Feeling more and more like the nation’s healthcare piggy bank? Shaken, pinched and poked at every turn? No wonder! The Kaiser Foundation reports insurance premiums soared a whopping 131 percent in the last decade. Commercial insurance and government payers are shifting healthcare costs onto consumers faster than Farmer Dell can ring the dinner bell. And to some enterprising allergy and asthma businesses, that spells opportunity!
Don’t go running wee, wee, wheezing all the way home! We’ve got work to do!
Bet your paycheck didn’t increase $5,000 since 2008. However, medical costs for the average U.S. family of four have, according to Milliman Medical Index. Families tell Allergy & Asthma Network Mothers of Asthmatics (AANMA), “We’re paying more but getting less.”
Allergy and asthma care account for $32 BILLION each year in direct and indirect costs in the U.S. More than $20 billion of that is for doctors’ visits and prescription medications alone.
One belt-tightening idea offered by Food and Drug Administration (FDA) would “reduce routine asthma and anaphylaxis visits and free up prescribers to spend time with more seriously ill patients, reduce the burdens on an already overburdened healthcare system, and reduce healthcare costs.”
It would “make certain asthma and anaphylaxis medications available under certain conditions of safe use without a prescription.” They’d “require pharmacist intervention to ensure appropriate nonprescription use or healthcare kiosks to aid in the assessment, diagnosis and treatment” of your condition.
However, kiosks don’t care. They, and the information you volunteer (read fine print before clicking “agree”), belong to the kiosk vendor for the purpose of merchandising in-store drugs, vitamins and paid physician referrals based on how you answer their leading questions. Kiosk vendors, stores and pharmacists are not liable for advice given or actions you take as a result.
Cold lard facts: Big box retailers are already moving forward as if FDA’s proposal, which focuses on the most expensive chronic diseases, is a given! Such measures are short-sighted, leave patients at increased risk, and shift the financial burden to the backs of patients while insurance premiums keep going up! More OTC medications are not the answer.
The fleecing doesn’t stop there.
Increasingly, patients are unknowingly exposed to less than professional allergy testing immunotherapy practices and fraudulent billing schemes embedded in a growing number of primary care physician (PCP) practices throughout the United States.
How does it happen? Generally, allergy testing and immunotherapy services are marketed to PCPs as the answer to allergist shortages and patient non-compliance. In some cases, all the practice must do is provide an exam room for the “certified allergy technician” and refer patients to reap shared profits with the allergy testing company. In others, PCPs pay an up-front investment. Either way, projected annual revenues for PCPs are greater than six figures per year depending on the size of practice and number of patients tested.
Each day, thousands of PCPs nationwide shuffle their patients to these technicians for environmental allergy testing. Some are offered panels of food allergy testing, too. Patients then receive either allergy shots (subcutaneous immunotherapy-SCIT) or drops (sublingual immunotherapy-SLIT) to administer at home.
Meanwhile, patients have no idea this is not even close to the standard practice of an allergy evaluation. They have no clue there is no such medical accreditation as “allergy technician.” They don’t know the dangers of taking SCIT or SLIT at home!
If SCIT vials contain active antigen, you could have a life-threatening event at home. That is why insurance companies assign reimbursement codes for immunotherapy to be administered in a medical office where a life-saving crash cart and medical professionals are present.
SLIT, on the other hand, is still not FDA-approved in the United States and therefore clearly is not reimbursable! Every office that is billing your insurance company for SLIT is committing fraud whether your PCP knows it or not! If this is shocking to you, it’s an education for many PCPs, too.
Regardless of healthcare wars waging out there, our insurance companies, Medicare and Medicaid set up rules so that we can see board-certified allergists and immunologists. Don’t let anyone tell you differently!
Great PCPs won’t allow substandard allergy care to creep into their practices. Others don’t even know it is happening. Some work in large groups and are not aware of business contracts with outside vendors or how they work.
Say NO to Rotten Pork
No one should be using our children or loved ones as healthcare piggy banks.
AANMA led the national charge for schoolchildren to now carry and use asthma inhalers and epinephrine auto-injectors, but it was your surge that ultimately made it possible.
With your help, AANMA stopped reimbursement fraud for nebulizer medications that were illegally mass manufactured under the guise of compounding!!
Now with your help, it’s time to tell FDA “NO!” to asthma and anaphylaxis do-it-yourself diagnosis and treatment!
With your help, we can stop fraud and abuse of our families and protect our access to quality asthma and allergy care!
By Nancy Sander and Tonya Winders
Nancy Sander is president and founder of AANMA and Tonya Winders is chief operating officer.