MedWorm: Medical Lawyers and Insurers

Speaking of independence

InsureBlog — Thu, 03 Jul 2008 17:32:00 +0100

FoIB David All asked me to help introduce a new 'Net intiative designed to highlight the true costs and risks of government-run health care. It's just now being rolled out, and promises to become a great resource.Called BigGovHealth, it's presented by the Center for Medicine in the Public Interest (CMPI). Its mission is to offer "news, information, and first-person experiences and views about government-run health care systems to help educate the public, the media and elected officials about the potential costs and consequences of more government control in health care."Do check it out. (Source: InsureBlog)

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Pre-holiday potpourri

InsureBlog — Thu, 03 Jul 2008 14:00:00 +0100

■ First up, we go south, and learn that:"A state court jury on Tuesday found two major pharmaceutical companies defrauded Alabama in a long-running Medicaid drug pricing scheme and ordered the firms to pay more than $114 million in damages."Although both companies denied that they'd done anything untoward, the jury disagreed. The alleged scam was not a short term deal, either; prosecutors claimed the scheme ran for some 14 years.My question is: why did it take so long for this to unravel?■ Our friends at The Industry Radar and the Kaiser Daily Report tell us that The Grand Experiment (aka Massachusetts Health Care Plan) is in a spot of trouble [ed: you're surprised?!]:"Since the law was enacted in 2006, the percentage of uninsured Massachusetts adults has decreased from 13% to 7%...the actual cost was $625 million."According to the article, that $625 million was spent on 355,000 people (some got more than others, of course). And it's only getting more expensive:"Gov. Deval Patrick (D) has requested $869 million for the program for fiscal year 2009, compared with previous estimates of $725 million." That's a roughly 17% increase. But I thought that this would help "lower" the cost of insurance? My bad.■ Finally, our Cousins Across the Pond have some advice for us:"Ad by Brit says, 'You won't better your system with ours' "Oh.Turns out, not everyone is thrilled with the MVNHS©; lots of folks are a bit put off by the fact that, for example, some treatments are covered if you live in one area, but not if you live across town. The campaign features folks from Britain, Canada, and Europe, and has a simple message:"Nationalized care systems...distribute care services and products based on whether it is cost-effective for the government, not whether the patient needs it or it will relieve a health problem."Sounds about right. (Source: InsureBlog)

The anti-hailey: unfathomable

InsureBlog — Thu, 03 Jul 2008 12:00:00 +0100

Earlier this week, we saw the lengths to which a loving parent will go to find some kind of treatment to save a child's life. Even given the long odds against a successful conclusion, one can certainly understand Mrs Goranflo's motivation.But what does one make of this:"A woman has been charged with withholding cancer medication from her 8-year-old autistic son, who prosecutors say likely will die because the cancer has returned."Kristen LaBrie's son Jeremy had been in remission from non-Hodgkin's lymphoma, and had a very positive prognosis. According to his doctors, young Jeremy had an 85-90% chance of recovery; that's now dropped to less than 10%.So what changed?You won't like the answer:Jeremy was diagnosed with non-Hodgkin's lymphoma about 2 years ago, and began a five-step chemo treatment, and which also included med's that his mother was supposed to have given him.Unfortunately for Jeremy, mommy dearest "canceled at least a dozen appointments for chemotherapy treatments...[and] did not fill at least half of the prescriptions her son was given."And why is that?We simply don't know. There doesn't seem to be any religious component to this case, nor is there any suggestion of a parental power play with a spouse (or ex-spouse). Perhaps it's as simple as Kristen deciding she really couldn't be bothered raising an autistic boy with cancer.Disgusting. (Source: InsureBlog)

More from gary cohen: challenges now, and hopes for the future

Pioneering Ideas — Thu, 03 Jul 2008 04:00:00 +0100

Yesterday's discussion with Gary Cohen introduced us to Health Care Without Harm and the recent achievements of the green hospital movement in the United States. Today, Cohen speaks about green health care internationally, outlines the challenges facing the green hospital movement, and offers his both short- and long-term predictions for the movement's future. Health Care Without Harm is part of a global movement; what lessons do you think the US health care system can learn from the international community?Right now we’re learning a lot from Europe. A typical Northern European hospital uses half as much energy as a typical US hospital. That’s a very significant issue, because as we are entering into a period of global climate crises and reducing reliance on fossil fuels for health care is a public health imperative (this sentence needs better structure). There are very direct links between a hospital’s energy sources and community health; we have evidence that shows if a hospital is reliant on coal fire power plants, there will be increases in asthma, respiratory problems and increased hospital visits. This also offers the opportunity to move to renewable sources of energy. Another reason hospitals in Northern Europe are using less energy is because of hospital room ventilation. In a typical US hospital the ventilation duct is at the top of the room and pushes air into the hospital, into the patient room, and it circulates out and then it goes back up. So it actually circulates a lot of the germs, and it goes against gravity. In Europe, the intake of the ventilation of the room is at the sidewall level. And so the air comes up and then goes out the top. As a result, you need 30 percent less energy to run such a system. And now there’s research to evaluate whether this type of ventilation actually decreases infection rates in the hospital. Instead of recirculating the air and reinfecting people, the Northern European systems draw the air up and out the top. If changing the ventilation in hospital design reduces infection and reduces energy it is a big win both for patients and for the environment. What are the biggest barriers and challenges facing the green hospital movement in the US?The health care systems that have made the most comprehensive changes always have buy-in from the executive level. Once the CEO says that we’re going to make this change happen, then the rest of the system gets in alignment and people are given a mandate to implement change, whether it has to do with their built environment or their purchasing or their operations. Where we don’t have that high-level buy-in, we might have a lot of champions, either nurses or facilities managers or environmental coordinators. Their efforts are critical, but they are swimming upstream, against the priorities of the system. And while those champions may be doing great things in their small corner of the hospital, it’s hard, though not impossible, to diffuse those changes system-wide. The Luminary Project of HCWH has seen the power of nurses as change agents and is telling the stories of nurses who are working to human health by addressing environmental health. Cost analysis is another barrier. Where we’ve been able to showsome intervention saves money or is cost neutral, it’s been very easy to make the case for green solutions. The places where it’s very cost competitive is around reducing waste, reducing water use and reducing energy use. There are immediate positive financial impacts and environmental impacts with those kind of interventions. We’re also in the midst of developing a business case around sustainable health care building. We are seeing that there’s quite a small differential up front for some of the pilot hospitals, in the neighborhood of 1-2%. But because it’s going to save over time we’re now trying to measure how quickly that investment’s recouped. The medical education system in the U.S. does not address the links between environmental exposures and disease or health impacts, and this continues to be a significant barrier for our work. A typical doctor may get four hours of environmental education in four years, and that will include issues around smoking and diet. And yet the science suggests that there are incredibly strong links between a very specific set of illnesses and diseases and very specific set of environmental exposures. The science is way ahead of the medical education, and that’s a real impediment to the transformation. Are there specific things you are looking to accomplish in the next 5 years?In the next 5 years we’re hoping to get to change the way that hospitals operate so that they’re moving toward being toxic-free, carbon-neutral, with minimal waste and dramatic water conservation measures. To that end, we’re going to be helping hospitals develop their health care footprint, so they can measure where they are now, and then work with them over time to dramatically reduce that footprint. We are working hard to link sustainable health care design with what’s called evidence-based design. Used by the Center for Health care Design, evidence-based design integrates patient and worker safety into the design process. Linking sustainability and evidence-based design to make green and healthy building practices the absolute standard in all future health care construction is a short-term goal for us. And it will be important for us to document how those changes in design and construction affect patient outcome and worker health and safety. We also hope to collectivize the purchasing practices of all the major hospitals in the country to drive the marketplace for safer and healthier products across the whole sector. I think there is an enormous opportunity for the health care sector to define an economy and a society that is places health at the center of it all. We need to transform our society to one that supports healthy people, healthy communities and a healthy planet. We are also going to be working with the UN and the WHO to eliminate mercury from health care globally and to use that as leverage for a globally binding treaty to eliminate mercury completely. If the health care sector really decides to move in the green direction, what impact is it going to have 10-15 years down the line?We will see that changes in the health care industry become a driving force in our society, it will help us move away from our addiction to oil and petrochemicals, it will move us toward preventive medicine and we’ll begin to see reduction of diseases in our society. Now, we’re working on a wedge of a larger problem. The larger problem is that we need to be providing health care to everybody who needs it. And at the same time it needs to be as environmental responsible and supportive of safety as it can be. We are part of a larger confluence of consciousness in the planet around the need for health care and the kind of health care that will keep us and our planet healthy. It’s exciting and we’re happy to be part of this movement. (Source: Pioneering Ideas)

