CMS has decided that Medicare private plans are going to get higher rates this year despite the fact that many Congressional Democrats want to cut the rates they’re paid. There’s been a healthy debate on THCB in the last few days on whether or not these plans add much value (and to whom that value is added!). However, it does seem a bit crass for CMS to go an announced next years rates, when it’s clearly being changed in Congress as we speak. Even if they say “well it was Congressionally mandated” they too need to notice who’s running Congress these days.
Above the Fold
PHARMA/POLICY: John Tierney covers the Hurwitz Trial
John Tierney, who sadly gave up his libertarian op-ed column in the NY Times reports on the William Hurwitz trial. Regular THCB readers will remember how appalling the DEA is in its draconian persecution of pain doctors, and how they deliberately changed their own guidelines during this trial and removed them from their website because the defense was going to show that Hurwitz prescribed by them.
If I believed in hell, I’m sure that DEA head honcho Karen Tandy would be going there for her statement that Hurwitz deserved 25 years because he “was no different from a cocaine or heroin dealer peddling poison on the street corner.” But apparently Tandy’s travels are instead taking her to more interesting locales at the taxpayer’s expense.
TECH: More on the Pango-InnerWireless Merger
Over at Digital Healthcare and Productivity I have an article about the latest merger in the asset tracking world. It’s called Pango-InnerWireless Merger Raises Hopes and Questions. I was relatively optimistic about it when I spoke to Pango’s (now InnerWireless VP) Michael Campbell, but another conversation with Tim Gee threw a bucket of cold water on that optimism! I hope the article comes out relatively balanced!
TECH/PHYSICIANS: What’s wrong with eRx?
Health Affairs has a study from HSC about ePrescribing. here’s the press release. The team interviewed a bunch of practices using eRx and some not. About 2/3 were using it as part of an EMR, the rest were using a standalone eRx system. It’s not an encouraging study. The main problems identified:
1) Challenges to maintaining complete patient medication lists. Most physicians were able to use e-prescribing systems to access prescriptions written by other physicians in their practice. But none were able to access comprehensive lists of patients’ medications prescribed outside their practices. As a result, physicians continued to rely on patients as the main source of information to complete medication lists.2) Difficulty obtaining accurate patient-specific formulary information. Physicians in slightly more than half of the practices did not have access to formulary data electronically, because either the systems did not have the feature or the practice had chosen not to enable it. In the practices where physicians had access to formulary information, respondents pointed out information was available for only a subset of patients, with estimates ranging from 25 percent to 90 percent. Even when information was available, practices often questioned the data’s reliability. Physicians’ views varied on the value of the formulary information, and in many practices, physicians routinely ignored it.
If the RxHUB vision is working the information about both current medications and formulary information should be available for a substantial share of patients in the eRx application. 90% sounds a little optimistic, but 25% doesn’t sound at all good, considering that the 3 big PBMs who own RxHub allegedly account for more than 90% of commercial lives. It appears tha accurate patient identification is a problem within RxHUB. Given that we’re not getting a patient identifier anytime soon, that’s also not good news..
3) Limited connectivity with pharmacies and mail-order PBMs. Only the practices with stand-alone e-prescribing systems were using electronic data interchange (EDI) that allows electronic transmission between computers in the physician practice and those in the pharmacy or PBM. Local pharmacies’ lack of readiness was cited as a barrier to full electronic transmission. Most practices using electronic fax or EDI reported spending substantial time educating local pharmacies about e-prescribing. It took a couple of months of daily communications about individual patients for pharmacies to be able to treat electronic transmissions as routine.
That tells me that neither of the Surescripts and RxHub visions are yet working in practice. By this stage most pharmacies should be getting the eRx direct into their pharmacy system. If it’s a Surescripts certified vendor (which mot standalones and many EMRs are), then there shouldn’t be a need to rekey in the information at the pharmacy. In fact this line from the actual report “For example, a physician in Syracuse reported that despite the presence of national chains reportedly capable of electronic transmissions, pharmacies in the area were not yet even "fax-friendly." is pretty frightening and suggests that Surescripts has much more work to do amongst its owners!
4) Challenges continue after initial implementation. Practices were not prepared for the amount of interaction needed with outside parties, such as vendors, state regulators, and local pharmacies, to implement and maintain the system. Practices continued to devote staff resources for maintenance well after e-prescribing products were in use.
Hmmm….also not good. The idea is that this is supposed to save staff time.
5) Limited use of clinical decision support. All but one of the practices’ e-prescribing systems offered some clinical decision support (CDS) in the form of drug-drug interaction alerts. However, access to more advanced CDS was limited; about half of practices reported being able to check for drug-allergy interactions, and only 20 percent for drug-condition contraindications. There was general agreement that pop-up alerts were triggered too easily. As a result, physicians typically overrode them.
Alert fatigue is commonly talked about by the vendors of these systems—it’s a problem that will take some intelligence to overcome. But I’m not so sure that this is a gamebreaker. The previous four may be.
There is though some hope:
Practice efficiency. Most physicians agreed that writing new prescriptions electronically took about the same amount of time as writing them on paper once they became familiar with the system and had created a "favorites" list. For those practices that sent new prescriptions electronically, e-prescribing systems eliminated much of the staff time spent printing, faxing, and calling in prescriptions.Legible prescriptions also meant many fewer callbacks for clarification. But respondents believed that the greatest time savings came from streamlining management of renewals, particularly for patients with multiple medications.
