Category: Uncategorized

Narrow Networks – Part II

Mar 24, 2009• 8

By CHARLIE BAKER

For the past six years, Harvard Pilgrim has offered a limited
network product to our New Hampshire members called “New Hampshire
NetOption.” Simply put, all New Hampshire providers are Tier One
providers – lowest co-pays – and so are all Massachusetts community
hospitals. Tier Two providers are MA-based teaching hospitals (members
have a higher co-pay for services there). That’s it. Two tiers – one
for NH hospitals and MA community hospitals, and a different one for
MA-based teaching hospitals.

There is, however, one catch. All NH hospitals and their physicians
and all MA hospitals and their physicians are “in network” for this
product – except Partners. When we set the product up, Partners chose
not to participate because the plan design treated teaching hospitals
differently than it treated community hospitals. That’s their call.
NBD, as my kids would say.

The Public Program Impasse: A Proposal

Mar 23, 2009• 14

By ROGER COLLIER

Health care reform proponents could find encouragement in recent Obama administration comments on the issue of taxing health care benefits. The President, having adamantly rejected the concept during last year’s campaign (thereby violating a cardinal rule of politics: “never say anything you can’t later on claim was misinterpreted by your enemies”) indicated through White House budget director Peter Orzsag that he considered the issue very much on the table.

Since passage of health care reform is likely to require almost unanimous support by the fifty-eight Senate Dems—or maybe fifty-nine, depending on the eventual emergence of a winner from the long Minnesota winter—the President’s willingness to back down is a positive step (although sophisticated financial thinkers will note that shuffling funding sources will do nothing to reduce total costs).

What the administration’s openness to compromise also does, however, is move the spotlight onto another issue with the potential of sinking health care reform: the inclusion or otherwise of a public program option in a reform structure.

Commentology

Mar 22, 2009• 3

JR wrote to us with an interesting question:

“Given the attempt to recover bonus payments to AIG, can you envision a scenarios where CMS attempts to recover payments from physicians that they retroactively deem too high? What if a new national standards board establishes a rate for hip replacements that is lower than what it is today? Similar situation? Not at all? I’d like to see a discussion on this.”

CCHIT President Mark Leavitt likes the Obama administration’s pick for National Health IT Czar. He left this comment on Matthew’s post on the selection.

I had the opportunity to work with David Blumenthal recently when I served on an expert panel for the health IT adoption studies. He has a deep understanding of applied health IT and, even more important, how clinicians interact with these systems in the real world. This is great news for everyone interested in advancing the use of health IT to improve quality, safety, and cost efficiency.

Commentology regular Christopher George thinks the courts missed the underlying point in both of the cases that Tobias Gilk discusses. “Pharma vs. Devices – FDA, Supreme Court and Liability Whiplash“

“In both of these [instances] the product was mis-administered. The
Medronic balloon was inflated above the pressure for which it was
rated; the drug was mis-administered by the nurse. In both cases, the fault lay with the doctor or nurse using the
product, not the product. There is no “failure to warn” here. The
balloon was over inflated. Every balloon, when overinflated enough will
burst. The injection was made into an artery.”

Health Wonk Review, up and intense at HealthBlawg

Mar 21, 2009• 5

By Matthew Holt

David Harlow did a great job, go see.

Life in the Goodman bubble

Mar 20, 2009

There’s reality, and then there’s the world John goodman lives in

Health Care Reform: Do Other Countries Have the Answers?.

Bluementhal is new health IT czar

Mar 20, 2009• 10

By Matthew Holt

David Blumenthal, known slightly more for being a policy wonk than a geek (or perhaps known best for being a wonk about geek issues!), has been appointed the new Director of the Office of the National Coordinator for Health IT. No official word on Rob Kolodner’s new role, although John Halamka suggests that he’ll stay on to run the stimulus package. Don’t forget that ONC gets $2 billion as part of the HITECH bill, so someone needs to be there to manage the bureaucratic part of that.

And no, none of the five candidates pimped on THCB by Kibbe and Klepper got the job…I’m sure we’ll hear from them about Blumenthal shortly.

