Category: Physicians

PHARMA/PHYSICIANS: Yet more on Rx data sales

The NEJM has a perspective about the sale of Rx data of physicians prescribing patterns, which caused a lot of fuss on THCB a while back. In my view this is problem about number 728 on the docket of what’s wrong in American health care, and those physicians complaining about it should look to solve the first several hundred before they set their sites on changing the law, or just kick the drug reps out of their offices. There’s nothing particularly good about the current situation but it’s just not that big a problem and banning the sale of data won’t change it too much. the perspective from Robert Steinbrook largely agrees.

Prohibiting the release of prescribing data to sales representatives will not put an end to another practice to which some physicians object: the use of such data by managed care or pharmacy benefit managers. These entities have sources of information that are independent of the AMA Masterfile. It also will not stop visits from sales agents, which doctors have always had the right to refuse, nor will it curtail the marketing of drugs. According to the AMA, the potential effects of restricted release may include a reduction in the number of “offers physicians currently receive from the pharmaceutical industry, such as drug samples, CME programs and speaking engagements.”

PHYSICIANS/POLICY: Brian Klepper on the end of life as we know it, or something like that

Brian Klepper was recently up at Medscape bemoaning the lack of physician leadership in righting the troubled ship of our health care system, and challenging physicians to do better.

He got lots of feedback, not all of it as negative as you’d think, and he had his own response. All well worth reading.

On the other hand, HSC says that in real terms we’re paying physicians substantially less than in 1995. I suspect that most of that pay "cut" was in the 1990s, and things seem to be picking up again, but — as one reader asked me — there is not that much good data on physician incomes, and in real terms they did very well between 1960 and 1990.

PHYSICIANS/TECH/POLICY/POLITICS: Hard to generate savings when you spend more, eh?

The real medical story of the day is of course Michael Owen’s torn ACL, which leaves the idiot Swede’s decision to take only one fully fit striker plus a kid he won’t play to Germany as dumb as they come. But you lot don’t care about that. Instead let me tell you about my conversation with a consulting firm looking into home monitoring. The people interviewing me, once they’d got past my somewhat cynical notions about how technologies get reimbursed by Medicare and whether private insurers actually give a rats arse about saving money, kept harping on about reimbursement and how to get home monitoring reimbursed.

I made a point that will be all too familiar to THCB readers that if (and it’s not a tiny “if”) remote monitoring of the chronically ill, and all the DM processes that go along with it, is to be done routinely, then someone somewhere will have to give up some of their income to pay for it. In other words, if catching bad things happening to patients before they crash is the end result of home monitoring, there’ll be less money spent on the ones who crash. The optimists among us believe that the amount of that money not spent will exceed the amount spent on the home monitoring and DM, but that’s a subsidiary point. Instead the key issue is that under our current diversified system the people not getting the money for the patients (e.g. doctors and hospitals) who no longer crash are going to be different from the people who get the money for the monitoring (e.g. tech companies and DM service providers).

So if DM programs based around tech use, like the Medicare Health Support pilots or BeWell Mobile’s asthma DM program, are to be successful then they’ll either need additional funding from payors, or redirected funding from payors. When you have a global budget, like the VA, then it may well make sense to bring in this type of program, which is why Health Hero Network is having success with the VA, but struggled to get wide adoption outside it before. But, and you all know this, the VA, Kaiser et al are exceptions.

While leads me to the second part of the equation; how willing is the rest of the system (those doctors and hospitals) to accept less money for any reason—let alone subsidizing the adoption of new technology that will benefit someone else? Well you know the answer to that one, and yesterday came more proof, as apparently the AMA has beaten the Republicans to a bloody pulp and will not have to deal with the draconian fee cuts that were coming their way.

So I remain a skeptic that we’re going to spend more to spend less; I just think that we’re going to (slowly) just spend more.