European health care: germany

HealthLawProf Blog — Thu, 03 Jul 2008 04:00:00 +0100

National Public Radio has a brief overview of German health care. It is quite an interesting piece and shows the importance of access to health care and also how differently the government role in providing or financing or regulating health... (Source: HealthLawProf Blog)

Senator kennedy and universal healthcare

HealthLawProf Blog — Thu, 03 Jul 2008 04:00:00 +0100

The Boston Globe reports on Senator Kennedy's new efforts to prepare for universal healthcare. Lisa Wangass writes, Senator Edward M. Kennedy's office has begun convening a series of meetings involving a wide array of healthcare specialists to begin laying the... (Source: HealthLawProf Blog)

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Urgent plasma bleg

InsureBlog — Wed, 02 Jul 2008 20:52:00 +0100

I just received this email from one of our carriers:As we approach a weekend in which Americans gather to celebrate our good fortune to live in a great nation, it is also appropriate to consider ways to give back. DCPG is asking healthy men with Type AB +/- blood types to donate blood over the next few days in an effort to save the life of a fellow broker's brother.As many of you know, an ample supply of blood and blood plasma remains an urgent, unmet need in many communities. We all hear the appeals to donate blood and plasma, yet often postpone acting until the supply issue hits home. Yesterday, the issue hit home at DCPG when one of our account managers received a message from Jamey Bennett of Farmers Capital Insurance in Frankfort, Kentucky.Jamey's brother, C. Thomas Bennett of Shelbyville, Kentucky, has been admitted to Baptist East Hospital in Louisville to receive treatment for a potentially fatal blood disorder known as TTP. Over the next several days, he will undergo a series of platelet replacement therapies. The local blood bank has a three-day supply of Tom's blood type, but will require much more.HOW YOU CAN HELP:The Bennett Family has established a private blood bank account to collect donations from throughout the Midwest specifically for Tom. Just contact Vicky Reed at The Dental Care Plus Group to get a copy of the form that donors should take with them to their local blood bank.Vicky's Contact Information: vreed@dentalcareplus.comThe Dental Care Plus Group wants to thank anyone in advance who is able to assist Jamey Bennett and his family at this difficult time. We also want to commend everyone who regularly donates blood. It's a simple gift with tremendous impact.If you (or someone you know) can help, please do so. It would be great if you'd let us know, but that's not critical.Thank you. (Source: InsureBlog)

Stupid lobbyist's tricks

InsureBlog — Wed, 02 Jul 2008 17:00:00 +0100

Beginning this year, Ohio agents who wish to (continue to) sell Long Term care insurance are required to take a new, specially-designed, eight hour training course. A while back, I did that and, at the conclusion of the course, received a "temporary" certificate of completion. I was advised to wait a few weeks, and then log on to the AHIP site to download "the real deal."Well, one thing led to another, and I finally got around to getting my permanent cert. So one day last week, I clicked over to the site, and was stopped cold. The only way to sign in was to have an existing account (I was never given one, nor informed how to get one) or create a new account, which would require signing up (and paying) for a class. I hardly needed that, so I looked around and found an 800 number. Terrific, I thought, I'll have this taken care of in no time.Not so fast, fella:I called the number, and was directed to Scott's voicemail (as far as I know, this is his real name, and I see no good reason not to use it here). Left a message, and went about my business. As of last Thursday, however, still no return call, so I figured a little nudge was in order. Unfortunately, I had to leave another voicemail, because Scotty's obviously too busy to either return my call, or have "one of his people" do so for him.That afternoon, Scotty did call me back, and we determined that the AHIP folks had an incorrect email address for me. He assured me that it would be corrected, and that I'd have the link I needed by the next day.Well, Friday came and went, and no link, no cert. And again on Monday. So yesterday, having had my fill, I called AHIP again, and tried to go up the food chain. I left a rather detailed (and rather firmly worded) message, insisting on a return call by noon today.Of course, we all know how that ended up.All of which seems to underscore the folly in allowing those with a vested interest (such as a lobbyist) write and enforce the rules. It may be convenient for legislators, but it just begs to be abused. If this is how well organized AHIP is, by the way, I certainly hope the carriers that fund it demand a refund.I have no doubt that I'll eventually receive my precious little piece of paper, but one of the perks of blogging is to make fun of incompetent organizations (or just incompetent folks at "normal" organizations). But I think it does point out the danger of having an industry lobbying group (i.e. AHIP) in charge of industry training: who do you turn to when the lobbyist can't (or own't) fulfill such a simple mission as this?What do you think, Scotty? (Source: InsureBlog)

Can't win for losing: another tale from the p&c side

InsureBlog — Wed, 02 Jul 2008 14:00:00 +0100

Our primary focus hear at IB is on life and health insurance (mostly health), but from time to time, we find interesting/infuriating stories from or about our P&C colleagues. For example:"Scientists say the jury is still out on whether rising sea temperatures will cause more hurricanes to hit U.S. coastlines. Yet some insurance companies are boosting premiums based on assumptions that they will. Others are withdrawing from coastal communities altogether."While calamities such as Hurricane Katrina make the news even years later, it's the day to day, season to season losses that really rack up the big dollars, and losses. On our side of the biz, new underwriting tools like genetic testing cause major controversy; likewise, a new program called "Computerized Catastrophe Modeling" promises to cause a comparable uproar on the P&C side.CCM uses advanced computer modeling to predict real-world events, and then to extrapolate losses. Of course, it's not the only tool that actuaries and underwriters use to assess the scope of the risk, but it has apparently become a very useful and productive one.Critics, on the other hand, charge that CCM predictions have led to ever-increasing insurance rates, forcing some folks to move to more user-friendly climes. They also have a problem with one of the underlying premises of CCM programs: that water temperatures are rising and thus triggering more frequent and powerful storms.It's interesting reading for those of us in flyover country: we hardly ever get any hurricanes here. But it's literally life and death on the coasts, and could have far-reaching economic impact, as well.Thought-provoking. (Source: InsureBlog)

Cavalcade of risk #55 is up!

