1) Americans are sharing their prescription medications more often than ever.

My take: There are a variety of reasons why medications should not be shared. Drug interactions, unknowingly harming the fetus in pregnant women, and incomplete antibiotic courses are all potential risks.

However with the cost of medications rising, I do expect this to be a growing trend.

2) “If you don’t hear providers yelping about it, it isn’t going to save money.”

My take: That’s partially true. The most direct way of saving costs is to deny services. None of the politicians dare suggest this.

Cutting provider payments only superficially saves money. This logic is seriously misguided as physicians would respond by increasing utilization, thus driving up costs in the long run.

3) A reader writes: “I wonder if you could address the issue of quality of care. For chronic conditions like diabetes, it would be great if doctors can remind and enroll patients in some kind of adherence plan to keep the disease and hence the side effects under control . . . with technology being so easy to use today, what can help physicians to pro-actively manage adherence of patients? Are there are factors that do not promote such behavior?”

My take: Many primary care clinics have support staff, nurses, and diabetic educations who do outreach and ensure that patients are appropriately monitored for their chronic diseases.

For smaller clinics that don’t have these resources, adherence programs become more difficult to implement. The reason lies in the reimbursement system. Any counseling, coordination of care, and patient outreach is not paid for outside of an office visit. Thus, there is little incentive to pursue this avenue.

In these cases, a chronic disease adherence program would involve bringing the patient in for an office visit on a more frequent basis.