Dr. Kevin Most: The cost of medicine and the flu

Steve Cochran and Dr. Kevin Most

Topics to discuss- Federal law requiring hospital to post prices, Influenza is coming very soon, New influenza medicine $150/dose. Study about Flu Mist bad timing of the release of the study. Thoughts?? Too much? We could move price transparency to its own or tee it up and say we need to discuss it in more depth later. Flu should be pretty rampant in the next 2 weeks and the confusing flu mist study results is concerning, plus the new medication for flu is interesting.

Price transparency- not as simple as a McDonalds price list

The cost of health care has been one of the most confusing and aggravating issues for the public. The bill that shows a $20 Tylenol to the bill that cannot even be read none the less understood have raised the ire of the public for decades. The federal government for years has been trying to figure out what it can do with price transparency and as of January 1, 2019 they think they have done something. The reason I say they “think” they have done something is quite simple. As of January 1, each hospital must post a list of their charges for the public to view. Now many of you may be saying it is about time. However this is not as clear or simple as it seems.

The prices posted are not the prices patients or their insurance companies pay. You ask why? And the answer gets a bit more complex. In some cases the price posted is not used at all, for some insurance companies that have negotiated specific prices for some procedures, for Medicare patients the government has set a price it will pay for a specific diagnosis regardless of what the hospital charges, and those patients are not billed for the difference. Some insurance companies negotiate a discount over charges with the discount varying with each company and even more confusing is with each plan the company has will be different as well. Blue Cross for example has many different products each with negotiated rates that differ from each hospital.

Dizzy yet? For many of you with high deductible plans the price you pay will be a negotiated price for your deductible and then after that you may not be responsible for any health care costs or you may be responsible for 10, 15, 20 , 30% It all comes down to your plan. So when you sign up for insurance understanding your plan is much more important than looking at the list of charges posted by your hospital.

Now, I am not saying this a bad idea, I just am concerned of some of the unexpected outcomes. The patient who needs a colonoscopy may try to look that up, if they find it and find the right one, may see a price that they think is too high and they may put off or postpone that screening test when in fact it was totally covered by their insurance plan.

So posting prices may have been thought to be a good idea but it may lead to outcomes and issues that may have a negative effect on healthcare.

Flu Season is upon us

You really enjoy when you have a good idea and it is copied, I am sure some of you saw that the Golden Globes copied our idea of giving flu shots live on TV in the middle of the broadcast on Sunday night. I would bet that one of their producers was listening as we provided flu shots to The Steve Cochran Show, The Roe Conn Show and The Patti Vasquez Show this season. In reality they were just faking giving the flu shots where we did it for real. Either way the exposure of the celebrity getting a flu shot hopefully impacted the general public as a reminder of this health issue.

Well we are in Flu season and although many of you may have had the bad upper respiratory infection that has been running rampant thru businesses, the flu season is on the way. Currently there are 19 states with Flu activity being reported as high with Indiana and Kentucky being two of the states. The concern is that in one week we went from 9 states to 19 states with high activity. We also have seen the number of states with widespread activity go from 11 to 24 states in one week. So for the procrastinators who have not gotten their flu shot yet, your window of opportunity is closing very quickly. In Chicago the screening sites noted a significant spike in the positive tests this past week, which will bring us to high activity within the week

The timing should also now put us in a high awareness of our surroundings and doing whatever we can to protect ourselves. Remember the importance of washing your hands and staying away from individuals who are sick. Those who are feeling the symptoms of the flu should stay home from work, stay away from seniors and stay away from infants as those populations are the most vulnerable.

Symptoms include high fever treatment, cough, sore throat, muscle aches, headaches and fatigue. The differences between influenza and the common cold include influenza symptoms coming on suddenly, fever lasting 3-4 days, severe body aches, headaches and chills. Most of those symptoms are usually not found with the common cold.

For the individuals who have not been vaccinated and get the flu, the good news is that the anti-viral flu medications have also been shown to work against these strains, there has been no resistance. This is good but remember these medications must be started within 48 hours of the onset of the flu and in reality only knock a day or two off of the illness. There is a new medication Xofluza, this medication was just approved in the fall and is a single dose medication that like the others needs to be taken within 48 hours of the onset of symptoms. The studies have shown this is just as effective as our other current flu medications. The cost of the medication may cause you to pause as it is $150 for the single dose and may knock a day or two off of the 7-10 day illness.

Now that we have some flu activity, the usual next question is, “does the flu shot cover what is being seen?” well the good news so far is that the strains identified thru the end of the year were noted to be similar to the virus strains in the 2018-2019 Northern hemisphere influenza vaccine. This is good news for those who received the vaccine.

An article in this week’s journal of Pediatrics has placed some confusion in the pediatric world. The Journal reported a study that showed that the Flu Mist was not very effective against the flu for the 2013-2014 and 2015-2016 when compared to the flu shot. This was information that we had known in the past and impacted the removal of the Flu Mist from 2016-2017 and 2017-2018 flu seasons as an option. The company however continued to provide the product in Europe and also reformatted it for this flu season and won approval from the CDC to begin using it again for this flu season. The reformatted product has obviously not been studied but will be watched very closely this year for its success rate in preventing the flu. This study will certainly raise some concerns in the parents of children who got the flu mist as well as those adults who opted for the mist vaccine as well.

This year we are seeing a predominance across the country of an influenza A H1N1, in fact over all it is approaching 97% of the cases. If you remember last year we also started out with an Influenza A virus, however it was a different strain and then finished with a strong surge of Influenza B strain that came on in March. The flu season last year was a bad season and lasted a total of 19 weeks. Estimates this year are that the flu season may last 20 weeks.

An article in this week’s journal of Pediatrics has placed some confusion in the pediatric world. The Journal reported a study that showed that the Flu Mist was not very effective against the flu for the 2013-2014 and 2015-2016 when compared to the flu shot. This was information that we had known in the past and impacted the removal of the Flu Mist from 2016-2017 and 2017-2018 flu seasons as an option. The company however continued to provide the product in Europe and also reformatted it for this flu season and won approval from the CDC to begin using it again for this flu season. The reformatted product has obviously not been studied but will be watched very closely this year for its success rate in preventing the flu. This study will certainly raise some concerns in the parents of children who got the flu mist as well as those adults who opted for the mist vaccine as well.