Neil Minkoff MD's blog

A survey released at HIMSS by the American College of Physicians shows that there is growing serious dissatisfaction by practicing doctors with their EMRs. The type of practice doesn’t matter and neither does the brand of EMR.

It appears as if the doctors surveyed feel that the technology was oversold and does not live up to expectations. The results were compiled over by AmericanEHR Partners, an organization started by ACP and Cientis to help implement EMRs and focus on ways to use them to improve quality of care.

The surveys included over 4,200 responses collected between 2010 and 2012. Over 70% of the doctors surveyed were in practices of 10 or fewer practitioners. Over 80% were participating in Meaningful Use Incentive programs.

They may be practicing with EMRs and getting their Meaningful Use revenue, but they don’t like it.

Overall EHR satisfaction dropped 12 percentage points.  Read more »

The title is part of a quotation from Henry Chao, a CMS official who is involved with building and launching the health care exchanges. The federal government is running or co-managing 33 exchanges. They are expected to be functional by October 1 to enroll patients for coverage starting on January 1.

At a recent panel discussion at Americas Health Insurance Plans (AHIP). more than one government official showed some apprehension about missing the deadline. Chao’s full statement was, “The time for debating about the size of text on the screen or the color or is it a world-class user experience, that’s what we used to talk about two years ago. Let’s just make sure it’s not a third world experience.”

This will be a huge blow to consumers who will be depending on exchanges for next year’s coverage.  Read more »

Amgen is making a huge bet on biosimilars and helping to define the market.

The company announced that it is targeting 6 biotech blockbusters and will start selling them as  biosimilars in 2017. The initial targets: Avastin, Herceptin, Rituxan, Erbitux, Humira and Remicade. That’s over $40 billion in product. Even a small savings, like 15% to 20%, would result in a huge change in premiums.

It is still unclear what hurdles will need to be cleared from the FDA and/or other regulatory bodies, but a few other things have become very clear:

• The biotech industry is starting to see biosimilars as more of an opportunity and less of a threat.
• A large company like Amgen can bet on its qualifications and reputation to be a trusted manufacturer of biotech products introduced by other companies.
• The more that companies like Amgen announce forays into the biosimilar space, the more that payers will be counting on price relief from specialty Rx products.

 It will be curious to see which company makes the next announcement and how aggressive it will be.

Neil Minkoff, MD, is medical director of MediMedia  Managed Markets and also an independent health care consultant.

Researchers in Britain recently published a paper in Pediatrics showing a dramatic swing in admissions for childhood asthma after indoor smoking was banned by the British in 2007. A hospitalization trend that had been steadily around 2% fell to minus 9%. The trend was sustained.  10.1542/peds.2012-2592

I'm wondering, "What should Managed Care do with this information? What is the appropriate level of response? What haven't we tried already?"

We're already covering smoking cessation products and counseling. We've been trying to get our smokers to stop for a long time, but maybe this would be effective for those smokers with children. Is it a matter of further  education? I'd like to think so, but I doubt it. I don't believe that any smokers out there remain ignorant of the dangers to themselves or their families.

Is it a matter of incentives? Do we need to consider paying people to stop smoking? What about making smoking cessation free such as no cost-share on nicotine aids? I hear a lot about the robust public health systems in Europe, but smoking remains a serious issue there as well.

I hate to be on the ban-smoking bandwagon, but I'm at a loss at what to do. PLEASE let me know in the comments if you've got a smoking cessation program in managed care that really works.

Neil Minkoff, MD, is medical director of MediMedia  Managed Markets and also an independent health care consultant.