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TECH/PHYSICIANS/INDUSTRY: Communists in press stirring up trouble

• 12

Cypho
So a disgruntled reporter is stirring up trouble by daring to question the way medical advances happen in this great nation. Apparently this Joel Rutchick character is suggesting that when respected surgeon Dr. Isador Lieberman and his organization the Cleveland Clinic began pushing a new type of back surgery, we are supposed to be surprised he didn’t plaster memos about his stock options and holdings in the company that made the device all over the foreheads of his patients.

Lieberman did not tell his patients about his financial conflict of interest unless asked, the Clinic acknowledged. According to Plain Dealer research, he also did not reveal his stock holdings in numerous articles he wrote about kyphoplasty.

Bunkum! Does every computer come with a message that you’re making Bill Gates richer every time you turn it on? Of course not.

And when he (Lieberman) testified to the treatment’s benefits at a government hearing last year, he did not divulge past stock interests in Kyphon Inc. and other device makers – even when explicitly asked to disclose such holdings.

Well he was correct. He had apparently sold the last of his stock a few months before the Congressional hearing. Like any good capitalist Dr Lieberman is onto the next pony. As he told the commie rag The Plain Dealer

"I strive to be transparent in my disclosures and believe that I have disclosed my interests within the guidelines and policies of the Cleveland Clinic," Lieberman said in a written statement. He declined to be interviewed.

Who needs an interview in the face of that transparency!

Didn’t Rutchick know that unlike a bum masquerading as a reporter Dr Lieberman had been to medical school and therefore knew all about ethics? And didn’t Rutchick also know for there to be great inventions like this it’s required that not just the inventor but anyone who uses it gets rich? Otherwise what incentive would physicians have to help patients and save lives! After all who except some communist would disapprove of such a system?

When Kyphon officials took their company public in May
2002, they disclosed in a filing with the Securities and
Exchange Commission that they had offered stock options to
the eight members of their advisory board. All took them
except Dr. Joseph Lane, a New York orthopedic surgeon who
teaches at the medical school affiliated with Cornell
University. "I felt it was very awkward for me to be honest about
these things if I owned stock in the company," Lane
said last week.

Yeah, and we know what color state this Dr. Lane character is from, don’t we?! Enough said on that topic. Honestly, virtually every great medical advance absolutely requires this kind of capitalist incentive for those using them. After all, most other medical advances come about the same way. The important thing is that there’s clear evidence of an improvement.

On the SpineUniverse Web site, Lieberman, Kyphon co-founder
Reiley and three other doctors published a four-paragraph
synopsis of their initial experiences with kyphoplasty
involving 26 patients. "These results support further
use of kyphoplasty," the March 2000 summary concluded.

What possible other evidence than this initial, non-per reviewed disinterested study could be needed? None, of course! The important thing is to get the new procedure into as general use as quickly as possible for the betterment of patient care and to save lives!

Before 2004, there had been only one reported death
associated with kyphoplasty and seven with vertebroplasty.
Since then, the numbers have changed dramatically. From 2004
through September, 16 deaths involving kyphoplasty were
reported to the FDA versus three vertebroplasty-related
fatalities. Experts agree that vertebroplasty is used more
frequently than kyphoplasty, although the gap has closed in
recent years. “These sorts of complications are extremely rare,” said
Julie Tracy, a Kyphon vice president. “These are procedures
that are very safe and do a lot of good for these patients.”

In a study published two years ago, researchers at the Johns
Hopkins Hospital in Baltimore also concluded that
kyphoplasty was more closely associated with serious
complications than vertebroplasty. Lieberman led the rebuttal for kyphoplasty proponents,
challenging the methodology of the study and completeness of
the data. However, those deaths and other complications underscore a
fundamental flaw of kyphoplasty: the risk of subjecting an
elderly patient to trauma and a general anesthetic, said Dr.
Kieran Murphy, one of the authors of the Hopkins study.
Murphy has disclosed that he receives royalties from one of
several manufacturers of the equipment used in
vertebroplasties.

Exactly, it’s clear that the naysayers are paid off by the communists. And at least we know that the insurance industry and the government are getting better value for money from the new procedure.

Murphy and other critics of kyphoplasty say hospitals need
the fees from general anesthesia and admission to recover
the costs of the equipment used in the procedure. That
equipment averages $3,500 to treat a single fracture,
according to Kyphon; vertebroplasty kits generally cost $500
to $600. Costs vary, but all told, vertebroplasty was found
to be $6,000 cheaper for each fracture treated, according to
a research report.

