In your Friday funny….
Police seek ‘professionals’ who removed St. Paul man’s testicles. Apparently this was consumer choice! They must have really hurt before and I’m sure they did afterwards.
Above the Fold
THCB Reader Mail
Bazian’s Tom Donald responds to critics of evidence-based-medicine in
our post discussing the company’s
new approach to the controversial field.
"Unfortunately EBM has, in many circles, become a “dirty word” through its
blunt application by insurers and regulators, as well as its devaluation by groups (mostly published products) who say they’re evidence-based when they’re
not. EBM does, however, play a critical function, as you note. So it’s time
for a fresh start. The sullying of its reputation leads us all to evidology –
aka EBM 2.0. Evidology recognises that “getting evidence based” requires a new
specialisation, one which sits between the clinical front line and the bean
counters, assuring quality care without wasteful expenditures. As a company,
we’re working towards the day when evidology bridges the clinicians’ world to
the bean counters’ world, allowing them to better understand each others
needs, requirements and decisions."
Bob Mooney has this to say to critics who think too much time is spent at medical schools teaching prospective doctors to "think like entrepreneurs" and not enough on the trickier subject of teaching them how to cost-effectively treat disease.
"What you learn in school and during training is how to diagnose and to treat disease. As Dr. Bradley observes, little attention is payed to doing so in a cost effective manner. There are physicians who are positioned so as to have a financial incentive to order diagnostic testing."
Most physicians, however, have no such incentive. We see a patient and we try
to get through the encounter without overlooking something that will cause us
to have to face the patient months or years later having to own up to the fact
that we missed a diagnosis. Every office encounter presents an opportunity to
make a mistake that is going to get us sued. We don’t know what the MRI
costs, what the CT scan costs, or what cost is of the exhaustive laboratory
workup that our patient is demanding to explain why they are always tired."
Xoova VP of Communications, Miriam Bookey was so inspired by the post on the HEALTH AFFAIRS
interview with Regina Herzlinger that she wrote to us. (Disclosure, as
required by the unwritten Geneva convention for blogs we now humbly disclose the fact that Xoova is a Health 2.0 sponsor.)
"I know more about my Raisin Bran than about the guy who delivered my
children or the hospital in which he practiced. That’s because there’s
no consumer market yet in health care, and these information
organizations exist only in consumer market." — Regina Herzlinger Yes, there’s a need for physician ratings, and there are resources on the
Internet that already provide that. But we need more than the nutrition label on
the side of the cereal box. We need a real connection with the doctors who
provide our care, because selecting a doctor is both an intellectual and an
emotional choice. That’s where an enhanced profile rather than a simple
directory listing can make a difference. Today we have thousands of enhanced
physician profiles nationwide, and in time, Xoova aims to be the most popular,
trafficked site for doctors to communicate directly to patients. Today they can
do this by updating their own profiles, offering forms for download, and adding
online appointment scheduling…for free. Soon we’ll incorporate the consumer
voice in moderated testimonials, along with physician to physician referrals.
Hopefully, this will take us a step further to the world Herzlinger envisions in
which we know as much about the person who, say, performs our mastectomy as we
know about the restaurant that prepares our dinner …"
TECH: First Opinion–mysterious but now rich
I’ve heard about this company but despite a couple of half-hearted efforts to get in touch never figured out what First Opinion did.
The First Opinion system is a medical knowledge-based system designed to give medical advice to the general public. Using Internet, wireless, interactive voice response, and automatic speech technologies, as well as three new authoring languages, the First Opinion system encodes a highly useful core of expert and general practitioner diagnostic and treatment knowledge into a computer system that can be accessed by non-medically trained personnel. <SNIP> The First Opinion system provides up-to-date medical advice for approximately 200 of the most commonly encountered problems in general practice and emergency medicine. If a chronic disease is diagnosed, the diagnostic system can refer the patient to the First Opinion system’s automated disease management system. The system also transmits a full report of the interaction to the patient and the patient’s physician. It can also provide valuable information to the public on numerous additional medical topics.
But at least someone was paying attention. Last week Healthways paid $22.3m for the company.
