Health Business Blog

Who’s the most fun to operate on?

Four surgeons were sitting around discussing who they like to operate on…

Librarian, accountant, electrician, or politician?

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In Disuse of System is Cited in Gap in Soldiers’ Care, the New York Times takes the military to task for lack of continuity of care. Information from medical records in Iraq and Afghanistan is not always transferred seamlessly stateside even though a system to do so has been mandated for two years.

No doubt there are plenty of problems. But it doesn’t sound worse than the civilian sector, where such inter-hospital medical record systems are almost never in place at all. No one should be under the illusion that this problem is limited to the Defense Department. And we don’t learn from the article if the system is any good, just that it’s been mandated.
Madigan Hospital at Fort Lewis in Washington State comes in for a severe pounding, being blamed for causing a soldier’s suicide because doctors didn’t look into the system to check his records. The Times makes the place sound like a backwater, resistant to the benefits of medical information technology.

I don’t know much about Madigan, but since it is one of the hospitals that signed up for institutional access to advanced decision support software, I give them the benefit of the doubt.

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From the Wall Street Journal:

Most Americans who have used retail-based health-care clinics say they are satisfied with the care they received, a new Wall Street Journal Online/Harris Interactive health-care poll finds, but concerns about quality remain among the general public.

It’s interesting that the Journal chose to spin the story this way, i.e., clinics convenient but quality is questionable. The “quality concerns” reflect the fact that 64% of respondents agreed –26% “strongly” and 37% “somewhat”– that “I would be worried about the qualifications of the staff that provides care in a health clinic not run by medical doctors.”

But the  story could just have easily been spun another way:

More than 8 out of 10 Americans who’ve used retail clinics are satisfied with the convenience, and 9 out of 10 are satisfied with the quality of care.

Of course there will be concerns about quality –and those concerns are legit– but the more intriguing message is that users are even more satisfied with the quality of care than they are with its convenience. That’s something for physician practices to watch out for.

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Erick Novack, a contributor to The Health Care Blog, took what I consider a cheap shot at MA health care reform:

I must admit when I am wrong. My repeated claims that the Massachusetts Health Plan would be on life support—with a likely ‘pulling of the plug’—by early 2008 have been proven wrong. It has happened already.

I jumped in to offer a more balanced perspective in the comments and since then the impassioned and knowledgeable John McDonough of Health Care for All has entered the fray. It’s lively reading.

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Mickey pointed out this helpful news for asthmatics from the Glasgow Scotsman:

ASTHMATICS are set to benefit from a breakthrough new treatment – hot air.Researchers at Glasgow University have found that treating severely affected patients by heating parts of their lungs with warm air can lead to “significant” improvements.

During a year-long global trial, sufferers experienced a 50 per cent drop in serious attacks from an average of about 18 to eight or nine and had an extra 86 days when they were free of any symptoms.

It also enabled a reduction in medication use and the patients exhibited a general improvement in quality of life.

Patients have a tube inserted into their lungs under light sedation and certain areas are heated to 65C for about ten seconds.

The procedure reduces the amount of muscle tissue responsible for contracting the airways, which is usually above normal in severe asthma sufferers.

In the days of public steam baths, no one did controlled studies.

In recent years, companies did controlled studies of asthma drugs if they could be patented, but no one did controlled studies of steam baths. A company doing home steam showers contacted Mickey after he recommended steam showers in his guide to asthma but they did not have the resources to do a controlled study. Now, there is a controlled study. Hopefully people will install steam showers instead of thinking the only way to get relief is to “have a tube inserted into their lungs under light sedation”.

The full article is here.

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An article in the Sunday Boston Globe really bothered me. In “Hippocritical” Doctors, an OB attacked physicians who work for health plans. He was unhappy that they didn’t make the health plan pay for all the therapy he wanted for his daughter with cerebral palsy:

This doctor and others like him are making money denying care – and they might as well hang up their white coats. They may believe that their administrative decisions are medically justifiable. However, it often appears that they are hired because their MD degrees lend a patina of legitimacy to administrative decisions that are based on interpretation of a health plan’s policies, not a chart, lab test, or CT scan…

A physician who works for the health insurance industry told me that these doctors view themselves as having “an advocacy role for patient care.” Health plan physicians will argue that without them consumers would have no voice within the company’s walls. But I say let the businesspeople be the ones to withhold care in the name of cost savings and profit margins. Physicians are needed in the clinic and at the bedside, advocating for more care, not less.

The author shrugs off other physicians’ financial relationships with drug companies and banks, because they just damage society, “not… individual patients.”

I think the author is way off base. Remember the earlier days of managed care when doctors complained, sometimes legitimately about “being told how to practice medicine by someone from the HMO with a GED”? Isn’t it better to have a physician to speak with? Meanwhile, contrary to his statement, it doesn’t always make sense for the patient to get “more care.” It can be expensive and wasteful.

I sympathize with the author, who wants what’s best for his daughter, but health plan physicians don’t deserve the abuse he dishes out.

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Ever-thrifty US Airways serves a drink but no peanuts or pretzels between Boston and Philadelphia. As we prepared to land today the flight attendant announced that we should “pass all beverage service items” to the flight attendants coming through the aisles.

Beverage service items? Those are cups, I think.

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A friend who’s complained to me in the past about the lousy service he’s received from physicians told me about a much happier experience he had today when he took his nine year-old, Ron to a multi-specialty practice in Woburn, MA.

The PCP he went to had a state of the art imaging and PACS setup. Before leaving the office my friend was brought into another room and shown a variety of images that made clear what Ron’s problems were. The PCP brought in two specialists for real-time consults: an immunologist to advise on a swelling/fluid retention issue and a surgeon for an ACL complaint. The whole experience was extremely businesslike and service-oriented, a real breath of fresh air.

Oh by the way, Ron is a dog.
As my friend said,

I just can’t get this out of my mind because I’ve never seen anything like it in human health care.

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Wal-Mart is partnering with the University of Arkansas and Blue Cross Blue Shield of Arkansas to establish the Center for Innovation in Health Care Logistics. According to the press release:

The Center’s initial work will address information technology-based innovations for bringing visibility and tracking to every level of health care procurement and distribution processes.

Experience shows that such transparency leads to significant cost savings by eliminating duplication and confusion, enhancing collaboration among participating organizations and avoiding mistakes that can lead to dangerous errors.

Health care will definitely benefit from Wal-Mart’s expertise in supply chain management. It will be interesting to see where this leads. Wal-Mart’s committing just $1 million over five years, which may buy a lot generics at a Wal-Mart but won’t cover too many researchers. The Center plans to raise additional funds to cover its operations.

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Check out the Cavalcade of Risk blog carnival at The Sentinel Effect.

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