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POLICY/POLITICS: Will Medicare Advantage get slashed? with UPDATE

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Bob Laszewski has been, correctly, all over the issue of Medicare Advantage payments and what the Dems will do to them. And he’s at it again CBO Pours Gasoline on the Democratic Plans to Cut Medicare Advantage Payments to HMOs.

It just blows my mind that UNH is up 20% since the election. But the evidence is right here that Wall Street doesn’t believe Bob, or just doesn’t care. Maybe someone smarter (and richer) than me can explain why. I’m just glad I was too chicken to short UNH after the election.

Unh

 UPDATE: Bob has answered my question. He thinks that Wall Street is short-termist and doesn’t believe that there’ll be cuts in 2007.

TECH: Quick KP HealthConnect update

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Of course the other big non-HIMSS tech news is that KP dumped interim CIO Phil Bruce Tukstra and brought in another outsider. While the LA Times says that Tukstra ran Health Connect, I’m not so sure. Andy Weisenthal told me that he (on the TPMG side) and Louise Lang (on the plan side) ran it, and expressly said that Dodd (the CIO who went a few months back) had not much to do with it. And I’m a little cynical about the LA Times reporting on this last week too.

However, I have extracted a promise from a senior TMPG regional CMIO to go on the record about what he’s seeing—so hopefully I’ll have more details for you all soon but suffice it to say that not everyone was too happy about the Citrix approach

Meanwhile there was an interesting session I sat in on at HIMSS Monday from the CIO of Kaiser Hawaii about how to deal with down-time when you have an EMR. What he said was that every hour a mirror of the latest data is made and that it’s on a separate system that can be accessed if the main HealthConnect goes down. And then he said that most doctors would dream of having that level of data (i.e. what’s in the backup) and he’s probably right! But I guess the real question is was the low uptime (the Times says 80% only in some cases) a function of the power failures last year, or is it still going on? My understanding is that it’s the former.

Finally, I’m going to be on a panel in Vegas on April 30th with two one leading Kaiser basher”* (Justen Deal and Gadly) and apparently Kaiser has declined an invite <sigh>. Which I guess means that I’m going to be their tame blogger and be castigated for defending HealthConnect….

* term adopted from “Japan basher”

UPDATE: Justen emailed me to point out that not only had I called Bruce, Phil (hey it was 6 am!) and that he was not going to be on the Vegas panel (should have checked, his name was on an earlier agenda I saw but he never agreed) but also this:

Bruce was, without question, the "architect" of HealthConnect.  Before he became
interim CIO, he was the VP specifically for HealthConnect.  Dr. Liang has always
handled making sure HealthConnect improves the "quality" of our hospitals, while
Andy Wiesenthal’s job is to work with the physicians to make sure the system
meets their needs.  Turkstra was in charge of designing and implementing the
system, while Dodd was in charge of making sure the infrastructure was in place
to support it. Finally, I hope you’ll consider not calling me a "basher"
("Japanese" or American) of Kaiser Permanente. Trying to paint someone as a
"basher," frankly, only makes you look like a "cheerleader." Since neither, as
far as I know, is true, I hope you’d consider not using it in the future.

I don’t know about who did within HealthConnect, so hopefully someone who does will tell me if Justen’s right or not.

As for the "basher" term, this is a little inside baseball, but the "Japan bashers" of the late 1980s actually felt that they were very pro-Japanese but that Japanese politics and society needed to become more open. So I think the reference to Justen as a Kaiser-basher is extremely correct in that context.

LAT: Kaiser doc ordered fatal dose By John Irvine

The Los Angeles Times reports that police in Orange County and the Medical Board of California are investigating a Kaiser surgeon involved in the death of a patient under suspicious circumstances at Sierra Medical Center in San Louis Obisbo. Dr. Hootan Roozrokh is alleged to have "hastened" the death of a potential organ donor by ordering that he be given a lethal dose of painkillers. Roozrokh was suspended by Kaiser over the incident in May, at about the same time that the HMO ordered its controversial transplant program closed.

