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POLICY/POLITICS: Wyden gets a noted conservative to join him

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Ron Wyden’s interesting universal health care proposal, which is essentially a variant of managed competition with an individual mandate that decouples employment from insurance is getting some support. And notably it has a major Republican, Bob Bennett from Utah, signing on. (Following is an email Wyden’s office sent out)

U.S. Senators Ron Wyden (D-OR) and Bob Bennett (R-UT) are scheduled to join some of the nation’s top CEOs at a news conference this Monday, May 7, to announce new business support for efforts to reform the nation’s ailing health care system. Wyden and Bennett are the chief Senate sponsors of the Healthy Americans Act (HAA), the first bipartisan, comprehensive health care reform bill in more than a decade to guarantee health coverage for all Americans.

CEOs and business leaders scheduled to attend the news conference with Wyden, Bennett and U.S. Reps. Brian Baird (D-WA) and Jo Ann Emerson (R-MO) include Steve Burd, CEO, Safeway Inc.; Art Collins, CEO, Medtronic, Inc.; H. Edward Hanway, CEO, CIGNA; Nancy McFadden, Senior Vice President, PG&E Corporation; Steve Sanger, CEO, General Mills; and Ronald A. Williams, CEO, Aetna Inc. Baird and Emerson announced earlier this week that they will introduce the Healthy Americans Act in the House.

Realistically this isn’t going to pass any time soon, and if it did Bush would veto it. But it does set the groundwork for a universal insurance system compromise sometime in the future and at least Aetna and Cigna think that they’ll be better off taking that compromise than the alternative!

TECH/CONFERENCE: TieCon East, innovation conference in Boston 15-6 June

Peter Mueller from BCBS Mass asked me to let you know about TieCon East. This is a conference on innovation with a health care track (as well as a tech track and an enterprise track too). Peter is chairing the health track and has put together an interesting and varied line up on topics such as consumerism, technology in HC, personalized medicine, and medical devices. It’s in Boston on June 15–6.

HEALTH PLANS/POLICY: Ignagni–arguing out of both sides of her mouth, with UPDATE

My favorite lobbyist has a letter in the NY Times.
In which she argues that beneficiaries save money compared to regular
Medicare, and (this is the fun part) if payments are reduced then this
will have to be reflected in more charges to the poor. I have a long reply to this in waiting, but I’ve been persuaded to give my shorter version a shot at the NY Times letter’s page. If they don’t want to print it, then I’ll be back here with the long and the short version later in the week.

UPDATE: Not that this will surprise anyone remembering Medicare Risk Plans putting their sign-ups on the second story of a walk-up (I know no one eve proved those stories in the 90s…) but the NY Times today has a story about sales abuses in the Private Medicare FFS market which sound very like long distance phone "slamming" of 15 years or so ago. Except of course the victims are a little more vulnerable. Even CMS (which is at least partially run by Republicans who approved of the MMA) seems a little distressed by what’s going on.

TECH: Quadramed surveys consumers on EMRs et al

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Just to show that you don’t have to be Kaiser to survey the public on EMRs, mid-tier vendor Quadramed has done so too. The basic findings are that few consumers were aware that national quality ratings exist. And frankly I think that the few who are aware are wrong! But if they did exist they say they would use them (which is now what actually happens now BTW according to Harris data). Even fewer had heard of P4P, but in general they liked the idea once it was explained to them. And while roughly half had heard of EMRs, they like that concept too. Finally 42% said they’d experienced an insurance related error. I assume the remaining 52% have never filed a claim!

PHARMA/POLICY: DEA insanity continues–Dr. Hurwitz Convicted

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I’m a little late as this happened last week, but it has to be reported even though it makes me very angry. The DEA and its poodles in the DOJ have succeeded in getting Dr. William Hurwitz Convicted on 16 Counts of Drug Trafficking. Hopefully Hurwitz will be out of jail relatively soon—although no guarantees. He’s served 2 and a half years for just being a doctor, and could serve up to 18 more.

Unfortunately the chronic epidemic of untreated pain goes on and on. As I pointed out in Spot-on last year :

45 to 80 percent of nursing home residents have substantial pain.  The consequences of poor pain management include sleep deprivation, poor nutrition, depression, anxiety, agitation, decreased activity, delayed healing and lower overall quality of life. Fewer than half of nursing homes residents with predictably recurrent pain were prescribed scheduled pain medications

So we have a massive health problem, and the DEA acts like a bunch of brownshirts, going after pain doctors. Listen to Tierney’s account of one of the patients from the doctor that the prosecution used.

