Freudenheim punked twice in 2 weeks? Apparently so. More in the morning
POLITICS: Bill Frist–A wonderful man and a great doctor who has never done anything worthy of criticism in his life!
There was an puff piece last week in the WaPo called Bill Frist: A Doctor at Heart
Contrasted with the gossip-based assassination on fellow 08 candidate Hillary Clinton and her husband in the National Enquirer New York Times, this is just an incredible piece of uncritical fluff.
Perhaps the reporter was unaware of Frist’s less than brilliant piece of telemedicine when he diagnosed Terri Schiavo by videotape (and got it 100% wrong), and the minor, minor matter of the millions of dollars he has in HCA stock and the insider trading “allegations” that surround his recent sales of HCA stock. After all, they’d have had to google their own paper’s web site to find out about that!
But I just thought that this was a classic:
At the zoo hospital, a team of four veterinarians, three technicians, an animal keeper and a veterinary dentist were wheeling a 350-pound gorilla into surgery as Frist arrived. They would perform an ultrasound of the heart, a root canal and a physical. Frist joined the team, as he had on other mornings, tying on a mask. He unbuttoned his business shirt, revealing jungle-pattern surgical scrubs and a pair of hairy, toned biceps.
Now if you are a gorilla you get FOUR vets, THREE techs, a Keeper, a dentist AND the leader of the Senate to care for you. On the other hand if you are a patient at an HCA hospital—which is controlled by the family of the leader of the Senate—you’ll find that the nursing staff is stopped by subpoena from protesting at the shareholders meeting about the inadaquate amount of staff available to look after you! But apparently the available staff number is substandard and doesn’t conform to California law. While I don’t know the details of the case, let’s face it, HCA’s history doesn’t exactly inspire confidence in their ability to follow the law and do the right thing rather than take the quickest, easiest buck possible.
It’s good to know that the Washington Post has time to give us the full picture…
PHARMA/POLICY/POLITICS: McKinnell’s friends turn and bitch-slap him, by The Industry Veteran
The Industry Veteran is back. He notes a piece I’d missed in which the oh-so-rational editorial board of the Wall Street Journal declared Part D to be a future political liability for their desire to drown the government in a bath-tub. And it’s all or mostly the fault of poor Hank McKinnell. The Veteran’s not too impressed with their analysis:
In its May 19 editorial, the Wall Street Journal bitch slapped Pfizer’s CEO, Hank McKinnell, for strongly advocating the 2003 Medicare Modernization Act (i.e., Part D) before the legislation passed and since. In the week preceding the May 19 cuffing, McKinnell apparently did a panegyric for Medicare Part D in front of the Journal’s editorial board that the Goebbels Gang considered less than persuasive. Before writing their Night of the Long Knives editorial, the Journal’s editors knew that McKinnell’s partisanship for Part D was more than mere flack work, sycophancy or a simple affirmation of sound, eighteenth century economics. In his role as president of Big Pharma’s trade group, the Pharmaceutical Research and Manufacturers Association (PhRMA), McKinnell was a driving force behind the Medicare Modernization Act. Never more than six months behind the news, the Journal is finally reflecting some of the sotto voce criticism that McKinnell is receiving from within Pfizer itself.The Journal’s criticism of Medicare Part D and its advocates combines boilerplate, right wing economics with Monday morning political quarterbacking and crypto-fascist scare threats about single-payer health systems. The patellar reflex economics faults Part D for contributing to the federal deficit. In this respect the Journal aligns with Reaganite and other conservatives who label Bush a fraud for posing as a conservative when he is actually a big deficit spender who obtains Congressional acquiescence for his military Keynesianism by declining to veto porkbarrel legislation. The Wall Street Journal’s reproval of Bush’s spending, however, is less credible than Claude Rains’s declaration of shock at learning that there is gambling at Rick’s Cafe. Bush is only opposed to federal spending if it benefits the middle class and the poor. He doesn’t have the slightest problem with a fiscal deficit policy as long as the spending benefits his cronies and benefactors who run multi-billion dollar corporations. It is for this reason, rather than some fixation on 1960’s vocabulary, that I call George Bush a fascist. In siding with the stopped-clock conservatives who favor a balanced budget, the Wall Street Journal’s editors merely seek a cloak of principle for their Hjalmar Schacht economics.The Journal’s Monday morning quarterbacking faults Republicans for thinking that the Medicare Modernization Act would turn Medicare from a Democratic into a Republican issue. Instead the MMA gives Democrats a reason to call for constant improvements to the program that will require more federal spending. In the Journal’s horror scenario, the out of control spending will lead to calls for Medicare to act as a single purchaser that can constrain costs. The Journal holds some smelly socks and underwear between its thumb and forefinger to admonish thoughts of price constraint by claiming that the pharmaceutical industry will fail to discover new remedies if it can no longer gouge a cancer patient $300,000 a year for his medication. (I mean, is this a great country or what?) If a rejoinder to the Journal’s herring-stained fright-wig is necessary, it is the fact that the development of new molecular entities constitutes the sole reason for the existence and capital investment of branded pharma companies and biotechs. The aging demographics of the developed world, and our commitment to health and longevity, virtually guarantee a fair return on this investment for a biopharmaceutical industry. Not content with a fair rate of return, the Wall Street Journal, Hank McKinnell and George Bush take a unconscionable rate as their entitlement and that is where I want to see them bent, broken and humiliated. Is Medicare Part D turning out badly? If so, that’s good. When it comes to George Bush and all his constituencies, worse is better.
