The Health Care Blog – Page 829 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

THCB CEO denies improper relationships, payoffs

Apr 30, 2010• 5

By THCB Staff

The Health Care Blog’s Founder & CEO Matthew Holt today announced a policy of absolute transparency concerning the rash of “inappropriate relationships” apparently infecting the health care blogging community. Holt released this statement:

I can categorically deny the truth of any rumors suggesting that anything inappropriate has been going on in the relationships between myself and any THCB staff members. While anonymous contributors may have uploaded perhaps unseemly photographic evidence to Facebook of such a relationship, I’m here to stamp out any rumors that the employee concerned was getting more than special treatment in other areas. I’d also like to state for the record that he is still on the THCB staff, and also that any treats he receives around the neighborhood are direct gifts from the giftees concerned over which I have no influence, and I am not paying off Maria at the Java House for her bacon treats.

Reached while sneaking off early on a Friday to coach Little League, THCB Managing Editor John Irvine was said to be quote “Extremely relieved” that Holt was not having any inappropriate relationships with staff members, as “there aren’t any other staff other than me!” and he “didn’t think I’d enjoy it very much."

Upon being informed that apparently other inappropriate relationships have led to large pay-offs and bonuses, Irvine changed his tune somewhat and started inquiring exactly what level of inappropriateness he’d have to put up with, and how big the bonuses were.

To Know and Be Known

Apr 30, 2010• 7

By ROB LAMBERTS, MD

I was happy when I looked at today’s schedule.

Two husband and wife pairs were on my schedule, both of whom have been seeing me for over ten years. Their visits are comfortable for me; we talk about life and they are genuinely interested in how my family is doing. They remember that I have a son in college and want to know how my blog and podcast are doing. I can tell that they not only like me as a doctor; they see me, to some degree, as a friend.

Another patient on the schedule is a woman from South America. She has also been seeing me for over ten years. I helped her through her husband’s sudden death in an accident. She brings me gifts whenever she goes on her trips, and also brings very tasteful gifts for my wife. Today she brought me a Panama hat.

I know these people well. I know about their past illnesses and those of their children. I know about their grandchildren, having hospitalized one of them over the past year for an infection. I know about the trauma in their lives as well as what they take joy in. They tell me about their trips and tell me their opinions about the health care reform bill.

I spend a large part of their visits being social. I can do this because I know their medical situation so well. I am their doctor and have an immediate grasp of the context of any new problems in a way that nobody else can. This is not just in the context of their own medical ecosystem, it is in the larger family context. This means that I know how to read between the lines when they say something – knowing what I can ignore and what subtle things are out of character. This also means that I don’t have to practice defensive medicine – as I not only have a low risk of lawsuit, I also can rely on my intimate knowledge of them to keep excessive ordering of tests and referrals to a minimum.

That is the joy of primary care that doesn’t get talked about as often as it should: I have a genuine personal investment in my long-term patients. I know them and am known by them. It is also a much more efficient way to practice medicine. I don’t have to order tests to get information when my personal information is so great.

A 21% cut in Medicare may have put an end to it. When we were staring down the barrel of losing that much revenue, we seriously talked about our threshold for dropping Medicare. The political game of chicken was not only played at the expense of physicians, it put great fear into many of my long-term patients that they would lose me as their doctor. Yes, many of them would probably ante up and pay cash to maintain that relationship, but a new negative dynamic would definitely be thrown into the mix. Some just couldn’t afford to pay me out of pocket (even with a discount).

We need a system that encourages relational medicine rather than discouraging it as our system does now. Getting a bunch of mid-level providers in Walgreens is not the same as having an adequate primary care workforce. I cherish my relationships with these people and they are, to a very large extent, the reason why I haven’t seriously contemplated dropping Medicare until recently. I am a very important part of their lives – a stabilizing force that helps them deal with the difficulties of getting older and getting sick. But they are an important part of my life as well. I have a personal stake in their health because they bring me joy and connection.

After the visit, I gave the woman a big hug. I was wearing my Panama hat.

My nurse says it would look good with my Jimmy Buffett shirt.

Rob Lamberts, MD, is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.

ProPublica’s Pulitzer piss-take

Apr 30, 2010• 6

By Matthew Holt

In a decade when there are countless really, really important issues to investigate in health care, ProPublica took more than $400,000 and spent it on a rehash of a well known story. The story was about a completely exceptional circumstance that will likely never happen again. The original criminal investigation against the alleged perpetrator of the “crime” was abandoned. And the big important result that this new investigation caused in our health care system? Nothing.

