I have enjoyed preparing this series of articles relating to healthcare and medical education over the past few years. I find the research and analysis of data lying beneath many of the articles to be intellectually satisfying. People tell me that I am making a difference and encourage me to keep it up. In truth, I also found that the actual process of writing itself, and the sharing of my ideas or opinions to be personally rewarding. I am neither the first nor the last to be enthralled by the ability to self-publish – or less elegantly stated, to blog!

There have been occasions where I recognized that the subject of some of my offerings strayed from the main theme of health policy, but I could usually justify that, at least to myself. However, I increasingly feel the urge to write about things that even I cannot warp into the world of healthcare. Thus, to feed this imperative, I launched this week a second unabashed blog —     There are a couple of timely things there now.  Take a look from time to time and help me turn it into something interesting and useful.  I will place a link to the site in the sidebar of this one to remind you.


Prescription of Medicare Part-D Drugs Nationally: $Billions Left On The Table.

In my last article, I profiled the outpatient drugs prescribed to elderly and disabled Medicare beneficiaries of Kentucky in 2013. While I still had the analytical templates still in hand, I extended that analysis to all 50 states. Initial inspection suggests that the relative pattern of drug prescription (and dispensing) is not greatly different than that of Kentucky. It may not be a surprise that we of the Bluegrass state consume relatively more hydrocodone, oxycodone, and gabapentin relative to other drugs, but less oral anticoagulant. A more granular comparison of Kentucky to the the the nation will require a different approach. This Medicare data allows us to separate out the proportion of a given drug product that is dispensed and billed as a generic drug; a brand name drug; or as alternate preparations such as long-acting, tamper-resistant, or solid vs. liquid. The big take-away for me is that despite the supervision of Medicare’s prescription drug programs by pharmacy benefit managers and others, much money is being spent in less than a medically defensible manner– or is frankly wasted. We as a nation are leaving billions of dollars on the table for pharmaceutical companies and those who market and distribute their products. I will summarize below national utilization and cost figures and make available an Excel file supporting the graphics.

Background. I have been exploring the inaugural release of Medicare prescription drug utilization since its publication last spring. (We should get the numbers from calendar year 2014 in the next few months, but I have Medicaid 2014 in-hand and up-next!). The database does not include all Medicare beneficiaries, only those in Medicare Managed Care or in Medicare Part-D Drug plans, but that makes up a majority of bebefuicuarues. The proportions vary from state to state, but the Medicare programs covers eligible individuals over the age of 65, and some individuals who have been certified as disabled. There is a sizable proportion of individuals who are eligible for both Medicare and Medicaid for other reasons. I frankly do not at present have a good handle on the numbers of beneficiaries in these and other categories that may be included within the present data. Continue reading “Prescription of Medicare Part-D Drugs Nationally: $Billions Left On The Table.”

A Different Look At Drug Prescribing in Kentucky.

Visualizing prescription patterns for Medicare patients with an eye to safety and cost.

In the name of quality, accountability, and paying for results, what began as a trickle of information previously unavailable the public about utilization, cost, and outcomes of medical services became a torrent. The challenge for professionals and patients alike is how to evaluate and act upon all this data. I include myself among the learners. My readers may have guessed correctly that I like to look at spreadsheets, pivot tables, and maps. Exciting new ways of looking at such “big data” are also becoming available. “Data visualization” is a current buzzword and I am experimenting with it.  In this article I use a new way to summarize the number of prescriptions and associated cost for all drugs prescribed for Kentucky Part-D and Medicare managed care beneficiaries in 2013. This segment of Medicare patients received over 25 million prescriptions and refills that year with a total cost of $1.6 billion. I will show that a few dozen drugs comprised half the volume and cost of all prescriptions, attempt to shock you again with the volume of opioids and other controlled narcotics prescribed to the elderly and disabled, introduce you to Kentucky’s most rapidly growing drug of abuse, and illustrate in one fell swoop how America can save $Billions nationally without any decrease in safety or quality of care. Does this sound like a late-night TV come-on?  Read on. Continue reading “A Different Look At Drug Prescribing in Kentucky.”

Details of Settlement Between University of Louisville and Norton Healthcare.

Congratulations are in order!

Last December 17, representatives of the University of Louisville, Norton Healthcare, and the Commonwealth of Kentucky signed a set of agreements that, for the next eight years at least, settle disputes over the physical, programatic, and financial control of the currently named Kosair Children’s Hospital.  Both principal parties pledge a new beginning and promise to work together for the benefit of our community.  I congratulate them.  All of us should take them at their word, and help in whatever way we can to honor their promises to each other and to us.  After all, Children’s Hospital is a unique and vital resource for our community.  This and related litigation has not been helpful for it.

