#Massachusetts cares if #doctors have conflicts of interest, but do #patients care?

The Globe offers a peek at the drug company marketing/meals at smaller hospitals

Years after many big academic medical centers cracked down on industry perks, drug companies still regularly buy meals bll-leg-pix-webfor doctors affiliated with smaller hospitals, a new analysis shows, with some physicians receiving dozens of lunches and dinners in a single year.

At a number of community hospitals, well over half of the affiliated doctorswere beneficiaries of industry payments, suggesting there may be fewer restrictions on meals there than at large teaching hospitals.

Worth noting a UMass led-research mentioned in an NYTimes  column on medical conflicts of interest. The study by orthopedic surgeons reported that about 80 percent of patients “felt it was both ethical and either did not influence, or actually benefited their health care, if their surgeons were consultants for surgical device companies.”

Here’s a look at more data from the study:

Six hundred ten of 642 surveys had complete data. The sample population comprised more females and was older and more educated than the American population. About 80% of respondents felt it was ethical and either beneficial or of no influence to the quality of health care if surgeons were consultants for surgical device companies. Most felt disclosure of an industry relationship was important and paying surgeons royalties for devices, other than those they directly implant, would not affect quality of care. Respondents support multidisciplinary surgeon-industry COI regulation and trust doctors and their professional societies to head this effort.

Almost 40% of respondents felt the quality of care would be adversely affected if a surgeon received royalty payments for a medical device that would be implanted by that surgeon….  When questioned about who should be involved in regulation of COI, a majority of respondents (64.3%) felt that a combination of doctors, hospitals/universities, government, and company representatives should be involved; 34.9% of respondents felt that medical professional societies run by doctors should have the most control over COI regulation, almost two times more than the next most frequent answer; and 44.9% and 26.3% (70.2% combined) of respondents felt medical company representatives and government officials should not be involved in the regulation of COI….

Our survey found that 91% of respondents felt it was important for surgeons to disclose consulting agreements regarding devices in their
surgery (Table 3). Furthermore, 60% of respondents thought it was appropriate for surgeons to disclose consulting arrangements with all patients regardless of the planned usage of such devices in their own surgery

Also noted in the study

Leaders of the American Academy of Orthopedic Surgeons have recently made a consensus statement that the enhancement of patient care has and will continue to require orthopedic surgeons to collaborate productively with industry in the development of new technology and techniques

Also worth noting that a 2013  UConn study found the following

Overall, patients had a poor understanding of FCOI (financial conflict of interest.) Both level of education and previous discussions of FCOI predicted better understanding. This study emphasizes communication of FCOI with patients needs to be enhanced.

Finally, a Health Affairs blog post on patients and COI noted:

Physician ownership of orthopedic or spine hospitals has been correlated with higher rates of spine surgery. In these situations, doctors must keep these centers busy with procedures in order to generate profits and prevent losses; overhead costs are high, including financing, staffing, lease arrangements, and insurance. However, a busy center becomes a lucrative profit center for owning physicians.

 

 

Surgeons, MGH react to to Globe story on surgery scheduling

ss2 (2)Reaction to the Globe’s Spotlight series on simultaneous surgeries — where a surgeon has two operations going at the same time — continues in the paper and beyond

In late December, the paper reported:

 

The American College of Surgeons plans for a roughly 10-member committee — which includes both critics and supporters of concurrent surgeries — to craft a consistent approach to keeping patients safe and informed when doctors run two operating rooms, according to Dr. David Hoyt, executive director of the organization.

“We are going to move as quickly as we can on this,” Hoyt said. “This is a priority.”
A Globe survey of 47 hospitals nationwide found that it is common for surgeons to start a second operation before the first is complete, often after the surgeries were deliberately scheduled to overlap briefly. However, some surgeons have operations that run simultaneously for longer periods. And few hospitals call on doctors to explicitly tell patients when their operations are double-booked.

The paper also ran an editorial cartoon — a surgeon on RollerBlades –with a super long disclosure statement.

