MedWorm provides a medical RSS filtering service. Over 6000 RSS medical sources are combined and output via different filters. This feed contains the latest medical blog items that have been tagged with 'hostile'. Sat, 03 Sep 2011 02:32:07 +0100 http://www.medworm.com/index.php?rid=5169511&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F08%2Fwill-hired-executives-let-healing.html Hospital - noun, 1.  a charitable institution for the needy, aged, infirm or young  2.  an institution where the sick or injured are given medical or surgical care, Merriam-Webster             - noun.  1.  an institution providing medical and surgical treatment and nursing care for sick or injured people, Oxford DictionaryTwo recent NY Times articles raise concerns that changes in leadership may cause hospitals to stray from their original purpose.  Cook County Health and Hospitals SystemThe first NY Times article discussed leadership of Cook County Health and Hospitals System (in the Chicago, IL area). This is a public health system whose mission was traditionally "to serve Cook County... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5169511 Fri, 26 Aug 2011 18:20:00 +0100 5169511 http://www.medworm.com/index.php?rid=5107458&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F08%2Fwhy-ehrs-are-mission-hostile.html From "Revisiting E&M Visit Guidelines — A Missing Piece of Payment Reform" (free PDF as of this writing), Robert A. Berenson, M.D., Peter Basch, M.D, and Amanda Sussex, M.P.H., N Engl J Med 364;20 nejm.org May 19, 2011. Excerpt: ... Numerous problems have resulted. [From the CPT codes, Current Procedural Terminology codes used by physicians in billing, covering evaluation and management (E&M) services - ed.] The detailed guidelines often cause clinicians to overdocument, making the medical record an ineffective source of communication. ... A fundamental concern is that the office-visit descriptors and interpretive guidelines emphasize often-irrelevant elements of patients’ clinical histories and examinations, rather than decisionmaking and care-management activities. This is... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5107458 Mon, 08 Aug 2011 02:35:00 +0100 5107458 http://www.medworm.com/index.php?rid=5077624&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F07%2Fexecutives-get-rich-despite-ethical-and.html We recently posted about some shocking allegations suggesting that the for-profit corporations that now dominate hospice care may prey on vulnerable patients to increase their revenues, and may specifically recruit patients who are not terminally ill for hospice, and then neglect to attend to their treatable medical problems.  The post was based on a Bloomberg investigative report.The Bloomberg report focused on two large for-profit hospice providers, Vitas, a subsidiary of Chemed, and VistaCare, a subsidiary of Gentiva. We have repeatedly seen a pattern in numerous other health care organizations, non-profit as well as for-profit: despite questionable corporate behavior that appears to violate the values of health care professionals, executives receive rich compen... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5077624 Thu, 28 Jul 2011 18:51:00 +0100 5077624 http://www.medworm.com/index.php?rid=5069405&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F07%2Fprepare-them-to-die-for-profit-hospices.html A Bloomberg news investigative report illustrated the adverse effects of having for-profit corporations taking care of patients.Hospice as a Social MovementThe corporations in question this time are for-profit hospices. Hospices in general gained a good reputation for improving the quality of life for patients near life's end:Hospice got its start in the 1960s as a social movement. Volunteers, often meeting in schools and church basements, organized care so patients could die at home with loved ones, instead of at the hospital laced with tubes. Dame Cicely Saunders, the pioneering English physician who opened St. Christopher’s Hospice in London in 1967, fought traditional methods of unconditional resistance to death, and brought the concept to U.S. shores. Hospices Become CommercialSubse... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5069405 Tue, 26 Jul 2011 16:21:00 +0100 5069405 http://www.medworm.com/index.php?rid=5050459&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F07%2Fblood-money-at-border-red-cross-and.html Writing in our local Providence Journal, Felice Freyer reported on a story that becomes less bewildering when viewed in the context of how nominally not-for-profit health care organizations are now run.  The Border DisputeIt seems that two such non-profits are having a border dispute:Two local charities are fighting for your blood.The Rhode Island Blood Center, long the sole blood-collection agency in the state, is objecting to incursions by the American Red Cross of Eastern Massachusetts, which recently started holding blood drives here.A war of words has resulted, with the blood center accusing the Red Cross of a 'campaign of misinformation,' and the Red Cross calling the blood center 'hypocritical.' The Hospital Association of Rhode Island entered the fray with a letter to blood do... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5050459 Thu, 21 Jul 2011 17:58:00 +0100 5050459 http://www.medworm.com/index.php?rid=5050718&cid=t_178190_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2011%2F07%2F19%2Fdepression-and-empathy-in-couples%2F Discussions focused on eliciting support, with one partner playing the role of help seeker and the other playing the role of help giver. The couples were given an alarm that beeped after 6 min, at which point they switched roles and continued the conversation for an additional 6 min.” In the second part, each individual reviewed their recordings separately and after watching the discussion in 30-second segments, paused the recording and wrote down the thoughts and feelings they experienced at that time during the interaction. They were also asked to infer and write down their partners’ thoughts and feelings. In the third part of the study, five coders independently judged “the degree of similarity between perceivers’ and targets’ statements by examining the taped discussi... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=5050718 Tue, 19 Jul 2011 16:15:54 +0100 5050718 http://www.medworm.com/index.php?rid=4934029&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F06%2Ffirst-contaminated-heparin-case-verdict.html In February, 2008, we first posted about the case of the deadly adulterated heparin.  (A case summary is appended to the end of this post, and nearly all our posts are here.)  The case is of fundamental importance because it involves the failure of pharmaceutical companies to fulfill their core mission, to supply pure, unadulterated drugs.  It is also of fundamental importance because it may be about how this failure to fulfill core mission was not due to accident, or even simple incompetence, but due to putting financial goals ahead of patient safety.  The latest event in the very slowly unfolding aftermath of this case was the first verdict against the sellers of the heparin in a civil trial in a US court room.  As reported by the Chicago Tribune,A Cook Coun... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4934029 Mon, 13 Jun 2011 19:26:00 +0100 4934029 http://www.medworm.com/index.php?rid=4893344&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F06%2Fblogscan-another-health-care-foundation.html From Gary Schwitzer's HealthNewsReview blog, an aggregation of stories that shows how the famous Susan G Komen For the Cure foundation has lost its way.  Not only is this organization using its financial resources to launch legal challenges to other charities that dare to use the phrase "for the cure," but it now has joined a corporate partnership to sell perfume.   It seems that no matter how well-intentioned a health care organization is, infuse it with enough money and fame, and watch things unravel.  Health care charities now seem to be no more resistant to mission amnesia than are academic medical institutions.  (Source: Health Care Renewal) Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4893344 Wed, 01 Jun 2011 18:55:00 +0100 4893344 http://www.medworm.com/index.php?rid=4797764&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F05%2Fwere-only-in-it-for-money-big.html Discussion of some examples of what may happen to whistle blowers is here.  The survey mentioned earlier (here) showed that about one-third of faculty fear they may be punished for speaking  out. Leadership of academic medical centers by businesspeople - Ill-informed management may result from leaders who have no background or training in actual health care.  Leaders of teaching hospitals and universities become millionaires -  A recent example is here, and more may be found here.  Leaders of academic medical centers and the parent universities of medical schools often make more than $1 million a year in the US.  When such amounts are in play, executives may focus more on short-term measures that lead to even more pay than on upholding the mission. M... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4797764 Sat, 07 May 2011 16:13:00 +0100 4797764 http://www.medworm.com/index.php?rid=4775351&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F05%2Fperils-of-physicians-practicing-as.html A seriously chilling cautionary tale corroborated some of my previously expressed fears about the perils of physicians practicing as corporate employees.  It unlikely venue was the April 25, 2011 issue of Medical Economics.  The article, not yet on the web, was "Selling to a Corporation Poses Challenges," by Todd R C Neely.Here is how the case started:A start-up company with a new medical treatment became a publicly traded corporation. The company's top managers were not physicians; they were finance and business experts familiar with the ways of Wall Street.To meet the corporation's goals and Wall Street expectations, the company used stock sale proceeds to aggressively market itself to doctors and buy established physician practices around the country. It quickly captured ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4775351 Mon, 02 May 2011 19:54:00 +0100 4775351 http://www.medworm.com/index.php?rid=4696591&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F04%2Fmedinformaticsmd-and-dr-roy-poses-in.html I have considered Dr. Roy Poses' Dec. 14, 2010 post "The Lancet Emphasizes the Threats to the Academic Medical Mission" (with its hyperlinks to source posts and articles) an excellent summary of many of the pathologies we address at Healthcare Renewal, especially with regard to the academic mission and the disruption of the integrity of the medical literature by commercial interests. His post is consistent with what might be considered our mission statement:Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.The Wall Street Journal published the following letter to the editor authored by me today in which I cit... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4696591 Fri, 08 Apr 2011 11:15:00 +0100 4696591 http://www.medworm.com/index.php?rid=4693245&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F04%2Fmedinformaticsmd-and-dr-roy-poses-in.html I have considered Dr. Roy Poses' Dec. 14, 2010 post "The Lancet Emphasizes the Threats to the Academic Medical Mission" (with its hyperlinks to source posts and articles) an excellent summary of many of the pathologies we address at Healthcare Renewal, especially with regard to the academic mission and the disruption of the integrity of the medical literature by commercial interests. His post is consistent with what might be considered our mission statement:Addressing threats to health care's core values, especially those stemming from concentration and abuse of power. Advocating for accountability, integrity, transparency, honesty and ethics in leadership and governance of health care.The Wall Street Journal published the following letter to the editor authored by me today in which I cit... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4693245 Fri, 08 Apr 2011 11:15:00 +0100 4693245 http://www.medworm.com/index.php?rid=4696592&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F04%2Fspecial-k-red-berries-mission-hostile.html "You should not have to work around something that is not in the way" - SSThis post can be considered Part 9 of my multi-part series on the mission hostile user experience presented by commercial healthcare IT.Note: Part 1 is here, part 2 is here, part 3 is here, part 4 is here, part 5 is here, part 6 is here, and part 7 is here, and part 8 is here.Special K® Red Berries is one of my favorite cereals.In this context, however, "Special K Red Berries" is a metaphor for cerebral and other hemorrhages caused by health IT getting in the way -- actually obstructing -- physicians ordering emergency medications such as vitamin K given via the fastest route, intravenously.A cerebral hemorrhage at post-mortem (obviously). Note the "red berry." Similarities in appearance to above cereal bowl ironic... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4696592 Tue, 05 Apr 2011 17:36:00 +0100 4696592 http://www.medworm.com/index.php?rid=4684213&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F04%2Fspecial-k-red-berries-mission-hostile.html "You should not have to work around something that is not in the way" - SSThis post can be considered Part 9 of my multi-part series on the mission hostile user experience presented by commercial healthcare IT.Note: Part 1 is here, part 2 is here, part 3 is here, part 4 is here, part 5 is here, part 6 is here, and part 7 is here, and part 8 is here.Special K® Red Berries is one of my favorite cereals.In this context, however, "Special K Red Berries" is a metaphor for cerebral and other hemorrhages caused by health IT getting in the way -- actually obstructing -- physicians ordering emergency medications such as vitamin K given via the fastest route, intravenously.A cerebral hemorrhage at post-mortem (obviously). Note the big Red Berry.This EHR system, Eclypsis Sunrise Clinical Manager™,... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4684213 Tue, 05 Apr 2011 17:36:00 +0100 4684213 http://www.medworm.com/index.php?rid=4565865&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F03%2Fcogs-in-corporate-machine-more-on.html This article underscores my previously expressed fears about how making physicians into corporate employees may remove the last barriers preventing patients from becoming corporate financial cannon fodder.  Physicians' most central professional value is to put patients' interests first.  