What finally happened today was a data trove release that might be better than an NSA on any day. By going to Pro Publica they have the links to the information and their history with regards to some of their investigations into the immense money trove that is generated from prescription abuse - by Doctors.
Government Releases Massive Trove of Data on Doctors’ Prescribing Patterns
The move follows a ProPublica investigation showing that Medicare did little to find dangerous prescribing by doctors to seniors and the disabled. It is also part of the government’s new push to bring transparency to taxpayer-supported medical care.
by Charles Ornstein
ProPublica, April 30, 2015,
Medicare’s failure to monitor what doctors are prescribing has wasted billions of taxpayer dollars on excessive use of brand-name medication and exposed the elderly and disabled to drugs they should avoid.
The federal government released detailed data today on nearly 1.4 billion prescriptions dispensed to seniors and disabled people in the Medicare program in 2013, bringing more openness to the medication choices of doctors nationwide.
The data release comes two years after ProPublica reported that the Centers for Medicare and Medicaid Services had done little to detect or deter hazardous prescribing in its drug program, known as Medicare Part D. ProPublica analyzed several years’ worth of prescription data, obtained under the Freedom of Information Act, and created a tool called Prescriber Checkup that lets users compare individual physicians to others in the same specialty and state.
But Medicare itself hadn’t made this information easily accessible—until now.
“This transparency will give patients, researchers, and providers access to information that will help shape the future of our nation’s health for the better,” said acting CMS Administrator Andy Slavitt in a statement accompanying the data’s release.
The information released by CMS is part of the agency’s data transparency initiative. In recent years, CMS has released data on hospital charges, geographic variations in the way health care is delivered, and Medicare’s payments to doctors. The payment data, first released last year, came after the Wall Street Journal and its parent company challenged a long-standing legal injunction that had kept the information private.
Medicare changed its approach to overseeing Part D after the ProPublica reports.
Before, agency officials insisted that monitoring problem prescription patterns fell to the private health plans that administer the program, not the government itself. Congress never intended for CMS to second-guess doctors – and didn’t give it that authority, officials said.
Doctors didn’t even have to be enrolled in Medicare to prescribe to patients in Part D, making it impossible for the program to know basic facts about whether the prescriptions these doctors wrote were appropriate.
Since our reports, CMS has moved to fix Part D’s excesses and blind spots. In May 2014, the agency gave itself the authority to expel physicians from Medicare if they are found to prescribe drugs in abusive ways. Beginning next month, the agency also will compel health providers to enroll in Medicare to order medications for patients in Part D, closing the loophole that has allowed some practitioners to operate with little or no oversight.
Medicare Part D is popular among seniors for helping to lower their drug costs. But experts have complained that since Part D began in 2006, Medicare has placed a higher priority on getting prescriptions into patients’ hands than on targeting problem prescribers. The U.S. Department of Health and Human Services’ inspector general has repeatedly called for tighter controls.
Among ProPublica’s findings:
•Medicare had failed to use its own records to flag doctors who prescribed thousands of dangerous, inappropriate or unnecessary medications.
One Miami psychiatrist, for example, wrote 8,900 prescriptions in 2010 for powerful antipsychotics to patients older than 65, including many with dementia. A black-box warning on the drugs says they should not be used by such patients because it increases their risk of death. The doctor said he’d never been contacted by Medicare.
ProPublica also found that many of the top prescribers of the most abused painkillers had been charged with crimes, convicted, disciplined by their state medical boards or terminated from Medicaid. Nearly all remained eligible to prescribe in Medicare.
•Medicare wasted hundreds of millions of dollars a year by failing to rein in doctors who routinely give patients pricey name-brand drugs when cheaper generic alternatives are available.
•The top prescribers of some drugs received speaking payments from the companies that made them.
•Medicare’s process of flagging fraud was so convoluted and ineffective that the program was losing millions of dollars to schemes. Though the number of prescriptions attributed to Florida kidney specialist Carmen Ortiz-Butcher more than quadrupled in a year and the cost of her drugs to Medicare spiked from $282,000 to $4 million, Medicare didn’t ask any questions until Ortiz-Butcher realized that her prescription pads had been stolen and falsified.
The data released by Medicare today includes summary information, such as the total number of prescriptions written by each doctor in 2013, as well as more detailed information about each drug a doctor prescribed. It covers prescriptions worth more than $103 billion, not including rebates that lower the cost by an undisclosed amount.
The top prescribed drug in the program in 2013 was the blood pressure drug Lisinopril, prescribed 36.9 million times, including refills. Medicare spent the most on Nexium, $2.5 billion, not including rebates. The drug taken by the most Part D patients was the narcotic hydrocodone-acetaminophen. More than 8 million users filled at least one prescription for it.
Eric Hammelman, a vice president at the consulting firm Avalere Health, said the prescribing data could unlock clues about differences in how doctors practice medicine. Take, for instance, antibiotics, he said, which are often prescribed for inappropriate reasons. While the new data won’t show which prescriptions are inappropriate, it may flag providers who should be asked questions because they prescribe the drugs to a high proportion of their patients.
Beyond that, if consumers compare the prescribing data to data on the payments drug companies have made to doctors, they can see how often doctors prescribe products sold by companies with whom they have financial relationships.
“Knock on wood, these files are coming out on a regular basis. I think some of the doctors and manufacturers would prefer this goes away,” Hammelman said.
