Health Business Blog

A powerful New York healthcare union with a $20 million annual organizing budget and a quarter of a million members is poised to merge with a Boston local and intends to launch a major organizing drive at the city’s top teaching hospitals.

So says the Boston Globe (Union looks to organize at Hub’s top hospitals).

Like other organizations, the Service Employees International Union (SEIU) has found health care to be a growth market. Apparently this group has done well in New York by teaming up with hospital leaders to push for extra funding.

I hope the union won’t push for restrictive work rules and arbitrary staffing ratios that retard quality improvement. I’ve criticized Massachusetts nurses for this in the past.

It would be a shame for great initiatives like those of the Institute for Healthcare Improvement to be thwarted by traditional union tactics.

Does anyone know of SEIU’s record in this regard?

Share

“Pfizer falls from ranks of top 10 US advertisers,” shouts the Boston Globe today. According to the article this is because the FDA has taken a “tougher stance” on advertising this year and because of a consumer backlash against Direct to Consumer (DTC) ads.

All of that is true. But as I’ve written before (see Pulling the plug on TV advertising for drugs), another reason is that DTC ads don’t work that well. Pfizer’s sales of Viagra held steady when the FDA temporarily ordered the ads off the air earlier this year. Pfizer is finding better uses for its marketing budget.

Share

MedPundit reviews the new medical expense manager from Quicken. Sounds like a useful tool for consumers seeking to track and manage their medical expenses. Consumers are sophisticated in managing their household expenses. To the extent that health care can be treated the same way the power of the consumer can be unleashed.

Share

Victims of Hurricane Katrina will need a lot of help. An Associated Press article in the Boston Globe describes how rough conditions are in New Orleans area hospitals. Several hospitals have been evacuated. Here’s a description of one that’s still open:

…broken glass littered some areas, and patients and staff had fallen on floors slick with hurricane waters. With electricity and air conditioning out, generators were providing the only power. Some areas had no working elevators or phones.

If you’d like to make a donation for hurricane relief efforts, here are some suggestions:

• American Red Cross 1-800-HELP NOW
• AmeriCares 1-800-486-HELP
• The Humane Society of the United States 1-888-259-5431
• United Jewish Communities 1-212-284-6500
• United Way of Miami-Dade 1-800-226-3320

Charity Navigator makes the following suggestions:

• Give to an established charity
• Designate your gift toward hurricane relief. (On the other hand, my view is that you should consider giving to their general efforts instead or in addition if you support their mission –DW)
• Avoid telemarketers
• Research the charities and follow up in a few months to see how your gift was used

Share

Grand Rounds #49, the best of the week’s medical blogosphere, is up at HealthyConcerns.

Share

Check out Fixing Healthcare From the Inside, Today in the Harvard Business Review. Author Steven J. Spear documents lessons learned from the Institute for Healthcare Improvement (IHI), which I’ve written about before. If you don’t have time for the whole article, you can read Spear’s summary of it (The Health Factory) in the New York Times.

The Institute has been applying best practices from industry to health care processes, following in the footsteps of companies like Toyota, Alcoa, Southwest Airlines, and Vanguard. The principles of operational excellence are outlined in a sidebar:

• Work is designed as a series of ongoing experiments that immediately reveal problems
• Problems are addressed immediately through rapid experimentation
• Solutions are disseminated adaptively through collaborative experimentation
• People at all levels of the organization are taught to become experimentalists

Spear provides case studies that show how these principles can be applied to reduce infection rates, reduce medication errors, and improve process flow to increase efficiency and customer service. I posted here on the results of this sort of approach applied to C-sections when my wife was at Beth Israel recently and also noted how far they still have to go on more routine processes.

I’m a big fan of these sorts of initiatives. They are much more promising than the typical pay for performance (P4P) approach, which sets quality and cost targets for providers without the process support needed to help them achieve systemic improvements. P4P is also somewhat insulting to providers, whose commitment to quality is assumed to be manipulable with small injections of cash in a few places. Luckily, P4P is not incompatible with the IHI approach.

I’m encouraged that IHI is making an impact in the real world and that it’s becoming better known among the general public.

Share

For no good reason, Bloglines stopped updating my RSS feed on August 19 and only picked it up again last night. Hopefully that problem won’t recur. If it does you can still click on the “Health business blog” hyperlink at the top of the page.

Share

There are some lively comments on the posts about the JAMA fetal pain article. (See Reaction to fetal pain article and Politically charged journal article of the week.) One commenter wondered why the authors didn’t disclose their affiliations (one used to work for a pro-life group, another is a medical director at a clinic that performs abortions).

So I sent an email to the corresponding author Dr. Mark Rosen, and he replied as follows:

Please read the instructions to authors for JAMA, and take careful note of the editor’s comments made to the press about the relevance of this ‘failure to disclose’. There is no precedence for disclosure of clinical activities for physicians publishing a peer-reviewed, scientific article. The fact that Dr. Drey performs abortion procedures and the less than one-year employment of the medical student (more than 3 or 4 years ago) posed no bias and had no relevance to the content of the article. Those who wish to comment on our science, I’m pleased to engage, but to focus on this issue of disclosure seems like a subterfuge. Note that I didn’t ‘disclose’ that I have been providing anesthesia for fetal surgery for over 25 years, in fact, ‘invented’ the field.

Mark Rosen

Share

The Massachusetts eHealth Collaborative (MAeHC) is featured in today’s Boston Globe ($50m test seeks to end doctors’ paper chase). The collaborative is perhaps the most promising of the many similar-sounding initiatives going on around the country, and I’ve written about it here and here. That’s because MAeHC is properly funded, has the entire health care community on board, and is run by people who know what they’re doing, including CEO Micky Tripathi.

Blue Cross Blue Shield is picking up the entire tab. Why? According to the article,

Blue Cross, the state’s largest health insurance company, is footing the bill for this pilot initiative because it wants to show electronic medical records will benefit all players in the healthcare system by improving care and reducing costs.

”We really want to prove this is worth doing,” said Carl Ascenzo, senior vice president and chief information officer at Blue Cross and Blue Shield.

Actually, what really happened is that Blue Cross and Blue Shield was making too much money and rather than give it back through premium reductions they were given the opportunity to curry long-lasting influence in the system and further humble their competitors by fully funding this effort.

The article continues:

…[S]ome studies have predicted that health insurance companies, not doctors, reap the most immediate financial rewards through the elimination of needlessly duplicated tests and fewer errors.

”The people who are expected to make the investment, doctors, don’t see the benefit,” said Micky Tripathi, [MAeHC CEO].

He’s right. Other initiatives that require doctors to pay are facing much slower going. The MAeHC has seized on the rare opportunity to get one payer to pay for it all and is determined to make the most of that chance. I wish them well.

Share

There’s an interesting article on the front page of today’s New York Times (After Jail and More, Salesman Scores Big With Cure-All Book) about Kevin Trudeau, author of the bestseller Natural Cures ‘They’ Don’t Want You to Know About. Turns out the guy is a convicted fraudster.

Of course if you had read the post by the Krafty Librarian on August 8 or seen it mentioned in Grand Rounds on the 9th, you’d already know that.

Grand Rounds will be hosted on Tuesday at Healthy Concerns. Check it out and save yourself the trouble of buying the Times in mid-September.

Share