June 1, 2009

A different angle on all the ASCO news

Read the Forbes piece, "Are Cancer Drugs Worth The Money", for a different perspective on all the news coming out of the American Society of Clinical Oncology meeting. It begins:

ORLANDO - At the annual meeting of the American Society for Clinical Oncology, giant banners with pictures of heroic cancer patients proclaim doctors are "Personalizing Cancer Care."

But many companies seem to be maximizing cancer profit instead. Big drug companies are making big money off smaller and smaller improvements in cancer care. Newfangled cancer drugs can cost $50,000 a year, and that doesn’t mean they will add a year to the patient’s life--you might spend $50,000 for a year and extend the patient's life by only weeks.

The numbers would look better if drug companies did a better job of targeting drugs at the patients most likely to benefit. But that targeting has occurred in only a few scattered examples.

The skyrocketing costs for limited benefit are leading some experts to worry about whether the medical system has the right incentives.

"We are wasting a lot of resources treating people with treatments they don't need," says Otis Brawley, chief medical officer at the American Cancer Society.

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May 27, 2009

Battle for the soul of American medicine

Wow, what an article by Atul Gawande in the June 1 issue of The New Yorker.

He visits McAllen, Texas, "the most expensive town in the most expensive country for health care in the world."

There are dozens of vital themes in the article:

• Nobody there seemed to know that they were cost outliers.
• Everyone seemed to blame someone else for being cost outliers.
• Except one surgeon who said, "Come on, We all kow these arguments are bullshit. There is overutilization here, pure and simple."
• Doctors owning strip malls, imaging centers, surgery centers...with "entrepeneurial spirit." One surgeon said, "It's a machine, my friend."
• "Medicine has become a pig trough here," one surgeon said. "We took a wrong turn when doctors stopped being doctors and became businessmen."

Gawande concludes:

"Whom do we want in charge of managing the full complexity of medical care? We can turn to insurers (whether public or private), which have proved repeatedly that they can’t do it. Or we can turn to the local medical communities, which have proved that they can. But we have to choose someone—because, in much of the country, no one is in charge. And the result is the most wasteful and the least sustainable health-care system in the world."

This is a must-read.

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Hospital staffing cuts - pragmatic, panic or planned?

The Minnesota Nurses Association posted that headline on its website, followed by an article that asserts:

"As the world sits on the brink of a pandemic flu outbreak, Minnesota’s hospitals are attempting to reduce the ranks of personnel most skilled to address emergency health needs.

Minnesota Nurses Association, the union representing more than 20,000 Registered Nurses in 89 bargaining units across the state, has received demands from nine hospitals to reopen contracts regarding wages. In the metro area, more than 100 MNA members have been laid off from their jobs since December 2008. The economic situation sounds dire as employers raise concerns about rising uncompensated care, proposed state budget cuts and dips in census and investments.

"We’re not buying it," said MNA President Linda Slattengren. "Yes, we are pushing back at a time when our family and friends have all suffered from layoffs in this economic downturn. Yes, we are saying no to these demands from our employers."

Why? Call nurses cautious – skeptics perhaps. As 24/7 bedside providers, nurses know patient census fluctuates, sometimes wildly, as in the case of a pandemic. The hospital industry has not proven their case to MNA members, who express doubts because hospital administrative judgment has proven to be, all too often, less than stellar when it comes to the safety of patients in our care.

"North Memorial Hospital, where I work, enjoyed a nearly $179 million net profit over the last six years said Pam Scott, RN. "But due to decisions like purchasing NowCare for $3 million in 2008 and reporting a $4 million loss in the latest financial statement, we have our doubts about the wisdom of administrative choices. "My question: Isn’t the purpose of reserves to accommodate more unexpected circumstances, such as economic pressures?"

