Superb Critique of a Flawed 340B Study and its Unfounded Conclusions

Madeline Carpinelli Wallack’s response to the recent study in Health Affairs on hospitals’ alleged misuse of 340B drug discounts scores a direct hit on a highly flawed piece of research.

We wrote about SNHPA’s and AHA’s reactions to the Health Affairs study earlier this month. Researchers Rena Conti and Peter Bach said they found that “that hospital-affiliated clinics that registered for the 340B program in 2004 or later served communities that were wealthier and had higher rates of health insurance compared to communities served by hospitals and clinics that registered for the program before 2004.”

“Our findings support the criticism that the 340B program is being converted from one that serves vulnerable patient populations to one that enriches hospitals and their affiliated clinics,” they concluded.

After reading the study, Carpinelli Wallack wrote, “I had two questions: First, how are the authors substantiating their conclusions? Second, what kind of sensational sound bites are going to come from this?”

“Simply put, the authors’ conclusions are not substantiated by the data collected,” Carpinelli Wallack said. “Conti and Bach say that they ‘found’ that hospitals ‘served communities that were wealthier and had higher rates of insurance’ and ‘generated profits.’ They did not find this.”

“At most, the researchers’ data supports the fact that there is a statistically significant difference in the socioeconomic status between the areas where the hospital is located and the areas where its affiliated clinics are located,” she continued. “This is a far cry from the headlines concluding that hospitals are ‘enriching’ themselves off a program intended to help the poor.”

Carpinelli Wallack said she was saddened that the study’s “misleading conclusions will only serve to support 340B critics’ mischaracterization of program intent.”

“Responsibility in research is important if we are to have accurate and fair discussions about policy issues like the 340B program,” she said. “The 340B program is complex and absolutely needs more structure and oversight, but it does not need misleading and loaded rhetoric like ‘enriching and profiting.’ That type of terminology might be common in the current attack of the program by the drug industry but I would expect a more nuanced viewpoint from a scholarly piece such as this.”

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October 28th, 2014 at 4:32 pm

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Infographic: 340B DSH Hospitals Have Huge Low-Income Patient Loads and Uncompensated Care Costs

340B DSH Hospital Infographic

Pass it along.

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October 27th, 2014 at 1:29 pm

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Hospitals Rebut 340B Study’s Conclusions

Hospitals groups have issued strong rebuttals of a new study in the journal Health Affairs that its authors say supports criticism by the drug industry and others that disproportionate share hospitals increasingly use 340B savings to help themselves at the expense of the poor.

In a reply article published in Health Affairs, Safety Net Hospitals for Pharmaceutical Access says the study “neglects an essential point: compared to non-340B DSH hospitals, 340B DSH hospitals provide over twice as much care to Medicaid and low-income Medicare patients, and almost twice as much uncompensated care.”

“340B DSH hospitals across the board provide high levels of uncompensated care,” SNHPA’s response continues. “For these and other reasons … the article does not support the criticism that 340B DSH hospitals are no longer serving vulnerable patients.”

The American Hospital Association also took strong issue with the study. In its AHAStat blog, the group said the report “does a real disservice to this important program that has a proven track record in helping patients get the medicines they need.”

The study in Health Affairs, by Rena Conti of the University of Chicago and Peter Bach of Memorial Sloan Kettering Cancer Center, is entitled “The 340B Drug Discount Program: Hospitals Generate Profits by Expanding to Reach More Affluent Communities.” In a May 2013 opinion article in JAMA, Conti and Bach said some hospitals were earning “windfall” profits on cancer drugs purchased through 340B ” that might not be directly benefiting the poor.” Conti was a featured speaker at the drug industry-led group AIR 340B’s “national summit” on the drug discount program this past June.

Also in June, Health Affairs published a different study that helped to explain why 340B will continue to be needed after the Affordable Care Act is fully implemented. It found that, despite health care reform, safety-net hospitals’ uncompensated care costs and Medicaid shortfalls will keep climbing in California and the states that do not expand Medicaid.

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October 7th, 2014 at 3:43 pm

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Nation’s Largest Nonprofit Health System Defends 340B

The St. Louis Post-Dispatch published a strong op-ed from Ascension Health that highlights the importance of 340B to both the health system and patients. Ascension CEO Bob Henkel describes exactly how 340B saves lives. He also called out big pharma stating, “We need the help of the pharmaceutical industry to ensure the poor and vulnerable are not priced out of access to the medications they need to keep them out of the hospital, and to ensure a good quality of life.”

Click here for the full article.