Practicing physicians who practice as corporate employees are at risk of being pressured, or even threatened under the cover of contract enforcement to put their corporate employers' revenues ahead of patients' interests.  Physicians should not let their patients, and their own values be so threatened.  Physicians who have inadvertently, foolishly, or under duress signed contracts that could threaten their professionalism and their patients' welfare need to do the ri... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4565865 Wed, 09 Mar 2011 22:01:00 +0100 4565865 http://www.medworm.com/index.php?rid=4552049&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F03%2Frise-of-corporate-physician-end-of.html In discussing how concentration and abuse of power threatens health care professionals' values and professionalism, we have discussed how ostensibly academic institutions value faculty more for their earning power than their academic abilities.  We have discussed how financial relationships between physicians and drug, biotechnology, device and other companies risk abuse of entrusted power.  But up to now, I have been comforted by the hope that physicians in small independent practices who do not have such conflicts of interest are trying to uphold their professional values, even as they were buffeted by the perverse incentives imposed by managed care organizations/ health insurance companies and government insurance (e.g., US Medicare whose payments are controlled by the RUC).Ho... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4552049 Sat, 05 Mar 2011 16:48:00 +0100 4552049 http://www.medworm.com/index.php?rid=4522074&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F02%2Fsend-mercenaries-guns-and-money.html The latest twist in the tale of one of the US great safety-net public hospitals raises some interesting questions.  As reported by John Dorschner in the Miami Herald, Jackson Health System has had some bad times:the system, ... has served for a century as Miami-Dade County’s safety net healthcare system for the poor and uninsured. But money and management woes in recent years have pushed the system to the brink of failure time and again. Last week, its executives said it would run out of cash in July unless drastic measures are taken.The Bid for Jackson HealthThe latest drastic measure proposed was a take-over by a for-profit corporation, one that we have heard of before:A Massachusetts hospital chain led by a Cuban American heart surgeon with family ties to Miami has sent Jackson H... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4522074 Fri, 25 Feb 2011 17:39:00 +0100 4522074 http://www.medworm.com/index.php?rid=4441966&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F02%2Fnew-steward-health-care-will-superbowl.html Some recent publications raise interesting questions about the leadership of a regional health care organization which now seems to have intentions of going national.  A Superbowl Ad for Steward Health CareThe millions watching the Superbowl, maybe the biggest single US sports event, expect to be dazzled by the new, extremely expensive advertisements to be aired during the television coverage of the event.  The Boston Globe reported that the glitzy offerings by Volkswagen and Budweiser will have an odd companion, at least in the Boston area:The local television audience for Super Bowl XLV on Sunday will get the usual array of high-impact commercials, from the suds of Budweiser to the sedans of Kia Motors. But amid all the elaborate productions, one quieter spot might stand out �... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4441966 Sun, 06 Feb 2011 22:46:00 +0100 4441966 http://www.medworm.com/index.php?rid=4372008&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F01%2Fwhy-is-johnson-and-johnson-spinning-out.html Last week, a New York Times article by Natasha Singer and Reed Abelson cataloged some of the problems afflicting the giant health care corporation Johnson and Johnson.  Little red flags jut out from the shelves at a CVS drugstore in suburban Boston, alerting shoppers to shortages of nearly a dozen Johnson & Johnson products. Among them are Motrin, Rolaids, children’s Tylenol liquid and adult Tylenol, Mylanta, Pepcid AC and even some Neutrogena skin care products. 'Looking for Tylenol pain relief products?' asks one of the signs. The notices at CVS serve as a stark reproof to Johnson & Johnson, whose brands have for more than a century been synonymous with quality. Some of its products are in short supply at drugstores and supermarkets because the McNeil Consumer Healthcare u... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4372008 Wed, 19 Jan 2011 16:46:00 +0100 4372008 http://www.medworm.com/index.php?rid=4337878&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F01%2Fcurious-case-of-pfizers-asbestos-claims.html Here is a very strange and long-running story that raises some questions about how health care organizations are lead, but seems to have bee covered only in the business press.Pfizer Goes Into the Asbestos Business (in 1968), Faced Hundreds of Thousands of Lawsuits (in the 1980s), Promised to Settle (in 2004)Here is the background, per a 2004 report by the Associated Press, per Fox News:Pfizer Inc. (PFE) Friday said it has agreed to pay $430 million to settle all lawsuits against it alleging injury from insulation products made by a subsidiary.Pfizer and its Quigley Co. subsidiary were named, along with several other defendants, in 171,611 lawsuits claiming personal injury caused by exposure to asbestos, silica or mixed dust.Pfizer acquired Quigley Co. in 1968. It sold some products contai... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4337878 Tue, 11 Jan 2011 17:00:00 +0100 4337878 http://www.medworm.com/index.php?rid=4318314&cid=t_178190_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2F6wmy9RSy5n8%2F By Christopher PrebleI hadn’t planned to comment on the matter of Captain Owen Honors, the commanding officer of the USS Enterprise relieved of command following the release of some off-color videos that he recorded as the Enterprise’s executive officer (XO) in 2006 and 2007. But then Chris Kennedy in our media department twisted my arm, and the next thing I knew I had written 900 words for CNN. Before I delivered the essay for publication, I solicited feedback from a number of former officers, and one still serving, including several of my classmates at the George Washington University NROTC unit. Not all agreed with my take — I faulted Honors for his poor judgment, and concluded that the punishment fit the offense — but all appreciated the even-handed approach th... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4318314 Thu, 06 Jan 2011 18:35:29 +0100 4318314 http://www.medworm.com/index.php?rid=4258807&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F12%2Flancet-emphasizes-threats-to-academic.html Discussion of some examples of what may happen to whistle blowers is here.  The survey mentioned earlier (here) showed that about one-third of faculty fear they may be punished for speaking  out.  Leadership of academic medical centers by businesspeople - Ill-informed management may result from leaders who have no background or training in actual health care.  Leaders of teaching hospitals and universities become millionaires -  A recent example is here, and more may be found here.  Leaders of academic medical centers and the parent universities of medical schools often make more than $1 million a year in the US.  When such amounts are in play, executives may focus more on short-term measures that lead to even more pay than on upholding the mission. ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4258807 Tue, 14 Dec 2010 21:30:00 +0100 4258807 http://www.medworm.com/index.php?rid=4225186&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F12%2Funreasonably-dangerous-heparin.html It is time for an update on the case of the deadly contaminated heparin sold by Baxter International, which has received much less attention than seems warranted given its human costs (81 lives).  How the heparin was contaminated, and how the contaminated heparin ended up being sold as a US Food and Drug Administration approved American product are still unknown.  Despite the fact that the outcome of this case were so bad, it received disproportionately little attention when it was first made public, and now seems to have become nearly anechoic.Case Summary Baxter International imported the "active pharmaceutical ingredient" (API) of heparin, that is, in plainer language, the drug itself, from China. That API was then sold, with some minor processing, as a Bax... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4225186 Thu, 02 Dec 2010 19:34:00 +0100 4225186 http://www.medworm.com/index.php?rid=4219700&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F12%2Famerican-medical-schools-are-only-in-it.html We recently discussed the plight of young medical faculty.  It appears that their plight is even worse than we imagined.Last month, an abstract was presented at the Annual  Conference on Research in Medical Education at the Annual Meeting of the Association of American Medical Colleges, in a session entitled "Your Career is More than Your Specialty."  The citation would be: Pololi L, Ash A, Krupat E.  Faculty Values in the Culture of Academic Medicine: Findings of a National Faculty Survey.The authors described a large survey, of over 5000 faculty at 26 US nationally representative medical schools, done as part of the National Initiative on Gender, Culture, and Leadership in Medicine (known as C ‐ Change) project.  The overall response ra... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4219700 Wed, 01 Dec 2010 16:28:00 +0100 4219700 http://www.medworm.com/index.php?rid=3998924&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F09%2Finterface-problems-ill-informed.html ConclusionThe story does seem amazing. I am hardly an expert on the sinking of the Titanic, so should not try to comment on its truth. It does have some plausibility, and provides an explanation for one of the most important and influential disasters of the 20th century that is still poorly understood and a cause for controversy.In my humble opinion, if it were true, and had it come out earlier, this amazing story would have focused society's concerns on issues that have instead become scourges of our current era, and particularly important, if not frequently enough discussed causes of our health care dysfunction. The Titanic disaster lead to major changes in numerous safety practices, leading to rules about the adequacy of lifeboats and radio communication, and even swimming proficiency r... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3998924 Fri, 24 Sep 2010 21:08:00 +0100 3998924 http://www.medworm.com/index.php?rid=3965366&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F09%2Fsmall-hospital-system-loses-61-million.html As we have quoted many times, sunlight is the best disinfectant.  New US Internal Revenue Service requirements for reporting by not-for-profit organizations has resulted in more transparency about the finances of many health care organizations, and this transparency has shown that the culture of perverse incentives and management privilege has spread far and wide.How far and wide?  Consider this story in the (Harford County, Maryland) Aegis:Harford County’s Upper Chesapeake Health lost $70 million because of bad bets in the derivatives markets two years ago, but still paid its chief executive more than $900,000 in annual salary and bonuses.According to figures from their latest tax returns and from the state agency that regulates hospital rates, Upper Chesapeake Medical Center ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3965366 Mon, 13 Sep 2010 20:47:00 +0100 3965366 http://www.medworm.com/index.php?rid=3938309&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F09%2Fultimate-workaround-to-mission-hostile.html "Gentlemen, we can rebuild him. We have the technology. We have the capability to build the world's first bionic doctor. Dr. Data will be that doctor; better worse than he was before. Better, stronger, faster Worse, weaker, slower." -- parody of Oscar Goldman from the 1970's scifi series The Six Million Dollar Man."Gentlemen, we can rebuild him."The EMR is a technology that was supposed to improve clinical medicine (revolutionize it, some say). It was supposed to facilitate clinical medicine. It was not supposed to slow physicians and others down to the point of impairing their ability to practice medicine.However, the rosy predictions are not proving to be the case. Instead, we have the ultimate workaround to the health IT mission hostile user experience:Los Angeles TimesSeptember 6, 201... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3938309 Mon, 06 Sep 2010 22:34:00 +0100 3938309 http://www.medworm.com/index.php?rid=3880798&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F08%2Fhow-fallacy-of-perfect-health-care.html We began this blog way back in 2005 to discuss threats to physicians' values, especially from concentration and abuse of power.  Personal experience, and cases and anecdotes described by colleagues suggested that a dysfunctional health care system was making patients and physicians miserable.  Interviews with more physicians suggested pervasive threats to their values, many stemming from how leaders of health care organizations wielded their power.   Threats to Professional ValuesIn a 2007 post, based on an article in JAMA by Dr Arnold Relman, I asserted that the notion that threats to physicians' professional values are a major cause of health care dysfunction was becoming mainstream.  Furthermore, Dr Relman's review of the history of the probl... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3880798 Wed, 18 Aug 2010 16:37:00 +0100 3880798 http://www.medworm.com/index.php?rid=3761392&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F07%2Fmaude-database-patient-outcome-death.html I present another health IT problem case from the FDA's voluntary MAUDE (Manufacturer and User Facility Device Experience) database below.From FDA's description of MAUDE:MAUDE data represents reports of adverse events involving medical devices. The data consists of voluntary reports since June 1993, user facility reports since 1991, distributor reports since 1993, and manufacturer reports since August 1996. MAUDE may not include reports made according to exemptions, variances, or alternative reporting requirements granted under 21 CFR 803.19. The on-line search allows you to search CDRH database information on medical devices which may have malfunctioned or caused a death or serious injury. MAUDE is scheduled to be updated monthly and the search page reflects the date of the most recent up... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3761392 Fri, 16 Jul 2010 11:13:00 +0100 3761392 http://www.medworm.com/index.php?rid=3750145&cid=t_178190_118_f&fid=34702&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2Fmspblog%2F%7E3%2F_Qt9GR6_89I%2F After resigning her position, a female physician in North Carolina brought a claim of sexual harassment against her former employer, the physician-owner of a medical clinic.  Initially the court ruled against her claim, stating that it was “not uncommon in a medical setting to use off-color jokes to “ease the tension.” The 4th U.S. Circuit Court of Appeals reversed the lower court’s decision, refusing to accept the argument that because a medical setting deals with human anatomy on a regular basis, it is somehow “liberated from professional norms.” Read the case summary at Employment Law Matters - EEOC v. Fairbrook Medical Clinic, P.A., 4th Circ., No. 09-1610, June 18, 2010. (Source: MSSPNexus Blog) MSSPNexus Blog blogs http://www.medworm.com/rss/comments.php?id=3750145 Tue, 13 Jul 2010 12:09:56 +0100 3750145 http://www.medworm.com/index.php?rid=3611892&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F05%2Fdid-epic-ceo-judy-faulkner-of-epic.html At the HisTALK blog 5/31/10 update, a site with thousands of readers involved in all aspects of health IT, the following anonymous (at this point) report appeared:From Tabula Rosa: “Re: EMR usability. At one of the ONC Policy Committee meetings, [founder and CEO] Judy Faulkner of Epic supposedly declared that ‘usability would be part of certification over her dead body.’ I wonder if she has similar sentiments about making software accessible to people with disabilities?” Unverified. This inspired my new poll question – keep reading below. Epic Systems Corporation is one of the largest health IT vendors in the U.S.If this report is true, it would have very, very serious implications towards the healthcare IT industry's attitudes about the usability - and ultimately the safety - of... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3611892 Sun, 30 May 2010 12:10:00 +0100 3611892 http://www.medworm.com/index.php?rid=3585560&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F05%2F78-million-golden-parachute-for-not-for.html These sorts of hits just keep on coming.  This story comes from the Baltimore Sun. The Golden ParachuteFirst, let us just review the financial details,Former University of Maryland Medical System CEO Edmond F. Notebaert, who resigned two years ago during a tumultuous time that included infighting and a board shakeup, is again the subject of controversy over his $7.8 million pay package.The package included $2.4 million in severance, about $639,000 in salary for seven months, deferred bonuses and contributions to a retirement plan that instantly vested when he left. By the way, Mr Notebeart did not actually go into retirement after he received this largess,A spokeswoman for Temple University, where Notebaert now heads the health system, said he was not available for comment.The Justifi... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3585560 Thu, 20 May 2010 21:18:00 +0100 3585560 http://www.medworm.com/index.php?rid=3223216&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F01%2Fwhat-happens-when-well-manage-it-way-we.html Back in the early days of Health Care Renewal (2005, to be exact), we first wrote about some very strange actions by the management of Phoebe Putney Health System.  At first, we noted that the Phoebe Putney responded to a reporter's inquiry about lavish travel expenses pertaining to the system's Cayman Islands health insurance subsidiary by saying, "We own it. We'll manage it the way we damn well want."Then the story got far more convoluted.  In 2006, we wrote about the over the top response to anonymous faxes challenged hospital management's commitment to the institution's mission.  The system CEO compared the fax senders to "terrorists."  After the local district attorney handed over his investigative records to hospital system private in... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3223216 Fri, 29 Jan 2010 20:34:00 +0100 3223216 http://www.medworm.com/index.php?rid=3220489&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F01%2Fwhy-apple-ipad-will-not-revolutionize.html The announcement of the Apple iPad has been accompanied by the usual irrationally exuberant, buzzword-laden statements and bellicose grandiosity from the IT punditry about how it will "revolutionize" or "transform" medicine.However, this will not occur anytime soon, for in medicine, the device may help solve a portability and visibility problem (compared to PDA's), but it will not solve this problem: the mission hostile user experience.The solution to that problem will require significant human magic.-- SS (Source: Health Care Renewal) Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3220489 Fri, 29 Jan 2010 15:42:00 +0100 3220489 http://www.medworm.com/index.php?rid=3171854&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F01%2Funiversity-president-on-commission.html The Miami Herald reported on the latest thing in executive compensation for leaders of academia (and academic medicine):Florida State University's new president will have a larger salary than his predecessor, T.K. Wetherell, and stands to make even more in bonuses as a reward for big-time fundraising.FSU trustees chairman Jim Smith confirmed Monday that Eric Barron has signed a contract that includes a base salary of $395,000 a year in state and private dollars, plus the chance to earn annual bonuses of $100,000 for every $100 million in private donations raised. He'll also get free housing and a car, Smith said, as well as a retention bonus of $200,000 after a few years.Housing and car allowances have become standard fare for university president contracts, and in recent years Florida's u... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3171854 Thu, 14 Jan 2010 16:08:00 +0100 3171854 http://www.medworm.com/index.php?rid=3126570&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F12%2Fit-seems-common-wisdom-in-u.html It seems common wisdom in the U.S. that the "Europeans are way ahead of us" in computerized medicine.Perhaps the common wisdom is not so wise. This from Finland:HELSINGIN SANOMATINTERNATIONAL EDITION - HOMEClumsy computer systems consume doctors’ timeWhen Arto Virtanen, a doctor at a public health clinic, wants to access the information of a young patient, 12 windows of different sizes open up on different parts of his computer screen. Virtanen has to deal with each of them every time a patient visits him for routine postnatal care.“It used to be that a municipal doctor would see six or seven patients in an hour, when documentation was not at its present level”, Virtanen says. “Then there came more paperwork, and four patients were seen in an hour. Now if a doctor wants to read all... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3126570 Mon, 28 Dec 2009 19:45:00 +0100 3126570 http://www.medworm.com/index.php?rid=3066982&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F12%2Fcompensation-madness-insiders-hijacking.html As we learn more about the causes of the global financial melt-down, aka great recession, the lessons appear more applicable to health care.  My latest example comes from last week's Wall Street Journal.  There appeared an article by a Professor from the Faculty of Management of McGill University (Montreal, Canada) on executive compensation that has important lessons for health care (Mintzberg H. No more executive bonuses. Wall Street Journal, Nov 30, 2009.  Link here.)Prof Mintzberg's first major premise was that current executive compensation at major corporations resembles a rigged casino:Although these executives like to think of themselves as leaders, when it comes to their pay practices, many of them haven't been demonstrating leadership at all. Instead ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3066982 Mon, 07 Dec 2009 19:38:00 +0100 3066982 http://www.medworm.com/index.php?rid=3008043&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F11%2Fgenzymes-remarkable-businessstrategy.html In June, 2009, an article in the Boston Globe described how the Boston area based biotechnology company Genzyme sold some astonishlingly expensive drugs, usinga remarkable business strategy: In countries from Colombia to Taiwan to Libya, the Cambridge firm has compiled an extraordinary track record of searching out patients like Tania, providing desperately needed treatment, and then successfully pressing their governments, even poor ones, to pay full price for the most expensive drugs in the world.The article focused on how Genzyme marketed Cerezyme for Gaucher's disease.When Genzyme Corp. first introduced a bioengineered drug for Gaucher (pronounced GO-shay) disease in the 1990s, the very idea seemed almost absurd to most people in the pharmaceutical industry. It was expensive to manufac... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3008043 Wed, 18 Nov 2009 21:42:00 +0100 3008043 http://www.medworm.com/index.php?rid=2730067&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F08%2Fny-times-proclaims-anyone-can-run.html Last week, the NY Times published a somewhat breathless article on the wonderful opportunities available in health care management. Health care management seems to be the one area that is growing during the "great recession."Health care may be a costly drag on the economy, but it’s still a great place to find a job.Midcareer managers and other workers have been migrating to health care jobs for years, of course. Now, with the recession, the lure is even stronger. The article suggested managing health care organizations does not require knowing much about health care.'The demand for talented leaders in health care is only going to go up,' predicted Jane Groves, a senior vice president at Integrated Healthcare Strategies, an executive search and consulting firm in Kansas City, Mo. 'All tha... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2730067 Mon, 24 Aug 2009 19:41:00 +0100 2730067 http://www.medworm.com/index.php?rid=2709134&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F08%2Funiversity-leaders-goal-taking-new.html An article from the San Francisco Chronicle noted how the new Chancellor of the University of California - Davis (UC-Davis), Linda Katehi, is already contending with controversy. One brief section about her goals for the campus caught my eye. The article noted that Dr Katehi (who has a doctorate in engineering) holds 16 patents, then:Now Katehi wants to transfer that entrepreneurship to the campus she'll lead.'The campus is in a wonderful position to become a major force in improving and strengthening the economy of the state,' Katehi told The Chronicle, adding that she'll help UC Davis to become more aggressive in taking new biotechnology and agriculture products to market.So it would seem that Dr Katehi's goals are making UC-Davis more entrepreneurial, strengthening the California econom... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2709134 Mon, 17 Aug 2009 18:53:00 +0100 2709134 http://www.medworm.com/index.php?rid=2674256&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F08%2Fharvard-cut-money-for-primary-care-step.html This story, about cuts in the funding for Harvard Medical School's minimal program in primary care, has received little attention in the US. I was alerted to an article about it in the Harvard Crimson by a news article in the British Medical Journal that was picked up by Medscape.Here are the main points, from the Crimson article,Harvard Medical School has suspended funding for its Primary Care Division as part of a broader departmental restructuring effort, prompting students and faculty to circulate a petition calling on HMS Dean Jeffrey S. Flier to reaffirm the School's commitment to primary care education.According to Nancy J. Tarbell, dean for academic and clinical affairs at HMS, the School had provided roughly $200,000 in funding each year to the Division. She said that the Division... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2674256 Wed, 05 Aug 2009 15:27:00 +0100 2674256 http://www.medworm.com/index.php?rid=2570444&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F07%2Fblogger-that-dares-not-speak-his.html Dr Douglas Bremner is a Professor of Psychiatry and Radiology at Emory University, and Director of the University's Clinical Neuroscience Research Unit. He has also written a book critical of the pharmaceutical industry (Before You Take That Pill), and writes a blog (also called Before You Take That Pill) that is also skeptical about certain aspects of current psychiatric dogma. Inside Higher Education reported that Emory University can apparently no longer bear to have its name mentioned in Dr Bremner's blog:Emory University has been accused repeatedly over the last year of looking the other way while one of its prominent physicians built extremely close ties to the pharmaceutical industry and -- critics charge -- failed to adequately report those ties as required by university and federa... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2570444 Fri, 03 Jul 2009 19:26:00 +0100 2570444 http://www.medworm.com/index.php?rid=2441694&cid=t_178190_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F05%2F25%2Fmemorial-day-2009%2F This Memorial Day in the U.S. — like every Memorial Day — we commemorate and remember those who’ve given their lives for our freedoms and our nation. “Given their lives” is really not accurate, though, as Andy Rooney noted — these soldiers died, plain and simple. They died so that in the future, our country might be safer or democracy might be nurtured in an otherwise hostile environment. They died so that great evils could be done away with in WWII (and WWI). They died so that politicians could wage endless, unwinnable wars for political ideals (Vietnam, Korea, and now Iraq). They died, quite simply, so that we could enjoy the freedoms we so often take for granted in our country. I hope, like most people, that in the future war become less of an option ... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2441694 Mon, 25 May 2009 10:08:36 +0100 2441694 http://www.medworm.com/index.php?rid=2389729&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F05%2Fehrs-and-scarcity-of-public-reviews-of.html I recently downloaded the public beta (incomplete trial version) of Apple's new web browser Safari 4.I like its user experience and features, presenting a main page "posterboard" of most visited or user-selected sites, a searchable, flip-panel history of visited pages (using the Macintosh OS X Spotlight and Cover Flow paradigms), top located tabs, and other useful features. (Note: I use both Macs and PC's, and hold no financial stakes in Apple whatsoever.)What struck me was the vociferous online discussions and debates about every facet of the new browser version, down to the level of minutiae. The following review particularly struck me for its level of detail - Observations, Complaints, Quibbles, and Suggestions Regarding the Safari 4 Public Beta Released One Week Ago, Roughly in Order o... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2389729 Tue, 05 May 2009 18:09:00 +0100 2389729 http://www.medworm.com/index.php?rid=2389730&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F05%2Fbio-tech-u.html The San Francisco Chronicle just reported that a new Chancellor has been nominated for the University of California - San Francisco (UCSF). UCSF is functionally a health sciences university, and its Chancellor functions as its president. The UCSF medical school is generally considered one of the elite US academic medical institutions.Genentech executive Susan Desmond-Hellmann has been nominated to be the next chancellor of UCSF, making her the first woman or biotech leader ever asked to run the research campus and hospital system that is San Francisco's second-largest employer.Desmond-Hellmann has served most recently as president of drug development at Genentech, the South San Francisco biotech firm that was recently acquired by Swiss drugmaker Roche. She was trained as a physician, did h... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2389730 Mon, 04 May 2009 18:14:00 +0100 2389730 http://www.medworm.com/index.php?rid=2256084&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F03%2Fcolor-of-money-what-sort-of-school.html A letter to the NY Times by Dr Daniel Becker in response to the recent controversy at Harvard Medical School over financial relationships among industry and faculty (see our post here) brought up an interesting point:I take issue with the implicit assumption that faculty members who accept drug money are driven exclusively by greed; this issue is much more complicated than it may seem at first.Harvard Medical School’s 'drug money' problem relates, in part, to a little-known fact: Harvard rarely pays the salaries of its medical faculty directly. Despite substantial revenue from tuition, most faculty members teach medical students on a volunteer basis.Similarly, the salaries of research faculty are not paid by Harvard, but rather by grants from the National Institutes of Health, private fo... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2256084 Mon, 09 Mar 2009 20:52:00 +0100 2256084 http://www.medworm.com/index.php?rid=2240800&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F03%2Fit-vulnerabilities-highlighted-by.html Bill Gates's company, Microsoft, touts the User Experience as the Sine Qua Non of computing. Billions of dollars have been spent tweaking every little nuance of Windows, with version 7.0 soon to appear. Apple has done likewise with Mac OS X. (The various X-windows managers for Linux, less so). I respect these efforts and use both mainstream OS's in my daily work.In HIT, however, the "user experience" as I outlined in my eight part series starting here is deemed an issue to solve once the sale is made and physicians are scrambling to avoid harming or killing patients. After all, the HIT industry is unregulated, shielded from liability based on the "learned intermediary" doctrine (a.k.a., clinicians are the bank and insurance company for IT vendors, in that they are the creative implementors... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2240800 Wed, 04 Mar 2009 13:28:00 +0100 2240800 http://www.medworm.com/index.php?rid=2232505&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F03%2Fit-vulnerabilities-highlighted-by.html Bill Gates's company, Microsoft, touts the User Experience as the Sine Qua Non of computing. Billions of dollars have been spent tweaking every little nuance of Windows, with version 7.0 soon to appear. Apple has done likewise with Mac OS X. (The various X-windows managers for Linux, less so). I respect these efforts and use both mainstream OS's in my daily work.In HIT, however, the "user experience" as I outlined in my 8-part series starting here is deemed an issue to solve once the sale is made and physicians are scrambling to avoid harming or killing patients. After all, the HIT industry is unregulated, shielded from liability based on the "learned intermediary" doctrine (a.k.a., clinicians are the bank and insurance company for IT vendors, in that they are the creative implementors of ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2232505 Wed, 04 Mar 2009 13:28:00 +0100 2232505 http://www.medworm.com/index.php?rid=2232507&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F03%2Fmalpractices-of-multitudes-mission.html More on the origin of this post's title, penned in 1836, below.(Note: Part 1 is here, part 2 is here, part 3 is here, part 4 is here, part 5 is here, part 6 is here, and part 7 is here.)This post is part 8, and the finale, of a series on the stunningly poor human engineering of production healthcare IT from major vendors, in use today at major medical centers. These devices provide a decidedly mission hostile user experience, yet with an almost religious fervor are being touted as cybernetic miracles to cure healthcare's ills.My college is a member of the iSchool consortium, consisting of schools of information science and technology (notably, not "information technology and science").The iSchools are interested in the relationship between information, people and technology. This is charac... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2232507 Tue, 03 Mar 2009 22:55:00 +0100 2232507 http://www.medworm.com/index.php?rid=2227150&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F03%2Fwere-only-in-it-for-money.html We have previously discussed how academic medical leadership seems to care more about how much money their faculty bring in than their clinical, teaching or research performance. Why academic medicine came to put money ahead of mission has never been clear. However, a little bit of insight has been (probably inadvertently) provided by an announcement of a new university president.After the early resignation of President Trani, under fire for his coziness with tobacco money (see post here and links backwards), Virginia Commonwealth University (VCU) just announced its new President, Michael Rao. The official announcement of his appointment included:The VCU Board approved Rao’s salary of $488,500, $176,113 of which is paid by state funds and $312,387 from VCU Health System and private funds... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2227150 Sun, 01 Mar 2009 20:02:00 +0100 2227150 http://www.medworm.com/index.php?rid=2227151&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F03%2Feconomists-advice-on-healthcare.html In a Feb. 28, 2009 New York Times article entitled "How to Make Electronic Medical Records a Reality", we get advice from the same profession in part responsible for the worst economic downturn since 1982 and perhaps 1929:... It is scarcely surprising, then, that only about 17 percent of the nation’s physicians are using computerized patient records [to various extents, 13% of that 17% only having basic functionality - ed.], according to a government-sponsored survey published last year in The New England Journal of Medicine."This is really not a technology problem,” observed Erik Brynjolfsson (bio), an economist at the Sloan School of Management at the Massachusetts Institute of Technology. “It’s a matter of incentives and market failure.”No, Prof. Brynjolffson, it is a matter o... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2227151 Sun, 01 Mar 2009 17:12:00 +0100 2227151 http://www.medworm.com/index.php?rid=2227152&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F02%2Fit-makes-healthcare-easier-is-this.html This post is part 6 of a series on the stunningly poor human engineering of production healthcare IT from major vendors, in use today at major medical centers. These devices provide a decidedly mission hostile user experience, yet with an almost religious fervor are being touted as cybernetic miracles to cure healthcare's ills.(Part 1 is here, part 2 is here, part 3 is here, part 4 is here, part 5 is here, and part 7 is here.)During the Sunday morning talk show "Roundtable" this morning, I saw an IBM ad touting the fact that they'd surpassed the petaflop mark (built computers that can perform one thousand trillion floating point calculations per second).They touted how such computers will enable weather prediction, medical advances, solutions to social problems, and other cybernetic miracl... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2227152 Sun, 01 Mar 2009 01:42:00 +0100 2227152 http://www.medworm.com/index.php?rid=2182482&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F02%2Fphysicians-unexpected-un-helplessness.html At "Physicians' Expected Helplessness" I wrote that:I am going to coin a new term to describe what I have observed as a corollary to physicians' learned helplessness: "Physicians' Expected Helplessness."I observed that "Physician's learned helplessness", an adverse effect of dysfunctional medical training and culture described here, had perhaps led to societal expectations of physicians being weak in defense of their profession and its patient-protective values, and "having a target pasted to their backs."In a case of human bites dog - or perhaps, more to the point, doctors bite dogs - a physician revolt has led to the ouster of unpopular and apparently ineffectual executives including the CEO, COO and Chief of HR at a large healthcare system based in Nashville.Two more executives leave Sa... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2182482 Fri, 13 Feb 2009 01:16:00 +0100 2182482 http://www.medworm.com/index.php?rid=2160333&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F02%2Faetna-settles.html As reported by the Hartford Courant:Aetna will reimburse more than $5.1 million on 73,000 health claims for college students it underpaid between 1998 and April 1, 2008, under a nationwide agreement announced Monday by New York Attorney General Andrew M. Cuomo.The claims involved out-of-network care in which Aetna Student Health — formerly called Chickering Student Health — paid physicians what it considered reasonable and customary. Doctors whose charges were higher could bill students for the balance.Aetna will reimburse students if they paid such a balance. If a student wasn't balance-billed, Aetna will reimburse the doctor. The company says its under-payments averaged $25 each nationwide.The inadequate claim payments stem from outdated information that Aetna and other insurers used... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2160333 Wed, 04 Feb 2009 22:07:00 +0100 2160333 http://www.medworm.com/index.php?rid=2141324&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F01%2Fat-one-academic-medical-center.html A post on the Health Care Blog opened a window into the thinking of top leaders of health care organizations. The post was written by Gary S Kaplan MD, the CEO of Virginia Mason Medical Center, a well reputed US academic medical center. It seemed generally well-intentioned, and was focused on the creation of an organization of US health care CEOs "dedicated to transforming health care and creating a more sustainable health system."But my interest today is not this organization or its future plans.Dr Kaplan's post included,We, unfortunately, in the current payment system, reduce our profitability by doing the right thing. Despite my very supportive board of directors, they will not allow me to lead our organization into bankruptcy by doing the right thing. We need to change our payment syst... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2141324 Wed, 28 Jan 2009 07:54:00 +0100 2141324 http://www.medworm.com/index.php?rid=2094793&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F01%2Fcalling-dr-moe-dr-larry-dr-curley-fda.html At "Is Medtronic CEO Abrogating Responsibility Of His Company To Determine Device Safety?" I wrote that the CEO of this medical device company seemed to be punting the responsibility of assuring the safety and efficacy of his products to the FDA.Others have taken a similar stance, such as in the case of musician Diana Levine, who lost an arm after an improper IV administration of a drug ("The Court Confronts a Grievous Injury", New York Times, Nov. 7, 2008).Now, nine scientists at the Food and Drug Administration have written a letter to President-elect Barack Obama and his transition team, alleging gross mismanagement at the agency that has "placed the American public at risk."FDA scientists allege mismanagement at agencyJan. 9, 2009From Louise SchiavoneCNNWASHINGTON (CNN) -- Nine scienti... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2094793 Sun, 11 Jan 2009 01:16:00 +0100 2094793 http://www.medworm.com/index.php?rid=2060906&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F12%2Fsuing-poor-patients-in-maryland.html The Baltimore Sun published a series of articles reporting how some Maryland hospitals have been zealous in their pursuit of money from poor patients, in spite of a state program that is supposed to make sure hospitals are fairly reimbursed for the care of the poor. The series opened with this case:Willie Mae White began worrying how she'd pay the $36,224 bill from Johns Hopkins Bayview Medical Center a few weeks after having emergency brain surgery. She lived off Social Security and food stamps after decades working as a housekeeper. So she was thrilled when Bayview informed her in writing that her bill would be forgiven, at least in part. The hospital had little to lose, since it can recover its costs of free and unpaid care under a unique state program. Instead, the hospital sued her 15... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2060906 Tue, 23 Dec 2008 20:14:00 +0100 2060906 http://www.medworm.com/index.php?rid=1968748&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F11%2Fsilverglate-on-how-corporate-academic.html This article suggests several important points.First, there is a growing realization that academia's mission is being increasingly subverted as the leadership of academic organizations, including, in particular, academic medicine, increasingly resembles corporate leadership. (We, of course, have repeatedly discussed the prominent movement in health policy in the 1980s that advocated breaking the "medical guild" while handing power over health care to bureaucrats and managers.)Second, there is a growing realization that academic leaders who ape their corporate peers have a penchant for propaganda promoting their interests, and for suppressing discussion of their faults. Clearly these are causes of the anechoic effect. Never mind that controlling speech and communication in this manner is an... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1968748 Tue, 18 Nov 2008 22:22:00 +0100 1968748 http://www.medworm.com/index.php?rid=1883291&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F10%2Fascension-healths-descent-away-from-its.html This week, the Wall Street Journal continued its series on US not-for-profit hospitals and health systems with a story about how Ascension Health is abandoning inner-city Detroit for the more affluent suburbs,Ascension Health, the country's largest nonprofit hospital system, says its mission is to serve all, 'with special attention to those who are poor and vulnerable.' But in this city, where one in four people don't have health insurance, it's become harder for the poor and vulnerable to find Ascension.Last year, Ascension's local subsidiary closed Riverview Hospital, the third hospital it has shut down in Detroit in the past 10 years and the only hospital that remained on the city's blighted east side. Meanwhile, 30 miles away, in a suburb of multimillion-dollar homes, Ascension is open... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1883291 Thu, 16 Oct 2008 13:35:00 +0100 1883291 http://www.medworm.com/index.php?rid=1806222&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F09%2Fstaten-island-university-hospital.html From the New York Times comes the latest installment of the sorry story of Staten Island (NY) University Hospital:Staten Island University Hospital has agreed to return $88.9 million that prosecutors say it fraudulently obtained from government health insurance programs, one of the largest settlements of such a claim ever paid by a single hospital.The settlement, which prosecutors announced Monday, represents the third time in a decade that the hospital, which is the borough’s largest, has paid millions of dollars to resolve civil charges that it knowingly overbilled the government for treatment costs. Prosecutors had accused the hospital of conducting a collection of schemes from 1994 to 2005 that spanned many aspects of its operations, including substance abuse detoxification, inpatien... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1806222 Thu, 18 Sep 2008 19:13:00 +0100 1806222 http://www.medworm.com/index.php?rid=1775525&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F09%2Fim-not-hospital-guy-anymore.html Some of the issues most important to us at Health Care Renewal are how bad leadership and governance of health care organizations threaten physicians' core values, and thus help fuel our continuous health care crisis of rising costs, decreasing access, stagnant quality, and demoralized health care professionals. These issues are not often discussed in the "main stream medical media," but have been creeping in more often lately.An important cri de coeur just appeared in the Cleveland Clinic Journal of Medicine, by Thomas F Lansdale III MD [Lansdale TF. A medical center is not a hospital. Cleveland Clinic J Med 2008; 75: 618-619. Link here.] Dr Lansdale dealt mainly with poor leadership of teaching hospitals that threatened the core clinical and academic mission. The leadership was poor in t... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1775525 Mon, 08 Sep 2008 20:39:00 +0100 1775525 http://www.medworm.com/index.php?rid=1739036&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F08%2Fmerger-mania-redux-case-of-carilion.html The Wall Street Journal published an article on how one not-for-profit hospital system came to dominate its market, and the effects of that domination on local health care.How the System Became DominantThe WSJ article documented how a hospital merger created a vertically-integrated health care system. Note that in the old days of "merger mania," there was a lot of buzz in the health care research and policy circles about how creating such integrated systems to benefit quality and access, and lower costs. This rationale appears below.In 1989, the U.S. Department of Justice tried but failed to prevent a merger between nonprofit Carilion Health System and this former railroad town's other hospital. The merger, it warned in an unsuccessful antitrust lawsuit, would create a monopoly over medica... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1739036 Thu, 28 Aug 2008 16:30:00 +0100 1739036 http://www.medworm.com/index.php?rid=1726323&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F08%2Fmerger-mania-redux-combination-would.html The Philadelphia Inquirer published a story about what seems to drive merger mania in health care. In Pennsylvania, the two largest health insurance companies in the state, both not-for-profit, Highmark and Independence Blue Cross, have been pushing to mergeHighmark Inc. and Independence Blue Cross would pay their top executives as much as $4.2 million more if they were allowed to merge.Kenneth Melani, the chief executive of Highmark, who is expected to have the same job at the combined companies, would get a 31 percent raise, to $3.9 million from $2.97 million, including incentives, according to documents filed with the Pennsylvania Insurance Department.Independence Blue Cross' CEO, Joseph Frick, who is slated for the role of chief operating office after the merger, would earn $2.94 milli... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1726323 Fri, 22 Aug 2008 18:32:00 +0100 1726323 http://www.medworm.com/index.php?rid=1645890&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F07%2Ffines-re-statements-and-more-fines-just.html Several related stories about commercial managed care organizations/ health insurers surfaced recently.First, as reported by Lisa Girion in the Los Angeles Times,Anthem Blue Cross and Blue Shield -- two of the state's biggest health plans -- agreed Thursday to pay a total of $13 million in fines and to offer new health coverage to more than 2,200 Californians the companies dropped after they became ill.Neither company admitted to any wrongdoing in agreeing to pay the stiffest penalties yet in efforts by state authorities to curb what they view as an abusive practice of investigating and canceling policies after policyholders run up big medical bills.Blue Cross, a unit of Indianapolis-based WellPoint Inc., will pay a $10-million fine to the state Department of Managed Health Care, and it wi... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1645890 Tue, 22 Jul 2008 21:22:00 +0100 1645890 http://www.medworm.com/index.php?rid=1615945&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F07%2Fcommercial-fund-raises-may-keep-more.html An article in the Los Angeles Times analyzed how much money a variety of charities, including some well-known health related charities, spend on commercial fund raising. In summary,A Times investigation found hundreds of other examples of charities that pocketed just a sliver of what commercial fundraisers collected in their names. Some didn't get a dime or even lost money.According to a comprehensive review of state records filed over a decade, the problem of paltry returns extends well beyond what has been reported in recent years among benevolent societies for police, firefighters and veterans. It affects charities large and small, well-known and obscure. It spans a range of causes, including child and animal welfare, health research and opposition to drunk driving.In more than 5,800 ca... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1615945 Fri, 11 Jul 2008 18:51:00 +0100 1615945 http://www.medworm.com/index.php?rid=1605870&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F07%2Fwellpoint-settles-but-has-it-become-too.html We just posted about the latest travails of the UnitedHealth Group, a for-profit managed care organization founded by one of the early advocates of managed care as the cure for health care problems. Lately, the company has been better known for the lavish compensation it gave its former CEO.Another large, for-profit managed care organization/ health insurer has also lately been in the news, and not in favorable terms. We have previously discussed how Wellpoint Inc and/or its subsidiaries:misplaced a computer disc containing confidential information on 75,000 policy-holders (see post here) settled a RICO (racketeer influenced corrupt organization) law-suit in California over its alleged systematic attempts to withhold payments from physicians (see post here) was fined for cancelling individ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1605870 Thu, 10 Jul 2008 19:47:00 +0100 1605870 http://www.medworm.com/index.php?rid=1596343&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F07%2Funitedhealth-settles.html We had posted often (see these posts here, here, and here from 2006 with links backward) about the hugely lavish compensation afforded to the Dr William McGuire, former CEO of UnitedHealth Group, one of the largest US insurers/ managed care organizations, and how this remuneration stood in stark contrast to the (older version of the) stated mission of UnitedHealth Group:UnitedHealth Group is a diversified health and well-being company dedicated to making the health care system work better. The company directs its resources into designing products, providing services and applying technologies that:- Improve access to health and well-being services;- Simplify the health care experience;- Promote quality; and,- Make health care more affordable.Most recently, controversy has swirled over the t... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1596343 Tue, 08 Jul 2008 21:37:00 +0100 1596343 http://www.medworm.com/index.php?rid=1531156&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F06%2Foutsourced-to-death.html A while back, we posted frequently about the sudden toxicity of what used to be an apparently well understood drug. A summary of the story to date is below (in smaller type.):- We have posted several times, recently here and here, about the tragic case of suddenly allergenic heparin. Although heparin, an intravenous biologic anti-coagulant, has been in use for over 70 years, serious allergic reactions to it had heretofore been rare. Starting late last year, hundreds of such reactions, and now 21 deaths were reported in the US after intravenous heparin infusions.All the heparin related to these events in the US was made by Baxter International.- We then learned that although the heparin carried the Baxter label, it was not really made by Baxter. The company had outsourced production of the ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1531156 Thu, 19 Jun 2008 20:12:00 +0100 1531156 http://www.medworm.com/index.php?rid=1526072&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F06%2Foppressive-management-at-utmb.html The Houston Chronicle reported about troubles at the University of Texas Medical Branch (UTMB) School of Nursing:Discontent among nursing school faculty at the University of Texas Medical Branch at Galveston runs so deep that it hinders the ability to train nurses, a statewide faculty association says.Experienced faculty members are seeking new jobs because of an oppressive administration that has jettisoned the traditional academic system ensuring academic freedom, according to interviews with faculty members. The administration, they say, has embraced a corporate model emphasizing income and loyalty.The oppressive management style is fostering discontent not only in the nursing school, but throughout the university, including its medical programs, [Texas Faculty Association representativ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1526072 Wed, 18 Jun 2008 18:02:00 +0100 1526072 http://www.medworm.com/index.php?rid=1516457&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F06%2Fmotley-crew-formerly-known-as-leaders.html There has been an interesting confluence of news stories lately that dealt directly or indirectly with the leadership of the US largest for-profit health insurance/ managed care corporation, the UnitedHealth Group (UHG).UHG has not always been known for being particularly patient-, employer-, or physician-friendly. For example, as reported by the Hartford Courant, "UnitedHealth Group Inc., the largest U.S. health insurer, will refund $50 million to small businesses that New York state officials said were overcharged in 2006."We have previously discussed how UHG promised its investors it would continue to raise premiums, even if that priced increasing numbers of people out of its policies (see post here); allegations that the UHG acquisition of Pacificare in California lead to a "meltdown" ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1516457 Fri, 13 Jun 2008 17:02:00 +0100 1516457 http://www.medworm.com/index.php?rid=1499880&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F06%2Fworst-example-of-anechoic-effect-erase.html We posted earlier this week about how the US Federal Bureau of Investigation (FBI) let four alleged members of the Yakuza, that is, Japanese organized criminal gangs, into the US in the hope that they would talk about their gangs' activities in this country. One attractive aspect of visiting the US for the four was apparently the opportunity to get liver transplants at UCLA Medical Center. That hospital provided the transplants with with some alacrity, for which the four apparently paid full list prices. Later, two of the four also gave UCLA Medical Center substantial contributions. But none of them gave the FBI much useful information.In the post, I briefly mentioned that a reporter who was on the trail of this story in Japan was warned off by a threatening message from some shadowy stran... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1499880 Fri, 06 Jun 2008 21:18:00 +0100 1499880 http://www.medworm.com/index.php?rid=1492012&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F06%2Flinking-anechoic-effect-and-suppression.html We recently discussed ties between Virginia Commonwealth University (VCU) and the tobacco industry. Here we discussed how the university got a grant which gave proprietary control of any research results to the sponsor, Philip Morris, a tobacco company, not the academic researcher, and required the grant itself to be secret. Here we discussed issues raised by the university president's position on the board of directors of another tobacco company, Universal Corporation.A recent article in (Richmond, VA) Style Weekly alleged that VCU faculty fear publicly criticizing the university's relationships with tobacco companies:Virginia Commonwealth University researchers and faculty who fear reprisal for speaking out against a secret smoke-filled-room research agreement between the school and Phil... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1492012 Wed, 04 Jun 2008 09:53:00 +0100 1492012 http://www.medworm.com/index.php?rid=1492013&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F06%2Ffor-few-yen-more-ucla-liver-transplants.html Sometimes, you just can't make this stuff up.... As reported last week in the Los Angeles Times, UCLA [University of California - Los Angeles] Medical Center performed liver transplants on four people with apparent ties to Japanese organized crime.UCLA Medical Center and its most accomplished liver surgeon provided a life-saving transplant to one of Japan's most powerful gang bosses, law enforcement sources told The Times.In addition, the surgeon performed liver transplants at UCLA on three other men who are now barred from entering the United States because of their criminal records or suspected affiliation with Japanese organized crime groups, said a knowledgeable law enforcement official who spoke on condition of anonymity.The most prominent transplant recipient, Tadamasa Goto, had been... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1492013 Wed, 04 Jun 2008 07:32:00 +0100 1492013 http://www.medworm.com/index.php?rid=1475124&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F05%2Fhospitals-use-patients-personal.html The San Francisco Chronicle reported about how not-for-profit hospitals use information about individual patients for fund-raising:When patients check into hospitals or doctor offices, they presume their information will be kept in strictest confidence, but often, amid the pile of papers, they overlook fine print describing how their personal information can be farmed out for fundraising.Hospitals and other health care organizations widely use patient information, without patients' explicit permission, to raise funds. To the dismay of privacy-rights advocates and some in the medical field, fundraising to benefit medical institutions is allowed under federal law.Patients can opt out - after the fact.Typically in medical settings, patients are handed booklets called 'notice of privacy practi... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1475124 Wed, 28 May 2008 20:52:00 +0100 1475124 http://www.medworm.com/index.php?rid=1466013&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F05%2Ffor-few-dollars-more-academic-ideals-go.html Writing in the New York Times, Stephanie Saul reported on an unusual research program at Virginia Commonwealth University:a contract with extremely restrictive terms that the university signed in 2006 to do research for Philip Morris USA, the nation’s largest tobacco company and a unit of Altria Group.The contract bars professors from publishing the results of their studies, or even talking about them, without Philip Morris’s permission. If 'a third party,' including news organizations, asks about the agreement, university officials have to decline to comment and tell the company. Nearly all patent and other intellectual property rights go to the company, not the university or its professors.The contract appeared to contradict the university's research policies:Virginia Commonwealth’... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1466013 Fri, 23 May 2008 19:49:00 +0100 1466013 http://www.medworm.com/index.php?rid=1436813&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F05%2Fhospital-ceo-censors-internet-only-to.html The Fort Worth (Texas) Star-Telegram just ran a six-part series about the misfortunes of the JPS Health Network, a large county hospital network and health care system. The story had several twists. (See this page for links to the latter part of the series and related articles. The first three parts are here, here and here. )The series emphasized the overcrowding and long waits, problems with equipment and the physical plant, and jaded, demoralized staff that unfortunately fit stereotypes of underfunded public hospitals. Here are some quotes from the introduction to the first part of the series:The waiting room reeked. Along a crowded hallway, patients lay in beds, with only a thin curtain for privacy. Nurses readying for a new case in surgery noticed blood, bone and globules of fat on the... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1436813 Mon, 12 May 2008 21:32:00 +0100 1436813 http://www.medworm.com/index.php?rid=1373424&cid=t_178190_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2008%2F04%2F15%2F6-difficult-types-of-people-and-how-to-deal-with-them%2F Pages: 1 2 Next »     Single Page We all have difficult people we need to deal with in our lives on a daily basis. While such characteristics may be exaggerations, you may find traits of them in a few of the people in your workplace, amongst your friends, or even a loved one. Psychological research has suggested several ways of coping with difficult people in your life, e.g. hostile co-workers or bosses, complainers, super-agreeables, know-it-all experts, pessimists, and stallers. 1. The Hostile Co-worker or Boss Dealing with hostile people requires both tact and strength. Since persons who feel they have been wronged are more likely to be belligerent and violent, you should first try to be sure they have been dealt with fairly. In addition, it would be wise to hel... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=1373424 Tue, 15 Apr 2008 16:29:41 +0100 1373424 http://www.medworm.com/index.php?rid=1369662&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F04%2Fdid-politics-trump-mcat-in-admissions.html Several stories in the Gainesville (Florida) Sun and the Florida Alligator suggest issues with the leadership of the University of Florida College of Medicine. As first reported in the Sun,In a move that breaks with the norms established by medical school accreditors, the dean of the University of Florida's College of Medicine has opted to admit a student from a politically connected family, even though the student didn't have the backing of the Medical Selection Committee.Kone wouldn't name the student, but sources close to the situation identified him as Benjamin Mendelsohn, the son of Dr. Alan Mendelsohn, a Hollywood ophthalmologist and a Republican fundraiser who was a grassroots organizer for Gov. Charlie Crist during his 2006 campaign.Before Kone took over as dean in May 2007, Gov. C... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1369662 Sun, 13 Apr 2008 23:46:00 +0100 1369662 http://www.medworm.com/index.php?rid=1362388&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F04%2Funiversity-of-arizona-medical-college.html We have posted before (here and here) about how medical schools, despite their name, often fail to pay or otherwise reward faculty to actually teach.We also noted that one US medical school dean was frank enough to admit that his institution most values faculty members who are "taxpayers," i.e., those who bring in large amounts of what is euphemistically called "external support." On the other hand, faculty who are "welfare recipients," that is, those whose work fails to bring in such support, have at best a "tenuous" position. Since teaching in medical schools almost never brings in substantial "external support," faculty who spend most of their time teaching may be in a "tenuous" position. Similarly, faculty who do research that may not be popular with current research sponsors (now main... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1362388 Wed, 09 Apr 2008 20:50:00 +0100 1362388 http://www.medworm.com/index.php?rid=1314071&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F03%2Ffake-heparin-then-sick-and-dead.html We have posted several times, most recently here, about the tragic case of suddenly allergenic heparin. Although heparin, an intravenous biologic anti-coagulant, has been in use for over 70 years, serious allergic reactions to it had heretofore been rare. Starting late last year, hundreds of such reactions, and now 21 deaths were reported in the US after intravenous heparin infusions. All the heparin related to these events was made by Baxter International.We then learned that although the heparin carried the Baxter label, it was not really made by Baxter. In fact, the company had outsourced production of the active ingredient to a long, and ultimately mysterious supply chain. Baxter got the active ingredient from a US company, Scientific Protein Laboratories LLC, which in turn obtained it... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1314071 Wed, 19 Mar 2008 19:18:00 +0100 1314071 http://www.medworm.com/index.php?rid=1271273&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F03%2Fheparin-in-era-of-hogwash.html Two weeks ago we first posted about an emerging scandal about the production of the drug heparin, a biologic that has been in use for over 70 years. First, we posted about the sudden increase in the frequency and severity of adverse effects due to heparin that carried the Baxter International label. However, its "active ingredient," that is, the heparin itself, was purchased from Scientific Protein Laboratories LLC, which in turn obtained it from a factory in China operated by Changzhou SPL, which in turn was owned by Scientific Protein Laboratories and by Changzhou Techpool Pharmaceutical Co. Furthermore, it turns out that the factory was never inspected by either the US Food and Drug Administration (FDA) or its Chinese counterpart.Last week, we posted about how the CEOs of Baxter Interna... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1271273 Sat, 01 Mar 2008 22:21:00 +0100 1271273 http://www.medworm.com/index.php?rid=1253211&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F02%2Fjudge-cites-health-nets-egregious-and.html More than two years ago, we noted that Health Net Inc,, the large US health insurer/ for-profit managed care organization, had settled a class-action lawsuit brought by California physicians under the RICO (Racketeer Influenced and Corrupt Organizations) standard. Late last year, we noted that HealthNet was fined by the state of California for offering bonuses to employees who retroactively cancelled the most individual health policies after their holders got sick and filed claims, and that the company was under investigation in Connecticut for allegedly sending deceptive messages to pharmacists that denied payment for some low-income childrens' medication.Last week, Florida Health News reported,Medicare officials have ordered Health Net, Inc., one of the largest publicly traded health ins... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1253211 Mon, 25 Feb 2008 05:18:00 +0100 1253211 http://www.medworm.com/index.php?rid=1248885&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F02%2Fheparin-made-out-of-pigs-from-elsewhere.html Last week, we discussed what was known about the sudden increase in the frequency and severity of adverse effects due to heparin, an anti-clotting drug that has been in use for more than 7o years. The heparin all carried the Baxter International label, but its "active ingredient," that is, the heparin itself, was purchased from Scientific Protein Laboratories LLC, which in turn obtained it from a factory in China operated by Changzhou SPL, which in turn was owned by Scientific Protein Laboratories and by Changzhou Techpool Pharmaceutical Co. Furthermore, it turns out that the factory was never inspected by either the US Food and Drug Administration (FDA) or its Chinese counterpart.First, the Wall Street Journal reported how heparin is made in China.In a small, damp factory here [in Yuanlou... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1248885 Fri, 22 Feb 2008 04:45:00 +0100 1248885 http://www.medworm.com/index.php?rid=1236930&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F02%2Fin-middle-of-all-those-pigs-in-china.html The case of the allergenic heparin seems to be opening up a new window on how US pharmaceutical industry is managed, or mismanaged. The story started with reports of unusual numbers of allergic reaction, many serious, to parenteral heparin, a drug in use for over 70 years to reduce blood clotting. Most of the afflicted patients were dialysis patients who get large doses (boluses) of heparin to prevent blood clots during dialysis. The reactions included "nausea, difficulty breathing and rapidly falling blood pressure that can lead to death." The reactions affected patients receiving heparin from multi-use vials made by Baxter International. "About 350 events linked to Baxter's heparin have been reported since the end of last year compared with less than 100 reports in 2007." Baxter recalled... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1236930 Sat, 16 Feb 2008 18:38:00 +0100 1236930 http://www.medworm.com/index.php?rid=1230297&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F02%2Fwellpoint-halts-attempts-to-have.html We just discussed the sorry state of Merck Inc, whose founder once said, "Medicine is for people, not for profits," but now seems to be run by people who think otherwise, to the detriment not only of patients, but of the company and most of its employees.Here is another example of a company that seems to put short-term financial gain ahead of its stated commitment to "improving ... lives."Lisa Girion, writing in the Los Angeles Times, reported yesterday that Blue Cross of California, a subsidiary of for-profit Wellpoint Inc, has been "asking California physicians to look for conditions it can use to cancel their new patients' medical coverage." In particular,Blue Cross of California is sending physicians copies of health insurance applications filled out by new patients, along with a lette... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1230297 Wed, 13 Feb 2008 19:59:00 +0100 1230297 http://www.medworm.com/index.php?rid=1229205&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F02%2Fp-is-for-poor-management.html An editorial entitled 'P' is for Profit appeared yesterday about the latest Merck scandal that was mentioned in posts "What Are Those Consulting Fees and Speakers' Honoraria Really For?" and "Healthcare scandal-of-the-week: Merck settles Medicaid lawsuits." This company has a large presence in the Philadelphia region, and the editorial contains an important message:Philadelphia Inquirer - editorials'P' is for profit Tue., Feb. 12, 2008In 1952, Time magazine put Merck & Co. Inc. president George W. Merck on its cover, along with his quote: "Medicine is for people, not for profits." That admonition supposedly has guided Merck ever since. But the drug maker has run into a string of legal troubles that raise questions about the application of Mr. Merck's mantra.... just last week, Merck ag... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1229205 Wed, 13 Feb 2008 14:10:00 +0100 1229205 http://www.medworm.com/index.php?rid=1188558&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F01%2Fbungled-not-brilliant-results-of.html We had posted often (see these posts here, here, and here from 2006 with links backward) about the hugely lavish compensation afforded to the Dr William McGuire, former CEO of UnitedHealth Group, one of the largest US insurers/ managed care organizations, and how this remuneration stood in stark contrast to the stated mission of UnitedHealth Group:UnitedHealth Group is a diversified health and well-being company dedicated to making the health care system work better. The company directs its resources into designing products, providing services and applying technologies that:- Improve access to health and well-being services;- Simplify the health care experience;- Promote quality; and,- Make health care more affordable.Most recently, controversy has swirled over the timing of huge stock opt... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1188558 Wed, 30 Jan 2008 16:04:00 +0100 1188558 http://www.medworm.com/index.php?rid=1130959&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F01%2Fformer-leader-of-now-bankrupt-institute.html A brief AP story published in Newsday alerted me to a significant story of malfeasance that destroyed a once prestigious medical research institution, but till now has remained surprisingly anechoic. Let me piece it together chronologically.The Institute for Cancer Prevention (IFCP), formerly the American Health Foundation, was hailed (in a press release by New York Senator Charles Schumer) as "the only National Cancer Institute designated cancer center exclusively devoted to cancer prevention research." The Institute was described in a New York Post article (not on the web, Edelman S. Cancer scandal: bankrupt institute blew $5M. NY Post, Oct 3, 2004.):Known for its early research linking smoking and cancer, the IFCP was the only government-supported center that focused solely on preventio... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1130959 Fri, 04 Jan 2008 18:42:00 +0100 1130959 http://www.medworm.com/index.php?rid=1076203&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F12%2Fsome-payback-by-former-managed-care-ceo.html We had posted often (see these posts here, here, and here from 2006 with links backward) about the hugely lavish compensation afforded to the Dr William McGuire, former CEO of UnitedHealth Group, one of the largest US insurers/ managed care organizations, and how this remuneration stood in stark contrast to the stated mission of UnitedHealth Group:UnitedHealth Group is a diversified health and well-being company dedicated to making the health care system work better. The company directs its resources into designing products, providing services and applying technologies that:- Improve access to health and well-being services;- Simplify the health care experience;- Promote quality; and,- Make health care more affordable.Most recently, controversy has swirled over the timing of huge stock opt... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1076203 Fri, 07 Dec 2007 01:21:00 +0100 1076203 http://www.medworm.com/index.php?rid=1024234&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F11%2Fmore-about-hospitals-lists.html We previously posted about how one well-reputed US state-supported academic medical center allegedly maintained an "A-list" of donors and other VIPs who received additional amenities, and easier access to health care. One of our readers responded to it thus:The 'A list' idea is a very common practice. I've always found itoffensive, intrusive and detrimental to patient care. Of course it suggeststhat the UIP's (unimportant persons) get lower quality treatment.Our hospital has a program that is almost like calling a 'code.' When apatient on the list is admitted, the administrator on call is paged and theadministration people then proceed to make a nuisance of themselves. I haveactually had the chief of staff of the hospital poking around in thepatient's chart and giving the patient's family ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1024234 Tue, 13 Nov 2007 21:43:00 +0100 1024234 http://www.medworm.com/index.php?rid=1017617&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F11%2Facademic-medical-center-with-a-list.html The Dallas Morning News just printed a story about one hospital's alleged "A-list." UT Southwestern Medical Center at Dallas keeps a detailed list of wealthy, high-profile and influential people and their family members to ensure that they get favored treatment if they become patients.Here is what is known about the people on the list.The News reviewed a list dating from 2003 and found a virtual "Who's Who" of Dallas and the region. The list is maintained by UT Southwestern's Special Assistance Office and appears to identify wealthy and influential people who either are or might become major donors to the university. The list also includes family members, employees, friends and even one prominent person's maid.Business titans Trammell Crow, T. Boone Pickens and H. Ross Perot appear on the ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1017617 Fri, 09 Nov 2007 21:07:00 +0100 1017617 http://www.medworm.com/index.php?rid=980498&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F10%2Farbitrator-finds-yale-new-haven.html Several Connecticut newspapers have reported on findings against prestigious Yale-New Haven Hospital, the main teaching hospital for Yale University, by an independent arbitrator. Per the Hartfourd Courant,Arbitrator Margaret Kern said the hospital ruined any chance for a fair election by intimidating union supporters and spreading misinformation.She ordered the hospital to pay SEIU $2.3 million, to cover its organizing expenses and $2.2 million to about 1,700 hospital employees eligible to vote in the election. The second figure is the amount Yale-New Haven paid to IRI Consultants to Management Inc., the company it hired to coordinate its campaign against the union.'Employees were deprived of the right to truthful information, the right to do their job uninterrupted by solicitation, and t... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=980498 Fri, 26 Oct 2007 01:10:00 +0100 980498 http://www.medworm.com/index.php?rid=958841&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F10%2Fmedical-school-leaders-conflicts-of.html This article was covered in a variety of wire service reports, which contained some interesting commentary.The study's lead author, Eric Campbell, said (per HealthDay, via the Washington Post):There is not a single aspect of medicine in which the drug companies do not have substantial and deep relationships, affecting not only doctors-in-training, resident physicians, researchers, physicians-in-practice, the people who review drugs for the federal government and the people who review studies.Drug companies have relationships with everyone. They're involved in every aspect of medicine. Someone has to decide which of these is OK.I believe there's very little reasonable justification for why drug companies should be involved in the education of medical students. What knowledge do they have th... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=958841 Wed, 17 Oct 2007 19:05:00 +0100 958841 http://www.medworm.com/index.php?rid=935231&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F10%2Fmanaged-care-promises-vs-medicare.html Many health care insurance and managed care companies have lofty mission statements. For example, UnitedHealth Group promises to:- Improve access to health and well-being services;- Simplify the health care experience;- Promote quality; and,- Make health care more affordable.Similarly, Wellpoint promises to:- Bring affordable quality health care and coverage to medically underserved communities- Educate people to take an active role in their own health- Work with our health care partners to improve quality of care- Help shape public policy that makes health care more affordable and more accessibleAnd Humana promises that itmakes health benefits affordable, easy to administer and use, and instills confidence in both employees and employers.In contrast, Robert Pear, writing in the New York T... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=935231 Mon, 08 Oct 2007 20:41:00 +0100 935231 http://www.medworm.com/index.php?rid=782913&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F08%2Fafter-wellmark-college-of-public-health.html We previously posted, here and here, about a proposal to name the school of public health at the University of Iowa the Wellmark Blue Cross Blue Shield College of Public Health, or something like that, after that for-profit insurance company's foundation offered to donate $15 million to the school.The Des Moines Register is continuing to follow the story. And although the faculty voted against the naming rights, negotiations are underway to keep the idea alive, perhaps letting the school's name be shorted to just the "Wellmark College of Public Health," as if leaving "Blue Cross Blue Shield" off would conceal the ties to a large commercial health insurer with which the university's teaching hospital does considerable business.It is notable that this story, perhaps because of its vividness,... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=782913 Mon, 06 Aug 2007 18:32:00 +0100 782913 http://www.medworm.com/index.php?rid=747118&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F07%2Fnaming-school-of-public-health-after.html We previously posted about a proposal to name the new school of public health at the University of Iowa after a local health insurance company. But the faculty roundly rejected the notion of a "Wellmark Blue Cross and Blue Shield College of Public Health," and that seemed to be the end of the idea.But maybe not. On Inside Higher Ed was a report that the faculty reconsidered.Earlier this month, professors at the University of Iowa decided that they’d rather not work at the 'Wellmark Blue Cross and Blue Shield College of Public Health' — even if it meant potentially losing a donation of $15 million, which the insurance company’s nonprofit philanthropic arm promptly rescinded.But it looks like a significant proportion of the university’s faculty members are having second thoughts. At ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=747118 Fri, 20 Jul 2007 20:13:00 +0100 747118 http://www.medworm.com/index.php?rid=714692&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F07%2Fteaching-businesspeople-how-to-do-what.html Our local Providence Journal just ran a commentary by Mary Gentile on teaching ethics to business students that seems particularly relevant to Health Care Renewal, since businesspeople, not health care professionals, now run most large health care organizations (see recent post here).THE FALLOUT from 34 MBA students at Duke University having been caught cheating on an exam recently has put business education in the limelight once again. Business education hasn’t received this much attention since Enron and WorldCom.But the criticism and rebuttals have focused once more on whether business ethics can or should be taught. Instead, we should focus on teaching business students who already recognize right from wrong how to act on those values in the business world.Business-ethics courses spe... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=714692 Wed, 04 Jul 2007 20:01:00 +0100 714692 http://www.medworm.com/index.php?rid=564174&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F04%2Fkassirer-on-who-really-controls-medical.html The journal Perspectives in Biology and Medicine's first issue of 2007 was about "medicine and industry." Since many of my colleagues are returning from the US American College of Physicians meeting and others are getting ready for the Society of General Internal Medicine meeting, I thought starting with the first topical article in the issue, by Jerome P Kassirer, entitled "Professional societies and industry support: what is the quid pro quo?" would be apt. [Perspectives Biol Med 2007; 50: 7-17.]When I was researching my article based on physicians' thoughts about what was going wrong with health care [ Poses RM. A cautionary tale: the dysfunction of American health care. Eur J Int Med 2003: 14: 123-130 here] I found many cases of large health care organizations acting against physicians... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=564174 Mon, 23 Apr 2007 13:42:00 +0100 564174 http://www.medworm.com/index.php?rid=556744&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F04%2Fclosing-mcp-hospital-case-study-how.html Some of the issues on interest to Health Care Renewal readers have been getting a lot more attention in scholarly health care and medical journals. This is a good problem to have, but I am struggling to keep up with the recent relevant publications. It may take me a while to get caught, but I am starting now....An issue that came up a lot when I interviewed physicians back after the turn of the century about what they thought was wrong with health care [see results in Poses RM. A cautionary tale: the dysfunction of American health care. Eur J Int Med 2003: 14: 123-130 here]. An overriding concern was how health care is increasingly dominated by large organizations whose interests may conflict with physicians' core values.In the March issue of Academic Medicine appeared an illuminating case... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=556744 Fri, 20 Apr 2007 19:11:00 +0100 556744 http://www.medworm.com/index.php?rid=524126&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F04%2Fmedical-schools-to-faculty-show-me.html We have posted before (here and here) about how medical schools, despite their name, often fail to pay or otherwise reward faculty to actually teach.This month's SGIM [Society of General Internal Medicine] Forum (should be available here when the link starts to work) features an interview with Dr Lee Goldman, the Dean of the Faculties of Health Sciences and Medicine, and Executive Vice-President for Health and Biomedical Sciences at Columbia University. Dr Goldman, despite being a cardiologist, is a former President of SGIM, whom I had a chance to work with when I was the editor of the predecessor to the Forum. Dr Goldman is known for saying it like it is. In the interview, he explains with brutal honesty how things now work in academic medicine, and thus explains the apparent paradox of m... