Tag: 2019 News

Most people in the U.S. with health insurance don’t use the patient portals that are increasingly provided by doctors for online communication, a new study suggests. In a nationally representative survey, researchers found that nearly two-thirds of insured participants had not used an online medical portal in the past year.

Disparities among those who said they’d been offered portal use, and among those who chose to use it, suggest this technology can become a source of unequal access to healthcare, the study team writes in Health Affairs.

“Previous research has shown there are real benefits to portal use. Patients become more engaged in their own health and really stick to their treatments,” said senior author Denise Anthony of the University of Michigan in Ann Arbor.”However, new treatments in health care, and new technologies in general, can end up increasing inequality,” she told Reuters Health by email.

Anthony and her colleagues analyzed data on 2,325 insured patients who participated in the 2017 Health Information National Trends Survey and who had a medical visit during the year before the survey. The researchers wanted to understand the characteristics of portal users and nonusers and the reasons, such as technology issues or security concerns, why many patients don’t use online sites to access their medical records.

Overall, 63 percent of survey participants reported not using a patient portal during the past year, and 60 percent reported not having been offered access to a portal.

Nonusers were more likely to be men, aged 65 or older, to be unemployed, live in a rural location, have public insurance through Medicaid, have a high school diploma or less education and to lack a regular doctor. Similar characteristics, as well as being non-white, were seen among people who said they weren’t offered access to a patient portal.

Among the reasons participants gave for not using online portals, 25 percent mentioned issues with internet access, 32 percent said they had no online medical record, 70 percent said they preferred to speak directly to the doctor, and 22 percent were concerned about privacy issues.

“We also know from our previous research that privacy concerns can affect patients’ relationships with physicians, including how they communicate and trust their doctors, so these concerns are important beyond portals,” Anthony said.

“The underlying assumption is generally a ‘Build it and they will come’ mentality about technology, but this study gives great perspective about both who is offered/using the portal as well as why certain groups experience barriers,” said Courtney Lyles of the University of California, San Francisco, who wasn’t involved in the study.

“Everyone is generally interested in online tools to make life more convenient, but we can’t separate that from the skills and relationships that surround technology use,” she told Reuters Health by email.

Future studies should consider the role of digital inclusion and digital literacy, Lyles added. Doctors will need to do more to help patients use portals during visits, as well as connecting them to resources for digital support such as local libraries and community groups.

Limited information exists on the characteristics of US physicians who have been excluded from Medicare and state public insurance programs for convictions of health care fraud, crimes related to health care delivery, or substance abuse.

Common fraud schemes include billing for services not rendered, filing duplicate claims (including the unbundling of bundled services), and misrepresenting dates and locations where services were provided. Health crimes involve the provision of medically unnecessary procedures, illegal patient admittance and retention practices, the making of false statements (including physician medical identify theft), and the gross violation of professionally recognized standards of care.

Researchers decided to to examine the characteristics of physicians excluded from Medicare and state public insurance programs for fraud, health crimes, or unlawful prescribing of controlled substances. Alice Chen, PhD, MBA, from the University of Southern California in Los Angeles, and colleagues conducted a cross-sectional study to examine the characteristics of physicians excluded from Medicare and state public insurance programs for fraud, health crimes, or unlawful prescribing of controlled substances between 2007 and 2017.

“We found that the number of physicians excluded from participating in public health insurance has grown substantially over time and that excluded physicians were concentrated in specific regions of the United States,” the authors write.

The researchers found that 2222 physicians were temporarily or permanently excluded from Medicare and state public insurance programs during 2007 to 2017. On average, there was a 20% increase per year in fraud, health crimes, and substance abuse exclusions (from 236 convictions in 2007 to 670 in 2017). Researchers found the highest exclusion rates in the West and Southeast. The state with the highest exclusion rate was West Virginia, with 5.77 exclusions per 1000 physicians, while there were no exclusions in Montana. Exclusions were more likely for male physicians, physicians with osteopathic training, older physicians, and physicians in specific specialties.

