MedWorm: Health Managers

Innovation conference in boston

hospital impact — Fri, 16 May 2008 15:26:35 +0100

by Tony Chen I'll be at PDMA's "Front End of Innovation" Conference in Boston next week. If anyone is around and up for drinks, let me know. Last time I checked, I couldn't find any other hospital members of the PDMA (Product Development and Management Association). Think of them as the ACHE for innovation & product development people. As I interact with this group, I'm definitely stretched by their progressive thinking about how to bring innovation into any culture/organization (apparently, the Russians did a lot of innovation theory work back in the day that are still being utilized widely today). What can hospitals learn from the likes of Dow, Staples, Google, Starbucks, IBM, Kraft? I'll let you know. (Source: hospital impact)

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Boomers confront the economic downturn

Health Populi — Fri, 16 May 2008 11:20:00 +0100

The economic downturn has led to personal cutbacks on medications and funding retirement savings, according to the AARP's survey on The Economic Slowdown's Impact on Middle-Aged and Older Americans.AARP examined older Americans' responses to the economy in April 2008. The finding: that people over 45 share concerns about both the current and future states of the nation's economy. The downturn is characterized as a triple-threat combination of stagflation (slow growth + high unemployment), job losses and rising fuel prices.As a result of these macroeconomic concerns, older people have adapted their personal microeconomic behaviors. The chart on the right details some of these behavior changes, led by difficulties in paying for essential items (food, gas, meds) and utilities, reducing spending on entertainment and eating out, and postponing travel plans. Furthermore, 1 in 4 older people have prematurely withdrawn funds from retirement investments such as 401(k)s and IRAs, and 1 in 3 have stopped putting money into these investment vehicles. The survey was conducted in April among a nationally representative sample of 1,002 people age 45 years and older. Health Populi's Hot Points: The macroeconomic downturn is reflected in individuals' concerns with tightening credit markets, declining home values, and stock market losses. 72%, or 3 in 4, older peoples' retirement vehicles have lost money in the past year due to the downturn in the stock market. This has led to the dark financial outlook shared by older Americans. The personal adaptations to the market decline varies by life stage, according to the AARP data. Those over 65 are now having trouble paying for essentials given fixed incomes. This group of people have already made adjustments to consumptions since retiring. For older boomers age 55-64, with "retirement in their sights," the view is mixed to negative. They took the biggest hit to their 401(k)s and have withdrawn funds -- taking yet another hit in the form of early-withdraw penalties. For the youngest boomers, age 45-54, the downturn hurts because this group is still in the midst of educating kids and building careers and savings accounts, along with paying off mortgages. This is the group most likely to curtail leisure time activities outside the home such as eating out, travel, as well as making major purchases. As for health care, I see this as a wild card that I've been talking about with clients doing scenario planning on what the health system will look like in 2012-2016. If Boomers, as they begin to retire, confront eroding retirement investments and increasing out-of-pocket costs, we could have a mass generational call for a single-payer health plan. (Source: Health Populi)

Lessons learned from switching sides

Running a hospital — Fri, 16 May 2008 08:26:00 +0100

An email letter from a staff member to me. Many, many helpful suggestions that we will work on.Paul – I have unfortunately have had the experience over the past several months to switch sides from supporting MDs provide care to patients to that of becoming the loved one of a patient. My mom was admitted here on 12/29/08 with what was thought to be a stroke. After five weeks of treatment and the inability to control seizures that she was having every three minutes, it was discovered that it was not a stroke, but instead a Grade IV Glioblastoma.Since my mom’s first admission, she has been readmitted four other times. In total, I think my mom was an inpatient at BIDMC, 10 out of the past 14 weeks. For family reasons, coordination of her care has fallen to me. We have many supportive family and friends, but at the end of the day it’s just the two of us. Her prognosis is not good. They say less than three months. I never thought I would get to the point where I am o.k. with her passing, but life is not for existing, but living. She is now in long term care and luckily, has only had a few episodes of pain. Anyway, I have written and re-written this email in my head a million times, but seeing your (May 7 SPIRIT update) email today has prompted me to sit down and send you a few of my observations over the last ten weeks. I am sorry this is so long, but each bullet reflects an important point I wish to emphasize.Here they are: -- The nurses are phenomenal!!! Time after time, I have been impressed that here is this woman who they only know through my description (one of the results of the tumor and subsequent seizures is that she cannot speak) and the nurses are so dedicated, caring and empathetic. My mom has gone from a woman who walked seven days per week, took down her own fence this past summer and cared for my children to a woman who can’t talk, walk, wears a diaper and has to be fed. They somehow without even trying have time after time preserved her dignity. -- The coworkers (patient care technicians) are also phenomenal. They do not receive near enough credit. Their jobs are very hard. They lift, roll, clean, feed patients constantly and do so quietly and patiently. They must go home exhausted every night.-- Communication, communication, communication. If we could find a way to better communicate w/ families, our Press Ganey scores would exceed 90% instantly. I have worked here for 12 years and at times was so frustrated with my inability to find out what was going on. I had instant access to my mom’s oncologist and neurologist, but in most cases, families have to go through residents. The residents are so busy and they usually see the patients first thing in the morning prior to a family member coming. In addition, once you get to know one, they switch services and you have to start all over again. The same thing with medical students. One day over a weekend, I waited eight hours in my mom’s room to speak to a resident. No family member should have to do that. I at least would go into my mom’s record to read the notes (with her permission of course), but people that do not work her do not have that opportunity. If there was a way to block certain sections of OMR (online medical record), but provide families access to others or develop a summary page for family members that would be great.-- Another issue is communication between specialties. My mom was part of the Neurology Service. She started on Stroke, moved to Epilepsy, then to Neuro. Oncology, then back to Epilepsy and now is back on Neuro. Onc. Did you follow that? I have come to learn that Neurologists are highly specialized. You can’t ask a Neuro Oncologist about your mom’s seizure meds. You have to go to her Epilepsy Neurologist. Depending on what floor you are on, the quarterback varies. My mom was transferred from one floor to another and she ended up with a whole new attending that I had never met. What made it worse was she had one for the weekend and then a new one starting the following Monday because it was a new month. Again, I work here so I knew who to call, but imagine the 80 year old man trying to take care of his wife. Lack of information is so frustrating. There needs to be a better way to communicate with families and patients.-- Add-on surgical procedures need to be better coordinated. My mom’s biopsy was an add on for a Friday. Room Service forgot to bring her dinner on Thursday night so her last meal was lunch at around 12 noon that day. Pre-op did not come to pick my mom up until Friday at 6:30 pm. We then waiting there for three hours. She did not go into her biopsy until 9:30pm. The surgeon was ready for her at 9 pm, but we had to wait 30 minutes for her Halo to be delivered for the procedure. The surgeon, nurse and anesthesiologist sat there waiting. My mom’s roommate was an add-on for Monday. Her last meal was Sunday at 6 pm. She got bumped on Monday and not taken until 10 am on Tuesday. She did not eat for almost two days. -- Patient Satisfaction Surveys – Did you know that you receive one for every admission? That means we have received four. I filled out one. There has to be a savings there. Her experience did not change that much between each admission to warrant four separate surveys.-- We need better discharge planning. I found three medication errors during each discharge and I am not a doctor. I can only imagine the poor family member that does not speak English. On the day of my mom’s last discharge, the intern kindly called me at home and told me she would be discharged by 1 PM to a long term care facility in Hingham. I got there at around 3 PM and was surprised she was not there. I set up her room and waited. I asked the unit coordinator at the front desk about it and she said she would be in the same room and there must be traffic. I went back and waited. I finally called thr floor at the hosital where I was put on hold for about five minutes. Finally, the nurse got on and said she had her all ready to go at 1 pm and they told her she was not being discharged and did not know why. I then asked to speak to who did know and the intern got on, apologized for not calling me and said it would not be until Monday due to the antibiotics that they could not give to her at the rehab. The following Monday, I was on my way to meet her there when I received a page from the case manager that they had to move her to yet another facility because Hingham would not take her. Luckily, I am happy with where she is, but what a fiasco.-- MDs need to learn how to give options to families. Her Oncologist has recommended no further treatment with hospice. That was a big pill for me to swallow. Our family does not give up. Once I was able to process that I felt pressured by him to sign off on a DNR and agree to “his” recommendation. After I really thought about it, I realized that in fact that there was no decision to make because she was not even eligible for treatment given her low counts. I had to really push back with him. I’m not sure most families would feel comfortable doing that.-- Case Managers need to meet with families more. When selecting a rehab., I was given a photocopy of a book with rehabs in our area. The case manager had never been to one of them and recommended I go to visit. I have three children, another family member needing support, a husband, a mother with a brain tumor and full time job. When was I going to do that? This was going to be the place my mom would probably die. I wanted it to be excellent. It would have been helpful if she or another case manager could provide me with some information on the facilities, i.e. the DPH report, testimonials from other patients, etc.-- Families need to understand the financial implications of recommended treatments and care. Her doctor recommended long term care with hospice. What he neglected to say is that although hospice is covered, long term care room and board is not. This means that if she is not eligible for nursing care or rehab. we have to pay room and board of over $300/day. Luckily, my mom has savings for this, but I was not made aware of this until I sat down with the Head Nurse at the long term care facility. Thank you for listening. (Source: Running a hospital)

Change of shift

Life in the NHS — Fri, 16 May 2008 06:23:54 +0100

Great news, it is time for Change of shift again, this time hosted by Dr Emer over at Parallel Universes, there are some great posts once again. I for one am looking forward to having a good read over this weekend! More from me later! (Source: Life in the NHS)

What does the future hold for work comp tpas?

