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PHARMA/PHYSICIANS: Attacking the Rx data stream

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So perhaps this is getting serious. Doctors Object to Gathering of Drug Data

If the A.M.A effort succeeds, "legislators will turn their attention elsewhere, and the industry can hang on to one of its most valuable data sources," according to an article this week in the industry trade magazine Pharmaceutical Executive, which was co-written by an A.M.A. official and an executive with the leading vendor of prescription data. Even many critics concede that patients’ privacy is apparently not an issue, because the tracking systems identify only the prescribing doctors, not patients. But many doctors find the use of the data by sales representatives an intrusion into the way they practice medicine."These doctors were outraged that people came into their office and talked to them about how many times they prescribed a particular drug," said Dr. John C. Lewin, the chief executive of the state medical association in California, one of the states where complaints about the current system arose.  The California group is beginning its own program under which doctors who do not opt out under the A.M.A. system will get comparisons of their prescribing patterns in 17 classes of drugs from the data companies, said Dr. Lewin, who added that the program was being started as a pilot effort that he hoped would be extended statewide.

This latest dose of outrage is almost hysterical. In both senses of the word.

There are some doctors who are vehement in their opposition to drug companies. They won’t take the free lunch. There are some who take advantage. For most, they have a fairly neutral opinion of drug reps. But the concept of not allowing anyone to know their prescribing patterns doesn’t exactly smack of the transparency that we’ve heard so much about. And frankly if the drug companies don’t know how to detail docs as efficiently as possible (and for that they do need the data) it’s likely that their marketing efforts will get more unfocused and more onerous on the system as a whole. And in general I’m of the belief that useful targeted marketing & sales is better than blanket non-targeted efforts. So unless we are going to ban ALL pharma marketing (which will mean tossing a great deal of useful babies out with the bath-water) and fundamentally change how information about drugs is communicated to physicians, then getting rid of the IMS type data is not helpful.

HEALTH PLANS/HOSPITALS: Kaiser gets beaten up in LA Times

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There’s a series going on in the LA Times suggesting that, after it created its own kidney transplant program, either through inefficiency, incompetence or worse, Kaiser Permanente caused a delay in the transplants of several kidney patients. This morning’s report, called Kaiser Denied Transplants of Ideally Matched Kidneys is pretty damning, suggesting that Kaiser deliberately refused to cover the transplants of some perfectly matched organs for donors at UCSF. The unstated reason is of course that they’d have to pay for them at UCSF whereas it would be money they’d keep within their own system if they could perform the transplant at their own new center.

As late as Wednesday afternoon, Kaiser officials adamantly denied that they had ever instructed UC San Francisco to turn away such organs. But after being confronted with evidence to the contrary by The Times, the officials called back to say that they could not stand by that position. One of Kaiser’s own kidney specialists had confirmed that he directed UC San Francisco to turn down at least one of the near-perfect-match kidneys, they acknowledged.

Now as far as I can tell we don’t really know whether those patients quickly got their transplants within the new Kaiser center, or what their outcomes were. And we don’t really know why Kaiser pulled its business from UCSF in the first place—Kaiser in S.Cal is still contracting out transplants to academic medical centers.

I tend to believe that Kaiser is in general on the side of the angels, so I’m waiting to see more about this before I cast any judgments. But whatever they saved in the first few months of this program pales in comparison to what these kinds of stories will cost them.

 

POLICY/POLITICS: Colbert’s speech and the press reaction.

Let’s be honest. The reason the mainstream press ignored the Colbert speech (full transcript here) at the press club dinner was that he directly called them out for five years of being cheerleaders for the Administration—or at least not doing their jobs. The only one who’s tried to was Helen Thomas and that’s why she happily took part.

I saw it on Sunday (before the fuss) and I thought it was hilarious, and it was totally in character with his show.  Which is a straight parody of what liberals think Hannity/Limbaugh/O’Reilly and the rest of the wingnuts are like—although I don’t think they’re trying to be ironic. (Even though with Limbaugh bashing medical marijuana users while being a convicted drug felon it’s pretty much impossible to tell the difference).

The NYT has a self-important article about it here

 

POLICY: A Conversation with Paul Fronstiin from EBRI

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You won’t see this guy, Paul Fronstin from EBRI on the CDHP rah-rah circuit. But like many sober analysts of health care, what he has to say is very important and very sharp. So go read  A Conversation with Paul Fronstin in Managed Care magazine. If you’re too lazy/bored/time-constrained to do that, ponder at least this exchange which I don’t agree with—in that I think he’s not factoring in the outsourcing revolution—but is a pretty provocative viewpoint.

