So (finally!) the piece I co-authored with Jane Sarasohn-Kahn on the prescribing infrastructure has been published by the California Health Care Foundation. Please go take a look. It’s called The Prescription Infrastructure: Are We Ready for ePrescribing?
I’ll be writing more about the pieces that got cut from the report due to length considerations in THCB over the next few days.
The Industry Veteran is back on his preferred way to make a buck in health care
Another whistle-blower makes good, this time on the device side of health care manufacturing. It appears that Medtronic pays spinal surgeons upwards of a half million dollars a year in bogus consulting arrangements (e.g., for eight days of work during the year) if these payees agree to use the benefactor’s products. What brightens the career prospects for whistleblowers in this suit is the fact that the plaintiff is not a scientist, a physician, a sales rep, an MSL or any of the usual types within either the clinical or the business operations. The woman here worked as a travel agent for Medtronic, in which capacity she arranged accommodations for the bribed surgeons. Her duties made her privy to the occasions where the amorality of business managers intersect with the usual conditions of gross immorality and psychopathic narcissism among physicians. The news here is encouraging. The day might dawn where the greed-is-good, corporate, fiduciary officers and the my-son-the-genius-doctors will have to fear their own admin assistants, office managers, temps, and maintenance workers. Well, probably not, but at least the possibility brings a smile.
Over at iHealthbeat the ever wonderful Jane Sarasohn Kahn writes about Paging Dr. Google.
A group of tech bloggers are meeting at HIMSS at 8.30 pm on Sunday Feb 12th in San Diego at Hennessy’s Gaslamp pub. Sadly I wont be there as I don’t show up till the next a.m — being too cheap to pay for an extra night in a hotel and having non-refundable tickets and all — but Tim Gee, Neil Versel, Shahid Shah and maybe even MrHISTalk himself should be there.
John Cohn finds the December GAO report that says that CMS wasn’t ready for Part D’s launch, and also McClelland’s response that the GAO was underestimating CMS. Make that “mis-underestimating”, I think.
Here’s what the GAO Report says would be some likely problems with Part D’s introduction for the dual eligibles:
For dual-eligible beneficiaries who do not have Medicare drug coverage because they were either not identified and enrolled on January 1, 2006 or are newly qualified dual-eligible beneficiaries, CMS has developed a point-of-sale enrollment mechanism designed to enable pharmacies to assist these beneficiaries in obtaining immediate Part D coverage. The agency signed a contract with a designated PDP on November 22, 2005 to implement this mechanism. Because these arrangements were completed less than 6 weeks before the transition is to occur, limited time remains to educate all pharmacies about its availability and details of its operation.
For beneficiaries who were enrolled in a PDP but do not have their PDP information, CMS has facilitated a new information-technology process, known as the Eligibility Transaction, that will allow pharmacies to identify a beneficiary’s PDP and provide the beneficiary with the PDP’s contact information. As with the point-of-sale enrollment mechanism, it is unclear to what extent pharmacies are informed about the Eligibility Transaction and will use it. Despite CMS efforts to publicize this tool to industry organizations, a pharmacy industry association representative stated that it is unclear how many independent drug stores, which dispense the majority of the nation’s retail prescription drugs, plan to use the Eligibility Transaction.
Translation: a) Pharmacies are supposed to be able to immediately register dual-eligibles if they’re not already in a PDP but that was only developed in November and wouldn’t be ready. b) GAO was unsure how many pharmacies would use the eligibility transaction system.
GAO didn’t seem to predict what apparently is the major problem — the data on eligibility from the PDP’s that the transaction database is hitting against is wrong or it’s just not working.
We will find out more, but they had two years to get this right! And it seems to be getting worse!
One of the regular system updates Windows automatically downloaded to me the other day was an “enhancement” to the junk mail filter on Outlook. Until this “enhancement” my junk mail was doing farily well, with only a few false positives being missed. Now all manner of lottery winnings, offers of mortgages and longer personal appendages are once again turning up in my main in-box. Anyone else noticed the same problem?
Skip over to iHealthbeat to see the ever wonderful Jane Sarasohn Kahn’s 2006 Health IT Forecast
Jane is pretty gung-ho about ePrescribing. She says:
I predict that e-Prescribing will come of age in 2006. With Medicare kicking the tires on e-prescribing standards, we’ll see adoption of eRx on a selective basis. An innovative handful of health plans will foster adoption by providing incentives to prescribers in regional marketplaces. By the end of 2006, e-prescribing will reach a tipping point, and it will take off in 2007 because of Medicare’s push for adoption.
It’s not secret that we share this view — after all we spent last year writing a study about it that will be out shortly! this is one of the times when Morrison’s corollary to Herb Stein’s law comes into play. Stein said that “if something is unsustainable in the long run, it will end”. Morrison riffed on that to say, “If it’s going to be a big deal eventually, it’s got to start somewhere”. We think that the next 18 months is the “starting somewhere” period for eRx. I hope that we’re not being too optimistic!
Jane is however a little too polite about RHIOs. Ann Donovan from the California RHIO told me last week that the CEOs of the big players in Claifornia were sending people to their meetings but the people showing up didn’t know why they were there. Reading between Jane’s lines this looks like CHINS all over again. The first report we wrote together in 1994 was also about CHINs, and we said there that they might end up as a sideshow, and again we were being too optimistic!
Tech-over-achiever Shahid Shah’s new IT aggregator blog — the HITSphere— has started up a community feature that’s well worth tracking. Several people have started their own blogs there and one is an MD called Mike. He has some interesting things to say about how to get doctors to the point that they can “learn to love the EMR”. His piece is called: Healthcare IT, Informatics and GME: Are We Doing Enough? Go take a look but here’s a flavor.
If we teach our future physicians the basics and give them the tools to self-teach in the future, they will be better equipped to adapt, optimize and lead. Future challenges related to standards/inter-operability, languages and security should not be left entirely to non-physicians. We as a group want functional cost-effective solutions and so we should be willing to invest in that future by training leaders to help guide us.
Typepad (the hosting service I use) was down on Friday, giving THCB an involuntary day off. Here was my FierceHealthcare editorial on Friday. You can use this as a continuation of the discussion from last week:
There is little doubt that the big story in health IT circles continues to be
the CPOE study in Pediatrics which found an alarming increase in
mortality rates at Children’s Hospital of Pittsburgh. Those conclusions
generated a fierce debate as to whether we need CPOE systems, and whether EMRs
can be adapted for critical patient care situations. Yesterday, leading patient
safety expert Bob Wachter likened the phase medicine is undergoing to one
similar to that in aviation in the middle of last century–from independent test
pilots to team players–as described in Tom Wolfe’s The Right Stuff.
Even though no pilot would go back to doing things the old way, it was not a
painless transition. What is clear is that the introduction of new technology
requires a detailed examination of virtually every care process, and in some
cases the benefits can only be realized if the process is changed to fit the
technology. That is a very complicated sell.
So despite the denials, Cerner’s stock had another dreadful day. Following a fall on Wednesday, Thursday it was down another $10 on concerns that they’re cooking the books. Now Neal Patterson may be a rough around the edges guy, but he’s no dummy and he knows about Sarbanes-Oxley.
On the other hand, it’s not a bad time to be taking profits and people have sat around not believing it before, and then Enron and Worldcom happened. So a little bit of panic selling/locking in profits is a logical explanation.
Still, I at least am looking forward to seeing whether the clear gain in market penetration that Cerner is seeing is really not being translated into more cash flow, revenue and profits.
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