The medical arms race is alive and well in Minnesota, as hospitals have rushed to compete with each other by providing the latest gadgetry or architecturally-inspired surroundings. "They’ve projected at least $300 million in construction costs for the next three years at Children’s Hospitals and Clinics," said Melissa Hansing, RN, MNA Tri-Chair and staff nurse in Children’s emergency department. "My questions: Bricks and mortar may impress financiers, but what is going on behind the walls? Aren’t critically ill patients being attended to by overworked, fatigued nursing personnel who simply do not have enough colleagues on each shift? How do you justify cutting corners on skilled personnel at the bedside, when studies conclusively prove the increased risk to patients when staffing is not adequate?" ...

Our question: what cuts in salary have the administrative staffs taken recently?"

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May 14, 2009

More vested interest vilification of virtual colonscopy decision

The Colon Cancer Alliance has distributed a statement of disappointment over Medicare’s decision not to pay for virtual colonoscopy.

Let's do a reality check on what they say in that statement.

"This decision now leaves millions of older Americans exposed to a higher risk of colon cancer.”

• Nope. Not one bit higher than it was the day before the decision was made. The risk is the same. Ridiculous fear-mongering rhetoric.

“It also exacerbates an unequal standard of care between Medicare beneficiaries, who do not have the choice to undergo a virtual colonoscopy, and those with private insurance who do.”

• Euphemism for rationing – battle cry of almost any anti-health care reform movement.

"By denying coverage for virtual colonoscopy, CMS is sending the signal that increased screening amongst the Medicare beneficiary population is unimportant.”
• Hmmm. I didn’t get that signal at all. I heard a signal of “show me the evidence in a Medicare population.” Period. There's no denial of payment for methods WITH solid evidence in a Medicare population.

By the way, the Colon Cancer Alliance is sponsored by a host of drug companies and by GE Healthcare, which makes and sells virtual colonoscopy machines.

Let's be clear: I don't have a dog in this hunt. I have nothing to gain or lose by Medicare's payment decisions - no more than any other taxpayer. But I can't stand the rhetoric. And I'm going to write about it whenever I have the chance.

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May 7, 2009

Does the Twin Cities need five children's hospitals?

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This story has barely been touched by local Twin Cities news organizations. But a student journalist, Emma Carew, reported on it as her last story at the Minnesota Daily before graduating and before going to work for the Washington Post this summer.

As you'll see, the story touches on issues of duplication of services, increased costs, competition and the medical arms race.

A 1,200-word story by a student journalist on an important topic for local discussion.

In the inquisitiveness and determination of young journalists, there is hope for health care journalism. This is one shining example.

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May 1, 2009

NJ hospital reverses its ban on newspaper that asked tough questions

Intro to Hospital Public Relations: How to learn from bad examples.

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April 23, 2009

Documentary screening: Money-Driven Medicine

Minnesotans, wake up from your winter doldrums and get your heads around health care reform issues.

Tomorrow (Friday April 24) - free documentary screening of Alex Gibney's film on Maggie Mahar's book , "Money-Driven Medicine."

Link to map of Murphy Hall location. Parking in Washington Avenue ramp two blocks east of this location.

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April 21, 2009

Industry lining up lobbyists to fight comparative effectiveness

Howard Brody asks, "Why Is Industry So Scared of Finding Out What Really Works?"

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April 10, 2009

Big bucks on display at American College of Cardiology meeting

From the weekly newsletter of former US Senator David Durenberger (R-Minn.) at the National Institute for Health Policy at the University of St. Thomas:

At the recent meeting of the American College of Cardiology in Orlando, FL., 340 health companies paid $6 million for exhibit space. Of that, $3 million, plus another $1 million from medical drug/device industry went to the ACC to reduce the cost of attending the conference for cardiologists (who are among the highest income specialists in the country). The Pew Charitable Trusts have funded work by Columbia University physician David Rothman and others into the issue of appearance of conflict of interest at the intersection of medical education and medical decision-making. The resistance from doctors is enormous, because the financial rewards have always been very substantial.

That's the rationale behind every politician, every corporate CEO and every professional who claims "I can't be bought," while at the same time admitting they can't live without it.

