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HOSPITALS: How to play nice with workers, and how not to

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If you hadn’t noticed, the next round of unionization will come in the big service industries. This is going to build over time, but health care services will be the biggest push because (with the obvious caveat about overseas surgeries) it’s hard to move health care jobs off-shore, and it’s hard to replace labor with technology in those jobs (though lots of people will be trying!). So if you’re a hospital chain how do you handle the fact that the SEIU is targeting your industry? You basically have two choices. Enter into a partnership agreement with the unions and hand over a small slice of the vast profits you are making as an organization to your workers. Or tough it out, continue to make as much as you can, and let the unions eat cake.

In Northern California we have both examples. Sutter is deciding to essentially risk its non-profit status by being not only the consistently most expensive provider chain, but having a nasty fight with the SEIU at its most profitable hospital, Cal Pacific.  And of course the unions are highlighting the amount of money they’re making and helping get the Department of Justice to investigate.

Kaiser Permanente on the other hand has a big deal with its unions in which everyone gets a decent pay rise (at a time when KP is making bank, one might add) and about which the unions are deliriously happy. Here’s what the union rep said.

"This is the best (union) contract in the country," said Sal Rosselli, longtime president of SEIU’s Oakland-based United Healthcare Workers West and its predecessor, Local 250. "It’s the best contract we’ve ever reached with a hospital system." Praising Kaiser for including workers in every stage of planning, Rosselli called it "the opposite extreme" from Sutter Health, which runs California Pacific Medical Center in San Francisco, now in the third week of a bitter UHW strike. "Kaiser is serious about being the health-care provider of choice," he said, "and to do that it needs to be the health-care employer of choice."

Given that there is a huge connection between employee satisfaction and patient/member satisfaction, Kaiser might be on to something. Either way, at its current rosy spot in the revenue cycle, it’s a little odd that Sutter is drawing such a strong line in the sand. Perhaps someone wiser than me can explain why.

CONSUMERS: Medicare Part D … as in Detail by Mr Jib

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The Sacramento Bee has a good article which exposes a little detail which may be important to people who are thinking about signing up for Medicare Part D.  It turns out that people who are in managed care plans and sign up for a free standing drug plan with a different company may find their existing coverage terminated.  According to the Bee:

Seniors who are members of managed care health plans and then enroll in a drug plan offered by another organization could be dropped from their health plan, according to health plan and Medicare officials. Marketing campaigns for Medicare’s new prescription drug benefit plans are set to start Saturday. Advocates for seniors are worried that the benefits will be attractive enough to get seniors to sign up without first calling their HMOs.

From the managed care plan’s perspective, signing up for a drug plan offered by another managed care plan is seen as a decision to leave…

Oh. And Medicare Part D. marketing starts Saturday. 

Go read the article.

— Mr Jib

CONSUMERS: A little help from my friends, by Mr JiB

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THIS IS A GOOD idea. Barry Katz came up with Lotsa Helping Hands after his wife’s four year ordeal with cancer. The web-based calendar system he developed helps friends and family volunteer their time and support.  Beth Israel Deaconess Medical Center, the Colon Cancer Alliance and the other groups have already signed on.

—Mr JiB

PHARMA: Senator Grassley, I presume? by Mr JiB

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IN CALIFORNIA things are starting to heat up in advance of the November special election. Proposition 78, the drug-industry backed ballot measure targeting high prescription drug costs, picked up a key endorsement this week. On Monday, Governor Arnold Schwarzenegger gave his blessing to the proposal.  The politically powerful American Association of Retired People (AARP) formally announced its support on Wednesday, said it is siding with Proposition 79.  

Proposition 79, the alternative backed by Health Access California, key consumer groups and major unions, is seen as taking a tougher line on costs. It is also intensely disliked by drug companies, who see it as likely to encourage similar attempts to pass tougher laws in other states.  Recent tracking polls show support among Californians for the two measures about even. That is a bit of a surprise for those who were predicting the campaign would essentially be a formality, given the lobbying power and resources of the pharmaceutical industry.

HealthVote.org has been tracking ad spending, as it did during last year’s election. Huge amounts of money have been spent already. But the real action is likely to come over the last six weeks of the campaign.  According to the group’s release today:

Prop. 78 supporters aired 11,485 ads in California’s five largest media markets (Los Angeles, San Francisco, San Diego, Sacramento and Fresno) through September 25 at an estimated cost of $13.4 million. Proponents of Prop. 79 launched their ad campaign on September 29.