Picking up from the Times report:

State law specifies that transplant doctors cannot direct the treatment
of potential organ donors before they are declared dead. This
restriction is designed, in large part, to assuage concerns that organ
retrieval might take priority over patient care.In this case,
however, Roozrokh entered the operating room at Sierra Vista and was
directing the administration of drugs to Navarro, the sources said. When
the patient didn’t die, Roozrokh allegedly told nurses: "Let’s just
give him some more candy," according to a person who was briefed on
what took place but spoke on condition of anonymity because of the
ongoing investigations.

THCB: Sponsorships

THCB’s live blogging coverage of HIMSS 2007 New Orleans would not be possible without the generous assistance of the kind souls at CDW Healthcare. Take a moment to go check out their specials for physicians and other health care providers and you’ll help us continue to provide independent coverage and cutting edge discussion of the issues facing healthcare. We get credit for every person who clicks over, so please take twenty seconds and go visit their site. If you decide to place order, tell them the Health Care Blog sent you — Matthew

 

If you haven’t had a chance to sign up for THCB UPDATE
yet, you really should. You’ll get a helpful reminder email from us a
few times a week when important posts go up on the site. In the two
and a half months since the service launched more than 700 950 people have
signed up, thoroughly surprising me. I’ve pledged not to divulge any details about the people who
sign up, but I can tell you that list reads a bit like a health care
who’s who. Go on: It’s free. It’s useful. And people seem to like it.
Go visit the sign up page.

TECH: Self-serving press release of the day

Stark Study by GE Healthcare Predicts Accelerated Electronic Medical Record Adoption within the Next Year

“Stark Relaxation has created a tremendous opportunity for physicians to overcome the many barriers that prevent them from adopting EMR systems, most notably cost,” said Mike Raymer, Vice President and General Manager, Product Strategy and New Business Initiatives for GE Healthcare Integrated IT Solutions. “By allowing hospitals and other entities to provide EMR technology to physician practices at a subsidy of up to 85 percent, physicians are now better positioned to implement these comprehensive systems and provide a complete and current picture of a patient’s medical history – helping physicians raise the quality and improve the safety of healthcare.”

This is a bit of a Joe Namath guaranteeing a win story. Hmm, if there aren’t some pretty big Centricity/IDX wins in the next year, do you think that Mike Raymer will want to be reminded of this study?

PBMs: Bob Garris on their trail again?

In Brief non HIMSS news (as I’m still having a little insomnia from jet-lag, and I took it much easier last night on Bourbon street)….

Most THCB readers know that I’m just a wee bit cynical about the “value” provided by PBMs. Much of the data for that view comes from a Creighton University professor called Robert Garis. Well, he’s back:

“We found that brand-name drugs were slightly less expensive when purchased by mail, but generic drugs were more expensive by mail. When we combine the prices for brand-name and generic prescriptions, any differences virtually disappear,’ said Robert I. Garis, M.B.A., Ph.D., associate professor at the Creighton University School of Pharmacy and Health Professions.

And don’t forget that since 2002 (when the data for this report is from) PBMs have moved towards more generics as the rebates have become less important parts of their business and they’re making way more profits on generics. Medco for example increased total profits in 2005 after having its profits from rebates fall dramatically as it passed them back to customers. Margins on generics more than made up the difference. Now Garis is clearly on the side of the retail pharmacies, but given what we know about the PBM business, especially the stories from University of Michigan, I’m inclined to believe him when he says this:

Given a continued increase in generic-drug use by both mail and retail pharmacies and the practice of high markups on generics by PBM-owned mail outlets, he added, retail pharmacies ultimately may offer the better value. He noted that recent reports show generic drugs account for more than 55 percent of all prescriptions dispensed through both mail and retail channels.“Employers need to ask PBMs more questions about their markups on generics, just as they would when purchasing ink, paper or other supplies,” Garis said. “The truth is that PBMs are racking up record profits through an increased use of generic drugs and an increased use of PBM-owned, mail-order facilities.”

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