Well obviously those insurers must think it’s a better deal! Who could imagine insurers or Medicare just paying more for a new procedure without careful vetting it. After all they’re the end payer aren’t they? And they’re really strict about containing costs, as anyone paying insurance premiums knows! And if they weren’t so tough on containing costs for consumers and taxpayers, then why would we have a national clinical cost-benefit analysis center researching all these new treatments and being "transparent" about which ones cost what?

Answer me that, you Cleveland commie reporter, eh!

The only slightly disquieting aspect of this whole article is that the procedure concerned was invented in France. I know it’s a free market and all that, next time I hope that a red-blooded American like Dr. Lieberman could have been a little more patriotic. We don’t want those people with nice new backs only able to run backwards, do we?

 

INTERNATIONAL: This is why we have trial lawyers

Man changes sex, parents sue hospital

A couple whose only son underwent a sex change operation has sued a hospital for compensation and to have the surgery reversed because their “family line” was broken, a Chinese newspaper reported.The Yancheng Evening News said the parents and relatives of a person whose name the newspaper gave as Xie Xiaoxin also became violent and occupied a ward at the hospital for 11 days in September in an attempt to get US$3.6 million in compensation and their son’s gender changed again.

I guess there’s also some issues around who exactly gets to consent to "informed" consent!

THCB: Not today

• 2

Dealing with the recent computer crash has made me grumpy, and limited time for writing today. There’ll be something somewhat cynical up in the morning.

PHYSICIANS: Barry Bonds and the AMA’s still got management where they want them

• 19

Dilbertlie
The irony is quite staggering. On the same day that Barry Bonds gets the San Francisco Giants to bid against themselves–appalling the local baseball columnists–and give him $16m for one season in his tarnished chase of Hank Aaron, the Congress after a lot of high falooting talk, cancels the fee cut for Medicare Part B and gives a tiny P4P boost. Obviously like Bonds and the Giants management, the AMA still has Congress where it wants it — even though Bond’s numbers for the last two years have not exactly been worth $6m a year let alone $16m, and the cost to Medicare of Part B physician services has gone up despite previous fee cuts, while all the wonks agree that access to physicians for Medicare patients is not a problem (or at least not one affected by across the board fee increases or decreases).

Still let’s not look to baseball teams or Congress for rational decisions, especially with other people’s money. And I won’t even comment on the potential abolition of the limit to which people can put tax-free money in HSAs, other than to note that as they can be used for any spending after age 65 Congress may have just created the biggest tax avoidance scheme of all time!

THCB: Err…comptuer failure

• 2

Not much here today. Yesterday my computer started telling me that it had problems with some files in the registry, and after running the reccomended chkdsk utility (which took 2 hours), at the subsequent restart it kept on crashing and restarting without ever booting up (and no safe mode didn’t work, nor did anything else). After hours on the phone with Toshiba and on web searching out every possibility, I ended up doing a failed “recover”, noticed that it was wiping my data, and literally pulled the plug. This is the page that should work, but as Borat says “is no so good for meee!” I’m pretty well backed up other than one big piece and a few days email — I hope–and should be largely OK.

Now I have the hard drive in a bag and need to go buy a new computer. Something I was thinking of holding off on unitl Vista appeared. I guess I’m in the market for a Vista ready one. If you knew the project I was working on at the moment you’d find this all a little ironic.

By the way, I didnt know this but the Apple Macs automatically move your old computer data to your new one. For a PC you need a separate program. And if you only have a damaged hard drive, I guess that won’t work!

PHARMA: Maybe the Dems are serious about drug pricing

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Das Kapital

It’s hard to see how Medicare Part D as constructed can easily be changed for the government to go after prescription pricing, no matter how much Pete Stark et al may want to. But there are other drugs that Medicare buys directly under Part B, mostly for cancer and kidney care. And notice has been served that the tallest of those poppies may find itself trimmed a little — U.S. payments for Amgen drug criticized at hearing.

And if you thought you understand Part B’s “new” pricing schema, take a hint from JD Kleinke. You probably don’t

TECH: Brief musings on the PHR

• 9

Some brief musings on the PHR…given that I gave a talk on it for HIMSS N. Cal yesterday

— Email is unreliable! Not a comment on the PHR but I sent the organizer my talk in both Powerpoint and PDF (one for the talk, one for the web so the secret stuff hidded in the PPT stays hidden). Most of the intellectual property is of course in the fancy “builds” I did in Powerpoint. When I started clicking into my presentation, it became apparent that only the PDF version had gotten tp him, and was the one loaded on the computer. I of course had a copy of the Powerpoint on my thumb drive and this could have been avoided. Motto—always check what’s on the computer you’re presenting from.

