Fair pay or bone scam?

Tons of great health reporting in today’s Globe, not all of it on the health page. See stories on brain cells, osteoporosis testing, skanky diet pills and vitamin D.

BHN takes particular note of the bone scan story and wonders — Will politics and science ever find common ground? At this point, it is becoming more and more clear that more scans — be they mammograms, MRIs or test for bone density — do not equal better health.  The message, it seems, is not getting through to heavily lobbied lawmakers

“You have to view these things through common sense. And it doesn’t take a genius to figure out that providing bone density tests for elderly Americans will save this country billions of dollars,’’ said Berkley. “In addition to saving taxpayers money, it will prevent suffering that people with osteoporosis have.’’

Berkley and the key Senate sponsor, Blanche Lincoln, an Arkansas Democrat, who was a pivotal vote in the Senate in favor of health reform, have received hundreds of thousands of dollars in campaign contributions from medical industry sources, including physicians, as have many other lawmakers.

Among the lobbyists working on behalf of several corporations on the effort was a former top staffer to Lincoln, Drew Goesl, who was listed on public disclosure records as being among the people at Washington lobbying firm Capitol Counsel who worked on the issue.

Goesl did not respond to a request for comment. A spokeswoman for Lincoln said neither campaign contributions nor Goesl’s involvement played any role in her position.

For more on bone scans, see my piece on an alternative test, which ran in the Globe in ’08.

Some doctors believe the Fracture Risk Assessment Tool, or FRAX, will improve their ability to identify patients likely to suffer the worst consequence of osteoporosis – broken bones.

For another perspective, see the National Women’s Health Network’s page  on osteoporosis.  NWHN is one of the few patient advocacy groups that does not take industry money.

On the other hand, the National Osteoporosis Foundation courts industry sponsors including:   

The Alliance for Better Bone Health  which “was formed by Procter & Gamble and Aventis in May 1997 to develop and market Actonel collaboratively in Europe, the United States and Canada.”

Medtronic

Hologic, Inc.

GE Healthcare Lunar

Now you may return to the story on Vitamin D, which also offers news on bone health.

Finally, note that Newton’s Heywoods - the family that developed its own ALS research incubator in response to a brother’s struggle with the illness – makes the news once again. A story in the NYTimes about online patient communities features “PatientsLikeMe” a patient support site that also collects data for research.

Globe Mag: Medical mistakes and “professional egocentricity

This is why rich hospitals in Boston look like palaces.  From  today’s Globe magazine.

Our health care system has produced phenomenal achievements, discoveries, and cures. It would be hard not to let that go to our heads. And we have. As a hospital executive, I have noticed this attitude across the health care industry – in those who deliver it, those who teach it, even those who consume it. And though health care reform is now law, we will not see transformational change until we address this collective arrogance that infects our system.

This from an insider, Douglas S. Brown, VP and general counsel of UMass Memorial in Worcester. He notes good intentions but bemoans the arrogance of doctors and hospitals.

Hospitals are governed by mostly volunteer boards. Given the sobering statistics on preventable harm, one would expect these trustees to be intensely focused on overseeing the quality of care in their institutions. But another study published last year in Health Affairs surveyed more than 1,000 US hospital boards, and fewer than half rated quality of care as one of their top two priorities. If a board isn’t sufficiently focused on quality, how can we expect the rest of the organization to be?

Can a computer save you from an extra x-ray?

Two news round ups today.

First, check out the latest edition of the Health Wonk Review, hosted by Boston’s own David Williams at  The Health Business Blog.  As he reports: It’s a wonderful day in the wonkerhood, with so much health care policy fodder to chomp on. Let’s jump right in.

Also, here’s some local news of note:

Kaiser Health News and NPR report on an MGH study about HIT doing its job.

A funny thing happens when a computer challenges orders for medical scans that aren’t likely to help diagnose patients: Doctors often drop the test requests.

This morning’s Globe gives us this disturbing news:

At least 200 emergency medical technicians and paramedics in Massachusetts and New Hampshire have been practicing without legitimate certification, paying for fake credentials, rather than receiving medical training, state public health officials said.

 The Boston Review rounds up some of the usual and unusual suspects for a debate on industry influence on medicine.

 They start with pharma critic and former NEJM editor Marcia Angell, the run several responses:

Some of Angell’s respondents share her concerns and extend them to other areas of medical practice—including nursing and the identification of novel diseases. But not everyone agrees. Emma D’Arcy thinks that patients, newly empowered by modern information and communications technology, can make sensible judgments about treatments and drugs. And Thomas Stossel, writing separately, rejects the entire framework of analysis. For Stossel, results (what he calls “value”) are the only significant measure in assessing the nexus of academia and industry. The results that matter are longer lives of higher quality with less pain. And measured by these standards, the nexus looks pretty good.

Finally, here’s a little advance news — Tinker Ready is now the “Hub Leader” for Nature Network Boston. 

