The Health Care Blog – Page 974 – Everything you always wanted to know about the Health Care system. But were afraid to ask.

Above the Fold

What’s on the horizon of Medicine 2.0

Sep 15, 2008

By Neil Versel

Travel and deadlines got in the way of me posting about the second day of the recent Medicine 2.0 Congress in Toronto, but I saved my notes.

Something super-cool I saw there: Medting.com, a "global" repository of medical images, developed in Spain and soon to branch out to the U.S. Is it another YouTube for medicine? Not exactly. Miguel Cabrer, president of the company, sees it as more like a Snomed for multimedia.

In Canada, they’re getting interactive with physicians.

Late last month, the Canadian Medical Association launched a social networking portal called Asklepios—named after the Greek god of medicine—on its site. Access is limited to physicians, but CMA online content director Pat Rich says it’s partially in response to doctors who bemoan the demise of the staff lounge.

In the spirit of Facebook and MySpace, it is more than just a professional site; physicians can use Asklepios for blogging, discussing hobbies, posting photos and even, theoretically, dating.

Has Steve Poizner gone soft?

Sep 12, 2008

By Matthew Holt

California’s de facto health insurance commissioner Lisa Girion reports on California’s actual Insurance Commissioner Steve Poizner’s agreement with Healthnet. After all that fuss, the deal is that Healthnet pays $14m in canceled medical bills, reinstates around 1,000 canceled policy-holders and pays a $3.6m fine. Poizner agreed to this despite all his tough words of not too long ago.

How is it that the punishment fine is less than the cost of the offense? So let me see. Don’t pay $14m in medical bills you’d agreed to insure, and either get away with it, or run the slight risk of not getting away with it and pay $18m several years later. That’s a deal any self-respecting egregious booty capitalist would take. And let’s face it being one of those is a requirement of the job to run a health plan these days.

Of course, the separate $9m fine Healthnet has already seen in one case alone—handed down by an arbitrator whose decisions cannot be overturned later—gives a clue to what the real damages will be in the courts should these cases get there.

So no wonder Shernoff and the trail lawyers are pissed that this settlement may undercut their case. And why has Poizner rolled over?

UPDATE: Darrel Ng, Press Secretary at the CA Department of Insurance is working late on Friday and responded to this post "One of the highlights of the settlement is that by accepting the payments and health insurance, patients do not have to forgo future litigation. So while I know critics have made the assertion that their case may be undercut, I’m not sure why they would believe that’s the case." Darrel didn’t explain why the fine for one case in arbitration was three times the fine for 1,000 cases from the DOI.

Perils of Pay for Performance

Sep 12, 2008• 4

By Josh Siedman

Dr. Sandeep Jauhar wrote an essay this week in the New York Times about the perils of pay-for-performance (P4P). Specifically, Dr. Jauhar discusses how P4P may have unintended consequences and create perverse incentives due to poorly designed performance measures. The point is well taken, but it’s important not to confuse the merits of P4P with the measurement issues that exist.

With respect to the latter, back in my days as Director of Measure Development for the National Committee for Quality Assurance (NCQA), I co-authored a paper with Partners’ cardiologist Tom Lee, Jim Cleeman from NHLBI, and others working with us at NCQA on the development of new HEDIS cholesterol management performance measures. In the JAMA article, “Clinical Goals and Performance Measures for Cholesterol Management in Secondary Prevention of Coronary Heart Disease,” we tried (among other things) to communicate the difference between quality improvement measures and comparative performance measures.

Wonder if your doctor is laughing at you?

Sep 12, 2008• 3

By Sarah Arnquist

That CNN headline grabbed my attention and got me to read a column that basically chastises the 17 percent of internal medicine residents who reported they had laughed at patient in a survey published in JAMA.

The author then goes on to express great relief that 94 percent of those who find humor in their patients considered it unprofessional behavior.

Lighten up! Of course, no doctor — or any professional for that matter — should laugh in a patient or client’s face or use humor maliciously. That’s basic human decency.

But humor is a release, and in a work environment as stressful as a
hospital, people need a release. Maybe that release should occur
outside the hospital walls, but funny things occur in stressful
environments and people do strange things that often merit a chuckle or
two.

McGuire not in prison. Reyes is. Anyone understand?

Sep 12, 2008• 18

By Matthew Holt

So Bill McGuire has settled with CALPers in the scandal where he backdated the value of his United HealthGroup stock options. He’ll pay a $30m fine which sounds a lot but is a rounding error on his net worth. So it appears that his troubles are over.