InsureBlog — Wed, 02 Jul 2008 12:30:00 +0100

The Colorado Health Insurance Insider hosts this edition of the Cavalcade of Risk.Hosting slots are still available for late summer, so please drop us a line to reserve yours. (Source: InsureBlog)

Cms addresses anti-markup provision in 2009 proposed medicare physician fee schedule rule

Medicare Update — Wed, 02 Jul 2008 04:00:00 +0100

On June 30, 2008, the Centers for Medicare & Medicaid Services (CMS) released a display copy of a Proposed Rule, which would revise payment rates and policies under the Medicare Physician Fee Schedule (MPFS) for calendar year 2009. In the Proposed Rule, CMS proposes 2 approaches to revising the anti-markup provision (at 42 CFR 414.50) for certain diagnostic tests. Under the first approach, the anti-markup provision would apply in all cases where the professional component (PC) or technical component (TC) of a diagnostic testing service is either: (i) purchased from an outside supplier; or (ii) performed or supervised by a physician who does not share a practice with the billing physician or physician organization. As an alternative approach, CMS would clarify the anti-markup provision of the MPFS final rule for 2008 by providing guidance on various terms of the rule, including what constitutes the "office of the billing physician or other supplier" and concepts such as "outside supplier." CMS also proposes to amend 42 CFR 414.50 to: Clarify that the "office of the billing physician or other supplier" includes space in which diagnostic testing is performed that is located in the same building in which the billing physician or other supplier regularly furnishes patient care; Clarify that, with respect to TCs, the anti-markup provision applies if the TC is either conducted or supervised outside of the office of the billing physician or other supplier; Clarify that a TC of a diagnostic test is not purchased from an outside supplier if the TC is supervised by a physician located in the office of the billing physician or other supplier; Clarify that, for purposes of applying the payment limitation in 42 CFR 414.50(a)(1)(i) only, the "performing supplier" with respect to the TC is the physician who supervised the TC and, with respect to the PC, the "performing supplier" is the physician who performed the PC; and Propose an exception for diagnostic tests ordered by a physician in a physician organization that does not have any owners who have the right to receive profit distributions. CMS also solicits comments regarding: Defining the "net charge;" Whether, in addition to or in lieu of, the anti-markup provision, CMS should prohibit reassignment in certain situations and require the physician supervising the TC or performing the PC to bill Medicare directly; and Whether CMS should delay, beyond January 1, 2009, the effective date of certain anti-markup provisions published in the MPFS final rule for 2008, or delay the effective date of any proposed revisions to that rule, to the extent they are finalized in the MPFS final rule for 2009, or both. On January 3, 2008, CMS published a final rule in the Federal Register, delaying until January 1, 2009, the applicability of the anti-markup provision, as revised by the MPFS final rule for 2008, except with respect to: (i) the TC of a purchased diagnostic test; and (ii) any anatomic pathology diagnostic testing services furnished in space that is utilized by a physician group practice as a "centralized building" (as defined at 42 C.F.R. 411.351) for purposes of complying with the physician self-referral rules and does not qualify as a "same building" under 42 C.F.R. 411.355(b)(2)(i). Finally, the Proposed Rule includes a projected update to the fee schedule conversion factor of -5.4 percent. CMS also estimates that total Medicare spending under the 2009 MPFS will be approximately $54 billion, which is 5 percent lower than the $57 billion projected for 2008. The Proposed Rule is scheduled to appear in the Federal Register on July 7, 2008. CMS reports that it will be accepting comments on the Proposed Rule until August 29, 2008. CMS expects to publish the final MPFS rule for 2009 by November 1, 2008. In conjunction with the release of the Proposed Rule, CMS also issued a Press Release and posted a Fact Sheet on the CMS website. (Source: Medicare Update)

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Conversations with pioneers: gary cohen of health care without harm

Pioneering Ideas — Wed, 02 Jul 2008 04:00:00 +0100

Last month, we kicked off Conversations with Pioneers, a series of interviews with Pioneer grantees. The series continues this week with an interview with Gary Cohen (photo at left), executive director of Health Care Without Harm.Health Care Without Harm hosted its annual conference, Clean Med, last month and Susan Promislo and Theresa Kanter both posted updates from the conference. Working to drive environmental sustainability in health care, Health Care Without Harm has been on the forefront of efforts to accelerate the development, use, and diffusion of environmentally preferable products and practices in the health care system.Abbey Cofsky spoke with Cohen recently about the organization and its work:Health Care Without Harm’s mission is to transform the health care sector --why have you chosen to focus your efforts on the health care industry? We’ve chosen the health care industry for multiple reasons. Increasingly it’s clear that in order to prevent diseases in the general public, we need to understand the environmental links to those diseases and do whatever we can to reduce environmental exposures. And of all the sectors of society who should understand this growing science, it should be the health care sector --they’re in the healing business. And they have a responsibility to clean up their own house. We think that one very important objective for the 21st century is ensuring health care facilities operate with the least amount of environmental exposure as possible, and to move to a model of a high-performance healing environment – an environment that actually promotes healing, as opposed to contributing to further disease or exposure or infection.The second important reason to focus on the health care sector is because it’s such a big part of the economy. Health care is 16 percent of the gross domestic product and quickly increasing as the baby boomers get older. Transforming the way that hospitals build, buy and operate their facilities will have a broad transformative effect on the economy. That’s really important, because we need our general economy to move away from oil and chemicals made from oil. We’re approaching the end of the petrochemical age, and we need the health care sector to be a leading force in ushering in a new economy that’s based on green materials, green chemistry and green energy to promote healing and sustainability on the planet.The third big reason that we are focusing on health care is because our society trusts health care leaders. And so by having nurses and doctors and hospital leaders serve as leading advocates for the larger transformation we need in our society, they’ll be increasingly important social change agents.How have hospitals begun to adopt environmental sustainable changes and what successes have you seen? When we started Health Care Without Harm in the mid-‘90s there were over 4,000 medical waste incinerators in the country. And the Environmental Protection Agency was reporting that medical waste incinerators were the largest source of dioxin emissions in the country. Dioxin is probably the most dangerous human-made chemical with known links to cancer, neurological damage, immune suppression, reproductive problems, diabetes and a whole host of other problems. In the last 10 years almost all of those incinerators have been shut down -- there are probably less than a hundred medical incinerators left in America today. Many hospitals have reduced their waste generation significantly and moved towards safer treatment technologies for their waste, and they’ve saved money in the process.Mercury is another great success today. When we started Health Care Without Harm, the health care sector was seen as responsible for 10 percent of all mercury air emissions and a significant contributor to mercury in wastewater. And that was because hospitals were dumping mercury fixatives down the drain. In the last 12 years or so, more than 5,000 hospitals in the country have started to move dramatically toward mercury elimination across the board. All the major pharmacy chains in the country have stopped selling mercury thermometers. The European Union recently banned mercury thermometers, and they’re looking to do the same on mercury blood pressure devices. We are now working with the World Health Organization and the United Nations to support a global ban on mercury-based medical products. This is an example that exemplifies how it starts with a simple effort. This mercury initiative began with a simple thermometer exchange and education day at Beth Israel Hospital in Boston. We paid for a couple of hundred digital thermometers, and told hospital administrators that they should be educating people around mercury. We gave them replacement thermometers to share with their staff and encouraged them to educate staff about the dangers of dumping mercury. From that moment, the initiative mushroomed and cities across the country started to ban mercury thermometers and started instituting their own exchange programs.A third area of progress is the green building movement being led by the U.S. Green Building Council. Using their metric leadership guide called LEED, which stands for Leadership for Energy and Environmental Design, we and the Center for Maximum Potential Building Systems developed a similar framework for health care facilities: the Green Guide for Health Care. Based on the success of the Green Guide (150 hospitals have piloted its use), we have been working directly with the U.S. Green Building Council, and in 2009 the new LEED for Health Care, which is based on our Green Guide, is coming out. Hospital CEOs realize that they need to develop more environmentally responsible and healthier hospital facilities in the midst of this huge building boom. And so it’s bound to be quite ascendant as the sort of de facto standard in the country for future health care construction. We’ve also spent a lot of time around developing environmentally preferable product specifications. When hospitals decide to purchase a device, a computer, a cleaning product or building materials and there’s not a performance trade-off, we want them to ask is there an environmentally superior product? We’ve developed specifications around over 50 products used in health care to inform hospital systems and we are working with all the largest group purchasing organizations in the country, which control about 90 percent of all health care purchasing, equivalent to $100 billion, to help them develop environmental preferable product strategies. We have seen a great deal of success here around PVC-free IV systems. Once we highlighted the toxic impacts of using PVC IV systems that contained DEHP, a reproductive toxin, we were able to convince the Food and Drug Administration to issue a health care warning to hospitals about the dangers of DEHP-containing PCV IV systems. Then, working with manufacturers we were able to develop safer alternatives to PVC IV systems. One company in particular, Hospira, has started a whole new line of PVC-free medical devices and we are beginning to see the market being completely transformed as a result of these interventions.Lastly, we’ve made a very strong case that hospitals should be aligning themselves with sustainable agriculture in their communities and serving healthy food to their patients and staff. We know there’s an important link between food and health and hospitals should be using meals as an opportunity to educate people about the essential connection between healthy food and healthy lives. And more than that, if hospitals are supporting organic and sustainable agriculture in their community, it’s an extension of what we call community benefit. By using their purchasing power to support sustainable agriculture, it means less environmental exposures in the larger society – an example of the kind of transformation around food production that we need to see broadly in our society. Today, there are well over a hundred hospitals who have taken a healthy food in health care pledge, and are on a journey to transform the way they purchase food and feed their patients and staff. This is another example where the health care sector can really maximize its clout in the marketplace.How does the environmental sustainability link to patient safety? It is critical for us to link patient safety and worker safety with environmental sustainability. To address this issue, Health Care Without Harm joined with 20 of the most influential healthcare systems nationwide, as well as their Group Purchasing Organizations, to launch the Global Health and Safety Initiative to identify and promote sector-wide initiatives that link patient safety, worker safety and environmental issues. PCV flooring is an example of one such initiative. If a hospital switches from PVC flooring, which is used a lot because it’s so cheap, to synthetic rubber and other flooring materials, you eliminate the off-gassing of toxic materials from the PVC floor into the health care environment. This cuts down on patient exposures to what is thought to be a contributor to respiratory problems. The synthetic rubber floor also cuts down on worker exposures as well as trips and slips and falls. And it has a very strong environmental performance factor. Now our challenge is to find other interventions that cut across all three safeties and encourage hospitals around the country to implement and standardize these interventions.Check back tomorrow to read more from our interview with Gary Cohen, and to learn more about Health Care Without Harm, visit http://www.noharm.org/us/.Gary Cohen is a founder and Co-Executive Director of Health Care Without Harm and is also the Executive Director of the Environmental Health Fund, which works on domestic and global chemical safety issues. Mr. Cohen has been working on environmental health issues for twenty years and has published numerous articles on environmental health issues in the United States and India. He is an advisor to the John Merck Fund on issues of environmental health and a co-founder of Green Harvest Technologies, a bio-based materials start up. Mr. Cohen was awarded the Skoll Global Award for Social Entrepreneurship in 2006 and the Frank Hatch Award for Enlightened Public Service in 2007. (Source: Pioneering Ideas)

