One doctor described the losses he and his office associates will incur under the 21% professional fee reduction that the Medicare law has put into place. In this recession, they will have to cut staff, cut services to those who cannot afford to pay them (the federal government has just cost-shifted its reduction to the full-pay population, but perhaps you had not noticed) and are entertaining the question of how to reduce the number of Medicare patients who now take up office space and time but don't bring in the revenue to pay office bills. All of the doctors seemed bothered by the American Medical Association's inability, or unwillingness, to represent their professional interests and one astute observer noted that the Association has long outlived the purpose for which it was founded and seems much more interested in perpetuating itself and its bureaurocracy now. One of the few people at the table who still is an AMA member declared his intention to quit the organization, which was not a surprise to the others who had made that decision some time ago.
None of the doctors believed that the health insurance industry would provide payment for the care that sick people need and they shared their experiences of hearing patients tell them that they could not longer afford health insurance because they were being priced out of the market, a problem not resolved by current health care reform legislation. There was cynicism about the insurers underwriting practices which would make insurance available to the sick, but at an unaffordable cost.
What were the doctors in favor of? All seemed to support a single payer system and there was hope that the current health reform is a transition to that system. The single payer system takes inefficiencies perpetuated by insurance companies out of the system and uses dollars to pay for care, not executive suites and unconscionable administrative overhead (link requires Medscape password which few readers may have).
Thursday, April 22, 2010
Tuesday, April 20, 2010
The Coming Intersection of Health Care and the New Financial Industry?
The financial industry knew what it was doing when it capitalized on mortgage failure. By culling out predictably failing mortgages, selling them to their witless customers, and then betting against those very same customers, the financial industry demonstrated mastery of the complexities of double-crossing the people who were dumb enough to believe that the guys in the sharp pinstriped suits really intended to honor the fiduciary obligation that their relationship inferred.
Now that their "failing mortgage"game has been exposed the financial people are going to have to find another way to sucker the dim-witted trusting public. And health care- particularly "failing health" - may be just the ticket.
Like mortgage insurers, certain health insurers may be ripe for the picking. As they acquire sicker and sicker populations under health care reform, and their profit and loss statements turn to negative and balance sheets show lots of red ink, savvy financial people can sell those insurers' stock short and then, when the sick population starts to die off, repurchase the now- bargain stock at rock bottom prices, assuming that the now healthy list of subscribers will pay premiums but not use expensive services. High-cost high-quality hospitals, which will not be fully reimbursed by insurers or the government, will be ripe for well-heeled financial people's picking; and just as was done in other industries, hospitals' assets including land, high-tech equipment and other items can be resold at an unbundled profit. Interesting acquisition targets will be health care organizations that don't take care of very sick people and have lots of physicians and other personnel who can process a great many people without being distracted by serious illness such as cancer, heart disease, expensive genetic disorders and hard-to-treat mental illnesses.
Investments in pharmaceutical companies will favor those which don't spend much on research, but do generate steady profits from selling drugs for chronic conditions which allow people to have long uncomfortable lives. Financial people will have no interest in antibiotics for an outbreak of the next plague; they want drugs that will keep you taking pills from the company they invest in for the rest of your miserable life. No cure; just steady income is what brings smiles financial peoples' faces.
Perhaps some financial people will take out advertisements to attract patients to insurers, hospitals, health systems and providers whom they want to drive into insolvency as they invest in insurers, hospitals, health systems and providers who provide little care, but generate substantial profits for their financial investors. So some night, when you are watching TV pitchmen at 2 AM, they won't be selling you knives or frying pans, they'll be selling you failing health that brings profits to their advertisers.
Limitless opportunities will be there for those aggressive enough to invest in failing health. And then there's the funeral industry . . . .
Now that their "failing mortgage"game has been exposed the financial people are going to have to find another way to sucker the dim-witted trusting public. And health care- particularly "failing health" - may be just the ticket.
Like mortgage insurers, certain health insurers may be ripe for the picking. As they acquire sicker and sicker populations under health care reform, and their profit and loss statements turn to negative and balance sheets show lots of red ink, savvy financial people can sell those insurers' stock short and then, when the sick population starts to die off, repurchase the now- bargain stock at rock bottom prices, assuming that the now healthy list of subscribers will pay premiums but not use expensive services. High-cost high-quality hospitals, which will not be fully reimbursed by insurers or the government, will be ripe for well-heeled financial people's picking; and just as was done in other industries, hospitals' assets including land, high-tech equipment and other items can be resold at an unbundled profit. Interesting acquisition targets will be health care organizations that don't take care of very sick people and have lots of physicians and other personnel who can process a great many people without being distracted by serious illness such as cancer, heart disease, expensive genetic disorders and hard-to-treat mental illnesses.
Investments in pharmaceutical companies will favor those which don't spend much on research, but do generate steady profits from selling drugs for chronic conditions which allow people to have long uncomfortable lives. Financial people will have no interest in antibiotics for an outbreak of the next plague; they want drugs that will keep you taking pills from the company they invest in for the rest of your miserable life. No cure; just steady income is what brings smiles financial peoples' faces.