Then, during cross-examination by the defense, Dr. Hamill-Ruth was shown records of a patient who had switched to Dr. Hurwitz after being under her care at the University of Virginia Pain Management Center. This patient, Kathleen Lohrey, an occupational therapist living in Charlottesville, Va., complained of migraine headaches so severe that she stayed in bed most days. Mrs. Lohrey had frequently gone to emergency rooms and had once been taken in handcuffs to a mental-health facility because she was suicidal. In 2001, after five years of headaches and an assortment of doctors, tests, therapies and medicines, she went to Dr. Hamill-Ruth’s clinic and said that the only relief she had ever gotten was by taking Percocet and Vicodin, which contain opioids.

Mrs. Lohrey was informed that the clinic’s philosophy “includes avoidance of all opioids in chronic headache management,” according to the clinic’s record. The clinic offered an injection to anesthetize a nerve in her forehead, but noted that “the patient is not eager to pursue this option.” Mrs. Lohrey was referred to a psychologist and given a prescription for BuSpar, a drug to treat anxiety, not pain.“You gave her BuSpar and told her to come back in two and a half months?” Richard Sauber, Dr. Hurwitz’s lawyer, asked Dr. Hamill-Ruth. Dr. Hamill-Ruth replied that unfortunately, the clinic was too short-staffed at that point to see Mrs. Lohrey sooner. Under further questioning Dr. Hamill-Ruth said that she was not aware that BuSpar’s side effects included headaches.

Mrs. Lohrey looked elsewhere for help. Having seen Dr. Hurwitz on television _ — “60 Minutes” and other programs had featured his controversial high-dose opioid treatments — she sent him a letter describing her pain and the accompanying nausea and vertigo.“I have lost hope of retrieving my life as it was,” she wrote, because she could find no doctor to take her seriously. “I currently have a physician who has said that I am psychologically manufacturing my headaches, and that I am addicted to narcotic pain relief. This of course is not the first time that I have been treated as a ‘nut’ or a ‘junkie.’ ”

<SNIP>

“I felt that I had a duty to the patients,” Hurwitz said. “I hated the idea of inflicting the pain of withdrawal on them.” After the closure of his practice in 2002, he said, two of his patients committed suicide because they gave up hope of finding pain relief. The most moving testimony came from Mrs. Lohrey and other patients who described their despondency before finding Dr. Hurwitz. They said they were amazed not just at the pain relief he provided but at the way he listened to them, and gave them his cellphone number with instructions to call whenever they wanted.

“I felt like I was his only patient,” Mrs. Lohrey testified. “I think he truly understood the nature of what I was going through.” When she lost her health insurance, she said, Dr. Hurwitz continued treating her at no charge, and helped her enroll in a program that paid for her opioid prescriptions. After Dr. Hurwitz’s practice was shut down, she could not find anyone to treat her for seven months. Eventually, she found a doctor willing to prescribe small numbers of low-dose Percocet, but she said she was not getting enough medicine to consistently blunt the headaches.

“The last two weeks, I was pretty much in bed and sick with the headaches and the nausea and the whole nine yards,” she said, explaining that she had deliberately undergone the two weeks of pain in order not to use up any of her pills. “I had to save up medication,” she testified, “so I could be here today.”

Tell me which physician was guilty of malpractice, and why on earth one of them deserves to be in jail?

PODCAST/TECH: Interview with Chris Hobson, Orion Health

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Since John Irvine’s taken over as the business lead for THCB, we now have a raft of new sponsors including CDW, Silverlink and now Orion Health. Apparently the marketing folks at Orion thought that it would be a good idea for me to interview their Chief Medical Officer Chris Hobson. What I didn’t realize is that Chris is a wealth of knowledge about health care systems around the world, and in particular how EMR use became prevalent–yup that essentially 100% adopted–in New Zealand We had a very interesting conversation about that, and if you’re as interested in that conundrum as you ought to be (which is very!) you need to read this. And hopefully the marketing people wont be too upset that their CMO barely got close to the topic of what OrionHealth actually does!