Physicians in the West and Southeast were most likely to be excluded for fraud, substance abuse, or health crimes. Although California, New York, Florida, and Texas had the highest absolute counts of excluded physicians from 2007 to 2017, they also had the largest physician populations.

When considering the rate of physician exclusions per 1000 physicians, only Florida remained in the highest category of exclusion rates. West Virginia had the highest exclusion rate, with 5.77 exclusions per 1000 physicians (32 exclusions among 5720 physicians), while Montana had 0 exclusions during this period.

There were several explanations for the observed increase in exclusions, and rates of identified health care fraud, waste, and abuse. First, this finding could be evidence that regulators, who have been aided by recent public policies targeting the reduction of fraud and waste, may be getting better at identifying perpetrators of fraudulent activity.

Physician exclusions were more common in certain states in the West and Southeast. Many of these regions had Medicare Fraud Strike Force Teams, which were established in “hot spots” of unexplained high Medicare billing levels (Florida, California, Michigan, Texas, New York, Louisiana, Florida, and Illinois as of 2017).

In addition, the growth in physician exclusions could also be due, at least in part, to growth in the total number of US physicians participating in public insurance.

Two Illinois-based nonprofit risk pools, who provide more than 203 local municipalities and other public entities with workers’ compensation and employee healthcare insurance, filed a joint lawsuit in the Circuit Court of Cook County against leading opioid manufacturers, distributors, professional associations, and prescribers. It is the first opioid lawsuit brought by insurance risk pools in Illinois.

The Intergovernmental Risk Management Agency (IRMA) and Intergovernmental Personnel Benefit Cooperative (IPBC), seek injunctive relief and financial compensation from defendants to recoup substantial costs resulting from the far-reaching impact of the over-prescription and abuse of opioid medication. IPBC’s costs include vast expenditures on hospitalizations due to overdose, addiction treatment services, and overdose reversal medications, while IRMA has paid millions of dollars in cases involving injured workers who were unnecessarily given long-term opioid prescriptions to treat chronic pain.

The suit alleges opioid manufacturers, including Purdue Pharma, Allergan, and Teva, engaged in aggressive and deceptive marketing campaigns; distributors including AmerisourceBergen, Cardinal Health, and McKesson failed to act as gatekeepers against overprescribing the addictive narcotics; professional organizations including Chicago-based American Academy of Pain Medicine and American Pain Society deceptively promoted the use of opioids for chronic pain management; and suburban Chicago doctors Paul Madison and Joseph Giacchino served as “pill mills,” doling out opioids to anyone who came through the door of their clinic.

The 217 page civil complaint  alleges that the defendants’ plan to flood the Illinois market with opioid medication worked: in 2015, eight million opioid prescriptions were filled in Illinois, the equivalent of 60 prescriptions per 100 people.

The lawsuit is the latest step in a proactive multi-pronged strategy IPBC and IRMA have enacted to address and reduce opioid abuse in their members’ employee communities.

“This lawsuit is about real costs incurred directly as a result of the opioid epidemic. We have seen fully employed, respectable public employees with work injuries who were prescribed opioids unnecessarily and became addicted, ultimately rendering them unable to return to work and costing our members millions,” said IRMA Executive Director Margo Ely. “Opioid abuse and addiction has cost our members through not only lost productivity, but very sad stories of lost careers and lives.”

“As a taxpayer-supported health insurance provider to public entities across Illinois, we have a fiduciary obligation to aggressively seek to recoup the millions of dollars in claim costs that have been wasted due to over-prescription of opioid medications and addiction treatment,” said IPBC Executive Director Dave Cook. “The impact of long-term opioid use and abuse has been significant to our organization financially, and to many of our members who have suffered as a result of defendants’ egregious behavior.”

Founded in 1979, the Intergovernmental Risk Management Agency (IRMA) was the first municipal risk pool in Illinois, and today, provides comprehensive risk management services, including workers’ compensation coverage, for 72 municipal groups in northeastern Illinois.

The Intergovernmental Personnel Benefit Cooperative (IPBC) is a public risk entity pool established in 1979 by Chicago area municipalities to administer some or all of the personnel benefit programs offered by participating members to employees and retirees.