Managed Care Matters — Fri, 16 May 2008 04:00:00 +0100

For some, red ink. Most workers comp TPAs are struggling. The softening market has pushed many larger employers back to insured programs - for good reason. If a policyholder can buy fully-insured coverage for less than their projected losses plus... (Source: Managed Care Matters)

Podcast interview with david hom, chairman of the center for health value innovation (transcript)

Health Business Blog — Fri, 16 May 2008 01:04:36 +0100

This is a transcript of my recent podcast interview with David Hom, Chairman of the Center for Health Value Innovation. David Williams: This is David Williams, Co founder of MedPharma Partners and author of the Health Business blog. I am at Consumer Health World in Las Vegas where I spoke today with David Hom, Chairman of the Board of the Center for Health Value Innovation. David and I spoke about value based insurance design and health care consumerism. Hom would like to see consumers become CEOs of their own care, and he believes we are at the cusp of using information technology effectively to enable consumers to adhere to therapies. The Center’s approach represents a clear departure from business as usual, but the concepts are strongly rooted in improving the existing employer based model rather than overthrowing it. David, thanks for joining me today. David Hom: You’re welcome, David. Williams: What is the Center for Health Value Innovation, and who is involved in it? Hom: The Center was established to share best practices with employers, both large and small, both state and private. We have at the table all the key players in the health system, from health plans to insurance brokers to health systems, physician groups, employers, business coalitions and unions. Williams: What was the impetus to get all of those groups together? Hom: The impetus was really simple. It’s how do we create a safe environment for these organizations to share best practices, to innovate in health care in order to reduce the rate of health care inflation primarily through improving patient adherence to treatments for chronic conditions? Williams: Who has an interest in doing that? Often, you hear about adherence as being something that’s pushed by the pharmaceutical companies as another form of marketing, but this sounds like something. Hom: Absolutely. The ones that have been most upset about this are the health plans, physician groups and hospital systems. What this will do is it will reduce the level of intensity for ambulatory services. At the same time, it will reduce ED visits and hospitalization costs for payers. Williams: You have the word “value” in the name of your organization. Value is a term that is being thrown around a lot in health care these days, starting with the Secretary of Health and Human Services. Can you tell me what you think about when you use the term value? Hom: We define value from a payer perspective, which is how do we measure the dollars spent in health care? What does it do to employee productivity? How does it drive higher employee engagement and thus reduce disability days for organizations? Williams: Is that a concept that people can agree on, or do people come at it from different angles? Hom: I think, most people understand the concept of ‘an ounce of prevention is worth a pound of health care.’ They get through the solution multiple ways, but by and large people focus on this concept around data, aggregating data and then understanding what are the patterns within the data. What are the barrier issues for access to care? How do you remove the barriers –whether admin barriers or financial barriers? Then, how do you track the ROI? How do you measure the return on investment of those dollars? Williams: How good are the data today that are being used? I’ve heard about value based insurance design, which seems to be mainly about reducing co pays in certain situations. Is that done in broad strokes? Will happen on an individual person basis or a dynamic basis over time? Hom: We see this concept happening at the population base level, looking at what the patterns are, what the barrier issues are, and how to manage those issues. However, when you set your designs up, it drives individual consumer behaviors. That’s the most powerful thing. When someone is highly compliant with their regimens –taking their annual physicals, doing their pap smears, doing their colorectal exams– they tend to be CEOs of their own health, which is what you want them to do. Williams: What are you finding in terms of the evolution of consumerism in health care? How much credit do you give consumerism, and how much potential is there for consumerism to resolve some of the cost and quality issues that exist today? Hom: In terms of consumerism, we are at the cusp. We are at the cusp of using emerging technologies to provide information on a chronic to the patient and guiding them through the health care system in an effective way. The example I use is that when you go to the doctor, the doctor spends six minutes with you. You get a set of directions. You walk out saying, ‘What am I doing? How do I do it and when do I do it?’ And you get confused. We want to use technology as an enabler to train patients one at a time to adhere to what the physician recommends. Williams: What sort of evolution is required of the typical physician, and does the Center play a role in that? Hom: We work with a number of physician groups. The concept is to align pay for performance –which is how you assess physician practice patterns– to this concept of benefit design. If you are going to lower the barriers to access care, then how do you hold physicians accountable for the management of their diabetic patients, for example? And then, how do you steer patients to those physicians, and how do you modify the reimbursement rates to those physicians to pay for the appropriate care? Williams: It sounds like what you are doing is mainly within the construct of the current system, the current private payment system whereas a lot of what’s being discussed on the campaign trail sounds pretty radical. Even the Republican, John McCain talks about blowing up insurance coverage from employers. How does that fit in with what you are doing, and do you think there is an opportunity to preserve the private system? Hom: Absolutely. People often talk about health care from 30,000 feet. What we’ve learned is that not only is health care delivered locally, but health care decisions are made locally, too. You have to create successful case studies within geographic areas, test the hypotheses, roll out the interventions, measure them and then scale them to other organizations. Williams: We’re here in Las Vegas at the Venetian Hotel at Consumer Health World 2008. I believe you are running a workshop this afternoon as part of the National Conference on Health Care Consumerism. Can you tell me about that? Who is participating? What are you hoping to get out of it? Hom: We have a great panel today. We’ve got 10 folks representing insurance brokers, health plans, physician groups, hospital systems, PBMs, employers, business coalitions, really talking about health care innovation from a pay perspective. We’ll discuss what they have done to a) identify the problem; b) solve the problem; and then c) measure the results. It is very action oriented. It includes case studies, and it will create tangible results for people to walk away with versus talking heads. Williams: I have been speaking today with David Hom, Chairman of the Board of the Center for Health Value Innovation. David, thanks for speaking with me today. Hom: Thank you, David. I appreciate it very much. (Source: Health Business Blog)

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Health wonk review is up at healthcare economist

Health Business Blog — Thu, 15 May 2008 20:00:42 +0100

Check out the latest edition of the Health Wonk Review at Healthcare Economist. (Source: Health Business Blog)

Searching vs. using health information: the "just looking" mode of health search

Health Populi — Thu, 15 May 2008 12:58:00 +0100

Consumers, at least Californians, do a lot of looking for health information on the Internet -- but very little health management.California HealthCare Foundation (CHCF) has taken a snapshot of Californians' use of the Internet in health care. The profile is presented in CHCF's report, Just Looking: Consumer Use of the Internet to Manage Care.Topline: insured, more affluent, and younger people use the Internet in health searching. As the chart details, the most popular care-related uses on the Internet include searching for information about conditions and drugs, finding a physician, checking ratings, and looking for claims and benefit information online.Some 13% of Californians are lucky enough to be making appointments online, and 12% are filling Rx's online. Methodologically speaking, Harris Interactive conducted the survey of 1,096 Californians by telephone between November 5 and December 17, 2007. Health Populi's Hot Points: Converting citizens from "search" to "health management" is a challenge. As I ponder the implications of CHCF's findings for Californians, I am reminded of the Deloitte segmentation of the "online and onboard" consumers who are ultra-engaged in both personal online and health worlds. As in the diffusion of all technologies, we look to early adopters to pioneer, to experiment, to demonstrate the goods to those who are "Missourian in spirit" in Show-Me mode. One of the barriers for some consumers in using providers' and plans' websites is the challenge of health literacy, and health plan literacy. You can read more about each of these significant problems with the U.S. health scene in Health Populi. If you build it, as they say, folks won't necessarily come unless tools and information are engaging, relevant, and even fun or entertaining to interact with.The drive to further adoption among citizens will be, first, among patients themselves who are learning from each other in search of "patients like me." An early and ongoing gem of an example of this phenomenon is ACOR, the Association of Cancer Online Resources. I recently spent some time talking with Gilles Frydman, ACOR's guru, and will be writing more about this phenomenal organization that was founded long before any of us were talking about social media and health. Furthermore, as pioneers such as CHCF, the Center for Information Therapy, Robert Wood Johnson Foundation, the Markle Foundation, and the eHealth Initiative continue to generate models and data which demonstrate the benefits and positive outcomes from online health engagement, more financial and other incentives will be aligned with consumers' use of the Internet for health management. We're already in the early-adopter stage. The question in these cases is always how steep with the S-curve be? PS--My friend just sent me the following snippet from Prevention magazine...from the American College of Surgeons Poll, 2008:How much time Americans spend researching:Medical procedure or surgeon: 1 hourPlanning a vacation: 4 hoursPIcking out new appliances: 5 hoursDecideing to buy/lease new car: 8 hoursThinking about a job change: 10 hours.... (Source: Health Populi)

League table obsession

Life in the NHS — Thu, 15 May 2008 07:04:53 +0100

My hubby spends time on a Saturday or Sunday evening studying the football league tables after the weekend’s games have taken place. Now at the end of the season Manchester United have beaten Chelsea on goal difference, hubby is sure if that game 3 weeks ago had been won rather than drawn then Chelsea would be top. Football is a game (though many people would hate me to say so) and the league table is based on how many games you win, lose or draw and the number of goals you score or concede. What though are the league table the government has become so obsessed with publishing show? As a parent I can apparently judge the worth of my son’s school by the league tables of GCSE and A levels plus some kind of value added score (whatever that is). His school is not at the top of the table, his experiences have been generally good, though there have been some moments when I have questioned teacher quality, the way in which particular things are done and the influence of the people around him. The league table shows me little, my son has turned out to be above average in a slightly below average school but probably pretty average within the country as a whole. His education continues, he is working hard and hopefully will turn out with pretty good grades which in turn will raise the average of his school. What about hospital league tables? What do they tell us? The latest is based on a survey of those using the hospitals, and if you are a really sad person you can look at some kind of rating system, helpfully colour coded red, amber and green to give you an idea of how well they do on things such as infection control, cleanliness, perceived waiting times and dignity measures. All of this of course is relative and based on opinion. This is no exam league table, nor does it tell you how many goals have been scored. I have had a quick look at the scores for my two local hospital trusts, and sadly one of them is significantly worse than the other plus pretty much near the bottom of the pile. This trust is pretty much always near the bottom. It changes its CEO frequently, struggles with staff morale, and often has high staff turnover and vacancies. The local people are always being told how bad the hospitals are in the league tables and the trust is always having to defend itself. I wonder then if you were a patient and asked to fill in a national survey based on your perception of various things such as do the doctors wash their hands sufficiently, were you treated with dignity or was the food up to scratch, whether your perception would be coloured by what you already know. I am not saying the hospitals in this group are perfect (far from it) but I am not convinced they deserve to be classed as bottom of the pile. I also wonder how on earth the staff can improve not only reality but perceptions of it? (Source: Life in the NHS)

