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PHARMA/POLICY: Quick Plan B update with UPDATE

For those of you still playing along at home, it now looks like the FDA is going to make a final decision on the status of Plan B by September 1. So that should get us to a confirmation of Crawford as FDA Commissioner soon thereafter, although if Plan B is over-ruled I doubt whether the Democrats holding up the confirmation will be best pleased.

Meanwhile one of my dinner companions last night (can you guess the gender?) scoffed at the need for Plan B anyway, saying that if you just take 3-4 normal contraceptive pills it works exactly the same way. I timidly pointed out that if a woman had contraceptive pills lying around the house she probably wouldn’t need Plan B in the first place.

UPDATE: Late Monday Crawford was confirmed as commissioner.

POLICY/QUALITY: A good round up of lefty propaganda, and Berwick gets a gong

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The Christian Science Monitor has a quick diatribe on what a mess health care is, and how the HSA/CDHP movement will be a five to ten years distraction before we end up at some type of universal coverage/single payer.  The article is called Why the healthcare crisis won’t go away and is definitely worth a read as it pretty much encapsulates my views on the matter.

Meanwhile those of you who think that we need an Escape Fire will be amused to know that Don Berwick was given a Knighthood recently. Two quick explanations for you non-limeys. No he can’t call himself "Sir Donald" — you can only do that if you are a Brit (Hence "Sir" Bob Geldof isn’t).  Second, no it’s not in the least likely that the Queen picked him out of a line-up — these awards are nominated by the government, and its just an indication that the quality/pay-for-performance crowd have had quite a bit of influence across the pond.

PBMs: Just to keep you up to date, with UPDATE

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We haven’t heard much about the plans that will end up being the Medicare Part D quasi-PBMs. These are known in CMS-speak as the Participating Prescription Drug Plans [PDP], and they’re going to be selling plans/enrolling seniors and then administering their benefits similarly to the way that PBMs do it for the private sector now. The first enrollment date is November 15th. I looked diligently in this CMS document advising the plans but I couldn’t tell when the applications to qualify had to be in by, but suffice it to say that they are well under way and CMS will presumably soon be announcing which plan is up in which area when.

On the other hand if (as we can assume they will) the current PBMs get into this game, they may have to think twice about continuing some of their business practices. Caremark, for example, is facing even more whistleblower suits about reselling returned stock. Supposing that the Federal government is now the end customer, I suspect some clean up needs to go on across the PBM industry which has sailed very close to the legal wind in recent years and has several state AG suits in process to show for it.

UPDATE: Promoted from the comments, (thanks Matt!) Forbes ran an article last month that I missed on how and why the scams will increase as Medicare Part D takes shape. It’s really worth reading the whole thing. As my old boss Ian Morisson use to say, a claim is an agreement made between a doctor and a patient to defraud an insurer!

POLICY: New York Medicaid fraud

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While I’ve been ragging on Florida, the NY Times has noted something we’ve all known for a while — New York’s Medicaid fraud may reach into the billions. Given that New York’s Medicaid program spends more in total and way more per capita than California’s, the tricks going on within the system there have been going on a long time.

The Industry Veteran comments:

Of the $44.5 billion annually spent on the program, sources tell the Times that as much as 10% is diverted to fraud and abuse. I quote here what I consider to be the article’s key paragraph:

"The lax regulation of the program did not come about by chance. Doctors, hospitals, health care unions and drug companies have long resisted attempts to increase the policing of Medicaid. The pharmaceutical industry, which has spent millions of dollars annually on political contributions and lobbying in Albany, has defeated several attempts to limit the drugs covered by Medicaid; other states have saved hundreds of millions of dollars annually with such restrictions."

I can’t say that this is exactly surprising news and I eagerly look forward to indictments of numerous physicians, hospital administrators and pharmaceutical company vice-presidents. I have written before in THCB my opinion that a large percentage of physicians are amoral, sociopathic mafiosi who lack even the charm of a Tony Soprano. When these “made men” (and women) join forces with the truly narcissistic psychopaths who run our Big Pharma companies, corruption on a scale of the Tweed Ring remains inevitable. I can see why Frank Rich and others refer to the U.S. under George Bush as a new Gilded Age.

PHYSICIANS: Apparently Florida remains exceptional

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Why is there a nursing shortage in south Florida? Apparently it’s because the doctors are very badly behaved, sometimes.

The South Florida Hospital and Healthcare Association, seeking to recruit more nurses from other areas, organized focus groups of nurses who had moved here in the past two years and asked them what they didn’t like about South Florida. ”The No. 1 issue was physician abuse,” says Linda Quick, president of the group. ”Sometimes it was omission — the doctors didn’t engage them in the treatment process. But they also indicated there was hollering, yelling, sarcasm. They indicated it was a particular problem here,” compared to other places they had worked.

As ever Florida is just a strange place. We know their practice patterns are out of whack, we know that health care fraud and corruption is a greater problem there than elsewhere, and we know they can’t arrange elections …and left us with the hopeless bunch of clowns running the show now in charge.

I still think they should tow the whole state into the Caribbean and leave it there.

PHARMA/POLICY: Medicare Part D

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This is a complete cop-out as I’m still hacking away on my Hillarycare piece, and haven’t even read this, but the article in Health Affairs called Riding The Rollercoaster: The Ups And Downs In Out-Of-Pocket Spending Under The Standard Medicare Drug Benefit looks pretty interesting and I think suggests that we have an ongoing spending problem emerging in Part D even before it hits!.