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March 29, 2009

Two of the new realities in the business of health care

Bad debt and bad debt. Two of the themes in two health care stories in the Star Tribune today. (Neither of the two links below this paragraph will take you to the complete story. The paper is reserving some content for the hard copy newspaper first - subject of an editor's note in the paper today.)

Laid-off Minnesotans and those with jobs but without insurance have ballooned the number of individual health insurance plans that insurers are selling.

And hospitals are using new billing tactics to battle rising bad debt - tactics that surprise some who don't associate this with health care.

Meantime, congratulations to the Star Tribune team of Josephine Marcotty, Chen May Yee, Warren Wolfe and Maura Lerner for winning a National Headliner Award for their project, "Your Choice: Health Care's New Era."

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March 22, 2009

Consumer confusion over how much a CT scan costs

Whistleblower column in Star Tribune tells important little story about how lost consumers can be in the alleged consumer-driven health care era.

The Strib should note that at 9 a.m. there are already 58 comments online about this column. They - and other US news organizations - should give more voice to the voiceless, confused and angry health care consumer.


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November 25, 2008

Gotta have a robot to compete

Paul Levy. President and CEO of Beth Israel Deaconess Medical Center in Boston, blogs about keeping up with the Joneses in the medical arms race. He wrote:

"Many months ago, I wrote about the da Vinci Robot Surgical System and expressed doubts about whether there was evidence to support the clinical efficacy of this equipment, as opposed to the marketing efficacy of the company selling it. Well, the time has come to graciously say, "Uncle!"

Without making any representations about the relative clinical value of this robotic system versus manual laparoscopic surgery, I am writing to let you know we have decided to buy one for our hospital.

Why? Well, in simple terms, because virtually all the academic medical centers and many community hospitals in the Boston area have bought one. Patients who are otherwise loyal to our hospital and our doctors are transferring their surgical treatments to other places.

Prospective residents who are trying to decide where to have their surgical training look upon our lack of the robot as a deficit in our education program. Prospective physician recruits feel likewise. And, these factors are now spreading beyond urology into the field of gynecological surgery. So as a matter of good business planning, concern for the quality of our training program, and to continue to attract and retain the best possible doctors, the decision was made for us.

So there you have it. This is an illustrative story of the health care system in which we operate."


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September 10, 2008

More health care choices don't mean lower prices

In a study published in the journal Health Affairs (subscription required) and reported in the Star Tribune, there's another challenge to the notion that more choice in health care lowers costs.

Excerpts from the Star Tribune:

Going to a MinuteClinic is cheaper for patients than going to a physician's office or urgent care, but there is no evidence that the advent of the popular retail clinics reduced medical costs overall.

A study published today found prices charged by all providers rose by double digits over the four years tracked, a trend that went against the conventional wisdom that more providers leads to more competition and lower prices. ...

"The data does not support the idea that MinuteClinic or other retail clinics has had any negative impact on rising health-care costs," said the study's author, Dr. Marcus Thygeson, an associate medical director at HealthPartners.

Even if a large number of HealthPartners members switched to retail clinics, the immediate savings would be relatively small, Thygeson said.

What tends to happen, he said, is other providers will raise their charges to make up for lost revenue.

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September 2, 2008

The Downs side of health info on the Web

Longtime TV celebrity Hugh Downs is apparently promoting cures for just about anything. A website with his name and face on it proclaims "2,618 staggering breakthroughs" from "the greatest medical team ever assembled."

The site offers:

•bypass in a pill
• cure high blood pressure in hours
• Secret Super Vaccines Beat Prostate Cancer...Breast, Lung and Brain Cancer, Too!
• and much more.

The site says, "Hurry! You'll Never See This Offer on TV." Thank God.

Let's hope Downs didn't really lend (or sell) his name to this effort.

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August 15, 2008

Hospital ads and hospital hype

See Maggie Mahar's entry on the HealthBeat blog.