Two drugs, one problem

Running a hospital — Wed, 14 May 2008 22:09:00 +0100

Our head of pharmacy, Frank Mitrano, likes to say that he wishes that all drugs were packaged in exactly the same sized containers, with covers and lids of the same color, and with simple black lettering on a white background in the same font. Why? Because it is human nature to assume that a vial of medicine with a green cap and green lettering is, in fact, the medicine you were looking for, even if it is something quite different. And, also, the more layers of safety protection information systems and other technology that you have in place, the more likely you are to assume that you have the correct drug and the less likely you are to read -- in detail -- what the label actually says before administering the drug to a patient. On the other hand, if every vial were to look exactly the same, a human being would actually have to carefully read what is in it before administering a drug.Here's the particular story that led Frank to say this today. Don't worry. No harm was done to any patient. But when we heard the story, there was some quick breathing.Our obstetric service, like all others, uses Oxytocin to induce labor when it is necessary during childbirth. The service had made a practice of stocking each labor and delivery room with a vial of this medicine, in case it would be needed in a hurry. By mistake, one day, the wrong vial of medication was placed in each room. Instead of Oxytocin, a drug called Zemplar, generic name Paracalcitol, was placed in each room. Zemplar is a drug that suppresses the production of the thyroid hormone in a person. Giving a mother Zemplar instead of Oxytocin in the middle of labor would have been quite bad.The good news is that a nurse noticed this error in one of the L&D rooms before any of the wrong medication was used, and she quickly notified everybody to check all the other rooms and take out the wrong medicine and replace it with the right one. Congratulations to her for her attentiveness.But how could this happen in a hospital focused on reducing medication errors? Well, in the stockroom rack, medications are grouped alphabetically by generic name on the shelves. So Oxytocin and Paracalcitol are near each other. And look at the bottles above. Zemplar is on the left, and Oxytocin in on the right. Or is it the other way around? They are remarkably similar. So, it might have been a simple stocking error in the pharmacy which then cascaded down the distribution system until the wrong box was delivered to L&D, where the wrong vial was put in each room.Multiple opportunities for error. In case you have wondered, yes, both the pharmacy folks and the L&D folks have been informed of this particular case. And steps have been put in place to make sure it does not repeat.Meanwhile, in part of the hospital we have already replaced the manual stocking shelves with a computer controlled electronic stocking carousel that is designed to reduce this kind of error. And we will add this feature elsewhere, too. And, we are also moving towards bar-coding of every single dosage of medication so that it can be matched with the written order and the bar code on a patient's ID band.But every electro-mechanical system has some flaw. The biggest flaw is that it creates an impression of security and precision that becomes a crutch upon which the medical staff relies. Frank Mitrano is not going to get his wish. So, ultimately, it will still be the responsibility of every single nurse and doctor to actually read the label on each dosage, compare it to the order given, and make sure each patient gets the right medication. Every time. Hundreds of thousands of times per year. (Source: Running a hospital)

Health business blog on medscape

Health Business Blog — Wed, 14 May 2008 16:17:52 +0100

As part of the preparation for Grand Rounds (hosted here yesterday), Nicholas Genes profiled me on Medscape. This year’s writeup focuses on some of my more strident positions: in favor of immigration and in defense of commercial health plans. Last year’s piece emphasized my work in medical tourism and the year before’s was a general introduction. (Source: Health Business Blog)

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Wellness, a global business imperative: pwc

Health Populi — Wed, 14 May 2008 12:16:00 +0100

Chronic disease will account for 2/3 of all deaths globally in the next 25 years."We have to move from illness to wellness. Businesses will have to invest in wellness. There is no choice. It's not philanthropy. It's enlightened self-interest," according to Shrinivas Shanbhag, the Medical Adviser at Reliance Industries in India.A new report from PricewaterhouseCoopers (PwC) and the World Economic Forum, Working Towards Wellness: The Business Rationale, details the future of chronic disease to 2030. Globally, today's emerging BRIC economies -- Brazil, Russia, India and China -- will lose millions of productive life-years due to the sorts of chronic conditions that today plague the U.S.The #1 culprit is metabolic syndrome, the combination of obesity and other health risks, which results in a 2 to 9 times higher prevalence of chronic disease. The conditions that flow from metabolic syndrome include hypertension, high cholesterol, Type 2 diabetes, stroke, coronary heart disease, gallbladder disease, osteoarthritis, sleep apnea, and some cancers (endometrial, breast and colon).Why should business follow Mr. Shanbhag's advice, stated above as thought written by Adam Smith himself?Because productivity losses associated with employees who have chronic disease can cost 400% more than health costs for healthy workers. There are four impacts that directly affect employers: presenteeism, absenteeism, disability (short- and long-term) and direct medical costs.The economic burden of disease would crowd out resources that will be sorely needed between now and 2030 for economic development, public health, environmental management, and peace initiatives.PwC and the World Economic Forum recommend that business, globally, raise health and wellness to the executive suite. Wellness goals should be integrated with overall business strategy, which is a tactic currently used at Cadbury Schweppes (which demerged this month into Cadbury and the Dr. Pepper Snapple group)on a corporate level. Work environments should support a culture of wellness from the food provided in company cafeterias to "pedometer" challenges in multi-level buildings. Interventions should be targeted particularly to metabolic syndrome. Employees should be given incentives that attract them to participate, including work-life balance programs that encourage healthy living and direct financial incentives.Health Populi's Hot Points: Across the OECD countries, only 3% of health costs go to prevention. Yet we are well aware that once a person develops a chronic condition, it is much more expensive and difficult to reverse. It appears that the developed world is exporting sick-care medical systems to the developing world. This is a prescription for global health financing implosion -- in addition to the extraordinarily negative impacts on business on a global basis. (Source: Health Populi)

Drug costs in workers comp - and the answer is

Managed Care Matters — Wed, 14 May 2008 04:00:00 +0100

I've just about completed compiling results of the Fifth Annual Survey of Prescription Drug Management in Workers Comp. While the report won't be completed for a couple weeks, here are a few factoids that are rather compelling. Drug trend continues... (Source: Managed Care Matters)

Kadlec decision reversed by appeals court

MSSPNexus Blog — Wed, 14 May 2008 04:00:00 +0100

Information excerpted from an article by Michael Callahan, Katten Muchin Rosenman LLP (Source: MSSPNexus Blog)

The perfect storm in healthcare?

hospital impact — Wed, 14 May 2008 00:12:49 +0100

by Nick Jacobs What’s this generation coming to? It started some years ago with new rules for residents. They no longer were permitted to be worked 80+ hours per week as part of their residency. In fact, many residents actually keep time sheets and then tell their MD/Professors when their work week is complete. It wasn’t that many generations ago that student nurses and residents were the only people working the night shift in even prestigious medical centers. What else is happening? New generations of physicians are actually seeking to attempt to balance their work time with their free time. A front page article in the Wall Street Journal by Goldstein reported that U.S. medicine is in the middle of a cultural revolution. According to the article, young physicians are beginning to challenge the fact that they must be available to treat patients around the clock. According to President Ronald Davis, M.D., “There has been a sea change in how young physicians today balance professional responsibilities and personal needs, compared to their colleagues from a few decades ago . . .Physicians who manage their own stress and feel happy with their own daily circumstances are probably better physicians.” As a hospital CEO in Pennsylvania, we are seeing “The Perfect Storm,” as catastrophic liability insurance is no longer available to our physicians. Ninety plus percent of our State’s finishing residents are leaving. The newer physicians who are considering staying in State are actually demanding free time, comprehensive call coverage, and weeks of vacation and continuing medical education time. Quality of life issues? So, as 78 million Baby Boomers head toward the proverbial wall, we not only have a significant shortage of gerontologists and other sub specialists, we are also faced with young, smart physicians who actually want a life. Hold onto your hats. (Source: hospital impact)

Spirit can shred red tape

Running a hospital — Tue, 13 May 2008 17:32:00 +0100

A recent report on the SPIRIT log shows that process improvement can show up in unexpected ways. Nice to see residents using it, too! We prefer that they spend time with patients rather than dealing with red tape. With an organization of our size and history, we can expect bureaucratic glitches to show up a lot.Location of Problem: Employee Health & Emergency DepartmentProblem: I was recently splashed in the operating room and directed by employee health to have my labs drawn in the ED since it was 4:30pm. In the ED, my vitals were taken and my blood was drawn by an RN. The triage nurse of the ED confirmed that obviously there would be no bill sent, yet about 2 weeks later I received a bill from both the ED Department and the ED Physician for almost $600. After speaking with employee health, I was told this happens "all the time" and I can expect to receive another bill or two but they would work on getting the charges reversed - but it would not be immediate.Suggested Solution: Better coordination between employee health and ED billing. First, the billing for an occupational exposure should not occur, but if it does, the reversal of charges should be immediate. I shouldn't have to waste my time and continue to follow up through a cycle of bills. I should be able to contact the billing department and have a zero balance as soon as the report of the error occurring.Person Describing Problem: Vijay Saluja (Anesthesiology Resident)Root Cause: Vijay, thank you for calling this out. I can address the BIDMC ED charging issue. You are correct that the charges should not have been billed to you for an occupational exposure. There are provisions for covering those cases. Thanks to your call out we have identified a system bug that caused the BIDMC charges to be billed to you and to others in error, and the inconvenience caused is regretted. Martina Comiskey, Revenue Cycle Systems and Training.Solution (after investigation): Billing system configuration issue causing BIDMC charges to bill to patients instead of Workers Comp Coverage. Needs to be resolved to prevent future incidences. Retroactive report of all impacted patients needed. All accounts need to be corrected and the charges appropriately redirected.Action Plan (who, what, by when)WHO: Revenue Cycle Systems team1) BIDMC billing system bug fix - completed 5/8/082) Retroactive reporting will be completed 5/9/083) All patient accounts will be corrected by 5/12/084) Monitor monthly to ensure that process is working as intended.Investigation Closed (Complete w/ root cause, solution, action plan complete) (Source: Running a hospital)

