For those of you who believe in Open Source at LinuxWorld in San Francisco on Aug 15 there is a Healthcare Day. Sometime THCB commenter and contributor Fred Trotter is on at 2pm running a panel on innovation.
BLOGS: HEWR is up at Medical Connectivity Consulting
Health Wonk Review is up at Tim Gee’s excellent Medical Connectivity Consulting. The next HWR is going to be here at THCB on August 10 so hurry over to Dimitriy’s The Medical Blog Network to submit…
Yup I’ll remind you in advance
POLICY/HEALTH PLANS/PHARMA: Part D–a tale of two headlines
Most Beneficiaries Enrolled in Medicare Rx Benefit Satisfied With Drug Plan, Nearly Two in 10 Experienced Major Problem, Study Finds
or if you prefer
Poll shows 80% of those enrolled in Medicare drug plan satisfied
So go ahead and guess which headline came from a non-profit foundation’s news service and which one was from the inhouse newsletter for the trade group for health plans, which of course run the biggest Medicare PDP (Part D plans).
So when is a series of problems not a problem? Apparently if you don’t care much about consumer problems.
34%, of seniors who have used their drug plans have experienced what they perceived as problems, including 18% who described them as "major" problems and 16% who described them as "minor" problems. The experiences cited as problems included having unexpected costs, not being able to fill a prescription at the pharmacy, not receiving an enrollment card and having to change medications because a prescription is not covered. Ninety percent of seniors who experienced minor problems and 55% who experienced major problems feel the issues were resolved satisfactorily. (my emphasis)
So by my math 9% of Part D recipients have had major unresolved problems. Most consumer companies would freak out if they had that level of unsatisfied customers.
But don’t worry, for the $600 billion over 9 years (or whatever mythical number we’re now being quoted is the cost of Part D) that the taxpayer is spending, we’re sure saving all those recipients lots of cash right? Well not quite all—in fact not even most!
Of seniors who have used their Medicare drug plans, 46% say they are saving money on prescription drug costs, while 34% say they are paying about the same as before the drug benefit and 17% say they are paying more.
Oh well, at least the people who the bill was designed to help are benefiting. On Tuesday the NY Times told us that:
The summer revival in the pharmaceutical industry continued as Merck and Schering-Plough, two major American drug makers, reported second-quarter profits yesterday that were well ahead of analysts’ expectations. Medicare Part D, which offers prescription coverage for people over 65, is fueling the profits, as drug makers benefit from new prescriptions and somewhat higher prices for medicines, Wall Street analysts say. The number of prescriptions has risen 3 percent this year, and growth accelerated in June to more than 5 percent, according to a report from Merrill Lynch. Eventually, Part D could fuel a political reaction if prices continue to rise, but analysts expect the industry’s influence in Washington will delay any changes for years.
And the taxpayer isn’t getting screwed any more than they were going to be already in Part D are they? Well there’s this little nugget too
Overall prescriptions are also increasing, according to data from Citigroup and Merrill Lynch. For the year, total prescriptions in the United States are up about 3 percent, but they accelerated in June, rising 5.4 percent over the previous June. Drug makers have also increased prices for many popular drugs and are paying rebates to the private insurers who run the Medicare Part D program that are lower than the 15 percent rebates they paid to Medicaid.
Well at least the market is working—of course Adam Smith might not notice this as being the kind of free market he was thinking about.
HEALTH PLANS: And just in case the pro-Kaiser bias is getting out of hand
Now that we’ve let Pat Salber be so nice to Kaiser, Gadlfy reminds me about a couple of things.
First a lost laptop apparently filched out of Oakland HQ with a mere 160,000 patients’ details on it. They were fined $200K by Dept of Managed Care for putting 150 names on the Internet, so proportionally this one should come in around the gross national product of Belgium!
And then much more dirt about the kidney transplant disaster–including the reason that the story broke. The whistleblower went to the press and the authorities including the LA Times. It was the LA Times series on Kaiser’s kidney transplant program that made the brown stuff hit the whirling metal thing. And what’s worse is that they still have not have had the no-holds barred public enquiry that they ought to allow and that I called for when it happened—mostly (according to Chris Rauber in the SF Business Times) apparently out of fear that it’ll upset the Permanente Group.
I half expect several commenters to (again) question how Robbie Pearl’s father really died. But the point is that the EMR KP is introducing is capable of massively improving care quality. But it’s a necessary but not sufficient condition.
Meanwhile, there are also allegations that the non-profit guys (Blue Shield and Kaiser) are joining the real schlockmeister behavior of retroactively cancelling patient policies—the ones that Wellpoint’s Blue Cross unit is in hot water for doing. No examples about KP, although there is one for Blue Shield, who’s underwriting is pretty tough these days.