And for a little wisdom of the crowd, here is one online reader reaction to Maggie's post:

"Our local CBS station has a regular feature called "Breakthroughs Everyday" featuring one healthcare network. I've written to the news director at this station requesting, in the interests of fair and impartial journalism, that they also have a regular feature entitled "Failures Everyday" and start reporting on the stories of patients from the same hospital. No reply. ... The hospital PR has disgusted me for years."

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August 14, 2008

Big business in snoring and apnea

I've been waiting for someone to do a story on the amount of attention and money that's being spent on snoring and sleep apnea, and a USA Today story comes closest to what I've been waiting for.

The story explains that Medicare approved $571 million in payments for devices called continuous positive airway pressure (CPAP) machines last year, up from $291 million in 2004. The story explains that "Spending could grow even faster under a new federal rule that makes it easier for patients to get the devices by testing for sleep apnea at home rather than in a sleep testing lab."

The story raises some important questions:

Some experts warn there is a potential for unneeded prescriptions for CPAPs. "Are people getting treatment they don't need?" asks Fred Holt of the National Health Care Anti-Fraud Association, composed of health insurers and law enforcement groups.

"Not everyone with a diagnosis of sleep apnea needs CPAP," says Holt, an ear, nose and throat surgeon. "Weight loss, avoiding alcohol and sedatives at bedtime or changing sleep position could eliminate the problem for some."

For others, treatment involves sleeping with a mask connected to the CPAP machine, which blows air into the patient's nose, helping prevent obstruction to breathing.

Until this spring, Medicare would pay for CPAP machines only if a sleep center diagnosed patients with apnea. New rules say a diagnosis can be made with a test taken at home.

Opponents say home testing is less accurate. "To be adequately treated, you have to make sure patients are adequately diagnosed," says Mary Susan Esther, president of the American Academy of Sleep Medicine, a trade group representing sleep labs.

Proponents such as William Abraham, a sleep expert and chief of the division of cardiovascular medicine at Ohio State University, say the change makes it possible for more patients to get tested.

"By allowing home testing, perhaps Medicare is opening the floodgates," he says. Yet given the problems of untreated apnea, "it's not only the right thing to do, but may ultimately prove to be a cost savings."

Still, any time you hear about more testing, and with financial incentives to test and to treat, you should know that the risk for abuse, and for unnecessary testing, treatment and spending is high.

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August 4, 2008

Would you like first class or second class skin care?

In case you missed it, the New York Times last week reported on how dermatology "is fast becoming a two-tier business in which higher-paying customers often receive greater pampering." Excerpt:

"In some dermatologists’ offices, freer-spending cosmetic patients are given appointments more quickly than medical patients for whom health insurance pays fixed reimbursement fees.

In other offices, cosmetic patients spend more time with a doctor. And in still others, doctors employ a special receptionist, called a cosmetic concierge, for their beauty patients.

Dr. David M. Pariser, a dermatologist in Norfolk, Va., and the president-elect of the American Academy of Dermatology, said some practices did maintain preferential policies for cosmetic patients.

“The message is that the cosmetic patient is more important than the medical patient, and that’s not a good message,? Dr. Pariser said.

At a time when dermatologists are trying to advance the idea of a national skin cancer epidemic, such a two-tier system is raising concerns that the coddling of beauty patients may divert attention from skin diseases."

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July 30, 2008

More MRI & imaging centers - do we ever say "NO"?

A few days ago, the Star Tribune reported on plans for still another diagnostic imaging center in a Minneapolis suburb that has more MRI machines than in many entire countries. Excerpt:

Along a two-mile stretch of France Avenue in Edina, medical providers have installed so many powerful magnetic resonance imaging (MRI) scanners that radiologists joke that anyone driving through with a pacemaker should beware.

Come September, there'll be a new one. ...

Its opening is likely to reignite a debate on whether Minnesota has too many diagnostic imaging facilities, encouraging doctors to order unnecessary procedures and pushing up medical costs. It's also likely to raise the ethically thorny question of whether doctors should refer patients to a facility in which they have a financial stake.

"Imaging has been an area of concern for a long time," said Julie Sonier, director of the Minnesota Department of Health's health economics program, which does reviews of major medical investments. "Issues about the concentration in Edina have also been a concern for some time."

