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POLICY: Orszag makes the CBO get religion

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Somehow last week in the midst of one of the busiest working months of my life I managed to squeeze in a little time with Peter Orszag who’s the new-ish Director of the Congressional Budget Office. Or as he called it the “soon to be Congressional Health Care Budget Office.” Peter is  a true convert to the cult of Wennberg, and so we had a real meeting of the minds. He has started telling his story to all who’ll listen, and given the power of the CBO in Washington, plenty of important people are listening.

Go read his testimony on health care and the budget (PDF) (similar html here) from earlier this week. Pay particular attention to the figures which you can click on directly in the PDF navigation menu—especially the charts on the variance in costs for Medicare recipients by region (#3) and the impact of the current trends on future Medicare costs (#4). If enough politicians pay attention, then the second biggest problem in health care (practice variation) might get addressed at the same time as the first (lack of universal coverage).

He’ll also be having the CBO in future produce some slightly more synopsized and bite-sized reports, but for now there’s more data on their web site and you can subscribe to RSS feeds of their latest reports. I feel a blog coming on….

Meanwhile it won’t surprise you to know that the first hearing on any comprehensive health care reform legislation since 22 June 1994 is happening tomorrow, when the Wyden bill gets a hearing before the Senate Budget committee. If you want a clue as to how it’ll go, the line up on the panel is Len Nichols, Ph.D., Director, Health Policy Program, New America Foundation; Sara R. Collins, Ph.D., Assistant Vice President, Program on the Future of Health Insurance, The Commonwealth Fund and Arnold Milstein, MD,Medical Director, Pacific Business Health Group.

Luckily there were no problems in the health care system between the end of 1994 and the middle of 2007, so it didn’t matter that Congress ignored the issue.

Thank God the lunatics have at least had their charge of that part of the asylum taken away…

POLICY: We want Moore…or something like that

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John Cohn on Michael Moore–Fan-fucking-tastic. It’s called “Will Michael Moore’s Sicko help or hurt the universal health care movement?” Go read it.

Ezra Klein takes the wider view on Moore’s attack on American exceptionalism, equally worth it.

As for me, well over at Spot-on I manage to link Sicko with the other big release this week…

Strange things are afoot in the normally rarefied world of health care
punditry. It’s going primetime. And I’m blaming Steve Jobs.

Come back here to comment.

POLICY: Why isn’t more being done about ASD? By John Whitmer

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One in 150 children is diagnosed
today with Autism Spectrum Disorders (ASD).  ASD is a neurological
and immune deficiency disorder that affects people’s behavior, communication,
and socialization.  ASD is genetic—in other words, children are
born with ASD.  It is passed-down from parents, and siblings have
a greater chance of having ASD if another has it.  There are also
environmental triggers.  Symptoms of ASD closely resemble heavy
metal poisoning such as exposure to mercury.  There is no cure
for ASD, it is a life-long condition.  ASD is very difficult to
diagnose.  ASD is a spectrum of disorders, including specific diagnoses
of Autism, Asperger’s Syndrome, Rhetts Syndrome, Child Disintegrative
Disorder (CDD), and Pervasive Developmental Disorder-Not Otherwise Specified
(PDD-NOS).  No two people with Autism have exactly the same characteristics. 
Some have language, other do not.  Some with Asperger’s Syndrome
are brilliant; others have a comorbid diagnosis of mental retardation. 
Some will be fully included into school and work places; others will
always live at home or in institutions.  Skeptics emphasize the
difficulty in diagnosing ASD and changes to the classifications of diagnoses
as evidence of an overzealous culture and of inflated numbers. 
I should know, I was skeptical too.

But ASD is real.  I should
know, my son is the one in 150.   

