Health Business Blog

It was a quiet afternoon

Until a cure for cancer was announced. Worked in two patients out of 17 anyway.

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Good news for Tropicana and the rest of us

Researchers found that drinking juice four or more times a week is associated with a 76 percent lower rate of Alzheimer’s, according to the BBC. And, as Mickey points out, that’s consistent with the report from today’s New York Times:

[R]ecent studies find that genes may not be so important in determining how long someone will live and whether a person will get some diseases — except, perhaps, in some exceptionally long-lived families.

Taken together, this is good news for those who weren’t lucky enough to be born with great genes. Drink up!

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Non-profit doesn’t mean non-payment

From the Boston Globe:

Chief executives at charitable hospitals in Massachusetts received substantial pay and benefit increases in fiscal year 2005, for the first time boosting their overall compensation to more than $1 million at most of the largest institutions.

Also, the highest-paid hospital executive in the state, Partners HealthCare chief executive James J. Mongan, broke the $2 million barrier, another significant milestone

Running one of these hospital systems is not that much fun. I wouldn’t do it for less than $2 million.

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Another vintage pharmaceutical

Check out the ingredients in this photo of a bottle of cough syrup, courtesy of Medpundit

• Alcohol
• Cannabis
• Chloroform
• Morphia

And to think you can’t even buy real Sudafed anymore!

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Patient websites: a positive impact of customer service ratings

There’s a very good article (with a bad headline: Patient-created Web sites carry risks, rewards for hospitals) in Modern Healthcare.

Communicating the details of a family member’s illness — or even one’s own — can be a grinding process involving repeating sensitive facts over and over again to different, well-meaning individuals who want to know the latest status of a friend or family member undergoing treatment. Just keeping everyone informed can be exhausting for patients, families and providers. Technology has stepped in to help spread the word.

There are now several companies –including CarePages, CaringBridge, and theStatus– that let patients and families create secure websites to convey this kind of information. Authorized users receive a username and password so they can access the information. It’s good for patients for the reasons described above. It’s good for nurses who don’t have to field so many calls from worried friends and relatives –and don’t have to worry about HIPAA breaches. And it’s helpful for those seeking information because they can get better information without having to call the hospital and endure long hold times (at best) or be treated rudely and receive wrong or no information at worst.

Hospitals are making these tools available because it improves patient satisfaction. And patient satisfaction is starting to matter more to hospitals now that CMS is planning to publish data from the H-CAHPS survey, which will allow people to compare hospitals with one another.

I haven’t worked with the systems, but a lot of what they offer is fairly generic, and not tied into the hospital’s data systems. Hospitals generally reserve the right to monitor the content of the pages (they seem worried about people making complaints) and of course they can seldom resist the temptation to throw some marketing information around. If I were a patient, I think I’d steer clear of a hospital-sponsored system unless it provided some clear advantages to make up for the lack of independence. But all in all I think these patient sites are a good thing.

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When bias isn’t bad

From the Washington Post (Group Says FDA, Advisory Panels Show Bias Toward Drug Approvals):

The panels of experts assembled by the Food and Drug Administration to advise it on whether to approve new drugs and medical devices are often biased in favor of recommending approval, according to a consumer group’s analysis released yesterday…The group’s report also said the FDA is more likely to accept its panels’ advice when they recommend approving a product than when they vote against approval.

Bias is a word with strong negative connotations (e.g., “racial bias”) but bias is not always a bad thing. When I worked at the Boston Consulting Group, one of the attributes we looked for in job candidates was a “bias for action.” In other words, all else being equal we wanted the consultant to do something rather than sit still.

The FDA was quick to reject the allegation of bias –and is especially sensitive about accusations of conflicts of interest– but I think it’s ok to have a bias toward approval of new drugs. The FDA should allow drugs with borderline safety and efficacy profiles make it to market, but as a society we should insist that other segments of the health care system exercise judgment. In particular, physicians should have a bias toward using tried and true drugs –in my experience most already have this bias– and should be skeptical of claims made by interested parties.

Consumers need to exercise similar judgment, but they also have the right to expect their physicians to look out for them. Consumers (and doctors) may be swayed by clever advertising and marketing. I advocate addressing this issue in the broader context of educational reform –teaching students to be skeptical (not cynical). I don’t think it’s wise to hold potentially promising drugs back from the market or place undue restrictions on advertising.

