My buddy Laura Locke has a nice article in Time about San Francisco’s Latest Innovation: Universal Health Care. This one’s closer to the George Bush agenda than gay marriage—and I’m pretty sure that we’ll all have accepted gay marriage long before we’ve got to genuine universal health insurance. Essentially it’s about redirecting funds from the City and County back to the city and county health facilities, and making the uninsured pay into a pool. Not a bad start given that a City can’t do much, but it’ll run into trouble, just as I explained a while back when the proposal first came out because it’ll mean small low-wage businesses will have to pay more.
PHARMA/POLICY: Scottish Drug Czar Says Drug War Is Lost, Causes Big To-Do
Everyone with half a brain knows that the drug “war” is lost and was always unwinnable and that the drug “problem” is only controllable by sensible legalization, regulation and education—as has been done with other addictive drugs like alcohol and tobacco. But it’s pretty rare that someone at the center of the drug “fighting” business—an industry with its mouth firmly attached to the teet of public funding—actually comes out and admits the truth. So when a drug Czar says so, perhaps some of his counterparts should listen.
Pity that it’s the Scottish rather than American drug czar who’s saying just that. But he at least comes from a place that has a real problem (remember Trainspotting) and an even more Calvinist past than we have over here. So there is perhaps some hope in the madness, although not much I’ll admit.
HOSPITALS/POLICY: MY 2 cents on the non-profit conundrum….incentives matter more than labels
Here’s my follow up to Maggie’s interesting piece and it’s the editorial in FierceHealthcare later today
The non-profit hospital world has been in the news lately, and this week a study of all the studies ever done on the non-profit/for-profit contrast came out in Health Affairs. The story is pretty well known and the study confirmed that non-profit hospitals offer a little more charity care, and have slightly lower costs than for-profits. But then again, there are three factors that make those results a little less than great. First is that location matters and the non-profit category includes a great number of hospitals that are in unfavorable locations, like inner city areas and poor rural counties. Second, the behavior of their for-profit competitors over the years has tended to center on the border between scandalous and criminal. And far too many non-profits have been imitating that behavior, such as New Jersey’s St. Barnabas, which settled with the government for as much as it could afford for apparently over-charging Medicare by over $500m. Third, for-profits have stayed at around 15% of hospital beds for decades and aren’t expanding their market share much. So the main issue is how do hospitals overall behave.
The truth is that whatever the label put on an organization, in an environment where doing more and charging more brings more profit/margin, there will always be institutions and people within them that will fall temptation to taking the easy (and fraudulent) way to more money. Proponents of self-reform may point to the improvements in quality brought about with no financial incentives which were reported by IHI last week, but until we create incentives for organizations to do well by doing the right thing, the label will be largely irrelevant.
QUALITY: Improving health care from within, by Eric Novack
Eric Novack sees hope in the IHI’s 100K lives program which announced impressive results this week, and being Eric, he thinks that there’s a political message in there too. There’ll be more on his show this Sunday.
The Institute for Health Improvement’s ‘100,000 Lives Campaign’ (www.ihi.org) just released the results for the first 18 months: participation of over 3000 hospitals and an estimated 122,000 lives saved.
In a word, astounding.
What is more astounding is HOW they did it. First, the ‘they’ are the organizers of the program and the THOUSANDS OF DOCTORS, PHARMACISTS, AND NURSES who implemented some simple changes in hospitals all over the country.
Did they focus on hundreds of best practices and brow-beat institutions into submission?
Did they threaten to not compensate anyone for trying to provide care?
Did they threaten lawsuits?
No, No, No.
The 100,000 lives campaign focused on 6 simple steps that are essentially universally accepted to be good practices to get the right care, at the right time, in the right place, and to reduce infections along the way.
With success breeding more success, more hospitals are continuing to sign up for the programs and looking to expand their involvement in the program further.
Most remarkably absent, however, was new federal legislation and government regulation. May I repeat: no federal bureaucracy was and is required to make improvements to our healthcare system.
This, no doubt, is like fingernails on the blackboard for many denizens of The Health Care Blog-osphere.
I was fortunate to interview Alexi Nazem, National field coordinator for the IHI’s 100,000 Lives Campaign for my show this weekend. You definitely want to find time at 3pm west coast time this Sunday to tune in at www.ericnovack.com to hear the whole interview- and to better understand both the IOM ‘To Err is Human’ report and get an insider’s view of patient safety efforts.
QUALITY: Book reviewer?
There’s an article out called “How We Die in America” which is from a new book called UNPLUGGED: Reclaiming our Right to Die in America, by William Colby.
The publisher is looking for a reviewer, so if you’re interested in reviewing a copy and having your review on THCB let me know by email
TECH: PHRs and Info Therapy
While I was away Health IT World published a short piece I wrote about the integration of the PHR with Information Therapy. Comments back here, if you please.
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.
TECH: Lost in the memory hole at McKesson
I’ve given my view on RelayHealth before—Nice product but apparently no physician or actual patient demand for it, well not enough that would have sustained a real business that didn’t get unbelievably lucky with its financing in the dotcom days. Now McKesson has bought it to roll it into their health management side that includes the old Access Health and a whole lot of other stuff. If you wnt to read more take a look at this Modern Healthcare article which by its title, McKesson deal gives docs new PHR purveyor, seems to think that RelayHealth is a PHR (stop laughing you at the back).
But what fascinates me is how this stuff happens in Corporate America. In 2000 McKesson purcahsed a company called Medivation. Medivation was tossed into its iMckesson subsidiary and obviously didn’t make it out alive. But the key point is that Medivation’s technology—at last when they bought it—did exactly what RelayHealth’s (the then Healinx) did. Given that neither of them has established much in the way of what you’d recognize as market share or profitability—cue yet more angry emails from Relay Health’s lovely marketing people—I assume McKesson is buying RelayHealth for the technology not to double up on market share. So that means whatever Medivation had has since been lost. And those of us who remember iMckesson may find this line from the story strangely familiar.
In addition to RelayHealth, McKesson’s personal health systems include in-home patient monitoring, web portal technology, triage software and personal emergency response systems. The full suite will include products and services from recently acquired HealthCom Partners, LLC, which provides patient billing solutions designed to simplify and enhance financial interactions between healthcare providers and their patients.
Longtime McKesson observers may not be too surprised —after all I don’t use their products, I just get my cues on their lack of interoperability that from HISTalk. But what I’d like to know is who’s getting fired for buying the same thing twice? For that matter when’s Charlie McCall finally going on trial for screwing up McKesson in the first place? It’s 7 years since that happened? Answers on a post card….
Coda: My best guess is that RelayHealth had c. $40m in funding in rounds C, D & E, so perhaps $45m overall. Now that no one’s feelings can get hurt, and now that the health care Internet is sexy again, I wonder whether their investors got out whole. I assume that we’ll find out in the next 10Q. Any guesses in the comments?
BLOGS: Peter Rost fired again?
After writing a post questioning the scoring of comments at his blog home the Huffington Post, in
which he exposed a "troll" as being the Huff Post’s technology manager, Rost was fired from writing at the Huff Po this morning. At least this one didn’t lose him a $500K paycheck! But what the hell is the Huff Po thinking?
Isn’t this shooting the messenger? I’m a big Arianna fan, after all we both went to Girton College, Cambridge, and I gave money to and volunteered for her failed 2003 gubnetorial campaign—but what are they/she thinking in firing one of their featured bloggers who exposes that one of their own employees is up to no good. Even if it’s all a storm in a teapot, the rest of the blogging world (which regards HuffPo as a celebrity driven interloper) will have a field day.
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.