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Surgical workaround

Running a hospital — Tue, 13 May 2008 11:00:00 +0100

A note from one of our surgeons:Paul,I'm writing this out of frustration. The door C334 to the male locker room in the Shapiro OR has been dysfunctional for weeks. You need an access card to open it. The mechanism is faulty and each morning for some time now surgeons, techs etc have had to battle to get in the room and change for the OR.Efforts have been made to 'repair' the mechanism but nothing has worked.Please forward this to the appropriate person and have them leave the door unlocked till such time as it can work effectively. People have had to force the door open at times which is causing more damage ( to the door and shoulders).I just don't know who is in charge of this kind of thing but am sure you can forward it to the appropriate authority.Response from our head of maintenance a few hours later:Dan Kendall from our offices was approached on this issue directly and has already both assessed the problem and rectified it. In essence, a staff member had taken it upon himself to tape (surgical tape) the latching mechanism so as to avoid having to use his swipe card for access to the locker room. Some of the adhesive residue remained within the moving parts of the mechanism even after the tape was removed.Dan was able to locate the individual who admitted to taping the mechanism and agreed not to bypass this (or any other) security measures again. Dan was also successful in removing all remaining sticky residue, and the latching mechanism is once again fully functional. Note to self: Teach surgeons how to use BIDMC SPIRIT to reduce blood pressure. (Source: Running a hospital)

What we can all agree on: the post-latte economy

Health Populi — Tue, 13 May 2008 09:07:00 +0100

There's a new New Yorker cartoon I'm using in a presentation today to a health plan titled, "Starbucks goes downscale: drinks for the post-latte economy." Three new drinks are offered in the economic downturn-menu: instant coffee with Cremora, the Big Gulp of "American joe," and my personal favorite, "The Floyduccino." It's this last drink I forecast will have the biggest uptake given the blues that we're all feeling due to economic woes.The Floyduccino is coffee with a shot of Wild Turkey: "good for what ails ya."In the latest Gallup poll published May 12, 2008, 9 in 10 Americans feel the economy is getting worse. Furthermore, prospects for improvement are gloomy: combining the current state and future personal forecasts, 80% of Americans share a negative outlook.In April, Gallup conducted a survey into Americans' personal views on retirement. When asked about their financial worries in Gallup's April 6-9 Economy and Personal Finance poll, 63% of Americans say they are worried they will not have enough money for retirement. Retirement finance overtook health care finance worries with 56% worried about not being able to pay medical costs in retirement.Health Populi's Hot Points: There's another New York cartoon I'm using in today's presentation called "Gas 'N Health Care." This cartoon features a service guy at the pump asking the driver-customer, "Your oil's fine, but your blood sugar level's a little low."In my PowerPoint version, I change the "N" to "Or."In the post-latte economy, Americans aren't just choosing the Floyduccino, perhaps instead of the fluoxetine. They might choose gas over health care. (Source: Health Populi)

Grand rounds 4:34 at the health business blog

Health Business Blog — Tue, 13 May 2008 04:01:08 +0100

Welcome to the latest edition of Grand Rounds at the Health Business Blog. This is my fourth time hosting (fifth if you include the April Fool’s edition). We’ll start things out with a little fun before getting serious Who says radiologists don’t have a sense of humor? Not Totally Rad’s iPhluoroscope is the latest antidote to the cocktail party consult syndrome. Clinical Cases and Images advises that starting to drink in middle age may reduce cardiovascular events as much as statins do. If the effect is synergistic, expect to see combination products enter clinical trials soon. Liquitor anyone? And if you want to play games while drinking, Vitum Medicinus likes to pour hot water in one ear and cold in the other to make your eyes quiver. Medical manners, miscues and menschen I was struck by the number and depth of posts discussing the complexity of relationships among doctors, administrators, patients, nurses, and chaplains. Other Things Amanzi offers a story from his surgical training. A senior physician had essentially left a patient to die –pronouncing his diagnosis of a fatal condition by phone and refusing to come in to help out– but our blogger and a colleague saved that patient’s life. The next day another senior doc took the two trainees to task (in public) for not performing the surgery exactly the way he would have, while the doc who’d given up on the patient and abandoned the trainees sat by silently. Dr. Anonymous interviewed Beth Israel Deaconess president Paul Levy. The Blog That Ate Manhattan was eating it up at least for a while. Here’s an administrator who gets it, who’s empathetic toward docs and generally a good guy. But then she reacts (or possibly overreacts, as she admits) to a comment Levy made about dealing with a difficult doc in a negotiation. In the comments section Levy explains himself further: Doctors should be expected to communicate and negotiate well as part of their jobs, and not just in dealing with administrators. Meanwhile GruntDoc was listening to the podcast, too. He didn’t take umbrage at Levy’s comment. In fact he’s a bit embarrassed that doctors display such “horrible” negotiation skills. In case you think you can’t teach an old doc new tricks, The Entrepreneurial MD presents Secrets of developing new habits. Physicians fall into certain patterns of thinking, but they can become creative and innovative again by pushing themselves out of their comfort zone (and perhaps learning to negotiate and communicate). For the RoboDocs who aren’t quite ready to leave their comfort zone, the NEJM ran an article entitled Etiquette Based Medicine. In Sickness and In Health is saddened by NEJM’s cookie cutter approach to etiquette in the doctor/patient relationship, e.g., “Sit down. Smile if appropriate.” She considers it a poor substitute for real empathy and connection. I’m more sanguine on the concept –courtesy and manners can go a long way for patients, even when it’s not heartfelt. Over time, following such mechanical steps may actually lead to a change of heart. But if your doctor isn’t the compassionate (or polite) type, you could do a lot worse than to receive a visit from Rickety Contrivances of Doing Good, a volunteer chaplain. What she calls Two Moments of Grace I would call, A Touch of Class. Her offer to get a glass of water for a fatigued family is greatly appreciated, and her “few trite, awkward sentences” for another patient help that person turn the corner. Medical Pastiche offers up commentary on 7 famous medical TV shows. Some are more realistic portrayals than others, but as a whole they offer insights into doctoring and the nature of medical relationships. In any event they do have an impact on real-life patients and medical professionals –current and potential. Meanwhile, Mind, Soul, and Body was introspective and insightful in his choice of pediatrics over adult medicine. My favorite reason: “Kids don’t have that unmistakable adult hospital smell.” Own Your Health provides advice on creating a “meaningful, healing partnership with a physician.” Old fashioned talking plays a big role. Emergiblog offers words of wisdom to graduating nurses. Among them: “Please, please remember that you practice nursing and not medicine… Act like the consummate professional, and you will find that the doctors will treat you accordingly. Those who don’t have a problem. You do not.” Suture for a Living offers aspirational words for physicians to live by, circa 1871 but still relevant today. Patient tales HealthBlawg went to Israel and had a pretty good experience at the emergency room. For one thing, no one asked about payment. Delayed arrival at Shakespeare’s Falafel Stand was the only real downside. Chris is going to be quite a good husband if Six Until Me’s story of nighttime low blood sugar woes is any indication. At a minimum he’ll get used to hearing the term “honey” thrown around. Decreased amniotic fluid? Not good, says Fruit of the Womb, and here’s why. Well, Well, Wellness The biggest change since I last hosted GR is the plethora of submissions on wellness. The Fitness Fixer shows us how to stretch mindfully so we don’t just cause new problems. Wellness tips advises: “pretend that your pelvis is a bucket,” to avoid hip pain. SharpBrains (surprise!) is into brain fitness. Teen Health 411 recommends healthy eating for teens. The Diet Dish lets us on to the fact that a dietitian is a professional while a nutritionist is a nobody. Dr. Penna reminds us that breast is best. Medicine for the Outdoors suggests avoiding ground-level ozone. In case you’re still having trouble sleeping after all that wholesome advice, How to Cope with Pain has tips on getting better sleep and so does Highlight Health. How to Cope recommends using the bed only for sleep and sex. Apparently insomniacs had been giving the kitchen a bad name. Health Wonk Review it ain’t, but we’ve got a few policy posts Dr. Rich of The Covert Rationing Blog establishes that he is no friend of lawyers but then explains that medical malpractice insurance reform is a bad idea for everyone, at least at this stage. FDA is dissing insulin pumps. If they’d read Diabetes Mine they’d know better than to say such things. Are doctors overmedicating kids? Dr. Anonymous raises the issue but keeps his own verdict close to the vest. Freedom from Smoking worries that tobacco control money is being cut in tough economic times. He may not realize that we need smokers to pay cigarette taxes for all the new domestic initiatives –like universal health insurance. Taking Accutane for acne? You might be blackballed when you try to get insurance, says InsureBlog. Technology’s turn From Healthline Connects: Cochlear implants may be the number one medical advance of this century, but adjunctive therapy is a must. ASTHMA IQ helps physicians implement clinical guidelines, says Allergy Notes. Wait Time & Delayed Care applies the Boston Consulting Group’s richness vs. reach framework to explain the tradeoff between quality service and wait times in health care. (I wish he’d continued in the same vein as the BCG authors, who used the construct to explain how the Internet breaks the compromise between richness and reach. Workflow innovations and health care IT display some of the same potential in health care.) Efficient MD is launching a new wiki for health care professionals. “Clinical pearls” and “life hacks” are among the rewards to be found there, we are told. Perhaps they can resolve Wait Time’s issues. Thanks for reading Grand Rounds. You can read my previous Grand Rounds editions here, here, here and here. Next week’s host is Musings of a Dinosaur. (Source: Health Business Blog)

Placebo surgery

Health Business Blog — Tue, 13 May 2008 03:25:09 +0100

You can read a good take on placebo surgery at Science Channel. This leads me to an extremely bizarre — but nevertheless intriguing — thought: If fake surgery actually helps study subjects, what about using it to treat ordinary patients, particularly ones for whom no other effective treatment seems to be available? (Source: Health Business Blog)

Telemedicine beats the emergency room

Health Business Blog — Tue, 13 May 2008 02:42:08 +0100

Several years ago, while seeking to establish the ROI for RelayHealth, we found that users of RelayHealth had lower spending for emergency department visits than the control group. The explanation was reasonably straightforward: better, more timely access to physicians obviated the need to show up at the emergency room with its attendant costs, inconvenience and dangers. Now a study from the University of Rochester has shown something similar. More than 25 percent of pediatric ED visits could be avoided through telemedicine. Researchers found that many ED visits were for non-emergency issues like sore throats and ear infections. That’s no particular surprise to anyone, I don’t think. The group in the study with access to telemedicine did access care 23 percent more than the control group, but overall costs were much lower because ED visits were 24 percent less frequent. Cost savings translate into about $14 per year, enough to buy a pretty decent dinner in Rochester. As technology improves –with better communications and remote monitoring technology– I expect such benefits to grow. (Source: Health Business Blog)

