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TECH: Uh-oh, dissent in the orthodoxy that EMR will save money

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In his Health Affairs piece It Ain’t Necessarily So (which steals its title from my one Health Affairs article on which I was 4th banana author back in 1994) Jaan Sidorov claims that merely introducing “The Electronic Health Record” is unlikely to reduce overall system health care costs.

Stone him I say! Stone him!

Oh, hang on, I mostly agree. Although I do think that EMRs, eventually, will improve patient care quality, which he kinda doubts. But to actually reduce health care costs? Nice try RAND, CITL et al, but to do that requires limiting the amount of money put into the system. And that leads to unpleasant consequences for the main actors in the system. And as the Industry Veteran often reminds us, the whole IT thing is a side show helping us avoid that (eventual) conversation.

HOSPITALS: Apparently they’re shooting them down in Texas.

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Additional light shed on Houston Healthcare firings.

I can’t claim to know anything about this, other than isn’t it a little rare for this type of mass firing in the rather clubby hospital industry? Usually grand larceny and Medicare fraud is required, and sexual harassment is insufficient! And even then it takes all kinds of tooing and froing.

If you know more please comment. 

DISEASE MANAGEMENT BOSTON JULY 30 – AUG 2At a three day conference in Boston MA, scheduled between July 31 and Aug 2, industry leaders from managed care companies, employer groups purchasing healthcare services, providers, third party administrators, physicians, healthcare technology players, nursing and pharmacy practitioners, disease management experts will meet at the 4th Annual Disease Management Conference. The event is posted online at www.srinstitute.com/ch142

BLOGS: Nurses–lots of them

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Did you know that there were 4 million nurses in America? OK I made that up, but there are about 3 million RNs, not that all of them are working as nurses. I tell you this because virtually all of them have their own blog and most of those are in the nurses carnival called Change of Shift. This may be why there’s such a nursing shortage, as they’re all writing blogs instead!

POLICY/POLITICS/HEALTH PLANS: HSAs for Medicare? Crazy but apparently true

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So the HSA ideology has wormed its way into CMS, and now Medicare is seeking proposals for its Consumer-Directed Health Plan demonstration. Those taxpayers who can do basic math might wonder why you’d want to to give healthy Medicare beneficiaries cash for health services that they’re not going to use, while taking that cash away from the pot that pays for the sick beneficiaries that do use said services. But we’ve asked that question so many times before and no-one on the free market side dare answer it. And I guess you might say, why not give the taxpayers money straight to the “healthys” instead of laundering it through Medicare Advantage plans as we’re doing it now so that they can hand out free gym memberships to seniors and boost their executives’ stock holdings.

But given that risk adjustment is coming to Medicare Advantage, it may be that that gravy train is ending. Perhaps we’ll get to see if the private plans really can stand on their care management merits—and there’s so much fat in Medicare that they ought to be able to, easily.  Although they failed to do so in the late 1990s.

However, it’s just bizarre to increase the costs of a tax payer funded universal risk pool by allowing people who are not paying into it to withdraw cash from it. So the only real explanation is that CMS and its political masters in the White House are eventually intending to put the entire system into a high-deductible plan and not fund the amount below the deductible.  Just the same as most employers are doing (as I explained in this Spot-on piece about Intel).  That of course makes perfect sense for the government and the taxpayer. Until, that is, the seniors find out! I wouldn’t want to be in charge of Medicare when that happens, remember what those seniors did to Rostenkowski!

QUALITY/PHYSICIANS: Klein on malpractice

Ezra Klein has written a pretty good state of play about Medical Malpractice over at Slate. As you know I’m all for putting the solution for malpractice within the context of an overall medical error/practice guideline/EBM policy. Of course, politically the AMA and the docs are being used by the “tort reform” lobby who don’t give a rat’s arse about doctors or patients but are using them as sympathetic front men in their campaign to make corporate malfeasance unpunishable by any branch of government. So politically I wish the Democrats would sell out the trial lawyers on this one and work towards a wider solution (as Ezra suggests they might do). Not very likely of course, but slightly more plausible than the AMA cutting a deal, or the Republicans doing the right thing.

QUALITY/PHARMA: Someone’s going to get fired at the DEA for sure

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The WSJ writes about a serious scientific study of the hallucinogen in magic mushrooms.  As you might expect virtually all of the participants thought that the sessions had a very powerful effect and 60% of the clinical trial participants said that effect was very positive indeed. But 30% of the cases felt incredibly bad effects, largely increasing paranoia. That’s not much of a surprise—people react differently to different drugs. The researchers are interested in seeing if these drugs (and presumably others like MDMA/Ecstasy) have value in treating psychiatric cases.

What’s amazing is that someone in the DEA signed off and allowed this research. After all, this is a substances banned for hysterical political reasons and, like LSD its synthetic equivalent, no one is pretending that they’re not very powerful. Of course the government does allow equally powerful psychotropic drugs to be widely used and dispensed with a false pretense that somehow their use is morally different.

The main differentiator is of course what the government will allow to go through clinical trials. Now that an approved trial of one class of banned drugs that may have a positive effect has been allowed, how can the DEA justify the continued delays in granting permissions for real trials of another banned drug that we all know has significant medicinal qualities? They can’t justify it morally or rationally or even legally, but they certainly continue to raid medical marijuana dispensaries to justify their existence, their power and their budgets. So when word gets out that someone inside the DEA made a rational decision on allowing a study that counters the drug warriors’ propaganda—well, I’m sure their career is on the outs.

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