PHYSICIANS/POLICY: Physician Shortage Looms–hold onto your wallet

Quoting a bunch of head hunters and a rural doc who can’t find anyone willing to move to Ukiah, the Los Angeles Times says this:

A looming doctor shortage threatens to create a national healthcare crisis by further limiting access to physicians, jeopardizing quality and accelerating cost increases.

And so apparently we must build more medical schools and train more doctors, even though the doubling of the number trained in the 1970s hasn’t fully worked its way through the system and won’t for another ten years.

Momentum for change is building. This month, the executive council of the Assn. of American Medical Colleges will consider calling for a 30% boost in enrollment, double the increase it called for last year.

Meanwhile the Dartmouth guys (who maintain their starring role in THCB) say something oh so slightly different:

AMC inputs were highly correlated with the number of physician FTEs per Medicare beneficiary in AMC regions. Given the apparent inefficiency of current physician practices, the supply pipeline is sufficient to meet future needs through 2020, with adoption of the workforce deployment patterns now seen among AMCs and regions dominated by large group practices.

The powers that be in health care are advocating more money to come directly from the taxpayer into the system to train more doctors, who will then cost the nation much more when they go into practice. Of course that’s a much easier answer for them than rational reorganization of the health care system by somehow or other making it all look more like Mayo.

So how do they start using language to persuade those of us suckers who are going to have to pony up for this that they’re right and the Dartmouth crew are wrong?

The AMA changed its position on the physician workforce a year ago, acknowledging that a shortage was indeed emerging. The consensus has shifted so quickly that experts who view the physician workforce as adequate — though poorly distributed, inefficient or wasteful — now are seen as contrarians.

So that’s it. Wennberg (and Goodman and Fischer and the rest of them) are now officially “contrarians”. Hmm…aren’t they the ones who make all the money on Wall Street?

CODA: The same edition of the LA Times has an article about the international outsourcing of radiology reading, which gives a clue as to how some of that “rational reorganization” might happen.


I was checking out potential book titles when I cam across this site, Health Care for Dummies. Given that I’ve spent some of the week beating up on the AMA, and spent some of yesterday touching on why the health care system looks like it does today—mostly based on Paul Starr’s book. But the real conspiracy theory is much more fun (even if I can’t exactly vouch for the truth). Read on for an amusing Friday diversion.

I’ll see ya back here on Tuesday



To those of you who’ve been paying attention, this may not exactly be news.

Apparently, health insurers don’t pay claims immediately and deny some of them. But it is news because practice management/billing company AthenaHealth has quantified the numbers across its practices and published a list by plan of who’s paying when. They’ve even sent me the spreadsheet with every plan’s numbers. And they, or rather their apparently amazing PR company (which called me at 6 am—don’t worry I’ll be making them pay my divorce lawyer’s fees) have done amazingly well to get this into Milt Freudenheim’s story in the NY Times called The Check Is Not in the Mail.


But is this news? Insurance companies make money off the float—always have. So it’s in their interest to be at the bottom of the list until either they get fined by the state (as happened to United in Arizona lately) or they get sued by medical associations (as happened to all the big guys in the late 1990s) and settle as Aetna and a bunch of others did three years ago. The numbers AthenaHealth put out seem to be a little better than they were in the 1990s, but maybe not as good as the doctors would like. If I was Humana CEO I’d call my CFO in and ask why we’re on the top of the list when the bigger more profitable plans are down the bottom!

Maybe I just love conspiracy theories too much, but given the NY Times penchant for printing up any rubbish that gets pushed to it by the current administration, perhaps Freudenheim is craving some of Judy Miller’s publicity! After all the CEO of AthenaHealth is not only named Bush but he’s a blood relative.

I’m also amused by the comments from the doc quoted:

Dr. Molly Katz, a Cincinnati gynecologist and former president of the Ohio Medical Association, said she hoped the publicity would encourage insurers to improve their payment practices. "I would much rather have my staff talking to patients than talking to insurance companies," Dr. Katz said.

