Globe: Justice to investigate Partners Healthcare

The Boston Globe reports this morning that the Justice Department is investigating Partners Healthcare  for “anticompetitive behavior.”

In a letter sent to Partners and the state’s three largest health insurers on April 19, investigators from the Justice Department’s antitrust division demanded documents relating to Partners’ “contracting and other practices in health care markets in Eastern Massachusetts.’’

The letter, obtained by the Globe, said the probe sought to determine whether the practices violated the Sherman Antitrust Act, which bars companies from using their market power to limit trade or artificially raise prices. The parties were told to respond by May 19.

Partners responded  by saying the company was cooperating in the investigation, which a spokesman described as ”an ongoing analysis of health care in Massachusetts.’’

The group, which owns MGH, the Brigham and a more, is the biggest health care player in the state. Investigations by both the Globe and the state’s attorney general suggest that Partners’ market power and high prices are fueling high health costs in the state and limiting competition. Partners responded to the Globe series on its own website.

All that’s changing now. Stay tuned.

If all that is too depressing, John Stewart has collected all his Daily Show reports on health care on one page with titles like “Men who Stare at Votes.”

For the humorous take on health reform from the other side, see comments by former Saturday Night Live cast members Victoria Jackson, who performed with the Tea Party Express,  and Fox regular Dennis Miller.

Getting the most out of the ER

I know I’m supposed to call it ED, but…

A Boston coalition of hospitals, insurers, clinics and patient advocates has been chosen by the Robert Wood Johnson Foundation as part of a program called “Aligning Forces for Quality (AF4Q),” described in a press release as an “unprecedented effort to lift the quality of health care provided in select communities nationwide.”

 BHN thinks they buried the lead a bit. The group’s first effort with be to reduce “preventable emergency department visits and associated admissions.” According to the group, preventable ED visits offer a measure of access to primary care, “primary care effectiveness, appropriate treatment in community settings, and system integration.”

 In other words, some people with no insurance wait until they are seriously ill and show up at the emergency room. They are sicker and their care is more expensive than it would have been at an earlier stage in a doctor’s office.  Others say they just can’t get an appointment with a primary care doc.

 According to a recent review of the data “Prevalence of inappropriate ED use varied from 20 to 40% and was associated with age and income. Female patients, those without co-morbidities, without a regular physician, without a regular source of care, and those not referred to the ED by a physician also showed more inappropriate ED use.”

MGH and the rise of psych meds

Tuft psychiatrist and blogger Daniel Carlat details how his education at Mass General focused on medication over therapy. In tomorrow’s NYTimes Magazine features his story  “Mind over Meds: How I decided my psychiatry patients needed more from me than prescriptions.”

He takes us back to MGH to explain.

 …(On)a steamy July day in 1992, I stood on a Boston street, far from home, gazing at Massachusetts General Hospital (known as M.G.H.), where I was about to start my training.

This was a momentous time at M.G.H. Prozac was introduced four years earlier and became the best-selling psychiatric medication of all time. Zoloft and Paxil, two similar medications, were in the pipeline, and many of the key clinical trials for these antidepressants were conducted by psychiatrists at M.G.H. who were to become my mentors. M.G.H. and other top programs were enthralled with neurobiology, the new medications and the millions of dollars in industry grants that accompanied them. It was hard not to get caught up in the excitement of the drug approach to treatment. Psychopharmacology was infinitely easier to master than therapy, because it involved a teachable, systematic method. First, we memorized the DSM criteria for the major disorders, then we learned how to ask the patient the right questions, then we pieced together a diagnosis and finally we matched a medication with the symptoms.

 BHN links to his blog — to your right –  at  “Pharma and med ed”

For more on MGH psychiatrists’ excitement over those industry grants, see The Boston Globe’s reporting on pharma funding and conflicts of interest at MGH.

Tipping point for health costs in Mass?

BHN is not a fan of the overused term “tipping point.”  But, it works here.

Let’s connect the dots. 