QUALITY/INDUSTRY: Healthways buys Lifemasters
Over in the disease management world, a little piece of consolidation late yesterday. Healthways is buying Lifemasters for some $307m. Healthways is running at a $400m annual revenue rate and has a $1.75 billion market cap, so that suggests that Lifemasters is less than one fifth of its size, even though it’s apparently been growing fast the last couple of years. (It’s private so there are no official numbers). It’s also been around a long long time (I met the first founder in 1995!) waiting for DM as a market to take off. You can tell that in part from its funders:
LifeMasters Supported SelfCare, Inc. is privately held. Financial backing is provided in part by Intel Corporation, Lightspeed Venture Partners, Pacific Venture Group, Knotty & Co., VantagePoint Venture Partners, SightLine Partners, National Healthcare Services, The Northwestern Mutual Life Insurance Co., J. and W. Seligman & Co., Landmark Partners, ORIX Venture Partners, Siemens, Pacific Life Insurance Company, Cove Investments, Comerica Bank and Lion Investments Limited.
Sixteen different venture investors suggests that a lot of money has gone in over the years, and most of those investors must be tired enough that they are taking the rather thin bird in the hand than the fatter one which apparently was not hiding behind the IPO bush. Still with Medicare getting interested in DM, and the whole market belatedly taking off (Lifemasters is advertising over 60 vacancies on its website), it’s a little curious that they decided to take the offer rather than soldier on alone. Still Healthways stock is down some 5% on the news, so its investors aren’t exactly thrilled.
Anyone know more or have any thoughts?
TECH: PACS in 450 words or less!
I have an article up at Health-IT World which is about the evolution of PACS — largely based on a long interview I did recently with Oran Muduroglu, a founder of Stentor which Philips bought last year. I found it pretty tough to squeeze this one into the few words allotted, as it’s largely about a market and tech evolution that’s pretty messy! Again feel free to come back here and comment.
POLICY/HEALTH PLANS: HDHPs are indeed appearing in big companies
The Detroit Free Press notes that HDHPs are even showing up in the automakers. They’re of course following the lead of a few high tech companies.
BLOGS: Grand Rounds is up
KidneyNotes hosts Grand Rounds
POLICY/INDUSTRY: Money-driven Medicine, a sorta review
I must be getting vaguely famous as I was sent (unsolicited) a copy of a new book by Maggie Mahar called Money-Driven Medicine. On Sunday it was reviewed in the Boston Globe, which fairly accurately portrayed it as an indictment of 30 years of corporate medicine. Here’s the Globe’s conclusion:
The core message of "Money-Driven Medicine" is that the quintessential doctor-patient relationship has been transformed by the requirements of corporate medicine into a retailer-consumer relationship, and every sector of the system is trying to sell its products and services to that consumer and reap profits for its stockholders.This market-driven system, Mahar shows, turns the law of supply and demand on its head. The competition generates excess supply, but that does not lead to less costly medical care. It is the cost of replicated facilities, equipment, products, and services, along with millions spent on marketing and advertising, that keep the cost of medical care in this country soaring
So unlike many others, as this was a book looking at my core topic, I read it cover to cover. It’s a good read and broadly accurate as a narrative. If I had to nitpick I’d complain that Mahar spends too much time quoting other people rather than telling the story herself. I got the impression that being a financial journalist who came to health care as a fresh topic, she was a little over-wowed by what she found — although I guess that means that old middle-aged fogeys like me are too cynical about how badly people in the system behave. But at least the people she quotes at length like Jamie Robinson and Sheryl Scholnick are pretty sensible.