Continue reading…

PHARMA/PHYSICIANS/HOSPITALS/QUALITY: Busy busy busy

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My correspondents have sent me lots of articles today. All worth a read—

When Is a Pain Doctor a Drug Pusher? Basically never as far as I can tell but in the DEA’s view any time the DEA feels that its livelihood is threatened. What a disgusting scumbag organization (and I include the US and State DA’s in their ecosystem), and I’m beyond disgusted that as a taxpayer I’m paying for this insanity. The DEA needs to abolished and anyone who’s

Report Rates Hospitals on Their Heart Treatment. The “report” is from CMS using Medicare data and it names names. I spent the last two days with lots of hospitals. They don’t think this type of hospital ranking matters yet, and they’re right. But it will matter increasingly as patients figure this out (more from me on this next week).

 

3 drug makers busted and fined for drug reimbursement scam in cancer drugs. Not exactly a surprise:

The plaintiffs argued that the drug makers had sold medications to doctors at steep discounts to the “average wholesale price” that Medicare and pension funds paid, while secretly encouraging them to claim full reimbursement from insurers.

There is nothing rational about allowing doctors to profit from selling drugs. But then again there’s nothing rational in our payment system as a whole. This is, though, one abuse that should be ended quickly.

Finally from the WSJ, yet again showing that it’s a socialist rag, How many doctors does it treat to see a patient? (Behind sub wall I’m afraid), but let me give you the first few lines:

In the mid-1990s I worked weekend shifts as a “moonlighting” doctor in a suburban Chicago hospital. When I would show up on Friday evenings, the other doctors would always say: “Peter, remember, no roundtrips on weekends.” Translated, that meant no patients admitted over the weekend should go home before Monday afternoon at the earliest. I soon understood the genesis of the “no roundtrip” rule. At the crack of dawn on Monday mornings, before their regular office hours, the doctors would go from room to room, providing consultations and filling out billing cards.

The villain is of course fee-for-service medicine. The author wants it eliminated and he’s right. But note the interesting screw-up in the current incentives. The doctors wanted to see their patients on the Monday so they could bill FFS and make more money. But the hospital was getting a fixed DRG payment for most of those patients. It was in their interests to get them out of the hospital as soon as possible, as every moment they stayed they were making less money because they were filling a bed that could be filled with a new admission. Both of them are crazy incentives for the overall health care systems, but more than a decade later we still do not have hospitals and doctors on the same set of incentives—even irrational ones!

PODCAST/TECH: Interview with Isabel’s Joseph Britto and Jason MaudE

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Over at the Worldhealthcareblog I have a video interview up with Joseph Britto and Jason Maude, the joint CEOs at Isabel Healthcare. Isabel is a very interesting company that uses natural language recognition to search clinical texts in order to help doctors make more accurate diagnosis. These are two very passionate and smart guys, and this interview tells you a lot about both their technology and how its application can improve health care.

HOSPITALS/POLICY: King-Drew and the wider issues of care for the poor

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It looks like it might be the end for King Drew, or as it’s known now, King–Harbor. Some of the LA board of supervisors are in favor of closing the hospital immediately, and yesterday the State of California initiated proceedings to revoke its license. No one can pretend that this hasn’t been coming for quite some time.  A couple of years back, a long series in the LA Times found incredible graft, mismanagement, and corruption and appallingly poor care quality at King Drew. Given the hospital’s origins after the Watts riots of the 1960s, and its special place in the African-American downtown community, doing anything to King-Drew has always been politically charged issue. But after the recent incidents, particularly the one where the woman was left to die on the floor of the emergency department waiting room while nurses ignored her, and cleaning staff swept up around her, the hospital seems to have finally run out of defenders.

On the other hand, this is emblematic of a wider problem in American health care—how do you provide care to the poor in a system where there is no universal coverage or systemic primary care?  Bob Sillen, who now runs California’s prison health care system, but used to run Santa Clara Valley Medical Center used to remark that if there wasn’t a County Hospital in which to showcase how the poor were treated it would be impossible to get any attention on to the issue.

So it is my hope that as we enter a period of concern about the future of universal insurance coverage, we don’t abandon the extremely limited safety net that is in place for the poor while we all focus on fixing the wider systemic problems.

