit better about taking their drugs than women. And people with more other medical conditions were also more compliant pill-takers. The study tied medication adherence to use of mail-order pharmacy, which PBMs like Medco tend to push over retail pickups. PBMs typically make more money when enrollees use their mail order services.

PBMs are getting increasingly aggressive about research and services that push medication compliance, which isn?t a big surprise because they make money partly based on prescriptions being filled. Their corporate clients are interested in such efforts because research shows that only about half of people who are prescribed drugs for chronic conditions are still taking them regularly after a year, and those dropouts can generate much bigger medical claims down the line.

Further reading:

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Survey: Plenty of Uncertainty on Impact of Health-Care Overhaul

Almost half of private-company CEOs and CTOs surveyed by PricewaterhouseCoopers say health-care overhaul legislation may affect their business financially, while another 31% say it’s too soon to assess the impact.

The uncertainty isn’t totally surprising, since most of the provisions of the bill haven’t kicked in yet. But employers are still sussing out even the provisions that took effect Sept. 23 — or will in the next plan year.

Take the requirement that plans cover dependents until age 26, for example: 28% say they’re not certain of the impact (or didn’t answer the question). Another 29% said it would likely have no impact, and 43% said it would have either a slight or moderate/significant impact.

The executives surveyed said the increase in Medicare tax on high-income individuals would have the biggest financial impact — 31% reported it would have a moderate or significant impact. (Then again, 27% said it would likely have no impact.) The provision getting the greatest proportion of “no impact” votes — 66% –? was the penalty for companies with 50 or more employers that fail to provide minimal affordable coverage.

The new PwC survey covers the views of 224 CEOs and CTOs representing private companies averaging $257 million in annual sales.

Even without knowing the full financial impact of the law, some 70% say they’ll reevaluate their company’s overall benefit strategy and 60% plan to change benefits to comply with the law. More than half — 52% — say they’re likely to change employee contributions for medical coverage. That’s not too far off from a recent National Business Group on Health survey reporting 63% of big employers plan to increase the proportion of premiums paid by workers.

Further reading:

View the original article here

XMRV On Everyone’s Mind at a Chronic Fatigue Syndrome Meeting

The Chronic Fatigue Syndrome Advisory Committee — which advises the head of HHS on policy and scientific issues related to CFS — just wrapped up its latest meeting. During three days of presentations and debate (you can watch it all here), it was hard to avoid talking or thinking about XMRV.

That?s the retrovirus that was linked to CFS in a study published last year in the journal Science. Scientists have been debating the finding ever since, with some labs finding the virus in a majority of CFS patients and other labs not finding XMRV in a single case.

At the meeting’s public comment period, CFS patients pressed for more funding to study XMRV and to launch clinical trials. Many of the patients wore shirts with “NIH: What have you done for ME/CFS today?” emblazoned on the front. And some held up “Act Now” placards. (”ME” refers to myalgic encephalomyelitis/encephalopathy, another term used to describe the condition.)

For the first time, an extra day was added to the advisory committee meeting to focus solely on scientific developments; XMRV got prominent billing. In its final recommendations to HHS, the committee called for the creation of a national clinical trials network. “When [the science behind] XMRV gets sorted out, we?ll be ready to jump,” advisory committee member Nancy Klimas, a University of Miami professor who runs a CFS clinic and researches the condition, tells the Health Blog.

The idea, Klimas says, is to set up a network of at least five centers to serve as a kind of hub for research, clinical care and education. Doctors would start collecting standardized clinical and research data from patients at the sites, and teams of investigators would work together to develop common clinical trial protocols to start pushing drug development for CFS.

Yet a number of scientists at the meeting expressed caution about XMRV. Stuart LeGrice, who has helped lead XMRV efforts at NCI, gave the scientific talk on the virus and urged patients to wait until more is known before taking anti-retroviral medications. (Some are already taking the meds, as the WSJ reported recently.) “We?re not far from a controlled clinical trial,” he told participants during a Q&A session.

And while XMRV is a hot topic, Christopher Snell, the chair of the advisory committee, said at the meeting that research on XMRV has “overshadowed” other possible CFS research avenues. Klimas tells the Health Blog that research in CFS is finally yielding a number of possible therapeutic strategies that spring from other hypotheses unrelated to XMRV.

However, for patients like Robert Miller — who testified at the meeting — it’s clear what’s providing the momentum in CFS research. “This all started because of XMRV,” he said.

Image: iStockphoto

View the original article here