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3 posts from June 2010


Reality Check

Recently, and with much fanfare, President Obama touted the delivery of millions of $250 checks from the Federal government to older Americans. These rebates are being sent to Medicare beneficiaries who fall into the gap in prescription drug coverage, “the donut hole,” under the Medicare Part D program. And while these billions of dollars are being advertized to improve healthcare, the reality is that anyone who has studied this issue, or even who appreciates and is willing to admit to human nature, knows that little if any of these funds will find their way to impacting healthcare. Instead these funds are there to provide a positive feeling to those in a troubled healthcare system—a feeling that turns into votes at election time.

The mailing of $250 rebate checks is an example of how far we have traveled from reality. The problem is that what is occurring in healthcare today is so far separated from the real problems and solutions that a reality check is deeply needed.

Getting What You Pay For
Medicare has produced the results that the system pays for since its beginning in 1965. One clear example is the demise of the primary care physician (PCP). While other countries have embraced the PCP as the foundation for coordination of care, Medicare instead has focused on reimbursing specialists dedicated to procedures. The resulting system is dominated by specialists all to willing to focus on their narrow procedures rather than coordinating care in a cost-effective manner.

In addition to fostering the demise of primary care, the system has paid only for the units of care provided rather than the quality. The result again is a provider system focused on volume rather than outcomes. Seemingly aware of this issue, Medicare is now promoting a focus on quality and investing in systems of care, but unless the payments are appropriate to motive a change in behavior, little will come from this investment. This includes the some $40 billion set aside for health information technology

Easy (Wrong) Answers
Another area where a reality check is needed is the rush to easy answers that are often wrong. Currently, Congress is debating the continuation of the Sustainable Growth Rate Formula (SGR), a payment plan declared broken from its beginning. The SGR was based on a simple enough principle: if Medicare expenditures exceed a budgeted amount in a year, then the following year, provider reimbursements will be cut by that percentage. The problem is that this system again favors specialists’ procedures, further negatively impacting primary care providers. Specialists have the ability to more easily increase their number of procedures while primary care providers find it difficult to decrease their visit time to increase their volume of work. With its negative impact on the primary care providers, this formula is further hurting older Americans from being able to find a PCP.

Facing Reality
One last area for a reality check is our fascination with the baby boomers. While the doubling of the number of older Americans over the next two decades is a major change, one that will have even greater and longer impact on the healthcare system is receiving far less attention. Our explosion in our weight will likely have a much more far reaching impact on bankrupting our healthcare systems than our aging population. Yet, no real focus is being paid to this major problem.

It should become increasing clear that we are in desperate need to get very real, very quick. We are facing a crisis that makes our current man-made disaster in the Gulf of Mexico seem trivial. Perhaps the title wave of voter discontent that is forcing incumbents out of their long held political offices is a sign of us waking up. Washington is in dire need of a reality check, rather than billions of dollars in rebate checks.

Dr. Richard G. Stefanacci is an internist/geriatrician and director of the Institute for Geriatric Studies at University of the Sciences. He can be reached at r.stefan@usp.edu.


New Frontiers for Particle Physics

Particle physics is a rapidly changing field, thanks to the opening of the Large Hadron Collider near Geneva and the continued operation of Fermilab in Illinois.  For the paperback edition of my book Collider:  The Search for the World's Smallest Particles I've added a whole new preface:  "The Fate of the Large Hadron Collider and the Future of High–Energy Physics" that updates these exciting new developments.  It also has a colorful new cover, depicting the CMS (Compact Muon Solenoid) detector.

Collider: The Search for the World's Smallest Particles

Collider:  The Search for the World's Smallest Particles


Herb Denenberg - The Ultimate Activist and a Great Friend of Pharmacy

By Daniel A. Hussar, the Remington Professor of Pharmacy at the Philadelphia College of Pharmacy at the University of the Sciences in Philadelphia. He serves as the author and editor of The Pharmacist Activist newsletter (http://www.pharmacistactivist.com) from which this editorial was taken.

Herb Denenberg died on March 18, 2010. His credentials and accomplishments would fill a book, and a short list includes PhD and JD degrees, service as the Insurance Commissioner and Public Utility Commissioner in Pennsylvania, a professorship at the Wharton School of the University of Pennsylvania, service as a consumer and investigative reporter for several television stations, columnist for newspapers, authorship of insurance laws and a widely acclaimed series of shopper's guides regarding insurance and health care, and membership in the Institute of Medicine of the National Academy of Sciences. He was the recipient of hundreds of awards in recognition of his accomplishments.

The following tributes are examples that capture the passion and expertise that characterized Herb's work:

From NBC Philadelphia:

"He spent his life fighting for the little guy."

"He made the news because he made a difference. Many consumers have better, safer choices because of Herb."

"You could not intimidate Herb and he never thought twice about going head to head with product makers, big business or the government to right a wrong."

From Pennsylvania Governor Ed Rendell:

"He wasn't afraid of taking on anybody, any politician, any company, any multinational. He didn't care. If he thought things had to be changed, he went after it with a vengeance."

From Ralph Nader (at the time Herb was Pennsylvania Insurance Commissioner):

"He's clearly the most consumer-oriented insurance commissioner in American history."

However, it was not the awards and tributes that motivated Herb to be such a driven activist on behalf of consumers ("the little guys"). He had a genuine concern for the health and welfare of his fellow man, and was not willing to tolerate the deception, indifference, and incompetence that characterized many of the issues and individuals he addressed. He identified what motivated him in this manner: "My greatest satisfaction is keeping some kid from drinking poison or making some government agency do what it is supposed to do."