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Bidmc annual nursing awards ceremony @ fenway park

Running a hospital — Tue, 13 May 2008 02:22:00 +0100

(Source: Running a hospital)

Eprescribing gathers steam at brookings, the ama and on the hill

Health Populi — Mon, 12 May 2008 11:29:00 +0100

ePrescribing = safety, lower costs, and better health care. This consensus was clear last week during a major meeting of stakeholders at The Brookings Institution discussing the prospects and barriers to ePrescribing (eRx).Matthew Holt and I wrote a report back in 2006 for the California HealthCare Foundation where we discussed the opportunities and barriers for eRx. Two-and-one-half years have passed since that report was written. So 30 months later, continue to read this blog to learn about how Medicare, physicians, PBMs, Congress and pharmacies are getting into Kumbaya mode for eRx. While the actual number of ePrescribers is something between 10% to 15% of physicians, the forces driving adoption of eRx are many and formidable. First, the big "M:" Medicare. Next year, the Medicare Part D regulation dealing with eRx comes into play. CMS issued final standards for eRx in April on formulary and benefits; medication history; fill status notification; and, provider identifiers. These will be in effect in April 2009. Several other standards were written into the Part D legislation that went into effect in 2006 (such as drug benefit eligibility, etc.).Now, 2.5 years since our eRx report was published, physicians are demonstrating growing support for eRx among professional associations, many of whom appeared at the Brookings meeting.The AMA is advocating a 2-year phase in for physicians, taking into account some of the more challenging practice situations such as rural physicians without broadband, and solo and small practices. In addition, physicians want and need information technologies to be certified to make certain they meet these new standards. While the AMA would like to see funding incentives for physician adoption, that doesn't appear to be in the cards for now.Physician associations such as the American Academy of Family Physicians, American Academy of Pediatrics, American College of OB-GYNs, American College of Cardiology, American Osteopathic Association, and the Medical Group Management Association, have organized GetRxConnected, a website that helps physicians figure out how to get involved with eRx. The MGMA has calculated that administration and paperwork attributed to prescribing in the physician's office costs a practice $15,700 per each full-time physician in the office. Third, PBMs are ready now for eRx. The industry's association, the Pharmaceutical Care Management Association (PCMA) has launched a multimedia campaign that's promoting ePrescribing, "before more people die." The ad is targeted to consumers and patients, not providers.There is also bipartisan support for eRx in Congress. The E-MEDS Act (Medicare Electronic and Safety Protection Act of 2007) was introduced by John Kerry and John Ensign last year. Some 29 co-sponsors have crossed the party aisle to support this bill. Newt Gingrich, author of Paper Kills and proponent of driving paper out of the medical system, worked on this Act, too.Finally, pharmacies have come together for eRx. Look for signs reading, "e-Prescriptions Filled Here" to grace the doors of your local CVS, Duane Reade, Longs, Rite Aide, Wal-Mart and other pharmacies.Over 40,000 pharmacies have cooperated in this effort with SureScripts to turbocharge eRx in their communities through their Pharmacy Health Information Exchange. The website http://www.learnabouteprescriptions.com/ hosts a patient education campaign on this project. Health Populi's Hot Points: If you take MGMA's average cost of prescription drug administration per physician of $15,700 and multiply that by the 563,000 physicians who prescribe medicines in the U.S., you get a whopping $8.8 billion worth of potential savings that eRx would generate. That's a bolus of savings that would genuinely benefit patients in the U.S. health system -- and it doesn't even include the benefits of patient safety that would accrue to society and American families. (Source: Health Populi)

Celebrating nurses day

Life in the NHS — Mon, 12 May 2008 06:18:19 +0100

In the UK we don’t tend to have a whole week celebrating nurses and nursing, but rather just the day. That day is today the birthday of Florence Nightingale, and let us just say this is pretty low key. Professions go through different patches in terms of popularity and whether those who are part of it are worthy. My assessment would be that nursing is going through a rocky time right now as it attempts to find its place. Traditionally nursing has been seen to be about caring, about providing a particular type of care for patients but increasingly it has been about developing new skills, perhaps specialising in particular areas and that has led people to question whether nurses have forgotten their roots. The Royal college of Nursing has a set of pages devoted to Nurses Day this year, within which nurses tell the story of the work they do. Entitled ordinary people, extraordinary care nurses from different backgrounds with different roles tell us about their daily life. Take a look they are worth a read and cover areas of practice many wouldn’t even think of as being roles within nursing. Sadly it would be my guess that few people in the UK know that it is Nurses Day today, for goodness sake many people don’t even celebrate national days like St Georges day but if you come across a nurse today, perhaps rather than criticising them for perceived wrongs with them and their profession, congratulate them, after all nursing isn’t something that just anyone can do, but then of course I would say that, because I am one! (Source: Life in the NHS)

Triggers happy

Running a hospital — Mon, 12 May 2008 05:00:00 +0100

A year ago or so, I wrote about the introduction of our Triggers Program, a rapid response team approach to patients on medical floors who might soon decompensate or have other serious changes in their condition. The program has been incredibly successful in reducing mortality and morbidity. In fact the number of "codes" on our floors has gone down so dramatically that residents now need to practice emergency resuscitation mainly in the simulation center because so few actual patients need it.I recently asked a couple of our folks who were deeply engaged in the design and implementation of this program -- Dr. Michael Howell and Patricia Folcarelli, RN, Ph.D. -- to tell me what lessons have come out of the last year's experience with Triggers. Here is what they sent me. I offer it in the spirit of sharing information with people in other hospitals.In the year after implementation of the Triggers program, one of the major focuses of our reviews was on patients who had major adverse events happen in spite of the Triggers program. When these adverse events occurred, we tried to understand the factors that contributed to them even being possible in our organization. A few months after Triggers began, we began to notice some patterns. Here are some examples of the things we learned.Oxygen is not a utilityPatients in the hospital sometimes need extra oxygen. Low oxygen levels in the blood can be due to pneumonia, heart failure, or a number of other problems. Surprisingly, extra oxygen usually does not help with the feeling of shortness of breath, but rather prevents further problems from not getting enough oxygen to vital organs. We found that, in many cases, providers often treated oxygen as a utility -- like the water that comes out of the sink – rather than as a drug used to support a feeling organ system. (The members of our Triggers Steering Committee had worked in about twenty other hospitals total, and we all felt it was the same in every hospital in which we’d ever worked.)We saw a pattern in which providers would repeatedly increase the amount of extra oxygen that was being provided to patients. We often monitor the oxygen level in the blood through a noninvasive device -- as his number was normal, providers felt reassured – not taking into account the fact that the patient was needing higher and higher levels of artificial support to keep this number at the “right” level.In fact, interns would sometimes round in the morning and would find their patients on oxygen with no explanation, and the patient had been breathing room air the night before. Sometimes, neither the nurse nor the intern knew why the patient got put on oxygen; it had happened overnight and was viewed as an unimportant event.As a result of this we conducted a Failure Mode Effects and Criticality Analysis, a tool used in the military and industry to understand points at which complex systems are likely to fail, and implemented substantial changes in the ways that we order oxygen, in a way that patients are monitored from a respiratory standpoint. We also introduced physician, nurse, and patient care technician education on this matter.Aspiration riskWe also learned that aspiration was a bigger threat to patient safety than was usually appreciated. When physicians and nurses talk about "aspiration" they are talking about when a patient swallows something the wrong way. This can be the person's own saliva and secretions or, more commonly, can occur when they try to eat or drink something. Since the mouth is usually full of bacteria, this can lead to pneumonia; sometimes, the person actually swallows his or her stomach acid in the lungs, which can lead to very severe chemical injury to the lungs. In some cases, aspiration leads to death. For this reason, when we think that someone is at high risk for aspiration, we put them on “aspiration precautions." This means that nurses, patient care technicians, and physicians are all alerted to the increased risk of this problem. In addition, we put a sign up on the patients at the patient's bedside to warn visitors and those providers who may be seeing the patient before seeing the chart.As we dug a little deeper into some of these cases, we learned that patients sometimes aspirated food that their families brought in. Family members obviously did this out of love, but it sometimes led to very severe consequences for their loved one. When we tried to figure out why this happened, we found that our warning signs depended heavily on written English, rather than on easily interpretable symbols. This meant that if family members came to visit and English was not their first language, or if they had trouble reading English, we might not convey the right information to them. In coordination with a provider education campaign about the risks of aspiration, we therefore redesigned our signage to overcome these barriers – by using multiple languages and universal symbols (think Mr. Yuck!) that were likely to be interpretable even if the family member was unable to read the sign.Who does what?As inpatient medical care has become more complex, more people are needed to provide it. For example, our nurses do a number of safety checks as they're preparing various medications because these medications have inherent risks. There is also substantial amount of documentation that nurses have to do for safety, compliance, and legal reasons. This means that nurses need extra manpower to get work done. Most hospitals, therefore, have a group of providers who are variously known as nursing assistants, nurse’s aides, or patient care technicians. These providers are trained by the hospital, and sometimes by external schools, but are not licensed in the same way that nurses and physicians are. Patient care technicians may check vital signs, help with turning patients, assist with toileting, etc. In our hospital, for example, many of the routine vital signs are taken by patient care technicians. The Triggers program taught us a few things about patient care technicians and their relationships with our other existing systems of care. In particular, when we did our initial education for the Triggers roll out, we forgot to include patient care technicians in the educational campaign. This was a huge oversight, which we quickly learned when we would see patients who did not Trigger even though they had abnormal vital signs. Why didn't they Trigger? They didn't Trigger because we forgot to provide education to this very important a set of providers in our institution. Once we had included them in the educational campaign, this mechanism of Trigger failure essentially vanished.We also learned that what patient care technicians do on any given floor is extremely variable. We therefore began a program to help standardize the scope of practice for patient care technicians at BIDMC.Unintended consequences of improving patient satisfactionA few years ago, as we tried to improve patient satisfaction, we changed the way that patients order their hospital food. The program was called “At Your Request" and let patients call up to order their meals from a menu of options – at essentially anytime they wanted to eat. (From a practical standpoint, this works a lot like room service: you call and order your meal, and it shows up half an hour later.)However, this turned out to be another way that patients who were at high risk for aspiration (see above) could get food that was unsafe for them to eat. A patient on aspiration precautions, for example, could literally call and order a hamburger, which would generally be delivered, warm and tasty, a half hour later. When we saw events related to this, we redesigned the process by which food was delivered, creating an electronic Diet Dashboard and directing the delivery of all food for patients on aspiration precautions to the nursing station. (Sometimes, patients at high risk for aspiration just need help eating food safely, which we can now provide.)If the nurse is worried, you should be worried too.This is an example where our analysis confirmed something we already believed to be true.The Triggers Program has various specific criteria mandating a response from providers. For example, if the pulse rate is acutely greater than 130 beats per minute, a Trigger is called and the team responds. However, we have one criterion which is much more subjective: "marked nursing concern." When we implemented the Triggers program, many physicians were very nervous about giving this criterion. They were afraid that they might be called in the middle of the night for things that weren't really important, and that nurses might use this as a weapon if they did not like the physician or if they disagreed with the plan of care.Well, it turns out that nurses use this Trigger quite judiciously – only 15% of our Triggers are called only for nursing concern. (In another 27% of cases, nurses express “marked concern” but the patient also meets other criteria simultaneously.) It also turns out that if nurse has “marked nursing concern,” it means you’re really sick. The in-hospital mortality rate for a patient who has a Trigger called for “marked nursing concern” is 10.7%.This is roughly twice as bad as showing up to the Emergency Department with a heart attack. Literally. (Source: Running a hospital)