Pharma vs. Devices – FDA, Supreme Court and Liability Whiplash

Mar 18, 2009• 16

By TOBIAS GILK

Whiplash. I don’t know what else to call it when the US Supreme Court does a near 180° reversal on a decision from just a year ago on medical product liability. Consider the following…

On February 20th, 2008, the US Supreme Court ruled in favor of Medtronic in the case Riegel v. Medtronic. The case involved a cardiac catheter, which ruptured during surgery. Medtronic asserted (and the Court agreed) that, because the company had received premarket FDA approval for the device, the company was immune from suit in state courts. The prevailing argument was, in essence, that the rigor of the federal review and approval process trumped the individual’s right to seek judgment using the state courts.

Many supported the notion of keeping federally-regulated medical devices above the reach of state courts, but at the same time questioned whether the FDA was really capable of the safety rigor that the Court attributed to it.

A Sticky Solution to a Sticky Problem

Mar 16, 2009• 23

By ALISTAIR ROCK

“Don’t pull the knot tight,” the philosopher Ludwig Wittgenstein once warned, “before being sure you have got hold of the right end.” Those who hope to sort out the tangle of health care spending would do well to heed his advice.

Clearly, there’s been no lack of solutions put forward since the Clintons first put health care atop the national agenda more than a decade ago. But with health care spending still rising at twice the rate of inflation, few have made any real and lasting impact.

Employers (who still pay the lion’s share of health insurance premiums here in the U.S.) know, of course, that keeping employees from getting sick in the first place—and minimizing the severity and duration of their illness when they do—is the first step in reducing this unwelcome “growth sector” of our economy. They understand, for the most part, that healthier employees equal not only lower healthcare costs but reduced absenteeism and greater productivity for the economy as a whole.

Op-Ed: Pathway for FOBs Should Balance Need for Competition and Need for Innovation

Mar 14, 2009• 5

By JAMES BIANCO MD

President Obama's first budget calls for the creation of a regulatory pathway for the creation of follow-on, or biosmiliar, biologics. This is obviously now the most high-profile call yet to move forward with a system that will provide the benefit of biotech drugs to patients who need them the most.

The biotech industry has done an outstanding effort in the last 10 years producing some of the most high-tech but also the most expensive drugs on the market. Some biotech medicines cost hundreds of thousands of dollars each year. Many of these products face no competition, because there is no legal way for a generic version of the product to get on the market. Individual patients as well as the healthcare system generally simply cannot absorb these continually rising costs.

To date, the debate over follow-on biologics has been mostly political posturing between the trade groups that represent the generic drug industry and the pioneering companies. The generic industry wants biotech companies to have only three to five years of market protection after bringing a new drug to market. The industry counters it needs up to 14 years of exclusivity to recapture its investment costs, which can reach over $1 billion for a single product.

Another Look: The Wal-Mart and E-ClinicalWorks Deal

Mar 13, 2009• 14

By David E. Williams

The New York Times reported this week (Wal-Mart Plans to Market Digital Health Records System) that
the company’s Sam’s Club division will bundle eClinicalWorks
electronic medical record software, Dell computers, installation,
maintenance and training to offer to small physician practices. Pricing
is about $25,000 for the first physician in an office, and $10,000 for
each subsequent physician. Annual maintenance and support costs will be
about $4,000 to $6,500 (though it doesn’t say whether that’s per
physician or per practice).

Wal-Mart says its package deal of hardware, software,
installation, maintenance and training will make the technology more
accessible and affordable, undercutting rival health information
technology suppliers by as much as half…

Dell will be responsible for installation of the computers, while
eClinicalWorks will handle software installation, training and
maintenance. Wal-Mart is using its buying power for discounts on both
the hardware and software.

This program has promise, but it isn’t revolutionary and is by no
means certain to succeed. Interestingly, the Wal-Mart PR people, who
usually send me a heads up about any new Wal-Mart move in health care,
didn’t tell me about this one. It makes me wonder what’s really going
on. There are a couple of very promising aspects of this program: