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The CMIO Should Be a Doctor

By MAGGIE MAHAR

A hospital’s Chief Medical Information Office (CMIO) should be a physician, says Pam Brier, president and CEO of Maimonides Medical Center, “because nobody knows a doctor’s business like a doctor.”

As a hospital’s information technology (IT) point person, a CMIO needs to be able to persuade physicians and other health care professionals that health information technology (HIT) can help them care for patients.

It is not that Brier believes that non-physician managers can’t talk to doctors. . . After all, she herself is not an M.D. Yet she runs Maimonides, a top-ranked 700- bed teaching hospital in Brooklyn, New York.

On the other hand, Brier is not an MBA either. She has a master’s in Health Administration, which means that, unlike many hospital CEOs who went to graduate school to study business, she understands that an organization that provides health care is not a “business” in any ordinary sense of the word. A hospital is a service organization: its raison d’etre is to meet the needs of a community and its patients.

It is telling that before coming to Maimonides in 1995, Brier spent fifteen years in New York City’s municipal hospital system, and  still says: “Even though I’m not working for government anymore, I still feel that I’m a public servant.”Continue reading…

Myths and Facts About Health Reform

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By MAGGIE MAHAR

This is the first in a series of posts that will try to pierce the myths and reveal the facts about the reform legislation. This first post focuses on the impact that reform will have on the private insurance industry–and on the industry’s customers.

MYTH # 1: Health Care Reform represents a “boon” for private insurers.

FACT It is true that, beginning in 2014, virtually all Americans will be required to buy insurance, or pay a fine. But while insurers will pick up a boatload of new customers, many will be refugees who have been battered by a health care system that rationed care according to ability to pay. Think of the boat as a life raft. These could be very expensive customers.

Moreover, between now and 2014, insurers will face some serious financial hits. These new rules will  make our health care system fairer and more affordable  But the rules also suggest that for-profit health insurance may not be a viable business unless insurers learn far more about what is best for patients.Continue reading…

Some Thoughts On the Word “Filibuster”

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By MAGGIE MAHAR

As I noted in another post, the media seems to be turning “reconciliation” into an ugly word.

But “filibuster” is the word with a more unsavory history. (Thanks to HeathBeat reader Barry Carroll who sent me a link to the history of the word.)

“Filibuster” finds its root in the Spanish word “filibustero,” which means “pirate.” The filibuster was originally seen as an opportunity to “pirate” or “hijack” a debate.

In modern American history the filibuster became infamous as a tool used to block civil rights legislation.  This tradition goes all the way back to 1946 when Southern Senators blocked a vote on a bill proposed by Democrat Dennis Chavez of New Mexico that would have created a permanent Fair Employment Practices Committee to prevent discrimination in the work place. The filibuster lasted weeks, and Senator Chavez was forced to remove the bill from consideration.

Continue reading…

The President’s Proposal

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By MAGGIE MAHAR

You might be wondering why I haven’t written about the President’s Health care bill. The reason is that I have very little to say.

This, I realize, is unusual. But the truth is that the president’s proposal is very similar to the Senate bill—which is not a surprise.

Nevertheless, I am very glad to see the proposal. I was worried that the White House had put reform on the back burner.

Will it pass? As always, I’m trying to be optimistic. But I think that everything depends on whether the White House decides to twist arms. The president will have to persuade House liberals that this is a good first step—and that we can worry about improving the plan over the next three years.

I would still like to see a public option, and I hope that, in the end, the federal government will wind up overseeing the state-based exchanges. But the legislation doesn’t goes into effect until 2014; that gives us more than enough time to improve on it.

The President also will need to keep an eye on Senate moderates. I would favor sending Joe Lieberman on a special mission to South Korea. A relative who is stationed there tells me that the demilitarized zone is particularly bleak this time of year.

There is no need to worry about the Republicans. They can be counted on to vote against any reform bill that even attempts substantive reform. Universal coverage is not their top priority, and they definitely don’t want to pay for it.

Continue reading…

Health Reform is Possible; Voters Still Hold the Power

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By MAGGIE MAHAR

In a post originally published here on The Health Care Blog and reprinted Health Care Policy and Marketplace Review health care analyst Brian Klepper asks: “Is Meaningful Health Care (Or Any Other Kind Of) Reform Possible?”

