By Ted Burnham, NPR News
This story comes from KHN partner ‘s Shots blog.

Drug errors inside hospitals remain a big problem.

By one estimate, 1 in 7 hospitalized patients suffers some form of error in care. Nearly a third of those mistakes are related to drugs. And those mix-ups can lead to longer hospital stays, unnecessary suffering, permanent damage or death.

One way to reduce mistakes is to have doctors enter the prescriptions on a computer instead of with pen and paper. After the switch, hospitals can see error rates drop by a whopping 60 percent.

That’s the result of a study,published today in PLoS Medicine, that tracked medication errors in two Australian hospitals before and after installing electronic prescription systems.

For starters, the old saw about doctors having illegible chicken scratches is for real.

“People can actually read the prescribing orders now,” Johanna Westbrook, director of the Centre for Health Systems and Safety Research at the University of New South Wales and lead author on the study, tells Shots. “You’re not relying on trying to interpret handwriting.”

Incomplete and unclear prescriptions, which numbered in the hundreds during the months before the systems were installed, dropped to single digits at both hospitals.

But the computerized systems do more than eliminate poor penmanship. Even the most legible prescriptions can include miscalculations and oversights. A doctor might get the dose wrong, or choose a drug that interacts harmfully with another medication.

On the other hand, Westbrook says, the design of the software can introduce errors “that would never occur on paper,” like picking the wrong option from a drop-down menu.

In Westbrook’s analysis, software design accounted for 35 percent of the remaining errors after the systems were installed. Most mistakes were minor, and many could be prevented by improving the program — say, by putting the most-used options at the top of each menu.

That means the potential of electronic prescriptions is even greater than the 60 percent error reduction seen in the study. For comparison, Westbrook points to a standardized paper medication chart introduced in Australia in 2006, which she says reduced errors by a paltry 4 percent.

With numbers like these, you’d think hospitals would be rushing to move to digital prescriptions. But an annual survey by the Leapfrog Group, a nonprofit that has established quality and safety standards for health systems, finds only 17 percent of responding hospitals in the U.S. use computerized ordering systems now.

“I think it’s surprising to most people that the vast amount of hospitals are still using pen and paper for prescribing,” says Leapfrog CEO Leah Binder.

Hospitals are reluctant to install the systems, Binder says, because they’re seen as expensive and painful to implement. And hospitals that do make the investment can’t assume they’ll be perfect right out of the box, she says.

Leapfrog requires that hospitals test their systems to see if the pre-programmed rules actually catch harmful mistakes. They feed in fake patients and fake prescription orders — some of which contain fatal errors. Across the board, about one-third of them slip through.

In practice, most of those mistakes would be caught by a doctor, pharmacist or nurse before any harm was done. Binder says the failures in the software underscore the need for continued testing and improvement.

But, she says, there are clear advantages for hospitals that have made the switch. Take Boston’s Brigham & Women’s, which was an early adopter back in 2004. “That’s a safer hospital,” Binder says. “Period.”

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Photo by Sanja Gjenero

Imagine if finding out the cost of a particular treatment or procedure at a doctors’ office was as easy as locating the prices of entrees at a restaurant. The menu might read: school physicals – $40; office visit for a cold – $80; diabetes screening – $200.

But to the dismay of some consumer advocates, this push for health care pricing transparency never made it out of the kitchen.

While a Florida state House committee approved legislation that would expand the state’s requirement that certain providers post the out-of-pocket prices of common health care services, a state Senate committee shot down a similar measure after an aggressive lobbying push by health care provider groups.

Organizations representing the state’s doctors weren’t wild about the idea that certain facilities would have to display bulletin-board sized postings of their prices.

Jeff Scott, general counsel for the Florida Medical Association, said that providers are all for transparency, but they don’t need the government telling them exactly how they should do it.

“Next thing you know they’re going to say it has to be neon or include pictures,” he said.

But providers’ most strenuous objections were to provisions in the legislation that would require providers to disclose prices to out-of-network patients and limit so-called balance billing, which happens in health care settings when providers bill patients the difference between what they charge for a service and what insurers pay it.

Meanwhile, the state already requires urgent care centers to post in their reception area the prices of their 50 most frequently used services, and the posting must be at least 15 square feet.  Physicians are not required to do so, but they must follow the same rules if they post prices voluntarily.

Under the proposed legislation, ambulatory care centers and diagnostic-imaging centers would have had to follow the same rules as urgent care centers, and the original bills also would have expanded the requirement to physicians.

The House committee-approved bill softened this language to maintain the voluntary status quo for doctors. Both bills would have required physicians to provide patients with a written statement of prices at each visit.

Richard Polangin, health care policy coordinator for the Florida Public Interest Research Group, said the legislation would have been a boon for consumers, many of whom are unaware that prices can vary among doctors and facilities.

