THCB

Categories

Above the Fold

The Massachusetts Plan: What did they know, and when did they know it? by Eric Novack

• 6

Dateline, Boston…

According to an article in the Sunday,November 18th, 2007, Boston Globe, “(Massachusetts) the state could face a funding gap as large as $147 million by the end of the fiscal year, according to a state projection.”

2009 looks worse: … “Since insurers who participate in the subsidized program are expected to ask for significantly higher payments from the state”.But, government regulators are keeping up appearances: "It’s too early to make any departure from the health reform plan," said Leslie Kirwan, secretary of administration and finance and chairwoman of theCommonwealth Health Insurance Connector.”

“"It’s a good problem to have – people are getting insured and hopefully getting care," state Senator Richard T. Moore told the newspaper.

Continue reading…

When the Patient is a pain the doctor blames Google, by Matthew Holt

• 2

This article in Time written by an New York-based orthopedic surgeon is called When the Patient Is a Googler. But the problem is not Google, or online health information searching. Most doctors like a better informed patient. The problem is that this patient didn’t respect the doctor and that the doctor in turn didn’t respect the patient.

Trot over to Tara Parker-Pope’s Well blog on the NY Times to see a lot of comments about the surgeon’s attitude. (And no cracks from those of you who know a few orthopedic surgeons!)

Matthew Holt

POLICY: Low prices ain’t cheap enough

• 23

Mercer says that the number of small businesses offering health insurance to workers went down last year despite the greater and easier availability of high-deductible and HSA plans.

Fewer small employers offered health insurance this year, despite
the widespread availability of new, lower-cost high-deductible
insurance plans, a survey released today by benefit firm Mercer shows.
Advocates of the high-deductible plans touted them as one solution to
the growing number of uninsured, expecting the plans to appeal to small
employers, who would continue to offer health insurance as a result.
"That’s not happening," says Blaine Bos, a Mercer partner and one of
the study authors. "In fact, the reverse is happening."The
study of nearly 3,000 employers found that the percentage of employers
with 200 workers or fewer offering any kind of health insurance fell to
61% this year from 63% in 2006.That drop came even as the cost
of high-deductible plans with tax-free savings accounts averaged $5,970
per worker per year. That was $700 less than a comparable plan without
a savings account and far lower than the $7,120 for the average HMO,
the study says.

HSA/HRA type plans are growing in the market, but not as fast as employers are dropping coverage.

Continue reading…

POLICY: The NY Times Remembers the War on Drugs, but has learned none of its lessons

• 1

No one bothers to care much about the war on (some) drugs these days. Sure it’s an $80 billion a year boondoggle for law enforcement and criminals, paid for by the taxpayer at an untold cost in lost civil liberties. But that pales in comparison to the $200 billion a year boondoggle otherwise known as the War in Iraq—a trough in which there are even more snouts. And of course one which has created even more problems than the war on drugs, which may even have a larger effect and last as long. But out of nowhere, the NY Times Editorial page has remembered.

Sadly remembering and understanding are two very different things.

Mexican criminals make money off the criminilization of personal behavior in the US. That money, in the form of cash and guns, flows south. And there’s a terrible inevitability about it, as the Times says, Yet so long as there is demand, the narcotics will always find a route, through Mexico or some other way.

So what, after 90 years of failed prohibition, is the NY Times’ radical answer? Send more money to the Mexicans from the US taxpayer so that the police there can buy more guns.

Did Judy Miller get moved to the editorial department? The NY Times editorial is drinking the kool-aid straight from the futile but endless fundable idiocies of the drug warriors at the DEA. Can it not do better?

 

HEALTH2.0: Personal Genome Management–The Next Big Thing?

• 3

There are 160m Americans looking for health information online and
somewhere in the realm of 10–30% of those are viewing and creating
their own content. But that has made moderate impact on the mainstream
press (with Laura Landro being an honorable exception). So it was a
little  surprising to see both the WSJ and the NY Times feature a related issue in the last week—online genetic screening.

Suddenly the concept of getting your genome tested and laid out online is really hot. 23andme (with its Google connection and Esther Dyson on the board) and Navigenics
(with Kleiner Perkins and MDV as blue chip VCs in a $25m round) are the
two best known west coast players. 23andme has already found out that Warren and Jimmy Buffet are not related and you can go to their site and sign up for their service for under $1,000. (And learn lots more about it in this Wired article) But they’re not alone. In Boston, Knome is
gearing up for something similar and Icelandic company DeCODE genetics,
which already has a database with the island’s entire population in it,
has also introduced a similar service called DeCodeMe.

And of course there’s The Personal Genome Project. It’s an effort led by George Church and includes 10 people who are putting all their genetic information online. (One is Esther Dyson of course)

Meanwhile, plenty of other companies are doing genetic testing mostly on genealogy grounds. The Genetic Genealogist Blog estimates that some 600,000 tests have been done and they are worth about $300 each. but for an annual market, that’s only $25m. The Genetic Genealogist Blog also has a long list of those genetic companies.

Finally, while there’s all this excitement about doing comprehensive DNA testing, DNADirect has been offering a direct to consumer service for a couple of years which offers the most common tests. You can see their price list here. One estimate which seems in the ball park is that the total market for that testing is $200m.

But let’s hang on a minute. (Read the rest on Health 2.0 Blog)

When is a Medical Error a Crime? by Bob Wachter

• 17

Bob Wachter is one of the nation’s leading experts on medical safety and one of the pioneers of the hospitalist movement. And now he’s descending into the mire of blogging! So we’re pleased to cross post one of the more recent pieces from his (relatively) new blog Wachter’s World.

