At the current rate, in less than 10 years the U.S. will spend $1 of every $5 on healthcare

Reviewthe medical

THE BOTTOM LINE

Top 10 Best Hospitals For Medical Travel

1. Fortis Hospital–Bangalore, India

2. Gleneagles Hospital–Napier Road, Singapore

3. Prince Court Medical Centre–Kuala Lumpur, Malaysia

4. Shouldice Hospital –Toronto, Canada

5. Shoen-Kliniken–Munich, Germany

6. Bumrungrad International–Bangkok, Thailand

7. Bangkok Hospital Medical Center–Bangkok, Thailand

8. Wooridul Spine Hospital– Seoul, Korea

9. Clemenceau Medical Center–Beirut, Lebanon

10. Christus Muguerza Super Specialty Hospital–Monterrey, Mexico

Source: Medical Travel and Health Tourism Quality Alliance

Covidien will make its oral Transmucosal Fentanyl Citrate available to distributors serving retail pharmacies across the country. The FDA approved the Abbreviated New Drug Application (ANDA) for Oral Transmucosal Fentanyl Citrate on October 30, 2009. The product is expected to be available at retail pharmacies in mid April 2009.

The drug is a generic alternative to the branded ACTIQ®. It is a solid formulation of fentanyl that resembles a lozenge on a handle. Oral Transmucosal Fentanyl Citrate, a Class II controlled substance, is an opioid analgesic indicated only for the management of breakthrough cancer pain in patients 16 years of age and older with malignancies. These patients must already be receiving and be tolerant to around-the-clock opioid therapy for their underlying, persistent cancer pain. The dosages include 200 mcg, 400 mcg, 600 mcg, 800 mcg, 1,200 mcg and 1,600 mcg strengths. The company has implemented an extensive risk management plan to help ensure the appropriate and safe use of this medication.

However, the risk for inappropriate use remains high for this drug. As with Actiq and Fentora, off-label use of this Fentanyl preparation will be widespread. It is not unusual to see 30 day supplies prescribed of 700-800 pills with annual costs exceeding $500k for non-approved use of this narcotic. It is impera-tive that close clinical scrutiny be given when claims are processed for this drug. Although the generic preparation is expected to have lower costs, the medical necessity of the drug should be assessed in the absence of a cancer diagnosis.

Covidien Launches New Fentanyl Citrate Formulation

In March 2010, the FDA approved Botox (onabotulinumtoxin A) to treat spasticity in the flexor muscles of the elbow, wrist, and fingers in adults. Spasticity is common after stroke, traumatic brain injury, or the progression of multiple sclerosis. Botox works by temporarily blocking the connec-tions between nerves and muscles, resulting in a temporary paralysis of the spastic muscle. In clini-cal trials, Botox was found to be beneficial for only upper limb spasticity.

Lower limb spasticity, other upper limb disorders and fixed contractures did not see the same therapeutic effect. Botox should also

be used in conjunction with physical rehab on these patients and is not meant to replace other therapeutic modalities. Botox can also be used for therapy to treat abnormal head positions and neck pains related to cervical dystonia and eye muscle problems.

Botox has high off-label usage spanning both appropriate and experimental. Although individual use may not be expensive, the long-term financial impact can be costly. Often, there is no treatment end point for patients so select cases should be reviewed for medical necessity. Average wholesale price for 100u of Botox A is $630.

Botox Therapy Update

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Spring 2010Volume 7, Number 1

In March 2010, A Los Angeles jury con-cluded that Anthem Blue Cross should cover the cost of an out-of-state liver transplant. Blue Cross approved the patient’s liver trans-plant in late 2006, and he was on the waiting list at UCLA Medical Center. But the company refused to pay when the patient decided to have the operation in Indiana, where wait times are far shorter than in California. The Anthem Blue Cross contract stated that transplants must be performed only at Cali-fornia Centers of Excellence and, thus, the denial was issued. The patient reportedly had a very high MELD score at this time and was considered an urgent case.

The jury voted 10 to 2 that the company breached its contract with the patient. It

voted 9 to 3 that the health insurer acted in bad faith by refusing to pay for the out-of-state operation. The panel deliberated for less than two days and awarded the patient $206,000 for the liver transplant cost plus legal expenses. Anthem admitted that they had erred and should have approved the patient’s transplant. They had offered to settle with the patient months earlier for more money than what was awarded, but the patient declined on principle. The patient’s attorney planned to broaden the jury’s ver-dict under the state’s unfair competition law. He wants Blue Cross to allow its California members to pursue organ transplants at hospitals nationwide that do business with its parent, WellPoint Inc. The patient will donate his monies to liver research.

Anthem Blue Cross Loses Lawsuit In Liver Transplant Denial

According to an article published in Healthcare Finance News, The Mayo Clinic is responsible for $22 billion in healthcare spending nationwide. Mayo has locations in Min-nesota, Florida and Phoenix with the Rochester, MN location accounting for $9.6 billion of the spending. Mayo considers itself the largest integrated, not-for-profit group practice in the world.

In a study conducted by the Battelle Memorial Institute, the results noted that each dollar spent by Mayo on operations, supplies and personnel generates an additional $2.05 for the national economy. It also found that Mayo directly and indirectly supports 144,468 jobs, generates nearly $1.9 billion in federal tax revenue and more than $1 billion in state and local tax revenue. Mayo also invested $391 million of its own funds into research and education activities in 2008. President Obama’s administration also looked towards Mayo in considering processes that could streamline healthcare operations.

In considering the financial impact Mayo has had to date, it is important to note that Mayo (in all locations) is a serious offender in the inflation of its hospital billed charges. All facilities bill via a central agency, offer limited discounts and will not negotiate on claims. The network status of a claim is not pertinent as Mayo ceased all individual negotiations with payors in 2006. Although Mayo is to be applauded for their contribution to the national economy, it does beg the question at what price does that become too expensive?

Mayo Clinic’s Impact On Healthcare Spending

Currently, the average first year costs for a cadaveric liver transplant are $425,000.