In medicine, we have seen how methotrexate or anti-TNF drugs disrupted the prior management approach for treating rheumatoid arthritis or how new techniques in interventional radiology have bypassed the need for some invasive forms of surgery. Yet here we are, about to start a new year, and the key elements of office management and chart documentation that we are forced to use include technologies that rekindle memories of failed disruptions, such as the bulky 8-track cassette tape, the forever challenging videocassette recorder and the flip phone.
There has been endless wailing by physicians about using electronic health records (EHRs) (see “How Non-Transferable EHRs Have Affected Physician Practices,” Rheuminations, July 2015).6
The medical office has been transformed into a documentation center, where the collection & uploading of reams of data becomes the focus of the visit. We sacrifice the human interactions, those precious moments when we should be talking to the patient, listening to their story, asking questions & carefully examining them.
The poor visual layout, including tiny fonts and monotonous lists that form the basis of these costly and highly ineffectual systems, require our full attention, fixating our gaze and keeping our heads buried in the monitor screens. The expended effort that is required for the user to stay afloat in this sea of minutiae has a severe impact on the quality of the visit. The medical office has been transformed into a documentation center, where the collection and uploading of reams of data becomes the focus of the visit. We sacrifice the human interactions, those precious moments when we should be talking to the patient, listening to their story, asking questions and carefully examining them.
2016 will see even more practices moving to the EHR. But don’t consign your fax machines to the electronic recycling center yet. They will still be needed to accept piles of data from other offices, labs and pharmacies because many EHR systems remain gated and offline to others.
The Rise of the PBM
The PBM companies that exploded on the scene just a few years ago have forever changed how drugs are sold and dispensed. They have quietly amassed considerable power and hold sway in determining a patient’s access to medication. Because size is a major requisite for their success, this field has seen considerable consolidation, with just a handful of key players controlling 70% of the U.S. market.7
In theory, PBMs serve as the go-between for health insurers and their patients. This sounds simple enough. However, their multiple revenue streams—including fees for negotiating separately with such competing interests as pharmacies, insurers and drug manufacturers and for processing prescriptions and operating mail-order pharmacies—make their business model somewhat opaque. Are they looking for the best ways to serve their patient customers or are they hindering their access to the drugs that their doctors have prescribed? Are the savings that are generated by the scale of their purchases being passed on to the consumer, rebated to the health insurer or simply pocketed? As third-party negotiators, PBMs haven’t always disclosed rebates, discounts, itemized billing statements or the percentage of savings passed on to insurers. This leaves clinicians in a quandary, because the PBMs have the power to reject any of the drug recommendations that a physician may suggest.
