Health Business Blog

When medical device companies recall their products, they typically notify only physicians, not patients in whom the devices have been implanted. That might be fine if physicians were set up to systematically notify their patients, but sadly many are not.

The Boston Globe wrote about this problem recently Doctors see flaw in device recalls

”If your car tires have the potential to malfunction, you as a car owner get a letter,” said William H. Maisel, a cardiologist at Brigham and Women’s Hospital in Boston. “It’s remarkable to me that if you have a [problem] device, you are not notified directly.”

But some in the device industry have a more paternalistic view.

Robert B. Nicholas, who represents some medical-device companies as head of the FDA practice at the law firm of McDermott, Will and Emery in Washington, said companies sometimes negotiate with regulators to avoid the bad publicity associated with recalls. Also, Nicholas said, sending notices to all consumers might needlessly worry some of them because they are not as well informed about the issues as their doctors.

Is there really any reason not to notify both doctors and patients?

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A little-noticed aspect of the growing US military activities is the impact of veterans on the health care system. The Veterans Administration –essentially a single payer, socialized system– is well known for its use of information technology and management of chronic care patients. (22 years ago I had a summer job at a VA hospital developing a computerized decision support tool on a DEC PDP-11.)

With more fighting and a larger military, we are seeing more veterans, and more disabled ones coming into the system. As a result the VA’s caseload is rising faster than had been expected, and the Senate had to approve an emergency $1.5 billion allocation for VA medical services yesterday. Believe me, that’s just the start.

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Aggressive and abusive behavior appear to be rising at US healthcare facilities due to overcrowding, longer waits, and an influx of individuals with addictions or psychiatric disorders, said Gail Lenehan, editor of the Journal of Emergency Nursing…

…in the Boston Globe (Hospitals support measures to protect nurses).

Where’s DrTony with the Mid-az-o-lam when you need him?

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From iHealthBeat, here’s some more fodder for the recent debate on whether technology drives medical costs up or down.

Infection-tracking technology has saved four Alabama hospitals that have participated in the Alabama Hospital Quality Initiative for two years a total of $4.96 million in addition to “an incalculable amount of needless patient suffering,” HealthLeaders reports.

The software helps hospitals identify root causes of infection outbreaks quickly, which lets them react before it’s too late.

Process technology tools like this, which spots problems early before they spiral out of control, should keep costs down. On the other hand, technology that opens up new avenues of expensive investigation and testing –like some advanced imaging tools– may drive costs up.

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As reported here, Cisco recently made its first investment in a health care company, RelayHealth. Among other features, RelayHealth offers webVisits (also called E-visits) that are effective, efficient substitutes for certain office visits.

Like other employers, Cisco is trying hard to get a handle on rising health care costs. And like other technology companies such as Dell, they are hoping to leverage information technology –not just cost-shifting to employees– to do so. Jeff Rideout, MD, Cisco’s corporate medical director and VP of health for Internet business solutions told InformationWeek:

“We want to keep the lid on the rate of increase by using a health IT strategy.”

While the insurance industry has adopted a new billing code for E-visits, very few health-care providers offer those visits, and few health-insurance companies reimburse for them. More doctors would provide those E-services if payers reimbursed them, Rideout says, and Cisco wants some of its largest health payers, including Cigna and United Health Care, to do so.

Cisco is putting its money where its mouth is by taking a stake in RelayHealth.

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John Hagel at Edge Perspectives has a good discussion of the Myelin Repair Foundation’s (MRF)innovative approach to development of a treatment for MS. I’m a big fan of the MRF (see Research funding levels are only part of the story) so I’m glad to see it getting some attention.

I donate time and money to MRF. If you want to support them, donate here.

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Judy Foreman in the Boston Globe asked, Why can’t people hospitals be more like those for animals? Consider:

• When her cat was in the hospital, the cardiologist called her twice a day with updates
• Other staffers called during the day with updates, and she could call in any time and have updates read to her off the computer

Foreman interviewed a Harvard School of Public Health professor, whose dog was hospitalized.

“The cardiology resident called me every single day. Yet I’ve had the personal experience with human relatives where I could never get through to the physician or resident.” Discharge instructions…are…”better in well-trained veterinary programs than in many discharges from [people's] hospitals.”

