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The Great Balance Billing Scandal By Eric Novack

Novack_sm_2In California, the possibility exists that the unelected
department of insurance, under pressure from the insurance industry and
patient advocacy groups, may fundamentally alter the way medicine is
practiced. In an effort to get a work around the
disgraceful- yet very culturally sensitive- single payer bill recently
vetoed by Governor Schwarzenegger, there is a move afoot to ban the
practice of balance billing.
 
What is balance billing you say? Sounds very wonkish and unimportant. Sounds like those unethical, over-utilizing, quality-unconcerned doctors are just trying another technique to scam the ‘system’. (But I thought the familiar refrain is that we do not have a health system? …) I will explain with an example.

Continue reading…

PHARMA/POLICY: U.S. Drops Program to Halt Discount Drugs From Canada

U.S. Drops Program to Halt Discount Drugs From Canada

The federal government plans to halt a controversial crackdown on discount drugs mailed from Canadian pharmacies to U.S. customers, removing a significant hurdle to Americans buying cheaper medications from abroad.

So 80% of Seniors support importing Rx from Canada, and the DOJ backs off its crackdown on imports.

Could there just possibly be an election coming up soon? Just possibly, could these two events be related?

TECH:….and talking about 1999 again

Aetna introduces a PHR for its members, only 5 1/2 years after sending me the funniest email of all time, which said that they were spending all their time fixing their IT system and even if the solution (a PHR) that we had for them would fix all their problems, they still couldn’t buy it for 2 more years. Well I guess they meant 5 more!  Sadly we were out of business well before the 2 years expired!

Their PHR is an off shoot of Active Care Management’s Care Engine. Aetna bought ACT last year. At that point Empire Blues was the biggest user of Care Engine. They didn’t go with it for their PHR though—they’re using WebMD’s version. Which makes me wonder how good Active Care’s version is. Perhaps I’ll be able to check into it soon and tell you.

Meanwhile all care will soon be delivered at home by clever in-home dialysis and monitored by Health Buddies. It must be true because it says so in Business2.0. Yes I know that’s an unfair slam on Health Hero Network (who I know and love), but their new direct to consumer model is, shall we say, a brave business innovation, given that it demands $50 a month from the chronically ill.

Good luck to them and I’m sure they’ll keep me appraised on the models success while the rest of us are waiting for Medicare funding for remote monitoring.

PHARMA: But this is how it’s done

The NY Times has an article about how a biotech drug that basically is no better than a generic is selling off the shelves at $4,200 a Dose. Doctors think it’s better, patients believe it’s better and payers are too wimpy to stand up to them. Of course they haven’t got a government agency to help them, as exists in the UK.

Interestingly enough this is exactly what happened nearly twenty years ago with one of the the first major biotech drug, Genetech’s Activase (tPA) for the immediate treatment of heart attacks. it cost about ten times what the competing drug (streptokinse) cost, and basically had no better results. At the time there was lots of murky stuff including a positive NEJM article written by scientists with close (and undisclosed) ties to the company. (If you want to know much more about that ugly debate, look at the debate starting at page 3 in this link and particularly the far right column of page 9). And then after a study showed incredibly small relative and absolute benefits in survival from using Activase, allegedly Genetech sent lawyers to lots of hopsitals explaining what a jury might say now that a lawyer could "prove" they weren’t using the best possible drug. Pretty soon everyone switched over.

Sounds like despite lots of talk about cost-benefit analysis, cost controls, and pharmaco-economics, nothing has changed.

 

POLICY/POLITICS: Personal angst on research

There are sometimes when two contradictory thought streams start charging through my brain and I can’t cope. This is one.

I got an email from a PR person for this website http://www.yourcandidatesyourhealth.org/ which tells you your local candidates record essentially for or against embryonic stem cell research. As you might guess, the idea from Research!America and the Lasker Foundation is to encourage people to vote against candidates opposing stem cell research (or at least get them to change their mind. The Research!America folks are a cross-section of business and academic types who like medical research.

And honestly how can any rational person be against them? When the choice is between them and the creationists who were only happy when we all lived in the dark ages, and don’t believe in the Enlightenment, personal liberty, the scientific method, et al. (Not of course that they won’t use the technological fruits of the movements they despise, particularly Talk Radio!).

But on the other hand, any really rational assessment of the health care system shows that we are spending way too much on medical research. The NIH alone is $30 billion a year, and that’s about doubled by private industry. Now we’re adding billions more at the state level. The problem is that the application of the products of that research is downright shoddy, and we’re spending almost nothing comparatively to figure out how to make it better.

It would be much better for the country and the health care system if we took the $30 billion spent on the NIH and the $300 million spent on AHRQ and flipped them. Then we’d really figure out how to apply the stuff we already know evenly and appropriately. We just don’t need more me-too cancer drugs at $4,000 a pop, when we can’t figure out how to get an Rx for aspirin in to the hands of discharged cardiac care patients (or whatever the appropriate cheap therapy is).

I’m convinced that if we put a ten year moratorium on all new medical research today, and spent all the money figuring out how to apply—and then actually applying—our medical knowledge across the board, we’d be much better off. Of course that’s never going to happen, and we need to save science from the hands of the anti-Enlightenment Philistines. But I remain to be convinced that the Research!America folks are applying their scientific resources in the most appropriate way possible.

Meanwhile, Steve Parker tells me about the launch of a new site called www.BreastCancerAwareness.com  which is pretty self-explanatory and looks like it’ll be a useful resource.

BLOGS: Is the AMA getting angry?

When THCB started I lived two buildings down in the same block where this happened in SF yesterday.

2006.10.01 Fire on 5th Street 001 I assume that my change of address wasn’t picked up in Chicago and that this is a word of warning from the Capos at the AMA to tone it down a bit.

(Just kidding, guys…)

PS I dont want to denigrate local journalism, but the pictures in the SF Chronicle were clearly taken from their office building at 5th and Mission (the one on this page was taken by a friend of a friend). Was the Chron photographer too busy to walk 3 blocks for a better one?

JOBS: Product manager health IT, SF Bay Area

And in today’s job announcement. A SF Bay Area company is looking for a Product Marketing pro to work at the intersection of technology and healthcare—Think improving the supply chain within the hospital.

The ideal candidate will have direct clinical/hospital setting experience as a nurse or other direct practitioner in the setting, but will have moved on from that environment to a track record in marketing, product and brand management. The company is not a start-up – they’re public, profitable, and have a substantial installed base of customers using and loving the systems.

If you’re interested *******@*********lt.net“>email me and I’ll pass it along.

 

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