Categories

Month: July 2007

The Week in Review

New York attorney
general Andrew M. Cuomo sent a letter to UnitedHealthCare
demanding that the insurer cancel
the launch of an online service
that would rate doctors by the quality of
care they provide and the cost of their services. Linda Lacewell, an attorney
on Cuomo’s staff, noted that the program could be used to push patients toward
selected doctors. “To compound the situation, we understand that employers may
act on these ‘ratings’ to offer financial inducements such as lower co-payments
or deductibles to promote ‘cost-effective’ doctors to their employees."

The Wall Street Journal reports that state and federal officials are continuing
to ask tough questions about the status of non-profit hospitals
. Yesterday,
the IRS released a study that notes that "many" hospitals spend less
than three percent of revenues on charitable care. The analysis is based on a survey of  500 non-profit hospitals. Meanwhile, Senator Charles Grassley
released a memorandum in response that suggests that Congress may set new rules governing how
much charity care non-profits are required to provide. 

Dr. Anna Pou, the New Orleans surgeon charged with second degree homicide in the deaths of four patients in
her care in the days after Hurricane Katrina, filed
a lawsuit accusing Louisiana attorney general Charles Foti
of using the
case against her to "advance his political career." The suit argues
that Foti would better serve the state’s residents by investigating the inept
official response to the disaster."The real cause of loss of life is the
government’s abandonment of the patients and the doctors," the lawsuit
notes. "There can be no doubt that this will be the central issue in the
defense of this matter."

The thread on Dr. Pou and her case, which began more than a year ago when we ran a brief item about
the defense fund set up to help pay her legal expenses, has been surprisingly active for a long time. Various posters and acquaintances — including many doctors and other healthcare workers who have worked with her – have left messages of support,
encouragement and criticism. Many have had nasty things to say about Charles Foti. 
Bill writes in claiming to have an inside angle the case. (Note: These claims have not been verified.) He says:         

"Anna is also my friend and I promised her I would not talk about the
things we have talked about. I wish I could tell you more, but I made a
promise and I am therefore bound to keep it. What I can tell you is this: Foti was not the principle in the original investigation.  Instead Jullie Cullen, Director of the Criminal Division of the Attorney General’s Office spearheaded the original investigation. The case against Anna will not go further than the Grand Jury. There will be no court case and the charges will be dropped. I wish I could tell you more, but I cannot. But please know this: what happened on the seventh floor was done out of love."

Val responds: "First of all I am an MD and I did go through Katrina and I do know Anna
Pou. But trying to be objective and somewhat logical here no one is
allowed or justified to "play God" and decide when another’s life
should end. However, we are bound to reduce suffering whenever
possible. It is completely bogus to say that you cannot give versed and
morphine together– we do it all the time in ICU or the OR etc."

Jonathen sounds more Perry Mason-like. "The charges were based not just on the eye witness statements that
indicated Dr. Pou, in her own words, told them she was going to
administer lethal doses but on the original autopsy reports which
showed high levels of morphine, including a morphine overdose test, and
Versed and Ativan. Mr. Foti was doing his job. And as for Anna, this
case is not about whether she is a nice or not nice person, whether she
is a competent or incompetent doctor.This is a case about a doctor who
told multiple eye witnesses that lethal injections where going to be
administered to the remaining patients on the seventh floor."

The Center for Science in the Public Interest’s Merrill Goozner drew
attention to a post last week by Beth Israel Deaconess Medical Center CEO Paul Levy discussing a new treatment for severe asthma. Goozner noted
that that BDMIC is both
a clinical trial site for the procedure and a
consultant to the device’s maker
, Ashtmatx of Mountain View California. Levy mentioned neither fact in his post.  Medical
journals have rules that disclosure of potential conflicts. So do newspapers.
Yet "the blogosphere operates without rules, even when the blogger runs
one of the nation’s leading teaching hospitals," Goozner writes. Levy says
he was "unaware of the relationship" at the time he wrote about the treatment.

Two years ago, the University of Pittsburgh Medical Center ignored
the advice of consultants and pushed ahead with an ambitious $402 million IT
services contract with IBM. The deal was one of the most talked about of the
year. Did it pay off? UPMC CIO Daniel Drawbaugh says yes.

In Vermont, government
officials think "socialized data" could help develop a
new model
for fighting chronic diseases. Government Health IT News examines
the ways that the Vermont Information Technology Leaders program, a
public/private partnership, is combining the regional health information
organization with traditional disease management methods. The article
examines similar efforts around the country, noting projects in Kentucky and Calgary. Orion Health’s Dr.
Chris Hobson
, the star of a recent THCB podcast, makes an appearance to talk
about the company’s technology, which is being used in both Calgary and Vermont.  [Full disclosure Orion is a THCB sponsor.]

