The other day Mark Bard (formerly of Manhattan Research) came by for a quick chat. Mark’s now running the Digital Health Coalition which is trying to get some voluntary agreement on guidelines as to what Big Pharma can and can’t do on sites that feature user-generated content. Pharma’s still tipping all its consumer advertising into TV when it would be much better off moving the 5% it spends online to 15-20%. But because Pharma’s scared of the FDA, and because–despite holding hearings in the 1990s and in 2010–the FDA is still not close to issuing guidelines, everyone is stuck. I saw Ben Lei who runs eMarketing at Genentech speak at a conference this week and he basically confirmed that they could do much more, but they won’t for now. And it may be that this is getting worse. This has real financial consequences. WebMD missed earnings badly last quarter and lost about 1/3 of its market cap because a bunch of pharma advertising was delayed/put on a longer regulatory review. If you want to dig into this, here’s a link to their earnings call Q&A in which Chairman Marty Wygod himself felt it important enough to come face the music–which is being provided by class action plaintiffs as we speak. In any event, I’m sure that the agencies, the online guys and the pharma marketing types are hoping that Mark can come up with something and soon!
CER Kills?
By
According to the Pacific Research Institute recently, because of “Comparative Effectiveness Research” (CER) “under conservative assumptions, R&D investment in new and improved pharmaceuticals and devices and equipment would be reduced by about $10 billion per year over the period 2014 through 2025, or about 10-12 percent. This reduction in the advance of medical technology would impose an expected loss of about 5 million life-years annually, with a conservative economic value of $500 billion, an amount substantially greater than the entire U.S. market for pharmaceuticals and devices and equipment.” [Study available here.]
I haven’t read the study. I don’t need to, since it is so obviously true, if we just make certain assumptions, such as:
- Every dime spent on R&D for drugs and devices is wisely spent, on advances that will save and improve lives.
- Every dime spent on finding out whether those drugs and devices actually work as advertised, and don’t actually kill people, and do it better or cheaper than other drugs and devices, is a dime wasted. CER just slows down legitimate, helpful research.
- Experience does not show us any examples of wasteful or unnecessary drugs or devices. Those multiple peer-reviewed research papers showing that we waste hundreds of billions of dollars every year on useless complex back surgeries, the 22% of implanted defibrillators that are unnecessary, tens of millions of unnecessary scans, coronary stents put in people with stable heart disease and no heart pain, the heartburn surgeries that work no better than over-the-counter drugs—those studies are all false, wrong, some kind of mumbo-jumbo that we can safely ignore.
If we just make those few simple assumptions, the study has a valid point. If we don’t accept those assumptions, we have to wonder about the mental state, motivations, and personal finances of someone who would cook up such an obvious bit of flim-flam.
Joe is a healthcare speaker, writer, and consultant, working with clients ranging from the WHO, the Global Business Network, and the U.K. NHS, to the majority of state hospital associations. Joe writes at imaginewhatif.
Learning Hard Lessons from the RIM Story
One of our account managers sent me a link to this open letter written by a high-level employee to the leadership of Research in Motion or RIM, makers of the BlackBerry, laying out their concerns about the company. The company faces stiff competition in the smart phone market and recently announcedplans for 2,000 layoffs.
The account manager thanked me for what I have done to lead us in a way that has avoided this fate for athenahealth. So, thanks to him.
HOWEVER, I don’t think we are totally free of all eight concerns rattled off by one anonymous OG RIMMER. Here are some of her/his pleas to management and some of my thoughts on them as they apply here at athenahealth. (If you could see our internal blog version of this post, you’d see more than a dozen thoughtful comments from athenahealth employees on how they think we can learn from this story.)
A Technology in Search of a Market
PHRs are much like the tides, news about them ebbs and flows. Right now, with the relatively recent demise of Google Health, Dossia’s attempts at rebirth, and the significant inquiries we are receiving regarding meaningful use requirements to host a PHR (patient portal). But in and amongst all this Chilmark has heard on more than one occasion the following statement: “The problem with PHRs is that they are a technology in search of a market.”
This statement is simply wrong for the following reasons:
1) As we have said countless times before in previous posts, very few people are interested in a digital filing cabinet for their health records. Unfortunately, many PHRs in the market today are just that, digital filing cabinets. In this case it is not an issue of a technology in search of a market, it is just a bad product that really has no market.
2) Technology adoption does not occur for its own sake, it occurs when there is perceived value by the user that leads to adoption. PHRs, PHPs (personal health platforms), patient portals, etc., is certainly a technology, that when well-designed, and implemented can deliver significant value and subsequently see high adoption rates. Just look to Kaiser-Permanente’s instance of MyChart, where patient adoption is well over 40%. Up in the Pacific Northwest, the Group Health Collaborative (GHC) is seeing PHR adoption that is well over 50%. That’s a market!
US Rumor and Hospital Report
It has been almost four years since I commented on the annual hospital ranking prepared by US News and World Report. I have to confess now that I was relatively gentle on the magazine back then. After all, when you run a hospital, there is little be gained by critiquing someone who publishes a ranking that is read by millions. But now it is time to take off the gloves.
All I can say is, are you guys serious? Let’s look at the methodology used for the 2011-12 rankings:
In 12 of the 16 [specialty] areas, whether and how high a hospital is ranked depended largely on hard data, much of which comes from the federal government. Many categories of data went into the rankings. Some are self-evident, such as death rates. Others, such as the number of patients and the balance of nurses and patients, are less obvious. A survey of physicians, who are asked to name hospitals they consider tops in their specialty, produces a reputation score that is also factored in.
