Michael Millenson writes on the new possibilities of predicting disease status and utilization using huge databases. As usual Michael is clever. Perhaps too clever!
Above the Fold
PHARMA/POLITICS: Closing the loop on Plan B
So finally we got some resolution to the ridiculous Plan B situation which has helped drag the FDA even further into the mud —F.D.A. Gains Accord on Wider Sales of Next-Day Pill . It will go OTC but only for people over 18.
The drug agency has asked that the new Barr application restrict over-the-counter sales to women older than 18. Girls younger than 18 would have access to the pills only with prescriptions. Over-the-counter pills would be sold just in pharmacies and licensed clinics, the chairman of Barr, Bruce Downey, said.Mr. Downey said the acting Food and Drug Commissioner, Andrew C. von Eschenbach, had assured him in a call that the agency was committed to resolving the Plan B impasse. Barr had hoped to sell Plan B to women and girls of all ages, Mr. Downey said, “but I don’t have the ability to get all that I want.”
Of course this is bloody stupid, as women under-18 are those just as likely to be having unprotected sex and the consequences of them having unwanted pregnancies are much greater for them, and for the taxpayer and society, than for older women. And they are far less likely to want to have to deal with the shame and expense of going to a doctor to get a prescription. Plus the solution is unenforceable, because those under-18 will just get their friends to buy it, and they won’t even have the minor benefit of the pharmacist’s counseling.
But don’t worry about them, or the rest of us dealing with teenage pregnancies, Jesus (or at least his "representatives" on the loony right) will be happy. And they’re the ones who make scientific decisions these days.
HOSPITALS/TECH: Getting the machine that goes “ping” into the EMR
Tim Gee managed to get to one of my posts when I didn’t submit for the last HWR for which he was host, to my chagrin and I failed to return the favor. But he does have a really interesting piece on his blog about the integration of RFID, WiFi, Pumps and Monitors into hospital IT systems. This is crucial stuff, as most of the mess (i.e. process errors) in the hospital comes from poor management of this data, and the recording of this data probably accounts for 25% of nursing time, and is fraught with error too.
If we’re going to fix the process mess inside the hospital, the integration of digital clinical data into IT is essential. Tim gives us a progress report on how we’re doing (well with pumps, not so well on integration of the bio-med and IT staff), and if you care about health care progress you should read it.
POLICY/POLITICS: The Real Politic$-As-U$ual of Health Care
I am up at Spot-on putting Health Care Politic$-As-U$ual in context. As ever come back here to comment if you like.
BLOGS: Health Wonk Review
Welcome to Health Wonk Review. The bi-weekly round up of the great and the good in health policy wonkery around the web. Putting HWR together this week confirms that health wonks know alot about health care, but can’t follow simple instructions to save their lives. There’s a lesson in there for health care as a whole, and the lesson is that user interface design of software, insurance products, compliance regimens, or blog carnivals has to be mind-numbingly simple and foolproof.
So on with the show…
From Managed Care Matters, Joseph Paduda notes that some US employers are sending their employees to India for expensive procedures and that word is bubbling up into the mass media—more evidence that drastic times call for drastic measures. His take? The more pressure from alternative solutions like Indian surgeons, the better as it will force us to confront our mess of a health care system. Ain’t competition great?
At Ambulatory Computing Robert J Lamberts writes that Medicare has backed off due to pressure from device manufacturers. There were cuts due for reimbursement for high priced, high end devices, but caving to pressure from the lobbyists for the device manufacturers, the current administration has backed off from this plan. This entry is a rant by a primary care doctor who faces the threat of cutbacks on reimbursements for physician visits. "Politics as usual" threatens to undermine any attempt at real reform. His version is called Medicare Cuts Scaled Back
On the same topic at Health Care Renewal, Roy Poses says that some naively thought that CMS proposed cuts of its high reimbursement rates for high-tech procedures might make more money available for primary care, etc. Alas, the cuts were speedily rescinded. CMS bureaucrats could not withstand the onslaught of commentary from executives of big device manufacturers and hospitals, and surprisingly two famous left-wing senators.
At TMBN Dimitriy shares reports from two Silicon Valley conferences which hint how blogs and social media will transform health care, much like news, politics and entertainment. The AlwaysOn Stanford Summit offers an analogy with Hollywood (do not miss the War of the Worlds spoof video!). BlogHer offers a model of online community fused with a conference and an inspiration for TMBN. Finally, note how the health care blogger survey may help us find the right way to apply BlogHer ideas to health care.
What do the Grand Canyon, a Lotto ticket and the Union Jack have in common? Henry Stern from InsureBlog reports on how one nationalized health system gambles with folks’ lives.
Meanwhile Glowing appraisals of Cuba’s state-run health care system are plentiful in the health policy literature. But even if a few isolated metrics indicate something good (like a high doctor per capita figure), does it justify the whitewashing of medical apartheid? And how reliable are health data from a dictatorship, anyway? The Lucidicus Project touched on these questions.