What do we need to do to fix the medicare physician payment problem?

Health Care Policy and Marketplace Review — Wed, 02 Jul 2008 04:00:00 +0100

Whenever the subject of Medicare physician fee payments comes up on this blog, the reaction from physicians, particularly primary care docs, is predictable: "You can't cut us, we haven't had a Medicare raise in years, we are already dramatically underpaid, and if Medicare cuts our payments we are going to stop taking Medicare patients." There is no doubt that doctors have a point--particularly (Source: Health Care Policy and Marketplace Review)

Balancing billing

HealthLawProf Blog — Wed, 02 Jul 2008 04:00:00 +0100

The LA Times reports on the California's recent move to prevent PrimeHealth from billing its privately insured patients for unpaid treatment received at PrimeHealth medical facilities. Daniel Costello writes, The Department of Managed Health Care, in a lawsuit filed Friday... (Source: HealthLawProf Blog)

Parents and health care issues

HealthLawProf Blog — Wed, 02 Jul 2008 04:00:00 +0100

The Boston Globe reports on a tragic case of an austic boy with leukemia whose mother apparently failed to follow a specific treatment regime and now faces jail time. The parents are divorced, their relationship is strained and it is... (Source: HealthLawProf Blog)

2009 joint commission standards: now available online

Health Care Law Blog — Tue, 01 Jul 2008 23:13:00 +0100

The Joint Commission's revised standards are now available online. Additional details about the revisions are available on the Standards Improvement Initiative web page.The timetable for the release of the new standards, manuals and scoring information is as follows: July 2008: Standards will be posted to The Joint Commission website August 2008: Scoring information will be posted to the website September 2008: Hard copy manuals will be available for Phase 1 programs (ambulatory, hospital, critical access hospital, home care, office-based surgery) November 2008: Hard copy manuals will be available for Phase 2 programs (behavioral health care, laboratory services, long term care)* November 2008: Single-user access to E-dition (electronic manuals) will be available for all accreditation customers.According to the press release, "the standards will take effect January 1, 2009 and will be placed online to give all health care organizations time to become familiar with the new language, ordering and numbering."The press release continues by stating:The changes are part of the Standards Improvement Initiative (SII), launched in 2006 as part of The Joint Commission’s ongoing quality improvement efforts. SII focuses on clarifying standards language, ensuring that standards are program-specific, deleting redundant and nonessential standards, and consolidating similar standards. While no new requirements were added, chapter overviews, standards, introductions, rationales, and elements of performance were designed for ease of use. In the standards reorganization, requirements were split or consolidated. Standards have been renumbered and reordered to allow electronic sorting and to allow the addition of new requirements in the future. (Source: Health Care Law Blog)

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Sermo physicians launch doctors unite campaign

Health Care Law Blog — Tue, 01 Jul 2008 21:56:00 +0100

Can online social networking by health care professionals be the catalysts for group action and change in the health care industry?Fellow friend and health blogger,Fard Johnmar,at Healthcare Vox explores this question and more in his post, "Sermo Docs Launch An Online Health Reform Movement: Will It Matter?". A current effort social networking campaign lead by the physicians who participate in the physician-only social network Sermo (think Facebook for doctors).The online effort - called "Doctors Unite" is an open letter to Americans to highlight the challenges physicians face in delivering appropriate patient care and targets three industry groups: insurance companies, government and malpractice attorneys. The counter currently shows over 5,200 signatures by Sermo physicians. You can click on the tabs "Our Story" and "Why Sermo" for more of the back story on the effort. Also check out the Sermo press release.This effort will be interesting for those involved in the health care industry to watch develop. Will this be the grassroots social networking effort that drives change from the bottom up? (Source: Health Care Law Blog)

Health care consumers

HPHC — Tue, 01 Jul 2008 19:50:22 +0100

Earlier this year, the Deloitte Center for Health Solutions published a survey of health care consumers that covers a lot of ground. In fact, I would recommend it to anyone who’s interested in learning about what’s on consumers’ minds these days. The report itself is quite long, so I won’t try to capture everything it says here, but it does make some important points that are worth repeating. First, the health care consumer is not monolithic. He or she is a bunch of different types of people - with very different views of the system, and how to approach it. Deloitte breaks the consumer up into six categories… 1) Content and Compliant (29%) - While not regular users of the system, these folks do what they’re told by their physician, have a traditional view of how the system works and what their role in it should be, and are more satisfied than most with how it works. 2) Casual and Cautious (28%) - Not terribly engaged with the system - mostly healthy, and pretty low users of it - not particularly impressed, or unimpressed, with how it works. 3) Sick and Savvy (24%) - Highest users of the system, smart about how it works, and generally speaking, pretty satisfied with how it works for them. 4) Out and About (9%) - Medium users of the system - not committed to traditional care delivery models, willing to try alternatives, and not all that satisfied with the status quo. 5) Online & Onboard (8%) - High users, willing to think “outside the box” on care delivery, heavy users of online tools to chase down data - reasonably satisfied with the way it works for them. 6) Shop & Save (2%) - Sporadic users, price/value sensitive, and willing to modify usage patterns to save a few bucks. While I wouldn’t necessarily break the consuming public up along these lines, I think the larger notion - that the health care consumer represents a multitude of approaches and points of view - is exactly right. More importantly, many of these folks - in this case, well over 60% - are pretty happy with the way things work now, and aren’t jumping on the bandwagon to throw out the baby or the bathwater. This makes wholesale change a tough sell. Deloitte also points out that in some cases, what consumers say they want and what they say they did - or do - is not always the same. Aspirational beliefs and practical acts can vary in health care a bit - more so than in other areas. Add to this mosaic the fact that most of these people get their health insurance through their employer - and that their employer’s approach could vary dramatically, depending on the size and nature of the company they work for - and figuring out what moves people and why gets extremely complex. In short, the health care consumer should be understood the same way we understand other consumers - not one size fits all, and interested, more often than not, in many different notions of what constitutes what’s right for him, for her, or their respective families. Makes this whole reform thing a bit more complicated, no? (Source: HPHC)

Appalling - again!