His answer: “I’d be surprised. Delighted! But surprised.”

Klepper believes that the lobbyists are just too strong. Always incisive, he pulls no punches: “In a policy-making environment that is so clearly and openly influenced by money,” it’s just not likely that “Congress will be able to achieve health care reforms that are in the public interest.”

I disagree. I believe economic pressures are pushing us toward a political turning point. (If you want to understand what is happening in history or in politics, follow the money.) The Bush administration has been thoroughly discredited. Americans are ready for change. Health care reform will not happen tomorrow; it will require a bare-knuckled political fight. But it will happen, and this is why: Although lobbyists are powerful, so are voters. And they realize that we are approaching a flashpoint: middle-class Americans are being priced out of our health care system.

Continue reading…

Quotable

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By THCB STAFF

We asked THCB contributor Maggie Mahar for her quick take on the health care policies of each of the presidential candidates. We were pretty much expecting one of Maggie’s trademarked dissertations – a meticulously researched critique of each politician’s views on various important substantive issues. Instead this entertaining reply turned up in our email inbox.

“If Clinton wins we have real national health care reform.

If Obama wins, I’m not so sure, given that Cutler thinks we’re getting value for our dollars, and healthcare doesn’t seem to be a big priority for Obama (although his plan seems a lot like hers).

If McCain wins, we all move to Canada. Northern Canada, where will not only have healthcare, but may be able to avoid the fall-out from the nuclear war that he starts.”

THCB Reader Mail: Maggie Mahar On That Checklist Decision

Frequent THCB contributor Maggie Mahar did a little detective work on the Office of Human Research Protection’s (OHRP) mysterious decision to suspend a trial designed to reduce medical errors by requiring that hospitals follow standardized safety and infection control procedures, a story that Atul Gawande wrote about over the weekend in an op-ed piece for the New York Times.

The logic behind the ruling – namely that patients should have been required to provide their express written consent before participating in a clinical trial, even one involving hospital staff and not some radical new experimental drug or treatment – struck Maggie as slightly, shall we say, strained. Particularly for an administration which boldly ran for office on a campaign platform of vanquishing bureaucratic incompetence and embracing scientific innovation.  Maggie writes:

I read the letters that OHRP sent to Johns Hopkins and Michigan. They are dense with bureaucratic language, but make no sense whatsoever. So then I looked into OHRP and who runs it.Continue reading…

POLICY: A roadmap for reform by Maggie Mahar

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Maggie Mahar is an award winning journalist and author. A frequent contributor to THCB, her work has appeared in the New York Times, Barron’s and Institutional Investor. She is the author of Money-Driven medicine: The Real Reason Why healthcare costs so much, an examination of the economic forces driving the healthcare system.

In its June
2007 report to Congress, MedPac (the
Medicare Payment Advisory Commission) highlighted one of the dirty secrets
of our healthcare system:  as a nation, we are currently spending billions
on drugs, devices, surgical procedures and diagnostic tests without
having a clue as to whether they are effective. The reason, MedPac explained:
we have very little “comparative-effectiveness research” that provides
head-to-head comparisons of various treatments for a particular malady.

Meanwhile,
the Medicare commission observes, “Many new services disseminate quickly
into routine medical care without providers knowing whether they outperform
existing treatments, and to what extent. For example, a recent study
showed that inexpensive diuretics may control hypertension as effectively
as expensive calcium-channel blockers (ALLHAT 2002).”

One might think
that the FDA would require that a manufacturer show that its new drug
or device is better than existing treatments—at least for some patients. 
After all, new medical technologies are almost always more expensive,
so wouldn’t you think they would have to be “improved” in order
to be “approved”?

Think again.
That’s not the FDA’s job. The FDA exists simply to decide whether
the benefits of a particular treatment outweigh its risks. Thus, in
order to pass FDA scrutiny
manufacturers need only test their product against a placebo—which,
as MedPac notes, is what most do. In other words, they demonstrate their
treatment is “better than nothing.”

Continue reading…