Does one of my contributors care to read it and review? (email me for a Health Affairs pw if you haven’t got one)

POLICY/POLITICS: The evolution of Hillary Clinton and the failure of reform in 1993 (TO BE CONTINUED)

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I have been meaning for some time to write about what really happened in 1993-4.  But I’m finally going to get off my duff (or more accurately) sit on my diff and do it because of the close to ridiculous rubbish written in an article called The Evolution of Hillary Clinton in Wednesday’s New York Times. But as that’ll take me a little while, I’m reproducing the key part of the argument about health care here:

No other policy issue defined Mrs. Clinton in the 90’s as starkly as health care. Not only did her effort to establish universal health insurance end in embarrassing defeat for her husband’s administration, but it also emboldened Republicans and contributed to the notion that she was a big-government liberal. More then a decade later, it is clear that that experience has profoundly altered her approach now that she is a member of Congress.

She has deliberately avoided the major mistake she made as first lady, namely trying to sell an ambitious plan to a public with no appetite for radical change. Over the last four and a half years, she has stuck to a host of more modest initiatives, apparently mindful of the political perils of overreaching. She summed up her approach in the first floor speech she delivered in the Senate about four years ago, when she unveiled a series of relatively modest health care initiatives.

"I learned some valuable lessons about the legislative process, the importance of bipartisan cooperation and the wisdom of taking small steps to get a big job done," she said, referring to the 1994 defeat of her health care plan. She has not completely discarded her 90’s view that there is an urgent need to overhaul the way health care is delivered in the nation. In fact, she has not been shy about embracing proposals that might be seen as liberal in some quarters, like seeking to provide medical coverage to everyone living in poverty.

But on the whole, Mrs. Clinton, who has served in a Republican-controlled Congress for most of her tenure, has assembled an agenda with practical-minded initiatives that appear to be aimed at the political center.

Perhaps one of the most notable is one that drew support from unlikely quarters: Senator Bill Frist, the conservative majority leader from Tennessee, and Newt Gingrich, the former House speaker who had a major role in defeating her health care plan in 1994.

The bill these three embraced seeks to encourage greater online exchanges of medical information among patients, doctors, medical insurers and other health care experts. Mrs. Clinton has argued that such an approach would, among other things, reduce medical errors resulting from poorly kept paper records and reduce the number of costly malpractice suits.

She has denounced the "contagion" of sex and violence in children’s entertainment, apparently attempting to move the issue beyond the question of morality and values, where Republicans have long held a political advantage. Citing studies indicating that graphic images of violence lead to more aggressive behavior among children, she has cast the problem as a health issue that amounts to an epidemic and requires a vigorous response from public health officials.

Her longtime focus on children’s health has also continued through her Senate service, most notably in the passage of legislation she sponsored ensuring that prescription drugs approved for adults but prescribed for children be tested for children.

I’ll be back later to explain why Hillary Clinton doesn’t understand what went wrong in 1993-4 and why that may have some big time implications if she is the candidate in the game of "continue the dynasty" that we’ll be playing in 2008 or 2012.

Meanwhile, read the full article

To Be Continued

BLOGS/TECH:Sacred Cow Dung and physicians and technology

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Chris Mayaud is one of the more amusing entrepreneurial doctors it’s been my pleasure to go drinking with and have on the odd panel (Also the only one ever to use an almost appropriate 4 letter word and get away with it!). He also was a founder at Physicians’ Online and these days appears to be the most connected person in the world on Linkedin as well as being some type of venture capitalist (although I’m still waiting for the check!).  And of course he’s got a blog, called Sacred Cow Dung — pretty interesting stuff mostly about the VC world, and you can usually get him to buy you a beer if you’re visiting New York.

Here’s a interesting post he put up a few weeks back on why it’s not doctors’ fault that they don’t use IT — Sacred Cow Dung: MYTH: Physicians are Resistant to New Technologies.

TECH: PHRs for health plan members…maybe, maybe

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And in the bitter, twisted segment of THCB this week, apparently Empire Blues will be offering personal health records to their patients. And the records will be prepopulated for the members with information gleaned from claims data. including outpatient lab test results, physician visits, hospital stays, reported diagnoses and prescriptions. They can also (self-enter, I assume) values, such as cholesterol levels, that can be grouped together and graphically tracked over time. They’re using WebMD (who bought Wellmed, the last man standing in the PHR space phase 1 c.2002) to provide the service.

This is a screamingly logical thing for health plans to do. It gives them a compelling front end web application for their members, and thus gives their members a reason to stick with the plan (given the choice, although I know a lot of members are not). In addition they are the only ones who’ve got the majority of a member’s data all in one place. The only real exceptions are providers with a full service HMO like a Kaiser or a Group Health of Puget Sound who can then offer views into their electronic medical record system (e.g. MyEpic). For the traditional health plans, who’s CRM for their members has been completely crap for decades, this is an easy and relatively cheap way to improve their "customer service".

I’m just a little bitter that they’ve decided to do it now rather than FIVE years ago when I was selling exactly the same thing….

However, if any health plan or tech company wants to know more about this, I will work for food.

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