 The site comes via the Nature family of peer-reviewed research journals. She’ll be blogging and tweeting for this networking site for scientists, entrepreneurs, policymakers and others interested in the life sciences. Once they work the bugs out of the home page, we’ll have a more formal announcement.  In the meantime, feel free to browse and/or join up.

Gouger’s disease?

 Read this, about Genzymer’s new drug for Pompe disease:

Most immediately, the FDA approval means Genzyme will be able to sell Lumizyme to about 200 adult patients in the United States who have been receiving it for free under a charitable program.

The company can also begin marketing the drug to about 1,000 adults who also have Pompe disease but are not yet being treated.

Genzyme executives said the drug’s price would probably be in line with what it costs in the more than 40 countries in Europe and elsewhere where it is already approved: about $300,000 per patient annually, depending on the dose and on the weight of the person.

Most of the expense is paid by insurers or governments.

 Then hit the Globe archives and read this about a Costa Rican girl with Gaucher disease. Genzyme also make a drugs for this rare condition.

For Jose and his family, it was as though a hand had reached down to answer their prayers. But in that moment, something else had happened as well: The Cambridge drug company Genzyme had just found its first potential patient in Costa Rica. And now that it had found one, it would supply the drug to Tania, but at an astonishing cost – $160,000 a year, possibly for the rest of her life.

This was far more money than the Costa Rican government had ever paid for a drug, and Genzyme would not bend on the price. The country’s health officials were forced to weigh the prospect of a healing gift for one girl against the needs of a nation struggling to care for millions.

Should Tania get the drug?

Not to belittle the effort to treat rare, fatal diseases. But something is wrong here.

 

“Exergaming” and “rehabtainment”

 Can an organization be forgiven for adding those words  to the lexicon? Maybe, if “The Games for Health Project” can find a way to make Farmville into exercise. 

This conference is ongoing and geared toward professionals, not teen gamers.  Starting today at the Harbor Hyatt and running through Thursday.

The Games for Health Project – Sixth Annual Games for Health Conference

Exploring the role of interactive videogames in health and healthcare at the 2010 Games for Health Conference with 40+ sessions covering topics such as global health, exergaming, surgery simulation, health education, cognitive and emotional health and more. Opening keynote May 26 by Sony’s Dr. Richard Marks, with additional keynotes by game developer Chaim Gingold. Tickets and info: www.gamesforhealth.org.

“Our biggest and most advance event ever promises to provide great insight to the growing worlds of exergaming/active games, health training games, disease management efforts, and much much more.  ”

 

Massachusetts insurers push back on hospital costs

The Globe reports that insurers in the state, emboldened by the high costs at some hospitals (a euphemism for Partners HealthCare) are offering lower rates and asking hospitals for cuts. The hospitals say they are taking from institutions that are already losing money. No doubt true in some cases. In others, it’s not clear what “in the red” means.

Unlike in past years, insurers believe they have widespread backing from politicians, regulators, and employers to aggressively push back against large price increases, even if it means some unhappy providers drop out of insurers’ networks, forcing patients to find new doctors and hospitals.

Blue Cross Blue Shield of Massachusetts, the state’s largest insurer, this month sent letters to hospitals and large physicians groups “putting them on alert that the world has changed,’’ said chief executive William Van Faasen. Blue Cross recently began negotiations with 25 hospitals whose contracts expire in October, about one-third of its network.

Two other large insurers, Harvard Pilgrim Health Care and Tufts Health Plan, also have sent letters in recent weeks, requesting rate rollbacks from some hospi tals and doctors groups.

Many providers are in no mood to back down, however, after recently released data showed that some hospitals and doctors groups are paid vastly more than others for providing similar services, because of their market power. The lower-paid providers are demanding more equitable rates.

Hospital executives acknowledged that their industry must help control costs by becoming more efficient, but they said many hospitals are struggling and cannot withstand rate freezes or reductions, particularly since the state has cut Medicaid payments and they expect the federal government to reduce Medicare rates under the new national health insurance law.

Accountable health care in Vermont

Accountable care organizations could be key to containing costs under health reform. Doctors’ practices, clinics and hospitals would work together as one organization and and meet all the health needs of a group of patients. The ACO also takes responsibility for the total cost of care and the quality and effectiveness.

The Commonwealth Fund just released a report on an ACO pilot in Vermont

What did they find? A lot of pieces need to be in place for an ACO to work. The report gets a little jargony. For a slightly less technical explanation, see this state powerpoint.  

And, for more on Vermont’s ambitious “blueprint for health reform,” click here.

The new report concludes that ACO pilots need to have threshold capabilities in five areas to get started:  

 

First, the ACO must be able to manage the full continuum of care settings and services for its assigned patients, beginning with a patient-centered medical home approach to primary care.

 

 Second, it must be financially integrated with both commercial and public payers, and all payers need to participate, so that at least 60 percent to 70 percent of patients in a provider’s practice can be eligible for inclusion in a shared-savings model.