This was a complete waste of resources in an era when very few are available to investigate the major issues in our health care system which cause so many problems for so many people. Could ProPublica really not think of any other major investigative health care story to pursue? Like one that impacts millions of people? They could have asked me for a few suggestions. Instead they went looking for something that was purely sensationalist, akin to the National Enquirer chasing down Tiger Woods.

And now whoever awards Pulitzer prizes has decided that this is the best investigative reporting of any kind done last year. Pathetic.

I repeat–where the hell is Lisa Girion‘s Pulitzer?

Does Market Power Help Patients?

Apr 29, 2010• 14

By PAUL LEVY

Rob Weisman and Liz Kowalczyk report in today’s Boston Globe that the US Justice Department is investigating possible antitrust violations against Partners Healthcare System, the dominant hospital and physician provider group in Massachusetts.

The letter, obtained by the Globe, said the probe sought to determine whether the practices violated the Sherman Antitrust Act, which bars companies from using their market power to limit trade or artificially raise prices.Continue reading…

The New Joint Commission

Apr 28, 2010• 4

By BOB WACHTER

Until about 8 years ago, inspections by the Joint Commission (TJC) were predictable and fairly silly. Hospitals were given a couple of years’ notice of the week that “The Joint” would be visiting. Everybody scurried around preparing – waxing the floors, locking up all the medications, that sort of thing. (It always struck me as the most dangerous day to be in the hospital, since nobody could find any of the medications, and the floors were slippery as hell). After arriving, the inspectors spent most of their time sealed in a conference room, pouring through policy manuals (we dusted them off before the visit) and meeting with administrators, exposed to whatever reality the hospital wanted them to see. It was an ineffectual kabuki dance.

Last week, the Joint Commission visited UCSF Medical Center. Luckily, our director of regulatory affairs, Jolene Carnagey, is tasked with checking the TJC website every Monday at 7:30 am to see what hospitals they’ll visit that week. Because of this, we had advance notice of our inspection – by about 15 minutes! Once Jolene spotted UCSF on the TJC schedule, she sent stat alerts to our key people, like a parental phone tree on a school snow day.

By 7:45 am, there were half-a-dozen TJC accreditors in our hospital lobby.

As important as the unannounced visits (which are, of course, what you’d want if you were a patient), TJC has made other major improvements over the past decade. The inspectors spend far more time walking around on clinical units – talking to docs, nurses, hospital administrators, and patients – and less time wading through policies and procedures. Their agenda is a bit less focused on the nitpicky “Standards” and more on a series of National Patient Safety Goals that TJC began issuing in 2003 – things like the pre-operative time out and developing methods to analyze errors and use the results to improve safety. The important stuff.

Lisa Girion is a hero

Apr 28, 2010• 7

By Matthew Holt

One reporter changed the behavior of every health plan in California all by herself.

Even before Tuesday’s announcements, however, health insurers in California had all but stopped the number of policy cancellations, state records show. Last year, only four such cancellations were reported to the managed healthcare department, down from 1,552 in 2005.

Where the hell is her Pulitzer prize?

Reg strikes back! Apparently Wellcare were a bunch of crooks after all. Maybe

Apr 28, 2010• 4

By Matthew Holt

Everyone’s favorite Harvard Business School professor is back in the news. Those of you with long memories may remember that at THCB I’ve been a tad critical of Regina Herzlinger’s ideas, her presentation of said ideas and—resulting in a letter from her lawyer whose previous gig was writing the Patriot Act—her stewardship of the shareholders and other stakeholders of Wellcare. Wellcare is a pretty scummy Medicare and Medicaid HMO in Florida. The scuttlebut I heard about Wellcare a few years back was that it was hiding money offshore in some weird re-insurance arrangement with a fully owned subsidiary, and was essentially faking profits a la Enron.

While that may or may not have been exactly accurate, Wellcare was certainly overcharging its client, the taxpayer in Florida. It was raided by the FBI and eventually settled with the state.

What did one of its best known directors says when she joined the board in 2003?

