It’s a quiet return around here from the prolonged July 4th weekend. Meanwhile, there’s a new sponsor at THCB. This time it’s a book called “On Track To Quality” by James Todd, a pediatrician at Children’s Hospital in Denver. The book is a philosophical investigation into quality, involving not a motorcycle trip, but a train journey. Interesting stuff, and a longer review will be forthcoming shortly.
HOSPITALS: HCA’s Californication problem
Not all is well with HCA in California. The SEIU has been trying to start a fight with HCA over staffing for some time.. Apparently three Southern Calif hospitals are threatening to go on strike and in Northern California something similar is going on at HCA’s Good Samaritan Hospital in San Jose. The union employees have been negotiating with HCA and working without a contract for months now. They voted on Weds overwhelmingly with 90% approval to go on strike sometime in the near future, possibly this week.
BLOGS/QUALITY: Big themes and signing off from FierceHealthcare
Here’s my last ever FierceHealthcare editorial. The FierceMarkets team is taking the editorializing of FierceHealthcare back in-house and I wish them luck. It’s been fun for me (and John Irvine who’s supported me all the way) to work on this over the past couple of years, but I’m happy to get away from the deadline grind and concentrate on THCB and my consulting work. And hopefully I’ll find the time to start working on that book I’ve been threatening you all with. Anyway my last editorial is about the two biggest themes in health care—fixing process and fixing insurance.
Perhaps the dominant theme of the decade in healthcare has been patient safety. Since the 1999 IOM report, hospitals and doctors have focused on improving the medical error situation. Last week, Don Berwick’s IHI announced that a precise number of lives (123,000 and change) had been saved since the voluntary 100,000 Lives Campaign started. This week, the carping started with The Wall Street Journal suggesting that the IHI numbers were inaccurate. Commenters also started down the path of whether saving the "life" of a severely ill patient who was going to likely die soon anyway was all that important–or at least as important of saving the life of an otherwise young healthy patient.
But beyond questions about the data, there are two crucial related points we must hold onto. First, medical errors are symptoms of poorly designed medical processes, and we know that reducing "muda"–waste in medical care–is an achievable goal. Second, patients are not just vulnerable to physical harm from interacting with the healthcare system, they’re also extremely vulnerable to financial harm caused by that "muda" and facilitated by our dog’s breakfast of an insurance and financing system. These are two sides of the same coin, and efforts like the 100,000 Lives Campaign should be applauded for focusing on at least part of the problem. It would be nice if there was a similar system-wide commitment to concentrate on the whole of the cost and care crisis rather than just one part.
DISEASE MANAGEMENT BOSTON JULY 30 – AUG 2At a three day conference in Boston MA, scheduled between July 31 and Aug 2, industry leaders from managed care companies, employer groups purchasing healthcare services, providers, third party administrators, physicians, healthcare technology players, nursing and pharmacy practitioners, disease management experts will meet at the 4th Annual Disease Management Conference. The event is posted online at www.srinstitute.com/ch142
OFF-TOPIC: Football, bloody hell
It’s World Cup 1/4 final weekend. So what did you expect me to write about over at Spot-On. It’s called Football, bloody hell
Bonus points if you know the quote.
HOSPITALS: Scrushy guilty of something at last
Those of you despairing of rich people being able to buy their way out of trouble may be encouraged by this headline—Scrushy, Siegelman found guilty on federal conspiracy, bribery charges . Well at least he’s going down for something. Perhaps this jury wasn’t quite a susceptible to the bought and paid for black Ministers that are Scrushy’s new best buddies, or maybe he didn’t bother hiring them this time around. At any event hopefully he gets what’s coming to him this time.
HOSPITALS: Tenet saga over for now
This edition of the soap opera known as Tenet Healthcare Corporation is over, or at least has gone to commercial break. The DOJ settlement is for $725m in cash and another $175m in billing to Medicare it won’t collect. How much of that will come from the execs who sold stock before the news got out in 2002? Not much I guess.
If previous history is a guide, expect a name change and another scandal in 5–10 years.
BLOGS: Health Wonk Review is up
I knew I should have hired an unpaid summer intern. At IBM they have them by the dozen and one of them, Emily Goodson, has done a nice round up of health care blogging in Health Wonk Review over at HealthNex.
Any unpaid interns looking to boost their resumes know where to apply…
PHARMA: The Macular Degeneration Rip Off, By PAT AWASH
Occassionally I get actual patients writing into me at THCB and sometimes it’s worth letting their experience with the system tell a story about how the opaque world of drug and health services pricing comes home to ground level. This is a verbatim email from a 70 year old patient Pat Awash:
Friday, June 9, 2006 I was facing imminent blindness in one eye and poor vision in the other. Beginning Saturday a miracle began to unfold after an initial injection in my eye of Avastin. Avastin is used to treat mestasticized colon cancer and someone deduced that it might, just might be effective for Age-Related Macular Degeneration, the leading cause of blindness and vision impairment among the elderly.
