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Tag: Michael Millenson

Humor: Voluntary Cost Control? Never Mind!

Michael Millenson

Health Care Stocks Hurt as “Promise” Spooks InvestorsNEW YORK – Major health care stocks plunged today as investors worried that a series of voluntary actions the industry pledged in order to control costs represented a serious threat to profits.“Leaders of drug, device and health insurance companies gave their solemn word to the president of the United States that they will cut costs,” said Pinocchio Paparazzi, an analyst with Bear, Bulle and Morbull.  “Simple math says if you trim two trillion dollars from spending, that’s two trillion dollars lower revenue. That reality should be reflected in stock prices.”Merck and Edwards Lifesciences, two companies whose CEOs personally attended a White House briefing announcing the coalition’s goals, led the decline with double-digit drops. Health insurance giants Wellpoint and UnitedHealth Group also slumped, as did the for-profit hospital sector, as investors decided that making the health care system “more affordable and effective for patients and purchasers” might be good politics but was bad for the bottom line.

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RFID EMR Pioneer Says “RIP”

When Harvard Medical School and CareGroup CIO Dr. John Halamka agreed to place his medical  information on an RFID chip and have it implanted it in his arm, he triggered an instant global spotlight on this unusual form of portable electronic medical record. The decision, made in December 2004 and disclosed in early 2005, captured worldwide attention from places a diverse as Fox News, the BBC and the New England Journal of Medicine (where Halamka contributed a commentary ).

As recently as 2007, a debate over chip privacy and safety versus having critical medical data instantly at hand (as it were) was featured in a PLoS Medicine exchange.  In it, Halamka asserted, “Implantation of RFID devices is one tool, appropriate for some patients based on their personal analysis of risks and benefits, that can empower patients by serving as a source of identity and a link to a personal health record when the patient cannot otherwise communicate.”

Two years later, Halamka’s chip remains under his skin but he’s ready to turn over the idea that he’s a trendsetter to the undertaker. The technology “has been adopted by no one,” Halamka told me at a meeting on Patient-Centered Computing sponsored by Partners HealthCare’s Center on Information Technology Leadership. “As a technology it’s dead. Use the network, use the cloud to store your personal health records. Or in a pinch, use a USB drive. But the implanted RFID chip is not as a society where we’re going.”

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Commentology:

Microsoft's, Bill Crounse, said this about David Kibbe's article, "The Parable of the Wicked EMR."

"Excellent, well written piece, David.  Thanks for sharing your insights.  It is important to not only meet the regulatory and privacy requirements associated with health data, but also expectations around its intended use.  EMR or PHR data is just data unless it contributes to user knowledge.  EHRs and PHRs don't add value unless they improve our understanding of health status and direct us toward health improvement."

Harvard Pilgrim's, Charlie Baker had this to say about Anne Tumlinson's article, "Reforming Long-Term Care and Post-Acute Care Could Save Billions."

"I've
written about the extraordinary lack of connectivity between Medicaid
and Medicare when it comes to long term care for dual eligible seniors
many times at www.letstalkhealthcare.org.  Medicare & Medicaid are
their own worst enemies – and do senior citizens a tremendous
disservice – when it comes to financing care for seniors who are
eligible for both programs.  There's a problem here that needs to be
solved."

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Medicine’s Missing Foundation for Health Care Reform

Preface by Michael Millenson: Lawrence L. Weed published a seminal article in the Archives of Internal Medicine on using the medical record to improve patient care back in January, 1971.

To give you an idea of how glacially the health care system changes, that same issue contained an article entitled, “Universal Health Insurance is the Wave of the Future,” by New York Gov. Nelson Rockefeller, and another, “What Possible Use Can Computers Be to Medicine?” by a Duke University physician that began this way: “The physician's attitude toward computing machinery has changed greatly in the last ten years. A bright future is predicted for its application within medicine.”

In an era when the autonomy of the individual physicians was nearly unchallenged, Weed boldly asserted that “modern data acquisition and retrieval systems” could help doctors make more accurate diagnoses and provide “proper care” more effectively. Weed has continued that same fight ever since, later joined by his son, attorney Lincoln Weed. In the process he has acquired neither fame, popularity or riches — merely become legendary to a small segment of us familiar with his work.

ABSTRACT:  Medical practice lacks a foundation in scientific behavior corresponding to its foundation in scientific knowledge.  The missing foundation involves standards of care to govern how practitioners manage clinical information.  These standards of care, roughly analogous to accounting standards for managing financial information, are essential to exploit the enormous potential of health information technology. Moreover, without these standards and corresponding information tools, evidence-based medicine in its current form is unworkable.  Medical practice has failed to adopt the necessary standards and tools, because its historical development has diverged from the paths taken in the domains of science and commerce. The culture of medicine tolerates unnecessary dependence on the personal intellects of practitioners.  This dependence has blocked the use of potent information tools, and isolated medicine from forces of feedback and accountability, that operate in the domains of science and commerce.  If the necessary standards and tools are adopted, health care cost and quality could become an arena of continuous improvement, rather than a quagmire of intractable dilemmas.