HEALTH PLANS/QUALITY: Klepper on the transparency conundrum

Over at The Doctor Weighs In Brian Klepper talks about the transparency conundrum. Should We Have Health Care Performance Transparency? By Whom? And How?. Should transparency be left in the hands of untrustworthy health plans with their own proprietary techniques? Probably not. Is that a reason for abandoning the whole concept? Not exactly.

Meanwhile, I have a hell of a travel day today, and I’m miles behind on some other stuff. I will though be back with an interesting set of updates about Health2.0–User Generated Healthcare on Monday, so please check in then.

 

Don’t Blame The VA

I never wrote too much about Walter Reed at the time of the scandal. But this week’s resignation of the VA Secretary, reported by the AP as being connected to Walter Reed, is now being used by some on the right to re-attack the concept of universal health care. It’s bad enough that I have to range the web to combat this misinformation. It’s almost worse that it comes from a fellow columnist at my “lay people’s site, Spot-on. So I’m up over there saying, Don’t Blame The VA.

I like to combat the odd Republican in my columns in Spot-on, but it’s fairly unusual that the object of my humorous chiding is a fellow Spot-on-er. But this week Scott Olin Schmidt reworks the tired argument over Walter Reed Army Medical Center saying that since the hospital was revealed as a disaster some months back the government has no hope of competently running health care facilities, and by extension no hope of successfully running any type of health care organization including health insurance.

The evidence that Scott introduces – based on a somewhat misleading Associated Press story – is that Jim Nicholson Secretary of the Department of Veterans Affairs (VA) has resigned, apparently because of the Walter Reed scandal. Scott then makes the huge leap to say that if you don’t want to see the kind of problems Walter Reed represents, then you should be opposed to the very notion of universal health-care. And for good measure, he suggests that it is all Hillary Clinton’s fault as she "would apply the VA model for healthcare to everyone with one single-payer."

The problems at Walter Reed were indeed severe, but they were mostly concerned with the incredibly disorganized treatment of outpatients, and their being housed in shameful conditions, while the system essentially ignored them. No one is denying that these were terrible problems, or that whoever was in charge should have fixed them. But blaming this on the VA as a knee-jerk reaction reveals a teeny tiny error.

Walter Reed is not a VA-run hospital. More

Come back here to comment.  UPDATE: Other THCB posts on Walter Reed and the VA worth noting:             "In Defense of the VA" by Maggie Mahar

            "The VA and Health IT. A model that works" by Maggie Mahar

            "A National Disgrace" by John Irvine

            "Army pledges fixes at Walter Reed" by John Irvine             "Debating the Quality of VA care" by Eric Novack

            

INDUSTRY: Medical Bankruptcy Rate Disputedby Eric Novack

For those who remember the endless headlines of "50% of All
Bankruptcies Due to Medical Debt", and particularly for those who have
based many calls for national, single-payer health care, on that paper
by Single-payer zealot David Himmelstein, here is a must read.  Law
professor Todd Zywicki, testifying at the US House of Representatives
Judiciary Committee, this week. The link to the testimony is a downloadable word file… all 21 pages are worth reading.

Health 2.0: Live from Healthcare Unbound

Today
I’m at the HealthCare Unbound conference in San Francisco, where
I’m on a panel on PHRs at the end of the day. Tomorrow morning
I’m presenting at the Silverlink/HealthWise session on Information
Therapy in Boston
. You do the math and figure out where I’m spending
the night! Funnily enough as I type I’m sitting next to Josh Seidman,
the President of the Center for Information Therapy, who’s on a panel
here later today. Tomorrow I’ll be seeing his colleague Dorothy
Jeffress
. At least those two have figured out the divide and
conquer thing.

First
up was Vince Kuratis. He told us the DM world was
ending (otherwise known as Medicare Health Support crapping
out).

Liz
Boehm, Forrester
was looking at tech adoption among
seniors and trying to do it by same store growth versus new growth in
tech use by seniors as they age over time. Most growth in familiar
technologies; (e.g. replacement technologies like cell phones, DVD,
etc) was dominated by real growth BUT going online regularly and having a
computer at home are primarily from people aging in (new growth rather than
same store growth). And that means the adoption will take much longer.