In a series of articles in these pages beginning over two years ago, I made available to the public as many documents relevant to the dispute as possible to allow readers to form opinions of their own about the dispute. In this spirit, and in what I trust will be the the last installment of the series, I publish in their entirety the settlement documents which were kindly provided to me by the University.

In brief summary, it appears to me that both parties got most of what they initially declared was most important to them. Norton receives adequate protection against the threat of eviction from their hospital.  The Hospital’s medical staff remains open to all credentialed physicians in the community and Norton retains the ability to cooperate academically and clinically with the University of Kentucky.  The University is declared to be the sole academic sponsor of the graduate medical education program at the hospital and is assured of a predictable and generous flow of financial support – albeit with a greater degree of accountability attached.  One might reasonably ask then, why did it take so long to come to agreement? What changed in the recalcitrant endgame?  I will venture a few thoughts on this question at the end of this article.  In the meantime, here are the four documents with a few comments about each. Continue reading “Details of Settlement Between University of Louisville and Norton Healthcare.”

Governor Bevin Comes to President Ramsey’s Rescue.

Things are unraveling more swiftly at the University of Louisville. Against a background of mounting local, state, and even national concern about the ability or appropriateness of President James Ramsey to lead the University; and with more frequently heard rumors that his remaining tenure is numbered in days and weeks; at last week’s Board of Trustees meeting, two Board members withdrew their support of his presidency and the Board Chairman voiced support of decentralizing the leadership of the University and UofL Foundation – a change President Ramsey vigorously opposed. Support from the community demanding that the Board exercise their statutory and community responsibilities to protect our University seemed to actually be having an effect – at least for some Board members.

A life preserver is thrown.
No sooner than it takes to make a phone call to Frankfort, Governor Bevin announced his intention to declare illegitimate the last three or four Board members appointed by his predecessor – which includes the Board’s current Chairperson. He furthermore voiced a request/demand that the Board as a whole cease immediately to do any business until a judicial opinion about the legality of the racial makeup of the board could be determined. This of course might give Gov. Bevin an opportunity to appoint four new Board members of his own – a total of nearly one quarter of the Board’s membership that is subject to his discretion! The Governor’s actions would emasculate the Board, abort potential reforms, thwart demands for accountability, and perpetuate for months a rudderless ship – unless one is content with the way things have been going in recent years. Surely only the most rabid fanboys and those doing business with the University or its associated foundations can be happy with the status quo. Continue reading “Governor Bevin Comes to President Ramsey’s Rescue.”

Per-capita Opioid Prescription to Medicare Part-D Patients in the United States.

Test of Tabloid Public software.

I am still testing software with the capability to map data geographically. This page may change as I manipulate the page layout.

Below is a map of the number of opioid prescriptions written for Medicare Part-D beneficiaries in 2013 divided by the total general population of each state. This version of “per-capita” adjustment corrects somewhat for the large differences in the population amount the states. I have shown earlier that prescriptions of opioids to Medicare patients correlates well with opioid prescription to the general public. It is disappointing to see Kentucky and our neighboring states stand out as hot-spots of prescription opioid drug use. Hover your cursor over the map to interact with the actual data. Here is a link to a full size version.

Peter Hasselbacher, MD
President, KHPI

Norton Healthcare and University of Louisville Settled Their Dispute Over Children’s Hospital

Breaking News!

Andy Wolfson of the Courier journal is reporting that Norton and UofL have settled their dispute over Kosair Children’s Hospital.  We are all waiting to learn the terms of the settlement related to this important community asset.

Peter Hasselbacher


Website Theme Change for KHPI.

I have been using the same basic theme for this WordPress-based website for several years. It was not very friendly to the mobile devices that many of our readers use.  For that and other technical and aesthetic reasons, I upgraded the theme-in-use to “Twenty Sixteen,” WordPress’s new default theme released recently with an update of the underlying software. Among other changes, you  will find that the sidebar materials collapse to the bottom on smaller screens making it easier to use the site on phones and pads.

There are new technical resources available to me that I will have to learn. You may notice some other smaller changes as I tweak the site’s banner-image and add additional widgets to make the site more useful.  Do any of the more technical of you out there have any other suggestions?  Is there anything that is not working?

Thanks for your patience!