The bills would “enable persons who must pay for doctor visits, diagnostic images such as CT scans and MRIs, and for care at ambulatory surgery centers, to know the cost in advance,” he said. “The uninsured and persons with insurance deductibles would be able to make more informed health care decisions.”

Insurers and business groups also supported the legislation. And, though the measure’s future is uncertain, at least one person involved in the lobbying effort said work would continue.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

By Judith Graham

Research already demonstrates that physicians are sometimes uncomfortable talking about weight with their obese patients. Now, a new study shows that the doctors’ weight makes a difference too.

Physicians who pack on the pounds discuss weight loss less frequently with obese patients than doctors who have normal body-mass indexes (18 percent versus 30 percent), according to the report published this week in the medical journal Obesity.

And they’re significantly less confident of their ability to provide effective counseling about diet (37 percent vs. 53 percent) or exercise (38 percent vs. 56 percent).

The findings come from an Internet survey of 498 family doctors, internists and general practitioners conducted early last year by researchers at Johns Hopkins Bloomberg School of Public Health.

Two-thirds of the physicians were male, almost three-quarters were at least 40 years old and 53 percent were overweight or obese.

The results matter. More than 66 percent of American adults are overweight or obese and their medical costs total $147 billion. If heavy doctors won’t acknowledge that patients have a problem and offer help, that can be a barrier to effective care, says Sara Bleich, lead author of the new study and an assistant professor of health policy at Johns Hopkins Bloomberg School of Public Health.

A notable finding in the study speaks to the problem: 93 percent of physicians of normal weight said they would be more likely to identify an obese patient when that person was as large or larger than they were. By contrast, this was true of only 7 percent of obese or overweight physicians.

“It seems to be the case that doctors are less likely to diagnose the patient until the patient’s weight meets or exceeds their own,” Bleich says. This could be because physicians’ sense of what’s “normal” changes as they put on pounds and see more excessively heavy patients in their practices, she speculates.

Asked what might explain heavier doctors’ reluctance to discuss weight loss, Bleich says, “It could be that they feel that their advice will not hold a lot of weight with their patients, because they themselves are heavy.”

Overweight and obese physicians expressed greater confidence in prescribing weight loss medications than other doctors, perhaps because they’ve had personal experience with the medications or with the difficulty of behavior change, she observes.

This isn’t the first time that research has shown a link between physicians’ personal characteristics and their willingness to advise patients on lifestyle issues.

“We know that physicians who follow healthy dietary practices themselves are more likely to spend time counseling patients about diet,” says Dr. Robert Kushner, a professor of medicine at Northwestern University Feinberg School of Medicine and clinical director of Northwestern’s Comprehensive Center on Obesity.

Other research has shown that physicians who smoke are less likely to help patients quit tobacco use.

Bleich and her co-authors close their study by suggesting that doctors, who also report high levels of stress, substance abuse and depression, need to be encouraged to take better care of their health, both for their own sake and patients.

Northwestern is one of the few medical schools to incorporate this in its curriculum: Since 2008, it has offered a mandatory six-week course on healthy living.

“Our philosophy is that if doctors understand how to take care of themselves, then they can be a better teacher and guide to their patients,” Kushner says.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

By Merrill Goozner, The Fiscal Times
This story comes from our partner 

Julie Grabow, an oncologist at the Fred Hutchinson Cancer Center in Seattle, recently prescribed an exciting new therapy for a 60-year-old woman with metastatic breast cancer.

Three-and-a-half years into her battle against the disease, the patient had already exhausted three different anti-estrogen therapies, each of which only put a temporary check on the spreading tumors.

The newly prescribed drug, Novartis’ Afinitor, is one of the recently approved targeted therapies that have generated a lot of excitement among cancer patients and oncologists in recent years.

Drugs that target just the cancer cells promise the same or better results as toxic chemotherapy, but with far fewer side effects.

There was a catch, though. Like many of the latest cancer drugs, Novartis is charging exorbitant amounts for the treatment – in this case, $10,000 per month.

That quickly put an end to that possibility for Grabow’s patient. Her monthly co-payment, even after her insurance company agreed to pay its share of the off-label use the drug (the Food and Drug Administration has only approved Afinitor for kidney and pancreatic cancer, not breast cancer), was $2,900.

“She can’t afford this, even though it’s potentially a less toxic and potentially equally effective regimen,” Grabow said. “Chemo will help her, and it’s a reasonable choice. But that choice is 100 percent driven by economics.”

Over the past year, official Washington and candidates on the campaign trail have locked horns over the best way to curb rising health insurance costs. The public has been bombarded with dueling slogans – Republicans vowing to fight the “death panels” and “rationing” of Obamacare while Democrats promise “guaranteed access” and “affordability” with the Affordable Care Act.