A 2007 Health Department report said there was anecdotal evidence in Minnesota that physician investments in facilities led to financial conflicts of interest and overuse.

Among the reader responses are these:

• As a patient, how do you know that you really need a test that may be uncomfortable, that might have some risk associated, that might have radiation exposure associated, and that you might have to pay for when you know that the person telling you you need it stands to make up to $1000 just for suggesting it? The answer is you can't. This practice is a pox on medicine.

• There are as many MRI scanners in the Twin Cities as in all of Canada. Is the health of Canadians compromised by fewer imaging studies? Obviously not. There is no relationship between the number of tests and procedures performed in medical care and the health outcomes of the patients. More medical care is not better care. The Health Department should carefully examine the merits of this expansion of imaging services.
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July 2, 2008

UnitedHealth faces the music

The Associated Press reports:

UnitedHealth Group Inc. will cut at least 4,000 jobs, or 5 percent of its workforce, in a restructuring and warned Wednesday that a weaker environment and higher costs will cut into profits this year. ... The company also said it will pay $895 million to settle lawsuits over stock options backdating, and will pay $17 million into a fund in an agreement to resolve a suit related to the Employee Retirement Income Security Act. ...

The options settlement stems from a 2006 complaint filed in U.S. District Court in Minnesota. The California Public Employees Retirement System (CalPERS) and Alaska Plumbing and Pipefitting Industry Pension Trust, the lead plaintiffs, argued that the backdating cost shareholders money.

The scandal ultimately forced out Bill McGuire, UnitedHealth's chief executive.

Hemsley said the settlement helps the company avoid more costly litigation.

Ramzi Abadou, an attorney representing CalPERS, called it "a significant, epic settlement" that far exceeded previous payouts in options backdating lawsuits. ...

McGuire is not part of the settlement. His attorney, David Brodsky, issued a statement saying McGuire will continue to fight "because he is not liable for any alleged shareholder losses."

Also see reader comments coming in to the Star Tribune website. Some examples:

• This was bound to happen due to their corporate greed. This company is imploding and as a former employee who knew well enough to get the hell out, I am happy to see it. Enough of these CEO's and the like making mulit-million dollar salaries at the expense of the little people, both employees and policy holders.
• How dumb do corporate PR departments think we are? They try to blame market conditions, but don't you think having to pay $895 million due to the backdating scandal has an impact on "rising costs". 4,000 jobs gone because of the illegal actions of a few people at the top. They pay out of their excess, and the rest pay with their jobs. Yeah, United Health!
• Mcguire "not responsible for alleged shareholder losses" - I love that quote! He certainly was willing to take credit (and MAJOR cash - 93m one year?) for shareholder gains! Seems to be a running theme - small groups of people making huge rewards but as soon as the money goes away they bail, leaving the taxpayers and shareholders to cover the loss. Some pundit on the radio said it well - our nation is one where we are capitalists when it comes to rewards but socialist about risk. one more way the average citizen gets shafted.
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April 5, 2008

Nonprofit hospitals as profit machines

The Wall Street Journal story, "Nonprofit hospitals, once for the poor, strike it rich," should be required reading for anyone who wants to understand the current hospital industry.
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Excerpts from the story:
• one nonprofit hospital system has a treasure chest of $7.4 billion - more than many large, publicly traded companies;
• the CEO of Northwestern Memorial Hospital in Chicago recently received a $16.4 million payout while the hospital spent $20.8 million on charity care - less than 2% of its revenues and a fraction of what it received in tax breaks;
• one nonprofit hospital system counts the salaries of its employees as a "community benefit" - including the $1.8 million in CEO compensation;
•"Nonprofit is a misnomer - it's nontaxable," says the president of a small for-profit hospital in a poor neighborhood on Chicago's west side. "When you're making hundred of millions of dollars a year, how can you call yourself a not-for-profit?"

Posted by schwitz at 7:11 AM | Comments (3)
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