Health Business Blog

Saw these two headlines on the homepage of Boston.com just now:

Study: Spanking children affects their adult sex lives

and (referring to Red Sox fans)

Yanks’ owner spanks the Nation

Somehow I don’t think Hank Steinbrenner’s going to have much of an effect on us up here.

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Health care costs in Massachusetts have been rising rapidly for years. There’s more pressure to do something about it now, though because of the state’s commitment to providing health insurance with affordable premiums to nearly everyone. Right now the state is unhappy with the fact that health insurers want to raise premiums for the subsidized plans by something like 14 percent. See Bay State pulls back on health contracts. If the government is tough enough insurers may back down and settle for smaller increases.

That won’t solve the problem, however.

As I posted before, my own company’s premium with Blue Cross Blue Shield of Massachusetts went up 26.3 percent this year. No one’s been able to give me a good answer as to why our premium went up so much –especially since this is supposed to be a community rated state, and nothing really changed from our side in terms of location or staff– but my suspicion is that at least part of the increase is a result of health plans and providers shifting the cost even further onto those of us who can still afford to pay. If the state forces the subsidized plans to keep premium increases down, the same insurers will raise premiums on other business if they can. If they don’t have that flexibility, they may try to put the squeeze on providers. When that happens the providers go to the big commercial plans (Blue Cross, Harvard Pilgrim, Tufts, Fallon) and tell them they have to make it up to them. So they raise reimbursement rates and then take it out on companies like ours.

It would have been nice if the expansion of health insurance in Massachusetts could have been self-funding –if high-cost ER visits had been replaced by more efficient and effective primary care visits. But that’s not what’s happening. Newly insured people are actually using their health insurance. Imagine that! They’re using the system more, just like other people who are insured. That’s driving total costs up, not down.

There are ways to reduce health care costs, but it will take some fundamental changes in the way medicine is practiced to make it happen. One of the most promising paths is to improve processes to reduce errors and improve patient safety. In industry, we call this reducing rework. It can reduce costs dramatically and improve quality. Live long enough and we’ll see it transform health care delivery.

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In Asia Domain Name registration scam I described a scam by a Chinese or Hong Kong company to scare people into buying lots of extensions of their existing domain name at outrageous prices. Now the same folks seem to be back with a similar email and similar phone number. I’m posting the contents of this latest email in the hopes of saving others from the same scam.

From: jesse

Subject: Mppllc Intellectual Property Rights(To CEO)

Dear CEO,

We are Fexon Technology Ltd, which is the Internet Registration Center in Asia. We have something important need to confirm with your company.
On the February 28, 2008, we received an application formally. One company named “MNIDERPY Holdings Limited” applied for the internet  Brand Name”Mppllc”

Domain names
” mppllc.info
mppllc.net.cn
mppllc.hk
mppllc.tw
mppllc.mobi
mppllc.asia .” etc

These days we are dealing with it, After our initial examination, we found that the internet Brand Name and domain names applied for registration are as same as your company’s name and trademark. hope to get the affirmation of your company because that may relate to your intellectual property on internet. Now we have not finished the registration of MNIDERPY company yet, in order to deal with this issue better, please let someone who is responsible for trademark or domain name contact me as soon as possible.

Best Regards,

Jesse.Chen

Sponsoring Registrar

Fexon Technology Ltd
Tel:  +(852)3059 3099  +(852)3075 9838
Fax:  +(852)3177 1520  +(852)3177 1510
Email: jesse@asiaip.org  www.Fexon.hk

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The Boston Globe’s Style & Arts section is not my usual inspiration for blog posts, but today’s article, A healthy dose of hospital chic is an exception. According to the Globe:

As Jennifer Lopez’s due date drew near, the buzz began: The fashion-obsessed pop star would not be wearing any sad, frumpy hospital gowns when she delivered her twins.

Only couture would do.

Whether J.Lo gave birth last week wearing Roberto Cavalli or the hospital gowns made for her by Wellesley-based dearjohnnies, only her OB and her husband, singer Marc Anthony, know for sure. But J.Lo’s demands for wearable and stylish hospital garb are part of a growing trend, not just for new mothers but for other patients and doctors, too.

