Medical Association Blatantly Distorts DWC Report

Tuesday, January 15, 2013 | 0

Warning, this post contains adult language.

Not content with reaching into employers’ pockets and taxpayers’ bank accounts, the physician dispensing industry’s slimy tentacles are oozing into the world of what passes for journalism at the Sunshine State News, and, based on SSN’s own writing, may well be spreading their noxious slime into the Florida Medical Association as well.

Nancy Smith, ostensibly an ”editor” at the Sunshine State “News” said this: "A new report from the state Division of Workers’ Compensation (DWC) points to continued interference by insurance carriers into the doctor-patient relationship," citing payers’ efforts to control the cost of physician-dispensed repackaged drugs. I’ve read the report – I doubt Smith has – and that is NOT WHAT THE REPORT SAYS. It doesn’t infer that, imply that, implicitly or explicitly state that or anything close to that. There are a number of other completely false assertions in Smith’s pathetic piece, but my head will explode if I go into them individually…

Here is the report – and I’d encourage you to send it to Smith on the off-chance she actually decides to read it and correct her gross mischaracterization. Her email is nsmith@sunshinestatenews.com.

It appears Smith is just parroting a blatantly misleading hatchet job put out by the Florida Medical Association. If the FMA wrote it, shame on them. If it was written by a physician-dispensing company and just distributed by FMA, even worse.

BTW, I emailed the FMA and asked for a copy of the FMA’s statement about the DWC report. No response.

The DWC report indicates the number of reimbursement disputes is up some 872% over the prior year, driven primarily by “increases involving physician dispensed medication.” That’s a good thing; employers and governmental entities, fed up with paying outrageous upcharges for repackaged drugs, are disputing physician dispensers’ bills. As it is indeed their fiduciary obligation to do, and as they were encouraged to do by the previous CFO of the State of Florida. In reality, in many of the disputes, payers are paying a nominal amount, and end up agreeing to pay what they’d normally pay a retail pharmacy.

So that’s what the DWC report said. And somehow this shill who masquerades as a journalist – and/or the FMA, masquerading as a patient advocate – interprets this as insurers interfering in the doctor-patient relationship.

This is absolute, complete, total, utter bullshit. 

Here’s how a colleague put it when asked if insurers are “interfering”:

“…we’re interfering all right.

We’re interfering with their clear abuse of the workers’ compensation system, of employers who foot the bills; we’re interfering with their profit-seeking brethren who hide behind a curtain of their arrogant claim to be a sole protector of their patients, when they can’t know in dispensing repackaged drugs what all other medications their patient might be taking and thereby potentially jeopardizing their patient’s health. And, we’re interfering with their unethical practices that even their own professional organization has frowned upon. The AMA has an ethical rule against physician dispensing for profit. So, yes we’re interfering – and we’re imploring Florida’s policymakers to interfere, to protect the public from the cost abuse, to protect patient safety, and enforce their own medical ethics. Since the FMA is unable to do this themselves. That’s what I’d say.”

Here’s what the AMA says in Opinion 8.06

(2) Physicians may not accept any kind of payment or compensation from a drug company [emphasis added] or device manufacturer for prescribing its products. Furthermore, physicians should not be influenced in the prescribing of drugs, devices, or appliances by a direct or indirect financial interest in a firm or other supplier, regardless of whether the firm is a manufacturer, distributor, wholesaler, or repackager of the products involved.

(3) Physicians may own or operate a pharmacy, but generally may not refer their patients to the pharmacy…

Hello, FMA! Can you spell “conflict of interest”?

Sorry for the adult language – this is the first, and hopefully only – time.

Joe Paduda is co-owner of CompPharma, a consortium of pharmacy benefit managers, and owner of Health Strategy Associates, an employer consulting firm in Connecticut. This column was reprinted with his permission from his Managed Care Matters blog.