Only one practice could quantify savings from e-prescribing. Most of the others provided examples of how it had freed up support staff to do other tasks, although they could not point to staff cuts exclusively from e-prescribing. Several respondents felt that there were no substantial savings because any efficiency gains needed to be balanced against the up-front and ongoing costs of implementing the system and the additional effort invested in tasks that had not been done routinely–for example, collecting information on outside prescriptions. Their perspective was that e-prescribing produces better outcomes for a comparable effort.
Furthermore the data in the study is more than a year old now—so we have to hope that things are getting better. But clearly more work on the plumbing is needed.
TECH/PODCAST: RHIOs, physician messaging et al–the word from Axolotl’s Ray Scott
Ray Scott is CEO of Axolotl. Ray is a British egghead (a math whiz) who somehow got himself dragged over to California in the mid-1990s. Since then, and quietly building on a great success in the oddball Northern California surfing mecca of Santa Cruz, Axolotl has been putting in the infrastructure for messaging between health care system participants (and rather more than just that) in lots of different communities. And they’ve embraced the RHIO concept as part of their marketing–(something I keep telling their marketing whiz Nicole Spencer is a bad idea!)
As you know, I’m not a convert to the RHIO concept, so I was keen to hear Ray explain all about what Axolotl does, why they’ve been growing in recent years and how they’re going to keep being successful. Listen here–a transcript will come soon.
PHARMA: 60 Minutes on the MMA
60 Minutes on Sunday had an entertaining story about the Medicare drug bill’s passage in late 2003. Not exactly new news, but a fun retelling of how Tom Delay, and PhRMA rammed the bill through literally by holding the vote open for three hours and torturing the crap out of any Republican who was a fiscal conservative and likely to vote no.
What amazes me was that any Republicans at all felt squeamish about that. Hadn’t they seen how Delay operated? Hadn’t they met a PhRMA lobbyist in their time in DC? Hadn’t they noticed the Administration cow-towing to industry in every other sphere of government? Didn’t they know that every possible opposition group was bought off in the bill? Hadn’t they noticed the deficit going through the roof?
And what’s the relevance of telling the story again three and a half years later?
(CODA: Dan Burton, one of the Republicans interviewed, is actually somewhat interesting. For example he’s a long time drug war loon, but in 2002 he actually said some interesting things about the drug war almost hinting at the fact that he realizes what a waste of time and money it is. So maybe there is some hope…)
TECH/CONSUMERS: Health2.0 mashup site of the week
User reported data about who is sick, where and when. The site thinks that it’s likely to help people figure out whether they’re sick or whether they jsut have something that’s going around. I have zero idea whether that’s useful or whether this is the eventual use of the site. But an interesting concept indeed. Go play around.
HEALTH PLANS/POLICY: Lawmakers Should Not Reduce Funds for Medicare Advantage Program, apparently (with quick UPDATE)
Who says so? Well it’s the BCBSA CEO. Lucky that’s not self -serving or anything. Perhaps he’d like to explain how his members and the other health plans valiantly stayed in the Medicare market last time, took huge losses but stuck it out all the way to 2004 when rates were put back up. But this time they’ll quit instead. (BTW here’s the WSJ original to those of you with access)
After all, if we’re going to have revisionist history….
UPDATE: I was rushing to an interview (which you’ll hear tomorrow) so I didn’t get a chance to add one thing Mr Serota appears to have missed out in mentioning regarding the subject. Just like much of the American health care system Medicare Advantage is a good deal for its members, a great deal for its vendors (including but certainly not limited to the Blues) but not such a good deal (according to the CBO et al) for the poor saps who have to pay for it. And who would they be? Yup, it’s that taxpayer fellow again, and of course—due to the accounting and financing techniques of the con-artists who wrote the 2003 MMA, took us into Iraq et al—it’s also going to be paid for in the years to come by their children and grandchildren. But who cares about them when the Blues and other insurers are richer than they’ve ever been?
TECH: In which Dmitriy challenges Health2.0, but reveals that he’s challenged, and not just by the calendar
Over at Trusted MD Dmitriy “jumps on Health 2.0 Bandwagon”. Well actually he’s taking the piss, as we English say. The only problem is that today is April 2, not April 1. And Dmitriy doesn’t understand technology diffusion as opposed to stock market bubbles (which Health2.0 and Web2.0 are quite evidently not, unlike the companies in the DotCom boom which obviously were….)
Never mind. It’s fun to have a contrarian point of view. And don;t worry Dmitriy some people who are if not wiser at least a lot richer than you and me are already using the Health3.0 moniker.
As for Health2.0. You’ll be hearing much more about that on THCB. But don’t worry, it’s just a label, and labels don’t mean a whole hell of a lot. But the technology and the trends embodied in it are too powerful to be ignored—just as they were in the DotCom boom. Or is Dmitriy still buying paper tickets from his travel agent?
TECH: Top Health IT innovators 2007
FierceHealthcare (which I have NOTHING to do with any more!!) is out with a list of Top Health IT innovators for 2007 . Funnily enough several companies I’ve featured here or in my talks are on the list, and #1 is Enhanced Medical Decisions—which I liked so much when I saw it that I started working with it! (So if you’re interested in them, you can email me!) Here’s the full list:
FierceHealthIT Top Health IT Innovators 2007
| 10. | NaviMedix |
| 9. | PatientsLikeMe |
| 8. | MDVIP |
| 7. | Get Well Networks |
| 6. | MedApps |
| 5. | athenahealth |
| 4. | Devon IT |
| 3. | QlikTech |
| 2. | Practice Fusion |
| 1. | Enhanced Medical Decisions (EMD) |