A few facts about pharmacy management in workers comp

Managed Care Matters — Mon, 12 May 2008 04:00:00 +0100

I'm knee deep in my annual survey of pharmacy management in workers' comp, and if I look at one more column of data I'm going to need a few class 2's myself. So in the interest of my sanity, here... (Source: Managed Care Matters)

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Hospital specialists assume national and state leadership roles

MSSPNexus Blog — Sun, 11 May 2008 04:00:00 +0100

From (Source: MSSPNexus Blog)

Alert: food and drug administration (fda) heparin recall for all provider types

Health Business Blog — Sat, 10 May 2008 01:51:57 +0100

I’m reprinting this message I received from FDA: Please help FDA spread the word about recalls of injectable heparin products and heparin flush solutions that may be contaminated with oversulfated chondroitin sulfate (OSCS). Affected heparin products have been found in medical care facilities in one state since the recall announcement. Although product recall instructions were widely distributed, they may not have been fully acted upon at all sites where heparin is used. There have been many reports of deaths associated with allergic or hypotensive symptoms after heparin administration (see FDA link at http://www.fda.gov/cder/drug/infopage/heparin/adverse_events.htm ). We ask that health professionals and facilities please review and examine all drug/device storage areas, including emergency kits, dialysis units and automated drug storage cabinets to ensure that all of the recalled heparin products have been removed and are no longer available for patient use. In addition, FDA would like to inform health professionals about other types of medical devices that contain, or are coated with, heparin. To read this update, and to learn how to report these problems to FDA, please go to: http://www.fda.gov/cdrh/safety/heparin-healthcare-update.html. Please report to FDA adverse reactions associated with these devices, as well as any reactions associated with heparin or heparin flush solutions. If you have questions or would like more information about this request, please contact the Division of Drug Information at 301-796-3400. (Source: Health Business Blog)

60 days in umbria

Running a hospital — Sat, 10 May 2008 00:17:00 +0100

If you are in Cambridge, please visit the BAAK Gallery at 35 Brattle Street to see the paintings of Kathryn Sanfilippo, a Boston-based (450 Harrison Avenue) artist displaying paintings inspired by her time in Italy. The one above is called Countryside and gives you a sense of the colors and broad brush strokes used by Kathryn. The show opened tonight and goes until June 5, when the Italian Consulate presents it at the Federal Reserve Building.P.S. Health care folks in Atlanta and Columbus might recognize the last name, also associated with brother Fred, CEO of Emory's Woodruff Health Sciences Center and Chairman of Emory Healthcare, and formally Senior Vice President for Health Sciences and Dean of the College of Medicine at Ohio State University. Fred is the first to admit, though, that the real talent in the family lies with his sister. (Source: Running a hospital)

A new idea: the 338 foundation

hospital impact — Sat, 10 May 2008 00:03:15 +0100

by Tony Chen I have an idea that I wanted to share with you - please give me your honest opinion (i.e. you can tell me if I'm crazy!). I would love to find others to collaborate with on this. So, if you're interested, contact me directly (tony at hospitalimpact dot org) or comment below. Obviously, the idea is still very rough, but hopefully you'll see where I'm heading. And hopefully, we can refine it together. What do you think about a new a philanthropic/VC hybrid that invests in preventive health projects that yield at least 338% ROI? (thus the name "The 338 Foundation.") I'm going on 2 key assumptions: 1. Prevention is one of the biggest opportunities in healthcare. We don't have a healthcare crisis as much as we have a health crisis. We need to pour out a lot more creativity and resources for prevention/healthy living. 2. The biggest obstacle around prevention is a lack of (or misaligned) incentives. No one wants to invest the real money for what's truly best for the patient because these potential investors (whether they be hospitals, insurance companies, pharma, or other companies) make the investment, and others would get the benefit. For example, a hospital may choose not to hire a chronic disease mid-level practitioner because the "cost savings" it generates essentially goes to the insurance company. Maybe the hospital saves some real costs from reduced ER visits, but not enough to pay for itself. With so many pressures on margin, I can't blame them for that decision. Insurance companies are investing in some disease management 2.0 items, but I doubt they will ever really invest because their members stay with them for only a few years (I've heard 2.5 years?). So any investment they make into keeping the patient healthy is most likely benefiting their competitor (i.e. who ever happens to be their member's insurance company 5 years from now) It's the classic case of no one wanting to do what's "right" because they pay 100% of the costs while reaping only a fraction of the benefit. So this idea would turn that notion on its head by getting all interested parties to pool their resources together into initiatives that collectively will pay off for all of them. How I could see this playing out: - Some smart, collaborative healthcare people could solicit and collect all potential ideas/projects/research and rank them by ROI & approximate benefit to each industry. - We would welcome individual and corporate donors to the foundation. - We could do a targeted pilot (i.e. partner with the City of Chicago - i.e. trying to get Chicago to be the "healthiest city in the U.S. by 2015") - Solicit proposals/applications from organizations who can most effectively implement these projects. - Fund based on potential ROI and effectiveness of organization's implementation proposal. So, what's the significance of 338? I'll leave that as a riddle for you. It has to with an important year coming up in our lifetime. (one side note: One of the ideas I would love to see funded is a savvy viral advertising campaign that changes how people think about their lifestyle habits, like how http://www.thetruth.com/ reduced teenage smoking) Imagine investing in a fund that yields $3.38 savings/benefit for our country for every $1 we put in. Please comment/brainstorm with me! Is this crazy or what? (Source: hospital impact)

Podcast interview with richard noffsinger, ceo of safemed, a clinical decision support company (transcript)