InsureBlog — Tue, 01 Jul 2008 16:58:00 +0100

IB readers may recall our story last summer recounting the (tragic) misadventures of Martin Luther King Hospital in California. There a woman was left writhing in pain, vomiting up blood and moaning in sheer agony while the ER staff did nothing to help.Well, this unconscionable behavior is apparently not the exclusive province of the West Coast:">"Video from a surveillance camera at a Brooklyn hospital shows a woman dying on the floor of a psychiatric emergency room while staffers initially ignore her."The good news is that a handful of staffers were canned. The bad news is that this facility, like Grady in Atlanta, is run by the (local) gummint (as was the aforementioned MLK facility in Los Angeles). Again, I keep wondering why anyone would want to turn our entire health care system over to these folks. (Source: InsureBlog)

An exemplary grand rounds

InsureBlog — Tue, 01 Jul 2008 12:41:00 +0100

Dr Rich, host of the Covert Rationing blog, presents this week's edition of the best of the medblogs. The theme is - no surprise - independence, and most of the entries reflect this. And while you're there, be sure to check out the accompanying illustrations.If time is money, how do you determine when you've gotten your money's worth from your physician? Over at Rural Doctoring, family physician Theresa Chan explores this valid (but not so obvious) question. (Source: InsureBlog)

Healthcare futures

Health Care Law Blog — Tue, 01 Jul 2008 06:01:00 +0100

A welcome to Michael Ryan, FACHE, Chairman of Executive Impact Group, now blogging at Healthcare Futures. Mike is a recognized eHealth, healthcare and social networking pioneer having served as a founder, executive, advisor and board member of numerous companies. He also has a West Virginia connection to my wife who grew up in the Morgantown area that we uncovered when we first met.Healthcare Futures plans to explore health care industry news, trends, and future visions from Michael's view over his career as an observer, executive, advisor, author, innovator, patient and online pioneer.Check out his recent posts on the need for medical mentors as the baby boomers begin to overwhelm the health care system (what I have previously referred to as the pig in the python) and his post on Health Social Networking, which explores the "niche'ing" of social networking.If these posts interest you, pick up Healthcare Futures RSS Feed here. (Source: Health Care Law Blog)

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Connecting for health: another wave in the shift to consumer controlled health information

Health Care Law Blog — Tue, 01 Jul 2008 05:09:00 +0100

The recent announcement of the Common Framework for Networked Personal Health Information by the Connecting for Health collaboration lead by the Markle Foundation is just the next wave in what may be a tidal shift. The tidal shift is one centered on the input, control, ownership, and administration of health information that results from the active and real use of PHRs by consumers.Those participating in and endorsing the Connecting for Health initiative are a diverse group of health care and technology companies, including Google, Microsoft, Intuit, WebMD, Dossia, BlueCross BlueShield, AARP, AAFP, SureScripts and others.Whether or not the wave is large enough or just one of many more to come is yet to be determined. The ocean of health information and health information exchange is so fluid these days as we undergo major projects surrounding health information technology at the national level, state level, by HIEs, private industy, etc. For health lawyers - it is a field day for spotting regulatory legal issues and implications. Some of the real life factual scenarios we have been going through as a result of work related to the West Virginia Health Information Network and the NIH2 project remind me of law school exams.For more insight on the Connecting for Health collaborative check out thoughts by other health care lawyers: Jeff Drummond who talks about the provider "betamax" and "culture fears, David Harlow who raises good questions and applauds the effort to gain public trust. He also looks at whether the recent PHR developments might obviate the need for local HIE infrastructure (with follow up commentary from Micky Tripathi at MAeHC Blog). Matthew Holt looks at the important health vs. wealth issue underlying the effort and the (non)involvement of the EMR vendors in the process.Check out the latest developments with a Google News search: "connecting for health". (Source: Health Care Law Blog)

Save the date - new frontiers in personal health records

Pioneering Ideas — Tue, 01 Jul 2008 04:00:00 +0100

Mark your calendar now -- we're pleased to announce that details have been set for "New Frontiers in Personal Health Records: A Report Out from Project HealthDesign and Forum on Next-Generation PHRs." Here's the logistical info: Date: September 17, 2008 Time: 8:00-5:00 Location: Westin Washington, DC City Center RSVP: Erica Garland, GYMR Public Relations We hope you can join us to explore the vast potential for personal health records (PHRs) and related technologies to help consumers take charge of their health like never before. The event also provides the opportunity to showcase the array of next-generation, user-centered PHR applications developed by grantees of Pioneer's Project HealthDesign program. Project HealthDesign grantees have pushed PHRs far beyond just providing consumers with access to their health information...these PHR tools are designed to meet people's varied and specific health needs, interpreting their health data and delivering customized feedback that can guide their daily health decisions. In addition to highlighting what Project HealthDesign has learned in the process of developing these tools, the Showcase will feature panels and discussions with leading health IT pioneers, policy makers and industry experts. At the event, you will have the opportunity to:* Participate in an open dialogue about the prototypes and the future of PHRs, including lessons learned from user-centered design and policy directions to support continued growth and innovation in the PHR arena. * Engage in discussions with key experts on a variety of topics, including future directions that key industry players may take in this arena. * Hear lessons coming out of Project HealthDesign and how they might influence emerging PHR services. * See the prototypes that Project HealthDesign innovators developed to demonstrate the practical applications of PHRs to improve people's daily health. * Learn about the functional requirements and common platform components developed by Project HealthDesign and explore how they could have broad application across the PHR field. Please spread the word to others that may have interest in this event - we'll be posting back regularly with updates on the agenda and speakers. We hope to see you in September! (Source: Pioneering Ideas)

Emergency room malfunction - again

HealthLawProf Blog — Tue, 01 Jul 2008 04:00:00 +0100

Wasn't fairly recently that we read about person dying in the emergency room after she fell to the floor and displayed symptoms of severe distress. It seemed too terrible to repeat - but yet today we read about an emergency... (Source: HealthLawProf Blog)

New medicare rules for hospice

HealthLawProf Blog — Tue, 01 Jul 2008 04:00:00 +0100

The Washington Post reports on the new Medicare rules for hospice care. Alicia Ault writes, Twenty-five years after Medicare began paying for hospice care, the federal health program has issued a new rule calling hospice providers to closer account on... (Source: HealthLawProf Blog)

Fda - more bad produce?

HealthLawProf Blog — Tue, 01 Jul 2008 04:00:00 +0100

The Washington Post reports that it may be more than just tomatoes that contain the salmonella that has sickened more than 810 across the United States. Annys Shin reports, Tomatoes carrying a rare form of salmonella that has sickened more... (Source: HealthLawProf Blog)

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Women and health insurance

HealthLawProf Blog — Tue, 01 Jul 2008 04:00:00 +0100

Ezra Klein reports on the findings of Jon Cohn regarding the health insurance industry and women He writes, Jon Cohn peers into insurance price differentials and comes back with a depressing, but unsurprising, finding: Insurers charge women more than they... (Source: HealthLawProf Blog)

Movin' on up!