Here are the details:
Survival score (32.5 percent). A hospital’s success at keeping patients alive was judged by comparing the number of Medicare inpatients with certain conditions who died within 30 days of admission in 2007, 2008, and 2009 with the number expected to die given the severity of illness. Hospitals were scored from 1 to 10, with 10 indicating the highest survival rate relative to other hospitals and 1 the lowest rate. Medicare Severity Grouper, a software program from 3M Health Information Systems used by many researchers in the field, made adjustments to take each patient’s condition into account.
Self-tracking gets hip: Withings & more
We’ve been watching self tracking at Health 2.0 for a little while, as it emerges from the world of the Quantified Self geeks to becoming a more mainstream set of shiny consumer gadgets. Today’s NY Times takes a look at just a few of the shiniest including Fitbit and the French company Withings. It has a Wi-Fi scale that sends your weight to the cloud and a beautiful (really!) blood pressure cuff that attaches to your iPhone-both of which I’ve been test driving and like. Also although the NY Times author Farhad Manjoo doesn’t seem to care–despite the fact he obviously has a young kid–a Withings baby monitor is on the way to market too. Many other players aren’t in this article, including sleep monitor Zeo, exerciser tracker BodyMedia and emerging data utility layer platform RunKeeper. But you won’t be surprised to hear that all four and more will be at the forthcoming Health 2.0 Conference on Sept 25-7
The Debt Ceiling and Health Care
Over the weekend, I watched Twitter as drops of information about the debt ceiling leaked out bit by bit. There was a deal. No deal. Well, maybe a deal.The deal would require Congress to wait until a Balanced Budget Amendment passed in the states before it acted. Well, no it actually didn’t include that. Medicare was on the chopping block. Well, not cuts to members, only cuts to physicians and other providers. What’s an ordinary person to think?
There was plenty of humiliation to go around. Speaker Boehner didn’t return the president’s phone calls. Speaker Boehner couldn’t rally his own party to support his deal. Majority Leader Reid couldn’t get Republicans to talk to him. Sen. McConnell would only talk to Biden not Reid, and his unfortunate facial expressions left us with the impression that he had a serious digestive problem. The classic picture was Boehner in the House elevator letting out a long groan as the doors closed. He was not the only one groaning.
Pundits made the worst cliché pronouncements. Everything was a “crisis”; there was lots of “kicking the can down the road.” TV time had to be filled and fill it they did. Those smart folks who spent the weekend outside, barbecuing or swimming, were the wise ones. We all knew it would come down to the last moment, but oh, was it painful to watch those last agonizing hours.
There Will Be Blood
The debt deal is finally done. But it really isn’t an agreement on what cuts will be made, just the process that will be used to make them.
The real work is left to the Congressional appropriators for the first $917 billion and for a super-committee of Congress for the second $1.2 trillion to $1.5 trillion in ten-year cuts.
That second tranche is where health care will make its contribution. The super-committee has to make its decisions by November 23rd and, as a practical matter, the Congress can only accept what the super-committee decides or face the consequences of the automatic $1.2 trillion fallback cuts.
When it comes to health care and the super-committee, all federal health care spending is on the table—–Medicare, Medicaid, the new law, benefits, and provider payments.
Since the budget window for the deal is ten years, it is not likely that any changes will be made to entitlement eligibility—such as delaying the Medicare eligibility age from 65 to 67. It just wouldn’t be fair to tell a 60-year-old their Medicare eligibility age is being raised. But we could see more means testing of Medicare premiums.
Attila the Cardiologist
The history of Western civilization, from prehistoric times until relatively recently (so recently, in fact, that one cannot be absolutely certain the pattern has been broken), has been marked by successive waves of invasions by wild barbarians from the north. (This explains why DrRich will never completely trust the Canadians.) Every few hundred years, one group of primitives or another – Scythians, Goths, Vandals, Huns, Avars, Norsemen, Bulgars, Mongols, and others named and unnamed – would sweep down upon their betters, upon the more civilized, more culturally and intellectually advanced people to the south, and by the expediencies of slaughter, rape and pillage, would take their land, possessions, freedom, and their lives. The advancing barbarian wave would eventually play itself out, and individual members of the untamed horde would simply settle in place, and over a few generations would become civilized themselves – until the next group of barbarians, in turn, would fall upon them.
It was a cycle as natural as the seasons.
What drove these irresistible barbarian movements? Historians still argue about it. Likely these violent migrations were caused by several different things – famine, plague, encroachment by even nastier barbarians from even farther north, and climate change (though this latter conjecture is now politically incorrect, since the official and proper view of the earth’s climate is that it was absolutely stable for millions of years, until Henry Ford and George Bush came along and bent the temperature curve upwards, like a hockey stick).
The reason DrRich brings all this up, of course, is: to warn his medical colleagues about the cardiologists.
Rethinking The Value Of Medical Services
One of American politics’ most disingenuous conceits is that health care must cost what we currently pay. Another is that the only way to make it cost less is to deny care. It has been in industry executives’ financial interests to perpetuate these myths, but most will acknowledge privately that the way we value and pay for medical services is a deep root of America’s health care cost explosion.
When the Resource-Based Relative Value Scale (RBRVS) became the framework for Medicare payment nearly twenty years ago, it equated a medical service’s “value” with four categories of physician work inputs: time, mental effort and judgment, technical skill and physical effort, and psychological stress. The assessment process, handled from the outset by the American Medical Association’s (AMA) secretive, specialist-dominated Relative Value Scale Update Committee (RUC), delineates and quantifies a service’s inputs in terms of its Relative Value Units (RVUs) which, with a monetary multiplier, define its worth.
In 1989, RBRVS’ lead architect, William Hsaio, confidently suggested that the process would be rational and reliable:
We found that physicians can rate the relative amount of work of the services within their specialty directly, taking into account all the dimensions of work. Moreover, these ratings are highly reproducible, consistent, and therefore probably valid.