A lot of the usual excuses for poor service in people hospitals are trotted out:

• Fear of lawsuits
• Paperwork
• Low reimbursement
• Privacy rules
• Complexity

But I think the real answer is we could do better if we made customer service a higher priority. That’s why I favor efforts by CMS to reward hospitals financially based on patients’ satisfaction with their experience.

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Some employees are facing $100 co-pays for branded drugs, which could be more than the retail price!

Separately, clinical trials are under way to see whether placebos can be used to reduce drug dosage or frequency of administration.

If the placebo plan proves out, the $100 co-pay for sugar pills won’t be far behind.

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Welcome to Grand Rounds XL, this week’s best of the medical blogosphere.

If you think HMOs are tough, wait till you hear about DrTony’s encounter with a Glock-wielding dope fiend.

Kevin, M.D. laments that defensive medicine means you can’t treat anything over the phone anymore. Is that why DrTony’s patient was so worked up?

If you’re wondering whether The Well-Timed Period merits its tagline, “At the intersection of medical fact and fiction,” read Fetus in Fetu, about a 16 year old boy carrying his twin brother in his body, and all doubts will vanish!

Information is Free explains that “the terror threat system doesn’t work, on a basic logical, psychological level.” Luckily the rest of the Federal government is working so smoothly.

Anyone reading from pharma product development? GruntDoc wants to know, Where are the combination products for drug resistant bacteria? The recommended treatment is two drugs and pharma loves combination products –so what’s up?

Catallarchy picked up where my Health business blog left off on the role of technology in driving up health care costs. Turns out things are not so simple!

Iatremia: The Chaplin.News reports on an innovative scheduling scheme to comply with laws limiting house staff to 80 hours per week.

Despite all the abuse, Respectful Insolence (a.k.a. “Orac Knows”) just can’t help making one more post challenging attempts to link thimerosal and autism.

Red State Moron writes about the difficulty of establishing quality measurements in OB and the pervasive culture of perfection in medicine.

Turns out doctors use Google, too, according to Clinical Cases. (Maybe that’s why the stock’s up to $300.) Luckily, most physicians are a little more discerning than the typical layperson and don’t make decisions based on what they read on blogs!

Although the country has a nonviolent reputation, apparently you can get away with murder (or at least manslaughter) in Canada, as long as you’re a pharmacist. Interested Participant tells us all about it.

In case that’s not bad enough, I pointed out in the Health business blog earlier this week that Shopping Around for the Best Prices Can Kill You.

Different River tells us that providing food and beverage can be considered “heroic measures,” that can be denied.

Two (presidential) terms later summarizes the resolutions passed at this year’s AMA meeting.

Aggravated DocSurg is bent out of shape about spending public dollars on chiropractic services.

In case you’re stuck, HealthyConcerns has a three-part series on how one doctor is trying to escape the “trap.” (He didn’t have to resort to gnawing his leg off.)

In the Examining Room of Dr. Charles, we learn about one man’s unpleasant encounter with a ten by eleven centimeter “stool ball.” (Threat level: Orange.)

Insureblog wants us to give Massachusetts Governor Mitt Romney’s compulsory health insurance plan a chance. If nothing else, it will be a good preview of Mitt’s rumored run for higher office.

A Chance to Cut is a Chance to Cure comments on the success of anesthesiologists in improving patient safety and reducing their own malpractice premiums, but laments that it may be more difficult and less successful as surgeons try to follow in their footsteps.

Dr. Jennings wants us to know about Pulmonary Roundtable, a new blog for discussion of cases about pulmonary or critical care medicine.

Dr. Bob writes a touching tale about a family that lost its children in a tragic plane crash in Alaska. Has anyone else noticed the number of fatal small plane crashes in Alaska? It’s not a coincidence –it’s dangerous.

MSSPNexus Blog reflects on the competence of older physicians, drawing a parallel with firefighters. The problem sometimes isn’t age, but complacency.

Speaking of danger, Parallel Universes provides an update on the status of malaria in the Philippines. You can’t always keep the mosquitoes away, so avoid places where malaria is endemic.

Who’s that lurking in the corner (and will he buy my staff some pizzas?) The Krafty Librarian reports that drug companies are keeping tabs on every prescription doctors write.

Next week’s Grand Rounds XLI will be hosted by self-described Connectologist, Tim Gee at Medical Connectivity. In this post, he discusses the Current State of Medical Device connectivity in hospitals.

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I’ll be accepting submissions for tomorrow’s Grand Rounds XL until 9 pm Eastern today. Please send to dwilliams@mppllc.com

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