It isn't only patients who dig deeply into their pockets to pay the shrink. Drug company payments to Vermont psychiatrists more than doubled in 2006, to an average of $45,692 per doctor, up from $20,835 in 2005, according to a report from the state attorney general. As states require drugmakers to disclose payments to doctors for lectures and other services, it appears that psychiatrists earn more from drugmakers than other specialists do. The second best paid specialists were endocrinologists, who earned an average of $33,730. The analysis identified only the top 100 earners, with 11 psychiatrists and five endocrinologists in the group. The sixteen internists in the top 100 received the third largest amount, $150,209, with an average of $9,388. In 2005, the 14 internists in the top 100 received $124,238, with an average of $8,874.

One osteopath was included in the top 100. This physician received payments of $46,642 — the highest average and median payment per prescriber in the top 100 in 2006.

"We don't think any other states have engaged in the in-depth data analysis that we have," says Julie Brill, assistant attorney general.

Other states are also taking steps to monitor payments made to prescribers. As of January, five states (California, Florida, Maine, Minnesota, and West Virginia) and the District of Columbia have laws or regulations pertaining to pharmaceutical marketing disclosures that concern payments.

Vermont's most highly paid doctors, by specialty
($ in thousands)
Specialty Number of recipients Total received Average per recipient Percentage of overall total
Psychiatry 11 $503 $46 22.4%
Endocrinology, diabetes, and metabolism 5 $169 $34 7.5%
Internal medicine 16 $150 $9 6.7%
Neurology 5 $115 $23 5.1%
Other 7 $71 $10 3.2%
Family practice 12 $71 $6 3.2%
Oncology 3 $59 $20 2.6%
Ionizing Radiation Privileges 9 $55 $6 2.5%
Osteopath 1 $47 $47 2.1%
Pediatrics 4 $43 $11 1.9%
Note: Percentages do not add up to 100 because these are only the top 10 specialties to receive payment.
Source: Pharmaceutical marketing disclosures. Report of the Vermont Attorney General William H. Sorrell. June 26, 2007

Managed Care’s Top Ten Articles of 2016

There’s a lot more going on in health care than mergers (Aetna-Humana, Anthem-Cigna) creating huge players. Hundreds of insurers operate in 50 different states. Self-insured employers, ACA public exchanges, Medicare Advantage, and Medicaid managed care plans crowd an increasingly complex market.

Major health care players are determined to make health information exchanges (HIEs) work. The push toward value-based payment alone almost guarantees that HIEs will be tweaked, poked, prodded, and overhauled until they deliver on their promise. The goal: straight talk from and among tech systems.

They bring a different mindset. They’re willing to work in teams and focus on the sort of evidence-based medicine that can guide health care’s transformation into a system based on value. One question: How well will this new generation of data-driven MDs deal with patients?

The surge of new MS treatments have been for the relapsing-remitting form of the disease. There’s hope for sufferers of a different form of MS. By homing in on CD20-positive B cells, ocrelizumab is able to knock them out and other aberrant B cells circulating in the bloodstream.

A flood of tests have insurers ramping up prior authorization and utilization review. Information overload is a problem. As doctors struggle to keep up, health plans need to get ahead of the development of the technology in order to successfully manage genetic testing appropriately.

Having the data is one thing. Knowing how to use it is another. Applying its computational power to the data, a company called RowdMap puts providers into high-, medium-, and low-value buckets compared with peers in their markets, using specific benchmarks to show why outliers differ from the norm.
Competition among manufacturers, industry consolidation, and capitalization on me-too drugs are cranking up generic and branded drug prices. This increase has compelled PBMs, health plan sponsors, and retail pharmacies to find novel ways to turn a profit, often at the expense of the consumer.
The development of recombinant DNA and other technologies has added a new dimension to care. These medications have revolutionized the treatment of rheumatoid arthritis and many of the other 80 or so autoimmune diseases. But they can be budget busters and have a tricky side effect profile.

Shelley Slade
Vogel, Slade & Goldstein

Hub programs have emerged as a profitable new line of business in the sales and distribution side of the pharmaceutical industry that has got more than its fair share of wheeling and dealing. But they spell trouble if they spark collusion, threaten patients, or waste federal dollars.

More companies are self-insuring—and it’s not just large employers that are striking out on their own. The percentage of employers who fully self-insure increased by 44% in 1999 to 63% in 2015. Self-insurance may give employers more control over benefit packages, and stop-loss protects them against uncapped liability.