Perhaps some financial people will take out advertisements to attract patients to insurers, hospitals, health systems and providers whom they want to drive into insolvency as they invest in insurers, hospitals, health systems and providers who provide little care, but generate substantial profits for their financial investors. So some night, when you are watching TV pitchmen at 2 AM, they won't be selling you knives or frying pans, they'll be selling you failing health that brings profits to their advertisers.
Limitless opportunities will be there for those aggressive enough to invest in failing health. And then there's the funeral industry . . . .
Thursday, April 15, 2010
Doctors' Lunch
A small group gathered for Thursday lunch, chatting about their concerns relating to "Health Reform," whether they anticipated difficulty in maintaining their incomes and whether they should be thinking about other career opportunities. Questions were directed to the drug company representative who provided lunch about opportunities to work for the drug company he represented, as experienced, well-trained, competent doctors articulated serious thoughts about leaving practice.
The drug company representative talked about his product, a monoclonal antibody given by injection, for treatment of arthritis targeted, at this time, for patients who fail on other drugs, even those of the same class. A kidney doctor asked about use of the drug in his field because of the high levels of inflammatory substances which might be susceptible to its effects and a similar question was asked by a pulmonary doctor who mentioned that for certain severe lung diseases there were very few treatments available. The representative was asked about the cost of the drug, eliciting a response of $1,000 - $2,000 a month, depending on dose. One doctor asked why many of the drugs of the general class seemed to be priced about the same and whether there was an agreement among the various manufacturers about target pricing. The drug representative said that he wasn't aware of any such agreement and that this wasn't an area where he had any information. Several of the doctors agreed that their patients who receive samples or low-cost initial ("come-on") supplies of this class of drugs can't afford to buy the drugs when their initial supplies are exhausted and leave their treatment programs. The analogy was made to illicit drug-dealers luring new customers for marijuana with low cost introductory deals.
Considering the high cost, and significant risk of serious side-effects, of the drug, the representative was asked whether there were any tests, such as genetic markers, which would predict which patient would benefit from the drug and which would not. He indicated that this was a subject of intense interest for his company, but there were no genetic tests available, to his knowledge.
If there were predictive genetic tests, they would probably reduce the number of prescriptions for the expensive monoclonal antibody since rheumatoid arthritis patients currently being considered for treatment first receive a prescription and then are removed from the medicine if they do not respond (rather than never get it). It would pose an interesting dilemma for health insurance companies which can now say that they won't approve the expensive drug without evidence of effectiveness of specific therapeutic benefit, and if there were genetic markers indicating a high likelihood of success, would have difficulty maintaining that position.
The drug company representative talked about his product, a monoclonal antibody given by injection, for treatment of arthritis targeted, at this time, for patients who fail on other drugs, even those of the same class. A kidney doctor asked about use of the drug in his field because of the high levels of inflammatory substances which might be susceptible to its effects and a similar question was asked by a pulmonary doctor who mentioned that for certain severe lung diseases there were very few treatments available. The representative was asked about the cost of the drug, eliciting a response of $1,000 - $2,000 a month, depending on dose. One doctor asked why many of the drugs of the general class seemed to be priced about the same and whether there was an agreement among the various manufacturers about target pricing. The drug representative said that he wasn't aware of any such agreement and that this wasn't an area where he had any information. Several of the doctors agreed that their patients who receive samples or low-cost initial ("come-on") supplies of this class of drugs can't afford to buy the drugs when their initial supplies are exhausted and leave their treatment programs. The analogy was made to illicit drug-dealers luring new customers for marijuana with low cost introductory deals.
Considering the high cost, and significant risk of serious side-effects, of the drug, the representative was asked whether there were any tests, such as genetic markers, which would predict which patient would benefit from the drug and which would not. He indicated that this was a subject of intense interest for his company, but there were no genetic tests available, to his knowledge.
If there were predictive genetic tests, they would probably reduce the number of prescriptions for the expensive monoclonal antibody since rheumatoid arthritis patients currently being considered for treatment first receive a prescription and then are removed from the medicine if they do not respond (rather than never get it). It would pose an interesting dilemma for health insurance companies which can now say that they won't approve the expensive drug without evidence of effectiveness of specific therapeutic benefit, and if there were genetic markers indicating a high likelihood of success, would have difficulty maintaining that position.
Saturday, April 10, 2010
A Solution To Prevent Deafness
From 8-9 AM on Mondays, I saw a stream of young people for "industrial pre-hires." During these exams I did a simple hearing test consisting of rubbing my fingers near a patient's ear or holding up a ticking watch and asking "do you hear this"? When the answer was "no", my next questions were "are you a musician" and "did you have a gig this weekend"? The answers were usually "yes" and I would take a few moments to explain that these young musicians were losing their hearing from the trauma of the loud music they were playing and that they needed protection from the noise.