When the Prop. 79 spot is posted, I’ll link to it, so you can take a look. But for now, you can go take a look at the spots the campaign for Prop.78  is running here.UPDATE: Lisa Girion has a piece on the topic in today’s LAT. The paper’s take:

Californians like the idea of a statewide drug-discount program for the poor: A recent Field Poll found Proposition 78 leading by a healthy margin. But that support sagged when respondents learned that the nation’s big drug makers were behind the initiative.  And therein lies the problem for supporters of the measure: Its biggest backer is also its biggest liability. 

— Mr JiB

POLICY: On von Eschenbach’s appointment, by Gregory Pawelski

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Greg Pawelski with a view on the new head of the FDA

More and more physicians and patients are turning to individualized therapies to treat cancers. Under this approach, scientists study how an individual’s cancerous cells respond to several drugs. Doctors have learned that even when the disease is the same type, different patients’ tumors respond differently to chemotherapeutic drugs. Treatments need to be individualized based on the unique set of molecular targets produced by the patient’s tumor, and these important treatment advances will require individualized assay-testing which can improve patient survival in chemotherapy for cancer. Assay-directed chemotherapy is an individualized approach to killing cancer. It’s time to set aside empiric one-size-fits-all treatment in favor of recognizing that breast, lung, ovarian and other forms of cancer represent heterogenous diseases, where the tumors of different patients have different responses to chemotherapy. It requires individualized treatment based on testing the individual properties of each patient’s cancer.

From yesterday’s Associated Press article:

WASHINGTON (AP) — The new acting   chief of the Food and Drug Administration says he will be presiding over a   transformation in medicine as scientists come to understand diseases in a more   detailed way that could improve doctors’ ability to treat patients.   

Now,"We are discovering so much about diseases like cancer at the molecular   level,"said von Eschenbach, a urologic   surgeon by training. "Much of what we have  done … has been based   on a model of empiricism." Soon, doctors will be able to intervene with   medical treatments more effectively matched to a specific patient’s illness.   

Read the rest at USA Today

Dr. Andrew C. von Eschenbach, tapped by President Bush as the temporary   chief of the regulatory agency, said Sunday that discoveries about diseases at "a molecular level" will lead to a new kind of health care. Doctors treat illnesses based on how well other people have   responded to a given treatment. Soon, they will develop a tailored response  built around specific understandings of the patient, the treatment and the   disease, he said.   

HOSPITALS/INDUSTRY: How stupid is Navigant really?

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So Navigant Consulting has been gilding the lily on its expenses in the apparently somewhat shoddy consulting job it’s doing at King-Drew.  Their basic excuse is that their private sector clients (almost all non-profit hospitals by the way) are quite used to not caring about the fact that they do things like leave rental cars in airport short-term parking for a week, take one day trips to work on other clients business, and fly their employees from San Diego to Los Angeles (a two hour drive) on a routine basis, and then send their clients the bill.

So Navigant is apparently dumb enough to think:

a) that their other clients won’t notice them basically calling them dumbb) that the King/Drew contract was sufficiently low profile that no one would care about what they did, despite the fact that the LA Times just won a Pulitzer Prize for investigating other malfeasance at the hospital, andc) that contracts they sign about expense reimbursement policies don’t apply to them.

BTW almost all of my clients either give me a total "capitated" fee for my expenses, or I make damn sure that they have an idea of what expenses are coming down the pike. And I don’t work for anyone who would have to respond to a Freedom of Information Act request!

PHARMA/POLICY/POLITICS: Well at least he gets to put “former FDA Commissioner” on his resume!

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So just like that after a contentious time getting confirmed, FDA Commissioner Lester Crawford resigns, after only formally being in the job for less than three months (although effectively having basically run the agency for three years). I wonder what further skeletons have crawled out of his closet?

Get ready for more confirmation fatigue as the Administration searches for someone else ready to screw their reputation by placing politics (and deeply unpleasant, mean spirited politics at that) before science.

CONSUMERS: Jessie Gruman on hammers and nails

Shorter Jess Gruman (Center for Advancement of Health):

Information therapy only works when the information is relevant to the exact individual and their exact culture — and patients vary tremendously in how they need to have that information conveyed to them, and their ability to deal with information and reality! So you guys (the information therapy crowd) have got your work out out for you!! If you think information therapy is a hammer, then not everyone is a nail.

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