There were also one or two minor gems. I didn’t know that the AMA had a televised presentation opposing Medicare in 1962 immediately after JFK had a rally promoting it in Madison Square Garden—although it’s worth remembering that the AMA (and by extension most doctors) opposed Medicare and universal health insurance basically all through the 20th century. I also missed the fact that the SEC dropped an investigation into Bill Frist’s brothers conduct in the Columbia/HCA scandal immediately before the 2002 elections under pressure from the Administration—but that’s not exactly surprising.
Overall it’s a pretty comprehensive review of the corporatization of the health care system, and probably a pretty good introduction for people who don’t understand health care much. Although I remember another other book very like it written in the 1980s (which I can’t remember the title of) which also decried the new world of the for-profit hospital chains and that was before the most recent round of Columbia/HCA and Tenet undertakings.
Where I disagree with Mahan is that the perversion of medicine by money is somehow a recent thing caused by Wall Street & corporate incentives — sure you could argue that it’s worse now, but the manipulation of the health care system for the ends of power and profit is as old as the economy. And the impact that has had on the quality and cost of medical care is just as crucial, as whatever Tenet, HCA or HealthSouth has been up to. Paul Starr and Michael Millenson wrote much better books about that in the 80s and 90s. On the human issues involved Jonathan Cohn has what promises to be an even more interesting book coming up (although I’ve only seen two chapters)
Meanwhile I’ve given the book to John Irvine, who’s a more recent arrival in health care than I am…so I hope that he’ll be able to do an interesting review later unclouded by my biased perspective.
HEALTH PLANS/HOSPITALS: United–not in enough trouble, goes looking for more
I don’t know what’s going on at UnitedHealth Group, but I am missing the strategic subtlety of this latest move. If I were trying to manage PR for the biggest and most profitable health plan in the country, and I found that my CEO had made hundreds of millions of dollars by (definitely unethically and presumably illegally) back-dating option grants, I wouldn’t want to see a major regional subsidiary written up in the New York Times about how it’s aggressively targeting one of New York City’s poorest safety-net hospitals. Apparently the hospital thought it had agreed a contract, but eventually they noticed that they were being paid at the old rate. When they enquired as to why, Oxford (which United bought in 2004) brought up other issues and the whole thing has since escalated to the close to nuclear option.
This spring, Oxford told hundreds of doctors and thousands of its subscribers that it would no longer pay for medical care at Jamaica Hospital Medical Center, and gave them a month to make new arrangements. It told some doctors that they, too, would no longer be allowed to participate in the Oxford plans, and it told many patients that they needed to find new doctors.
Now we tough Californians are used to this stuff—and usually used to the insurer losing. But the concept is new in New York apparently, and it’s just dreadful PR to use it on Jamaica hospital, which is that hospital in the run down part of Brooklyn that most wealthy Manhattanites only stare at out of the cab window when they’re heading to JFK
Kenneth E. Raske, president of the Greater New York Hospital Association, a trade group, said: "I field complaints from hospitals about insurers every day. But I have never seen anything like this." Jamaica Hospital, on the Van Wyck Expressway near Jamaica Avenue, serves a largely poor population with many immigrants and a large number of uninsured patients. It is generally considered well managed, but has had serious losses in recent years. Officials say it merely broke even in 2005.
There may be good business reasons for United to be doing this. Lord knows health plans have spent precious little time or effort in recent years trying to contain the excesses of the system on their clients’ behalf. But surely going after a hospital that relies on its better paying customers to keep the lights on for the poor is not going to generate the kind of PR that the company needs.
Is Mr Spitzer watching? I suspect so…
POLIY/HOSPITALS: And if you can believe this…
A post in a policy/politics blog about the nursing shortage with 61 comments! Who knew people got so worked up about this stuff?