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=524126 Thu, 05 Apr 2007 20:52:00 +0100 524126 http://www.medworm.com/index.php?rid=499175&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Fwellpoint-fined-1-million-for-canceling.html The Los Angeles Times just reported,Blue Cross of California 'routinely' violated state law when it canceled individual health insurance coverage after policyholders got pregnant or sick, making no attempt to determine whether they did anything to merit such "harsh" treatment, according to a state investigation of practices that appear to be industrywide.As a result of its unprecedented investigation, the Department of Managed Health Care on Thursday said that it had fined Blue Cross $1 million — an amount immediately criticized by canceled policyholders and consumer advocates as too small to matter to an insurer whose parent company, WellPoint Inc., earned $3.1 billion in profit last year on revenue of $57 billion.Indianapolis-based WellPoint disputed the findings, saying it acted legal... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=499175 Sat, 24 Mar 2007 14:46:00 +0100 499175 http://www.medworm.com/index.php?rid=496937&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Ffda-leader-warns-dissent-is-not-helpful.html And speaking of leaders of health care organizations who will not tolerate dissent...The Associated Press (here via SFGate.com) reported that although Dr Andrew von Eschenbach, the new chief of the US Food and Drug Adminstration (FDA) vowed during a congressional hearing to protect "the legal rights of every single employee within the FDA," he seemed to have a rather harsh view of any FDA employee who might speak out publicly in opposition to the party line.However, during a June 2006 meeting, von Eschenbach told a group of 30 to 40 employees that anyone who went against the "team" could end up being "traded," according to accounts by agency whistle-blowers, including Dr. David Ross.During Thursday's hearing, von Eschenbach apologized to Ross, who now works for the Department of Veterans A... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=496937 Fri, 23 Mar 2007 21:14:00 +0100 496937 http://www.medworm.com/index.php?rid=496938&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Ffunny-sorts-of-ombudsmen-at-cdc.html We have previously posted (most recently here) about allegations of mismanagement at the US Centers for Disease Control and Prevention (CDC).The Atlanta Journal Constitution just reported an unusual exchange between Dr Julie Geberding, the head of the CDC, and US Senator Charles Grassley, the senior Republican on the US Senate Finance Committee. It seems that Senator Grassley requested a briefing from the newly hired CDC ombudsmen, but Dr Geberding refused the request.In a March 5 letter to Grassley, Geberding said the two contract employees the CDC has hired to serve as interim ombudsmen believe that briefing the senator would violate standards of practice for ombudsmen and render them unable to continue to do their jobs effectively.'While I am respectful of your desire to get further inf... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=496938 Fri, 23 Mar 2007 20:58:00 +0100 496938 http://www.medworm.com/index.php?rid=484899&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Funitedhealth-declares-health-care.html Those who read the print version of the Wall Street Journal opened it yesterday (19 March) to find a full page advertisement from UnitedHealth Group, with a dramatic red background. The advertisement is not on the web, as far as I can tell, but its text is below:The health care system isn't healthy. There's no denying it. A system that was designed to make you feel better often just makes things worse. Costs are out of control, access is inconsistent, quality is too variable and the entire process has become unwieldy.Every day, more Americans are added to the rolls of the uninsured. This is an epidemic and it's time we found a cure.At UnitedHealthcare, we are committed to improving the health care system. We aim to take what's wrong and make it right.> Simplifying everything and eliminatin... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=484899 Tue, 20 Mar 2007 18:40:00 +0100 484899 http://www.medworm.com/index.php?rid=480737&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Fuk-doctors-protest-modernising-medical.html We have posted several times, most recently here, about the controversy over the new system developed by the UK National Health Service (NHS) to select physicians for senior specialty training positions, part of the the new "Modernising Medical Careers" (MMC) program. Since the last post, criticism of the selection process, called the Medical Training Application Service (MTAS), has been growing. The Telegraph, which has been providing most of the coverage of this story, reported,Prof John Bell, president of the Academy of Medical Sciences, and Prof Sir John Tooke, chairman of the Council of Heads of Medical Schools, criticised the scheme for undervaluing applicants' research experience and academic potential. In an open letter released yesterday, Prof Bell and Sir John said: 'Academic tra... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=480737 Sat, 17 Mar 2007 19:42:00 +0100 480737 http://www.medworm.com/index.php?rid=474363&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Fstrange-contracting-at-uci.html Well, it's been a while, but the medical school at the University of California - Irvine (UCI) is back in the news. We had posted last year about various management problems at the same institution, involving its liver transplant service, cardiology division, and bone marrow transplant service, (see posts here and here) which lead the new chancellor of the campus to "acknowledge a failure of leadership and accountability" (see post here.) Slightly more recently, we noted the almost 20 year history of questionable financial relationships that involved one of UCI's "biggest stars" in clinical researach and several pharmaceutical companies (see post here).Last week, the Los Angeles Times reported about questionable relationships between the medical school and a local orthopedic practice.UC Ir... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=474363 Wed, 14 Mar 2007 19:41:00 +0100 474363 http://www.medworm.com/index.php?rid=469292&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Fmodernising-medical-careers-goes-into.html We have posted several times, most recently here, about the controversy over the new system developed by the UK National Health Service (NHS) to select physicians for senior specialty training positions, called "Modernising Medical Careers." Now, after having a spokesperson say "it would be irresponsible to halt the interview process at this late stage," the NHS has decided to cancel the whole new system and go back to the traditional method of selection. As reported by the Guardian,The computerised application system for the training posts that lead to consultant jobs was scrapped by a review set up this week to establish why many of the best-qualified candidates had been left without a single interview.The review, led by the Academy of Medical Royal Colleges, took just three days to bin ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=469292 Mon, 12 Mar 2007 19:17:00 +0100 469292 http://www.medworm.com/index.php?rid=469293&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Fflash-harvard-medical-school-to-start.html The Boston Globe just reported on an amazing new development. Harvard Medical School is going to try to pay its faculty something, even more than $30/hour to teach medical students.Harvard Medical School will increase by millions of dollars a year its payments to doctors for teaching students, a recognition of how difficult it has become to persuade busy physicians to devote time to educating the next generation of care givers.The medical school, Harvard University, and three major Harvard teaching hospitals -- Massachusetts General, Brigham and Women's, and Beth Israel Deaconess -- have agreed to double the funds for hospital-based instructors from $8 million to $16 million a year starting July 1.There is wide variation in what the roughly 7,000 full-time instructors at Harvard Medical Sc... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=469293 Fri, 09 Mar 2007 21:46:00 +0100 469293 http://www.medworm.com/index.php?rid=469294&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Fuk-modernising-medical-careers.html Last week we discussed the controversy over the new UK system for selecting physicians for senior specialty training positions. Things only seem to be going downhill. Again, commenting at risk of misunderstanding the context in the UK...A group of senior surgical consultants suspended interviews of "short-list" candidates because they had no confidence in the system that selected them. Per the Daily Telegraph, Bob Spychal, the Chair of the interview panel, said,The 10 surgeons were unanimous. We know we have disappointed the candidates and we have spoken to all of them, but we have no confidence that the system is robust and fair. It is not fit for purpose. Someone had to do something. Perhaps other panels in other specialities will do the same thing.Meanwhile, the Academy of Medical Royal... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=469294 Thu, 08 Mar 2007 20:53:00 +0100 469294 http://www.medworm.com/index.php?rid=469295&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Fjohns-hopkins-administration-attempts.html We have posted before about institutional threats to free expression at Johns Hopkins University, home to one of the most renowned medical schools and teaching hospitals in the US. The story continues, as per the Johns Hopkins Newsletter,Members of the Student Council (StuCo) expressed frustration with some of the University's newest policies concerning equality and respect in the workplace -- including those endorsed by President William Brody himself -- in a meeting with members of the administration Tuesday night.The council met with administrators to discuss alleged ambiguities of the Principles for Ensuring Equity, Civility and Respect policy endorsed by Brody and the Johns Hopkins Committee on the Status of Women.In a letter sent in Dec. to Susan Boswell, dean of Student Life, the St... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=469295 Wed, 07 Mar 2007 20:06:00 +0100 469295 http://www.medworm.com/index.php?rid=469296&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Fmedical-school-and-tobacco-money.html Reported in the media, and perhaps best on Inside Higher Ed, was the story of how the University of Virginia accepted $20 million from tobacco company Philip Morris USA for research on how to prevent children from smoking.Medical researchers at the University of Virginia believe they have identified an enormously promising way to stop kids from taking up smoking. So when a company was willing to pony up $20 million to finance the research, they seized the opportunity.The fact that the company was Philip Morris USA, the largest cigarette manufacturer in the United States, has raised some eyebrows nationally, given the tobacco industry’s history of sponsoring research that suited its own commercial purposes.'The historical record going back to the mid-’50s of the industry using funding t... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=469296 Wed, 07 Mar 2007 18:45:00 +0100 469296 http://www.medworm.com/index.php?rid=469297&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Fwhile-hospital-board-members-slumber.html With some reading between the lines, a story in the Boston Globe by Christopher Rowland helps explain some of the problems that afflict the leadership of health care organizations. To summarize the story, in quotes,Hospitals increasingly are expecting volunteer trustees to go beyond the role of community boosters and tackle an imposing medical issue: preventing errors that lead to patient injuries and deaths.Trustees traditionally have used their positions on hospital boards for social networking with other business executives and raising money through events such as fashion shows and golf tournaments. But expanding the scope of their responsibilities and time commitment is seen by hospital officials as key to improving patient safety because it would focus more attention on flawed policie... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=469297 Wed, 07 Mar 2007 18:15:00 +0100 469297 http://www.medworm.com/index.php?rid=469304&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F03%2Fmission-hostile-management-chaos-as-uk.html A year ago we posted bout the problematic new system, called "Modernising Medical Careers," (MMC) that UK National Health Service (NHS) managers had put in place to match junior physicians with specialized training positions (called specialist registrar positions). Concerns at the time centered on importance in the matching process of applicants' responses, in the form of very short essays, to standardized questions posed on a web-site. It seemed there would be no way to check the accuracy of their answers, that the relevance of the questions to one's ability to practice in a given specialty was questionable, and that the whole system devalued traditional measures of clinical competence and educational performance.I wrote last year's post with some trepidation, fearing that I may have not ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=469304 Sun, 04 Mar 2007 22:29:00 +0100 469304 http://www.medworm.com/index.php?rid=469301&cid=t_178190_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F02%2Fcase-for-mission-hostile-management.html In conclusion, the authors suggested that the "convoluted evolution" of law and regulation reflects major unresolved policy questions. They noted sympathetically the "formidable challenges" which non-profit hospitals face, such as "cost increases that will outpace reimbursement," and "growing competition from medical staffs interested in tapping into profits from procedure based-care." The authors asserted that such challenges should cause hospitals to "develop increasingly aggressive business models." Thus, Studdert et al finally concluded that "one might argue that leaders of nonprofit hospitals are failing to act diligently if they do not test the boundaries of legal permissibility by considering every technique that their for-profit competitors use."This is an important article, one th... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=469301 Mon, 19 Feb 2007 16:43:00 +0100 469301