FRONSTIN: In the short term, I don’t see a tremendous erosion of coverage. One thing that people outside of health care tend to forget is the impact of the overall economy on health care. In the late ’90s, the strong economy enabled the managed care backlash. The lower unemployment rate drove employers to enhance benefits and drove small employers to offer benefits. Once unemployment drops below a certain threshold, the economy starts to have an impact on what employers do and don’t do. The likelihood that a small business offered health benefits increased 20 percent between 1998 and 2000, even though small businesses saw almost a 20 percent increase in premiums over those two years. That tells me that employers will do what they have to do to recruit and retain workers if they think it will affect the success of their business. Even if health care costs are increasing rapidly, if employers think cutting back on those benefits will affect their business, they’ll make other tradeoffs but they’ll maintain health benefits.MC: You see indications that we’re heading for another period like the late ’90s?FRONSTIN: Right now, we’re at 4.8 percent unemployment. The economy is certainly moving in the right direction as far as unemployment is concerned. We’re not that far away from that threshold. I don’t know if the threshold is 4.6 percent, 4.4 percent, 4.2 percent or 4 percent, but we’re within a percentage point of it as opposed to being within 3 percentage points. If unemployment continues down that path, employers will postpone abandoning health insurance

QUALITY: The patient satisfaction trap by John Irvine, with rant from Ann Farrell

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So in FierceHealthcare today my colleague John Irvine wrote this

Some hospitals have argued for years that patient satisfaction scores can be misleading when it comes to gauging the quality of the healthcare services they receive. After all, patients are only human, aren’t they? And can easily be swayed by factors that have little if anything to do with the true quality of care. A new study out in the Annals of Internal Medicine appears to back this view. RAND Researchers and a team from the University of California Los Angeles surveyed 236 elderly patients, asking them to rate the quality of the care they had received. The average response was 8 out of 10. Follow up on patient records determined that patients received the recommended care 55 percent of the time. Now those numbers may seem relatively unimpressive, but they are evidence of a something that many providers have intuitively believed. It will be interesting to see how this plays out.

That apparently struck a nerve with FH reader Ann Farrell. She wrote to me about this problem, and one senses a little frustration in her voice!

It drives me NUTS when people (smart people and even payors) confuse satisfaction with quality of care  – two things that are NOT THE SAME, and in fact many times not correlated.  In some studies patients getting ongoing excellent care are exposed to the health system more than their healthy counterparts thus have more opportunities for service gaps. People in this study’s satisfaction with plans decreased the more they received treatment, as good as it may be clinically. 

Quality of care has to do with the addressing underlying problems, i.e. getting diagnosed properly then improving status of  medical condition or receiving palliative care if no improvement possible .For example, my diabetes is being treated with best practices leading to optimal outcomes, lack of complications, etc. We know from recent market data that this only happens 55% (if my recall correct) of time. Consumers are by and large clueless about the actual quality of care they are receiving, and many unaware of the patient safety data, i.e. we’re killing close to 100K people a year, which is not only bad quality but introducing medical problems, e.g. nosocomial infections, or actively killing patients, e.g. drug errors. 
 
Quality of care and patient safety have nothing to do with service or satisfaction, which is often based on parking, food, access/TATs and perception of care providers, “does someone answer my call bell quickly when I need them?” You can have great service and woeful quality, or visa versa. When I worked with benchmarking data University Hospitals has better quality outcomes than community hospitals they competed with so patients tolerated bad service, i.e. waiting for hours in waiting rooms, etc. Now specialty hospitals and some community hospitals are delivering comparable care and differentiating based on improved service. So the fact that people still use the terms interchangeably is baffling. MOST patients haven’t known what the quality of their care is – the Internet is changing that in terms of better access to care standards and evidence.
 
Sorry, as you can see this struck a huge chord with me, we have to know what problem we’re tackling to solve it.  The industry confuses this.

For some reason the issue of quality, waste, doctors not providing optimal care, etc seems to be a contentious one on THCB. I personally believe that fixing the consumer satisfaction part of health care is easier to do and equally necessary than fixing the care process. But they are separate things (both of which the system deals with very badly). But what do I know? Feel free to have at it in the comments!

BLOGS: Email problems again

I yet again had email problems between 6 am and 11.27 am PST today. If you sent me a vital email during that time, please resend it. Matthew

QUALITY: Games For Health

There’s a Games for Health Day on May 9 in Los Angeles, California. It’s on the subject of Games for rehab, pain distraction, and health promotion. Want to know more? Games For Health

HEALTH PLANS/POLICY: RAND shows that HDHPs will only havea modest impact

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There’s an important article out in Health Affairs showing that, as has been suggested on THCB many times, contrary to some (and it is only some) of the HDHP/CDHC advocates rantings, the move to lower premium higher deductible health plans even with premium subsidies for the poor will have relatively little overall impact, and certainly won’t change the uninsurance numbers much. Here’s the Press Release and the money quote:

Price subsidies have only modest effects on overall participation in the individual health insurance market, RAND Corporation senior economist Susan Marquis and coauthors report in a Health Affairs Web Exclusive published today.

“A 20 percent [premium] subsidy would increase the number of subscribers in the individual market by 5-11 percent and decrease the number of uninsured people by 1-3 percent,” the researchers report. That comes from 1-2 percent more potential purchasers deciding to buy insurance and about 15 percent fewer current enrollees dropping coverage, as a result of the 20 percent subsidy.

I’ll be back later when I’ve read the article.

UPDATE: Damn, didn’t even get a chance to read this and I’ve already been interviewed about it. I must be getting famous. Wealth surely to follow?

JOBS: Positions at Telecare (Alameda, CA)

My former i-Beacon colleague Phil Chuang is now CIO at Telecare, a mental health management company in Alameda, CA (Bay Area). He is looking for warm (and hopefully bright bodies). Phil would be a great person to work for.

He’s trying to fill a couple of full time career positions right now  A senior project manager and an applications engineer (mid-to-senior level).  He’ll also be adding business analysts, help desk and network technicians, and programming staff (.Net skills) after the start of the fiscal year on July 1

If this is you or you know of anyone good in these areas, please have them email me.

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