The Globe‘s reports on back room deals at Partners, the hospital giant that helps fuels the regions high health care costs high. The ever-looming high costs of care in Mass.  The state’s – and now the public’s -- stake in high health costs. The insurance industry attempt to raise some rates for small businesses by, in some cases, more than 30 percent.

 Tipping point?

 The state says no to high rates.  Insurers sue – and lose — but some start dropping high-cost hospitals. Partners — facing pressure for running thos high-costs hospitals – chips in $40 million for small businesses insurers.  And the state has a plan to cut waste by rewarding docs for who cure patients, not those who order lots of tests.

 BHN  was going to put all these pieces together. But the New York Time did it in yesterday’s staff editorial.

  When Massachusetts’s politicians designed their reform, they calculated that achieving near-universal coverage first would then give all participants in the health care system an incentive to help rein in costs. There are encouraging signs that that is starting to happen.

 

Surviving the Boston Marathon

Some people would rather die that run a marathon. Others run the marathon and almost die.

 Here’s how Bostonians try to make sure runners avoid the big finish line in the sky.

 From the Boston Athletic Association, sponsor of the Boston Marathon

 The Athletes’ Village will have two medical tents that can offer assistance with most last-minute medical needs. Band-Aids, Vaseline, a pre-race stretch, or just a word of encouragement can be offered by our medical team….

 Write down your current or pre-event weight on the back of your bib. This figure may help us determine if you have been over-drinking during the event. Scales will be available at both medical tents…

The American Red Cross provides 26 medical aid stations strategically located along the course. Each tent is staffed with a variety of medical professionals, offering basic first aid to those in need. Course medical coverage is supported with ambulances and EMS bike teams provided by Fallon Ambulance, AMR and Cataldo Ambulance Company…

Medical sweep buses are positioned along the course aid stations. These buses are available to those runners that cannot finish the race and/or may have a minor medical problem. Each bus is staffed by medical volunteers who are available to provide first aid. A runner may choose to rest on the bus while it is parked at a first aid station. However, once the bus begins to move, the runner’s chip will be removed, once this occurs the runner may not re-enter the course to complete the marathon …

Medical teams are located at the finish line… Medical personnel can be identified by their red volunteer jackets: If you are injured or feeling ill, please seek out a member of the medical team for assistance…

Massage Therapy Services Massage therapy is offered to the athletes on a limited, first-come first-served basis. Treatments may last from five to 15 minutes…

After You Cross the Finish Line: During any prolonged physical activity, the body’s blood supply is usually redirected to the extremities and away from internal organs. Runners should continue to walk after finishing the race. Standing still or stopping can cause nausea, dizzy and weakness – normally resulting with a runner passing out. Walking will help redirect your blood to vital organs, so it is advisable to keep moving. In any event, if you think you need help, ask one of our medical personnel for assistance.

And, finally,

Any medical expenses incurred on race day are the sole responsibility of the runner.

 Also, Runner’s World rounds up a list of medical research on Boston Marathoners, including one out of McLean Hospital on “The Causes of Marathon Collapse.”

April 19 update: The Globe offers this on the physical impact of the race:

Cramps like Cruz’s are just one of the calamities small or large that can befall a marathon runner. Months of preparation can bring amateur and professional athletes alike to a peak of fitness, but training can also take a toll on muscles and minds — after several hundred miles of training, about 30 percent of runners already have weathered injuries, many from overuse. Cap that with 26.2 miles of leave-it-all-out-there exertion — or so runners hope — and the next job is recovery.

More Boston tea party plus best of the health policy blogs

Boston Health News is trying a new platform — NewsTilt — for some stories. Click here for a full story on the Tea Party Rally in Boston or check out yesterday’s photo post.

And Health Blawg hosts the current issue of the Health Wonk Review, complete with a tax day theme and an excellent link to Stevie Wonder singing “Superstition” on an episode  ”Sesame Street.”

Boston Tea Partiers on health care

Angst over health reform came to Boston with the Tea Party Express today. But, clearly, it was not the key issue on the commons. And more than a few came in support. Pictures now. More later.