Dr. Herzlinger said, “WellCare is a case study of a successful public-private partnership, and a model for delivering quality affordable healthcare. Over the years to come, companies like WellCare that reach out to members with information, wellness planning and screenings will be agents of change in the delivery of managed care under government programs.

So by late 2007 Herzlinger had been on the board for four years. What had been her major achievement given the the close-to-criminal activity that was going on the company? Oh yes, it was selling nearly $2.3m worth of stock—completely coincidentally—three months before the FBI raid when the stock was worth 5 times what it fell to shortly afterwards.

And then early last year (2009) Wellcare was suspended from Medicare sales for more bad behavior. Did Regi resign at that stage? Uh….no.

But on Friday she actually did quit!

Doing it on the radio? Yes we can!

Apr 27, 2010• 2

By Matthew Holt

Last week Indu and I were on the Patient Power show run by Andrew Schorr and Peter Frishauf (who is an old friend and founded Medscape). It’s a show aimed at consumers and we’re very interested in getting the word out about Health 2.0 direct to consumers. Here’s the show and it’s both well done by Andrew and Peter, and Indu (at least) sounds very intelligent!

In addition I and a team of cohorts will be starting a (brief) spot twice a week on KOMO 1000AM/97.7FM a news radio station in Seattle. I have also recorded my first spot about technology and policy for doctors for ReachMD—a radio channel exclusively for physicians with which THCB has a new agreement. So watch out for yet more radio stardom.

By the way, the full excerpt from Educating Rita is:

In reply to the question, “Suggest how you would resolve the staging difficulties inherent in a production of Ibsen’s Peer Gynt” you have written, quote, “Do it on the radio.”

Healthline on a roll: new funding, Yahoo! deal

Apr 27, 2010• 5

By Matthew Holt

Healthline has been a company that we’ve been looking at since we very first started talking about Health 2.0. Check out the very first podcast about Health 2.0 on THCB with Healthline’s Dean Stephens back in late 2006. In fact its roots go back to Yourdoctor.com in the halcyon days of the late 1990s, but these days Healthline uses its taxonomy based search to provide search and content for not only Healthline.com, but also enterprise software for Aetna & UnitedHealth Care, as well as powering health search on several media sites like Ask.com, US News & World Report and AOL. It’s been a hectic couple of weeks for Healthline and I spoke with CEO West Shell about several new developments.

Matthew: First off, tell me about the new funding, and tell me about the state of the business.

West: Healthline just raised another $14M led by new lead Investor Growth Capital. Several previous investors including GE/NBC and Reed Elsevier also were in this round. We doubled the scale of the business last year and this round is designed to add some incremental investment in our R&D for the network services business. We’re doubling down to accelerate the growth of the company. The total capital we raised is now $50m, and this follows on from our last round about 2.5 years ago. We’re already cash-flow positive and profitable, and although we’re not releasing figures, but we have about 100 people—so you can make your own educated guess.

Matthew: You run your own web site, you provide software for enterprise clients, and you have your own advertising network. Where do you aim to spend the money?

West: Essentially we’re investing heavily in expanding R&D. We’re hiring more engineers, more medical informatics staff. We think that this combination is why the big partners are choosing us. Taking on new partners means we need to build out our network services business. We need to support customers and we need to keep delivering the search, content and advertising that they’re looking for.

We’re also investigating some M&A opportunities; we looking both at some technology and content assets. We think that there are some interesting Health 2.0 technologies that would make a good addition to our current portfolio. Lots of small companies have built innovative tools but they don’t have the scale that we have—now over 100 million visits across all our network—so we can help monetize what they’ve built.

Dear Mr. President

Apr 26, 2010• 64

By ROB LAMBERTS

I am writing this as a representative of the examination room – one who sits facing patients, dealing with our healthcare delivery “system” on a daily basis. I am writing this as one who will bear the brunt of what you accomplish or fail to accomplish in your attempts to reform our “system.” I write this as a primary care doctor who makes a living (or not) by what I earn from that “system.” I write as someone who has seen people not take medicine they need, not get the help they should, and not care for themselves as they should because of our “system.”

I talk to patients every day about what you folks are doing, and let me tell you what they are saying: nobody has any confidence in you whatsoever. Whether conservative or liberal, insured or not, black or white, elderly or young, all of my patients express frustration, disillusionment, and pessimism over your chances at getting it right. Nobody is confident, nobody is all that passionate anymore, and nobody is holding their breath.