5 Things That Happened in Health Policy This Week is produced by a mix of research assistants from the Healthcare Quality & Outcomes (HQO) Initiative at the Harvard T.H. Chan School of Public Health. In each edition we feature a variety of news articles, reports, and studies focused on U.S. health policy and health services research.
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Chicago may be on its way to require licensing of pharmaceutical sales reps, as an effort to fight opioid addiction, the Chicago Tribune reports. The city expects to introduce an ordinance in the next month requiring reps to track who they meet with, what drugs were promoted, samples provided, among other things. As part of the licensing process, reps would also receive training on prescription drug abuse.
The big picture: Nationally, over 14,000 people are dying annually from prescription opioid overdose. Daily, emergency departments treat over 1,000 people for prescription opioid abuse. Last year, 403 people died from accidental opioid overdoses in Chicago. This places opioid overdose not far behind homicide as a cause of death in Chicago.
So now what? If enacted, the ordinance would help better track the flow of prescription opioids within Chicago. The new data could help identify to what extent unethical marketing practices by drugmakers are influencing opioid prescription habits among physicians.
What does this mean? If this measure is successfully implemented in Chicago, and new insights are drawn from the data, the ordinance could become an example for other states seeking new solutions to the opioid crisis. While some cities like Washington D.C. already have licensing requirements for pharmaceutical reps, Jesse Witten, a partner at the law farm Drinker Biddle & Reath notes that many drugmakers don’t do enough business in D.C. to make it worth the licensing fee of $175 per rep.
ON MEDICAID EXPANSION…
A new perspective out this week in NEJM finds that two years after Oregon’s experimental Medicaid expansion, rates of ED utilization remain higher for those who received Medicaid coverage than for those who did not, and have not declined meaningfully since the first year of expansion.
Reminder: A previous study of the Oregon Health Insurance Experiment found that while there was a decrease in depression diagnoses and reported rates of financial burden amongst those who received Medicaid coverage, there were no measurable changes in clinical outcomes, and ED utilization increased by 40%.
So now what? Some experts thought that this increase in ED utilization could have come from pent up need and would decrease over time, but these new results from Finkelstein et al. show that increased utilization continued even two years into expansion.
What does this mean? Supporters of insurance expansion often argue that increased access to healthcare will increase use of preventive care and primary care, thus altering utilization patterns and ultimately preventing hospitalizations and ED use, however this new data suggests otherwise. This could have implications for policymakers’ decisions around key provisions of the ACA, particularly Medicaid expansion.
ON ACCESS TO CONTRACEPTION…
In attempts to prevent unintended pregnancies, states are providing Medicaid reimbursement to hospitals for the insertion of long-acting reversible contraception (LARC) in the delivery room, immediately after a woman gives birth. Kaiser Health News reports here.
The big picture: So far, 20 states plus DC are promoting the option following urges from CMS this spring to adopt the reimbursement policy. However, lack of training for insertion of IUDs and general resources for making this a broadly adopted practice will be stumbling block.
Who benefits? Immediate postpartum insertion of an IUD is cost-effective for low-income patients, who might not have access to this method of contraception otherwise. Further, since doctors advise spacing pregnancies at least 18 months apart, this practice not only would prevent unintended pregnancies, but might also help keep women healthier in future, planned pregnancies.
Want more? Info on this from the American Congress of Obstetrics and Gynecology is here. An empirical study on how this practice has played out in Massachusetts is here.
ON DRUG PRICES…
This piece in Marketplace reports back on the newly released Bureau of Labor Statistics, which confirms that prescription drug prices are historically high. In fact, prices are up 7 percent since last year, the biggest increase since 1992 (and since I was born).
Catch me up. Unruly drug prices have been getting a lot of attention since Congress found out that EpiPen company Mylan has raised its prices. And before that, Gilead, producer of hepatitis C and HIV drugs, was in the hotspot.
Tell me though…why? Yale economist Fiona Scott Morton suggested the 7 percent increase has to do with a new class of drugs – biologics — that are used to treat things such as autoimmune disease and cancers may be partly responsible for the $$$. On a more dramatic note, Dr. Walid Gellad at the University of Pittsburgh postulated that increasing prices are becoming scandalous because of a political shift and that “the end is coming” for high prices in this industry.
Is that all? Nope. Valeant has increased their prices for a drug to treat lead poisoning by 2,700 percent in a single year. To make matters worse, this comes on the heels of lead poisoning in Flint, Michigan’s water supply.
ON HOSPITAL QUALITY…
A new report released by the Department of Health and Human Services (HHS) focuses on rural health and health care, examining how rural hospitals perform in Value-Based Purchasing (VBP) and other delivery system reform initiatives. Modern Healthcare reports here.
Some data: Last year only 34% of rural hospitals, in the VBP program were penalized compared to 49% of urban hospitals. However, over the same time period, 79% of rural hospitals were penalized due to the hospital readmissions-reduction program compared to 76% of urban hospitals.
Some ideas: The report stated, “High levels of trust in providers may facilitate better patient experiences” in rural acute-care settings. The report also did not note any reason for difference in readmissions, but did identify that adults in rural areas on a whole have poorer health, more tobacco use, and more chronic conditions.
The point: 59 million Americans living in rural settings, receive care and services from rural hospitals. Current payment incentives for mandatory hospital-based delivery system reform programs do not align perfectly with rural hospitals because of difference in payment structures and low patient volumes. Important to find a way to meet needs in rural settings when developing and implementing delivery system reform.
Contributors: Stephanie Caty (@stephaniecaty), Yevgeniy Feyman (@YFeyman), Kim Reimold (@KimReimold), Zoe Lyon (@zoemarklyon), and Anthony Moccia (@Anthony_Moccia).