Category: Daily News

People may happily, and safely, forgo in-person doctors’ visits after surgery by opting instead for talking with their surgeons by phone or video, suggests a small study of U.S. veterans. According to the summary in Reuters Health, most patients preferred the virtual visits and the doctors didn’t miss any infections that popped up after surgery, the researchers report in JAMA Surgery.

“These kinds of methods are really important in the climate we’re in now,” said lead author Dr. Michael Vella, of Vanderbilt University Medical Center in Nashville. “So I think anything you can do to save money, see more patients and improve access to care is really important.” There is interest in so-called telehealth to increase access to healthcare while also decreasing the costs associated with traveling to office visits, Vella and his colleagues write.

Past research has found that telehealth visits may be useful in the treatment of chronic conditions and after surgery, but less is known about patients preferences for these types of visits, they add.

For the new study, the study team evaluated data collected over several months in 2014 from 23 veterans, all but one of them men, who were seen three times after a simple operation that would require only a night or so in the hospital. One visit was via video, the second was via telephone and the third was an in-person office visit. The researchers found that no post-operation infections were missed during the video or telephone visits. “The veterans were very good at describing their wounds,” Vella said. “There was one patient who thought they were having problems, we brought them into clinic and there was an infection.”

Overall, 69 percent of the participants said they preferred a telehealth visit over the traditional in-office visit. Those who preferred the telehealth visit tended to live farther away from the hospital than those who would rather come into the office. “I think (the study) challenges the paradigm that we need to see all patients back for visits,” Vella said.

He cautioned that the study was small, and they can’t say telehealth visits won’t miss problems. The study also can’t assess how telehealth visits would work for patients who have undergone more complex surgeries.

The reputation of the biopharmaceutical industry continues to be battered by claims of illegal detailing of drugs or questionable sales and marketing practices. And now a new twist from the hands of Martin Shkreli, the CEO of Turing Pharmaceuticals and a former hedge fund manager. He raised the price of a 60 year old generic drug Daraprim acquired by his company in August from $13.50 to $750 a tablet, overnight.

According to the report in Forbes, Shkreli’s actions are being viewed as typical drug company behavior and yet another example of the industry’s price gouging. Daraprim was originally discovered, developed and manufactured by GlaxoSmithKline (GSK). The Daraprim patent expired decades ago and the drug is now generic, thus allowing others to make it.

However, it is a small product and no real competition has arisen. In 2010, GSK sold the marketing rights for Daraprim to CorePharma. Sales of Daraprim were less than $1 million in 2010 based on a price of about $1/pill. CorePharma raised the price to $13.50, which itself is surprising. But given the importance of the drug and the modest number of prescriptions per year (about 12,700), there was little complaint. However, a series of deals brought Daraprim to Turing Pharmaceuticals and the price was immediately increased to $750 a pill.

Turing’s price increase is not an isolated example. Although some price increases have been caused by shortages, others have resulted from a business strategy of buying old neglected drugs and turning them into high-priced “specialty drugs.”

Cycloserine, a drug used to treat dangerous multidrug-resistant tuberculosis, was just increased in price to $10,800 for 30 pills from $500 after its acquisition by Rodelis Therapeutics. Scott Spencer, general manager of Rodelis, said the company needed to invest to make sure the supply of the drug remained reliable. He said the company provided the drug free to certain needy patients.

Valeant Pharmaceuticals acquired two heart drugs, Isuprel and Nitropress, from Marathon Pharmaceuticals and promptly raised their prices by 525 percent and 212 percent respectively. Marathon had acquired the drugs from another company in 2013 and had quintupled their prices. Another drug, Doxycycline, an antibiotic, went from $20 a bottle in October 2013 to $1,849 by April 2014.

This is not the first time the 32-year-old Shkreli has been the center of controversy. In 2011, Mr. Shkreli started another company, Retrophin, which also acquired old neglected drugs and sharply raised their prices. Retrophin’s board fired Mr. Shkreli a year ago. Last month, it filed a complaint in Federal District Court in Manhattan, accusing him of using Retrophin as a personal piggy bank to pay back angry investors in his hedge fund. Shkreli has denied the accusations. He has filed for arbitration against his old company, which he says owes him at least $25 million in severance.

In the unpublished case of Hallmark Marketing Corp. v. WCAB and Gannon, Carol Ann Gannon sustained an industrial injury in December 2000 affecting her low back, neck, and bilateral carpal tunnels while working for Hallmark Marketing Corporation. Permanent disability was evaluated using the 1997 disability rating schedule. She has motion segment loss at two lumbar spine levels after two surgical fusions, one in 2004 and the other in 2007 and has a “failed back syndrome with chronic pain.”