Of course if you want to get beyond the rhetoric, perhaps you should look at some real data on the topic, as I did on this posting on Canadians grumpily waiting on waiting lists at THCB. Sadly for the anti-single payer crowd it’s just not as simple as they’d like it to be, even if most Americans can’t tell Cuba and Canada apart.
Talking about grumpy, also writing at THCB, surgeon Eric Novack is most pissed off with CMS for deciding just not to pay up for a few days….he should meet some of my clients!
Meanwhile a real full-time wonk, Michael Cannon at Cato@Liberty has not one but two interesting posts on P4P’s role in Medicare FFS (Hint: he doesn’t think it should have one). Michael also busts certain bloggers (err..me actually) for just reading the press release and not the whole report!
David Williams of The Health Business Blog writes about anesthesia-related adverse events which are four times as likely to occur when surgery starts at 4 pm compared to 9 am. Authors of the study call the results "expected." He’s not surprised either, but thinks it’s a scandal that quality varies so much based on time of day.
From MSSPNexus Blog, Rita Schwab writes that participating in the medical blogosphere has educated her about how strongly many clinicians feel about the Joint Commission on Accreditation of Healthcare Organizations. However, this post supports the premise that for all the angst and expense a survey generates, US hospital care is better than it would be without a "big brother" looking over our shoulders.
Vreni Gurd who writes the Wellness Blog says that drinking good quality water in adequate amounts is one of the foundational principles of good health. Therefore deciding where to source your water is important. Here are some ideas to help you make informed decisions.
Carol Krishner who’s still Driving in Traffic, tells us about a new senate bill (S 3719) introduced by Tom Harkin (D-IA) that would amend the Public Health Act and Rehabilitation Act of 1973 to establish a competitive grant program to support activities that would improve the health and wellness of individuals with disabilities.
At Drug Channels, Adam Fein has been busy..and he has a PhD too! He says that the Democrats are making Part D “reform” into a major theme of the 2006 elections, and wonders what effects direct negotiations between HHS and manufacturers would have on the pharmaceutical supply chain? Meanwhile the British fake Lipitor scandal continues to expand after an additional recall was announced. Adam wonders what can we learn from the European situation that can shed light on the misguided attempts to allow importation into the US? I think that we can all figure out his answers from his use of adjectives.
Finally people today are larger in stature and live longer than their ancestors. William Marcus Newberry, from Fixin Healthcare, tells us that most of this is the result of public health with sanitation, clean water, better nutrition and immunization, and antibiotics for life-threatening infections. Analysis reveals that conditions during pregnancy and the initial two years of life have a profound impact upon health status in middle and old age. The public would be well served if health policy was based upon these observations.
Meanwhile Fard Johnmar of Envision Solutions and Dmitriy Kruglyak of The Medical Blog Network have launched the first global survey of health care bloggers. It is open to all bloggers that spend at least 30% of their time blogging about health care-related subjects. The survey will run until September 29, 2006. Please go take it.
Next HWR is on August 24 at a to be disclosed location–check the HWR site for details or to volunteer. The one after that is at InsureBlog and the one beyond that at The Century Foundation.
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PHYSICIANS: The sky is falling
Mark McClellan says that Medicare payments to physicians are going down 5%. This of course is leading to political pressure, with the President of the AMA writing op-eds showing that the sky is indeed falling on the heads of seniors. And don’t let any of those pesky researchers at HSC tell you that cuts in Medicare reimbursement actually don’t lead to doctors dropping out of Medicare.
Oh well, perhaps the doctors will make their money back by investing in more specialty hospitals–after all, that moratorium is over. Let the self-referrals begin.
CODA: The AMA Pres uses this sentence "In 2006, Medicare is reimbursing physicians about the same as it was in 2001 — that’s in real terms, not adjusted for inflation." Someone needs to take him to a very basic economics class. "Real" means that it is adjusted for inflation. He means "nominal". And of course someone else needs to explain the P x V = I phenomenon.
BLOGS: Health Wonk Review is coming up this Thursday
Health Wonk Review is tomorrow, so please get yourself over to the form at Dimitriy’s place. Fill it in under the “Carnival” banner for Health Wonk Review
PLEASE include your link to your post linked to the relevant part of the "description" in the HTML. Just putting the link in the baox called link or title is NOT GOOD ENOUGH. That’s not a friendly request, it’s an order.
TECH: Apparently there’s something called the Internet
The Web Returns to Health according to the Washington Post. Who knew? S
adly not too much in the story. WebMD is still around, Steve Case, Time Warner put money in to something called EveryDayHealth—not launched yet. Healthcentral is back; rescued by defense-contracting money-bags the Carlyle Group. All these guys are aping the mainstream health success of WebMD.
Not in the report but more interesting is the attempt by Healthline, and a host of others—and of course Google—to create health information search verticals, and then the coming attempt to get at consumer long-tail sites which several people have been writing to me about.
Finally, the most interesting development is the integration of this information with the actual health information of individuals—that’s the role of the emerging PHR movement, and that’s where the really interesting health web activity is going on. And one version of that is the combination of those records with physician communication systems. yeah, yeah, I know you’re expecting some crack about RelayHealth and it’s long slow evolution, but the fact that at least the service exists is finally making some news. Today it’s in the Wall Street Journal in the column by single-payer touting Dr. Benjamin Brewer.
