Another Whitewash of GPO Culpability in Soaring Costs and Shortages in the Drug Supply Chain?

By Marion Mass, MD and Craig M. Wax, DO

It appears the House Energy and Commerce Health Subcommittee on Health is preparing to whitewash the culpability of GPOs in causing drug shortages and soaring prices at its May 9th hearing on the drug supply chain.

Will any Committee Members be willing to ask any of the hard hitting questions below?

1. Multiple government panels have pointed to the GPO (Group Purchasing Organizations) role as a root cause of drug shortages. This is causing an increase in overall costs. In Chairman Pallone’s spin memo announcing the hearing they are spun as ” GPOs help hospitals and physicians aggregate purchasing volume to negotiate discounts with manufacturers and distributors.” Americans are NOT seeing lower healthcare costs. Can anyone on the panel tell me why the GPO are given this free pass?  Perhaps Chairman Pallone needs a new title: honorary spin doctor.

2. Hopkins surgeon and author Dr. Martin Makary has written about these GPOs as a root cause of shortages and high prices in the Journal of the AMA: https://jamanetwork.com/journals/jama/article-abstract/2708613 .

Dr Resnick, you are the board chair of the AMA. what can you say about Dr Makary’s assertions that the GPO are causing supply chain disruptions and cost increases to the American patient? Can you comment particularly on how this is affecting rural communities?

3. Dr. Resnick,  has any section of the AMA explored the issue of the legalized kickbacks, (AKA rebates) enjoyed by the GPO and by the PBM? [“Fun” Fact about Jack Resnick, MD: in addition to serving as chair of the AMA Board of Directors… Guess what? He’s also on the board of the scandal-plagued National Quality Forum.

4. Question for Kave Niksefat of Amgen. Your company makes biologic medications. These biologics were given significant patent protection via the backdoordeals used to pass the ACA as evidenced in Stephen Brills Book, America’s Bitter Pill. Can you comment on your company’s role in these deals? As a result of patent protection, how much money has Amgen made above what it would have had there been competition?

5. Question for Lynn Eshenbacher, as the leader in a large hospital network, can you comment on investigations led by state attornies general regarding Amgen (also on the panel) regarding how an amgen anemia drug was getting overfilled by hospitals and clinics who received kickbacks? This overfill was paid for by medicare dollar. Are you aware of any such overfills now going on, or any bonuses given to your hospital system or other hospital systems encouraging the use of specific products? This could be via manufacturers themselves or the GPO that arrange the contracts for 90% of hospitals. https://www.healthleadersmedia.com/finance/15-states-sue-amgen-alleging-kickback-scheme .

6. Question for Jeffrey Hessekiel: Your company manufactures cancer medications. It is well known that chemotheraputics are in shortage. Here is a piece written by Liza-Marie Johnson, MD, a pediatric oncologist and bioethicist at St. Jude Children’s Research Hospital in Memphis, Tenn https://blogs.stjude.org/progress/cancer-drug-shortages-threaten-most-vulnerable-patients/ . describing shortages of drugs for children with cancer. Are these shortages impacting rural hospitals worse than non-rural? Can anyone else on the panel back up her assertions that the shortages are of ” older but proven drugs that are no longer profitable for their manufacturers. The older and cheaper a drug is, especially a generic, the more likely it is to be scarce.” Why is this? What is the ROOT cause of these shortages? if physicians like her desire the drugs, and they are older medications not on patent, what exists to prevent a multitude of companies from making life saving medications.

7. For Leigh Purvis, please describe the AARP relatonship with the following:

With insurance companies: What percent of AARP revenue comes from selling Medicare Advantage plans, supplement plans and Part D Plans?

With United health care’s PBM Optum: Do you or anyone on this panel encourage Medicare Advantage members to have home care visits? Are you aware of these visits increasing risk scores and causing more medicare money on these patients? https://ip4pi.wordpress.com/2019/01/24/corporate-giants-and-the-government-revolving-door-create-costly-and-fragmented-care/

If The AARP has a  relationship with United: can you comment on the DOJ’s investigations into how United is defrauding taxpayers? https://www.acsh.org/news/2017/02/21/department-justice-believes-united-healthcare-defrauding-medicare-10885

8. Most important question for all on the panel and for every member of this committee: Do you support legalized  kickbacks for any industries in the hospital supply chain, notably GPO and PBM who do no research, no manufacture and no distribution? The kickbacks are costing the American Public $200 billion PER YEAR

AMA looks for gold in mining patient and physician data.

Two more items to pitch into “the AMA is utter Garbage” file:

  1. The AMA supports resuscitating the dead-end failure that is the “Affordable Care Act.”  Patients have seen soaring premiums, deductibles, and medical costs, while at the same time often losing access to their doctor and other medical facilities of their choice. Physicians have suffered continued suffocation by ACA red-tape. But the AMA supports propping up this disaster of a law and throwing more good money after bad. 
  2. AMA looks for gold in mining patient and physician data. Why is the AMA advocating against the best interests of doctors and patients? Follow. The. Money. The AMA has discovered it is more lucrative to sell patients and doctors out than to support their interests. Since 1983 the AMA has been making millions of dollars per year from the CPT monopoly it secured in a secret deal with the feds back in 1983. CPT has metastasized into the EHR fisaco that now plagues nearly every office and facility. Now the AMA is hoping to find another pot of gold by mining the data CPT helped to create… patient and physician medical data to be exact. How much can the AMA make of the data? Who knows, but you can read more about the new initiative here: https://healthitanalytics.com/news/ama-launches-integrated-healthcare-big-data-analytics-platform.

Danger, Will Robinson! Danger!

The AMA is utter garbage. But, you knew that.