A friend, a well-known Silicon Valley caterer, and I were discussing my experience when he explained his solution to protecting his employees from loud music at parties, weddings, bar mitzvahs and other events. He carried a pair of insulated wire clippers in his pocket to all of his catering functions. If the music was too loud, he told the band leader "this is warning #1, reduce the sound level." If the band leader complied, that was the end of the matter. If not, he got warning #2. There was no warning #3: my friend simply took his wire clippers and cut the leads to the amplifier. He was never attacked (he was a physically imposing fellow) and he never ran into the same problem when he and the band leader were working at another function: the music level was reasonable.
My friend was aware that band leaders didn't know that their music was too loud because they were already deaf. They didn't have the slightest idea of the volume.
My friend's concerns were his employees and their hearing well-being, as well as the guests whom he was serving. Musicians (including band leaders and conductors) and all those exposed to loud noises are at a high risk of permanent hearing loss and progressive disability from deafness. A sensible "health care reform" step would be enforceable national, state and local standards on industrial and commercial noise exposure to protect the hearing of workers and others (including our kids) and the requirement that low-cost hearing protective devices (ear plugs) be made available to all exposed to loud commercial noise. Not only will hearing and function be preserved, but the significant social cost of hearing-aids (rarely fully insured and not covered by Medicare at all) would be reduced.
The cost of the insulated clippers: about $3.00. Hearing: priceless.
A friend, a well-known Silicon Valley caterer, and I were discussing my experience when he explained his solution to protecting his employees from loud music at parties, weddings, bar mitzvahs and other events. He carried a pair of insulated wire clippers in his pocket to all of his catering functions. If the music was too loud, he told the band leader "this is warning #1, reduce the sound level." If the band leader complied, that was the end of the matter. If not, he got warning #2. There was no warning #3: my friend simply took his wire clippers and cut the leads to the amplifier. He was never attacked (he was a physically imposing fellow) and he never ran into the same problem when he and the band leader were working at another function: the music level was reasonable.
My friend was aware that band leaders didn't know that their music was too loud because they were already deaf. They didn't have the slightest idea of the volume.
My friend's concerns were his employees and their hearing well-being, as well as the guests whom he was serving. Musicians (including band leaders and conductors) and all those exposed to loud noises are at a high risk of permanent hearing loss and progressive disability from deafness. A sensible "health care reform" step would be enforceable national, state and local standards on industrial and commercial noise exposure to protect the hearing of workers and others (including our kids) and the requirement that low-cost hearing protective devices (ear plugs) be made available to all exposed to loud commercial noise. Not only will hearing and function be preserved, but the significant social cost of hearing-aids (rarely fully insured and not covered by Medicare at all) would be reduced.
The cost of the insulated clippers: about $3.00. Hearing: priceless.
Monday, April 5, 2010
Would "They" Tell You That Their Asthma Medicine Might Kill You?
If you haven't noticed, there are lots of asthma medicine advertisements on television. These ads are skilfully put-together, are richly endowed with subliminal messages which play tricks with your mind, and show individuals of all ages, races, ethnicities and genders mightily relieved with just a few puffs from that magic inhaler.
But beware! If you have asthma and are using a "Long-Acting Beta-Agonist" ("LABA") as sole therapy, without supervision by a physician who has current training and knowledge in treating asthma (that means, the physician doesn't just get his information from a drug company representative or industry-sponsored education program), you may be placed at a small but serious risk of death from the medicine you inhale. Two publications,The New England Journal of Medicine and the Medical Letter have recently highlighted the reasons for the FDA's specific label change requirements for LABA drugs, The FDA label requirement, among others, contraindicates the use of a LABA without concomitant use of an asthma-controller medicine such as an inhaled corticosteroid and indicates the use of the controller medicine, without the LABA, once asthma control is achieved or for someone whose asthma is controlled by the controller medicines.
If you are using a LABA, speak to your doctor about the risk of death from the medicine. Ask whether he or she is familiar with the current FDA label requirements. If your doctor is not familiar with these changes, and the reasons for them,ask your doctor to send you for consultation with a pulmonary physician who has lots of current knowledge and experience treating asthma. Your doctors will tell you the truth, but will the drug companies? Watch a few TV ads and decide for yourself.
But beware! If you have asthma and are using a "Long-Acting Beta-Agonist" ("LABA") as sole therapy, without supervision by a physician who has current training and knowledge in treating asthma (that means, the physician doesn't just get his information from a drug company representative or industry-sponsored education program), you may be placed at a small but serious risk of death from the medicine you inhale. Two publications,The New England Journal of Medicine and the Medical Letter have recently highlighted the reasons for the FDA's specific label change requirements for LABA drugs, The FDA label requirement, among others, contraindicates the use of a LABA without concomitant use of an asthma-controller medicine such as an inhaled corticosteroid and indicates the use of the controller medicine, without the LABA, once asthma control is achieved or for someone whose asthma is controlled by the controller medicines.
If you are using a LABA, speak to your doctor about the risk of death from the medicine. Ask whether he or she is familiar with the current FDA label requirements. If your doctor is not familiar with these changes, and the reasons for them,ask your doctor to send you for consultation with a pulmonary physician who has lots of current knowledge and experience treating asthma. Your doctors will tell you the truth, but will the drug companies? Watch a few TV ads and decide for yourself.
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