The Health Care Blog – Page 1013 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

Rebuilding The Medical Home: What Walgreens Surely Sees

Mar 27, 2008• 11

By Brian Klepper

Though it probably went mostly unnoticed in the cacophony of health care stories, last week’s news that Walgreen’s had bought the two largest and most well-established worksite clinic firms, iTrax and Whole Health Management, was a harbinger of very big changes in health care. Walgreens, the ubiquitous drugstore company that, with Wal-Mart and CVS, has already leveraged its pharmacy platform to establish a strong footprint in retail clinics, undoubtedly startled many health care observers with its announcement. After all, isn’t the company doctor a relic?

Actually, no. The worksite clinic – and by way of disclosure for the better part of the last year I have
worked closely with a small, very innovative, Orlando-based startup worksite clinic
firm, WeCare TLC – has been
reinvented and refitted with 21st century tools, and offers the promise
of nothing less than a paradigm shift toward dramatically better care
at significantly lower cost. Understanding how these structures work and how they differ from both old-fashioned medical practices and retail clinics provides clues into what Walgreens likely sees and why that matters to American health care.

Happy Birthday, Viagra!

Mar 27, 2008• 3

By Jane Sarasohn-Kahn

It’s the drug that raised the profile of medicine in popular culture. It’s been hawked by a prominent politician and has been the butt of jokes on late-night TV. It’s Viagara, and it’s turning 10 today.

The FDA approved the drug on March 27, 1998. Here is the FDA’s approval page for it.

Pfizer’s Viagra reshaped pharmaceutical marketing in several ways. The company used direct-to-consumer advertising to great effect, and changed the game of DTC by advertising the drug not only in late at night broadcast outlets.

More broadly, the marketing of Viagra bolstered the trend of medicalization of everyday life. Viagra’s origin as sildenafil citrate was targeted to cardiovascular medicine. Originally conceived as a heart drug for hypertension and angina, the molecule was, serendipitously, found to be useful in erectile dysfunction.

In 1998, three scientists who studied the dynamics of nitric oxide, the secret sauce in Viagra, won the Nobel Prize.

Jane’s Hot Points: One of the most informative primers on Viagra is this book from Meika Loe of Colgate University. In it, she observes that we are Viagra nation where, "our sexual status quo has shifted dramatically." Ten years after Viagra’s entry on the health scene, the search remains for a "pink viagra," a version for women. No one can deny the game-changing role that Viagra has played in American health care and in popular culture.

THCB readers will not be surprised …

Mar 26, 2008• 11

By Eric Novack

Cancer patients covered only by Medicare face problems getting chemotherapy …

Massachusetts Health Plan underfunded

Average Time of Discharge: Why a Hospital is Not a Hilton

Mar 26, 2008• 7

By Robert Wachter

Do you get as annoyed as I do about being pressured on your “Time of Discharge?” I just received my monthly report, and we’re in The Doghouse again: our average TOD – 3:28 pm – is hours after “check-out time.”

But when did we turn into the Holiday Inn?
Robert_wachter

Let’s start by appreciating where this comes from. Many hospitals, including mine, tend to run full – given the huge fixed costs of operating a modern hospital, being full is probably the only way you can be profitable, just like the airlines. Queuing theory (don’t tell me you’ve forgotten your queuing theory!) tells us that, when you’re full, you should look for fundamental choke points and do your best to relieve them. There are PhDs working for McDonald’s whose lives are dedicated to figuring out how to avoid lines at lunchtime rush hour, and others working in aviation who model the best ways to load passengers onto planes (latest answer courtesy of a Fermi Lab astrophysicist: start in the back and load every third row, back to front, sequentially).

The main stenosis in hospitals occurs in the early afternoon: the morning’s OR cases are finishing, the ED is heating up, the clinics are sending over elective and urgent admissions, the respiratory therapists have done their weaning and “liberated” a few patients from vents… and everybody needs a floor bed. Now! But they’re all taken, since nobody’s gone home yet.

Gridlock. Bad for business.

How do you fix this? About a decade ago, some smart consultant (I can’t figure out who, but he or she must have had a terrific PowerPoint slide making this point since every hospital I know of picked up on it) came up with the solution: let’s measure and report the time of discharge by service, shining the holy light of transparency on service chiefs like me to get them cracking. And since everybody likes Goals, how about we set a guideline – “The Discharge Time on 5 South is 11 am” – and post it in every room and nurse’s station. Then it won’t be a shocker to the patients when we try to hustle grandma into the wheelchair and roll her out of her room before noon.

Prosecution in organ harvest case faces hurdles at trial

Mar 25, 2008• 4

By Sarah Arnquist

Although neither the prosecution nor defense has shown its entire case, the unusually long eight-day preliminary
hearing for transplant surgeon Hootan Roozrokh revealed considerable details about what happened during Ruben Navarro’s final hours and the hurdles both sides must overcome at trial.

San Luis Obispo County prosecutors jumped their final pretrial hurdle March 19, when a judge ruled that a jury would decide whether Roozrokh committed dependent adult abuse Feb. 3 and 4, 2006, at Sierra Vista Regional Medical Center in San Luis Obispo.

