Welcome to Health Wonk Review. Thanks to those of you who submitted in my own desired format. My sources tell me that (at least one of) the “commercial” carnival submission operations will have the perfect system shortly. But for now thanks for following those instructions (even if one or two of you claimed to find it easier this way!). This literally took me 2 hours less time than my previous hosting stint—for which my dog and fiancee thank you, even if my psychiatrist, 1-900 Psychic advisor, and various alcohol manufacturers are cursing at you.
On to the fray! We start with health care policy wonkiness.
Some folks seem to believe that transparency will solve all of humankind’s problems. Would that it were so, says David Harlow over at HealthBlawg. His post Of drug-resistant staph infections, public reporting of infection rates, and the consumer-directedness of it all applauds transparency, but cautions against viewing it as a panacea. Michael Cannon at Cato@Liberty also turns to transparency and quality information reporting. On THCB your host doesn’t agree that Michael got it anything like right the first time around, even though he was trying to be deliberately
opaque subtle. But I think there’s agreement generally (Agreement? Between us two?!) when Michael argues that patients do not even need to know quality information in order for there to be pressure to improve quality.
For his second round, in an alliterative bit of rhetoric, David also at HealthBlawg asks if we are prepared "to see a P4P system that penalizes poor performers or eliminates payment for certain procedures or pharmaceuticals?" He was responding to some of Gail Wilensky’s recent thoughts (at a Congressional committee hearing and at the Health Affairs Blog) on fixing Medicare’s sustainable growth rate formula approach to physician reimbursement policy.
In the debut blog e-CareManagement, Vince Kuraitis writes on issues relating to chronic disease management (DM), technology and strategy. Discussing a recent study in NEJM, he describes how “dispersion of care” makes P4P for physicians in Medicare problematic, particularly for patients with multiple chronic conditions. To your hosts great dismay (not), he also touches on how dispersion of care disparages Porter’s framework for “Redesigning Health Care”. Hmm, some skepticism of the great Porter’s ideas, I fear that has occurred on THCB in recent days too.
Michael Cannon also reports at Cato@Liberty on the failings of managed competition in Medicare Part D, noting that Humana encouraged its participants to switch plans. In rather stark and predictable contrast, at THCB, yours truly was also fascinated by the problems Sierra Health Services was having with its new Part D plan but come to a rather different conclusion. He thinks that it shows exactly why health care insurance reform requires Enthoven-style managed competition regulation–including risk adjustment and common mandated benefits, or else the market is doomed to fraud and failure. (And no Michael, Part D is not Managed Competition!).
Talking of Managed Competition, in general, economist Jason Shafrin is a fan of a voucher-based health insurance system. In one of his recent posts in the Healthcare Economist blog, however, Jason discusses the difficulties in adequately risk-adjusting the value of these health insurance vouchers.
On Health Care Renewal, Roy Poses comments on an excellent, but long-overdue article in the Annals of Internal Medicine assesses how primary care and other "cognitive" physicians have been relatively under-reimbursed by the US Federal Medicare system compared to specialist "proceduralist" physicians. The problem with increasingly penurious reimbursement of primary care and cognitive services and increasingly lavish reimbursement of procedures, high-technology, and new drugs has been going on for at least 15 years, and clearly is an important cause of ever rising costs, declining access, and stagnant quality. This article still begs the question of why little has been said and nothing has been done to fix the problem to date.
Henry Stern presents Hoosier Health Care Provider? posted at InsureBlog, saying the State of Indiana and the Feds are working together to help empower folks when it comes to health care. He explains why basketball isn’t the only game at which Hoosiers excel.
And then there’s the only in health care legal stuff…
Eric Turkewitz at the New York Personal Injury Law Blog has a tale of an appellate court in New York providing a much more stringent discovery rule for HIV or substance abuse records than is "normal."
Reporting on the intersection of medical devices and information systems at Medical Connectivity, Tim Gee was struck by the regulatory challenges faced by medical devices that depend on networks. While private or isolated networks supporting medical devices will be around for some time, the market requirement to support enterprise networks is only going to get stronger. He discusses issues facing infrastructure vendors like Cisco as well as medical device vendors, as they struggle to adjust to pressures from both the FDA and the market.
Also at Cato@Liberty, Dan Mitchell documents a disparity between the funding of traditional and alternative medicine in Britain’s NHS
Let’s not leave out the sometimes murky world of pharmaceuticals.
David Williams of the Health Business Blog notes that generic Zocor prices are all over the map. He suggests scrapping insurance for routine items and turning on the shopping power of consumers to drive down prices.
Again at Cato@Liberty, Sigrid Fry-Revere comments on HPV vaccination mandates, arguing that Merck’s profits will benefit more than the public’s health. Maggie Mahar had a most excellent post about the whole Gardasil controversy at THCB a few weeks back, that’s well worth a look if you missed it.
At BioHealth Investor.H.S. Ayoub presents about a Cancer Drug, but not Drug Company, Praised by Networks. A familiar theme for the beleaguered bio-pharma industry. On the Health Affairs Blog, UC Berkeley economist Jamie Robinson writes about a new book on the biotech industry from yet another Harvard Business School professor (James Pisano). Robinson notes: “The biotech industry gets plenty of love but not much respect from our author in this survey of organizational strategies.”
And let’s not forget about new technology for patients
Dmitriy Kruglyak over at Trusted.MD finally reports on his trip to Boomer Business Summit and ASA Annual Conferences in Chicago, where he spoke about the impact of social media.
Scott Shreeve, at his eponymous blogspot, wants to tell us all a bit more about Health2.0. You’ll be hearing more about that, I can tell you.
And finally also connected to social media—in the beyond off-topic department, I got one submission from the carnival engine that wasn’t about health care at all—a total mistake submitted to the wrong place, as the author confirmed. But it was gripping reading (and a lot of it!) and will surely become part of a “novel” that will top the pulp fiction lists. This is about a cyber-feud in the MySpace generation that is way beyond the far side…
That’s it till next time, when HWR will be at Health Affairs Blog. Jane Hiebert White there would like to receive html coded entries by
email at firstname.lastname@example.org. Deadline is April 4.