Tag Archives: Value Based Care Models (VBC)

PATIENT LEAKAGE CAN SINK YOUR REVENUES BY 20% OR MORE

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https://www.healthleadersmedia.com/finance/patient-leakage-can-sink-your-revenues-20-or-more

A majority of hospital executives recognize patient leakage as a problem that’s costing their respective systems, but few have taken steps to properly address it.

KEY TAKEAWAYS

Reducing patient leakage should be a top priority for CFOs in 2019, according to Scott Vold, CEO of Fibroblast.

The survey found most executives recognize the challenge of patient leakage but few have done anything to stem its effects.

Nearly one in five executives report losing more than 20% on patient leakage annually.

More than four out of five healthcare executives report that patient leakage is a serious problem facing their organizations, though not many have implemented solutions to curb the dilemma, according to a new survey from Fibroblast, commissioned by Sage Growth Partners.

Patient leakage occurs when a patient referral that should stay inside a health network ends up leaving for another or a patient that should receive care in the network but doesn’t follow through on the care.

Among the numerous financial challenges that healthcare executives face, patient leakage is a quandary with a clinical angle that requires immediate action to stem the tide and recoup lost revenues.

WHO’S AWARE OF PATIENT LEAKAGE:

  • 87% of executives say it’s a high priority
  • 23% don’t track it
  • 20% don’t know where or why it happens

Just over one-third of polled executives reported that they understand where and why patient leakage occurs, with 60% saying they don’t follow up with patients to determine if they received care from the physician they were referred to.

WHAT PATIENT LEAKAGE COSTS ANNUALLY:

  • 43% of executives say they’ve lost 10% or more of revenues
  • 23% say they don’t know how much they’re losing
  • 19% say they’ve lost 20% or more

Scott Vold, CEO of Fibroblast, the company which commissioned the Sage Growth Partners survey, told HealthLeaders that patient leakage goes beyond the traditional financial challenges CFOs face because it poses a risk to the value-based care model due to patients developing an event that is more acute than it should’ve been had they received care. 

“If it’s not already, reducing patient leakage, including the referral management process, should be their top priority for 2019,” Vold said. “They need to take thoughtful yet aggressive steps to do it. The good news is that it is an addressable problem that can be fixed and can have an enormous financial and strategic impact in a relatively short amount of time.”

WHAT’S AT FAULT AND WHO WILL FIX IT:

  • 57% of executives are somewhat satisfied with their EMRs
  • 19% say they are not satisfied
  • 69% say patient leakage is handled by more than one person
  • 19% say they plan to purchase a third-party solution
  • Only 2% currently have one in place

 

HHS proposes allowing some drug importation, but impact would be limited

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HHS proposes allowing some drug importation, but impact would be limited

Money pile and medicine pills representing medical expenses

Nevertheless, the proposed policy could take Martin Shkreli-like practices “out of the ballgame,” expert says.

Regulators could allow importation of certain drugs in an effort to keep prices down, under a proposal from the Department of Health and Human Services.

On Thursday, HHS Secretary Alex Azar requested that Food and Drug Administration Commissioner Scott Gottlieb create a working group to find how to safely import drugs from abroad in cases when their US-made marketed equivalents undergo dramatic price increases.

However, experts said the effect of such a policy on prices – if it passes – will be limited.

Azar pointed to the now infamous example of the toxoplasmosis drug Daraprim, whose price manufacturer Turing Pharmaceuticals increased from $13.50 per pill to $750 in 2015, drawing nationwide scorn for Turing and its CEO, Martin Shkreli. Shkreli was sentenced to seven years in prison in April following his August 2017 conviction on charges of securities fraud and conspiracy. Turing, which has since changed its name to Vyera Pharmaceuticals, is currently losing money, STAT reported, and shareholders will vote Friday on a proposal to change the name again, to Phoenixus.

Several political leaders have proposed allowing importation of drugs. In May, Republican Vermont Gov. Phil Scott signed a bill that would allow importation of drugs from Canada, though HHS must still certify the law. Independent Vermont Sen. Bernie Sanders also introduced a bill in the Senate, S. 469, The Affordable and Safe Prescription Drug Importation Act, that would allow the same, with cosponsorship from several Senate Democrats. The bill would wholesalers, pharmacies and individuals to import a range of medications.

However, the HHS proposal is more narrow, focusing specifically on drugs that have seen significant price increases. Gerard Anderson, professor of health policy and management at Johns Hopkins University, and several colleagues made a similar proposal in a paper published in JAMA in February 2016. Under their proposal, GlaxoSmithKline – the original manufacturer of Daraprim – would be able to import the drug from the United Kingdom, where it sells for less than $1 per tablet. The paper compared the proposal to FDA allowances for importation during shortages of critical medications.

Still, Anderson said in a phone interview that the HHS proposal will not likely have a broader spillover effect on drug prices, but will only affect the specific drugs that are included. “For a very narrow subset of medications, it could take the Martin Shkrelis out of the ballgame because these drugs are very inexpensive in other countries,” he said.

In addition to Turing, other companies that have become notorious for raising drug prices include Shkreli’s prior company, Retrophin, and Valeant Pharmaceuticals. Questcor Pharmaceuticals raised the price of Acthar Gel from $1,650 per vial to $23,269 in 2007, and the price has risen to $38,892 since Questcor’s 2014 acquisition by Mallinckrodt Pharmaceuticals. More recently, larger drug companies have also taken heat for smaller price increases. Pfizer backed down from a plan to raise the prices of about 100 of its medications after criticism from the Trump administration, while Novartis and Merck & Co. have pledged to limit price increases as well.

The government stipulating what constitutes a “dramatic price increase” could create a de facto price ceiling that drugmakers would stay under when changing their prices, said Lev Gerlovin, vice president at Boston-based consultancy Charles River Associates, in a phone interview. It’s hard to assess whether that would have a material effect on the industry, given that the ceiling may be greater than what most manufacturers already tend to do as a matter of course. However, while cautioning that he is not a Washington observer, Gerlovin said likely industry pushback citing patient safety concerns makes the proposal appear unlikely to pass.