Due to an undetermined cause, leaking fluid had formed a large blister behind my retina causing four changes in my eye-glass
prescription between February 24, 1906 and late May, 2006, the last of which
did not hold for four days. I was frightened to say the least. Only one day after the injection I experienced a 70% vision improvement. This improvement continues each day and I am using a three-year-old prescription.
I am writing in objection to the current policy of the FDA in regard to Avastin. It is an off-label use but the cost is minimal, only $60.00 when provided at cost as my physician does. The same drug company that
makes Avastin has developed Lucentis which has a slightly different molecular
structure than Avastin but is basically an analog. Only thing is, Lucentis will cost an expected $1,500.00 per dose. They claim a reported $400 million research cost but I’m wondering what is included in that amount.
I hope you get the picture. The manufacturer of Lucentis has changed the drug to the degree that it can be classified as a new drug. Whereas Avastin is expensive when used as a cancer drug it is very inexpensive for eye treatments because the dose is so small, and some would say Lucentis is not as effective. Once approved, Lucentis will be covered by
Medicare, a windfall for the manufacturer and huge cost to the public considering a rapidly aging population. Gentech could have done the trial on Avastin.
Everything would be ok except Genentech will no longer make Avastin available except to those who exclusively treat cancer patients.
No off-label applications and no choice for patients. Thankfully, my physician bought a substantial (several month’s) supply prior to the June 1, 2006 cut-off date.
I find this insane and I think you will too. I am sick and tired of experts saying how much trouble Medicare is in when this kind of shenanigan is going on.
Respectfully,
Pat Ahwash (a 70-year-old senior citizen)
TECH/CONSUMERS: Anytime, Anywhere Healthcare
This panel will focus on in-store clinics, and mobile devices in health care
On the panel is Michael Howe, CEO MinuteClinic, Delmer Dukjhart from Technology Center, Cisco & Don Jones, VP Healthcare, Qualcom
Intro from Richard Adler, IFTF—about 100 clinics around the country, small companies but big partners. Most NP run, no doc on site, but some experimenting with that problem. Lots of encouraging data presented about why these clinics are good in terms of cost and convenience. Of course one question is how much $$ per sq. ft can these clinics generate.
Next steps for these clinics? Video visit booth, with only pharmacy tech or EMT tech, remote contact to clinicians. CHCF has funded Mercer to create this.
Mobile health applications….several applications all built on growth in use of cell phones. Now 75% of adults have a cell phone (more than 60% of those in their cellphones) 8% of cell phones in US are smart phone. NOT just a US phenomenon 25% of worlds pop use them, and several other companies use them Italy’s cell phone penetration is 108%. China has 335m cell phones (25%). Lots of progress in medical devices, sensor arm bands, life shirt, etc, etc (Check out medgadget for more of all this). Two new ones are 3G doctor (apparently coming in the UK) and the VeriChip (My note—it is not far out….it already exists and John Hamalka has already got one).
Michael Howe, CEO MinuteClinic. Started because the founder was pissed off at having to wait 3 hours for an urgent care clinic visit for his kid’s ear infection, brought in retail experience (Michael). Have gone from 19 clinics to 84 clinics. Will have 250 clinics by end of years and going to 1000 clinics by end of 2008. It’s meant for binary decisions on confirmations of diagnosis and simple treatment. Cornerstone of the system is an EMR that functions like a pre-flight check list for a pilot. Can also change the algorithm/care for all clinics. Can provide summary of visit back to PCP if they can accept it.
Don Jones; “it’s very slow to drag that health care mule through the water”….but the fun part of his job is remote glucose monitoring, etc.
Del Dukjhart: So much synergy between wireless devices, clinics and the network. Lots of places where telepresence can get access to good quality health care. He thinks technology can solve many of the problems. Telepresence needs to get to be easier to use, that’s the big rock.
Michael—What’s the impact on PCPs? (my question)….there hasn’t been an impact on primary care docs. There’s resistance at first, but then they work as a complement, and then within a year or so they start giving referrals to their clinics. This is about making access and convenience for patients….it also means that patients will get access to maintenance care more easily. He thinks that the primary care doc is a coach who’ll uses resources like MinuteClinic
OFF-TOPIC: World Cup medical latest
So the main Aussie star, Harry Kewell, couldn’t play against Italy because of gout. Being a fellow traveler I sympathize, but isn’t he a bit young and thin for that?