But an economic drama that neither side wants to confront is playing itself out in cancer wards and oncologists’ offices across the country.

Unaffordable new drugs, even when they’re covered by insurance, are being rationed by price as patients, doctors and hospital officials struggle with what is likely to be the most pressing problem for the nation’s health care system over the next decade: how to pay for the spectacular rise in the cost of cancer care, especially drugs and diagnostic tests.

“In the real world of private practice where most care is delivered, it would be a mistake to say rising costs haven’t affected care,” said Eric Nadler, a head, neck and lung cancer specialist at Baylor University Medical Center.

The growing cost of cancer care will impose its greatest burden on the nation’s Medicare system, since 55 percent of all cancers are diagnosed in individuals 65 or older.

A recent study by the National Cancer Institute projected the cost of treating the 29 most common cancers in men and women will rise 27 percent by 2020, even though incidence of the disease is going down due to successful public health campaigns like the war on smoking.

The study pointed out that its projections were based on 2006 Medicare claims data, which predated the development of most of the latest targeted therapies.

There’s no doubt that there will be many new therapies for cancer coming to market in the years ahead. The nation’s $150 billion public investment in understanding the biology of cancer – the science side of the War on Cancer launched by President Richard Nixon in 1971 – is beginning to bear fruit.

The pharmaceutical industry, which draws on that publicly funded science to develop drug candidates, now has 887 new cancer drugs in development, over 30 percent of its total portfolio of new drug candidates, according to the Pharmaceutical Research and Manufacturers of America, the industry trade group. That’s up from 646 or 26 percent of the total devoted to cancer in 2006.

The industry is pouring increased research and development resources in cancer therapeutics in hopes that it will replace the revenue being lost from the expiration of patents on blockbusters like Lipitor.

However, since there are fewer cancer patients than there are people with chronic conditions like elevated cholesterol, and many don’t live very long, the prices needed to support the industry’s current size and structure, and profits must be substantially higher.

“They’re trying to maximize profits given their incentives,” said Peter Neumann, director of the Center for the Evaluation of Value and Risk in Health at Tufts Medical Center, which receives funding from the drug industry.

Possible solutions, he said, include letting Medicare set prices based on the medical value of adding extra months to life. That’s a variation on Great Britain’s cost-effectiveness model, which has been roundly condemned by most U.S. politicians and the press.

The other path is to turn to a bundled payment for every for every episode of cancer care and let the health care delivery organizations and private insurers sort it out. (Bundled payments account for all medical services associated with a given episode of care—doctors, nurses, technicians, etc.) That approach, in essence, would force the marketplace to execute the rationing.

“Bundled payment isn’t a panacea, but it does create incentives,” Neumann said. Some private insurers are experimenting with bundled payments for cancer care.

A quick review of the new cancer drugs approved by the Food and Drug Administration last year reveals how fast drug prices are rising.

Most of the older chemotherapy regimens for cancer, some of which have been around since the 1950s, are generic and relatively inexpensive.

But among the six new drugs approved in 2011, the cheapest – Johnson & Johnson’s Zytiga for advanced prostate cancer – cost $44,000 a year. The drug extended life by an average of less than 5 months to 16 months, according to a company spokesperson.

At the high end of the spectrum was Adcetris, a biotech product from Seattle Genetics that treats recurrences of Hodgkin’s lymphoma. A highly curable disease when initially treated in the 8,830 mostly middle-aged patients who get the disease every year, it is usually fatal if a drug-resistant strain emerges later in life.

Adcetris, the first new treatment to come along since 1977, kept the cancer in check for nearly 7 months in the single small trial that led to its quick FDA approval. It’s price tag: $216,000 for a full course of treatment.

Skin cancer specialists had a lot to cheer about in 2011 with two new therapies coming on the market for metastatic melanoma, which is fatal within one year for about 75 percent of the 10,000 people stricken each year.

But Roche/Genentech’s Zelboraf cost $61,400 a year and Bristol-Myers Squibb’s Yervoy, which nearly doubled the one-year survival rate from 25 percent to 46 percent, cost $120,000 for a four-month course of treatment.

“We price our medicines based on a number of factors including the value they deliver to patients and the scientific innovation they represent,” said Sarah Koenig, a spokeswoman for Bristol-Myers. “We have one of the most robust patient assistance programs for cancer patients in the industry.”

Most drug companies have patient assistance programs for poor or struggling patients, but many only come into play if patients are poor or families have exhausted their savings.

And since many of the latest therapies, like the older chemotherapies they are replacing or supplementing, extend life for brief periods of time, patients wind up weighing whether they want to deplete their children’s inheritances for a couple extra months of being very, very sick.