InsureBlog — Mon, 30 Jun 2008 19:00:00 +0100

Those folks who pay attention to these things may have noticed that we've been in the Top 20 at Wikio (Health) for quite some time, most recently at #16. I just received confirmation from the Wikio folks that that's about to change:"I am contacting you about the new Wikio ranking for July. Your blog InsureBlog moved from 16 to 11 this month."Awesome!While I'm still relatively clueless about how those rankings are determined, it stands to reason that readership plays at least some part, and so I'd like to thank our loyal (and brilliant, of course) readers.UPDATE: I've just received a follow-up email confirming that we're #10. (Source: InsureBlog)

Another ethical conundrum: little hailey

InsureBlog — Mon, 30 Jun 2008 18:00:00 +0100

When is someone too sick to be helped?"Two airlines this weekend declined to fly Miranda Goranflo and her daughter Hailey to Beijing, where the 5-year-old was to receive stem-cell treatments for a rare fatal disease."Little Miranda (and her baby brother) suffers from Late Infantile Batten Disease, which causes loss of muscle co-ordination and seizures that do not respond to anticonvulsant drugs. It is (apparently) always fatal. Other than this new, experimental treatment, there is no cure; a patient's life expectancy is about age 12.Once Hailey (and her mother) had reached Vancouver, Air Canada insisted on making their own determination as to whether or not she was fit to fly. Unfortunately, during the wait for the Air China flight, Hailey's health went from bad to worse, and she was admitted to Vancouver's Children's Hospital. When it was apparent that her health hadn't improved enough to make the flight to China, she was flown home, by air ambulance, to Kentucky.It now appears that she will be unable to take advantage of the stem-cell treatment that may have extended her life expectancy.This is just sad, on so many levels.As a parent, I can certainly respect and empathize with her folks' desire to exhaust every single avenue, no matter the cost or the effort. But I can also see the airlines' perspective: if her health had deteriorated that fast just waiting for the next flight, how well would things have gone once they were in the air and over the Atlantic? And what liability would the airline face in the event that she suffered even more? And finally, what about the safety of the other passengers?There's also the question of "what now?" Hailey's family is exploring the possibility of a direct commercial flight to China, or even ponying up the $125,000 cost of an air ambulance there. Since this is an experimental treatment, it's unlikely any insurance carrier would agree to foot that bill.I'm curious about our readers' take on this. (Source: InsureBlog)

What's your sign?

InsureBlog — Mon, 30 Jun 2008 17:41:00 +0100

Are you predisposed towards nearsightedness? Is there a chance you might be (or become) schizophrenic? What's your risk of cancer or heart disease?According to some psychiatrists the month and time of year you were born gives some indication of your future health.The association between birth season and health, meanwhile, has been confirmed repeatedly by studies published in peer-reviewed journals.It was first noticed with the neurological disorder schizophrenia; subsequent research has shown the month of birth can influence your risk of suicide and chance of developing certain cancers, Crohn's disease, coronary heart disease and brain tumors, says psychiatrist Emad Salib of Peasley Cross Hospital in Britain,That's a fairly broad association if you ask me.Literature reviews, meanwhile, show that more patients with schizophrenia, Alzheimer's disease, epilepsy and narcolepsy are born in December and January. Those with affective disorders—alcohol dependence, autism, dyslexia and multiple sclerosis—are reported more frequently in those born during spring and summer months.And what is the correlation?A mother's health is the root of several possible explanations. For instance, the fetal origins hypothesis holds that early environmental conditions in utero and during infancy can program human immune development. Some of these factors include a mother's access to fresh vegetables or vitamins, or her exposure to an infectious disease such as influenza that might harm the brain of a developing fetus.OK, I might be willing to buy into that.So is there any good news?"Children born in autumn will tend to be the biggest, strongest and most developed in their school year," he said. "So they are more likely to do better in sport, which may motivate them to stay active.But then there is this . . .Of course there will always be October-born people who are sedentary and June babies with perfect vision. Season of birth research is in its infancy, so it shouldn't weigh into family-planning decisions.As a September baby, I am more inclined to think I am in the bigger, stronger category.Wonder what my horoscope says for today? (Source: InsureBlog)

Unfair to men

InsureBlog — Mon, 30 Jun 2008 14:58:00 +0100

Tova Hack of Valencia, California is now paying more for her health insurance. She just got a renewal on her Blue Cross plan and the premium has increased 20% to $119 per month.Because she is a woman.She is crying foul."I don't think it's fair at all," said Hack. "I'm in perfectly fine health."So?Would she have been satisfied with the increase if her health was poor?as far as Blue Shield is concerned, Hack and all other women are somehow more accident-prone, or more likely to break a bone, or more susceptible to costly ailments.Why? Because they're women.Says who?"Our egghead actuaries crunched the numbers based on all the data we have about healthcare,"Egghead actuaries.Is that their official title?And then there is this.Individual health insurance typically costs more than group coverage because the risks can't be spread among a large number of people. Such risk pools allow all people with group policies to be insured equally, without biases for age or gender.That's not a quote from Blue or any other carrier. So what idiot reporter inserted that bit of information?Idiot reporter.That is their official title.But parsing rates according to gender is a relatively new phenomenonAnother non-quote from our idiot reporter.Back to the pricing differential . . .By age 20, women are paying $119 monthly, while men are charged $110.Sounds like men need to complain they are being under-charged and that isn't fair.Where is our idiot reporter when we need them? (Source: InsureBlog)

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Carnival of personal finance is up

InsureBlog — Mon, 30 Jun 2008 13:26:00 +0100

This week's edition is overflowing with helpful finance tips and info. Host Greener Pastures presents his CoPF with a "green" theme, which is interesting.Check it out! (Source: InsureBlog)

Mountain stage: the gold at the end of the rainbow

Health Care Law Blog — Mon, 30 Jun 2008 12:48:00 +0100

A memorable 2008 FestivALL ended last evening with a great Mountain Stage performance at the Clay Center. One of the best all around performances I can remember in recent past.A storm rolled through Charleston about 15 minutes before the performance and I captured the following photos. Coincidence or not? Well the pot of gold at the end of FestivALL was the "Gold" Mountain Rebels.Jakob Dylan and the Gold Mountain Rebels were excellent as expected as the headliner. The Gold Mountain Rebels had a smooth tight sound that mixed well with Dylan's voice and lyrics. I really enjoyed the performances by singer songwriters, Andy Davis from Nashville and Priscilla Ahn from LA. Great new performers who I was first introduced to at the show and plan to hear more from. Krista Detor and Hayes Carll rounded out the evening with solid performances. For another perspective, check out Roger Lilly's review of the evening at the Charleston Gazette. (Source: Health Care Law Blog)

Cms to temporarily suspend medicare physician payment cut

Medicare Update — Mon, 30 Jun 2008 04:00:00 +0100

The Associated Press reports in an article that the Centers for Medicare & Medicaid Services will hold physicians Medicare claims for services furnished on or after July 1, 2008. According to the article, the holding of claims is intended to temporarily delay the implementation of the 10.6 percent reduction in the Medicare payment rate for physician services until Congress returns from the July 4 recess and has time to address the scheduled payment cut. On June 24, 2006, the House of Representatives passed Medicare Improvements for Patients and Providers Act of 2008 (H.R.6331) in a 355-59 vote. As introduced, H.R.6331 would prevent the 10.6 percent reduction in the Medicare payment rate for physician services (which is scheduled to take effect on July 1, 2008), hold rates steady for the rest of 2008, and provide physicians with a 1.1 percent update for 2009. However, on June 26, 2008, the Senate failed (in a 58-40 vote) to invoke cloture and proceed to a vote on H.R.6331. (Source: Medicare Update)

