Two very interesting pieces. First MrHISTalk has an interesting interview with the CEO of MediNotes, which sells an EMR aimed at the small physician practice market. There are some interesting remarks about the future viability of Emdeon’s Medical Manager product. Fred Trotter is an open source and therefore not entirely unbiased advocate, but take a look at his history of Medical Manager which somewhat dovetails with the MediNotes view.
It’s a quiet return around here from the prolonged July 4th weekend. Meanwhile, there’s a new sponsor at THCB. This time it’s a book called “On Track To Quality” by James Todd, a pediatrician at Children’s Hospital in Denver. The book is a philosophical investigation into quality, involving not a motorcycle trip, but a train journey. Interesting stuff, and a longer review will be forthcoming shortly.
Not all is well with HCA in California. The SEIU has been trying to start a fight with HCA over staffing for some time.. Apparently three Southern Calif hospitals are threatening to go on strike and in Northern California something similar is going on at HCA’s Good Samaritan Hospital in San Jose. The union employees have been negotiating with HCA and working without a contract for months now. They voted on Weds overwhelmingly with 90% approval to go on strike sometime in the near future, possibly this week.
Here’s my last ever FierceHealthcare editorial. The FierceMarkets team is taking the editorializing of FierceHealthcare back in-house and I wish them luck. It’s been fun for me (and John Irvine who’s supported me all the way) to work on this over the past couple of years, but I’m happy to get away from the deadline grind and concentrate on THCB and my consulting work. And hopefully I’ll find the time to start working on that book I’ve been threatening you all with. Anyway my last editorial is about the two biggest themes in health care—fixing process and fixing insurance.
Perhaps the dominant theme of the decade in healthcare has been patient safety. Since the 1999 IOM report, hospitals and doctors have focused on improving the medical error situation. Last week, Don Berwick’s IHI announced that a precise number of lives (123,000 and change) had been saved since the voluntary 100,000 Lives Campaign started. This week, the carping started with The Wall Street Journal suggesting that the IHI numbers were inaccurate. Commenters also started down the path of whether saving the "life" of a severely ill patient who was going to likely die soon anyway was all that important–or at least as important of saving the life of an otherwise young healthy patient.
But beyond questions about the data, there are two crucial related points we must hold onto. First, medical errors are symptoms of poorly designed medical processes, and we know that reducing "muda"–waste in medical care–is an achievable goal. Second, patients are not just vulnerable to physical harm from interacting with the healthcare system, they’re also extremely vulnerable to financial harm caused by that "muda" and facilitated by our dog’s breakfast of an insurance and financing system. These are two sides of the same coin, and efforts like the 100,000 Lives Campaign should be applauded for focusing on at least part of the problem. It would be nice if there was a similar system-wide commitment to concentrate on the whole of the cost and care crisis rather than just one part.
It’s World Cup 1/4 final weekend. So what did you expect me to write about over at Spot-On. It’s called Football, bloody hell
Bonus points if you know the quote.
Those of you despairing of rich people being able to buy their way out of trouble may be encouraged by this headline—Scrushy, Siegelman found guilty on federal conspiracy, bribery charges . Well at least he’s going down for something. Perhaps this jury wasn’t quite a susceptible to the bought and paid for black Ministers that are Scrushy’s new best buddies, or maybe he didn’t bother hiring them this time around. At any event hopefully he gets what’s coming to him this time.
The NEJM has a perspective about the sale of Rx data of physicians prescribing patterns, which caused a lot of fuss on THCB a while back. In my view this is problem about number 728 on the docket of what’s wrong in American health care, and those physicians complaining about it should look to solve the first several hundred before they set their sites on changing the law, or just kick the drug reps out of their offices. There’s nothing particularly good about the current situation but it’s just not that big a problem and banning the sale of data won’t change it too much. the perspective from Robert Steinbrook largely agrees.
Prohibiting the release of prescribing data to sales representatives will not put an end to another practice to which some physicians object: the use of such data by managed care or pharmacy benefit managers. These entities have sources of information that are independent of the AMA Masterfile. It also will not stop visits from sales agents, which doctors have always had the right to refuse, nor will it curtail the marketing of drugs. According to the AMA, the potential effects of restricted release may include a reduction in the number of “offers physicians currently receive from the pharmaceutical industry, such as drug samples, CME programs and speaking engagements.”
This edition of the soap opera known as Tenet Healthcare Corporation is over, or at least has gone to commercial break. The DOJ settlement is for $725m in cash and another $175m in billing to Medicare it won’t collect. How much of that will come from the execs who sold stock before the news got out in 2002? Not much I guess.
If previous history is a guide, expect a name change and another scandal in 5–10 years.
I knew I should have hired an unpaid summer intern. At IBM they have them by the dozen and one of them, Emily Goodson, has done a nice round up of health care blogging in Health Wonk Review over at HealthNex.
Any unpaid interns looking to boost their resumes know where to apply…
Occassionally I get actual patients writing into me at THCB and sometimes it’s worth letting their experience with the system tell a story about how the opaque world of drug and health services pricing comes home to ground level. This is a verbatim email from a 70 year old patient Pat Awash:
Friday, June 9, 2006 I was facing imminent blindness in one eye and poor vision in the other. Beginning Saturday a miracle began to unfold after an initial injection in my eye of Avastin. Avastin is used to treat mestasticized colon cancer and someone deduced that it might, just might be effective for Age-Related Macular Degeneration, the leading cause of blindness and vision impairment among the elderly.
Due to an undetermined cause, leaking fluid had formed a large blister behind my retina causing four changes in my eye-glass
prescription between February 24, 1906 and late May, 2006, the last of which
did not hold for four days. I was frightened to say the least. Only one day after the injection I experienced a 70% vision improvement. This improvement continues each day and I am using a three-year-old prescription.
I am writing in objection to the current policy of the FDA in regard to Avastin. It is an off-label use but the cost is minimal, only $60.00 when provided at cost as my physician does. The same drug company that
makes Avastin has developed Lucentis which has a slightly different molecular
structure than Avastin but is basically an analog. Only thing is, Lucentis will cost an expected $1,500.00 per dose. They claim a reported $400 million research cost but I’m wondering what is included in that amount.
I hope you get the picture. The manufacturer of Lucentis has changed the drug to the degree that it can be classified as a new drug. Whereas Avastin is expensive when used as a cancer drug it is very inexpensive for eye treatments because the dose is so small, and some would say Lucentis is not as effective. Once approved, Lucentis will be covered by
Medicare, a windfall for the manufacturer and huge cost to the public considering a rapidly aging population. Gentech could have done the trial on Avastin.
Everything would be ok except Genentech will no longer make Avastin available except to those who exclusively treat cancer patients.
No off-label applications and no choice for patients. Thankfully, my physician bought a substantial (several month’s) supply prior to the June 1, 2006 cut-off date.
I find this insane and I think you will too. I am sick and tired of experts saying how much trouble Medicare is in when this kind of shenanigan is going on.
Respectfully,
Pat Ahwash (a 70-year-old senior citizen)
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