HEALTH2.0: User Generated Healthcare UPDATE

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We’re pleased to announce that Allscripts president Lee Shaprio will be joining the lineup at Health 2.0 San Francisco. Lee will be participating in the "Health 2.0: Looking ahead" panel along with EdVenture Holding’s Esther Dyson, RevolutionHealth’s Jay Silverstein, RelayHealth’s Bob Katter, Jack Barrette (ex Yahoo Health care Guru) PBGH’s Ted van Glahn, and CommerceNet’s Marty Tennenbaum. If you’ve yet to sign up, alas, we’re sorry – early bird registration is now closed.  The regular conference rate now applies. But some discounts are still available for those who are referred from some other select blogs and sources. Registrants from government, foundation, academic and poor non-profit organizations qualify for additional price breaks. And we’re working on a scholarship program for students and individuals.

Again, in case you missed the earlier announcement, the event will now *officially* be held at The Hilton San Francisco, September 20th, 2007. A limited number of reduced rate rooms ($189/night)  are available on site at the Hilton. The first block sold out within a day of going on sale. Our friends at the Hilton have kindly arranged to make an additional block available. After those are gone, standard rates will apply. Registrations are going well, and we’ll be announcing some
additional sponsors and a few more high-profile speakers shortly. So
please head over to www.health2con.com to check it out.

Continue reading…

JOB POST: Help Wanted, Intrepid Physician Needed

Who would like to join a Norman Rockwell inspired, old-fashioned New Hampshire General Practice, and put some grace in their life?   

The Last privately owned and operated General Practice in all of Strafford County New Hampshire seeks a young(er) associate physician. The good news: I am a Harvard educated MD MPH with 42 years experience, working this practice since 1989. I run an old fashioned General Practice/Walkin Practice and am on call 24/7 via pager and cellphone.  This generally means that all calls are handled before 9PM, and then we see those who called, the very next day, on immediate followup.

This “bygone era” immediate care approach gives me the lowest admission rate of any physician on the local hospital staff, and extraordinary acceptance by local and distant patients. (We see patients from New Hampshire, Maine, and Massachusetts, and further) Approximately 10,000 people in the Rochester catchment area, and beyond, believe that I am their family doctor, and have been fiercely loyal.

Continue reading…

PHYSICIANS: A “black box” for docs by John Irvine

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OB-GYN Dr. Gil Mileikowsky was forced from his position at Encino Medical Center in Los Angeles after he testified in a 2003 case involving a medical mistake at the hospital. A day after confirming in court that doctors in his department mistakenly removed both of a woman’s fallopian tubes in error, he found himself being escorted from the building by security on the orders of administrators. Tenet Health Systems, the company that operates the hospital, likely rues that day.

Enraged by his treatment,  Dr. Mileikowsky went to war, becoming an outspoken advocate of changes to the federal whistle blower laws
protecting doctors, arguing that administrators use dirty tricks to destroy
the reputations of doctors who speak out when mistakes are made — labeling them as "disruptive" and organizing "sham peer review" proceedings.  His passionate arguments won the support of the Association of American Physicians and Surgeons. He would be represented in court  by star attorney Alan Derschowitz. A California court threw out Mileikowsky’s subsequent case against Tenet.  Earlier this month, however, that decision was reversed, in a ruling that likely foreshadows serious problems ahead for hospital operators who want to avoid scrutiny of safety conditions at their facilities.  Last week, Dr. Mileikowsky testified to a hearing held by the Small Business Administration on the need for added protections in the system. His solution: a metaphorical "black box" at hospitals and an "FAA" to monitor safety conditions in the healthcare system. In this YouTube segment he talks about the issues involved and the current state of safety reporting. — John Irvine

UPDATE: You can learn more about Dr. Mileikowsky’s campaign against medical errors at the web site of the organization he founded, the Alliance for Patient Safety.

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