Health Business Blog — Fri, 09 May 2008 21:12:01 +0100

This is a transcript of my recent podcast interview with Richard Noffsinger, CEO of SafeMed. David Williams: This is David Williams, co founder of MedPharma Partners and author of the Health Business Blog. I spoke today with Rich Noffsinger, CEO of SafeMed, a clinical decision support company based in San Diego. I first met SafeMed’s founder, Dr. Ahmed Ghouri, a couple of years ago when the company was starting a pilot at Beth Israel Deaconess Medical Center in Boston. I liked the demo I saw then and I have been following the company ever since. In our interview today, Noffsinger brought me up to speed on SafeMed’s collaboration with Google, its progress in radiology and the impact the company hopes to have on cost, quality and patient safety. David: Richard, it’s a pleasure to speak with you today. Richard Noffsinger: It’s great to be with you David. I appreciate the opportunity. David: Richard, tell me first of all, what is SafeMed and how does it work? Rich: SafeMed is an exciting new technology in the clinical decision support arena. We’ve set a new bar in clinical decision support that personalizes and identifies and prioritizes treatment options for both doctors at the point of care, as well as patients in a PHR, or doing it on a mass population basis. It then specifies best treatment options based on that information and is specific to the patient, their conditions, issues and their demographics and profile. David: Richard, what kind of information does SafeMed rely on? It sounds like if you have more information, it will lead to better decisions. Rich: David, you are exactly right. The more information that SafeMed has, the deeper and more specific the recommendations or information and clinical decision support we can provide. At the point of care, if there is an EMR we are going to have much better information, much better results, than if we just have a few pieces of information. We pull personal information: age, weight, sex, that type of thing, and also what drugs are they taking. We also take business rules into consideration: what formularies they’re on, what their insurance covers and we also analyze and compute on lab results. We consider not just that they had a lab test but what the lab results are. The more information we have, the better we can provide the depth and context of the information in providing the safest, most effective and affordable treatment options. One of the areas that we have done this in is radiology, where we take into consideration all the data points for imaging. When a doctor is ordering an image, we can look at the different options and point out the highest efficacy based on the profile of the patient and what they are trying to determine for that patient and what makes the most sense from an imaging test. We are doing that at Beth Israel in Boston, for example. David: Richard, you mentioned radiology and I know that has been a focus for the company. In fact, I saw that radiology model at BI a couple of years ago when it was first being tried out. Why do you have such a focus on radiology and how does what you are doing in radiology relate to, for example, National Imaging Associates or a cost containment organization that an insurance company might hire or own? Rich: The imaging market is a very rapidly growing market and it is very expensive, north of $100 billion a year, and there are companies out there that are trying to contain those costs through call centers and requiring authorization and that type of thing. What we have done is automate that at the point of care, so there is not a 24, 48, 72 hour turnaround. It provides and empowers the physician at the point of care and where appropriate to direct them to possibly a more appropriate test for the patient given that profile. We’ve automated a lot of that call center type of functionality. Because our engine is so powerful it can do it literally in subsecond time right there in the exam room, if necessary. Now your question is why so much focus on that. It’s one of the capabilities of the engine but the search engine is so powerful that we can purpose it in different areas, whether it is drug contraindications or lab tests or whatever. We are using the same core engine and we are just extending the rules, if you will, to that engine and to that specific specialty or requirement. It is very compelling for a lot of institutions so they are not trying to maintain multiple decision support engines. David: There are a lot products out there and services that would call themselves clinical decision support. Do you have a market map of how you would position SafeMed relative to some other players that the listeners may have heard of? Or can you lay out where you stand relative to some other companies? Rich: Our capability, our technology, is unique in that it can truly serve multiple constituents. We can provide the clinical decision support in a very profound way at the point of care in an EMR or CPOE system. Because of its speed, there are very few systems that have the depth and breath of capabilities that we do at the point of care. We have built a methodology or business model where we’re an engine, and in that instance we want to integrate into the existing work flow. But that same engine can then be used as a clinical decision support in a PHR for a consumer. So as Google and other PHRs become available to the general population, we can help take that functionality to a whole new level by empowering the patient with actionable information. It becomes much more than just a filing cabinet. It is specific to their situation, the prescription drugs that they are on or the drugs that they are on and their profiled information. It becomes very empowering to the patient. That is on an individual consumer basis. So Google Health announced that they are in a pilot and going to be launching a PHR soon. We have been working with them for over a year to help deliver drug contraindications in their health portal, their PHR. It is very powerful to the consumer. We leverage the same engine for the payer market. There are many players out there that are engaged in analyzing the claims data. While we do this very well also, that is not the only place we do it, as we just talked about. So we give you one engine, purposing that in three different environments. At the point of care, for the consumer in a PHR, and analyzing a population, or a payer base of patients from a payer’s prospective. David: Richard, you mentioned payers as one of the constituencies, and I know that, for example, Aetna acquired ActiveHealth a while back and WellPoint just announced the purchase of Resolution Health. Do you fit at all in that space or have you had enquires from payers? Do you see that becoming a possibility further down the line? Rich: We do fit in that space and we do have a good deal of interest from payers because we not only provide the analysis, but we provide direction on where they can provide better care. Our engine not only can analyze, but can provide input on more economical directions and also on the safest direction to help a payer’s population. We are working with other payers and disease management companies in looking at how to leverage our engine. We think that the Resolution Health acquisition by WellPoint validates and increases the interest in this market and validates the value of what we are doing and what other companies are doing in this marketplace. David: You mentioned earlier on that you were doing some radiology physician support at Beth Israel in Boston and I said I had seen it there. Can you tell me a little bit about how that relationship has evolved? I noticed that John Halamka who is the CIO there at BID and also of Harvard Medical School has joined the SafeMed board. Rich: We are absolutely thrilled to have John on the board. His expertise, his intellect, his knowledge and his experience in the health care IT market is really exceptional. We are exceedingly fortunate to have somebody as smart and experienced as John on our board. Our relationship with Beth Israel is very strong. We have been working with them for a couple of years and we continue to expand the capabilities in working with them. This includes an IRB test with what we are doing in radiology and imaging and expanding the capabilities of the product. They have been a wonderful business partner through this process. David: Explain for me your vision of where clinical decision support can have an impact on cost, quality, and patient safety. How broad can SafeMed’s impact be? Is SafeMed the silver bullet for health care cost and quality? Rich: Well, as much as I would love to say that SafeMed is the silver bullet, I am not sure that there is one silver bullet. I can say that we think that we have developed something pretty special and that we feel that there is a strong place for SafeMed’s technology in the health care ecosystem. There is so much information out there and there is so much new information coming all the time that a doctor can’t possibly be expected, given the pressure to see more patients in the same amount of time or less time, the new information that is coming to the forefront all the time, the regulations and guidelines. It is just virtually impossible for someone to keep it all straight. We think a tool like SafeMed is incredibly empowering and helpful, both in the quality of care that is ultimately delivered, but also in the cost of care. There is a lot of defensive medicine going on out there. We think that we have the most powerful engine out there. We think it is foundational and transformative to health care as a whole. We think it can have a profound effect on what is going on in health care today. Health care is just too complex, too big, too many options, too many things to consider to expect one person to keep it all straight in their mind. We think a tool like SafeMed is profound in what it can do. David: Richard, what you mentioned there about defensive medicine reminded me of a piece that my fellow blogger Kevin Pho, who writes as Kevin M.D., had published in the USA Today. He talked about wasted medical spending, and about unneeded CT and MRI scanning in particular. It sounds like SafeMed may actually be able to address this. Rich: David that is an excellent example. That is right in the sweet spot of where we are going and where we see incredible opportunity. David: I have been speaking today with Richard Noffsinger, Chief Executive Officer of SafeMed, a clinical physician support company located in San Diego, California. Richard thanks very much for your time today. Rich: Thank you very much. I appreciated the opportunity David. (Source: Health Business Blog)

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Lean leaves well-oiled gears

Running a hospital — Fri, 09 May 2008 19:50:00 +0100

Remember when I told the story about using Lean process improvement techniques to enhance the service in our orthopaedic clinic? That was over a year ago.Here's a note from a recent patient, a local student:I just had to share this with you because it was such a neat feeling at the time. I saw Dr. Gebhardt yesterday (my orthopaedic surgeon) and there there was no wait for anything at all. Checking in was a breeze. I saw Dr. Gebhardt exactly on time. Afterwards, I was worried about getting the x-rays because the whole waiting room was full, but again, there was no wait. I've read about lean, SPIRIT, and process improvement on your blog, so it was such a neat feeling to experience and also to know what was behind my no wait experience! I think it provides a whole new meaning to patient-centered care. The only thing that was odd was that the front desk never asked me to pay...but I was so happy with my visit that I actually offered to pay my copay (and this is coming from a poor graduate student).We will work on the payment part next! (Source: Running a hospital)

Mind your manners

Running a hospital — Fri, 09 May 2008 19:29:00 +0100

Dr. Michael Kahn, from our Department of Pyschiatry, has published an article in the New England Journal of Medicine that suggests that doctors enhance their relationship with patients when they deal with patients in a polite manner. Here is a summary on the AOL web site, along with a poll on the issue. I like this summary: Etiquette-based medicine . . . "would put professionalism and patient satisfaction at the center of the clinical encounter and bring back some of the elements of ritual that have always been an important part of the healing profession."NEJM has published the entire article as freely available to the public here. This is a very polite thing for them to have done, and I thank them. (Source: Running a hospital)

Retirement forecast: work longer, see fewer medical specialists, take care of yourself

Health Populi — Fri, 09 May 2008 12:15:00 +0100

Older workers will work longer to keep health coverage. But even as they do so, they'll confront a dwindling supply of medical specialists.Watson Wyatt (WW) found that people over 50 years of age who receive health benefits from employers and don't expect to receive these benefits in retirement are 16.5 percentage points less likely to retire than people who have health coverage from another source (such as a spouse’s health insurance plan, Medicare/Medicaid, COBRA). In its report, Predictive Factors for Retirement Timing, WW identifies the main factors influencing when Americans will retire, including health and non-health considerations. The key findings are that:1. Increases in wealth increase the probability of retiring, but don't count out people postponing retirement if their earnings prospects are good at the expected retirement age.2. People with defined benefit plans are more likely to retire than those with defined contribution plans. DB plans may represent a more secure retirement income.3. Business cycles influence the probability of retirement. This is a corollary to point #2, where DC plans face risks of stock market fluctuations. If people enrolled in DC plans perceive their 401(k)'s, for example, have declined in value, they are more likely to put off retirement until they feel more 'flush.'4. Access to health insurance is a big determinant on the timing of retirement, of course.But even with health insurance, the retiree will face a deficit of health care specialists. A poll from Zogby conducted on behalf of the American System for Advancing Senior Health (ASASH) found that 7 in 8 Baby Boomers believe that specialty training in dealing with geriatrics and aging is important for their physicians, but the Boomers are having a hard time finding this sort of doctor. Women in particular believe this kind of expertise is critical for their health maintenance, yet only 1 in 4 said they perceive their health has suffered because they did not have access to such a physician.An intriguing finding is that about half of people 55 and older said they would seek a different health provider to achieve better outcomes. 1 in 2 said they could get better care than they are now receiving. This challenge was discussed in the IOM report I blogged about here in my post, Home care and garbage collectors.Health Populi's Hot Points: "We are seeing the Baby Boomers use the Internet to take a much more activist role in almost every aspect of their lives," according to John Zogby, pollster. Zogby points to the Internet playing a key role in educating and empowering people. One in 3 older Americans said they need more help with their health decisions, and 71% said they want to be able to find more information about their own health care. 9 in 10 older Americans want to be in control of their health decisions.One-half of older people believe they themselves are in the best position to help improve the quality of their health. These two polls together paint a picture of an engaged older American, in touch with the fiscal and health realities of retirement in the U.S. Based on these data, it appears that Boomers are not in denial about the tough choices ahead. The motivation to work longer for health may engender motivation to stay well, longer. It's never too late to engage in healthy behaviors. Perhaps this lightbulb moment in Boomers' lives will drive people in the 50s and beyond to get real about work, health, and wellness. There will be opportunity for providers and organizations to support this population in living better, longer, through services, information, and support. (Source: Health Populi)

Dear interns

Running a hospital — Fri, 09 May 2008 09:00:00 +0100

As each new class of interns arrives at the hospital, it is important to provide a context for their experience. Most of their advice and training comes from their clinical leaders, but the CEO has a role, too. Here are excerpts from one of my notes to the current class:Dear Interns,I'd like to turn to some important matters facing BIDMC and explain your role in helping us achieve some very important goals. The context is this: While you as doctors -- along with others who have come before you -- have received excellent training in biology, disease, diagnostics, and treatment, there is a growing part of clinical care that requires all of us to expand our scope and consider the manner in which we actually deliver care and how we might improve that. Our hospital has decided to be a leader in the science of care delivery, reviewing and enhancing our overall system of care to reduce harm to patients.Several months ago, our Board of Directors voted to set an audacious goal for BIDMC, to eliminate preventable harm over the next four years. See these entries on my blog for more details. Our chiefs of service are fully in support of this goal and are now engaged in many measures to make it happen. We know of no other hospital in Boston that has taken on this challenge, and there are likely very few throughout the country. It is a bit daunting. But we believe that we have a lot to learn and a lot to teach by making the effort.Part of the context for setting this goal is to hold ourselves accountable to the public and ourselves. We have been the leaders in this region in transparency of our clinical outcomes, for we believe that self-reporting of medical errors and process improvement is a sure statement of our commitment to progress in this arena.We have also established an overall process improvement program called BIDMC SPIRIT, in which you will be trained after your arrival. Here's the introductory message about this program. The concept is simple -- to encourage people throughout the organization to call out problems as they see them and to solve them to root cause -- rather than creating work-arounds that just add layers of poorly designed process in the organization. Here are a couple of examples to give you the idea.I look forward to having you join us as we invent and implement these programs and eliminate preventable harm for our patients.Sincerely,Paul (Source: Running a hospital)

