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OMNI: The Oncology Metrics National Index – Brian Klepper

An innovative Ft. Worth consulting firm comprised of experienced oncology professionals, Oncology Metrics, has linked private oncology practices throughout the country in a collaborative, knowledge-sharing enterprise, called the Oncology Circle. The first round of information brought together 22 practices containing 167 medical oncologists. Combined, the practices treated almost 63,000 patients annually, had $600 million in revenues and spent $375 million on drugs.

In a separate but related effort, Oncology Metrics has established a new national data aggregation effort, The Oncology Metrics National Index (OMNI), which brings together data from practices using electronic medical records (EMRs), mapping the data in each EMR to a standard template. Then those data are aggregated and mined to produce different cancer care-related clinical measures associated with procedures and processes: e.g., the administration of erythropoietin (anemia drugs), hemoglobin (Hgb) testing, and patient staging. A primary goal is to create a data mine that can allow each practice to see how it compares to others, and how they might improve. But a secondary and also very important objective is the development of transparency information that can help rationalize the practices and costs that have dominated oncology.

This is a leading edge project that leverages the data that is newly available through EMRs, and that is indicative of the kind of progress that we can anticipate throughout health care in the next few years. Clearly a company to watch.

PHARMA: Time to get Shakespearean at big Pharma? by The Industry Veteran

The Industry Veteran has been busy this summer, but luckily for those missing his unique view of the pharma world, he’s ba-ack. And in his purview this time is the whole issue of why Big Pharma is filling its top jobs with lawyers.

DICK: The first thing we do, let’s kill all the lawyers.

CADE: Is not this a lamentable thing, that the skin of an innocent lamb should be made parchment, that parchment, being scribbled o’er, should undo a man? Some say the bee stings: but I say, ’tis the bee’s wax; for I did but seal once to a thing, and I was never mine own man since.

Shakespeare, King Henry VI, part II: IV, ii

Late last week (July 26) Merck announced the promotion of corporate counsel Kenneth Frazier to succeed Peter Loescher as president, global human health, effectively making him the company’s chief operating officer.  Given Pfizer’s earlier decision to make their corporate counsel, Jeffrey Kindler, the CEO there, Frazier’s promotion means two Big Pharma companies within the past year have elevated lawyers to key, strategic positions.  The moves in both cases indicate the unwillingness of the respective companies to cleanly break from the unsavory and dysfunctional practices of their recent past.

By naming Kindler to the top spot, Pfizer’s board clearly desired a relatively inexperienced manager without settled attitudes toward the pharmaceutical industry.  As CEO it seemed apparent that he would move slowly and rely upon practiced hands within the company for guidance.  Kindler immediately acknowledged this when he promoted his rival for the CEO spot, CFO David Shedlarz, and publicly referred to him as his "right hand."  Such thinking among board members appears mystifying because if any pharmaceutical company requires fundamental changes to the economic model by which it conducts business, it is Pfizer.  Since the 1990s Pfizer led the industry in implementing the blockbuster, mega-company approach.  Under William Steere, an agile and precise thinker, the company grew and prospered with the strategy.  In the hands of his successor, the arrogant head of finance, Hank McKinnell, Pfizer’s capitalization declined by more than 30% while the rest of the industry ignorantly followed his long walk down a short pier.

Kindler’s claim to fame as corporate counsel consisted of his use of outside contractors to pursue foreign Viagra counterfeiters and harass them into ceasing their operations.  While serving as Pfizer’s legal counsel Kindler hired the former number-three man at the FBI to direct corporate security and together they retained companies such as the Blackwater Group, one of the largest US contractor in Iraq.  Blackwater, which maintains close ties with right wing religious groups in the US, performs the usual range of corporate security and sleuthing services.  It is also a mercenary army for hire that makes abundant use of stealth surveillance technology.

One example of Kindler’s failure to break with the blockbuster/mega-company approach appears in his dealings with third-party payers. 

Continue reading…

PHARMA/PHYSICIANS/HOSPITALS/QUALITY: Busy busy busy

My correspondents have sent me lots of articles today. All worth a read—

When Is a Pain Doctor a Drug Pusher? Basically never as far as I can tell but in the DEA’s view any time the DEA feels that its livelihood is threatened. What a disgusting scumbag organization (and I include the US and State DA’s in their ecosystem), and I’m beyond disgusted that as a taxpayer I’m paying for this insanity. The DEA needs to abolished and anyone who’s

Report Rates Hospitals on Their Heart Treatment. The “report” is from CMS using Medicare data and it names names. I spent the last two days with lots of hospitals. They don’t think this type of hospital ranking matters yet, and they’re right. But it will matter increasingly as patients figure this out (more from me on this next week).

