ORA Survey Reveals Patient Worries About Insurance Coverage
and How They Skip Their Medication to Save Money
An important part of caring for patients with chronic illness is to understand the forces that are at work in their lives - forces beyond just the physical signs and symptoms of their disease. One area of increasing stress for patients is their relationship to the reimbursement system. In an attempt to understand these forces, the ORA commissioned a survey in the spring of 2004. The Oregon Survey Research Laboratory, a professional survey company affiliated with the University of Oregon, talked with physicians and multiple patient focus groups. Woody Carter Ph.D., the Director of Research, and Juyeon Son MS, MA, surveyed 19 different rheumatology practices with a carefully constructed questionnaire. Of the 1598 patient questionnaires distributed, 87 percent were returned--a very high response rate. The resulting data has revealed important findings for patients, physicians, and the medical care system.
Medical office workers were also surveyed regarding insurance company difficulties, including time spent on insurance matters, best and most problematic companies, and suggestions for improvements.
Although a detailed summary will be sent to ORA members, several striking findings are important to note. When asked to rate their health insurance on different dimensions, patients said that both the cost of medicine co-pays and premium cost were of great concern to them. They rated customer service, convenience of lab location, and doctor co-pays as less of a problem. When patients were stratified by their arthritis status, many of the health insurance concerns were significantly worse for those who were doing poorly in regard to their arthritis. In other words, insurance problems were more stressful when the patient was also doing poorly medically.
Other questions probed future concerns about insurance matters for the next twelve months. Increased co-pays, loss of coverage and denial of arthritis medications were grave concerns for between 10-20 percent and a cause for concern for an additional 25-35 percent. In addition, when the results were stratified for those patients who are doing less well, the concerns were significantly magnified.
"Those patients who report themselves to be the most affected by their arthritis are the least secure about the continuity of their insurance coverage and the quality of care their insurance provider will permit," reported Dr. Carter.
Because patients are often so worried about their medical care and its cost, the survey asked what cost-cutting strategies they had adopted. Twenty percent reported that they had stopped taking their medication at some time in the last twelve months for cost reasons and 14 percent had skipped doses to make the medication last longer. Eleven percent had not filled an arthritis prescription and 9 percent had skipped a doctor visit or a lab test. All these figures were statistically significantly higher for those who were doing poorly in regard to their arthritis. Thus, the patients who could least afford to cut back on treatment were doing so.
When the medical office personnel were asked about their concerns with their patients insurance, they reported that the most important issues were pre-authorizations for medications and insurance paperwork regarding arthritis medications. Over 80 percent said that they believe the present health insurance implementation system impairs their patient's health in many ways and to a significant degree. When asked to rate the "best" and the "worst" insurance companies, they ranked Pacific Source, ODS and Life Wise the best and ranked Cigna, Blue Cross (Regence) and Pacific Care the most difficult with which to deal.
Many questions had room for comments as well. Examples of patient courage and perseverance were heart rendering, often in just a matter of a few words. "Please give us a health insurance we can afford. I have a wonderful doctor, he cares." "You are still human; pain meds are important, riser in seats are a must" "You need to realize I have no money to live my life after all the medical bills. I am on disability and can barely hang on to my home. I have no money left for a life."
Making the correct diagnosis and finding the best medicine are only parts of the problem. We need to fix the broken health care system. We hope that the results of this survey can be used in our advocacy efforts for patients at all levels of the health care system.
Cox-2s on the Hill
ACR President Elizabeth Tindall ascended capitol hill in February to testify at a FDA hearing on the risks and benefits of cox-2 inhibitors.
The FDA called the three-day hearing to decide whether Bextra and Celebrex should be more closely regulated or pulled from the market after studies showed problems with the class of drugs and Merck pulled Vioxx from the market.
In her February 17th statement, Dr Tindall recommended that the FDA lead the effort to ensure that patients and the public are aware of drug toxicities, including traditional and cox-2 selective NSAIDs. She told regulators that the ACR supports the FDA's efforts to ensure clarification of the most important drug toxicities in all direct-to-consumer advertising and to provide a full disclosure of results of all industry-related trials. The ACR also supported the formation of an independent Drug Safety Oversight Board that the FDA previously announced would strictly monitor medicines already on the market. But until more complete information about the risks of nonselective and cox-2 NSAIDs become available, Dr Tindall strongly suggested that physicians be able to prescribe these medications when physicians and patients agree that the benefits outweigh the risks.
Other advisors on the panel suggested the FDA impose severe "black box" warnings, restrict which patients could obtain the drug, and require manufacturers to include more patient information with the medication.
Although the FDA is not required to follow the panel's advice, it voted to keep both Bextra and Celebrex on the market. The FDA recognized that limited Bextra studies showed higher cardiovascular risks.
Some panel members thought the drugs should be second- or even third-line treatment choices, Dr. Garrett FitzGerald, chair of the University of Pennsylvania Pharmacology Dept., noted in the AMNews. "I will be surprised if third-party payers continue to reimburse for these drugs."
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Letter to the FDA
ILester Crawford, DVM, PhD
Dear Dr. Crawford,
I wish to express my dissatisfaction with the recent FDA rulings mandating black box warnings for all NSAIDs, selective, non-selective, prescription and OTC. As a practicing rheumatologist for nearly 25 years, I have MORE>>
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Its All About Mom ... Editorial
After looking at the results of our patient survey and the new data from the AMA on the failures of HMO's, I've come to the conclusion that the best way to look at our faltering health care system is to visualize it as one big dysfunctional family. We have the hard working Father, who MORE>> |
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Medicare Opens Ears to Physicians
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Humira
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Making LIfe Easier in Central OR
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Medicare Tests Pay-for-Performance
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Salem Target for Texas Rheum
Dr Bobby Han recently completed his rheumatology fellowship at the University of Texas Southwestern Medical School in 2004 and made his way to Salem, where he now practices. Dr Han, originally from Seoul, South Korea, earned his medical degree at the Seoul National University College of Medicine. He served his mandatory service MORE>> |
CMS Judges Increased Complexity
Beginning January 1, 2005, the Centers for Medicare and Medicaid Services (CMS) implemented coding changes for physician-administered drugs, according to the ACR's Practiceview: 2005 Revised Medicare Drug Administration Codes. As a result, rheumatologists can bill for infusions of monoclonal antibodies and other biologic response modifying agents using the same codes as oncologists and other physicians MORE>> |
OHSU Gains New Rhuem
Dr Lauren Kim joined the ranks of the Oregon Health & Sciences University Rheumatology department as an Assistant Professor of Medicine last June when she and her family decided to leave snowy Boston for a milder Portland, Oregon. Our newest member earned her medical degree at State University of New York MORE>>
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Fall & Winter Meeting Summaries
The 4th Annual Fall Meeting of the ORA was held last September at the Salishan Lodge on the Oregon Coast. Dr John Esdaile presented his talk on " Cost Effectiveness for Clinicians: What You Need to Know." Brian Johnston, a leading attorney and mediator rallied the troops with his talk on effective negotiation. Dr Richie Wernick Rheumatologist at Providence Hospital and OHSU and his band, the BeachGrass Brothers serenaded the group MORE>> |
OR Rheumatology Growth
By 2015, Rheumatologists will be retiring faster than they can be replaced by current training programs, the ACR estimates. To prevent a shortage in Oregon, ORA, through a grant provided by Daiichi Pharmaceuticals, encourages rheumatology fellows to consider Oregon as a practice location. Twice a year, ORA invites fellows to attend MORE>> |