A study released at last June’s annual conference of the American Society of Clinical Oncology, which represents the nation’s 25,000 oncologists, revealed that patients with co-payments over $500 a month were four times more likely to refuse treatment than those whose co-payments were under $100 a month.

“The price of drugs can’t be set so outrageously high,” study author Lee Schwartzberg told Reuters. Schwartzberg is the chief medical officer at Acorn Research, which conducted the study.

“All stake holders have to get together and compromise to translate this great science into great patient care without breaking the bank.

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.

Every week, Kaiser Health News reporter Jessica Marcy selects interesting reading from around the Web.

Washington Monthly: The Yaz Men: Members of FDA panel had industry ties

Last month, the U.S. Food and Drug Administration convened a committee of medical experts to weigh new evidence concerning the potential dangers of drospirenone, a synthetic hormone contained in popular birth control pills including Bayer AG’s Yaz and Yasmin. … the committee concluded by a four-vote margin that the benefits of drugs with drospirenone outweigh the risks.

However, an investigation by the Washington Monthly and the British medical journal BMJ has found that at least four members of the committee have either done work for the drugs’ manufacturers or licensees or received research funding from them.

The FDA made none of those financial ties public. … When asked whether the agency was aware of any financial ties between its advisors and manufacturers or distributors of drospirenone, FDA spokeswoman Morgan Liscinsky said, “No waivers were issued” (Jeanne Lenzer and Keith Epstein, 1/9).

CNN: Doctors Cheated On Exams

For years, doctors around the country taking an exam to become board certified in radiology have cheated by memorizing test questions, creating sophisticated banks of what are known as “recalls,” a CNN investigation has found.

The recall exams are meticulously compiled by radiology residents, who write down the questions after taking the test, in radiology programs around the country, including some of the most prestigious programs in the U.S. …

Dozens of radiology residents interviewed by CNN said that they promised before taking the written test to memorize certain questions and write them down immediately after the test (Scott Zamost, Drew Griffin and Azadeh Ansari, 1/13).

Governing: Why Are Dentists Opposing Expanded Dental Care?

Try finding a dentist in the remotest rural or deepest urban pockets of the land, and for blatantly economic reasons, they just aren’t there. That’s why states are looking to fix the problem by creating a so-called mid-level dental provider.

Much like a nurse practitioner (NP) or physician assistant (PA) is to a doctor, this provider would be educated and licensed to perform basic dental services — routine checkups, cleanings, filling cavities and extracting teeth — under the supervision of a fully trained dentist. …

Yet in much the same way that the American Medical Association fought against the creation of NPs and PAs, the American Dental Association (ADA) and its state chapters are lobbying hard to thwart state legislatures as they work to create this new level of dental care providers (David Levine, January 2012).

American Medical News: Former Drug Reps Eyed to Pitch Physicians on Referrals

The Laser Spine Institute, a Tampa, Fla.-based endoscopic spine ambulatory surgery center with locations in seven cities … is expanding its marketing beyond the public and aiming at physicians in the community who might send them new patients.

To help in the effort, the 25-doctor group is looking to hire four new representatives — called physician liaisons or physician relations associates — who have at least five years’ experience as drug or device-company detailers. …  people in the field say demand is growing for professionals with the ability to call on doctors in person to help drive referral business in profitable areas such as cardiac care, cancer care and orthopedic surgery (Kevin B. O’Reilly, 1/16).

See related Kaiser Health News article: Hospitals Adopt Drug Industry Sales Strategy (Galewitz, 12/13)

Columbia Journalism Review: Medicare Vouchers Explained

In the Republican presidential debate Monday, Mitt Romney came out in favor of a “premium support program, which allows people to buy either current standard Medicare or a private plan.”

He said he supported the proposal made by Wisconsin congressman Paul Ryan … So far, the mainstream media has done little to explain the concepts and terms being tossed around by politicians on all sides.

Campaign Desk sat down with Henry Aaron, a senior fellow at the Brookings Institution, to sort all this out (Trudy Lieberman, 1/18).

Health Affairs: New Federal Policy Initiatives To Boost Health Literacy Can Help The Nation Move Beyond The Cycle Of Costly ‘Crisis Care’

Health systems often function as if all patients have health literacy skills and can be vigilant advocates for themselves. In reality, however, a wide chasm often separates what providers intend to convey in written and oral communication and what patients understand. …

Fortunately, many organizations have already responded to the call to make health literacy a key element of health care improvement. …

The time is right to accelerate our national commitment to providing the American people with clear, understandable, and actionable science-based health information (Howard K. Koh, Donald M. Berwick, Carolyn M. Clancy, Cynthia Baur, Cindy Brach, Linda M. Harris and Eileen G. Zerhusen, 1/18).

This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.