 

Third, a health information technology platform that connects providers in the ACO and allows for proactive patient management is essential, along with a strong financial database and reporting platform for managing the global medical budget.

 

 Fourth, physician leadership, as well as the commitment of the local hospital CEO and leadership team, is vital to driving changes in process, cost structure, and mission.

 

Finally, it must have the process improvement capabilities required to change both clinical and administrative processes to improve the ACO’s performance so that it can achieve its financial and quality goals

Shell game on Massachusetts health costs

Hospitals are making money. Insurers are losing money. If only it were that simple.

Most hospitals in the state are flush, according to a pair of new state reports.

Well, maybe sort of.  Partners told the Globe said they’ve started losing money since the report on hospital reserves showed that Partners has $5.7 billion in total net assets.

“Having sufficient assets allows us to sustain our mission of patient care, teaching, research and service to the community during economic downturns like the one we just experienced,” said Partners spokesman Rich Copp. “Since 2008, our numbers have been reduced by hundreds of millions of dollars as a result of the recession.”

The Mass Hospital Association called the state numbers “misleading.” The Globe story also quotes Nancy Kane, a Harvard School of Public Health researcher, saying that it all depends on how you define profit and losses

“More needs to be done before one could make a final determination that there are excess resources in these institutions,’’ Kane said.

While trying to make sense of all this, it is worth noting that a recent BU study found that Acute hospital costs per person in Massachusetts have long been the highest in the nation, and therefore in the world. In hospital fiscal year 2007, hospital costs here reached 55.4 percent above the U.S. average—the greatest excess then recorded.

So, is it a surprise that, at the same time, health insurers say they are losing money?

Or are they? Again, the Globe reports:

Barbara Anthony, undersecretary of the state Office of Consumer Affairs and Business Regulation, which oversees the insurance division, said insurers continue to enjoy large financial surpluses. A state report released May 2 showed eight health insurers in Massachusetts had a total surplus of $2.5 billion in 2008, the latest data available.

“The real issue in health care is the skyrocketing increases that are drowning small businesses and working families, who do not have billions of dollars in reserves to fall back on,’’ Anthony said. She said regulators are working to make sure insurers remain solvent while state officials try to engage insurers, hospitals, and doctors to tackle the issue of costs.

In the midst of all these swirling apples and oranges, the state Senate passed a health care measure yesterday that would use some of the hospital surpluses to help small businesses deal with rising premiums. AP reports.

To slow premium increases, the bill would require wealthier hospitals to contribute to a fund to help ease those rising costs. Senate backers of the bill say the contribution of $100 million could reduce small-business health care costs by 2.5 percent.

Boston conference on technology and global health.

The World Health Medical Technology Conference, was a “workshop dedicated to exploring the opportunities and challenges of designing, building and funding medical technologies for the developing world.”

In other words, trying to find inexpensive tests and treatments that are simple to use and don’t require a lot of infrastructure, like labs and clean water.  

BHN sat in on the morning sessions at BU, which features presentations from local groups, including Cambridge’s “Diagnostics for All.”  Una Ryan, the group’s CEO, said: “We have all this advanced and innovative technology and we don’t know how to get it to the people who need it the most.”

So, the non-profit has created a tiny, paper diagnostic tool that works like a home pregnancy test.  Imagine a miniature game of Twister. Instead of a foot, health care worker can put a drop of blood on one of the dots. The dot then changes color based on, say, how well the patient’s liver is functioning.

 Since hepatitis and drugs for HIV and TB can cause liver damage, this simple, inexpensive test will allow docs to monitor patients even if in remote villages with no roads and a couple of generators for electricity.  The costs – ten cents. The group plans to use the technology to give rural health workers tools to test for and monitor TB, malaria, HIV/AIDS, and diabetes.

The session also featured a presentation on a Seattle group called PATH, which describes itself as an “international nonprofit organization that creates sustainable, culturally relevant solutions, enabling communities worldwide to break longstanding cycles of poor health.” Among other projects, PATH is   working with a Cambridge start up called Daktari on an inexpensive hand-held device that can perform key blood tests on patients with HIV/AID.

Daktari was founded in 2008 by Bill Rodriguez, who has worked at both Harvard and at the Clinton Foundation, and Mehmet Toner, a Harvard/MIT engineer.

Innovation was the theme, as the morning speakers said many existing devices simply can’t be adapted to work in communities without water, doctors, or electricity.

“The technologies we use to diagnose diseases are way too complex,” Rodriguez said. “They were never designed to work in these settings.”

So for details, check out the Mass Device blog.

 

Malcolm Gladwell on Massachusetts cancer research

In this week’s New Yorker, Malcolm Gladwell uses the history of leukemia drugs to get into a tale of the ongoing search for effective cancer treatments. He followed compound know as elesclomol from a successful Phase 2 studies through several Phase 3 clinical trials.  His main character is emeritus Harvard researcher Lan Bo Chen, who co-founded Lexington’s Synta Pharmaceuticals and did much of the research on elesclomol.