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Health 2.0 vs. Ix Therapy

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I was staring at the program cover for the special joint conference between Health 2.0 and the Center for Information Therapy going on here in Boston when a sudden realization jumped out at me: both of these movements talks about the consumer, yet both are disconnected from the consumer in an important way any consumer would notice but none of us wonks have commented upon.Before we get to the basis for this flash of insight, allow me to provide some context. One of the themes of this conference is exploring where Information Therapy and Health 2.0 converge and diverge. One area of convergence is that both Information Therapy founder Don Kemper and Health 2.0’s Matthew Holt are widely recognized within the health care community as extraordinary individuals. In addition, their respective missions are aggressively “pro-consumer.” And yet, there is a disconnect.

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Like Us, Personalized Medicine is More than Its Genes

Millenson_122k_3 For those familiar with the famous Gartner Hype Cycle, the page one New York Times headline, “Genes Show Limited Value in Predicting Diseases spawned an uncontrollable urge to mark an “x” by the spot where the
Peak of Inflated Expectations starts its plunge into the Trough of
Disillusionment.

The Times’s curtain call for DNA cure-alls reported on a critical examination by the New England Journal of Medicine 
related to the strategy of comparing genomes of patients and healthy
people. So-called genomewide association studies, it turns out, have
not fulfilled their goal of discovering DNA changes responsible for
common ills. Instead, they “explain surprisingly little of the genetic
links to most diseases,” wrote the Times. “The era of personal genomic medicine may have to wait.”  
Note that the Times
carefully avoided the term “personalized medicine.” Despite the
tendency of drug and diagnostic firms to lay sole claim to that label,
molecular medicine comprises just one part of the personalized medicine
triad. Sickness and health are complex, and, like us, personalized
medicine is more than its genes. 

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An Economics Lesson From Erectile Drugs

-2The Wall Street Journal reported Wednesday that hospital and pharmaceutical companies have been pushing  through large price increases in the first quarter of 2009 even as most businesses struggle just to
stay above water. (And later Wednesday, the CPI recorded its first
actual decrease since 1955.)

As an example of drug company tactics, the newspaper reported a recent
20.7 percent price increase by Pfizer for Viagra and a 14.2 percent
price increase by Eli Lilly for Cialis, two popular erectile
dysfunction (ED) drugs. Sadly, neither the Journal nor
the drug makers took the opportunity explain the concept of “inelastic
demand” for treatments of a condition where elasticity is the problem.
Pfizer and Lilly are betting that very few of their customers will say,
“Honey, I was in the mood for love tonight for $15, but for for
$18…let’s go see a movie.”

Of course, I shouldn’t be surprised by the lack of economic clarity
because the drug companies clearly don’t understand some basic economic
concepts. For example, a Pfizer spokesman, asked to defend the
aggressive price increases, responded that “the vast majority of our
customers receive some type of legislated or negotiated discount off
our announced list prices.” Gosh, I guess he never thought about the
fact that if you get a 10 percent discount off list price, and the list
price goes up 20 percent, the price you pay also goes up 20 percent!

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Dennis Quaid Overlooks Too Much

Anyone who cares about patient safety has to be grateful to Dennis Quaid
for the way he and his wife Kimberly reacted to the near-death from a
medication error of their twin baby girls. Using his celebrity and his
contacts as an award-winning actor, Quaid launched a crusade to stop
similar errors from ever happening again. He has appeared on 60 minutes , testified before Congress and, Sunday, came to HIMSS to tell his story once again.

At HIMSS, Quaid was amusing (“I am not a doctor [and] I have never
played a doctor on television or in the movies”) and moving, as he
detailed how two massive heparin overdoses turned his newborn twins’
blood to the consistency of water and left them bleeding inside and
out. He was also generous and humble, repeatedly thanking the HIMSS
membership for the work they did in developing the technology that can
prevent inevitable human error from causing harm.

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Those Goody Goody Canadians Not So Good

C’mon admit it: you’re sick of hearing how those goody-goody Canadians provide comprehensive health care to all, while we let an estimated 22,000 Americans die each year (http://www.urban.org/publications/411588.html ) because they don’t have coverage. Or the way their cost of prescription medications is so much lower than ours that Congress finally threw up its hands and legalized the equivalent of small-scale (prescription) drug smuggling. Heck, Canadian provinces even do comparative effectiveness research  without anyone calling them Nazis

Now comes word from the Fraser Institute in Toronto that Canadians are not so goody-goody after all. The institute puts out a peer-reviewed and risk-adjusted report card comparing hospitals in Ontario, the nation’s largest province. Last year, the first for the report, just 43 of 136 acute-care hospitals agreed to participate. This year, though, the number of participants plunged 60 percent, to just 17 hospitals, according to a story in Healthcare IT News.

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Commentology

Michael Millenson had this response to a commenter in the thread on his recent post looking at web sites that offer the public data about provider performance.   (' Just OK Quality or the Best? ')

"Why does HealthGrades get so many more visitors than HospitalCompare? I think you're correct that it's because of promotion, but the context is the magnitude. HealthGrades constantly promotes, via Google-sense ads, via press releases to the trade and mainstream media, via the ads taken out by hospitals touting their ratings and via search engine maximization. And they've done this for many years, acting as if their economic future depends on it (which it does). The government promotes its site kind of the way you see those "stop smoking" public service announcements.

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