Meanwhile Gregory Reyes the CEO of Brocade did exactly the same thing and he’s doing 21 months in the big house as well as paying a similarly big fine.

For that matter Steve Jobs apparently did the same thing too, and just today Apple settled with the SEC for a mere $14 million (or about 8 minutes of iPhone sales) and Jobs himself doesn’t seem to be paying anything.

Isn’t there something about equal treatment under the law in one of those fuddy-duddy 18^th century documents we Americans are so keen on? Can anyone explain the rationale behind these differences in treatment?

Remember pensions? The big differences between Obama & McCain’s health care plans

Sep 11, 2008• 8

By Robert Laszewski Politics

This election is different than any other on the issue of health care because both candidates are giving us serious blueprints to reorganize America’s health care system and those blueprints are very very different.

As voters, you have a huge and critically important choice on health care.

There are dozens of details upon which they differ and for those I would point you to my comprehensive posts on the McCain Health Care Plan and the Obama Health Care Plan.

But to understand their big idea differences, I would point you to our pension system to better understand where McCain and Obama are going on health care. Back in the 1960s and 1970s, it was common for workers to have what is called a defined benefit pension plan.The worker got a promise from the employer that when retirement came he’d get a certain monthly benefit — often about 60 percent of his final average earnings. That might be $2,000 a month — every month for the rest of his life. Therefore, a defined benefit.

No such thing as Free Lunch

Sep 11, 2008• 1

By Matthew Holt

I’m over at Spot-On today writing about a great new book I’ve read, "Free Lunch." Check
out and it, and, as always, come back here to comment. Here’s a taste of what you’ll find.

Few of the books I’ve read lately have been quite as staggering as Free Lunch, from former New York Times investigative reporter David Cay Johnston who, heroically, made his career writing about – brace yourselves – the U.S. tax code. Free Lunch is a fabulous book by a veteran investigative reporter giving you his life’s work–a look at how corporations and wealthy Americans have profited, again and again, at the expense of you and me.

Johnston’s best known for his exhaustive investigations at the Times into how corporations and very very rich individuals subvert U.S. tax law so that they pay less to the government, while the rest of us pay more. But in this book – written after he’s free of the "responsibility" of being a Times reporter – he gets almost biblical in calling out the cheats, crooks and murderers.

Conference to explore innovation in health care

Sep 11, 2008

Second Annual Innovation in Services Conference: "The Service of Health Care"
explores the innovations in technology, policy, operations and methods that address the deceptively simple question: How can we improve the service of health care?

Panels of academic, technology, government and policy experts will discuss the impact of information and digital service on patient care, considering such innovations as telemedicine, mobile services, serious gaming, personal health records, and Web 2.0.

Conference agenda and registration information are available here. A limited number of complimentary spaces are available for students and those with demonstrated need. For more information, please contact CITRIS at (510) 643-2217, or ci****@*******uc.org.

Using social networking to breakdown research silos

Sep 10, 2008• 8

By John Halamka

On September 4, a group of collaborators at Harvard launched a new website called Catalyst that is publicly available. I encourage you to visit it.

This site is remarkable in many ways. It brings together all the people, lifelong learning, and resources for the Life Sciences across Harvard and its affiliates.

In the People area, you’ll find social networking for the research community called Profiles. It not only shows traditional directory information, but also illustrates how each person is connected to others in the broad research community.

The never ending stent-bypass debate

Sep 10, 2008• 2

By Charlie Baker

A new study – a big one ($50 MM) – was recently released that compared the short and long term effects of drug eluding stents to bypass surgery for patients with serious heart disease. The headlines — “Heart Surgery Bests Stents” — pretty much told the story. In this particular case, 18% of those patients who had stents installed to treat their disease ended up either dying or needing another treatment over the next twelve months. Only 12% of bypass patients ended up with complications or passing on. The death rate in both instances was the same – 8%.

Stents — the tool of choice for interventional cardiologists — and bypass surgery — the technique of choice for cardiothoracic surgeons — have been playing this “which is better” game for almost ten years. Needless to say, both sides were represented in the stories that ran covering the results of this study. The bypass surgeons said, “More people should have bypass surgery instead of stents.” The stent docs said this study proved that stenting – which involves a much less aggressive and invasive procedure than bypass surgery — comes in a close second to bypass surgery, even in patients with complex conditions.