District court denies motion to halt dmepos competitive bidding

Medicare Update — Mon, 30 Jun 2008 04:00:00 +0100

On June 30, 2008, the U.S. District Court for the District of Columbia issued a Memorandum Opinion and order denying the American Association for Homecare's (and other plaintiff's) motion for a preliminary injunction to stay the Medicare durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) competitive bidding program, which is scheduled to commence on July 1, 2008. According to the Memorandum Opinion, the U.S. District Court denied the motion because the Court concluded that the plaintiffs were unable to demonstrate an irreparable injury. The action was filed in the U.S. District Court for the District of Columbia on June 9, 2008 in an effort to stop the implementation of the DMEPOS competitive bidding program on July 1, 2008. For information on the action, see the Press Release issued by the American Association for Homecare on June 11, 2008. (Source: Medicare Update)

Uninsured skating on medical bills

InsureBlog — Sun, 29 Jun 2008 19:06:00 +0100

Much is made of the uninsured, and especially when the press reports how much they are "overcharged" for services. But very little is made of how much the uninsured actually PAY for medical services.Grady Hospital in Atlanta is in crisis and services have been cut and more cut's will continue. A more recent casualty of mismanagement at Grady is the impending cutback in ambulance services.According to the AJC, the Grady medical transport unit lost some $8.7 million in the recent year.The reports indicate it costs Grady on average about $322 to transport a patient. Figures by type of patient play out as such.Medicare patients totaled 15,358 with total charges of $6,907,870 against total receipts of $5,254,123 or $342 per patient.Medicaid patients totaled 15,269 with total charges of $4,970,887 against total receipts of $4,140,589 or $271 per patient.Patients with insurance totaled 7,421 with total charges of $4,329,658 against total receipts of $3,129,299 or $422 per patient.UNINSURED patients totaled 28,871 with total charges of $18,709,722 against total receipts of $309,630 or $11 per patient.Read that again.Uninsured patients paid an average of $11 for services rendered. They comprised 44% of the trips but only paid 3% of the revenue.Seems like it is time for the uninsured to pay their "fair share". (Source: InsureBlog)

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Ct scans and new health technologies: a cost/benefit analysis

HealthLawProf Blog — Sun, 29 Jun 2008 04:00:00 +0100

The New York Times has a long front page article today on the value of CT scans and other new technologies that doctors feel they need to use for patient health without much proof that they promote and health. There... (Source: HealthLawProf Blog)

Still more festivall: blues & brews kicks off weekend events

Health Care Law Blog — Sat, 28 Jun 2008 11:45:00 +0100

Sorry for a lack of substantive health care posting the last couple of weeks. The result of being just too busy with client legal matters. This morning I was catching up on my RSS feeds and saw these great photos by Rick Lee (photo to right by Rick of Sonny Landreth) from last nights Blues, Brews & BBQ. Looks like everyone had a great time. We sat on the porch last night after the kids went to bed and caught some of the great music. Today Capitol Street comes alive with artists, performers, etc. Don't miss the fun. Looking forward to watching Jesse & James, Monkeys in the House, Expert Liar Bil Lepp, a variety of music and much more. Later in the day Michael Feldman's Whad'ya Know (Feldman visits Power Park) will be in town and tonight University of Charleston plays host to Wine & Jazz. Tomorrow Mountain Stage caps off the weeklong FestivALL wich a great show including Jakob Dylan and the Gold Mountain Rebels, Hayes Carll, Andy Davis, Krista Detor and Priscilla Ahn. My wonderful wife surprised me with tickets - can't wait to see the show. If you Twitter follow all the action aqt @FestivALL. In the words of Larry Groce, Mountain Stage host and FestivALL organizer, "Go out and see some live music [and arts] this weekend." (Source: Health Care Law Blog)

Run for the hills, the doctors are coming, the doctors are coming!!!!

Health Care Policy and Marketplace Review — Sat, 28 Jun 2008 04:00:00 +0100

What is the one thing no human being should want to be next week? A Republican Senator at a Fourth of July Picnic. In the most amazing turn of events I have seen in 20 years of following health care policy in Washington, DC the Democrats have the Republicans backed into an awful corner over the issue of the July 1st automatic 10.6% Medicare physician fee cut and corresponding private Medicare (Source: Health Care Policy and Marketplace Review)

Informed consent or compelled speech

HealthLawProf Blog — Sat, 28 Jun 2008 04:00:00 +0100

The Eighth Circuit has overturned an injunction granted to Planned Parenthood that prevented the South Dakota informed consent abortion statute from going into effect. The ASCBlog reports on the case and states, An en banc panel of the U.S. Court... (Source: HealthLawProf Blog)

Commenting - part 1

Addicted to Medblogs — Sat, 28 Jun 2008 04:00:00 +0100

I am a lurker. Some might even call me the world's most dastardly lurker. Part of the reason is because I’m shy, but mostly it’s because I suck at commenting. If you don’t believe me, here are the last 5 comments I’ve left on blogs during the past 3 months: 1. Feel better soon! Now I'm gonna go out and get me one of those cute c-collars. 2. I do love me some dinosaur porn. 3. Great (Source: Addicted to Medblogs)

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Paging dr willy wonka: chocolate update

InsureBlog — Fri, 27 Jun 2008 18:15:00 +0100

Over the years, we've touted the benefits of chocolate-based health care: whether you're pregnant, overweight, or just suffering from high blood pressure, chocolate seems to be the "go to" dietary hero (well, maybe next to tomatoes). It's not enough, apparently, for scientists merely to acknowledge cocoa's seminal role in the health care arena; now they want to map the delicious pod's genome:"Government scientists are launching a five-year project Thursday aimed at safeguarding the world's chocolate supply by dissecting the genome of the cocoa bean."It seems that there are a host of challenges that affect cocoa crops, from fungi to droughts, and researchers believe that they can learn more (and better) techniques for protecting the world cocoa bean supply by more completely understanding what makes it "tick."It's actually a pretty interesting venture, with leading edge genetic research which promises to have positive, real-world impact. (Source: InsureBlog)

Doctor discipline measure draws mixed reaction

Doc Advocate — Fri, 27 Jun 2008 14:26:13 +0100

Gov. David A. Paterson’s measures aimed at improving patient safety and putting more teeth into physician discipline drew a mixed reaction yesterday from experts in health care and the legal profession. During his news briefing yesterday, Paterson alluded to Dr. Harvey Finkelstein, the Long Island physician caught in controversy after more than 10,000 of his patients were notified they might have been exposed to hepatitis C, B and HIV. Under the governor’s plan, physicians would not be able to practice while an investigation is under way. But that denies doctors the right of due process, said Dr. Melissa Palmer, a liver specialist in Plainview who evaluated dozens of Finkelstein’s patients for liver disease. “What happened to innocent until proven guilty?” she said yesterday. “Don’t get me wrong, I think all doctors should be using universal precautions,” she said of guidelines to prevent the transmission of communicable infections in health care settings. “But until they’re actually proven 100 percent guilty, they should not be forced from practice.” Robert Tessler, a Manhattan lawyer, called the governor’s plans “a welcome move toward transparency and responsibility.” He was among lawyers who represented patients who contracted hepatitis C and possibly hepatitis B following exposure to contaminated colonoscopy equipment in Brooklyn. The cases were settled in the patients’ favor last year. Tessler said taking action against physicians has been tough in New York because the profession has protective firewalls. “It’s much easier to discipline a lawyer. The medical profession tends to be a little too protective.” One amendment authorizes an “administrative tribunal” to issue orders to the Office of Professional Medical Conduct to review personal medical records of physicians and other personnel deemed impaired by drugs, alcohol or physical or mental disability. “God is in the details on this one,” said David Rothman, founder of the Institute on Medicine as a Profession at Columbia University. “I hope this doesn’t mean that the doctors’ medical records would become public, but that the OPMC would have access to them.” (Source: Doc Advocate)

Nationalized health care: ruh ro!