This slideshow requires JavaScript.

Hormone disrupters: Is Triclosan the next BPA?

 From the Globe

 Some scientists and environmentalists say triclosan may do more harm than good because — while industry insists it is safe in everyday applications — there is evidence it can disrupt animal hormones.

 Representative Edward J. Markey, following several months of correspondence with federal agencies about potential health effects, is calling on the federal government to ban its use in a broad range of consumer products that are used to wash hands and prepare food, or are marketed to children. He is also filing legislation that would accelerate the government’s evaluation and regulation of potentially harmful products. 

Markey Press Release.

 From this office

A copy of the FDA response can be found here: http://markey.house.gov/docs/fdatriclosanresponsereduced.pdf
A copy of the EPA response can be found here:  http://markey.house.gov/docs/epatriclosanresponse.pdf

A fact sheet on triclosan prepared by Chairman Markey’s office can be found here: http://markey.house.gov/docs/triclosan_information_final.pdf

Health insurers united will never be defeated?

Seems the state’s health insurers are boycotting the state’s health plan.

• The state of Massachusetts decided to put the squeeze on health insurers and reject 8-32 percent increases in small business premiums. So, the Globe reports that the companies are refusing to sell new policies via the state insurance exchange. WBUR’s  Commonhealth blog offers the broker point of view and more.  

Catching up on other news:

• Public Citizen’s reviews how state regulators handle complaints about doctors.  Mass has more docs per capita than many states but fewer doc penalized for errors, competency and safety problems. Hmmm.   
• Globe story on how sick folks game the Mass system. Bodes poorly for health reform.
• Opponents of bisphinol-A  have launched BPA Action Week to urge the state to enact stronger restrictions on the controversial plastic additive.
•  

HIT safety and Boston-based “dream team”

Healthcare IT News reports:

WASHINGTON – If Donald Berwick, MD, is confirmed as administrator of the Centers for Medicare and Medicaid Services, he and David Blumenthal, MD, the national coordinator for health IT, would be a “dream team” in pursuing a coherent national healthcare and health IT strategy.

At least that’s the assessment of Kerry Weems, who spent 25 years in senior roles at the Health and Human Services Department and was acting administrator of CMS from Sept. 2007 until the Obama administration took over.

At the same time, reporters at The Huffington Post continue to raise questions about HIT and patient  safety that the above team will have to address.

Despite mounting concern over safety risks posed by digital medical records systems, government officials are years away from starting to track hazards stemming from use of the devices.

A federal advisory panel wants to create the first national database of medical software malfunctions and problems as a part of the Obama administration’s drive to spend billions of dollars in economic stimulus money helping doctors and hospitals adopt the technology. 

But the proposed system wouldn’t be up and running before 2013—even though a growing chorus of technology experts is warning that rapidly converting paper records into digital formats can unleash new types of medical errors.

Does the Feds strategic plan address safety?  Read their latest update. It mentions the issue, but not with the same urgency.

…(T)here are several key areas that will need continued discussion. Among the topics discussed during the development of this Framework were the following:

 

 Transparency and Access – ensuring that patients have access to information and knowledge to make informed decisions about their care;

 Personal Choice – finding the right balance between patient privacy and patient choice i.e., some patients do not want their data shared whereas some patients do not mind sharing or want to share their information for research, improved care, and/or for the betterment of society;

 Public Engagement – allowing for continued public discussion and debate on current and emerging health care issues that cannot be resolved easily or through easy technology solutions;

 Technology Innovation – learning from the impact that the internet and social networking has had on our daily lives, and leaving flexibility for how technical innovations may change the delivery of health care; capitalizing on the promise of emerging new technologies while preserving the rights of individuals;

 Support for Research – putting in place appropriate policies and technical infrastructure to allow researchers to access data to support new discoveries and treatments while protecting individual privacy; and

 Unintended Consequences – allowing for processes to capture and learn from unanticipated adverse consequences of HIT use, and developing actions to mitigate and prevent untoward effects.