Matthew Holt:  This is Matthew Holt at The Health Care Blog and today I’m doing another podcast. And with me I have Chris Hobson. Chris is the Chief Medical Officer at Orion Health. I’m very happy to be talking to anyone at Orion Health because unbeknownst to me last week they have decided to become a sponsor of The Health Care Blog. As part of that arrangement, I’m very delighted to interview Chris because I interview a lot of people who do not sponsor me. [laughter] Anyway, Chris, good morning. Thank you very much for joining me. Thanks to Orion. I don’t know who was it who your organization who decided to do this as I am no longer the business rep of the Health Care Blog but delighted to talk to you.

Chris Hobson:  Good morning. It’s nice to be here.

Matthew:  I sense by your accent you are one of these American immigrants. Well, you’re in Canada, right?

Chris:  Yes, actually I’m native from New Zealand. Orion Health, actually, we started in New Zealand. As we’ve grown from New Zealand across UK, Canada, Australia, and other parts in the US, I’ve sort of tagged along with the company.

Matthew:  That’s great. Well, it’s always good for people to come from the rest of the English speaking world to tell the North Americans how to do it. I’ve been doing it for years, not that anyone is listening.

Chris:  [laughter]

Matthew:  Let’s talk a bit about that. There are a couple of things that Orion does. For those people who don’t know about Orion, and you’ll explain it better than I do, loosely you’re in the business of improving data communications and data integrations and that ends up being a lot around messaging and interoperability issue–currently a big picture problem in the US. But also elsewhere. Let me ask you to start with a couple of things. First off let’s talk a bit about what you perceive to be the big problem in the US in that sector. Because you guys are also in a lot of other countries, you mentioned New Zealand, UK, Canada and also some other European countries, give me a sense of. Is this the same problem everywhere in health systems or is the US unique?

Chris:  Sure. Well, we have our own perspective on what’s wrong with the health care system, but I guess, there would be fairly few people who would disagree a major problem with health care is the fragmented nature of it. There are a lot of different people, all well intentioned, doing a lot of good things across that the patients may interact with. The problems that we see arise as the result of all this—Going on from fragmented system to provider-to-provider-to-provider. In particular the information does not move along with the patient and it is very easy for the provider to focus on a narrow area and miss the big picture for what is going on with the patient.In the US, health care is more fragmented probably than anywhere else. In the sense that there are six thousand hospitals and just a huge range of both providers and payers. And if you look outside of the US, health care is not as fragmented; however, it is still quite fragmented and the same problems do arise.So if look for instance, the classic kind of story comes where down to and I’m taking this case from Don Berwick, and so I hope that’s OK but–

Matthew:  [laughter] We steal from Don Berwick all the time.

Chris:  [laughter] You steal from Don Berwick all the time. That’s great. He’s a Harvard professor of pediatrics, and his wife developed an obscure neurological complaint. It took some nearly six to twelve months before she got better more or less as a result, or not as a result, of the health care system. Along the way, she saw a huge range of different professionals who were all trying, well intentionedly trying, to help. The problem from his perspective was that each time they went to see a new professional he had to remember the case history. Each time they would see another professional, they would ask, "Tell me about what’s been going on." sort of thing. Of course, he had told the story so many times and been questioned about it so often that by the time he got to about 10 days or 10 weeks of this it was very hard to be strictly correct or accurate even with the best intentions.Another case in a sense that may be described as another sort of sense from when I was working at South Auckland in New Zealand, we went out and visited a home visiting nurse. And the first thing she said as she went in to visit a patient, she said, "Everything you tell me will be kept completely confidential, and I won’t share it with anyone." She then proceeded to take the whole history about what had been going on, and the patient had diabetes and had been to see a primary care practitioner who had said, "You have diabetes." But of course, the patient didn’t like that message particularly. So, he did nothing and a few months later he still wasn’t feeling very well, and went to see another practitioner who said ‘You’ve got diabetes’, and he didn’t like that story either. But eventually he managed to end up in the emergency room in the hospital and they looked up the history and said ‘You’ve got diabetes’. And they operated on the patient and then sent him out into the community. So when the community visiting nurse went to see the patient to look at the ulcer on the leg and dressings she knew nothing of all of this. Even though she worked for the same hospital and the same surgeons had done the surgery they hadn’t communicated onto the next provider what needed to be done.Now let’s rewrite that script and go back and say. The patient goes to see the first GP and he says you’ve got diabetes and the patient doesn’t like hearing that news so he goes to see the second practitioner. When he goes to the second practitioner, this time the stories different because he says ‘hey you’ve got diabetes, and by the way that first doctor that you didn’t like for telling you that you’ve got diabetes. He was right. You’ve got diabetes and now two of us have told you and you need to take this seriously.’ Let’s imagine the patient still did nothing and ended up in the hospital. The hospital specialist will say ‘You’ve got diabetes, and by the way, all these other people who’ve been telling you the same thing, it’s about time you started to take note of it.’So that’s a short vignette on what we see as the biggest problem in health care from our perspective. I mean health care is full of problems, but the information continuity and sharing of information, and sharing it in a way that improves the quality of care and re-enforces messages to the patient and it’s consistent. We see the lack of that as a huge barrier to improving the quality of care.