Never before in the United States has a transplant surgeon been tried criminally under similar circumstances, and the transplant and medical communities have followed the case closely. No trial date has been set, but if the preliminary hearing is any indication, the trial likely will be lengthy with many witnesses and substantial expert testimony.

Entering Unfamiliar Territory

Mar 24, 2008• 13

By Kristen Trusko

If universal coverage mandates that employers provide health insurance or that people secure it themselves, it is highly likely that the majority will choose the lowest cost option, or “low premium” (aka HDHP or high deductible health plan). These plans enable consumers to open an associated financial account – HSAs. In addition to helping consumers plan their spending, savings and investment for current and future health needs, HSAs provide a triple tax free opportunity to save for retiree health.

Criminal charges filed against transplant surgeon

Mar 23, 2008• 10

By Sarah Arnquist

Prosecutors in a small town on California’s Central Coast are making history. For the first time in the United States, they brought criminal charges against a transplant surgeon, alleging he prescribed excessive amounts of medication in an attempt to hasten a disabled man’s death and harvest his organs. The case cleared its final pretrial hurdle Wednesday and will now go before a jury later this year.

San Francisco surgeon Hootan Roozrokh faces one felony charge of dependent adult abuse, for which the maximum punishment is four years in prison. Roozrokh, 34, has pleaded not guilty and his attorney, M. Gerald Schwartzbach said his client looks forward to clearing his name at trial.

The Roozrokh case has attracted much national attentionand raises worrisome questions about whether the transplant community is pressing too hard to increase the nation’s organ supply, thereby creating situations ripe for blurring ethical boundaries, such as this one.

A Detailed Analysis of Barack Obama’s Health Care Reform Plan

Mar 21, 2008• 115

Thanks to a very high Google ranking this has been the most popular ever post on THCB. And it's an excellent analysis by Robert Laszewski. who writes The Health Policy and Marketplace Blog. However, it was written during the Democratic primaries in 2008 and is of course out of date. THCB suggests that you checkout a few other intriguing posts too.

For more recent posts on health care reform, try a smattering of these:

Health Reform and Obama's Leadership by Rahul Parikh
The Affordability Model by Robert Laszewski
No Country for Old Men by Jeff Goldsmith
Two Rules by Which to Judge a Health Reform Bill by Matthew Holt
Ditching the Public Option by Robert Laszewski
No Alternative: An Analysis of the GOP Plan by Harris Meyer

and of course enjoy Bob's analysis too!:

By Robert Laszewski

Rt_obama_070116_sp_1 Barack Obama’s health care plan follows the Democratic template—an emphasis on dramatically and quickly increasing the number of people who have health insurance by spending significant money upfront.

The Obama campaign estimates his health care reform plan will cost between $50 and $65 billion a year when fully phased in. He assumes that it will be paid from savings in the system and from discontinuing the Bush tax cuts for those making more than $250,000 per year.

By contrast, the McCain Republican strategy for health care reform would first emphasize market reforms aimed at making the system affordable so more Americans can be part of the system and he claims that there would be no additional upfront cost.

Obama breaks his health care reform plan down into three parts saying that it builds “upon the strengths of the U.S. health care system.”

The three parts are:

1. Quality, Affordable & Portable Health Coverage For All
2. Modernizing The U.S. Health Care System To Lower Costs & Improve Quality
3. Promoting Prevention & Strengthening Public Health

Obama claims that his health care reform plan will save the typical family up to $2,500 every year through:

* Health information technology investment aimed at reducing unnecessary spending that results from preventable errors and inefficient paper billing systems.
* Improving prevention and management of chronic conditions.
* Increasing insurance industry competition and reducing underwriting costs and profits in order to reduce insurance overhead.
* Providing reinsurance for catastrophic coverage, which will reduce insurance premiums.
* Making health insurance universal which will reduce spending on uncompensated care.

Will Obama be able to cut the typical family’s health care costs by $2,500 a year?

Well, yes and no.

A Doctor Grows in Brooklyn

Mar 21, 2008• 34

By THCB staff

Doctor Jay Parkinson became a media celebrity last year as word spread about his unconventional practice in Williamsburg, Brooklyn. Instead of maintaining a traditional office and paying support staff, Parkinson’s operation is entirely virtual and requires almost no overhead. (Unless you consider a Mac overhead.) Using his apartment as a base, He runs a web site loaded with Web 2.0 touches that allows patients to communicate with him easily and explains his services in plain English. After an initial in-person consultation, exchanges can be online and are conducted through either instant messaging or web chat.

“The healthcare industry is so stuck in 1994,” he says, “The only way they’ve used the Internet is to provide information. I look at the Internet as something that provides communication.”

Health 2.0: Weighing In With a Reality Check

Mar 21, 2008• 5

By Michael Millenson

Maybe you saw the article: “Health 2.0 Helps, But Personal Contact Remains Top Weight Loss Strategy.”

OK. I made up the headline. But the information comes from an article that provides food for thought for those of us who speak, blog and otherwise evangelize about the good things the Internet is bringing to
health care. Here’s one question to start with: is there a different ethical obligation for those promoting the efficacy of an online health intervention than for those promoting a site to help you find a great
hotel?