The AME reported that Gannon “would be unable to sustain six to eight hours of work every day in a constructive, productive and consistent fashion. [She] would be able to work out of her home [(which actually means, in her home)] probably six to eight hours a day where she would be able to rest and take breaks and ‘spread’ the workday into a longer period. . . . [She] would be able on certain days to probably work between four and six hours a day, but other days not, and therefore I would consider that [she] is probably 100% disabled solely based on her orthopedic condition . . . .”

The WCJ disagreed with the rater’s conclusion that an industrial injury that limits the employee-applicant to working only from home is necessarily 100% permanent disability (termed a “sheltered workshop” or “sheltered workplace” by the DEU rater). The WCJ, instead, applied the following legal standard: An injured employee is 100% permanently disabled if having to work from home is necessitated by limitations that also render the employee unable to compete in the open labor market and awarded total disability. On reconsideration the WCAB did not adopt the WCJ’s legal standard but affirmed the 100% award based on the DEU rationale.

The Court of Appeal reversed finding that the WCJ used the correct standard. “The applicant has the initial burden, under this standard, to show that she can work only from home in work that is not generally available; if the applicant meets this burden, the burden shifts to the employer to establish the applicant’s ability to compete in the open labor market (i.e., to show there is work available that the applicant can perform).”

The San Francisco-based company ZenPayroll has offered a cloud-based system to automate tax calculations and payroll payments. Its web-based services are already used by more than 20,000 small businesses. The company has now changed its name to Gusto, and is competing in the workers’ compensation insurance marketplace. When it was still ZenPayroll, the company’s sights were set on helping the six million US-based small businesses – places like florists, churches, and salons – that have, in the past, done payroll by hand. But the company also announced that it will also be rolling out health benefits and workers’ compensation to these businesses.

Over the past few months, Gusto has quietly tested health benefits and workers’ compensation products. Now, it will offer both services to existing and new accounts, starting in California. That shift will put the San Francisco-based company in head-to-head competition with Zenefits, the powerful online health insurance broker. Traditionally, the two startups have been partners: Zenefits uses payroll data from the likes of ADP and ZenPayroll to manage its plans, but wants to reduce that dependency. As of late June, Zenefits claimed more than 10,000 accounts. Last year, it generated around $20 million in revenue and as of May its valuation was around $4.5 billion. CEO Parker Conrad told Fortune sales could quintuple this year.

So far, Gusto has raised approximately $86.1 million, including a massive $60 million round from Google Capital last April. As a side note, Google Capital just put $32.5 million into another disruptive insurance startup, Oscar Health. There are also plenty of other companies seeking a piece of the action, including those hoping to empower existing insurance brokers with cloud software, such as EaseCentral and Maxwell Health.

The California Legislature passed A.B. 1124, which would establish an evidence-based closed drug formulary for Workers’ Compensation by July 1, 2017 if signed by the Governor. Notwithstanding this legislation, the DWC has already commenced public hearings on a drug formulary believing that it has authority to adopt one without further legislation.

An article in Business Insurance reports that California insurance experts are optimistic that a new workers compensation prescription drug formulary will help injured workers and reduce comp costs in the state, but the legislation could face hurdles from claimants who need to be weaned from banned drugs or want to continue using them off-label.

The formulary “takes a significant step forward in improving the state workers compensation system as it will assist in injured workers’ medical outcomes, decrease system bureaucracy and provide for savings,” Steve Suchil, Western region assistant vice president of state affairs at the American Insurance Association, said Wednesday in a statement.

Mark Sektnan, president of the Sacramento-based Association of California Insurance Cos., said the proposal could help curb opioid addiction and ensure injured workers receive appropriate medications. “We need to be very careful about ensuring that we provide the correct drug at the right time to that injured worker so they can do what they need to do, which is get back to work,” Mr. Sektnan said.

While California’s formulary has received positive reactions, experts say there also could be some pushback. Mr. Sektnan said California insurance regulators have discussed limiting the off-label use of medications for conditions that aren’t Food and Drug Administration-approved for such drugs. For instance, injured workers would have difficulty getting prescriptions for some powerful opioids that are indicated for treating end-stage cancer pain, Mr. Sektnan said.

The formulary could include a process for claimants who want to continue taking medications for off-label uses. Speakers also cautioned that patients already on medications need a robust and carefully managed transition process – a provision in the bill requires a yet-to-be-determined transition period. However, Mr. Eichler advised against adopting transition rules from the plan Texas implemented in 2011, which used a two-year phase-in for legacy claims. “It doesn’t take two years to wean a patient,” Mr. Eichler said. “My personal recommendation is to go with one year for legacy claims. You need to protect injured workers with the best protocols possible.”

A major concern voiced by several participants during the public meeting was the need to ensure that the formulary is consistent with the state’s medical treatment utilization schedule, which provides guidelines for utilization review, a framework to evaluate and treat injured workers; and information for providers on understanding which evidence-based treatments have been effective.