So as everything in health care, there are two sides to the story. It would be very nice if KP made more of an effort to be open about this–I still think a full external inquiry into the Kidney transplant fiasco would be much better for them (and for health care as a whole) than us all having to read the tea-leaves via the unfair dismisall case….but the politics of KP as a whole are very delicate and I understand why they won’t do it. I don’t agree with that policy but I understand its genesis
HEALTH PLANS/PHYSICIANS/TECH:Health care, the way it should be (or How to stop worrying and learn to love the bomb), by Pat Salber
Pat Salber writes The Doctor Weighs In. She is a doc, an ex-med director at California blue shield, and a Kaiser Permanente member. And she loves them. This is why, and it’s quite an advertorial for Kaiser and an indictment of how everyone else does it. So if this becomes the standard, and people find out about it (and with $80m of advertising budget a year behind it, they will find out) can the rest of the US system compete?
Health care, the way it should be or (How to stop worrying and learn to love the bomb)
I have to tell you again about what great health care I get from Kaiser Permanente Northern Cal. 
(Yeah, I know, they screwed up on the transplant service). But, they are doing a lot of the things we, the wonks, have been hollering about for years. Read this.
Sunday night I noticed new “floaters” in the right visual field of my right eye. They were different from the run of the mill floaters – those little dark circles — most of us have. These were like long lines and they only moved on the right side of the visual field. The next day, I started having sparkling lights, again in the right visual field. Now, even an emergency physician knows this could indicate a retinal detachment (serious indeed). So mid-afternoon, when I had convinced myself it would be stupid to miss my own diagnosis, I called KP. The woman on the phone in the opthalmology department clearly had been trained. When I talked about the sparkles, she put me on hold and got a nurse.
The nurse tried her best to get me in the same day. She had an appointment available, but being rush hour, there was no way I could make it. She carefully went over the symptoms of retinal detachment and compared them to what I was experiencing. Together we decided it was OK to wait until the next am for an appointment. She carefully explained that if certain symptoms occurred (e.g., a sensation of a curtain coming down over the eye), that I needed to go to the emergency department right away as that could indicate a retinal detachment.
The next day (today) I showed up at the opthalmology department. The receipt I was given for my $15 co-pay listed the dates I had had all of my age/gender specific preventive services and the dates the next ones were due.
There was no wait to see the doctor. I was put in an eye exam room and saw a nurse right away. She explained everything she was going to do. She anesthetized my corneas, she tested my vision (with glasses and with pinholes), she used the slit lamp to look at the corneal surface, and then she put in drops to dilate my eyes.
After about 15 minutes (waiting for the eyes to dilate), Dr. Prusiner, chief of the department came in to see me (he is the brother of Stan Prusiner, the Nobel Prize winner who discovered prions). He did a very thorough exam of both retinas using a variety of techniques. He explained that I had a vitreous detachment (annoying, but otherwise, no big deal). He showed me a color picture of an eye with a vitreous detachment. He answered all of my questions. He did not seem rushed (because the nurse had done a lot of the early work for him).
We were finished, he gave me a 4 x 6 piece of paper with his name, his photo and the URL of his home page. Here’s the link so you can see how nice it is. This is, I think, the new KP Connect. It also showed all of the stuff (by major categories) that he had on his home page. He wrote down the diagnosis “vitreous detachment” on the paper and drew an arrow from it to name of the link where I would find the information he had chosen for his patients to read about this condition. He urged me to read it. I went on the site, found the condition, and, lo and behold, everything he told me was what was on the site.
He then told me, in detail, what symptoms would require me to call or go to the ER right away. But he assured me that the symptoms represented complications highly unlikely to occur.
By the way, he said as I was leaving. Be sure to make an appointment with the optometrist. I think we can improve the correction of your left eye.
I challenge you to find one single thing you would want that I didn’t get. This is the way health care should be.
TECH: Is Continua the work of the devil
You and I might have thought that Continua was a sensible business led approach to get medical devices and remote monitoring systems operating together. But looking at this photo of Intel’s Dave Whitlinger who runs the Continua Health Alliance over at Tim Gee’s blog, maybe more sinister forces from far below are at work?
(Yes, I’m kidding)
BLOGS: New hospital industry blog
Health Care Policy, Innovation and Renewal is a pretty interesting new blog from a hopsital system strategy exec, who appears to have something of a social conscience—if that’s not a contradiction in terms! Doesn’t seem to be updated all that often but every post I read is thought provoking (wish that I could say that for THCB!). It’ll be interesting to see its development
HOSPITALS: Yet more insider trading at HCA?
Apparently the SEC is understood to be examining suspicious option trades in the run-up to the HCA leveraged buyout. Which does give me the thought, can’t Bill Frist leave well enough alone?
BLOGS: How many nurses can dance on the head of a pin?
Change of Shift, the nurses compendium is up.
THCB: Tech stuff
If you’ve tried to sign up for the THCB Update email at any point in the past two or three days you may have encountered problems. THCB’s intrepid techies are working to resolve matters. Meanwhile, If you’d like to sign up, drop us an email at th******@***il.com.
