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 'incentives'. Sat, 03 Sep 2011 02:00:43 +0100 http://www.medworm.com/index.php?rid=5158873&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F08%2Fmore-executives-prospering-despite.html Cases that demonstrate the contrast between compensation given to the hired executives of health care organizations and their or their organizations' performance continue to appear.  Last week we discussed how freely million dollar plus compensation is given to executives of nominally non-profit hospitals, and discussed how well some executives were paid just prior to charges of financial mismanagement, arrests or guilty pleas that drove them from their jobs.I have also found a series of cases of executives whose pay seemed disproportionate in the context of their institutions' financial difficulties.  Here they are, discussed in alphabetical order.Greenwich Hospital, ConnecticutAccording to GreenwichTime.com, here is the context:Greenwich Hospital went under the k... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5158873 Tue, 23 Aug 2011 16:26:00 +0100 5158873 http://www.medworm.com/index.php?rid=5158874&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F08%2Fwhat-goes-up-non-profit-hospital-ceo.html We have frequently discussed the disconnect between incentives, particularly total compensation, given to the leaders of health care organizations and their roles, or lack thereof, in improving the health care of their patients or the public. One measure of that disconnect is how leaders' pay continues to defy gravity while the economy continues to suffer, and health care dysfunction continues to fester.In particular, total compensation given to CEOs of ostensibly not-for-profit hospitals and hospital systems is increasingly passing the magic $1 million mark. A round up including two recent articles and others from the last four months that we have not discussed before revealed more "million dollar babies" amongst the ranks of these leaders.  (Note that most of the data... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5158874 Fri, 19 Aug 2011 18:37:00 +0100 5158874 http://www.medworm.com/index.php?rid=5077624&cid=t_105236_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=5050460&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F07%2Fblogscan-bleeding-heart-prosecutors-in.html On the Hooked: Ethics, Medicine and Pharma blog, Dr Howard Brody further analyzed the case of the soft-hearted prosecutors, which we discussed here.  He suggested that the systematically increasing leniency that the US government is displaying towards corporate wrong-doing is due to "economism," his tern for a "free-market" ideology that is inherently self-contradictory.  (Source: Health Care Renewal) Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5050460 Wed, 20 Jul 2011 19:18:00 +0100 5050460 http://www.medworm.com/index.php?rid=5028068&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F07%2Fwould-you-like-fries-with-that-fast.html Allegations that suggest the continuing degradation of the professionalism of employed physicians just appeared in the Palm Beach (FL) Post.  A former physician employee of Solantic Urgent Care, a for-profit chain of urgent care clinics, described to state investigators the life of employed physicians there.Putting Revenue FirstPhysicians answered to managers who put revenue first:Thirty-something business graduates lacking in any medical training supervised the clinics' doctors and were encouraged to maintain an adversarial relationship with them, Prokes said.Those clinic managers' raises and bonuses depended on their achieving ambitious goals for patient visits, labor and overhead costs, per-patient revenues and customer satisfaction.Prokes said clinic manager turnover was high, and... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5028068 Tue, 12 Jul 2011 15:38:00 +0100 5028068 http://www.medworm.com/index.php?rid=5028069&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F07%2Fcase-of-bleeding-heart-prosecutors-how.html ConclusionsThis seems to be the most recently documented example of important but overlooked, or concealed changes in government policies that have enabled the health care system to become more unethical, dishonest and corrupt, and hence more dysfunctional.Here we discussed a Supreme Court decision interpreting US anti-trust law that has been used to prevent medical societies from enforcing ethical rules, and hence helped medicine to become increasingly commercialized, and to increasingly put money ahead of patient care.Here we discussed little discussed legislation from 1945 that allowed US insurance companies/ managed care organizations to avoid federal anti-trust investigation and enforcement, and hence to increased market power.Here we discussed failure of the executive branch, an... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5028069 Mon, 11 Jul 2011 20:09:00 +0100 5028069 http://www.medworm.com/index.php?rid=5008077&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F07%2Fbeing-non-profit-hospital-ceo-means.html When my arm was twisted heartily to see the movie "Love Story" a very long time ago, I could never understand why so many audience members sighed upon hearing that immortal line, "love means never having to say you're sorry."  I could not understand it then, and still cannot.However, it seems that for reasons that are not any more clear, being the CEO of a not-for-profit hospital or hospital system also means never having to say you are sorry, as shown in some recent stories from the media. Not Sorry for LeavingOriginally published in the Fargo (ND) InForum:The merger 1½ years ago of Sanford Health and MeritCare created a new entity that doubled in size and covers a service area of more than 130,000 square miles.But the unified health care giant needed only one top executive, and the... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5008077 Thu, 07 Jul 2011 19:59:00 +0100 5008077 http://www.medworm.com/index.php?rid=5008078&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F07%2Fhere-comes-your-new-doctor-brought-to.html A long time ago, practicing physicians were mainly self-employed solo practitioners. As health care became more bureaucratic, physicians formed group practices as partnerships, which sometimes employed additional junior or part-time physicians. Some physicians worked for non-profit practice foundations, often affiliated with academic medical institutions, sometimes with non-profit physician-run health insurers, like some Kaiser plans. However, traditionally, almost no practicing physicians were employed by for-profit corporations. In fact, until about 30 years ago, it was considered unethical for physicians' practices to be "commercialized, or treated like a commodity in trade." (See posts here and here.)That is all changing, and apparently quickly.We recently discussed how a private equit... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=5008078 Tue, 05 Jul 2011 19:18:00 +0100 5008078 http://www.medworm.com/index.php?rid=4911418&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F06%2Fcoverts-anechoic-misadventures.html We have frequently discussed how health care leaders' compensation seems to reflect the opposite of the pay for performance they often tout.  One example we discussed recently turns out to be even more vivid than we first discovered.Last week we discussed the case of Mr Michael Cover, the CEO of the small, public Palomar Pomerado Health system in southern California, whose total compensation increased to over $1 mllion a year, while his hospital system was cited for severe, life-threatening medical errors.  The current and previous system board chairmen called his work "excellent, and " phenomenal," and asserted Mr Covert was "one of the nation's leading health administrators."It turns out that a local weekly newspaper, the Community Paper, investigated Mr Covert's... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4911418 Wed, 08 Jun 2011 16:36:00 +0100 4911418 http://www.medworm.com/index.php?rid=4841388&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F05%2Fseverance-package-to-un-severed-ceo.html The latest jaw-dropping story about executive compensation in health care has been unfolding in California, but at least now I have a diagnosis for this syndrome.  A Generous Retirement Package, Paid Before RetirementIn April, the Los Angeles Times reported about the generous retirement package given to an outgoing public hospital district CEO in California:When he turned 65 two years ago, Samuel Downing received a $3-million retirement payment from a public hospital district in Salinas, Calif., where he serves as president and chief executive.But Downing continued working at his $668,000-a-year job for another two years, and after he retires this week, he will receive another payment of nearly $900,000. That comes on top of his regular pension of $150,000 a year.Note that not only wa... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4841388 Thu, 19 May 2011 21:11:00 +0100 4841388 http://www.medworm.com/index.php?rid=4820781&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F05%2Fwas-wright-medical-ceo-really-pleased.html This story fits into the "if you believed that one, I have a bridge to sell you" category.  Let's go back seven months to 2010, when we discussed the legal settlement, which included submission to deferred prosecution and corporate integrity agreements by Wright Medical, a device manufacturer.  We noted that the company CEO, one Gary D Henley, said he was "pleased to announce these agreements and look[ing] forward to working with the independent monitor as we continue our commitment to the highest standards of ethical and legal conduct."  At the time, we wondered whether the only real reason he was pleased was that he got to keep his job (with total compensation of greater than $2 million a year) and hang onto his stock options (then consisting of 43... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4820781 Fri, 13 May 2011 20:21:00 +0100 4820781 http://www.medworm.com/index.php?rid=4813253&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2F_wrupaZeHWs%2F By David BoazPresident Obama has been saying that if the United States government can find and eliminate Osama bin Laden after ten years of searching, it can do anything: Already, in several appearances since the raid, Obama has described it as a reminder that “as a nation there is nothing that we can’t do,” as he put it during an unrelated White House ceremony Monday. On Sunday night, during his first comments about the operation, he linked it to American values, saying the country is “once again reminded that America can do whatever we set our mind to.” This is, of course, nonsense. Finding bin Laden, difficult as it proved to be, was an incomparably simple task compared to using coercion and central planning to bring about desired results in defiance of economic reality. You ... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4813253 Wed, 11 May 2011 14:01:13 +0100 4813253 http://www.medworm.com/index.php?rid=4797764&cid=t_105236_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=4768050&cid=t_105236_109_f&fid=36089&url=http%3A%2F%2Fthesituationist.wordpress.com%2F2011%2F04%2F30%2Fon-money-and-motivation%2F This lively RSAnimate, adapted from Dan Pink’s talk at the RSA, examines some the ways that money doesn’t always buy motivation. Related Situationist posts: Shocking for Money The Situation of High Marginal Income Tax Rates and Motivation Money and the Situation of Happiness “The Situation of Money and Happiness,” “Receiving by Giving,” and  “Something to Smile About.”  To review a collection of Situationist posts exploring the causes and consequences of happiness, click here. (Source: The Situationist) The Situationist blogs http://www.medworm.com/rss/comments.php?id=4768050 Sat, 30 Apr 2011 04:01:58 +0100 4768050 http://www.medworm.com/index.php?rid=4753629&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F04%2Frucing-about-conflicts-of-interest.html Since 2007, we have been writing about the secretive RUC (RBRVS Update Committee), the private AMA committee that somehow has managed to get effective control over how Medicare pays physicians. The RUC has been accused of setting up incentives that strongly favor invasive, high technology procedures while disfavoring primary care and other "cognitive medicine." Despite the central role of (perverse) incentives in raising health care costs while limiting access and degrading quality, there was surprisingly little discussion about the pivotal role played by the RUC until the formation of the "Replace the RUC" movement (see post here).  Recently, the leaders of Replace the RUC scored a journalistic coup by putting the current list of RUC members publicly on-line.  As we have di... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4753629 Tue, 26 Apr 2011 21:26:00 +0100 4753629 http://www.medworm.com/index.php?rid=4747726&cid=t_105236_113_f&fid=34634&url=http%3A%2F%2Fwww.emrandhipaa.com%2Femr-and-hipaa%2F2011%2F04%2F18%2Fmeaningful-use-measures-eprescribing-meaningful-use-monday%2F I hope that by now, readers have heeded the advice I gave in a previous post, “No Matter What Else You Do in 2011, You’ve Got to ePrescribe” and are covering their bases regarding ePrescribing under MIPPA. Even though providers can’t collect a meaningful use incentive (as a Medicare participant) during the same year that they earn an ePrescribing incentive, having the ePrescribing workflow in place for MIPPA purposes will prepare them well for meaningful use. Meaningful Use Core Measure: ePrescribing More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology. This is a core, i.e., required, measure that can only be excluded by an EP who writes fewer than 100 prescriptions during the reporting period and attests t... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4747726 Mon, 18 Apr 2011 15:21:48 +0100 4747726 http://www.medworm.com/index.php?rid=4709168&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F04%2Fjohnson-and-johnson-runs-afoul-of.html Johnson and Johnson, the once highly reputed international pharmaceutical and device company, cannot catch a break.  International Bribery ChargesAs reported by Bloomberg, the latest story is about bribery claims across multiple countries and two continents:Johnson & Johnson (JNJ), the world’s second-biggest seller of medical products, will pay $70 million after admitting that the company bribed doctors in Europe and paid kickbacks in Iraq to win contracts and sell drugs and artificial joints.Subsidiaries of J&J paid bribes to doctors and hospital administrators in Greece, Poland and Romania, the Securities and Exchange Commission and Department of Justice said today in filings at U.S. District Court in Washington. The company also made illegal payments to Iraqi officials to... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4709168 Wed, 13 Apr 2011 21:47:00 +0100 4709168 http://www.medworm.com/index.php?rid=4704750&cid=t_105236_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2Fo9FhCCA_3sM%2F I am starting the discussion of the individual meaningful use measures with “reporting on clinical quality measures (CQM)” for two reasons: It is one of the three pillars of meaningful use identified in the legislation, and it is a measure that appears to be causing a great deal of confusion. Just one of the 15 core measures required of meaningful users, it sounds a lot like PQRI (now PQRS); and many of the measures are, in fact, taken from that program. However, unlike PQRS, meaningful use requires reporting only—it does not set required thresholds, at least not in Stage 1—and reporting is not limited to Medicare patients. Interestingly, physicians can earn both PQRS and EHR Incentives in the same reporting period (in contrast to ePrescribing and EHR incentives.) While EPs canno... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4704750 Mon, 11 Apr 2011 16:36:52 +0100 4704750 http://www.medworm.com/index.php?rid=4626770&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F03%2Fdespite-poor-financial-results.html It is the season for share-holders' meetings of big US publicly held corporations, and as the proxy statements prepared for these meetings, prepare for more eye-popping, jaw-dropping examples of executive compensation.  Pfizer's 2010 CEO CompensationThe AP (via the Wall Street Journal) just noted the compensation given to Jeffrey Kindler, the outgoing (in 2010) CEO of Pfizer, Inc, the world's largest pharmaceutical company:Former Pfizer Inc. Chairman and CEO Jeffrey B. Kindler may have left the world's largest drugmaker abruptly last December, but he didn't leave empty-handed thanks to a compensation package valued almost $22 million.Kindler received a 60 percent increase last year over his 2009 compensation, according to an Associated Press analysis of a Pfizer regulatory filing Tues... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4626770 Wed, 23 Mar 2011 21:14:00 +0100 4626770 http://www.medworm.com/index.php?rid=4622205&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F03%2Fmillions-to-health-insurance-ceos-but.html The revelations about the huge golden parachute given the outgoing CEO of ostensibly non-profit Massachusetts Blue Cross Blue Shield induced some public discussion about the disconnect between executive compensation and the mission of health care organization (see most recent post here).  Several other recent stories should generate more discussion on these issues.  First, new proxy statements revealed the compensation of executives of two large for-profit health care insurers/ managed care companies.  In alphabetical order,CignaAs reported by the AP, via ABC news, the CEO got a big raise:Cigna Corp. CEO David M. Cordani's total compensation more than doubled in 2010, his first year as leader of the nation's fourth-largest health insurer, and a period in which the company's ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4622205 Tue, 22 Mar 2011 16:32:00 +0100 4622205 http://www.medworm.com/index.php?rid=4600495&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F03%2Fdespite-recalls-legal-settlements.html For our latest story about the tremendous disconnect between the pay and performance of leaders of health care organizations, we turn to Reuters.  Astronomical PayDespite having a very bad 2010, Johnson and Johnson continued to reward its CEO royally:After a year in which Johnson & Johnson's product quality control was deemed such a shambles that the U.S. government will oversee some plants, the board had praise for Chief Executive William Weldon and awarded him almost $29 million in overall compensation.The once golden reputation of the diversified healthcare giant was severely tarnished by seemingly endless recalls of widely used consumer products as well as recalls of medical devices and products from other units in 2010.U.S. consumer product sales fell by more than 19 percent ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4600495 Wed, 16 Mar 2011 21:00:00 +0100 4600495 http://www.medworm.com/index.php?rid=4575025&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F03%2Fmassachusetts-blue-cross-blue-shield.html We have frequently discussed the kind of compensation now frequently given to leaders of health care organizations.  Although often even the most disproportionately outrageous compensation only attracts transient interest, a recent regional story in this genre has really gotten legs.How Big the Golden Parachute?The story was about the severance package given to one Cleve L Killingsworth, the former CEO of not-for-profit health care insurance company Massachusetts Blue Cross Blue Shield.  While first reported as being worth $8.6 million,(1) the estimate of his total severance was soon raised to $11 million.(2)This is a Way to Control Costs?Immediately, that amount was contrasted with the supposed emphasis of the company on controlling costs, and its recent poor performance: K... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4575025 Fri, 11 Mar 2011 22:37:00 +0100 4575025 http://www.medworm.com/index.php?rid=4560206&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F03%2Fgetting-out-of-our-ruc-open-letter-to.html Since 2007, we have been writing about the secretive RUC (RBRVS Update Committee), the private AMA committee that somehow has managed to get effective control over how Medicare pays physicians.  The RUC has been accused of setting up incentives that strongly favor invasive, high technology procedures while disfavoring primary care and other "cognitive medicine."  Despite the central role of (perverse) incentives in raising health care costs while limiting access and degrading quality, there has been surprisingly little discussion about the pivotal role played by the RUC.  Now there is a movement afoot to replace the RUC.  In a new post on the Care and Cost blog, and the Replace the RUC site, Paul M. Fischer and Brian Klepper urged four approaches:1. Make the p... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4560206 Mon, 07 Mar 2011 21:17:00 +0100 4560206 http://www.medworm.com/index.php?rid=4532282&cid=t_105236_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2FH5NRyC5wBA0%2F The last Meaningful Use Monday post detoured from the EHR incentives to ePrescribing under MIPPA—given its importance based on the impending schedule of penalties. Because I receive ePrescribing questions on a daily basis, I thought a quick recap of ePrescribing basics might be helpful: Incentives and penalties: Year Incentives* Penalties* 2011 1% – 2012 1% 1%** 2013 0.5% 1.5%** 2014 on – 2% *Percent of provider’s total Medicare Part B FFS Allowable Charges. (Incentives assume provider does not receive EHR incentive for that year.) **Based on 2011 ePrescribing activity Incentives are earned per provider, and each provider must individually meet the requirements. This means that some providers within a practice might qualify for an incentive, while o... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4532282 Mon, 28 Feb 2011 15:58:42 +0100 4532282 http://www.medworm.com/index.php?rid=4522073&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F02%2Freplace-ruc.html We have frequently posted, first here in 2007, and more recently here and here, about the little-known group that controls how the US Medicare system pays physicians, the RBRVS Update Committee, or RUC. Since 1991, Medicare has set physicians' payments using the Resource Based Relative Value System (RBRVS), ostensibly based on a rational formula to tie physicians' pay to the time and effort they expend, and the resources they consume on particular patient care activities. Although the RBRVS was meant to level the payment playing field for cognitive services, including primary care vs procedures, over time it has had the opposite effect, as explained by Bodenheimer et al in a 1997 article in the Annals of Internal Medicine.(1) A system that pays a lot for procedures, but much less for diagn... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4522073 Fri, 25 Feb 2011 21:46:00 +0100 4522073 http://www.medworm.com/index.php?rid=4489608&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F02%2Fafter-manufacturing-problems-genzyme.html In late 2009, I posted about problems at a Genzyme plant that manufactured some fabulously expensive drugs, e.g. Cerezyme whose cost to patients approximated $160,000 a year. We thought then that for a drug costing that much, the company ought to have figured out a conservative process to provide pure and unadulterated product. In a later post I asked why a company that could afford to make its CEO very rich could not afford to adequately maintain its manufacturing facilities. In May, 2010, I posted about a legal settlement of charges related to its manufacturing problems requiring Genzyme to pay a $175 million fine and function under US government supervision.  And in August, 2010, I posted about how this series of management missteps could lead to the company's C... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4489608 Thu, 17 Feb 2011 22:16:00 +0100 4489608 http://www.medworm.com/index.php?rid=4477869&cid=t_105236_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2FM7bwC-aDYy8%2F No Matter What Else You Do in 2011, You’ve Got to ePrescribe With all of the focus on meeting meaningful use, the requirements related to ePrescribing under the Medicare MIPPA program seem to be getting lost in the shuffle. Just as some practices didn’t get the message about the 2010 change in ePrescribing G-codes until late in the year, I am hearing that the communication hasn’t reached everyone about the importance of ePrescribing in 2011; so I thought I would post a reminder: 2011 ePrescribing activity will be the basis for the 2012 and 2013 ePrescribing Medicare penalties (AKA “adjustments”) under MIPPA. If you are not already ePrescribing, it’s important to start very soon. The following are the rules: ePrescribe on 10 Medicare encounters between now and June 30, 2011 to ... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4477869 Mon, 14 Feb 2011 15:39:08 +0100 4477869 http://www.medworm.com/index.php?rid=4424444&cid=t_105236_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2F878kSFkTBos%2F The pursuit of orphan drugs remains high and why not? The Orphan Drug Act, which encourages development of meds for diseases with small markets, gives drugmakers seven years in which to sell a product without competition for seven years and sometimes tax incentives, too. So it is not surprising that a record 323 requests for designation were submitted to the FDA last year. And the agency’s Office of Orphan Products Development obliged by designating 192 meds with orphan status. As a result, there are now 2,308 drugs with this designation, as noted by the FDA Law Blog, which scanned the FDA orphan drug database. However, the FDA approved only 14 orphan meds last year, down from 17 approvals in 2009 and down from a high of 25 back in 1996. Why is there so much interest lately? Hard to ... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=4424444 Tue, 01 Feb 2011 14:26:56 +0100 4424444 http://www.medworm.com/index.php?rid=4419082&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F01%2Fmore-on-hospital-executives.html Local US news media brought some more striking examples of how health care organizational leaders, even leaders of non-profit hospitals seem paid out of proportion to any reasonable standards.Carolinas HealthCare System: Corporate-Style Compensation for a Public Hospital CEOCarolinas HealthCare System describes itself as "the largest health care system in the Carolinas and the third largest public system in the nation" in its membership blurb for the National Association of Public Hospitals and Health Systems.  That association describes its members thus, Since the establishment of the first public hospital in the United States in the early 1700s, safety net hospitals and health systems have been an essential part of our nation’s health care delivery system.In the 21st century, safe... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4419082 Mon, 31 Jan 2011 20:36:00 +0100 4419082 http://www.medworm.com/index.php?rid=4405727&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2011%2F01%2Fmaking-their-numbers-examples-of.html Last week, we discussed how the large incentives for pharmaceutical executives to meet short term financial targets (that is, "making their numbers") may be an important cause of their firms' decreasing capacity to fulfill their most basic mission, manufacturing pure, unadulterated medicines.  