Here they go again. Once again the AMA is promoting what’s best for the big government / big insurance / big hospital cartel instead of advocating solutions that will truly empower patients, physicians, and increase access to high-quality, low-cost care.

Real Solutions Encourage Responsibility; Safety Nets Should Not Become a Chronic Need

Dr. Robert Villare responds to the AMA’s continued support for Medicaid Expansion and ACA:

To K B O’Reilly on AMA wire. Better question to ask is why so many Ohioans (700,000) are on Medicaid.

It is well documented that these populations reproduce with abandon and lack a mother and father family presence, are irresponsible and non-compliant, and practice poor health habits. You write nothing about their need to get responsible or the need for Ohio to create jobs to resolve this root cause problem of the need for Medicaid. Safety nets, while appropriate in some cases, should not become a chronic need for residents.

The rant about covering everyone, with no contingent duties and responsibilities is old. You note nothing about how you think this should be paid for–the real dilemma over the last 30 years. Easy to say “cover everyone” but not easy to pay for it without burdening hard-working people that you will mandate the taking of more monies out of their pocket to give to others who feel entitled and may well lack appreciation for the handout.

Solve that problem. Give them jobs to earn at least some of their medical care, and terminate the costly regulations and liability issues facing providers in this litiginous population.

Who does “Organized Medicine” work for?  Follow. The. Money.

With a significant portion of their physician constituency opposing the misnamed Affordable Care Act, i.e. Obamacare, and set to be harmed by bureaucracy-laden MACRA regulations why are some of the biggest names in “organized medicine” out in front cheering on these harmful programs?

Follow. The. Money.

The American College of Physicians has received about $3.5 Million in taxpayer funds from the federal government since 2011:
https://www.usaspending.gov/Pages/AdvancedSearch.aspx?sub=y&ST=C,G,L,O&FY=2016,2015,2014,2013,2012,2011&A=0&SS=USA&RN=American%20College%20of%20Physicians

The AMA $5.4 Million (not including CPT royalties):
https://www.usaspending.gov/Pages/AdvancedSearch.aspx?sub=y&ST=C,G,L,O&FY=2016,2015,2014,2012,2011&A=0&SS=USA&RN=american%20medical%20association

And this is “chump change,” explains Dr. Meg Edison, compared to the $86 Million taxpayer dollars the American Academy of Pediatrics raked in. “No wonder they were hashtagging the heck out of #VoteKids at election time. It’s a big business.”
https://www.usaspending.gov/Pages/AdvancedSearch.aspx?sub=y&ST=C,G,L,O&FY=2016,2015,2014,2013,2012,2011&A=0&SS=USA&RN=American%20academy%20of%20pediatrics

Bob Doherty, Exec. Dir. of ACP retorts that the taxpayer dollars “to help docs improve quality isn’t a COI but core to ‘ mission to promote excellence in medicine.”

“Helping docs improve quality” is apparently a euphemism for training physicians to comply with the crushing burdens of ACA and MACRA, a program passed in the name of “quality” but which ultimately punishes physicians for practicing individualized patient care, instead of cook book medicine as defined by CMS policy-wonks.

A sizable chunk of the funds flowing to ACP is ACA-driven funding “to help health providers achieve large-scale transformation” and “ensure sustainability” of these efforts.

With these large sums of money flowing into the coffers of those supposedly representing America’s physicians and their patients, it’s past time for hard questions to be asked and answered. Whose interests is “organized medicine” really looking out for? A hint: it’s not physicians or patients…

AMA Seeks to Soothe MACRA Mania?

Dr. Robert Sewell, author of A Surgeon’s Heart, replies to comments by AMA President Steven Stack’s comments about MACRA:

This statement from Stack is the exact same Drivel we heard from the AMA surrounding the passage of the ACA. “Don’t worry, we will revisit it every year and we’ll make it better.” To that I have only 2 words and they start with the letters B S. AMA “Leadership” is in the tank for the government and their total take over of medicine. No matter how the AMA tries to soft-sell all this crap, it is clear they are satisfied because they’ve salvaged themselves by making a deal with the devil. I say to hell with them. This is why I left the HOD in 2013 after four years of actively trying to change the organization from the inside. It can’t be done. Unless you are willing to play along with their scheme, your voice is ignored. They even have all board members agree to never discuss what goes on inside their closed meetings, AND every decision must be openly supported by every board member. I wish I could find a bookie who would take odds on the likelihood that MACRA will be delayed or altered in any substantive way. I might finally be able to retire by mortgaging my house and putting everything on the AMA/Government plan standing pat, despite the preponderance of negative feedback they are receiving. Continue reading

Members of our profession testified on Capitol Hill and sold us out.

Dr. Kris Held’s writes in:

Members of our profession testified on Capitol Hill and sold us out. Culprits include the AMA, ACP, AAFP, and Aurora Health Care Medical Group . I just finished reading these testimonies, and clearly they are vying for MACRA’s $20,000,000 per year for the net 5 years doled out to SAN awardees and PTN grantees to “educate physicians” about MACRA and “engage” with CMS. Selling our souls.

I would love to know how much $ the AMA got as a grantee of the TCPI and as an Awardee of the SAN. The ACP, AAFP, and Aurora Group (from WI) are begging for grant/award. ACP is working with AHIP.

“The AMA is also a grantee of the CMS Transforming Clinical Practice Initiative (TCPI). As a Support and Alignment Network (SAN) Awardee, the AMA is promoting the goals of the TCPI to the TCPI network of clinicians through education about MACRA, CME, dissemination of best practices, promotion of clinical data registry use, and provision of tools and resources on APMs.”

How did these private groups get invited to testify? Who authorized the to embrace MACRA and seek $Millions is awards and grants “Educate” their members(us lowly physicians) about it? Why were other “stakeholders” not invited to the party?