More from the conference. Steeve Kay is the founder of QTC, a disability company which provides outsourced evaluations. Given the problems in figuring out who’s disabled and who’s not, you can see why they care about getting these records electronic. Meanwhile, a private equity firm just bought his company, so he’s obviously convinced someone else that it’s a good business! Yet another little niche in the health care world where plenty (plenty!) of money is flowing around.

Steeve says that medical treatment is provider centric, medical disability is payer centric — and there are lots of payers. It’s about $350 bn total on the health care side (public and private) for medical care for disability, plus another $200 bn for cash payments to the disabled. There’s about 10,000 claim centers in the US who are involved in allocating money, and that includes about 250,000 people working as claims administrators (of various types) with some 10 m claims a year. (I may have that number wrong—Mapping this system is damn confusing!)

These all need evidence to process and judge a disability claim. Most of that needs to come from a medical record, and the legal custodian of the medical record for disability is the payer, while in the medical world it’s a provider. And the disability payer needs to do a bit more to make that complete.

And of course not much has been thought about how these different parties access medical records in an electronic world. His 2 key questions are can we standardize billing codes for disability? And is evaluating disability a practice of medicine.

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David Stapleton (from Cornell Univ Inst for Policy Research) is here to talk about disability. He says that we spend over $200bn on disability (via Medicare, SSI, and Medicaid) and the process of getting people onto disability is totally broken (Determination takes forever, and appeals take even longer). Much of that problem is due to the fact that there is no easy access to the medical record, and then if they actually get the record, figuring out what’s in it is hard, and the information may be biased because the provider is somehow colluding with the applicant (Imagine that in health care!), or applicants may withhold information early, and then produce it later. (If you let the consumer have control of the PHR, then they’ll fix the record to make it favorable to them to qualify for SSI!)

So if there was national PHR then the applicants could give these records out and they’d theoretically be available, accurate and complete! But funnily enough he thinks that disability is not the right place to target EHR development…and given the complications in that part of the world….yup! So why is he here? This conference (and in fact the sponsor of the center) are from a disability management company, hence the role of disability is coming up more than you might suspect! Still it’s a pretty interesting part of the system that we don’t hear about much, and it takes a lot of dollars. And if there was a national, reliable PHR with adaquate rules to get into it — and people trusted the government which Helga Rippen just told us they don’t — then management of the disabled population across programs could dramatically benefit in many ways, but we’re not holding our breath!

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Via Health Care Renewal, a great article on the ongoing scandals of the GPOs in the Fort Worth Weekly. It’s long but well worth a read.

Essentially the GPOs, on behalf of the hospitals, agree to pretty much exclusive contracts with big suppliers (BD, formerly known as Becton Dickinson, is singled out in the article) and lock out competitors from the hospital markets they control. The hospitals pay over the odds for their supplies, and then bill that back to their clients (who include lots of government agencies). So we all pay. Meanwhile the GPOs get administrative “fees” from the suppliers, which they in turn pass some of back to the hospitals. And it’s a fair bet that very little of that is reimbursed back to the end payer. Does this remind you of any other part of the health care business?

It does to the Congress which has been investigating GPOs for a while now with precious little result. Luckily the current Administration seems not to mind dubious business practices from monopoly sellers, well not if the company has close connections with certain politicians.  Whether the local authorities or the civil courts will be so kind seems less likely given the records of judgments in the article.

Meanwhile, while BD is being bashed it is also being accused by an ex-employee of stiffing the US government by refusing to sell it needed needles, when it has huge stockpiles in Europe. Apparently BD was also illegally trading with Iraq—something that other well connected companies seem to do with impunity.

A doctor twice promoted by medical device maker BD alleges he was illegally fired after repeatedly complaining about serious company breaches in safety, quality control and ethics, including deliberately keeping off the market syringes that could have stretched the supply of flu shots during the 2004 vaccine shortage. In a lawsuit filed Wednesday, Dr. Zeil Rosenberg also alleges that BD, formerly known as Becton Dickinson, refused to upgrade its shoddy clinical studies quality control system, illegally copied a syringe made by another company, and twice tried to ship syringes to Iraq in 2001 without government authorization. Rosenberg’s objections to the Iraq shipments halted them until proper approval was obtained, the lawsuit states.