MGH got a lot of space in the Sunday “Ideas” section to offer their unfiltered take on the matter, as did this doctor:

When I handle concurrent procedures, I have to carefully design the schedule around when I can and cannot be absent from an operating room. Surgical procedures have “critical” and “noncritical” portions, and this changes on a case-by-case basis depending on the patient and his or her unique problem as well as the team I’m working with. For instance, if I’m working with a brand-new intern, then every moment, from preparation to wake-up, is critical. If I’m working with a seasoned fellow with five years of operating experience, then the critical portions are much more focused.

From the Jan. 10 piece  by Dr. Peter L. Slavin –president of Massachusetts General Hospital  and Dr. Thomas J. Lynch chairman of the Massachusetts General Physicians Organization ran in the Sunday “Ideas” section of the paper

Overlapping surgery occurs at MGH and hospitals throughout the country for a variety of reasons. Overlapping surgery saves lives in certain clinical situations, such as after the Boston Marathon bombings and the Rhode Island Station nightclub fire, when multiple critically ill patients need rapid access to surgical care. Overlapping surgery enhances access to care, helping meet the high demand for certain specialties and specialists.

Partners has also posted detailed comments on its own web site.

 

Stat, the new (Boston Globe?) life science site, is up

ss1After trickling into The Boston Globe in recent weeks, the STAT website is up. Looks impressive and has some big names on the masthead. (Can we still call it a masthead?) Congratulations to all.

If you are confused about its relationship with the Globe, you’re not alone. STAT is a new animal, digital first with its own staff and budget. The Globe still covers life sciences, but the three fine health reporters there are not part of STAT. Their former editors have migrated to STAT. The team’s science writer migrated to The Washington Post months ago and has yet to be replaced. So, it was STAT that hosted the recent Morrissey Boulevard party for the National Association of Science Writers, not the science-writer-less Globe.

STAT casts itself as a national publication and some  stories run in the A section of the Globe — a nice break from the wire copy that replaced reporting from the long-gone national and foreign desks. They also have columns on Kendall Square — the pharma capital of universe — and  Longwood Avenue — the medical capital of the universe. So, it’s kind of local. Or offering a nod to local?

ss2 (2)

Here’s hoping that they don’t suck the life out of the life-science reporting in the Globe. Not for nostalgia reasons, but for those of us in Boston who need good, local health and science watchdogs. And the team at the Globe does great work.

While Hollywood is celebrating the “Spotlight” movie about the paper’s reporting on the cover-up of rampant pedophilia in the Catholic Church, the latest Spotlight series raises question about overbooking of surgery at Mass General. While the practice may not be unheard of, the story raises important questions about patient safety, informed consent and the hospital’s treatment of whistle blowers.

You think going up against the Catholic Church is scary? Try going up against Partners Healthcare.

Looking for Boston Globe health reporting? Try the business section

ssUPDATE: Props to Beta Boston, another source of Globe health reporting.

Since the Globe currently has no full-time health and science editor, no science writer and a hard-to-find, often dated health site, we turn to the business section for news on health, or at least health finance and pharma. Perhaps things will pick up in the fall.

In terms of Globe-ish  health-sci-ish  reporting, we see STAT continuing to pop up in the paper and the paper’s website but not the STAT website. The business section of the print version of today’s paper premieres a weekly column called Kendall Squared. Today, Andrew Joseph reports on the rebranding of the square-less square, the sale of dishes at the closed Hungry Mother restaurant, a Forsyth Institute dentist who runs a children’s clinic in Kuwait and a non-profit dispute resolution group that is being prices out of the Square.

In the meantime, best to follow individual members of the Globe‘s shrinking but solid Metro sci-health team:

Kay Lazar @GlobeKayLazar

Liz Kowalcyk @GlobeLizK

Felice J. Freyer @felicejfreyer

And, check the business page. The state Center for Health Information and Analysis has come out with it’s latest hospital profits report and today, The Globe helps sort it out for us.

The state’s biggest hospitals were the most profitable in 2014, with Massachusetts General Hospital, the largest academic medical center, earning $200 million, up 34 percent from the previous year, and Brigham and Women’s Hospital earning $152 million, up 9 percent. Both are owned by Partners HealthCare of Boston.

Other big earners were Baystate Medical Center of Springfield, Lahey Hospital and Medical Center in Burlington, Saint Vincent Hospital in Worcester, and Beth Israel Deaconess Medical Center in Boston. The results are for fiscal year 2014, which for most hospitals ended last September.