Meanwhile, payers are stepping into the void to guide drug decisions. They have a bias toward cost control, which is good for the system overall but not always the best for a specific patient.

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Grand Rounds is up at Protect the Airway

Check out Grand Rounds, the best of this week’s medical blogging, at Protect the Airway.

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Is it that bleak in corporate America?

A recent New York Times article describes the need for organizations to investigate and come to grips with bad news. Many companies and institutions have a problem here. The problem is apparently so bad that they are taking lessons from –gasp!– hospitals. Things must really be terrible.

“There is a lot more protectiveness than there used to be,” said Dr. Proctor, who is shaping a new field, the study of ignorance, which he calls agnotology. “It is often safer not to know.”

A desire not to learn too much may have guided Kenneth L. Lay, former chief executive of Enron, who died of a heart attack in July, six weeks after his conviction on fraud charges.

Fields like aviation and medicine have found ways to overcome this.

When a plane crashes, a specially designated agency, the National Transportation Safety Board, is there, with the mandate to investigate in detail. The emphasis is on finding cause, not fault. And the agency is not responsible for bringing enforcement actions for errors, which it says adds to its impartiality.

Surgery, too, has a standardized mechanism to learn from errors. In contrast to aviation, the analysis is not done by a large investigative body, but in individual hospitals, where surgical departments routinely hold “mortality and morbidity” conferences to analyze mistakes.

If it were me, I would advise looking for examples of best practices in companies with complex manufacturing processes, where safety is a major concern: chemicals or steel for example. Not hospitals.

Thanks to Mickey.

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That should fill a few donut holes

From the New York Times:

About 230,000 Medicare recipients were mistakenly sent refunds last week averaging about $215 for monthly premiums they paid this year for drug coverage, the head of the Medicare program said Wednesday.

Unfortunately for the recipients, they’ll have to give the money back.

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This is a post by Karen Donovan filling in for David Williams who I occasionally allow to take a vacation day!

OK… so finally, my wish came true. In April I blogged that the government better “put up or shut up!” Well, they finally did it… The AP Press reported this week “Bush seeks better health care cost info” as he signed an executive order that directs four “government agencies to:

• Use, where available, health information computer systems that talk to each other…
• Enact programs that measure the quality of care, and develop those measures with the private sector and other government agencies.
• Make available to beneficiaries the prices that agencies pay for common procedures.
• Develop and identify practices that promote high-quality health care.

The agencies affected by the executive order are the Health and Human Services Department, which oversees Medicare; the Defense Department, which oversees health care for the military; the Veterans Affairs Department and the Federal Employees Health Benefit Program. A draft of the order says agencies must comply by Jan. 1, but Leavitt said the programs must be under way by that point, rather than completed.”

Frankly, the order seems like a “statement of the obvious,” and it’s sad that it had to be mandated by some executive order. But please don’t get me started on that…

Many companies and healthcare industry think-tanks have tried to develop large databases that can be used for efficiency and efficacy purposes. Anonymous longitudinal patient data has evolved into a large and rapidly growing industry over the past 5+ years to aggregate and track patient medical, pharmacy, and lab data over time. There have been many stumbling blocks, the least of which is the lack of electronic repositories for the various data elements. Ohhh, just one more reason for EHR adoption!

Inherently, payers have had the broadest set of claims data given our country’s healthcare reimbursement system. Companies such as PharMetrics (acquired last year by IMS Health) and Ingenix (part of United Health) have helped lead the industry from an outcomes research data perspective. PharMetrics boasts “over 75 health plans across the U.S. contribute to our growing anonymous, Patient-Centric Database, which contains integrated pharmaceutical and medical claims on over 55 million covered lives.” And Ingenix boasts “over 35 million covered lives” in their database. Clearly this excludes the over 40 million Medicare enrollees.

Some industry experts have predicted that the government would start releasing the data within the next few years. One of the most vocal supporters for government release of data was Dr. Mark McClellan. When he was the FDA Commissioner, he strongly advocated for this from a safety and pharmacovigilance perspective. In 2004, McClellan left the FDA and became the CMS Administrator. He spoke last month about the Institute of Medicine report and called for many of these efforts as well.

I’m glad to see that the federal government is getting with the program! Thank you Mark. And now this should help pave the way for the states to follow too.

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