Robert_wachterThe first commandment of the modern patient safety movement was “Thou Shalt Not Blame.”
Old-Think:
errors are screw-ups by “bad apples,” and can only be prevented by some
combination of shaming and suing the doctor or nurse holding the
smoking gun. New-Think: errors represent “system problems;” any
attempt to assess blame will drive providers underground, inhibiting
the free-flow of information so crucial to error prevention. Like
most complicated issues in life, the truth lives somewhere between
these polar views. In the main, the “no blame” view is right – most
errors are committed by good, hardworking docs and nurses, and
finger-pointing simply distracts us from the systems fixes that can
prevent the next fallible human being from killing someone.Yet,
taken to extremes, the no blame argument has always struck me as both
naive and more than a little PC. Anyone who has practiced for more than
a month can name docs and nurses who they would never want caring for
their loved ones. And what about the substance-abusing nurse, the
internist who doesn’t keep up with the literature, the
retractor-throwing surgeon, or the provider who refuses to follow
reasonable safety rules. If nobody is ever to blame, who is
accountable?

Continue reading…

Think Again: Payments to doctors By Eric Novack

• 9

Eric NovackI am frankly a bit surprised at the lack of comment at THCB on the recent orthopedic device
manufacturers’ settlement with the government for concerns about illegal payments to physicians.  I would have expected Matthew or Maggie, at least, to be sounding the alarm over the dangers of the private sector in healthcare. The most interesting byproduct of the settlement is the development of a public database where you can search by company to see who is getting the ‘big bucks’.

But like many simple statistics, the data can be misleading.

Let me be clear—paying a surgeon for ‘work’ with the real expectation that he or she will use a specific product is unethical, not to mention illegal (but a problem inherent in our 3rd party paymentsystem in medicine, but that is another issue entirely…).

One Phoenix area surgeon has been paid $3 million this year by Stryker.

‘Outrageous’, you say. “Ah- ha—see, all doctors are corrupt and need to be controlled”, others exclaim.  But what are the facts?  In this case, the surgeon helped develop some of the early hip and knee replacement designs… These designs have served as the basis for literally millions of replaced joints over the last 20 years.  He owns a piece of the patent.Is it immoral to get paid for people using a product you work hard to develop?  Should Google’s founders still benefit?  How about those who own patents on everything vacuum cleaners to hair care products?

Of course they should– because our society encourages innovation by protecting the value of innovation.

Continue reading…

Health 2.0 at the CCR Workshop in San Diego and thoughts about Google’s Subauth, by Indu Subaiya

InduYesterday we attended David Kibbe’s CCR workshop in San Diego and learned lots about XML and the
utility of the continuity of care record in many different settings.  For more info about the CCR, read David’s posts on the topic – here and here. 

Over the course of the workshop, there were presentations by Rick Peters, the chief architect of the
CCR who has recently left a PBM start-up to look at several new
opportunities, Steve Waldren of the AAFP, Michael Rosenthal from Minute Clinic and Google’s
Jerry Lin. In the audience were people from Microsoft (Healthvault),
Qualcomm, Rediclinic, Patients Like Me, Edmund Billings from OpenHealth
and Michael Mee, who is working with Adam Bosworth on his new gig, and
a host of tech companies and provider groups offering or trying to
implement the CCR functionality respectively.

Google’s Jerry Lin sparked a heated debate about security and
authentication and whether username and password based systems were
enough or whether you needed 2 factor or 3 factor authentication.
Google’s subauth was pretty cool I thought although the open source
version known as oauth is more likely to be relevant to apps outside of
Google.Continue reading this post over at the Health 2.0 Blog

What the Blogs are saying …

Adam Bosworth, describing life post-Google:

"Well, as some seem to know, I’ve left Google. And now that I’ve
left, that old entrepreneurial fever has struck me again and I’m off
working on a startup. Google is a wonderful company and I had a great
time there and had a lot of fun building something I really believe in,
Google Health, which I think has a great potential to change the way
consumers manage their health when it launches. Still, for me, it is
time to start a new company and I’m off and running.

I’ve been dusting off extremely rusty engineering habits and writing
code. Not elegant code to be frank. Just enough to think through my
ideas. Some extremely clear-headed and smart people can work out
everything abstractly in their heads and then just go and implement it.
I’m not one of them. Watching me write code is like watching an
indecisive sculptor work with clay. I shape it. I look. I wince. I
reshape it. I play with it. I wince some more. I ask my friends, nurse
my wounds, and then reshape it yet again. And so on. Constant iterative
development. It takes three tries before it is even close to the way it
should be, best case. I think it is totally worth it. The arguments and
design decisions are just way more concrete and tested."

Continuez

The Download squad on the impending PHR Wars

"This raises an interesting question. Are doctors going to want to sign
up for Microsoft, Google, ZocDoc, and other online services just to
communicate with their patients? It seems more likely that an
individual doctor or medical practice will pick one service and then
stick with it.

For example, if you take your kid to Fluffy
Bunny pediatrics, you’ll find that the doctors are willing to share all
of your child’s medical records with you over Microsoft HealthVault. If
you sign up for Google Health, you’ll have to get old-fashioned paper
records. Because otherwise, Fluffy Bunny doctors would have to spend
time submitting all of their documents to 2 or more different sites,
which would increase their workload, not decrease it. This, of course
would force health consumers to sign up for multiple services if they
want to make sure they have access to the latest information from all
of their doctors, meaning that you’re the one with a disorganized mess,
not your doctor."

assetto corsa mods