 

3 drug makers busted and fined for drug reimbursement scam in cancer drugs. Not exactly a surprise:

The plaintiffs argued that the drug makers had sold medications to doctors at steep discounts to the “average wholesale price” that Medicare and pension funds paid, while secretly encouraging them to claim full reimbursement from insurers.

There is nothing rational about allowing doctors to profit from selling drugs. But then again there’s nothing rational in our payment system as a whole. This is, though, one abuse that should be ended quickly.

Finally from the WSJ, yet again showing that it’s a socialist rag, How many doctors does it treat to see a patient? (Behind sub wall I’m afraid), but let me give you the first few lines:

In the mid-1990s I worked weekend shifts as a “moonlighting” doctor in a suburban Chicago hospital. When I would show up on Friday evenings, the other doctors would always say: “Peter, remember, no roundtrips on weekends.” Translated, that meant no patients admitted over the weekend should go home before Monday afternoon at the earliest. I soon understood the genesis of the “no roundtrip” rule. At the crack of dawn on Monday mornings, before their regular office hours, the doctors would go from room to room, providing consultations and filling out billing cards.

The villain is of course fee-for-service medicine. The author wants it eliminated and he’s right. But note the interesting screw-up in the current incentives. The doctors wanted to see their patients on the Monday so they could bill FFS and make more money. But the hospital was getting a fixed DRG payment for most of those patients. It was in their interests to get them out of the hospital as soon as possible, as every moment they stayed they were making less money because they were filling a bed that could be filled with a new admission. Both of them are crazy incentives for the overall health care systems, but more than a decade later we still do not have hospitals and doctors on the same set of incentives—even irrational ones!

PHARMA/POLICY: Crackpots at Hoover

The NY Times gives an op-ed to a crackpot called Henry Miller who used to be a minor official at FDA and is now with the other loonies at Hoover. It’s called Crackpot Legislation in which he goes after those states allowing smoked medical marijuana as medicine. In this op-ed he apparently with a straight face can say this:

When presented with a cannabinoid development program that comports with modern scientific principles, both the F.D.A. and the D.E.A. have demonstrated their willingness to allow it to proceed.

This is complete and utter bullshit. The FDA has with the rest of the US government (including the crackheads at NIDA) in preventing the use of marijuana in clinical trials and medical testing for decades, despite the IOM study. Here’s a statement from a DEA judge (!) on the topic in March.

"NIDA’s system for evaluating requests for marijuana for research has resulted in some researchers who hold DEA registrations and requisite approval from the Dept. of Health and Human Services being unable to conduct their research because NIDA has refused to provide them with marijuana"

Two tiny smoked marijuana studies (including the Abrams one he cites) have been finally allowed after decades of pressure from academics, and now Sativex is being allowed into clinical trials because a) it has a pharmaceutical company behind it which is going to make money off it, and b) because the Brits and Canadians have already allowed it on the market. That action, after thirty years of preventing research into the medical usefulness of marijuana for purely political reasons, does not suggest anything like what Miller calls “willingness.”

Miller thinks that the FDA should be allowed to regulate marijuana. But of course the US government already does regulate marijuana. It’s been a schedule 1 drug, banned since 1937 by Congress incidentally against the then wishes of the AMA with no debate. So what is the FDA’s likely vote on the matter now? To continue the ban of course. Which is why medical marijuana proponents are opposing the amendment to allow the FDA to regulate them, as it’s a back door way of outlawing the progress made at the state level.

The NY Times should be asking itself why it’s allowing such a bunch of half-truths to be published when somewhere between 60 and 80% of Americans are in favor of legalizing medical marijuana, and it’s abundantly clear to anyone that the reasons for the continued ban is the politically and economically-inspired persecution of people who want to use marijuana—whether for medicine or pleasure.

And if Miller really thinks that the current drug-policy powers that be will allow Sativex to get past the FDA and be openly sold in the US, then he really is a crackpot.

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