InsureBlog — Fri, 27 Jun 2008 14:00:00 +0100

"(T)he chairman of a government committee reviewing...health care this year...concluded that the system is in "crisis."For example:"Sylvia de Vires....afflicted with a 13-inch, fluid-filled tumor weighing 40 pounds, was unable to get timely care."And she's far from the only one:"At some hospitals, seriously ill patients are kept in ambulances for hours so as not to run afoul of the regulation."Wow, sure sounds like we need to switch to a Canadian-style, nationalized health care system, and right away!Or maybe not: "the chairman" cited above is actually considered the "the father of Quebec medicare," the system on which Canadian health care is based. And he made those remarks recently, adding "(w)e thought we could resolve the system's problems by rationing services or injecting massive amounts of new money into it," and proposing a much greater role for private health care for our Neighbors to the North©. In fact, he's "proposing to give a greater role to the private sector so that people can exercise freedom of choice."And poor Mrs de Vires? Well, she's from Ontario, and because the Canadian system wouldn't approve treatment for her, she took a little trip down to Michigan. There, a surgeon successfully removed her tumor, and none too soon: the surgeon estimated that "she could not have lived longer than a few weeks more."And you may be wondering about the folks being "stored" in ambulances. In Britain, it has become commonplace for acute care patients to have long waits before being seen, much less treated. So the Ministry of Health promulgated a new rule requiring that those in need of emergency care receive it inside four hours. All well and good in theory, but the Law of Unintended Consequences trumps a mere gummint regulation, and so hospitals refused to allow the patients inside; that four hour meter didn't start ticking until they hit the actual door.I'll give "the father of Quebec medicare" the last word on this:"We are proposing to give a greater role to the private sector so that people can exercise freedom of choice."[Hat Tip: RWN] (Source: InsureBlog)

Cavalcade of risk #55: submissions due

InsureBlog — Fri, 27 Jun 2008 12:00:00 +0100

Our friend Jay Norris hosts next week's Independence Day edition of the Cavalcade of Risk. Submissions are due by next Monday (June 30th), and Jay requests that you include:■ Your blog's url ■ Your post's url ■ The post's trackback URL (if available) ■ A (brief) summary of the postYou can submit your post via Blog Carnival or email.We're scheduling late summer, so please drop us a line to reserve your Cav. (Source: InsureBlog)

Senate fails to avert medicare physician payment cut

Medicare Update — Fri, 27 Jun 2008 04:00:00 +0100

On June 26, 2008, the Senate failed (in a 58-40 vote) to invoke cloture and proceed to a vote on the Medicare Improvements for Patients and Providers Act of 2008 (H.R.6331). On June 24, 2006, the House of Representatives passed H.R.6331 in a 355-59 vote. As introduced, H.R.6331 would, among other things, prevent the 10.6 percent reduction in the Medicare payment rate for physician services (which is scheduled to take effect on July 1, 2008) and provide physicians with a 1.1 percent update for 2009. (Source: Medicare Update)

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Macfie, mccain, and mcprizes

BioLaw: Law and the Life Sciences — Fri, 27 Jun 2008 04:00:00 +0100

In late 19th Century Britain, a British Member of Parliament, Robert Macfie, vigorously advocated awarding governmental cash prizes to inventors whose inventions proved useful, and pressed for such a reward system to replace patents. Patents are usually justified on the grounds that they promote technological innovation. The United States Constitution is rather explicit about this, granting Congress the right to set up a patent system "To promote the Progress of...[the] useful Arts". However, the monopoly right to exclude that a patent confers to its owner can also create a deadweight loss to society. Macfie's system of government-funded rewards was intended to sidestep the deadweight loss from patent monopolies by making new inventions free for anyone to exploit. Earlier this week, John McCain revealed that he shares more with Macfie than just most of the letters in his name. McCain proposed a version of Macfie's invention reward system to improve automobile fuel efficiency: I further propose we inspire the ingenuity and resolve of the American people by offering a $300 million prize for the development of a battery package that has the size, capacity, cost and power to leapfrog the commercially available plug-in hybrids or electric cars...That’s one dollar, one dollar, for every man, woman and child in the U.S. — a small price to pay for helping to break the back of our oil dependency. Though McCain's formula for deriving the size of the prize may seem unsophisticated, he shares the philosophy underlying his proposal with Steven Shavell, a professor of law and economics at Harvard Law School. Shavell has suggested the advantages of a reward system over a patent system for more than a decade. As he and coauthor Tanguy Van Ypersele observe in their 2001 paper, "Rewards Versus Intellectual Property Rights" (Journal of Law and Economics, Volume XLIV: 525-547): We conclude in our model that intellectual property rights do not possess a fundamental social advantage over reward systems and that an optional reward system—under which innovators choose between rewards and intellectual property rights—is superior to intellectual property rights. Technological optimists tend to view technological innovation as the key to solving the world's problems, and the patent system has traditionally been viewed as playing a pivotal role in spurring and advancing innovation in the "useful Arts". However, other legal models of promoting innovation exist. In the spirit of Robert Macfie, not to mention Shavell and Van Ypersele, perhaps John McCain's proposal is worth a try. (Source: BioLaw: Law and the Life Sciences)

Personal health records on the hill

Pioneering Ideas — Fri, 27 Jun 2008 04:00:00 +0100

Last week, I joined the Project HealthDesign grantees in DC as they shared their projects on Capitol Hill. It was an opportunity for the grantees to brief members of Congress and their staff about personal health records (PHRs) and the importance of engaging patients in the design and functionality of PHRs. We've talked about Project HealthDesign before on this blog, so you may remember that Project HealthDesign focuses on the patient or end user. (Conversely, most PHRs available today respond to the needs of healthcare systems or providers.) I loved hearing from the research and design teams how the patients, through their testing of the applications, ultimately shaped the design and functionality. The patients gave feedback on icons, font sizes, and whether or not they would use specific functions. All of the researchers agreed that their feedback made for a better application. But, back to the Hill where the nine project teams took their ideas to their Representatives, to their Senators and their staffs. A number of the research teams were joined by patients who spoke about the value of the research. While the intent of the visits was to brief those on the Hill about Project HealthDesign, we also got a briefing of our own. We learned that the staffers knew quite a bit about PHRs, including who the major providers are. One of staffers we met has her own PHR, and many of the staffers used a simple PHR application to track their physical activity: a pedometer! Recently, Blue Cross/Blue Shield gave out pedometers and launched a challenge to track steps. It was no surprise for me to learn that some of the congressional offices have a challenge within the challenge for the top step-getter in the office. During our visit, the staffers and members also raised questions about privacy, security, and how the applications would interace with existing Electronic Medical Records. Since we've taken the pulse of PHR awareness on the Hill, I'd like to take the pulse of PHR awareness among our readers. Do you have a PHR? Are you doing something tracking your health on a daily (or just regular) basis? (Source: Pioneering Ideas)

Some happiness for your day

HealthLawProf Blog — Fri, 27 Jun 2008 04:00:00 +0100

Please click here --- I want that guy's job - fun dancing, travel and opportunity to show how much we all have in common with each other. More information about Matt and his mission can be found here. (Source: HealthLawProf Blog)

Medicare delayed

HealthLawProf Blog — Fri, 27 Jun 2008 04:00:00 +0100

The New York Times reported yesterday on the delay in the Senate's consideration of the Medicare Bill which would have blocked the 10 percent automatic cut in Medicare payments to physicians scheduled to begin in July. Now, those cuts are... (Source: HealthLawProf Blog)