In the news recently were two examples of how other health care leaders are incentivized to meet short-term financial targets.University of CaliforniaThe first, and bigger example appeared in the San Francisco Chronicle. First, note that the University of California system is currently in dire shape:Finances are so dire at the University of California that it might have to turn away qualified students,....Also,UC President Mark Yudof told the regents that UC will need to close a $1 billion budge... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4405727 Thu, 27 Jan 2011 21:03:00 +0100 4405727 http://www.medworm.com/index.php?rid=4372008&cid=t_105236_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=4298688&cid=t_105236_113_f&fid=34634&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FEmrAndHipaa%2F%7E3%2FsoNzKaEN3Zw%2F I guess I should have assumed that people would start posing this question. Turns out Jeff Rowe at HITECH Watch (part of Healthcare IT News) has posted the question about delaying the HITECH incentives twice in a week. I guess it’s a reasonable question to be asked, but my emphatic answer to the question is NO! It took us plenty long enough to get to this point. The wait for the details of meaningful use and certified EHR was a long enough wait that absolutely slowed the adoption of EMR software. There are 300-400 EHR companies just waiting for this EHR incentive program to get going. That’s a lot of companies to hold hostage while the government tries to “make meaningful use better.” Plus, you can quite easily argue that more time won’t actually make meaningf... EMR and HIPAA blogs http://www.medworm.com/rss/comments.php?id=4298688 Tue, 28 Dec 2010 19:19:37 +0100 4298688 http://www.medworm.com/index.php?rid=4265739&cid=t_105236_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fintensity-modulated-radiation-therapy-imrt-for-cancer-how-lucrative-is-it-for-doctors%2F2010.12.17 I’ve been traveling in Europe, including giving a talk at the Salzburg Global Seminar on involving and informing patients in healthcare decisions. In that presentation, I talked about promotion of a newer form of cancer radiation therapy called intensity-modulated radiation therapy (IMRT). So I want to point out that while I’ve been away the Wall Street Journal published an important piece on this very topic under the headline “A Device to Kill Cancer, Lift Revenue.” An excerpt: Roughly one in three Medicare beneficiaries diagnosed with prostate cancer today gets a sophisticated form of radiation therapy called IMRT. Eight years ago, virtually no patients received the treatment. The story behind the sharp rise in the use of IMRT—which stands for intensity-modulat... Better Health blogs http://www.medworm.com/rss/comments.php?id=4265739 Fri, 17 Dec 2010 14:00:35 +0100 4265739 http://www.medworm.com/index.php?rid=4265686&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2Fk2hjXnwNZEM%2F By Andrew J. CoulsonThe Brookings Institution released a new study today on charter schooling—assessing how well it’s working and what the federal government should do about it. One of the recommendations reads as follows: Student participation in lotteries for admissions to any public [charter] school and the results of such lotteries should be a required student data element in state or district longitudinal data systems supported with federal funds. Why? Because it would make it a lot easier to measure relative school quality, by permitting more widespread use of randomized, control group experiments. Experiments are certainly great from a researcher’s standpoint, but mandating that schools must admit students on a random basis has a catch: an observer effect as subtl... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4265686 Thu, 16 Dec 2010 19:15:37 +0100 4265686 http://www.medworm.com/index.php?rid=4233170&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FoWhkg6aROzo%2F By Daniel J. MitchellMuch to my surprise, Senate Republicans held firm earlier today and blocked President Obama’s soak-the-rich proposal to raise tax rates next year on investors, entrepreneurs and small business owners. I fully expected that GOPers would fold on this issue several months ago because Democrats were using the class-warfare argument that Republicans were holding the middle class hostage in order to protect “millionaires and billionaires.” Republicans usually have a hard time fighting back against such demagoguery, and I was especially pessimistic since every Republican senator had to stay united to block Senate Democrats from pushing through Obama’s plan for higher tax rates on the so-called rich. But the GOP surprised me earlier this year with the... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4233170 Sat, 04 Dec 2010 22:27:38 +0100 4233170 http://www.medworm.com/index.php?rid=4230152&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FoWhkg6aROzo%2F By Daniel J. MitchellMuch to my surprise, Senate Republicans held firm earlier today and blocked President Obama’s soak-the-rich proposal to raise tax rates next year on investors, entrepreneurs and small business owners. I fully expected that GOPers would fold on this issue several months ago because Democrats were using the class-warfare argument that Republicans were holding the middle class hostage in order to protect “millionaires and billionaires.” Republicans usually have a hard time fighting back against such demagoguery, and I was especially pessimistic since every Republican senator had to stay united to block Senate Democrats from pushing through Obama’s plan for higher tax rates on the so-called rich. But the GOP surprised me earlier this year with the... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4230152 Sat, 04 Dec 2010 22:27:38 +0100 4230152 http://www.medworm.com/index.php?rid=4219725&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FtoxT0OW_Sag%2F By Alan ReynoldsIn The New York Times, Robert H. Frank of Cornell University repeated his perpetual argument that high tax rates on the rich do no harm to demand (not supply) because the rich can just draw down savings, year after year,  to pay more taxes yet maintain a showy lifestyle.   Then he resorts to the old trick of asserting there is no “credible” evidence that tax disincentives and distortions have any ill effects on the economy. Frank asks, rhetorically, if an increase in top tax rates might reduce economic growth.  And he replies, “There’s no credible evidence that it would.”   This is a timeworn trick among people too intellectually lazy to look for a single academic study or statistical fact.   As I have shown before, Mr. Frank has a history of abusing b... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4219725 Wed, 01 Dec 2010 21:23:47 +0100 4219725 http://www.medworm.com/index.php?rid=4183297&cid=t_105236_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Femployers-up-the-ante-for-workers-health%2F2010.11.19 More than half of employers are likely to keep offering insurance rather than use state health insurance exchanges when they become available under health care reform in 2014, reported a survey by an insurance broker. Willis Human Capital Practice released results of its Health Care Reform Survey 2010, which showed 55 percent of employers would keep their health plans in 2014 even if the new state exchanges offer competitive prices. The survey sampled 1,400 employers of varying sizes, industry sectors and geographies whose plans cover more than 9 million employees and dependents (including retirees). Key findings from the survey include: • 88 percent believe that group health plan costs will increase as a result of health care reform; • 76 percent expect administrative compliance co... Better Health blogs http://www.medworm.com/rss/comments.php?id=4183297 Fri, 19 Nov 2010 15:00:00 +0100 4183297 http://www.medworm.com/index.php?rid=4167924&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F11%2Fabout-to-be-bought-out-non-profit.html A report from FloridaToday (in Brevard County) about the sale of a not-for-profit Florida hospital system to a for-profit corporation raises some interesting questions. The background is that the non-profit Wuesthoff Health System was bought by for-profit Health Management Associates (HMA):HMA, a for-profit hospital management company in Naples, bought the not-for-profit Wuesthoff Oct. 1 for $145 million. Wuesthoff lawyer William Kopit has said it was forced to sell because the hospital system lacked the capital to compete.The question is about the conditions of the sale:A foundation formed to manage the proceeds of the sale and continue providing indigent health care has refused to disclose the executive packages to the state, claiming it constitutes a trade-secret exemption under Florida... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4167924 Mon, 15 Nov 2010 17:22:00 +0100 4167924 http://www.medworm.com/index.php?rid=4151702&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F11%2Fela-medical-now-sorin-group-settles.html And we return to the parade of legal settlements, which is still marching along.  The next entrant to the parade was described by the Miami Herald:In a four-year-old case with nationwide implications, Ela Medical has agreed to pay $9.2 million to settle a whistle-blower case brought by a former Miami technician who charged the company used several schemes to pay kickbacks to South Florida doctors.The details of the allegations were:In the Miami case, brought by May and Ben Kuehne, Lee alleged that Ela gave money to doctors for questionable studies, had Ela techs do work on patients that doctors later billed Medicare for, gave doctors free trips and helped doctors get monitoring equipment that to led to more Medicare billing.The moves were made by the company to boost sales in the mult... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4151702 Mon, 08 Nov 2010 22:35:00 +0100 4151702 http://www.medworm.com/index.php?rid=4125009&cid=t_105236_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fthe-future-of-american-healthcare%2F2010.11.01 You want to see a doctor? You’re going to have to wait. And I don’t mean like an hour in the office. I mean like 53 days. It’s not some doomsday story from the future. It’s happening today here in Massachusetts. Massachusetts — the state whose 2006 law was the model for the federal healthcare reform law. Massachusetts — home to some of the world’s best medical centers and doctors. And, as the Boston Globe’s “White Coat Notes” blog reports, Massachusetts — home to doctor shortages and long waits to see a doctor: When primary care patients do secure an appointment for a non-urgent matter, they have to wait to get in the door, the survey found. The average delay is 29 days to see a family medicine doctor, down from 44 days last year, and 53 days ... Better Health blogs http://www.medworm.com/rss/comments.php?id=4125009 Mon, 01 Nov 2010 14:00:44 +0100 4125009 http://www.medworm.com/index.php?rid=4124996&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FCLn49L0lLoA%2F By Daniel J. MitchellThe death tax is a punitive levy that discourages saving and investment and causes substantial economic inefficiency. But it’s also an immoral tax that seizes assets from grieving families solely because someone dies. The good news is that this odious tax no longer exists. It disappeared on January 1, 2010, thanks to the 2001 tax cut legislation. The bad news is that the death tax comes back with a vengeance on January 1, 2011, ready to confiscate as much as 55 percent of the assets of unfortunate families. I’ve criticized the death tax on many occasions, including one column in USA Today explaining the economic damage caused by this perverse form of double taxation, and I highlighted a few of the nations around the world that have eliminated this odious... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4124996 Mon, 01 Nov 2010 11:04:15 +0100 4124996 http://www.medworm.com/index.php?rid=4118812&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F10%2Fruc-it-up-how-us-government-fixes.html We have frequently posted, first here in 2007, and most recently here and here, about the little-known group that controls how the US Medicare system pays physicians, the RBRVS Update Committee, or RUC.  Since 1991, Medicare as set physicians' payments using the Resource Based Relative Value System (RBRVS), ostensibly based on a rational formula to tie physicians' pay to the time and effort the expend, and the resources they consume on particular patient care activities.  Although the RBRVS was meant to level the payment playing field for cognitive services, including primary care, vs procedures, over time it has had the opposite effect, as explained by Bodenheimer et al in a 1997 article in the Annals of Internal Medicine.(1)  A system that pays a lot for procedur... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4118812 Thu, 28 Oct 2010 22:09:00 +0100 4118812 http://www.medworm.com/index.php?rid=4118791&cid=t_105236_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2010%2F10%2F27%2Fjournal-of-the-american-medical-association-2010-vol-304-no-16%2F The objective of this study was to test whether a free prepared meal and incentivised structured weight loss program promotes greater weight loss and weight loss maintenance at 2 years compared with usual care. The article concludes that compared with usual care, this structured weight loss program resulted in greater weight loss over 2 years. An NHS Athens password is required to access this article online, alternatively contact the Library for a copy of this article. Filed under: Athens Password, Current Awareness, E-Journals, Journals Tagged: Incentives, Randomised Controlled Trials, United States, Weight Loss, Women (Source: Fade Library) Fade Library blogs http://www.medworm.com/rss/comments.php?id=4118791 Wed, 27 Oct 2010 13:01:15 +0100 4118791 http://www.medworm.com/index.php?rid=4077231&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FErcVlLhBYqE%2F By David BoazNPR reports on more doctors giving up private practices and going to work for hospitals. Hospitals think they can manage care better and get more patients, and doctors like being relieved of administrative headaches. But it isn’t a perfect solution. Reporter Jenny Gold notes one of the problems: GOLD: This isn’t the first time hospitals have gone doctor shopping. In the 1990s, hospitals bought up as many practices as possible. Dr. Bill Jessee is the president of the Medical Group Management Association. He remembers the ’90s as something of a disaster. Dr. BILL JESSEE (President, Medical Group Management Association): The first thing a lot of physicians did was took a vacation. And when they came back, they weren’t working as hard as they were before th... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=4077231 Mon, 18 Oct 2010 14:47:08 +0100 4077231 http://www.medworm.com/index.php?rid=4013112&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F09%2Fmore-tales-of-hospital-executive.html I have collected another series of stories from the wild and wacky world of health care executive compensation.  These are from three different hospitals/ hospital systems, ordered from smallest to largest.Jefferson HealthcareThis story, from Jefferson County, Washington state, came from the Peninsula Daily News:When Mike Glenn takes over the Jefferson Healthcare CEO office Oct. 4, he will be receiving $225,000 annually to run the 25-bed publicly funded hospital.And he will become the highest-paid public official in Jefferson County.Jefferson Healthcare's budget is $65 million, and it employs 360 full-time workers and about 550 part-timers.Note that the amount above is apparently salary, not total compensation, which could well be higher.Lakeland Regional Medical CenterThis story, fro... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=4013112 Tue, 28 Sep 2010 19:24:00 +0100 4013112 http://www.medworm.com/index.php?rid=3987035&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FYHZGYI1lNxs%2F By Daniel J. MitchellThanks to the Obamacare legislation, we already know there will be a new 3.9 percent payroll tax on all investment income earned by so-called rich taxpayers beginning in 2013. And the capital gains tax rate will jump to 20 percent next year if the President gets his way. This sounds bad (and it is), but the news is even worse than you think. Here’s a new video from the Center for Freedom and Prosperity that exposes the atrociously unfair practice of imposing this levy on inflationary gains. The mini-documentary uses a simple but powerful example of what happens to an investor who bought an asset 10 years ago for $5,000 and sold it this year for $6,000. The IRS will want 15 percent of the $1,000 gain (Obama wants the tax burden on capital gains to climb to 23.... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3987035 Mon, 20 Sep 2010 21:08:20 +0100 3987035 http://www.medworm.com/index.php?rid=3968992&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FnaeXpB6NehA%2F By David BoazIn the Washington Post, columnist Courtland Milloy praises the “profound egalitarian insights” and “radical oneness” of D.C. Schools Chancellor Michelle Rhee (and billionaire Warren Buffett): “I believe we can solve the problems of urban education in our lifetimes and actualize education’s power to reverse generational poverty,” Rhee wrote. “But I am learning that it is a radical concept to even suggest this. Warren Buffett [the billionaire investor] framed the problem for me once in a way that clarified how basic our most stubborn obstacles are. He said it would be easy to solve today’s problems in urban education. ‘Make private schools illegal,’ he said, ‘and assign every child to a public school by rand... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3968992 Tue, 14 Sep 2010 22:16:42 +0100 3968992 http://www.medworm.com/index.php?rid=3965366&cid=t_105236_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=3957869&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F09%2Fgolden-parachute-for-captain-outrageous.html A year ago, I posted about leadership and governance problems at Northeast Health Systems, a small hospital system located in neighboring Massachusetts.  The colorful story included leaders who solicited money from the community but concealed what they were doing from the same community, an adolescent pregnancy pact after the hospital system refused to provide confidential birth control information at the high school clinic it ran, a hospital vice-president accused of art theft, various cuts, some concealed, of medical services, accusations of conflicts of interest affecting the board of trustees, and no-confidence votes by nurses and physicians. Finally, Stephen Laverty, the CEO held responsible for much of the mess, resigned and things quieted down a bit.  H... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3957869 Fri, 10 Sep 2010 20:35:00 +0100 3957869 http://www.medworm.com/index.php?rid=3920789&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F08%2Fmore-hospital-ceos-join-millionaires.html As we predicted, more stringent requirements by the US Internal Revenue Service for financial reporting by not-for-profit organizations, including hospitals and hospital systems, have produced an enlarging parade of revelations of obese pay packages for hospital leaders.  The latest report came out courtesy the Baltimore Sun:Baltimore-area hospital CEOs and presidents boast seven-figure salaries, club and gym memberships, and paid financial planning and tax services as part of compensation packages from their nonprofit employers.According to a survey of Baltimore-area hospitals, the highest-ranking executives were often the recipients of financial payouts and perquisites that many private-sector companies have abandoned in the face of intense public debate about excessive CEO pay. The... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3920789 Tue, 31 Aug 2010 15:09:00 +0100 3920789 http://www.medworm.com/index.php?rid=3914933&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F08%2Fcan-1-billion-group-of-babies-provide.html The issue of executive compensation in health care seems to be attracting more media attention.A St Louis Post-Dispatch editorial noted how executive compensation for for-profit health insurance CEOs has grown. It started with a quote from Steven Hemsley, the CEO of UnitedHealth:Today the American people are questioning whether or not we receive fair value for the $2.6 trillion we, as a society, are expecting to spend this year on our health care system. The vast majority, including those of us at UnitedHealth Group, believe the answer is, 'No.'Here is a summary of the compensation information:Modern Healthcare, a leading health industry trade journal, published its annual executive compensation survey this week. Topping the list is Stephen Hemsley, quoted above, who gave a speech to the D... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3914933 Sun, 29 Aug 2010 23:49:00 +0100 3914933 http://www.medworm.com/index.php?rid=3902901&cid=t_105236_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fprimary-care-doctors-rewarded-for-time-with-patients%2F2010.08.25 Abraham Verghese is a professor of medicine at Stanford University and one of the most articulate physician-writers today. He recently wrote an op-ed highlighting primary care’s plight, and focuses on the scarcity of time: The science of medicine has never been more potent – incredible advances and great benefits realized in the treatment of individual diseases – yet the public perception of us physicians is often one of a harried individual more interested in the virtual construct of the patient in the computer than in the living, breathing patient seated on the exam table.Time is the scarcest commodity of all. Patients, particularly when it comes to their routine, day-to-day care, want a physician who has time to understand them as people first, and then as patients. It’s bee... Better Health blogs http://www.medworm.com/rss/comments.php?id=3902901 Wed, 25 Aug 2010 14:00:27 +0100 3902901 http://www.medworm.com/index.php?rid=3880827&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FdG-eJOp0oV8%2F There’s been a bit of chatter in the blogosphere about a recent post on Ezra Klein’s blog, featuring estimates from various economists about the revenue-maximizing tax rate. It won’t come as a surprise that people on the right tended to give lower estimates and folks on the left had higher guesses. Donald Luskin of National Review estimated 19 percent, for instance, while Emmanuel Saez, Dean Baker, Bruce Bartlett, and Brad DeLong all gave answers around 70 percent. There are two things that are worth noting. First, every single answer is to the right of the Joint Committee on Taxation. The revenue-estimators on Capitol Hill assume that taxes have no impact on overall economic performance. As such, even confiscatory tax rates have very little impact on taxable income. The ... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3880827 Wed, 18 Aug 2010 19:12:04 +0100 3880827 http://www.medworm.com/index.php?rid=3872508&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F08%2Fst-vincents-goes-bankrupt-executives.html St. Vincent's Hospital in the Greenwich Village section of New York City was a landmark institution which filed for bankruptcy in April, 2010, and then closed its doors.  BackgroundA New York Times article written earlier this year described an institution "threatened with extinction" because it stuck to its mission of "compassionate care" in a health care environment that values "fancy equipment and celebrity doctors."  Thus, "officials blamed a high rate of poor and uninsured patients as well as cuts in Medicare and Medicaid and the hospital's inability to negotiate favorable contracts with health insurance companies...."  Painting Another PictureHowever, a story this week in the grittier New York Post painted a different picture:St. Vincent's Hospital was looted by execs ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3872508 Mon, 16 Aug 2010 20:49:00 +0100 3872508 http://www.medworm.com/index.php?rid=3865227&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F08%2Fbeing-health-insurance-executive-means.html WellPoint, the largest US for-profit health care insurance company, has provided a steady stream of examples of poor management and bad behavior for the edification of Health Care Renewal readers.  Most recently, a company whose core functions include reliably and confidentially managing electronic data on policy-holders allowed what should have been private data from nearly half a million people to appear on-line (see post here.  For other examples, look here.) This week, the Los Angeles Times recounted what happened to a highly placed WellPoint executive who tried to improve the company's behavior.  Leslie Margolin was the public face of Anthem this year when it sought to raise individual insurance rates as much as 39%. The move triggered a backlash in ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3865227 Fri, 13 Aug 2010 19:52:00 +0100 3865227 http://www.medworm.com/index.php?rid=3865228&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F08%2Fgolden-parachute-for-making.html In late 2009, we posted about problems at a Genzyme plant that manufactured some fabulously expensive drugs, e.g. Cerezyme whose cost to patients approximated $160,000 a year. We thought then that for a drug costing that much, the company ought to have figured out a conservative process to provide pure and unadulterated product. In a later post we also why a company that could afford to make its CEO very rich could not afford to adequately maintain its manufacturing facilities.  In May, 2010, we posted about a legal settlement of charges related to its manufacturing problems requiring Genzyme to pay a $175 million fine and function under US government supervision.Recent news articles suggest that the fix of the company's inabilities to manufacture pure, unadulterated drug remained rem... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3865228 Fri, 13 Aug 2010 15:48:00 +0100 3865228 http://www.medworm.com/index.php?rid=3831319&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F08%2Fdespite-scandal-former-unitedhealth-ceo.html A little while ago, the Wall Street Journal reported on the highest paid US corporate CEOs of the past decade.  One name stood out for those interested in  health care: Dr William W McGuire, the former CEO of giant health care insurance company/ managed care organization UnitedHealth Group.  Dr McGuire was number 9 on the list, with a total realized compensation of $469,300,000.  We started discussing the disconnect between Dr McGuire's corpulent pay and his company's failure to uphold its stated ideals back in 2005, when he was reported to have received more than $124 million to lead a company which championed "affordable" health care.  Later, it turned out that much of Dr McGuire's compensation came in the form of back-dated stock-options, and the resul... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3831319 Fri, 06 Aug 2010 20:55:00 +0100 3831319 http://www.medworm.com/index.php?rid=3776362&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FYl2o2cca40M%2F By Daniel J. MitchellThe Wall Street Journal has an excellent editorial this morning on the obscure — but critically important — issue of measuring what happens to tax revenue in response to changes in tax policy. This is sometimes known as the dynamic scoring versus static scoring debate and sometimes referred to as the Laffer Curve controversy. The key thing to understand is that the Joint Committee on Taxation (which produces revenue estimates) assumes that even big changes in tax policy have zero macroeconomic impact. Adopt a flat tax? The JCT assumes no effect on the economic performance. Double tax rates? The JCT assumes no impact on growth. The JCT does include a few microeconomic effects into its revenue-estimating models (an increase in gas taxes, for instance, w... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3776362 Wed, 21 Jul 2010 18:17:49 +0100 3776362 http://www.medworm.com/index.php?rid=3767315&cid=t_105236_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2FUPI_dkTAal8%2F Now that Pfizer has decided to keep an R&D facility and about 300 jobs in Richmond, Virginia, the city may give the drugmaker $650,000 in tax grants over a 10-year period, starting in 2014. Although the grant would be capped, Pfizer would be able to request additional funds for every $50 million invested in the property. “It’s a performance-based grant - very modest,” Peter Chapman, deputy chief administrative officer for economic and community development, tells The Richmond Times-Dispatch, who adds the tax break is critical to hold on to the jobs. Such incentives, which some decry as corporate welfare, are regularly used to encourage companies to relocate or retain jobs, although results don’t always match expectations. Two years ago, the widely used practic... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3767315 Mon, 19 Jul 2010 11:46:08 +0100 3767315 http://www.medworm.com/index.php?rid=3753794&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2F_BHR3LouvLM%2F By Daniel J. MitchellAustralia got rid of its death tax in 1979. A couple of Aussie academics investigated whether the elimination of the tax had any impact on death rates. They found the ultimate example of supply-side economics, as reported in the abstract of their study. In 1979, Australia abolished federal inheritance taxes. Using daily deaths data, we show that approximately 50 deaths were shifted from the week before the abolition to the week after. This amounts to over half of those who would have been eligible to pay the tax. Although we cannot rule out the possibility that our results are driven by misreporting, our results imply that over the very short run, the death rate may be highly elastic with respect to the inheritance tax rate. It looks like this experiment is going to b... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3753794 Wed, 14 Jul 2010 20:02:28 +0100 3753794 http://www.medworm.com/index.php?rid=3742223&cid=t_105236_83_f&fid=34856&url=http%3A%2F%2Finsidesurgery.com%2F2010%2F07%2Fstudy-shows-email-helps-patient-outcomes-cost-effective-docs%2F A new study of Kaiser Permanente patients just published is reporting that patients that have unrestricted email access to their physicians see improvements in chronic conditions such as diabetes and hypertension, but suggests that physicians may be reluctant to spend the time developing these communication patterns because they lack financial incentives to do so. (Source: Inside Surgery) Inside Surgery blogs http://www.medworm.com/rss/comments.php?id=3742223 Sun, 11 Jul 2010 03:59:06 +0100 3742223 http://www.medworm.com/index.php?rid=3714128&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F06%2Fhow-can-101-million-year-ceo-help.html In 2005, we entitled a post, "How Can a $124.8 Million a Year CEO Make Health Care More Affordable?"  At that time, we contrasted the enormous compensation given to the then CEO of UnitedHealth, Dr William McGuire, with the stated mission of his corporation.  Since then, we have traced the travails of UnitedHealth and its leadership.  Dr McGuire was eventually accused of receiving backdated stock options (which at one time raised his personal fortune to over $1 billion), and was pushed into retirement.  UnitedHealth was accused of a variety of management and ethical lapses.  The rather sorry story as of April, 2010 was summarized here.The more things change, the more they stay the same.  The Minneapolis Star-Tribune just reported:Stephen Hemsley, a serious and... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3714128 Wed, 30 Jun 2010 21:20:00 +0100 3714128 http://www.medworm.com/index.php?rid=3714447&cid=t_105236_150_f&fid=35777&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FPharmalot%2F%7E3%2F1qoiyO53RnY%2F Hello, everyone. How are you today? We are motoring along here on the Pharmalot corporate campus, where the heat has lifted and the birds are singing our song. Just the same, another busy day lies ahead. Your schedules, no doubt, are equally daunting. So please join us for the mandatory cup of stimulation and a bit of news of the world. Dig in and have a great day… Biogen To Hire George Scangos As CEO (Bloomberg News) Celegene To Buy Abraxis For $2.9 Billion (Associated Press) Pfizer Gets Incentives To Stay In Virginia (Richmond Times-Dispatch) Sanofi-Aventis Pays $75M For TargeGen (Bloomberg News) A Fix For The Avandia Mess (Forbes) Genzyme Expects More Cerezyme, Fabrazyme Shortages (Reuters) Sanofi-Aventis To Build New Plant In Saudi Arabia (InPharma-Technologist) Bristol-Myers Con... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=3714447 Wed, 30 Jun 2010 11:47:29 +0100 3714447 http://www.medworm.com/index.php?rid=3710519&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F06%2Fwellpoint-dont-know-much-about-computer.html Big US based health care insurance companies have not been covering themselves in glory in the last week.Aetna's Math ErrorsFirst, there was the case of Aetna's mathematical prowess, e.g., as reported by the Los Angeles Times:A second insurance company in California has killed plans for double-digit rate hikes for individual policyholders because of errors in its filing that would have inflated premiums, state regulators said Thursday.Connecticut-based Aetna Inc. had sought an average 19% increase in rates for its 65,000 individual customers, but pulled back after multiple math errors in its paperwork were found by its own staff and by an independent consultant working for the state.Aetna's decision follows a similar move by Anthem Blue Cross, which canceled a rate increase of as much as 3... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3710519 Tue, 29 Jun 2010 21:49:00 +0100 3710519 http://www.medworm.com/index.php?rid=3695520&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F06%2Fedwin-lee-on-tiger-we-are-now-riding.html Some insights about why the leadership of large health care organizations has gone so wrong may be found on a blog I just discovered entitled "Dismounting Our Tiger," written by entrepreneur Edwin Lee. In particular, this post, triggered by the miserable results produced by BP in response to the gulf oil spill, posits the series of steps by which people become leaders of most big organizations, presumably including health care organizations:1.They always followed orders and met the cultural expectations of their organization. They went along to get along. Early in their careers they were faced with a choice: they could make a difference or get promoted; they chose to get promoted. (Those who attempt to make a difference make waves for senior management and fellow workers who then deal with... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3695520 Thu, 24 Jun 2010 19:59:00 +0100 3695520 http://www.medworm.com/index.php?rid=3687102&cid=t_105236_87_f&fid=39187&url=http%3A%2F%2Fgetbetterhealth.com%2Fpay-patients-to-take-their-medicine%2F2010.06.22 The New York Times reported recently on efforts by providers and payers to increase patient medication adherence through the use financial incentives paid to patients. The article cited the use of small financial payments (<$100), awarded via lotteries, to patients that take Warfarin –- an anti-blood clotting medication. There is certainly nothing wrong with financial incentives. Incentives have been proven successful in changing selected provider (quality and safety improvement) and patient behavior (stop smoking, weight loss and taking health risk surveys). But paying patients to take their medication is different. Actually, the evidence suggests that it is a just plain stupid idea for a whole lot of reasons. (more…) *This blog post was originally published at Mind The... Better Health blogs http://www.medworm.com/rss/comments.php?id=3687102 Tue, 22 Jun 2010 14:00:17 +0100 3687102 http://www.medworm.com/index.php?rid=3641002&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FAnpE4t_biLM%2F By Daniel J. MitchellArt Laffer has a compelling column in yesterday’s Wall Street Journal, where he makes the case that future tax rate increases will cause considerable economic damage because people have an incentive to maximize income this year to take advantage of current tax rates — resulting in an artificial drop in economic activity next year. In effect, this will be a reverse version of the experiment in the early 1980s, when entrepreneurs and investors had an incentive to postpone economic activity since Reagan’s tax rate reductions were phased in over several years. I am reluctant to endorse Art’s prediction that the “economy will collapse,” since even good economists are lousy forecasters. But we certainly will see a large degree of tax plann... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3641002 Tue, 08 Jun 2010 12:24:37 +0100 3641002 http://www.medworm.com/index.php?rid=3629618&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2F5Ij5q5GF5Jg%2F By Mark A. CalabriaOn the surface the failures of Fannie Mae and Freddie Mac would appear to have little connection to the fiscal crisis in Greece, outside of both occurring in or around the time of a global financial crisis.  Of course in the case of Fannie and Freddie, primary blame lies with their management and with Congress.  Primary blame for Greece’s problems clearly lies with the Greek government.  Neither Greece or Fannie would have been able to get into as much trouble, however, if financial institutions around the world had not loaded up on their debt.  One reason, if not the primary reason, for bailing out both Greece and the US’s government sponsored enterprises is the adverse impact their failures would have on the banking system. Yet bankers around the world ... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3629618 Thu, 03 Jun 2010 20:16:19 +0100 3629618 http://www.medworm.com/index.php?rid=3621625&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F06%2Fruc-off-new-england-journal-once-again.html Last week, the influential New England Journal of Medicine published an article by Bruce Vladek entitled "Fixing Medicare's Physician Payment System."(1)  Although only identified as working for Nexara, a health consulting business, Mr Vladek was a former administrator of what was then called the Health Care Financing Administration (HCFA) of the US Department of Health and Human Services (DHHS), the part of the department that then ran the US Medicare program.  Vladek thus can reasonably be viewed as an expert on Medicare.  Vladek identified two main problems with the current way physicians are paid by Medicare.  First, Medicare is captive to an arbitrary, if elegantly conceived, formula for total payments to physicians — the sustainable growth rate (SGR). In the alt... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3621625 Tue, 01 Jun 2010 16:28:00 +0100 3621625 http://www.medworm.com/index.php?rid=3569788&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FmgkLfgMvOOg%2F By Michael F. CannonObamaCare creates incentives not to climb the economic ladder.  It also creates incentives not to work at all; able-bodied people can quit their jobs, safe in the knowledge that the suckers working man will foot the bill for any health care they may need.  House Speaker Nancy Pelosi thinks that’s a not a bug, but a feature of the new law, at least if those able-bodied non-paycheck earners are artists.  (HT: CNS News.) Repeal the bill. (Source: Cato-at-liberty) Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3569788 Mon, 17 May 2010 15:34:37 +0100 3569788 http://www.medworm.com/index.php?rid=3533812&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FAwfJ783c1GI%2F By John SamplesJournalists are looking closely at the DISCLOSE bill, Congress’ response to Citizens United.  CQ says DISCLOSE will loosen independent spending by the parties on their candidates. Why is Congress liberalizing party spending? CQ explains: According to one GOP attorney, opponents of the Supreme Court’s decision are realizing that they will have a difficult time challenging the constitutional right of outside groups to spend money, so this bill is a response to free up the parties to compete. Mark that. Citizens United has altered the incentives regarding speech. In the past, Congress tried to suppress speech to win elections. Now leaders must liberalize in order to compete for votes. (Source: Cato-at-liberty) Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3533812 Wed, 05 May 2010 15:23:55 +0100 3533812 http://www.medworm.com/index.php?rid=3501494&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F04%2Fpay-for-hypocrisy-for-health-insurance.html A few weeks ago, we discussed the cognitive dissonance produced by huge salary boosts for top executives of health care companies with miserable ethical track records.  One of our examples contrasted a long list of ethical violations by US giant health insurance company/ managed care organization WellPoint and the huge raises given its CEO and top executives.  Now more ethical questions are being raised about WellPoint.Rate Hikes Retrospectively for Golden ParachutesAn op-ed published in several California newspapers (here via the Sonoma Index-Tribune) claimed that the huge rate hike that WellPoint's California subsidiary proposed earlier this year, an action that helped to revitalize the US legislative health care reform process, was meant to recoup costs of a pre... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3501494 Fri, 23 Apr 2010 20:09:00 +0100 3501494 http://www.medworm.com/index.php?rid=3479638&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F04%2Fwhat-me-worry-redux-another-leader.html We have posted lately (here and here) about how leaders of health care organizations seem to be getting even richer despite questions about their organizations' ethics or performance.  Here we go again.  The news about UnitedHealth over the years has provided plenty of examples of organizational behavior that did not fit the company's stated lofty goals, per its "Social Responsibility" page:UnitedHealth Group's mission is to help people live healthier lives.Social responsibility begins with us–and how we do business. Every day, our 75,000 employees strive to find smart ways to promote healthier lives in our communities. On its "Mission and Values" page:Our mission is to help people live healthier lives.* We seek to enhance the performance of the health system and improve the ov... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3479638 Fri, 16 Apr 2010 19:49:00 +0100 3479638 http://www.medworm.com/index.php?rid=3448806&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F04%2Fwhat-me-worry-leaders-prosper-despite.html There were two examples in the recent news about how the leaders of health care organizations seem to prosper no matter what questions are raised about their organizations' ethics or performance.WellPointIt seemed that anger over a rate increase by a subsidiary of the huge insurance company/ managed care organization WellPoint was one reason for the revival of efforts in the US to enact some sort of health care reform legislation.  In our comment on this controversy, we noted that questions about the ethics of WellPoint's actions have appeared again and again.  Wellpoint...settled a RICO (racketeer influenced corrupt organization) law-suit in California over its alleged systematic attempts to withhold payments from physicians (see post here).subsidiary New York Empire Blue Cross ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3448806 Thu, 08 Apr 2010 16:19:00 +0100 3448806 http://www.medworm.com/index.php?rid=3429130&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F04%2Fmore-doubts-about-private-equity-taking.html Last week, we posted about how buy-outs of not-for-profit hospital systems by private equity firms seemed to be a new fashion in health care.  Since then, new doubts have been raised about whether this is a good idea.Detroit Medical Center, Vanguard Health, and the Blackstone GroupLetters to the Detroit Free Press raised concerns,As a nonprofit corporation, DMC's mission is to provide quality health care to the community. Management is accountable to Detroit area citizens and health care consumers, not to profit-motivated investors.As a private, for-profit corporation, its mission will be to provide profit for its shareholders. Management will be accountable to shareholders and will be rewarded in relation to the rate of return on their investments.Also, the Free Press reported that a... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3429130 Thu, 01 Apr 2010 15:14:00 +0100 3429130 http://www.medworm.com/index.php?rid=3403828&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F03%2Fhealth-care-reform-bill-and-health-care.html I have not written much about the seemingly endless health care reform debate in the US, because much of it has not been relevant to the issues we discuss on Health Care Renewal.  Now that the current phase of the debate is done, and legislation has been passed, let me offer my opinions on the few aspects that do seem relevant to this blog.The Sunshine ActFor Health Care Renewal readers, the most important part of the legislation is that containing the provisions of the Sunshine Act, championed by Senators Grassley and Kohl.  (See this summary on Postscript, the Prescription Project blog.)  The act requires that all drug, device, biologic, and medical supply manufacturers report essentially all payments to physicians or teaching hospitals to the goverment, and on the in... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3403828 Wed, 24 Mar 2010 21:42:00 +0100 3403828 http://www.medworm.com/index.php?rid=3306828&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FrH1K8GAlV04%2F By Mark A. CalabriaToday, in what seems like an endless string of 3-2 votes, the SEC moved to restrict the ability of investors to short stocks, claiming that such restrictions would restore stability and protect our financial system.  The truth couldn’t be more different.  Short sellers have long been the first, and often only, voice raising questions about corporate fraud and mismanagement.  For instance, shorts exposed the fraud at Enron, WorldCom and other companies while the SEC largely slept. Bush’s SEC, lead by former Congressman Chris Cox banned the shorting of various financial industry stocks during the crisis.  The SEC then, as now, would have us believe that Bear, Lehman, AIG, Fannie, Freddie and others were not the victims of their own mismanagement, but rather vict... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3306828 Wed, 24 Feb 2010 18:50:16 +0100 3306828 http://www.medworm.com/index.php?rid=3302302&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FVaC4Z9KX-wk%2F By Tad DeHavenThe District of Columbia is providing tax incentives for a parking garage at a new Harris Teeter grocery store.  This follows a District subsidized parking garage boondoggle that opened at a Columbia Heights mall in 2008.  Whether it’s a parking garage, bike rack, or any other commercial transportation activity, government should remain neutral. If Harris Teeter believes a 150-car parking garage is in the best interests of the company’s bottom line, it should pay for it itself. Taxpayers shouldn’t be on the hook.  If the District or any other city wants to encourage economic development, it should seek lower taxes across the board, and remove costly regulatory barriers. H/T Chris Moody (Source: Cato-at-liberty) Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3302302 Tue, 23 Feb 2010 18:32:22 +0100 3302302 http://www.medworm.com/index.php?rid=3149005&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2010%2F01%2Fto-whom-does-leading-off-shore-medical.html ConclusionsSo here we have a new kind of example of what laissez faire unregulated capitalism has wrought for US health care.  The medical school in tiny, impoverished Dominica exists only to train physicians for the US not for Dominica, or the Caribbean area.  Nonetheless, the school does not do a great job: one-third of its students do not graduate even in six years, and one-fifth of those graduates never even start a residency.  Yet the students pay more than $30,000 a year in tuition, and graduate with an average debt much higher than US trained medical students.   In fact, the school is actually a subsidiary of a large, US for-profit corporation, although it is not clear if this is made obvious, or even revealed to prospectiv... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3149005 Wed, 06 Jan 2010 22:50:00 +0100 3149005 http://www.medworm.com/index.php?rid=3096826&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FPOXrOhebBeI%2F By Neal McCluskeyI’ve been fretting for some time over the growing push for national curricular standards, standards that would be de facto federal and, whether adopted voluntarily by states or imposed by Washington, end up being worthless mush with yet more billions of dollars sunk into them. The primary thing that has kept me optimistic is that, in the end, few people can ever agree on what standards should include, which has defeated national standards thrusts in the past. So far, the Common Core State Standards Initiative – a joint National Governors Association/Council of Chief State School Officers venture that is all-but-officially backed by Washington — has avoided being ripped apart by educationists and plain ol’ citizens angry about who’s wri... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3096826 Thu, 17 Dec 2009 16:07:30 +0100 3096826 http://www.medworm.com/index.php?rid=3066982&cid=t_105236_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=3048084&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FHQqn4XqYCUI%2F John Kay’s column in yesterday’s Financial Times criticizes government guarantees to banks because they involve hidden but large costs. According to Kay: Such guarantees distort competition: sheltered banks outperform rivals not because of greater efficiency, but because capital becomes cheaper to obtain. Sheltered banks gain too-big-to-fail status, which creates barriers to entry for smaller, more efficient banks. Relief from business risk leads to more risk taking, AKA moral hazard. Cheaper private risk management incentives are reduced within and outside the bank. Other kinds of government guarantees, such as social insurance, also involve large hidden costs. Social Security and Medicare’s guarantee of a paid holiday with medical care for the rest of retirees’ lives generates ... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3048084 Wed, 02 Dec 2009 15:23:22 +0100 3048084 http://www.medworm.com/index.php?rid=3035877&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F11%2Fwas-is-worst-biotech-ceo-worth.html Recently, we posted about misadventures of the leadership of biotechnology giant Genzyme.  Although the company has long priced its drug Cerezyme for the rare Gaucher's disease at a stratospheric level, it did not sufficiently reinvest money in its manufacturing facility for the drug.  Deferred maintenance at a production facility running at maximum capacity has apparently lead to two different kinds of contamination problems, forcing a shut-down of the plant, and now a shortage of the drug.  For this, Genzyme CEO Henri Termeer was just labeled the "Worst Biotech CEO of '09" by TheStreet.com.It was not always thus.  A 2008 profile of Mr Termeer in Boston Magazine chronicled the rise of Genzyme from a "startup [which] operated 15 stories above the Combat Z... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=3035877 Fri, 27 Nov 2009 17:15:00 +0100 3035877 http://www.medworm.com/index.php?rid=3012364&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FSxuNPIhmoN8%2F A report released today by the federal government’s non-partisan General Accounting Office finds deficits in the Department of Education’s financial and program oversight. According to the GAO, “These shortcomings can lead to weaknesses in program implementation that ultimately result in failure to effectively serve the students, parents, teachers, and administrators those programs were designed to help.” The GAO’s findings are consistent with the longstanding pattern: for forty years, Americans have steadily increased spending on public schools without any resulting improvement in student performance by the end of high school (see the figures here and here). The Obama administration has touted its $100 billion in education stimulus spending as a key to long term economic growth.... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=3012364 Thu, 19 Nov 2009 22:06:51 +0100 3012364 http://www.medworm.com/index.php?rid=2943766&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FeqxSRn-xIZQ%2F In an exchange I had with Charles Murray earlier this month, he complained that there was no bulletproof scientific research documenting miraculous improvement in student achievement attributable to great schools like those of Ben Chavis. At the time, that objection was beside my point, which is that there is copious evidence that competitive market education systems yield very substantial (if not “miraculuous”) improvements over the status quo government monopoly. We don’t need miracles to prove that there is a much better way of organizing and funding schools. But that wasn’t enough for Ben Chavis. He called yesterday to pass along a proposition to Charles: come perform the research yourself. In fact, Ben offered to put Charles up in his own house. I don’t k... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2943766 Thu, 29 Oct 2009 17:51:54 +0100 2943766 http://www.medworm.com/index.php?rid=2871565&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FQVk6Rjg9WV4%2F I was glad to see James Pinkerton engage my criticism of Louisiana Gov. Bobby Jindal’s (R) endorsement of federal price controls for health insurance.  I was even more pleased to see that Pinkerton has his own blog devoted to developing a Serious Medicine Strategy. If I understand Pinkerton, his argument is essentially: it’s all well and good for some unelectable wonk in the “citadel of libertarian thinking” to “uphold ivory-tower free-market purity” by opposing price controls.  But Republicans need “art-of-the-possible solutions” to win elections, and 90 percent of the public support those price controls.  “Everyone has a right to his or her principled position,” Pinkerton writes, “but the majority has rights, too.” Two problems. First, Pinkerton suggests that l... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2871565 Wed, 07 Oct 2009 20:33:48 +0100 2871565 http://www.medworm.com/index.php?rid=2871531&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F10%2Fpfizer-in-guise-of-pharmacia-pfound-to.html It was only a month ago that Pfizer Inc, the world's largest pharmaceutical company, submitted to a gargantuan $2.3 billion settlement and yet another corporate integrity agreement. As we posted here, this was the company's fourth major settlement of charges of unethical marketing behavior since 2002.Now Pfizer is in trouble again. As reported by the AP,A judge on Tuesday imposed $4.5 million in forfeitures on prescription drug company Pharmacia Inc.[a Pfizer Inc subsidiary] for misrepresenting prices and defrauding Wisconsin's Medicaid system.A jury in February found that Pharmacia violated the state's Medicaid fraud law 1.44 million times over a decade. State Justice Department attorneys had demanded about $212 million in forfeitures, but Dane County Circuit Judge Richard Niess said juro... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2871531 Wed, 07 Oct 2009 20:01:00 +0100 2871531 http://www.medworm.com/index.php?rid=2855522&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F10%2Frole-of-ruc-in-medicares-price-fixing.html An important part of the noisy and contentious debate about health care reform in the US centers on the role of the government as a provider of health insurance. Some on the left want a government "single-payer" plan to be the only health insurance available. Some left of center want a government "public option" health insurance plan to be available, particularly to those who have trouble obtaining commercial insurance. Some on the right want none of it, and sometimes note that the existing government single-payer plan for the elderly and disabled, Medicare, has important faults that would only become more significant if the plan is extended or duplicated. Yet even critics of Medicare on the right do not seem to want to talk about what may be its worst fault.The latest example, an op-ed pi... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2855522 Fri, 02 Oct 2009 14:55:00 +0100 2855522 http://www.medworm.com/index.php?rid=2838915&cid=t_105236_87_f&fid=38368&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDisruptiveWomenInHealthCare%2F%7E3%2FCc_Cvx0W2hA%2F This article is part of a series of essays on our health care system which are available on Society of Actuaries’ Web site: http://www.soa.org/library/essays/health-essay-2009-toc.aspx. Each of these essays presents a different perspective on the problems with our current system for providing and paying for medical coverage. It comes as no surprise, the current health care system is not working for any of the parties in the system; employers, medical providers, health plans and health insurance companies and especially not for the consumer.  More clarity is needed to help solidify a new path for healthcare reform. For the consumer, the current billing practices of providers and payment practices of insurance companies often result in the highest charges being applied to the individuals... Disruptive Women in Health Care blogs http://www.medworm.com/rss/comments.php?id=2838915 Mon, 28 Sep 2009 12:30:17 +0100 2838915 http://www.medworm.com/index.php?rid=2834237&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F09%2Fcongress-expects-physicians-to.html This has to be the lamest. most inept, and/or most patronizing Congress in history:Washington ExaminerBaucus claims it's too difficult to put health care bill onlineBy: BARBARA HOLLINGSWORTH09/24/09A proposal by Sen. Jim Bunning, R-Ky., that would have required the Senate Finance Committee to post the final language of the $900 billion health care reform bill, as well as a Congressional Budget Office cost analysis, on the committee’s website for 72 hours prior to a vote was rejected 12-11.... Chairman Max Baucus, D-Mont., himself admitted that “This probably sounds a little crazy to some people that we are voting on something before we have seen legislative language.” Indeed.Baucus’ excuse - that it would take his committee staff two weeks to post the bill online – sounds a littl... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2834237 Sat, 26 Sep 2009 12:25:00 +0100 2834237 http://www.medworm.com/index.php?rid=2774584&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F09%2Fpfour-legal-settlements-for-pfizer-why.html We recently posted about Pfizer's $2.3 billion dollar settlement with the US government (here), which we first mentioned six months ago (here). It is worth reviewing what we know about this settlement. We will start with quoted from the article by Gardiner Harris writing in the New York Times. We will also use quotes from other articles listed below:A Big Settlement(from the NYT)The pharmaceutical giant Pfizer agreed to pay $2.3 billion to settle civil and criminal allegations that it had illegally marketed its painkiller Bextra, which has been withdrawn.It was the largest health care fraud settlement and the largest criminal fine of any kind ever. The penalties include a very large criminal fine, an even larger civil fine, and a corporate integrity agreement (from the NYT).Under the agree... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2774584 Mon, 07 Sep 2009 17:08:00 +0100 2774584 http://www.medworm.com/index.php?rid=2715925&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FiSDJzCS6uyM%2F Earlier this summer, the House of Representatives approved legislation intended to, as Rep. Frank, put it, “rein in compensation practices that encourage excessive risk-taking at the expense of companies, shareholders, employees, and ultimately the American taxpayer.” While there are real and legitimate concerns over CEOs using bailout funds to reward themselves and give their employees bonuses, Washington has operated on the premise that excessive risk-taking by bank CEOs, due to mis-aligned incentives, caused, or at least contributed to, the financial crisis.  But does this assertion stand up to close examination, or are we just seeing Congress trying to re-direct the public anger over bailouts away from itself and toward corporations? As it turns out, a recent research pa... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2715925 Tue, 18 Aug 2009 21:34:59 +0100 2715925 http://www.medworm.com/index.php?rid=2712072&cid=t_105236_87_f&fid=36438&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FCato-at-liberty%2F%7E3%2FxvliMtiiy_Y%2F Marcus Winters offers a clever new national standards proposal in the current Education Week: reward states whose students do well on their own standards _and_ whose standards prove challenging to students from other states. Winters suggests administering each state’s standardized tests to random, nationally representative samples of students to determine how challenging they are. The federal government would then give the greatest amount of funding to states whose students perform well on tests that prove challenging to kids around the country. This system would be gamed. The way to “win” would be to develop highly detailed, easy, obscure standards. Literature would consist of detailed analysis of the early works of Nathanial Hawthorne, math would focus on theorems not ... Cato-at-liberty blogs http://www.medworm.com/rss/comments.php?id=2712072 Tue, 18 Aug 2009 16:16:37 +0100 2712072 http://www.medworm.com/index.php?rid=2681889&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2009%2F08%2Fsgim-urges-chuck-ruc.html This week, Society of General Internal Medicine (SGIM) members received the 5 August, 2009, Update in Health Policy that urged we "chuck the RUC," (quoted in its entirety below, italics added for emphasis):Who will assign the value of primary care services? Chuck the RUC!How does Medicare determine physician payment rates? The answer to this question is a core element of the ongoing debate about health care reform. Changing how Medicare sets payment rates for physicians is especially critical since Medicare rates also guide the rates set by private insurers. Since 1992, Medicare has paid physicians according to the Resource Based Relative Value Scale (RBRVS), a fee schedule that multiplies relative values for physician services by a conversion factor to determine the amount of payment. The... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2681889 Fri, 07 Aug 2009 15:30:00 +0100 2681889 http://www.medworm.com/index.php?rid=2649060&cid=t_105236_109_f&fid=34750&url=http%3A%2F%2Fpsychcentral.com%2Fblog%2Farchives%2F2009%2F07%2F29%2Fthe-tragedy-of-the-commons%2F The tragedy of the commons is a term coined by scientist Garrett Hardin in 1968 describing what can happen in groups when individuals act in their own best self interests and ignore what’s best for the whole group. A group of herdsmen shared a communal pasture, so the story goes, but some realized that if they increased their own herd, it would greatly benefit them. However, increasing your herd without regard to the resources available also brings unintentional tragedy — in the form of the destruction of the common grazing area. Being selfish by using a shared group resource can hurt others. But it doesn’t always have to. Since that time, we’ve had a great deal of research into this phenomenon that’s resulted in a few common solutions, as outlined by Mark Van... World of Psychology blogs http://www.medworm.com/rss/comments.php?id=2649060 Wed, 29 Jul 2009 11:23:00 +0100 2649060 http://www.medworm.com/index.php?rid=2601984&cid=t_105236_87_f&fid=34872&url=http%3A%2F%2Fwww.blisstree.com%2Fhealthbolt%2Fnurses-work-for-free-plastic-surgery%2F A recent New York Times article highlights to the growing nursing shortages around the world. Seems an understaffed Prague clinic has been offering liposuction, breast augmentation, and tummy tucks as incentives to get nurses to work there. All they have to do is sign up for three years and they can have the plastic surgery of their choice - for free. Interesting incentive plan. And apparently it’s working. According to the clinic manager, they are now fully staffed.  In fact, they had to reject dozens of applicants. But it sounds more like providing a bandaid rather than a cure to the continuing nursing shortages. (via Kevin MD.com) (image source) Post from: Healthbolt (Source: Healthbolt) Healthbolt blogs http://www.medworm.com/rss/comments.php?id=2601984 Wed, 15 Jul 2009 08:00:34 +0100 2601984 http://www.medworm.com/index.php?rid=2381045&cid=t_105236_134_f&fid=35187&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDiabetesDaily%2F%7E3%2FsnGee3nf0ao%2Fshould-poor-lifestyle-choices-cost-more.php Last week, I suggested five ways to control the cost of diabetes. Number four sparked spirited debate in the comments. Here's the provocative paragraph:Provide stronger incentives for healthy lifestyles. If someone has insulin resistance and is overweight or inactive, there needs to be a way to financially incentivize productive action. The dollar cost of carrying excess weight is enormous over the long run but it's hidden. Someone who is not... (Source: Diabetes Daily) Diabetes Daily blogs http://www.medworm.com/rss/comments.php?id=2381045 Thu, 30 Apr 2009 17:26:20 +0100 2381045 http://www.medworm.com/index.php?rid=2354017&cid=t_105236_134_f&fid=35187&url=http%3A%2F%2Ffeedproxy.google.com%2F%7Er%2FDiabetesDaily%2F%7E3%2FAxIhr0WvBUA%2F5-ways-to-control-the-cost-of-diabetes.php Let's continue our discussion of health care costs by looking at diabetes in particular. Here are five practical suggestions for lowering the total cost of having a lifetime of diabetes. Get rid of the term "pre-diabetes". Delete this word from the dictionary because it does more harm than good. If someone has started down the path towards insulin resistance, there is no going back. It may be controlled by weight... (Source: Diabetes Daily) Diabetes Daily blogs http://www.medworm.com/rss/comments.php?id=2354017 Tue, 21 Apr 2009 17:04:07 +0100 2354017 http://www.medworm.com/index.php?rid=2348960&cid=t_105236_115_f&fid=34672&url=http%3A%2F%2Fpengrad.blogspot.com%2F2009%2F04%2Fpayment-structures-influence-dental.html NHS dentists were traditionally paid for individual “items of treatment”: each X-ray they took resulted in a payment. In England, the number of X-rays taken in 2003/04 averaged 53.2 per 100 “courses of treatment”. Since 2006, however, NHS dentists in England have not received payments for individual X-rays, but only for completed courses of treatment. Preliminary results for 2007/08 show that the number of X-rays taken by dentists in England has decreased to 31.5 per 100 courses of treatment. In Scotland, by contrast, where the traditional method of payment for dentists continues, there has been no equivalent reduction.Margaret McCarthyFinancial Times 11 April 2009linkblogs.ft.com/mccartney (Source: www.MidEssexRay.com) www.MidEssexRay.com blogs http://www.medworm.com/rss/comments.php?id=2348960 Mon, 13 Apr 2009 11:40:00 +0100 2348960 http://www.medworm.com/index.php?rid=2305866&cid=t_105236_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2009%2F03%2F30%2Ffit-for-recovery%2F from the think tank Reform looks at the state of occupational health. It identifies that healthier companies are more productive and profitable; better health is a winning advantage in the economic survival of the fittest. More effort from employers would mean reduced demand on the NHS budget and particularly emphasises that the NHS as the UK’s largest employer should take the lead.  At 4.5 per cent, its average sickness absence rate is fifty per cent higher than the private sector. If the NHS could improve its sickness absence rate on the private sector model, it would save £1 billion a year. In terms of public health, the report emphasises the role of incentives: For individuals – through creative use of direct payments, of bonuses for healthy living and of charges for health... Fade Library blogs http://www.medworm.com/rss/comments.php?id=2305866 Mon, 30 Mar 2009 10:59:26 +0100 2305866 http://www.medworm.com/index.php?rid=2073950&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F12%2Fyale-settles.html The parade of settlements continues. The basics of this story were reported by AP:Yale University has agreed to pay $7.6 million to resolve allegations that it broke the law by mismanaging federally funded research grants, federal authorities announced Tuesday.The civil settlement with the government resolves allegations that some Yale researchers at times charged a federal grant account for costs unrelated to grant objectives. The government also alleged the researchers wrongfully charged 100 percent of their summer activity to grants when the researchers spent significant time on unrelated work.At issue were allegations that grant money was used to cover costs that did not relate to the objectives of the specific grant involved.Researchers allegedly were motivated to carry out wrongful t... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=2073950 Mon, 29 Dec 2008 16:53:00 +0100 2073950 http://www.medworm.com/index.php?rid=1990694&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F11%2Fquestions-of-benefits-vs-risks-for-upmc.html Last week, the Wall Street Journal published an investigative report on the liver transplant program at the University of Pittsburgh Medical Center which provided a troubling view of some the issues affecting US health care.Let me summarize the main points, as I would like to organize them, using quotes from the article, and my parenthetic comments.Liver Transplantation Strategies at UPMC were Aggressive and RiskyEarlier this decade, UPMC made an aggressive bid to reclaim its leadership by hiring an innovative surgeon named Amadeo Marcos, who promised to double the number of liver transplants the hospital did. Dr. Marcos delivered on his pledge. In doing so, however, he resorted to practices that some colleagues found questionable. These practices included:Lowering Standards for Donor Live... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1990694 Wed, 26 Nov 2008 18:36:00 +0100 1990694 http://www.medworm.com/index.php?rid=1951871&cid=t_105236_134_f&fid=34841&url=http%3A%2F%2Fwww.diabetesmine.com%2F2008%2F11%2Ftesting-testing-a-new-diabetes-rewards-system.html Are you on board with the notion of paying people to do the right things in life? I’m asking because I’m about to announce beta testing of a new diabetes education website that will offer incentives for engagement and progress (that means prizes to you and me). First, a bit about the whole notion of rewards: A [...] (Source: Diabetes Mine) Diabetes Mine blogs http://www.medworm.com/rss/comments.php?id=1951871 Tue, 11 Nov 2008 16:18:16 +0100 1951871 http://www.medworm.com/index.php?rid=1891916&cid=t_105236_86_f&fid=36669&url=http%3A%2F%2Ffadelibrary.wordpress.com%2F2008%2F10%2F20%2Ffinancial-incentives-healthcare-providers-and-quality-improvements%2F The Health Foundation have produced Financial incentives, healthcare providers and quality improvements which uses evidence drawn mainly from US employer studies and those providing public services directed at vulnerable communities. It considers  incentives used to promote positive behaviour change and incentives that remove financial barriers to change. Financial incentives such as prizes, payments and vouchers are the main focus of consideration. It asks whether incentives work across various clinical and public health issues.  This is relevant in the UK as UK-based trials of financial incentives are introduced finding that changes made by patients as a result of incentives tend to be short term and bringing about wholesale behaviour and lifestyle changes is a complex issue.  However... Fade Library blogs http://www.medworm.com/rss/comments.php?id=1891916 Mon, 20 Oct 2008 11:06:40 +0100 1891916 http://www.medworm.com/index.php?rid=1631012&cid=t_105236_87_f&fid=34872&url=http%3A%2F%2Fwww.healthbolt.net%2F2008%2F07%2F17%2Fcan-quit-smoking-contests-help-people-kick-the-habit%2F That’s what the Cochrane Collaboration, an international organization that evaluates medical research, wanted to find out. So they did a systematic review of 17 relevant studies that had taken place in the United States, Canada, the United Kingdom and Australia. These studies had used mostly monetary incentives to help encourage participants to quit smoking. Incentives such as … - being rewarded with one lottery ticket per day if they tossed their cigarettes down the toilet. - being offered cash incentives of $10 per month and participation in a monthly worksite lottery. - being offered cash prizes ranging from $100 to $250, along with certificates of recognition. Did it work? Not according review co-auhor Kate Cahill at the Univeristy of Oxford… “In my view, none of th... Healthbolt blogs http://www.medworm.com/rss/comments.php?id=1631012 Thu, 17 Jul 2008 10:22:43 +0100 1631012 http://www.medworm.com/index.php?rid=1416440&cid=t_105236_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F282119778%2F Especially if those kickbacks are paid by insurers that give docs incentives to switch to a generic from Lipitor. And that’s the hot issue this week in the Colorado legislature, where a bill would prevent insurers from enticing physicians with cash to prescribe fewer brand-name meds. The bill is opposed by AARP, Kaiser Permanente and the Colorado Association of Health Plans, but backed by patient advocates and Pfizer, the Associated Press reports. Pfizer lobbyist Colin Kennedy, however, declined to comment on whether the bill would benefit Pfizer financially. Nothing like candor to help vet the issues. In fact, Pfizer is scrambling to bolster its best-selling cholesterol pill and has made a point of contacting state medical associations about insurer incentives in hopes of fending o... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1416440 Fri, 02 May 2008 13:58:08 +0100 1416440 http://www.medworm.com/index.php?rid=1376681&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2008%2F04%2Fmore-wooden-headed-reimbursements-and.html The Associated Press just reported that the US Center for Medicare and Medicaid Services (CMS), which administers the Medicare single-payer insurance system for elderly and disabled Americans, just proposed a new policy for paying hospitals:Federal health officials on Monday proposed adding dangerous blood clots in the leg and eight other conditions to the list of complications that Medicare won't pay to treat if they were acquired at the hospital.Medicare set a new precedent last year by saying it would no longer pay hospitals for treating certain "never events" — conditions that occur as a result of hospital error. For example, if a patient were given the wrong blood type, Medicare would not pay the hospital more for the subsequent care a patient required. Originally, eight conditions ... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1376681 Wed, 16 Apr 2008 15:20:00 +0100 1376681 http://www.medworm.com/index.php?rid=1347623&cid=t_105236_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F263262514%2F Tax incentives used to lure - and more often keep - companies within state borders have always been controversial. New Jersey, however, has been particularly vulnerable over the past decade, because so many big drugmakers have global or US headquarters or large facilities in the Garden State and, for years, opined about building labs or factories in cheaper climes or locales where world-class teaching hospitals could be found, such as Boston. So New Jersey officials regularly ponied up. But one wag says the effort is a waste, and cites three familiar names - Bristol-Myers Squibb, Pfizer and Novartis collectively received more than $65 million in subsidies from New Jersey, but are now laying off employees and reducing their business. And so in an editorial in The Star-Ledger of New Jersey, ... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1347623 Thu, 03 Apr 2008 11:08:33 +0100 1347623 http://www.medworm.com/index.php?rid=1300627&cid=t_105236_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F250773399%2F Many long-suffering detail people are not in vogue in an era of thinning pipelines, patent expirations and sagging stock prices. Some are being tossed overboard. Still, what drugmaker can do without at least a few conscientious reps? To reward them for helping to keep the sinking ships afloat, most drugmakers dole out free trips, according to a recent survey. In fact, travel is the preferred incentive for high performers among 91 percent, while cash and gifts are handed out by 64 percent. “Travel incentives are perceived to have a greater impact on long-term performance and retention than cash alternatives,” according to Best Practices, a research firm, which queried execs from nearly two dozen drugmakers. By rewarding top performers with a free trip, which often involves allow... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1300627 Thu, 13 Mar 2008 13:56:04 +0100 1300627 http://www.medworm.com/index.php?rid=1280997&cid=t_105236_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F246101184%2F Last year, Pfizer announced it was laying off 600 workers and ending production at the historic Brooklyn factory where the company was founded back in 1849. The last employee at the Williamsburg plant will be gone by the end of this year. Yet, writes a columnist for The New York Daily News, the drugmaker is milking New York City for lucrative tax breaks by promising to create jobs - only to turn around and cut its workforce. Four years ago, Pfizer signed an agreement for nearly $10 million in tax breaks with the administration of Mayor Michael Bloomberg. In return, the company promised to increase total employment at its Manhattan headquarters and its Brooklyn plant (see photo) from 5,735 to 8,659. In 2004 alone, the first year of the agreement, Pfizer was supposed to add 1,000 jobs, colu... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=1280997 Wed, 05 Mar 2008 12:42:06 +0100 1280997 http://www.medworm.com/index.php?rid=1229205&cid=t_105236_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=1097685&cid=t_105236_87_f&fid=35052&url=http%3A%2F%2Fwomensbioethics.blogspot.com%2F2007%2F12%2Frewarding-kindness-of-strangers-or.html (Source: Women's Bioethics Blog) Women's Bioethics Blog blogs http://www.medworm.com/rss/comments.php?id=1097685 Sun, 16 Dec 2007 18:48:00 +0100 1097685 http://www.medworm.com/index.php?rid=1036876&cid=t_105236_87_f&fid=34765&url=http%3A%2F%2Fhcrenewal.blogspot.com%2F2007%2F11%2Fat-aspen-health-forum-dealing-with.html As I posted last month, I had the good fortune to be able to attend the Aspen Health Forum last month, and got to hear some presentations that were remarkably frank about some of the issues facing health care today.Just before I had to run to try to catch a plane, I attended the session entitled "Health, Humanity and Politics: Prospects for Reform." Again, I found that the speakers were remarkably frank in addressing some of the issues that we discuss on Health Care Renewal. However, many of the comments went by too fast for me to take accurate notes. The Aspen Institute just released video and audio from most of the Forum sessions. So I was able to transcribe some of the relevant thoughts.Mark Ganz, President and CEO of the Regence Group, a Blue Cross- Blue Shield affiliated health insura... Health Care Renewal blogs http://www.medworm.com/rss/comments.php?id=1036876 Mon, 19 Nov 2007 16:36:00 +0100 1036876 http://www.medworm.com/index.php?rid=987251&cid=t_105236_150_f&fid=35777&url=http%3A%2F%2Ffeeds.feedburner.com%2F%7Er%2FPharmalot%2F%7E3%2F176624082%2F This is one of the hazards that state governments risk when striking incentive deals with companies. In this case, the drugmaker was granted $4.6 million through various programs in exchange for maintaining employment at 6,900 jobs in Pennsylvania; Glaxo’s US headquarters are in Philadelphia and various facilities are located nearby. Right now, Glaxo’s employment level stands at about 7,000, but with job cuts planned the drugmaker may be on the verge of breaching its deal, according to The Philadelphia Inquirer. A Glaxo spokeswoman tells the paper that “the 6,900 is a commitment. I feel like we’re well within that, but I can’t make any commitment on what our overall numbers are going to look like.” And Dave Stout recently reiterated that Glaxo US headqu... Pharmalot blogs http://www.medworm.com/rss/comments.php?id=987251 Mon, 29 Oct 2007 11:24:02 +0100 987251 http://www.medworm.com/index.php?rid=551578&cid=t_105236_133_f&fid=35110&url=http%3A%2F%2Flisa-jedi.blogspot.com%2F2007%2F04%2Fpractical-applications.html The timing was perfect... after Monday morning's blog entry about re-thinking my expectations of Brendan, we had a regular, monthly, after-school appointment to see his psychologist. Brendan came bouncing out of school like a cork popped out of a bottle & as he piled into the car, announced that he felt like an "office-worker". He further explained that he'd gotten a lot of work done & had a bit of a headache, but his mood was quite positive, so I got the feeling that he was feeling good about his day. :) While he ate a snack, I asked him what the best part of the day had been (his weather research! Something that he'd been not very happy about before break...) & then what he'd done at lunch time, since we'd discussed this during our "food chain" conversations last week. He'd ended-up eati... Life in the New Republic blogs http://www.medworm.com/rss/comments.php?id=551578 Wed, 18 Apr 2007 14:10:00 +0100 551578 http://www.medworm.com/index.php?rid=487327&cid=t_105236_133_f&fid=35110&url=http%3A%2F%2Flisa-jedi.blogspot.com%2F2007%2F03%2Fincentives-continuing-saga.html This morning, as he took his boxer shorts out of the dresser, Brendan surprised me with a hug & a kiss :) The reason was that I had finally tie-dyed 3 pair of his new white boxers & he was quietly, but obviously, pleased. I have been making Brendan's boxers since he was in kindergarten, partly because he preferred to wear boxers & I couldn't find them in his size, partly because I made most of his clothes back then, anyway, & partly because he was so skinny that he regularly crawled out of his trousers & didn't notice. If he was wearing boxers made from fun fabrics the kids were more likely to say, "Wow, neon cats!" than laugh at him... About a year ago I made the final batch (size XL) from the KwikSew pattern for boys' boxers & went looking for a men's-sized pattern that was as easy to ma... Life in the New Republic blogs http://www.medworm.com/rss/comments.php?id=487327 Mon, 05 Mar 2007 14:18:00 +0100 487327