Miami leads nation in Medicare drug spending
10/15/2013 7:26 PM
10/16/2013 2:22 PM
Elderly Miami residents on Medicare filled more prescriptions for drugs in 2010 than seniors elsewhere in the country, and they were more than twice as likely as residents in Rochester, Minn., to fill at least one prescription for medications that have been identified as high-risk for patients over age 65, such as skeletal muscle relaxants, long-acting benzodiazepines, and highly sedating antihistamines.
These are two of the latest findings from the Dartmouth Atlas Project, which on Tuesday released a report on prescription drug use among seniors that showed, once again, Miami has by far the highest healthcare costs in the nation — with the average Medicare patient spending $4,738 on prescription drugs in 2010, more than any other region and well above the national average of $2,968.
Yet while patients in Miami filled more prescriptions (63 per year) and spent more on medications than their peers elsewhere, according to the Dartmouth report, Miami seniors also fared well in comparison to the rest of the nation for their use of effective medications, such as beta blockers to reduce blood pressure and manage irregular heartbeats within seven to 12 months after a heart attack.
About 78 percent of Miami heart attack survivors on Medicare Part D reported filling a prescription for beta blockers, and about 76 percent of diabetic patients aged 65 to 75 filled a prescription for medications known to reduce blood pressure and prevent kidney disease — both rates on par with national averages.
Jeffrey C. Munson, a physician and lead author of the report, said the findings offer important insights for physicians who prescribe drugs and for their patients.
“A lot of it really is demonstrating what kind of care is possible,’’ Munson said, “and I think that a lot of times physicians don’t have a source of feedback to tell them how they’re performing relative to their peers, and there isn’t an easy way for physicians to know what is the national norm and what is the best care possible.’’
Dartmouth’s research is one of the first comprehensive looks at Medicare Part D, the prescription-drug benefit program. Because the program was launched in 2006, there has been little data available for researchers to study the program’s benefits and risks.
Munson said the research suggests that the program has increased access to prescription drug healthcare and benefitted many Medicare patients, including the estimated 42,000 Miamians enrolled in Part D.
The research also shows that the use of both effective and risky drug therapies by Medicare patients varies widely across regions — evidence that location is a key indicator of healthcare cost and quality.
For instance, heart-attack victims living in Ogden, Utah, in 2010 were twice as likely (91.3 percent) to receive a statin prescription to lower their cholesterol and their risk of another heart attack than those in Abilene, Texas (44.3 percent). Statins are widely available, and Dartmouth researchers did not see a dramatic difference in prescription drug prices by region.
“There’s no good reason’’ for the difference in prescription drug treatment by region, he said.
Munson said cost and prescribing variations are not due to some regions having greater numbers of sick individuals, nor is it due to regional differences in the cost of prescription drugs.
He said the variations are more likely due to the regional culture of medical practice — and Miami has a history of high use of healthcare services.
For years, Dartmouth researchers have been analyzing why Miami’s costs are so much higher than elsewhere, even when adjusted for severity of illness and other factors.
Their findings have shown that a major contributor appears to be the large number of physician specialists in the area, a situation that tends to lead to more visits to doctors and more diagnostic tests. The large number of hospital beds in the area may also drive up usage, Dartmouth has found.
But that does not necessarily explain why Miami’s prescription drug use is so high and costly.
Unlike other forms of healthcare, physicians do not get reimbursed directly for prescribing drugs — so there’s no financial incentive for them to over-utilize prescriptions.
“One of the things that’s curious about high-spending regions like Miami or McAllen, Texas, or even Manhattan really speaks to this culture … of more aggressive care,’’ Munson said.
He said one clue to Miami’s high use and high costs lies in the findings for use of discretionary medications, or drugs that work well for some individuals but not for others, including antidepressants, dementia medications, and proton pump inhibitors to relieve heartburn.
Regions with high use of such discretionary medications, Munson said, tend to have higher prescription drug costs per Medicare patient.
“What we see,’’ he said, “is that spending is more closely tracking with use of discretionary medications.’’
Elderly Miamians rated well above the national average on the use of discretionary drugs — leading all other regions in the country by some measures.
For example, Medicare patients in Miami are the most likely to fill at least one prescription for an antidepressant, with an average of 30.2 percent filling one. And they were the most likely to fill at least one prescription for a dementia medication, with an average of 17.1 percent.
Munson said patient choice is certainly a factor in Miami’s high use of discretionary medications, but he added that some variation also is due to physician preference and an abundance of consumer advertising designed to persuade patients that they need a particular drug.
However, he said, the report’s findings show that spending more on prescription drugs does not lead to better care.
Nancy Morden, a physician and co-author of the Dartmouth report, said the data should motivate patients to learn more about the treatment they’re receiving.
“One of the most important things consumers can do,’’ she said, “is have these conversations with their prescriber: understand why each medication is prescribed; what’s the goal of the medication; what the risk and benefit tradeoffs are ... [and] ask about what you’re not taking that may be indicated for you and your particular disease state.’’
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