ProPublica will be analyzing the information in coming weeks and incorporating the data into our Prescriber Checkup tool.
Thirty-five years ago, the United States ranked 13th among the 34 industrialized nations that are today in the Organization for Economic Cooperation and Development in terms of life expectancy for newborn girls. These days, it ranks 29th.
In 1980, the infant mortality rate in the United States was about the same as in Germany. Today, American babies die at almost twice the rate of German babies.
“On nearly all indicators of mortality, survival and life expectancy, the United States ranks at or near the bottom among high-income countries,” says a report on the nation’s health by the National Research Council and the Institute of Medicine.
What’s most shocking about these statistics is not how unhealthy they show Americans to be, compared with citizens of countries that spend much less on health care and have much less sophisticated medical technology. What is most perplexing is how stunningly fast the United States has lost ground.
The blame for the precipitous fall does not rest primarily on the nation’s doctors and hospitals.
The United States has the highest teenage birthrate in the developed world — about seven times the rate in France, according to the O.E.C.D. More than one out of every four children lives with one parent, the largest percentage by far among industrialized nations. And more than a fifth live in poverty, sixth from the bottom among O.E.C.D. nations.
Among adults, seven out of every 1,000 are in prison, more than five times the rate of incarceration in most other rich democracies and more than three times the rate for the United States four decades ago.
The point is: The United States doesn’t have a narrow health care problem. We’ve simply handed our troubles to the medical industry to fix. In many ways, the American health care system is the most advanced in the world. But whiz-bang medical technology just cannot fix what ails us.
As economists from the University of Chicago, M.I.T. and the University of Southern California put it in a recent research paper, much of America’s infant mortality deficit is driven by “excess inequality.”
American babies born to white, college-educated, married women survive as often as those born to advantaged women in Europe. It’s the babies born to nonwhite, nonmarried, nonprosperous women who die so young.
Three or four decades ago, the United States was the most prosperous country on earth. It had the mightiest military and the most advanced technologies known to humanity. Today, it’s still the richest, strongest and most inventive. But when it comes to the health, well-being and shared prosperity of its people, the United States has fallen far behind.
Pick almost any measure of social health and cohesion over the last four decades or so, and you will find that the United States took a wrong turn along the way.
As the presidential campaign draws the political debate to our national priorities, these questions must take center stage. As candidates argue over the budget deficit and the national debt, debate what to do about income inequality, address the problem of mass incarceration or refight the battles over the Affordable Care Act and the minimum wage, they should be forced to address how their policy wish list adds up to an answer.
Looking at how the United States compares with other nations is illuminating. As I noted in last week’s column, over the last four decades or so, the labor market lost much of its power to deliver income gains to working families in many developed nations.
But blaming globalization and technological progress for the stagnation of the middle class and the precipitous decline in our collective health is too easy. Jobs were lost and wages got stuck in many developed countries.
What set the United States apart — what made the damage inflicted upon American society so intense — was the nature of its response. Government support for Americans in the bottom half turned out to be too meager to hold society together.
The conservative narrative of America’s social downfall, articulated by the likes of Charles Murray from the American Enterprise Institute, posits that a large welfare state, built from the time of the New Deal in the 1930s through the era of the Great Society in the 1960s, sapped Americans’ industriousness and undermined their moral fiber.
A more compelling explanation is that when globalization struck at the jobs on which 20th-century America had built its middle class, the United States discovered that it did not, in fact, have much of a welfare state to speak of. The threadbare safety net tore under the strain.
Call it a failure of solidarity. American institutions, built from hostility toward collective solutions, couldn’t hold society together when the economic underpinning of full employment at a decent wage gave in.
The question is, Is there a solution to fit these ideological preferences? The standard prescriptions, typically shared by liberals and conservatives, start with education, building the skills needed to harness the opportunities of a high-tech, fast-changing labor market that has little use for those who end their education after high school.
Ensuring everybody has a college degree might not stanch the flow of riches to the very pinnacle of society. But it could deliver a powerful boost to the incomes and the well-being of struggling families in the bottom half.
And yet the prescription — embedded in the social reality that is contemporary America — falls short. In contemporary America, education is widening inequity, not closing it. College enrollment rates have stagnated for lower-income Americans. Sean Reardon from Stanford University notes that the achievement gap between rich and poor children seems to have been steadily expanding for the last 50 years.
On the left, there are calls to build the kind of generous social insurance programs, which despite growing budget constraints remain largely intact among many European social democracies. Senator Elizabeth Warren, Democrat of Massachusetts, for example, is calling for an expansion of Social Security, paid for by lifting the cap on payroll taxes so the rich pay the same share of their income to support the system as everybody else.
That may be desirable, though at the moment, our greatest problems are not about the elderly. And at least for the foreseeable future, it remains a political nonstarter in a nation congenitally mistrustful of government. Just in time to kick off the presidential campaign, Republicans in the House and Senate were working on a budget that would gut Obamacare — most likely increasing the pool of the nation’s uninsured — and slash funding for programs for Americans of low and moderate income.
Yet despite the grim prognosis, there is hope. The challenge America faces is not simply a matter of equity. The bloated incarceration rates and rock-bottom life expectancy, the unraveling families and the stagnant college graduation rates amount to an existential threat to the nation’s future.
That is, perhaps, the best reason for hope. The silver lining in these dismal, if abstract, statistics, is that they portend such a dysfunctional future that our broken political system might finally be forced to come together to prevent it.