Meanwhile Healthways itself has seen its stock go on a tear the last few days. Anyone out there have a theory as to why? It can’t have been just Gordon Norman’s bullish views on DM—or was it just the Kramer effect once more?
Anyone knowing any more about either story, let the rest of us know in the comments.
POLICY/PHYSICIANS: In which I criticize Uwe Reinhardt, really!
Uwe Reinhardt has written to the NY Times about What Doctors Make, and Why. It’s great that they print his letter–they should be featuring a whole lot more of his stuff in comparison to their penchant for printing out of touch loonies who don’t we think we spend enough on health care. But, here’s the fact that may take some of you a moment to digest–I don’t actually think Uwe’s entirely correct here. Here’s what he says:
In “Sending Back the Doctor’s Bill” (Week in Review, July 29), you compare the incomes of American physicians with those earned by doctors in other countries and suggest that American doctors seem overpaid. A more relevant benchmark, however, would seem to be the earnings of the American talent pool from which American doctors must be recruited.Any college graduate bright enough to get into medical school surely would be able to get a high-paying job on Wall Street. The obverse is not necessarily true. Against that benchmark, every American doctor can be said to be sorely underpaid.Besides, cutting doctors’ take-home pay would not really solve the American cost crisis. The total amount Americans pay their physicians collectively represents only about 20 percent of total national health spending. Of this total, close to half is absorbed by the physicians’ practice expenses, including malpractice premiums, but excluding the amortization of college and medical-school debt.This makes the physicians’ collective take-home pay only about 10 percent of total national health spending. If we somehow managed to cut that take-home pay by, say, 20 percent, we would reduce total national health spending by only 2 percent, in return for a wholly demoralized medical profession to which we so often look to save our lives. It strikes me as a poor strategy.Physicians are the central decision makers in health care. A superior strategy might be to pay them very well for helping us reduce unwarranted health spending elsewhere.
Uwe’s right in saying that doctors pay per se isn’t a big enough share of medical spending (around 10%) that a cut in it would make much difference to overall health care costs. And he’s also right that we should change their incentives so that–at the least–they don’t make more by running up health care costs elsewhere in the system. And I’m including in that fixing malpractice, college debt and the other issues that make physicians feel under so much stress to increase their incomes.
QUALITY/POLICY: Sicko, Deloitte and the reason for EBM
The Deloitte Center for Health Care is best known for being headed by Paul Keckley, recently of the Center for Evidence Based Medicine at Vanderbilt, and a minor actor in Michael Moore’s recent spat with CNN. (CNN didn’t come clean that Keckley has consulted for lots of health plans and, horror of horrors, is a Republican). I personally thought that Moore won that spat pretty convincingly, in that CNN couldn’t spend 12 seconds googling Paul.
The joke is that some of what Paul said was exactly what Moore said. Health care that is free at the point of care is not without cost, as it’s paid for out of general taxation (or some variant of it). Of course, it’s pretty shallow to say Americans don’t like paying tax, but then ignore the fact that they are otherwise (via reduced wages) forced to pay a "private tax" in health costs which massively exceeds that paid in tax to governments in other countries (after all there it adds up to 10% of GDP, here 17%). And I thought Moore was pretty clear in the movie twice (once with Tony Benn in the UK, and once when he went to visit the well-off French couple) that Europeans accepted higher taxes so that they can take care of the poor. Of course they probably don’t realize that in paying higher private taxes they save money overall.
However, the good folks at Deloitte are moving on, led by Paul, to talk more about the problems within the US system, and I suspect that Paul has learned his lesson about letting CNN tape his words without being clear about what their going to do with them and how they’ll represent him.
Instead, Deloitte’s gone to Kansas. Topeka, KS to be precise. Overall Topeka is a mirror of the national average in healthcare delivery data. Their analysis done using Healthgrades’ and other data is that if hospitals in Topeka could just do a little bit better than average they could save over 150 lives a year by just performing a little better–and that in a metro of just under 230,000.
POLICY: Market forces driving down drug prices by Eric Novack
A tiny step, but what if more of healthcare was freed from excessive
regulation? Of course, this is being done purely because the Medicare
Part D program is driving small pharmacies out of existence …
PHARMA: Time to get Shakespearean at big Pharma? by The Industry Veteran
The Industry Veteran has been busy this summer, but luckily for those missing his unique view of the pharma world, he’s ba-ack. And in his purview this time is the whole issue of why Big Pharma is filling its top jobs with lawyers.