In 2008 it’s not really a blinding insight that new moms might not be thrilled to wear what the hospital issues to them. On the other hand, first time moms might not realize the amount of blood they’ll be dealing with either. Any experienced nurse will suggest saving the fancy gown for visitors and photos.

If patients are going to choose their own outfits, I recommend picking out something with enhanced functionality, not just style. Considering the rising awareness of risks that patients face from doctors and nurses who don’t wash their hands, medication errors and other ever-so-common no-no’s, there should be a market for patient safety clothing. In case any apparel engineers are reading this, here are some suggested features:

• Gowns with big letters declaring, Wash Your Hands! Better yet, a gown with its own alcohol gel dispenser attached or a mister that disinfects anyone who comes close
• Built in video cameras to let patients or caregivers keep track of who’s doing what to them
• A computerized voice that reminds doctor and nurses of good practices whenever they are within earshot. “Shouldn’t you remove that catheter?”, “Did you check if I have a latex allergy?”, “Are you sure I need that drug?”

Now how’s that for defensive medicine?

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RN Central has enumerated 20 ways clinics at Wal-Mart stores are likely to affect health care. They’re not all on the mark, but the post is worth a read.

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Writing in the Boston Globe, Dr. Joseph Dorsey (a former medical director from Harvard Pilgrim) and Dr. Donald Berwick (head of the Institute for Healthcare Improvement) call for a return to managed care, specifically captitation, as a way to control costs and improve quality. See Dirty words in healthcare.
The two of them pine for the old days of Harvard Community Health Plan, with its salaried physicians and emphasis on quality and innovation.

“Managed care” did not mean “restricted care”; it meant “care that makes sense.”

They blame greedy insurance companies and their highly-paid executives for “manag[ing] the money, not the care,” thus leading to a backlash against managed care that washed out the good with the bad. They’d like to see capitation in particular come back.

I agree with them on the benefits of capitation and the idea of getting paid for population management rather than transactions. It’s a movement that’s already underway, including here in Massachusetts.

But it’s a bit much to point the finger at insurance companies for all of our ills. Fact is managed care companies were doing exactly what their employer customers were asking of them: controlling health care costs. In the heyday of managed care they did a good job of it. Physicians certainly hated being dictated to by insurance companies but it doesn’t mean they were completely blameless.

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The latest edition of the Cavalcade of Risk is up at Wisdom from Wenchypoo’s Mental Wastebasket.

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We recently bought some compact fluorescent (CFL) light bulbs to install in our home. They’re supposed to save energy and last much longer than standard incandescent bulbs. There are plenty of problems however:

• The bulbs are too large to fit most of our lamps and ceiling fixtures
• They’re no good for recessed fixtures
• You can’t use them with dimmers
• They take a few minutes to reach full brightness, so are no good for places (like closets) where it’s important for the light to come on quickly

In addition, there are health risks because the bulbs contain mercury. Really they should be treated as toxic waste and handled accordingly, but in practice most people are just going to toss them out. An article in the Boston Globe (High-efficient lightbulbs come with mercury risk) outlined what to do when a mercury-containing light breaks:

The Maine study, which shattered 65 bulbs to test air quality and  clean-up methods made these recommendations: If a bulb breaks, get children and pets out of the room. Ventilate the room. Never use a vacuum — even on a rug — to clean up a compact fluorescent light. Instead, while wearing rubber  gloves, use stiff paper such as index cards and tape to pick up pieces, then wipe the area with a wet wipe or damp paper towel. If there are young children  or pregnant woman in the house, consider cutting out the piece of carpet where the bulb broke. Use a glass jar with a screw top to contain the shards and clean-up debris.

I don’t think the CFL bulb era will last very long. I can’t wait for LED bulbs to get cheaper and am hoping they won’t disappoint like the CFLs they’ll replace.

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Sit back, relax, enjoy your healthcare.

See: Patient Involvement Doesn’t Guarantee Better Outcomes

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The latest edition of Grand Rounds is up at ScienceRoll.

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