The pharmacy connection

When Herb Denenberg was the Pennsylvania Insurance Commissioner in the early 1970s, he had great concerns about the health care system and how he felt it was failing consumers. He made some very critical comments regarding pharmaceutical and insurance companies, hospitals, and health professionals, including pharmacists. Many of his criticisms were valid but we felt that his comments about pharmacists were off target and did not reflect an understanding of the importance of the expertise and professional services of pharmacists. We requested a meeting to which he quickly agreed. Approximately 20 pharmacists from throughout Pennsylvania came to Harrisburg and met with him. What was initially anticipated to be a brief meeting extended for more than two hours. He was attentive to our response to his criticisms, he asked questions, he listened, and he was surprised by our description of the role and services of pharmacists of which he was previously unaware. I was very impressed by his receptiveness to our comments and by his desire to learn more.

The outcome of this meeting was far more positive than we could have ever anticipated. Herb became an enthusiastic advocate for pharmacists and the importance of patients speaking with their pharmacists, although he reserved the right to be critical when we deserved it. In the mid-1970s, he wrote one of his renowned "Guides" on the topic of, "How to Choose Your Pharmacy," that was published in Parade magazine, a supplement to Sunday newspapers across the country. His promotion and enthusiasm for our profession and our role was more effective and persuasive than what most of us within the profession could have written.

Herb and I became good friends. Although his interests were broad-based, health care and drug therapy were among his favorite topics. He would usually speak with me when he was developing a newspaper column regarding medications, and I was often a guest on his television and radio interviews/programs. I have been the beneficiary of his wisdom and perspectives. He demonstrated the importance of having the courage of your convictions and being bold in communicating them. He was the ultimate activist and I highly value what I learned from his example.

In 1999, we asked Herb to update his "Guide to Selecting a Pharmacist," and it was published as a supplement to the American Pharmacists Association's publication, Pharmacy Today. I have reprinted two of the six sections of the "Guide" on the accompanying page. His observations continue to be so important and timeless that not a single word needs to be changed. I encourage you to use this in your interactions with your patients and in your communities (it is not necessary to obtain permission). It would be one more way to honor this great friend of pharmacy.

Herb Denenberg is survived by Naomi, his wife and highly capable contributor to his commentaries and to his success. Naomi has experienced some health challenges in recent years and Herb was devoted to her care.

Daniel A. Hussar

Guide to Selecting a Pharmacist*
by Herb Denenberg**

Tips for choosing your pharmacist

Look for a broad range of expertise and services. You need to be sure the pharmacist is knowledgeable about the proper use of over-the-counter medications and all the prescriptions you use.

Select a pharmacy and stick with it. Using more than one pharmacy can put you in jeopardy if you are taking several kinds of medications.

Get recommendations from doctors, nurses, and other health care workers as well as from friends and relatives. Pharmacists build their practices around satisfied patients and excellent relationships with other health care providers.

Talk with the pharmacist and observe the pharmacist at work. Look for evidence of professionalism and expertise. Check the atmosphere, too: Is the pharmacist always rushed and overworked? Does the pharmacy have a location set aside for consultations with the pharmacist?

Ask the pharmacist questions. Is the pharmacist readily accessible and approachable? If you need more than a few minutes of the pharmacist's time, is the pharmacist willing to telephone you or set aside a time for an appointment to spend more time with you?

Look for a pharmacist who is your health care advocate. A pharmacist must be willing to give you specific recommendations that help you address your needs. A pharmacist must be willing to refer you to other health care professionals and to work with your physician directly when needed.

Make sure the pharmacist asks about and keeps records of your medical history. To advise you properly or to share information with your physician, the pharmacist must know your medical history. Your history should include personal data (such as age, height, and weight), medical conditions, and all medications you take (including prescription and over-the-counter medications and any vitamins or other nutritional supplements). The pharmacist is bound to maintain the confidentiality of that information.

Determine how effectively the pharmacist communicates. The pharmacist must be able to provide verbal and written instructions, and they should be clear and specific. You should feel confident about the information you receive, and you should feel comfortable enough to return for more advice or telephone the pharmacist if you have questions.

Choose a pharmacist who looks for ways to help you keep to your medication regimen. The pharmacist should be ready to help you find solutions to issues that may affect your ability to follow advice and to take your medications as directed. This might include talking to your doctor about ways to simplify drug therapy or reduce the number of doses, checking for insurance coverage, or exploring less expensive alternatives.

Be an active, informed health care consumer. Your pharmacist should welcome your inquiries and assist you in learning more about your health care.

Your pharmacist and you: partners in health

Today more than ever, you—the patient—are the most important person on your health care team. Your pharmacist is trained and ready to help you take charge of your health.

So take advantage of the expertise of your pharmacist and the full range of medication counseling and wellness support that today's professional pharmacist has to offer. Talk to your pharmacist about the role that medications, self-care products, home health medical devices, and nutritional supplements can play in achieving better health. Go to your pharmacist when you're trying to decide whether a minor problem can be safely self-treated or requires a doctor's advice and care. Get recommendations from the pharmacist when you're trying to choose an over-the-counter medication or when you're having trouble taking your prescription medicines.

The pharmacist is your partner in health. So choose wisely—and look for the best. You owe it to yourself!

*These two sections are excerpted from a longer "Guide" that was published by the American Pharmacists Association as a supplement in Pharmacy Today.

**The late Herb Denenberg was an acclaimed consumer and investigative reporter whose numerous responsibilities included service as Pennsylvania Insurance Commissioner.

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