We’ve had our Web site going for about a year now and while only about 50 of my patients have taken advantage of our online services, they seem to like them. Currently, my patients pay $30 upfront for virtual office visits with a credit card. The software on the Web site takes a systematic and thorough history for any of more than 3,000 different complaints. I review the information and decide who can be treated online and who needs a face-to-face visit. Patients who are referred for office care are only charged for the standard office visit.
The histories these patients generate via the Web site might sound like a waste of time, but they aren’t: They go right into their electronic medical records, so I have their information ready when they come to see me. Patients like not having to repeat the same story to the receptionist, the nurse and then the doctor. I like it because it saves me time and eliminates transcription costs related to summarizing and recording what the patient told me — instead, I can just add some nuances I picked up while talking to the patient, as well as a key note or two. Online patient registration and insurance updates are our most-popular Web-site features, followed by secure bill payment and prescription-refill requests. (We don’t charge for simple email questions or for processing refill requests.) Patients will soon be able to access their own lab results and review their records online.
And of course there is the minor issue of consumer convenience, and competition for it!
Meanwhile, retail health clinics are springing up in a lot of places. These clinics are dedicated to treating simple problems quickly, and they’re threatening to skim the easy patients and the easy money out of the office. For doctors, online visits are a way to keep this from happening. Two weeks ago I was in a CVS pharmacy in Seattle and noticed most Minute Clinic visits cost $59. My patients get online consultations for the same sort of problems for about half the price — and they get them from their own doctor.
Tech: Desktopgate? By John Irvine
It seems like only yesterday that officials at the Veteran’s
Administration were issuing public apologies and pledges to get serious about
security after the theft of a laptop containing the personal data for 26
million U.S. servicemen and women. Laptopgate turned out to be a little less serious
than the early reports predicted. The missing laptop was eventually recovered. The perps dragged away in chains. And
government officials left feeling highly embarrassed. Desktopgate looks to be a little more serious. This time
a large government contractor (Unisys) appears to be responsible.
Leaving aside the question of how exactly you lose a desktop in the first place, this looks like it actually might be a bigger deal than the original security breach at the VA. While less
data is involved, the missing information includes the names, addresses and
social security numbers for tens of thousands of veterans treated at VA
hospitals in Philadelphia and Pittsburgh. It also includes insurance information and details about medical conditions. Making things even worse, data for an additional 20,000 patients
recently treated at the Pittsburgh hospital may also have been, er … lost.
Before anybody resigns or holds a press conference blaming a
culture of official incompetence at the VA, let’s think about this. If the incidents over the past few years are
anything to go by, computer theft is a problem that has now reached epidemic
proportions. It seems logical to assume
that the number of unreported incidents is far greater than the number we’re
hearing about. Unlike government
agencies, corporations are under no legal requirement to inform anybody if data
goes missing. Not many are willing to
take the PR hit that goes along to owning up to a mistake. Why would they?
As many observers have noted, it is apparently human nature to lose/take computers. So what can be done? Developing realistic
policies for data control would be a good start. One sensible approach might be
to equip all government laptops with RFID tracking technology (See: If he
beeps, He’s clean Bob) so that if a computer escapes it can be easily tracked
down. Alternatively, we could use the Tommy Lee Jones method and handcuff people to their computers. But that doesn’t sound like a very good solution in the long run, given that handcuffs are generally considered fairly uncomfortable things. I have a feeling that a fortune – not to mention a government contract – awaits whoever comes up with a clever solution to this problem …
TECH: Metcalfe’s law in reverse
Patient demand is growing as the U.S. population ages. Use of implantable defibrillators has risen from about 21,000 in 1995 to more than 250,000 last year. With such high numbers involved, some doctors worry whether they’ve got enough staff and time to process the influx of data home monitoring systems can provide. For example, what responsibility do medical staff face to respond immediately to a potential sign of trouble that turns up in a batch of downloaded data? How do they sort out real problems from the false alarms?"There are concerns about information overload," said Dr. David Martin of the Lahey Clinic in Burlington. "Physicians have less and less time, and they don’t want to have fewer patients coming to their clinics at the expense of having too much paperwork." But Martin expects remote monitoring will enable his team of five electrophysiologists to track their more than 4,600 patients more closely. "There are not enough doctors and nurses to follow these people, so it makes sense to use technology to automate some of the functions that don’t require physicians’ input," Martin said.
So as the technology races ahead, the service organizations which will do the monitoring need to be put into place. But of course this being health care they are only going to be put into place if someone pays for them. And that someone is Medicare. So the key question remains, is this a medical service that has already been granted Medicare’s blessing, or is this some type of disease management service that is still in trial? We know which end of that scale the manufacturers want this to be on, but if this technology cuts physician visits and doesn’t replace them with other funding streams, it won’t be too popular amongst doctors. Which means that it’s all very well but for now these patients are a bit like the guy with the first fax machine!
