PPO Pharmacy Benefits Survey

Posted on December 11, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Managerial Results for 2007 – Just Released

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[By Staff Writers]

  • In 2006, the average number of eligible employees in PPOs that used managed care pharmacy programs was 203,768, up 7.2% from 190,097 the previous year.
  • For the sixth straight year, the share of PPOs that used PBMs for drug utilization review (DUR) services fell, to 62.7% from 66.1% in 2005.
  • The percentage of reporting PPOs that followed drug formularies increased fractionally in 2006, to 98.6% from 98.3% the year before, the sixth consecutive annual rise.
  • For the fifth consecutive year, the percentage of reporting PPOs that contracted with mail-service pharmacies grew, to 98.9% in 2006 from 98.3% in 2005.
  • Between 2005 and 2006, the overall share of PPO prescriptions filled with brand name drugs fell modestly, to 53.8% from 55.4% the previous year.
  • The average number of contracts between PPOs and hospitals jumped 18.9% in 2006, to 145 from 122 the year before.
  • The percentage of PPOs using a pharmacy benefit manager (PBM) was 99.2% in 2006, up slightly from 98.6% the year before, and the highest such share since this Digest began tracking this measure.
  • In 2006, PPOs contracted with an average of 38.9 ancillary providers per 1,000 eligible employees, up 28.4% from 30.3 the previous year, and the highest such number since 2002 (41.4).
  • At PPOs with at least 1 million eligible employees, the average number of hospital contracts per plan climbed a notable 14.2%, to 1,804 from 1,579 in 2005.

*Acknowledgements

The editors acknowledge Verispan LLC, Yardley, Pa., as the research and reporting source for this data, reprinted with permission and based on information gathered by mail and telephone surveys gathered and effective as of December 31, 2008, unless otherwise noted.  It was commissioned, sponsored and underwritten in an arm’s length fashion by the Managed Care Digest Series of sanofi-aventis, Bridgewater, NJ, and developed and produced by Forte Information Resources, LLC, Denver, Colorado.

Conclusion

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About PatientsLikeMe.com

Posted on December 11, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Empowering Health 2.0 Social Networks                                       stk178277rke

According to its website, www.PatientsLikeMe.com was founded in 2004 by three MIT engineers whose collective experience spanned from running the world’s only non-profit biotechnology laboratory – to large scale online commerce applications. Today, PatientsLikeMe is a privately funded company dedicated to making a difference in the lives of patients diagnosed with life-changing diseases.

A Personally Generated Idea

A personal experience with ALS [Amyotrophic Lateral Sclerosis] – Lou Gehrig’s Disease – was the inspiration to create this on line social community of patients, doctors and organizations that informs and empowers individuals. The firm has committed to providing patients with access to the tools, information and experiences they need to take control of their disease. Currently, it has signed-up 23,000 participants and membership is growing 35% per month.

The Promise

The promise of PatientsLikeMe is to provide a better, more effective way to capture valuable information and share it with patients, healthcare professionals and industry organizations trying to treat the disease.

The Goal

To reach its goals, the site created an internet based platform for collecting and sharing real world, outcome-based, patient data and is establishing data-sharing partnerships with doctors, pharmaceutical and medical device companies, research organizations, and non-profit organizations. And, since the HIPPA statutes don’t mute patients themselves, a regulatory escape clause – of sorts – enables the virtual dialog.

Cost Coverage

Operating costs are covered by partnerships with healthcare providers that use anonymous data from, and permission-based access, to the PatientsLikeMe community to drive treatment research and improve medical care. The site shares anonymous data with trusted partners and all patient information is kept safe and secure [to the extent possible].

Assessment

Traditionally, physicians, organized medicine and groups like the ALS Association [ALSA.org] assumed [or abrogated] the role of treatment and thought leadership in niche spaces like this. But, the social networking phenomenon, known as Health 2.0, could fundamentally change the practice and business model of all medicine. For example, related concept models include:

*SugarStats.com for diabetics,
*Oncolink.com for cancer patients,
*Eurodis.org for rare diseases,
*Vitals.com to rate physicians,
*Trusera.com for general medical information sharing, and
*Disaboom.com for the disabled; etc

And, many more demonstrate the growing trend of patient empowerment.

More info: Business Week, page 58, December 15, 2008.

Conclusion

What do you think? Let us know with a post, opinion or comment on this topic; either as a doctor, patient, payer, employer, economic or financial advisor, politician or healthcare social engineer.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Executive-Post – is available for seminar or speaking engagements. Contact: MarcinkoAdvisors@msn.com or Bio: www.stpub.com/pubs/authors/MARCINKO.htm

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Accounting Deductions for Physicians

Posted on December 11, 2008 by Dr. David Edward Marcinko MBA MEd CMP™

Some Tax Basics for Medical Professionals

By Edwin P. Morrow; III, JD, LLM, and ME-P Staff Writersfp-book1

Astute financial advisors and healthcare focused accountants know that there are simple and overlooked strategies that can significantly add to the bottom line of any medical practice; just as much as increasing practice revenues or reducing expenses. Physicians and medical professionals themselves should also understand some basic accounting and simple tax strategies that do not require five figure consulting fees or excessive risks of audit. Here are some basic deduction concepts of financial accounting to know.

Commuting and Local Transportation Expenses 

Normally, standard commuting expenses to and from the home are personal expenses and not deductible. You cannot deduct the cost of your daily commute to work. There are exceptions, however. Commuting expenses to a temporary location outside of the normal business metro area may be deductible; such as the hospital or ASC. Expenses traveling from one medical office business location to another are also deductible. 

Life Insurance

Payments for life insurance are generally not excludible from income unless part of a medical group term life insurance policy with face amounts up to a maximum of $50,000 IRC § 79. Amounts of insurance greater than this amount will be taxable income to the employee (also subject to employment taxes).

Political Contributions

Political contributions in the recent elections cycle, for example, and lobbying expenses are not deductible, even if you can substantiate a direct medical business interest.

Professional Dues

Dues paid to professional organizations, like the AMA, ADA, AOA or APMA, are generally deductible. However, you may notice a disclaimer on some dues notices that indicate a portion of the dues used for political lobbying purposes, which are not deductible.  Dues to country clubs, athletic facilities, etc … will not be deductible, unless eligible for the 50% entertainment deduction mentioned earlier.

Assessment

Physicians and all taxpayers should keep records showing the nature of the expense, when it was incurred, the amount, and the business purpose.

Conclusion

And so, your thoughts and comments on this Medical Executive-Post are appreciated. How have you used these strategies in the past?

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