The profits overall, however, mask some of the struggles in the changing field. Quincy Medical Center lost $39 million last year, the most in the state. Its owner, Steward Health Care System, closed the hospital at the end of the year. North Adams Regional Hospital in the Berkshires closed several months earlier. The push to cut costs has, in part, prompted several hospitals to consider mergers or acquisitions.

Earlier this week, the paper reported that the advent of ACOs has cut Medicare spending at five major health systems in the state

New figures show five Massachusetts health systems saved a combined $141 million during that period as part of the program, which aims to rein in costs by better coordinating care for Medicare patients and cutting unnecessary hospital stays and medical services. Doctors manage care for these patients in pools known as Pioneer accountable care organizations.

Hospitals consolidation: Brill says yes, new Massachusetts AG says no

From Shirley Leung’s Monday column in the Globe:

partnersNo judge or jury delivered a verdict on the Partners HealthCare settlement Monday, but we didn’t need either after Attorney General Maura Healey’s three-page court filing.

She thinks the deal stinks, and if given the chance, she would bring an antitrust suit to block Partners’ efforts to expand. And just like that, the 43-year-old rising political star dared to rock the biggest boat in Massachusetts health care. In the wake of her threat, Healey left a list of winners and losers.

From Steven Syre’s column in today’s Globe:

Maura Healey has been on the job less than a week, but we don’t have to wonder where she stands on the biggest health care conflict in Massachusetts.

And, a Q. & A. from Steven Brill, author of “America’s Bitter Pill: Money, Politics, Backroom Deals and the Fight to Fix Our Broken Health System. That book looks at focuses on the debate over the Patient Protection and Affordable Care Act. But it also returns to Brill’s indictment of high hospitals costs that filled an entire issue Time magazine in 2013. His solution looks very much like a combination of the Kaiser Permanente insurer-plus-provider approach and the Partners’ plan.

HLM: Why will this consolidation approach work to curb costs where other reforms have failed?

Brill: The reason this idea may work is it is going to happen without my writing about it. It’s going to happen. The question is, do we seize that momentum, turn it around jujitsu- style and attach a whole bunch of regulations to it?

I really started thinking about this after my [heart] surgery. I decided: New York Presbyterian, it’s a damn good place and the guy who runs it is a good guy. [Later] I was watching a panel including Toby Cosgove [CEO of Cleveland Clinic] and someone said: You’re gobbling up Cleveland and your market share is way too high.

Cosgrove said, the FTC would never let us have too much of a market share. I’m thinking, this guy Cosgrove, he’s a celebrated surgeon, a war hero. He seems like a pretty good guy to me. The idea the he wants to control and provide healthcare all over Ohio, why is that such a bad thing?partners-logopartners-logo

Maybe not living so much longer if she has a bike accident

Local reporters, editors, data crunchers win health journalism awards

A lot of the heath care journalism awards out there are kind of soft — they come from trade or industry groups. They have their own place on our walls, and, in some cases, we appreciate them. (In other cases, an award may represent a conflict of interest.  An award from an institutions you cover? Just say no. )

But the Association of Healthcare Journalists awards come with a lot of cred. And the  New England awards are well deserved. Congratulations colleagues. We get a chance to thank you in person when the AHCJ holds its annual meeting in Boston in two weeks.

ahcj awards-logo

Public Health (Large)

First: Coverage of Fungal Meningitis Outbreak Tied to Contaminated Drugs; Staff, The Boston Globe

Honorable mention: Cancer’s New Battleground: The Developing World; Joanne Silberner, David Baron, PRI’s The World

Consumer/Feature (Large)

Third: A Rampant Prescription, a Hidden Peril; Kay Lazar, Matt Carroll, The Boston Globe

Consumer/Feature (Small)

Second: Gift from Grief; Michael Morton, MetroWest Daily News (Framingham, Mass.)

Third: Demand for Home Care Workers Soaring, But Will There Be Enough Takers?; Arielle Levin Becker, The Connecticut Mirror

 Special citation: 40% of High-Prescribing Docs Get Pharma Perks; Lisa Chedekel, The Connecticut Health Investigative Team

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