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October 3rd, 2014 at 2:52 pm

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How 340B Saves Lives on the Gulf Coast

Shannon Williams

Shannon Williams

Kudos to Executive Insight staff writer Michael Jones for his moving profile of Shannon Williams, an uninsured Mississippi woman with cancer who received lifesaving charity care from Monroe County Hospital in Monroeville, Ala., made possible by the hospital’s participation in 340B.

She originally received treatment from the hospital in 2006 when she had health insurance and returned for help in 2010 when, lacking insurance, her cancer came back. “They pretty much saved my life twice,” Williams said. “That’s how I feel about it.”

If Williams’ name and story sounds familiar, it might be because she is one of SNHPA’s original Faces of 340B.

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September 24th, 2014 at 12:52 pm

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340B Essential for Hospital Oncology Practices

Two leading oncologists detail the importance of the 340B program in the inaugural issue of Oncology Payers. In the article, Robert Chapman, M.D. and William Wood tout the benefits of the program stating,

“From the inner city of Detroit to the small towns of Michigan and Kentucky, the program provides an invaluable mechanism for the delivery of quality cancer care as well as discounted medicines and free clinical services. For many hospitals, the savings afforded by 340B are essential to keeping oncology programs running – and their doors open. The drug industry is eager to scale back the program. Some private oncologists have attacked 340B and blame it for driving hospital purchases of their practices as well as higher prices. In reality, hospital/private-practice mergers of all kinds are driven by economic forces associated with the changing health-care landscape – particularly low insurance reimbursements.”

Dr. Chapman is the Director of the Josephine Ford Cancer Institute at Henry Ford Health System in Detroit, Mich. Mr. Wood, who was a pharmacist at University of Utah Health Sciences Center, is now a Board Trustee for Aspirus Ontonagon Hospital in Ontonagon, Mich., and is also a consultant for Visante.

Click here to view the full article.

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September 18th, 2014 at 9:50 am

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Former U.S. Rep. Gil Gutknecht (R-Minn.) Goes to Bat for 340B

g000536_200“With so much partisan squabbling in Washington, it’s important to remember there are programs that not only work, but enjoy bipartisan backing,” former U.S. Rep Gil Gutknecht (R-Minn.) reminds readers of The Hill’s Congress Blog this morning.

And the 340B drug discount program is one of them, he says.

“I was proud to support it when I served in Congress,” Gutknecht continues. “Yes, the program is funded at the expense of extra profits by the drug companies.  More importantly, it allows hospitals and clinics to help poor Americans stay healthier and it actually saves taxpayer money by keeping people out of the hospital.”

“As the cost of medicine soars, the program becomes more essential than ever,” Gutknecht concludes. “It is time to hit the brakes on the pharmaceutical industry’s efforts to kill it.  If we don’t, the casualties will be America’s poor and the hospitals that treat them.”

Gutknecht served in the House from 1995 to 2007.

Read Gutknecht’s complete essay here.

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September 12th, 2014 at 11:29 am

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Hospitals Brief Capitol Hill Staff on 340B’s Importance

Bravo to the American Hospital Association for its briefing on Capitol Hill yesterday on how hospitals are using 340B savings to improve access to low-cost medications and provide quality care for vulnerable patients.

Congressional staffers and members of the press heard from senior executives and pharmacy directors at The Johns Hopkins Hospital in Baltimore; the University of Utah Hospital & Clinics in Salt Lake City; Providence Hood River Memorial Hospital in Hood River, Ore.; and Saint Thomas Health in Nashville. We’re proud that all four are members of Safety Net Hospitals for Pharmaceutical Access.

What would happen if Big Pharma succeeds in curtailing or ending 340B?

  • St. Thomas Midtown Hospital would scuttle plans to open a free pharmaceutical dispensary for the poor and uninsured.
  • The Johns Hopkins Hospital would have to cease medication assistance, hospital-to-home transitional care, and other services for low-income patients in east Baltimore, Md.
  • Providence Hood River Memorial Hospital would have to stop offering free or low-cost drugs and comprehensive pharmacy services to patients with cancer.
  • And the University of Utah Hospital and Clinics’ ability to provide highly specialized services in a region spanning six states would be severely compromised.

“Access to care is part of fulfilling our mission,” explained Providence Hood River CEO Ed Freisinger. “340B is helping us increase access to care in our community.”

Finally, click here for a great op-ed by AHA President and CEO Rich Umbenstock on how 340B is helping patients and communities across the country.

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September 11th, 2014 at 11:53 am

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