Why
is this adoption rate so slow? Seniors have trouble seeing. Seriously. She
showed a cool slide that showed problems with vision that more seniors have
(focus, seeing at night, etc, etc). And hearing, and using the mouse and
interacting with websites, etc, etc, etc. And there are problems with cognition
(as you age your short term memory falls apart, as we all know!). Liz tried to
get the crowd to follow some basic instructions like standing up, sitting down,
hopping up on one foot; she said that most seniors have trouble
following those instructions quickly. I noticed that most people were too lazy
to get up and follow along (Josh and I did of course). So motivation is a
problem too (after all if a good looking blonde woman can’t persuade
a room full of geeky men to do anything, what hope do the rest of us have!).
Liz then gave a whole list of things that companies targeting them should do to
change behavior. Looks like Forrester is having trouble get its clients to
figure this out, and is having to go back to real basics on the whole matter.
To me that’s not particularly good news, as if they have to be
helping them with that. Here’s the data from Forrester.

Continue reading…

TECH: Problems for Employer-backed PHR

The Dossia Project, the sweeping personal health record (PHR) initiative backed by Wal Mart, Cardinal Health, Pitney Bowes, Intel, BP and other major employers, looks as though it is running into serious problems. The consortium is suing JD Kleinke’s Omnimedix Institute, the non-profit group which was hired to develop the system seven months ago. "They went ahead to file
a restraining order to prevent us from suing them," Ominmedix chairman
and CEO J.D. Kleinke said in an interview. "They’ve gone ahead and
filed a restraining order against us, a 13-employee, 501-C
."

HEALTH2.0/TECH: Big day for Healthline

It’s a big day for Healthline Networks. The health “search and much more service” (if I call them “search only”, President Dean Stephens gets grumpy with me!) has raised another $21m in venture funding and announced deals with several customers—including some who have put money in as part of the round. Those on the funding and client side include NBC (which owns iVillage), Aetna, & US News & World Report. Also putting money in was Kaiser Permanente’s venture arm, so it’s reasonable speculation (if not announced yet) that KP is thinking of using Healthline too. In addition AOL and Ask.com are also going to use Healthline for search on their properties.

Given that vertical search is becoming a big deal in health care, this is some of the biggest news yet. So lots of activity! Healia was bought last month, Kosmix has been announcing deals, Medstory was sold to Microsoft, and some small company beginning withe letter G apparently is doing something in search too.

Of course, if you really want to know more you should consider coming to the Health2.0 Conference to hear from all of those companies and many more….

THCB Reader Mail

SeekCEO wonders whether there are any ex-WebMD/ex-Healtheon folks who would like to lead a new Healthcare Web 2.0 startup in Southern California? If you’re qualified email for details.

The Robert Wood Johnson Foundation’s Susan Promislo writes in with this to say about the "Disruptive Innovations in Health and Health Care" competition we wrote about last week.  

"Thanks for the note about the Robert Wood Johnson
Foundation/Changemakers competition to identify disruptive innovations
in health and health care. I also wanted to add that the $5,000
Changemakers cash awards are an important component of the competition,
but they are not where the action ends.  All entries will be reviewed
by RWJF’s Pioneer Portfolio, which has made available up to $5 million
to support innovative, disruptive approaches that come in through this
competition.  Once the competition closes, promising projects may be
invited to submit proposals to Pioneer for possible future funding.
More info. is available at
http://rwjfblogs.typepad.com/pioneer/2007/04/back_in_january.html

The deadline is July 18, which means you’ve basically got all weekend to get your entry in to win a grant!

Unity Stoakes of Organized Wisdom responds to concerns on the part of privacy advocates that the military-industrial Google complex
may pose a threat to consumer privacy. "Google already has all of our
data. They know more about me than I do.  May as well give them all the
rest and see how (on an aggregate level) this type of data can
collectively help us improve our health. For better or worse the age of
privacy is quickly being replaced by what I call THE AGE OF
TRANSPARENCY. Whether we want to or not, not only is the world flat
again, it’s also OPENING UP and AGGREGATING."

Ginger B comments on the thread about the reasons doctors don’t like to use email to correspond with patients. "I have Kaiser and I like the email feature. I have many other things to do besides sit next to my telephone waiting for a phone call from a Doctor. It’s one of those things where if you have one meeting that day, that will be when they try to call you. I’ll also add that when I emailed about my PCP ordering a lab test for me she emailed back and informed me that she was also ordering blood lipids to be done because I was due for those, and she wanted me to come in and get the results so we could review them."

Anonymous writes in to comment on the same thread.  "If our patients want to contact us, they must use email, we don’t use the phone.  For three days after an appointment and for special circumstances determined at the time of the visit (for which they are given a code) they may email us for free.  After that, it is $25, refunded if I can’t answer their concerns satisfactorily. Questions are answered within 24 business hours. I haven’t had one complaint and though my practice is closed, I have requests daily to take patients.

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