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LAT: Kaiser doc ordered fatal dose By John Irvine

The Los Angeles Times reports that police in Orange County and the Medical Board of California are investigating a Kaiser surgeon involved in the death of a patient under suspicious circumstances at Sierra Medical Center in San Louis Obisbo. Dr. Hootan Roozrokh is alleged to have "hastened" the death of a potential organ donor by ordering that he be given a lethal dose of painkillers. Roozrokh was suspended by Kaiser over the incident in May, at about the same time that the HMO ordered its controversial transplant program closed.

Picking up from the Times report:

State law specifies that transplant doctors cannot direct the treatment
of potential organ donors before they are declared dead. This
restriction is designed, in large part, to assuage concerns that organ
retrieval might take priority over patient care.In this case,
however, Roozrokh entered the operating room at Sierra Vista and was
directing the administration of drugs to Navarro, the sources said. When
the patient didn’t die, Roozrokh allegedly told nurses: "Let’s just
give him some more candy," according to a person who was briefed on
what took place but spoke on condition of anonymity because of the
ongoing investigations.

TECH: Self-serving press release of the day

Stark Study by GE Healthcare Predicts Accelerated Electronic Medical Record Adoption within the Next Year

“Stark Relaxation has created a tremendous opportunity for physicians to overcome the many barriers that prevent them from adopting EMR systems, most notably cost,” said Mike Raymer, Vice President and General Manager, Product Strategy and New Business Initiatives for GE Healthcare Integrated IT Solutions. “By allowing hospitals and other entities to provide EMR technology to physician practices at a subsidy of up to 85 percent, physicians are now better positioned to implement these comprehensive systems and provide a complete and current picture of a patient’s medical history – helping physicians raise the quality and improve the safety of healthcare.”

This is a bit of a Joe Namath guaranteeing a win story. Hmm, if there aren’t some pretty big Centricity/IDX wins in the next year, do you think that Mike Raymer will want to be reminded of this study?

PBMs: Bob Garris on their trail again?

In Brief non HIMSS news (as I’m still having a little insomnia from jet-lag, and I took it much easier last night on Bourbon street)….

Most THCB readers know that I’m just a wee bit cynical about the “value” provided by PBMs. Much of the data for that view comes from a Creighton University professor called Robert Garis. Well, he’s back:

“We found that brand-name drugs were slightly less expensive when purchased by mail, but generic drugs were more expensive by mail. When we combine the prices for brand-name and generic prescriptions, any differences virtually disappear,’ said Robert I. Garis, M.B.A., Ph.D., associate professor at the Creighton University School of Pharmacy and Health Professions.

And don’t forget that since 2002 (when the data for this report is from) PBMs have moved towards more generics as the rebates have become less important parts of their business and they’re making way more profits on generics. Medco for example increased total profits in 2005 after having its profits from rebates fall dramatically as it passed them back to customers. Margins on generics more than made up the difference. Now Garis is clearly on the side of the retail pharmacies, but given what we know about the PBM business, especially the stories from University of Michigan, I’m inclined to believe him when he says this:

Given a continued increase in generic-drug use by both mail and retail pharmacies and the practice of high markups on generics by PBM-owned mail outlets, he added, retail pharmacies ultimately may offer the better value. He noted that recent reports show generic drugs account for more than 55 percent of all prescriptions dispensed through both mail and retail channels.“Employers need to ask PBMs more questions about their markups on generics, just as they would when purchasing ink, paper or other supplies,” Garis said. “The truth is that PBMs are racking up record profits through an increased use of generic drugs and an increased use of PBM-owned, mail-order facilities.”

POLICY: Underfunded? By Eric Novack

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Governors from around the country are in Washington D.C.this week for the annual meeting of the National Governors Association. One of
the main bones of contention at this years’ meetings has been the expansion of
federal funding for state SCHIP programs. The governors want more, and lots of it. THCB’s own Eric Novack has been following this story like a hawk. And, as usual, he’s got a question.

The State Children’s Health Insurance Program was designed
by Congress to help states have money to provide Medicaid services to, well,
kids. The intent of Congress was clear,
given the “C” in the program’s name. Now
governors are screaming that SCHIP funding proposals by the federal government
are woefully inadequate.

Except for one thing—many states use SCHIP dollars to pay
for Medicaid for adults! Using 2005 data: In Minnesota, 87% of total SCHIP
enrollees in 2005 were adults, and 66% in Wisconsin. In Arizona, 56% of those enrolled
in SCHIP were adults.

Perhaps the states ought to use the funds for what they were
intended before complaining that they are being underfunded. If a child spent his ‘snack bar’ allowance on going to the movies, and then complained he was short, we would be likely to
require guarantees that the money would be spent properly in the future before
handing over the cash.

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