Rounding up the week

Life in the NHS — Fri, 09 May 2008 06:48:14 +0100

For a short working week (4 days one of which has only just started) I am feeling incredibly weary. Summer seems to have arrived early, which is no bad thing since we have suffered a miserable end to winter and most of spring; rain, hail, wind often all in one day. What is more my week has felt a little odd. From the person who found my blog through searching to purchase the ability to inseminate their chihuahua (you know that kind of small dog) which, while I know a variety of things, that is not one of them. Then there was a very strange dream which involved me flying off somewhere not too far away (it was a short flight) and then finding myself in the kitchen of Kim from Emergiblog where she was holding fort to a number of men eating breakfast (sorry kim, but that is the only bit I remember!) Work is incredibly busy, as a number of projects I have been working on come to fruition. I have discovered the power of the director - I might email and phone someone till I am blue in the face but I will still get no where, while the director sends one email and gets a response so immediate it makes me want to cry! I know lots of responsibility comes with that kind of job, but oh to have that kind of power! My other observation is that a blackberry is incredibly useful if you are out and about a lot as I have been and will be today, but it causes your inbox to be a complete mess when you actually do get to the office. I definitely need to spend some time sorting it out since I can no longer find anything and I like to pride myself with keeping it spick, span and pretty lean. So there we are as another weekend approaches, the questions to be posed are: will I be able to get my hubby into the garden to do some work there? Plus, will we go to the Apple shop to buy that new ipod touch I covert? Work is important, but I am happy to leave it at the office when it comes to 5pm ish this evening! (Source: Life in the NHS)

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Shooting yourself in the head

Managed Care Matters — Fri, 09 May 2008 04:00:00 +0100

I recently gave a keynote speech to a group of insurance brokers affiliated with the Institute for Work Comp Professionals; the talk focused on cost drivers in WC, with special emphasis on medical costs. The part of the talk that... (Source: Managed Care Matters)

Ncci conference - the rousmaniere report

Managed Care Matters — Fri, 09 May 2008 04:00:00 +0100

Friend and colleague Peter Rousmaniere recently attended the NCCI conference and was kind enough to provide a comprehensive report. Here it is, and thank Peter when you see him.... (Source: Managed Care Matters)

Grand rounds to be hosted at the health business blog

Health Business Blog — Thu, 08 May 2008 19:41:59 +0100

I’m hosting the upcoming Grand Rounds. Please submit your favorite post to me via email. The deadline is Sunday at midnight EDT. There is no theme. (Source: Health Business Blog)

Do you trust your blogger?

Running a hospital — Thu, 08 May 2008 09:29:00 +0100

Interesting post by Bill Ives, referring to comments by Andrew McAfee at Harvard Business School about Enterprise 2.0, about trusting bloggers, and the role of blogs in business communication. Bill and Andrew and Jessica Lipnack, also cited in the post, are key observers and thought leaders in this arena. Jessica asked yesterday whether email is obsolete. See the last paragraph in a related story on that topic below. (Source: Running a hospital)

Retail meds: pharmacy update and wal-mart price cuts

Health Populi — Thu, 08 May 2008 09:24:00 +0100

Wal-Mart continued its first-mover tactics in health by dropping the price of prescriptions again. This time, the target (sorry for the pun) is maintenance meds which Wal-Mart will price at $10 for 90 days' supply. This move puts Wal-Mart squarely in the pharmacy benefits management (PBM) segment vis-à-vis ExpressScripts, Medco, and the big PBM players. The 3-month mail order med business is the lucrative turf of PBMs. Wal-Mart's first move into this space was in 2006 when the company priced many 30-day scrips at $4, shaking up the industry. I wrote about that market disruption here in January 2008.Wal-Mart will also offer over 1,000 over-the-counter (OTC) meds for $4 and under. These will all be Wal-Mart's private labels for popular OTC brands. As the company with the red bulls-eye did the last time Wal-Mart dropped the price of meds, Target responded as fast follower by saying they, too, will match the Wal-Mart prices for 90-day supplies of drugs. Target's program will expand the assortment of $4 Rx drugs and the 90-day supply of these medications for $10 and private-label OTC medications for $4 or less.While price transparency is what retail pharmacy should be all about, Consumer Reports found that prices across and even within pharmacy chains can significantly vary -- by $100 or more from the same drug, from store to store and within the chain. Consumer Reports surveyed pharmacies' prices for 3 brand-name meds and one generic drug. The range of retail prices for each drug were:Pfizer’s urinary incontinence drug Detrol = $365 to $551BMS's and Sanofi-Aventis' blood clot drug Plavix = $382 to $541King Pharmaceuticals’ hypothyroid drug Levoxyl = $29 to $85Generic Fosamax for osteoporosis (alendronate) = $124 to $306.Consumer Reports also found that independent pharmacies can be price-competitive, given these price ranges, and can offer a higher level of service -- especially access to pharmacists for personal consults. In another prescription drug update, a study published in the American Journal of Public Health found that 1 in 4 Americans share or "borrow" prescription drugs from each other. Most common shared drugs include those for categories in allergy, pain (like Darvocet and Oxycontin), and antibiotics.Women are twice as likely to share prescription drugs as men.Health Populi's Hot Points: Almost a third of Wal-Mart's nonprescription drugs now sell for $4 or less, luring people also shopping for groceries and clothes. The price of gas is a powerful incentive for consumers to look for one-stop shopping, and Wal-Mart can deliver on this. That consumers respond to price incentives for prescription drug shopping is in general healthy; it's a rational economic response from the pages of Adam Smith and market theory. That people "share" drugs like OxyContin and antibiotics, however, is a rational economic response; but not sound public health. Here's an example of where market forces can drive bad health behavior. (Source: Health Populi)

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Podcast interview with dr. michael parkinson, president of the american college of preventive medicine

Health Business Blog — Thu, 08 May 2008 04:01:56 +0100

Michael D. Parkinson, MD, MPH has had an interesting career. In this podcast interview, Dr. Parkinson describes how his experience as an Air Force physician taught him about how personal health behaviors and organizational culture impact health and health care costs. He explains why he left government service to become Chief Health and Medical Officer with consumer-directed health plan startup Lumenos, where he emphasized prevention and chronic care management. He also discusses his current role as President of the American College of Preventive Medicine. Parkinson and I discussed the interaction between prevention and costs, the positioning of consumer directed plans as “high deductible” plans for the wealthy and well (something Parkinson doesn’t care for) and the role health care is likely to play in the general election. (Source: Health Business Blog)

The cost of ignorance

Managed Care Matters — Thu, 08 May 2008 04:00:00 +0100

Many payers look at 'medical' as a line item and nothing more. This myopia, this failure to look deeper, to try to understand what drives medical, is perhaps the most significant shortcoming in the industry. Many readers will dismiss this... (Source: Managed Care Matters)

Podcast interview with dr. jason yap, singapore medicine

Health Business Blog — Wed, 07 May 2008 15:40:37 +0100

I interviewed Dr. Jason Yap at Consumer Health World in Las Vegas. He is Director of Healthcare Services at the Singapore Tourism Board and part of the multi-agency Singapore Medicine Initiative, the goal of which is to promote, develop and maintain Singapore as an international medical hub. I first met Jason a year ago and he hosted me on a tour of hospitals in Singapore last summer. We’ve spoken in the past about medical tourism, but in this interview I focused on Singapore’s health care system and the potential lessons for the US. Singapore spends less than 4 percent of its GDP on health care yet has universal access and produces outcomes that are as good or better than the US and other wealthy countries. Singapore’s health care financing bears some resemblance to consumer directed health care plans in the US, which should lend encouragement to those who see consumerism as a way out of the health care thicket. One of the more interesting elements of the Singaporean system is free-market pricing. Providers set their own prices –just like providers of other services. The government focuses on making sure that the market mechanism is working well, but doesn’t dictate what the prices should be. I’m not saying that the US should adopt the Singaporean model (and neither is Jason) but I do find it an intriguing case study. (Source: Health Business Blog)

Employer-based health care erodes u.s. global competition: a new america report

Health Populi — Wed, 07 May 2008 08:56:00 +0100

The world is flat, but American manufacturers have known that since before Tom Friedman published the book on the subject. Globalization means American companies compete with foreign trade partners. The New America Foundation calculates that U.S. manufacturers pay an average of $2.38 an hour for health benefits, while trade partners pay only $0.96 an hour.That's the bottom-line in the Foundation's paper, Employer Health Costs in a Global Economy: A Competitive Disadvantage for U.S. Firms.The percent of payroll devoted to health benefits is about 13% for American manufacturers, and 5% for foreign trade partners.That adds up to one big competitive disadvantage which ultimately results in lost jobs for Americans. Health Populi's Hot Points: This is everybody's business. Labor is coming together with business and key stakeholder groups to address the impact of health insurance on business and competition. New America points out a few of these important coalitions: Better Health Care Together, uniting Wal-Mart, AT&T, the Service Employees International Union (SEIU), and the Communications Workers of America; Divided We Fail, a coalition of the Business Roundtable, National Federation of Independent Business, the AARP, and the SEIU; the Coalition to Advance Healthcare Reform, a business coalition led by Safeway CEO Steve Burd.Clearly, one-time adversaries like Big Labor and Big Business can come together. Why can't our legislators breach the same sort of chasm? Let's make 2008 the year to stop demonization of stakeholders and come together for the benefit of all. (Source: Health Populi)