DICK: The first thing we do, let’s kill all the lawyers.
CADE: Is not this a lamentable thing, that the skin of an innocent lamb should be made parchment, that parchment, being scribbled o’er, should undo a man? Some say the bee stings: but I say, ’tis the bee’s wax; for I did but seal once to a thing, and I was never mine own man since.
Shakespeare, King Henry VI, part II: IV, ii
Late last week (July 26) Merck announced the promotion of corporate counsel Kenneth Frazier to succeed Peter Loescher as president, global human health, effectively making him the company’s chief operating officer. Given Pfizer’s earlier decision to make their corporate counsel, Jeffrey Kindler, the CEO there, Frazier’s promotion means two Big Pharma companies within the past year have elevated lawyers to key, strategic positions. The moves in both cases indicate the unwillingness of the respective companies to cleanly break from the unsavory and dysfunctional practices of their recent past.
By naming Kindler to the top spot, Pfizer’s board clearly desired a relatively inexperienced manager without settled attitudes toward the pharmaceutical industry. As CEO it seemed apparent that he would move slowly and rely upon practiced hands within the company for guidance. Kindler immediately acknowledged this when he promoted his rival for the CEO spot, CFO David Shedlarz, and publicly referred to him as his "right hand." Such thinking among board members appears mystifying because if any pharmaceutical company requires fundamental changes to the economic model by which it conducts business, it is Pfizer. Since the 1990s Pfizer led the industry in implementing the blockbuster, mega-company approach. Under William Steere, an agile and precise thinker, the company grew and prospered with the strategy. In the hands of his successor, the arrogant head of finance, Hank McKinnell, Pfizer’s capitalization declined by more than 30% while the rest of the industry ignorantly followed his long walk down a short pier.
Kindler’s claim to fame as corporate counsel consisted of his use of outside contractors to pursue foreign Viagra counterfeiters and harass them into ceasing their operations. While serving as Pfizer’s legal counsel Kindler hired the former number-three man at the FBI to direct corporate security and together they retained companies such as the Blackwater Group, one of the largest US contractor in Iraq. Blackwater, which maintains close ties with right wing religious groups in the US, performs the usual range of corporate security and sleuthing services. It is also a mercenary army for hire that makes abundant use of stealth surveillance technology.
One example of Kindler’s failure to break with the blockbuster/mega-company approach appears in his dealings with third-party payers.
PODCAST/QUALITY/TECH/HEALTH PLANS: Disease management, technolgy and the future of health care–Gordon Norman tells all
Gordon Norman is Exec VP and Chief Science Officer at Alere Medical, formerly head of DM at Pacificare and a font of knowledge and opinion about disease management, technology, the role of health plans, and the chances for overall change in the system. We agree much more than we disagree, but if you have any interest at all in the restructuring of health care, I’m sure that you will enjoy our conversation.
You’ll also enjoy Gordon’s recent talk at Healthcare Unbound–his slides are here
TECH/HEALTH2.0: Harris Shows Number of Cyberchondriacs increases to an Estimated 160 Million Nationwide
Harris Shows Number of Cyberchondriacs increases to an Estimated 160 Million Nationwide
As you know I’ve been following this number for 10 years (not to mention working with and at Harris during part of that time), and the increase in the last few years has been remarkable. After all the fast pace growth in the internet was in the 1990s not in the 2000s, yet its use for health care continues to increase.
And talking about cyberchondria, I had severe chest pain about a month ago that felt pretty bad while I was out of state. I searched on the web for chest pain, confirmed that I had 3 of 4 symptoms of a heart attack and got myself to a doctor rapidly. The EKG was negative, but of course had there been no Internet I might not have bothered and I might have ignored a heart attack or arrhythmia. Presumably that’s not the preferred use of health online, but it really helped me.
BLOGS: Why Blogs?
Independence Blue Cross medical director Alan Adler has written a fairly comprehensive piece on medical and health care blogging in Managed Care Magazine. It’s called Why Blogs?