Be careful what you wish for, Dr. Katz. Given that the organized medicine is getting its wish and we’re seeing more high-deductible plans, she’ll find that her staff—while they may not spend less time on the phone with insurers—will be spending much more time on the phone with their patients. Trying to get them to pay their bills!


So why did I get so grumpy with the secretary of the AMA and his talk at TEPR. I actually stood up and asked a long question which he interrupted to tell a bunch of lies about Canada, ignoring that there are lots of other countries with universal health care that do it differently and better. When I finally got to ask about why when ePrescribing was originally mandated for Part B in the house version of the 2003 MMA eRx legislation and ask as to why it mysteriously was left out of the final bill, and what was the AMA’s role in that — well as Neil Versel said to me afterwards “no one dodges the question like the AMA.”

Things he featured prominently………………The uninsurance crisis and how tough that is for doctorsThings he didn’t mention……………………The AMA’s long, long history of opposing universal health insurance including 1994

Things he featured prominently………………The AMA’s proposal for tax credits for the uninsuredThings he didn’t mention……………………That those proposals do almost nothing to reduce uninsurance

Things he featured prominently……………….How Pay for Performance was unfair on doctorsThings he didn’t mention……………………The AMA’s long, long history of opposing quality improvement

Things he featured prominently……………….How Medicare pay rates have fallen by half over timeThings he didn’t mention……………………The vast real increase in physician incomes since 1965

Things he featured prominently……………….How physicians will drop Medicare patients if fees go downThings he didn’t mention……………………The research that shows that this is untrue and an empty threat

Things he featured prominently……………….How other countries government’s paid for doctors’ ITThings he didn’t mention……………………How other countries doctors earn much less than him and his colleagues

Things he featured prominently……………….How the government should pay for physician IT but not mandate its useThings he didn’t mention……………………Every other business has been force to get IT to better serve its customers

Things he featured prominently……………….How Canada has rationing and is going to allow some private medicineThings he didn’t mention……………………That low–middle income Canadians don’t go bankrupt from the cost of health care

Yup, apparently it is just everyone else’s fault and physicians have no need to change anything.

I am on record as wanting doctors to run our health care system. I want physician organizations to get the money and decide its rational allocation . But apparently organized medicine’s response is to bury its head in the sand and demand that the rest of us hand them a blank check, and let’s all pretend it’s 1972 again.

Please please someone tell me that this guy is an anachronism and that he really doesn’t represent physician opinion….or else I will get even more depressed…

PHYSICIANS/TECH: The intransigence of the AMA knows no bounds

Here’s what I wrote for FierceHealthcare today.

Attendees at the 22nd annual TEPR meeting could be forgiven for being a little anxious about the future. Conference organizer and Medical Records Institute Peter Waegemann put out a call for action, noting that at the first conference some speakers thought electronic medical records would be here within three years, then ten, and now more than twenty years later we’re still arguing about different standards. The keynote from AMA secretary Joseph Heyman showed where the problems lie. Although Heyman is a solo practitioner who runs a paperless office and has been using EMRs since 2001, he trumpeted his organization’s party line—No cuts in Medicare, or risk that doctors will stop taking patients. Great suspicion of pay for performance. Opposition to mandates to use technology. Demands for straight payment to acquire and use technology. Apparently the medical world has gone to hell and it’s anyone but the AMA’s fault, so apparently we shouldn’t expect doctors to save the health care system by using IT, unless it comes at no cost and inconvenince to them.

I’ll be back with a little more, and some much harsher words later.

PHYSICIANS/BLOGS: Disheartened? Maybe

I love people commenting on THCB, and 99% of the comments are very, very thoughtful. But I am a little dismayed that while only one person wants to comment on my long piece on the individual insurance market, one other on VC in health care (and that someone I wrote about clarifying a point she made) and none on my experience at the consumerism conference—28 people have something to say about a malpractice study I just point to!

People, malpractice is one percent of the dollars, and it’s about 17th on the list of major health care problems and issues we face in this country! It’s the abortion issue of health care—polarizing way way beyond it’s importance.  <sigh>


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