— Kaiser Permanente’s PHR is rolling out pretty well, and has decent usage so far. It’s relatively transparent in terms of the views it gives into the patient record (gives full lab results) and links well to Web 1.0 generation content/information therapy.

—One of the points Kate Christensen (from KP) made was that they felt PHRs should be portable. But thus far that means portable within the world of Kaiser. I asked  if a member using KP.org changing plans could move all their data to Palo Alto Medical Foundation (which uses the same basic Epic software and is therefore the easiest imaginable “move”). Kate said that a) no one had asked so far and they didn’t yet have a policy on that yet, b) the data structures were different so it was more complicated than I’d made it seem, and c) they had a technical team working on it, really! Take it as read that this is a major potential future stumbling block and  view all those slides about “portability” and “interoperability” with extremely jaundiced eyes.

—One word baby: Autopopulation

— I didn’t smell sulphur. In fact the entire HealthConnect EMR (clinician part) was basically unmentioned, other than by me saying I didn’t smell sulphur. I think that knocks the conspiracy theory on the head.

—This article finally confirms that the just announced Intel/Walmart/BP et al initiative will be using PHR’s developed by JD Kleinke’s Omnimedix Institute. He was keen to point out when I last talked with him that his was a data auto-population and storage, non-profit, trusted 3rd party model, which others could build applications on top of. (i.e. competition for WebMD/Intuit).

— Cleveland Clinic has rolled out its Epic System including the PHR, faster and harder (if that makes sense) than Kaiser. They also have a way that allows referring physicians to get access to their patient’s records when they’re at the Clinic’s hospitals. This is a model for how providers not integrated with insurers or using a “monogamous we hope” (to quote Kate) medical group can roll out EMR and PHR. However, it was very hard work. Holly Miller, the doc in charge of eClevelandClinic, had to buy a lot of pizza. She’s leaving next year to take up the CMIO role at University of Cleveland. I joked that this meant that the Clinic’s docs had succeeded in running her out of their organization, but not yet out of town! Rather more likely, the Univ. Hosp likes her pizza buying/persuasion skills and realizes that the quickest way to catch up with its major cross-town competitor is to steal the talent! (Isn’t that what the Dallas cowboys and the 49ers used to do to each other in the 1990s?)

—Cleveland Clinic is also doing virtual visits into Mexico and Arizona, separating the reading from the diagnosis, and they’re pushing second opinions online as a service. Clearly they see their brand as a major weapon in getting national and international market share. They may be early, but if enough records go online, why does your second opinion need to come from the same city or country? And more importantly why does the patient have to be in the same physical room, when a tech can move the stethoscope or instrument around the patient, and the doc can see it all on screen, or an entire team of experts can be assembled virtually online?

—One reason why is that state laws restrict practice across state lines, and in some states (Holly think Ohio, but it was certainly true till recently in Georgia) even a prescription has to be handwritten and signed by the doctor. So 200 years of trade protection will not go quietly into the night.

—Matthew Guidin from Frost & Sullivan has done some real research on PHRs, which may make my back of the envelope stuff obsolete (or more valuable?). He seems to think that the health plans are talking a good game about interoperability, but have little intention of doing much. He also thinks that CCR (the AAFP-based standard for moving data between EMRs) is being sabotaged by the IHE crowd before its really gets off the ground.

—Everyone I met at the meeting that used to be a client is now a consultant! Who’s doing the hiring these days?

—Whenever a new incredible “innovation”  on their PHR was shown by KP or Cleveland Clinic Phil Chuang (my ex-i-Beacon colleague) and I kept whispering to each other “Didn’t we build a better version than this in 2000?” And we did. Which goes to show that timing, politics and marketing are everything. And technology is largely irrelevant.

 

POLICY/POLITICS/HEALTH PLANS: Igleheart, Glasscock, pussycats

• 2

After a little prompting (i.e. 30 minutes after I posted a blog comment asking why it wasn’t up) Health Affairs has posted a letter I wrote two days ago in response to John Iglehart’s interview with Larry Glasscock in its web exclusives section. I already had some in depth discussion about that over here on THCB, so my letter attempts to use the rifle rather than the shotgun. Let me (and HA) know what you think.

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