AMCP Nexus to Start With Keynote From Surgeon, Transparency Advocate

This week, the Academy of Managed Care Pharmacy (AMCP) Nexus 2020 meeting, bringing together researchers, payers, health systems, and others, starts with a keynote from a surgeon who has also become a critic of a spurious billing practices and a proponent of price transparency.

Marty Makary, MD, MPH, chief of the Johns Hopkins Islet Transplant Center, has been visible over the past year and a half discussing what he says are “structural problems” behind the cost of US health care, such as certain practices of pharmacy benefit managers (PBMs) and group purchasing organizations.

Last year, he released his third book, The Price We Pay: What Broke American Health Care—and How to Fix It​, where he also lambasts what he says is inappropriate care, or “a crisis in medicine of appropriateness.”

Examples of inappropriate care, he noted in an interview last year on Managed Care Cast to discuss the book publication, are unnecessary screenings, or what he calls “predatory screenings,” that are conducted on older Americans because it is a service Medicare will pay for even though it is considered low-value care.

He also cites his own example of prescribing opioids post surgery that he says now, with more knowledge in the aftermath of opioid overprescribing by physicians, were not needed.

“I think we have good people working in a bad system,” he said at the time.

In the absence of a plan to fix what he calls a broken health care system, the private sector is moving on its own to create more competition, Makary has said. For one thing, employers, acting as payers, want to know what factors into the prices that they are being asked to pay to insure their employees. Some are doing direct contracts with health systems.

“I think if we got rid of kickbacks, and pricing secrets, we address a lot of the inefficiencies and waste in the markets today,” he said last year.

Other efforts to reform behavior that may help drive overall lower prices and improved care is to share metrics with doctors so that they know where they stand relative to their peers in terms of various quality and outcome measures, in order to prevent an overuse of inappropriate care.

Makary’s book also delves into the practice of hospitals suing patients for unpaid bills, seizing their assets, and forcing them into bankruptcy. The hospitals sue even if they have tax-exempt status.

A recent report released by Makary and other researchers says that in Texas, the amount said to be owed by makes up just 0.15%, on average, of hospital revenue, but the lawsuits are devastating to low-income and low-middle-class individuals and families. Meanwhile, Texas has the most expensive hospital markup of more than 6.4 times the Medicare allowable amount, the report says.