Continue reading…

TECH: Andy Grove ‘s Prescription By John Irvine

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Former Intel Chairman and CEO Andy Grove is in the latest issue of WIRED talking about the paradoxical relationship between healthcare and technology. “We have the Human Genome Project, personalized medicine, war on
cancer, CyberKnife, stem cell research on one hand — no doctor to be
found or to take care of your sore throat on the other," Grove says. "That’s a pretty
ugly picture. It’s pretty ugly today but it’s going to get uglier."

WIRED’s Kristen Philipkoski interviewed Grove after a recent talk he gave at Berkeley. (Watch the webcast here.) The Silicon Valley legend, who Harvard Business School biographer Richard Tedlow thinks "could [probably] hold his own against Benjamin Franklin," argues that part of the answer lies in less complicated solutions than the industry is currently pursuing. "Altogether," Grove tells the magazine, "I am obsessed with doability as opposed to desirability."

Like other tech executives who have been drawn to healthcare as both a business and social issue, Grove has been thinking and talking publicly about the problem for years. Philipkoski writes that Grove’s current thinking focuses on three general areas where he thinks quick improvements might be possible:


First: Keep elderly people at home as long as possible (an idea he
calls "shift left"). Use high-tech gadgets to help them remember to
take their medicine and monitor their health. In one year, if a quarter
of the people now living in nursing homes went home, it would save more than $12 billion, Grove says.


Second, Grove advocates addressing the uninsured by building more
"retail clinics" — basic health care centers in drugstores and other
outlets that can take care of problems that are presently, and
expensively, addressed in emergency rooms.


Lastly, unify medical records using the internet. In his vision, every
patient carries a USB drive containing his or her medical records,
which any doctor can download.

Continue reading…

POLICY: Slagging off Philip Longman, defending Jon Cohn

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Up at Spot-on I’m defending Jon Cohn from a way-off topic review of his book from Philip Longman in the Washington Monthly. This is an important topic because Longman is in the “we can’t afford universal health insurance because the delivery system is inefficient” camp. He’s way wrong about that and he’s not alone. In fact his logic is backwards. We need to sort that out quickly, and I have a go at doing so in a piece called New America? Old Excuses. (The “New America” is the Foundation Longman is from which for some reason has teed off my editor over at Spot-on in the past). Here’s the intro:

Last week, I came to criticize Jonathan Cohn (for being too nice). Today, I come to defend him. Phillip Longman who hails from the New America Foundation complains in the Washington Monthly that Cohn’s new book Sick is Misdiagnosed because Cohn concentrates on the financial consequences of living without health insurance and not on the overall problems with inefficient and ineffective care in the U.S. system. He doesn’t exactly get off to a roaring start, taking Cohn to task and getting it totally wrong in the process.

Read the rest and come back here to comment

TECH: KP promoting EHRs

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Kaiser Permanente is trying to shift the focus on its EHR programs back to the good things about it (and we’ve heard plenty about the controversy). They are having a conference today in DC with big guns like Carolyn Clancy and have put out a survey. Their spin on the survey is that Americans Want to Go Digital When it Comes to Their Health Care.

And while approximately one in ten (12%) of Americans currently review their personal medical records on their health insurance company’s Web site, over half say they would like to be able to check claims and coverage (56%) or access personal records (51%) electronically in the future.

It’s not all sweetness and light, but there clearly is more interest in accessing information that’s pertinent and personalized about health care from health plans, and of course KP is not the only one making steps in that direction. So they’re roughly right. As for HealthConnect, as I’ve been saying for a while, the proof of the pudding will be in the actual use when fully rolled out in California. And for that you’re going to have to wait.

assetto corsa mods