Rabu, 31 Agustus 2011

LabCorp Settles with State of California Over Kickback Marketing Scheme–Lab Wars

Both Quest and LabCorp were doing this and this is funny in the information here from BNET that he had the actual PowerPoint slides.  Quest settled up for $241 imagemillion for their portion of gaining market share. 

Quest Diagnostics Agrees to Settle California Medicaid Suit for $241 Million-Overcharging for Lab Tests

Quest does not appear to be done yet though as now they have a whistle blower alleging even more fraud, maybe a billion and this case is a little more complex and has to do with billing during the time of the Uni-Lab purchase. 

Lawsuit Filed Against Quest Diagnostics–Whistle Blower Case Alleging Medicare and Medicaid Over Charges of $1 Billion Or More

Labcorp is to pay up $49.5 million to settle the claims billed to Medi-Cal during a 14 year period.  A whistle blower was also who brought it to the attention of the State of California in this case as well.  To get a discount doctors were told to refer to LabCorp versus the other lab companies.  BD   

Labcorp’s (LH) $50 million settlement with the California attorney general over a kickback scheme highlights the federal government’s bizarre lack of interest in whether Medicare is being ripped off for hundreds of millions of dollars nationally by companies that provide diagnostic tests for doctors and hospitals.

The scheme wasn’t difficult to figure out — the company described it in PowerPoint slideshows that told employees what “not” to do. Prohibiting employees from breaking the law is fine, of course, but the Labcorp slideshows only made sense if the company knew how to execute a complicated “pull-through” kickback scheme, and knew it was wrong. One PowerPoint had a chapter labelled “Kickbacks.”

http://www.bnet.com/blog/drug-business/meet-the-company-that-outlined-its-kickback-scheme-in-powerpoint/9532?utm_source=twitterfeed&utm_medium=twitter

Another New Portable Device Slated to Make Fitness Fun - A Keychain to Reward for Exercise and Donate To Charities

How many more of these things are we going to see.  Folks I know that bough the imageFitbit tried it for a while and got bored.  I don’t have one and this is just what others told me as they said it was something else they had to do and they had enough overload with all the other consumer IT stuff and gadgets to worry about.  I think from what I hear on these devices is just like the consumer, the attention span is short and again it something you have to do something with and most all have a smartphone today, so I guess we will see when it arrives on the market. 

You know I just try and report on all of this and that in itself makes me tired <grin>.  What I found out too that most of the time the developers and the folks who work at some of these companies don’t use their own products, one of those “it’s for those guys over there” but send money please.  You have to wait until October so we see the proverbial promo to tease and generate interest here and the price shown is $99.  BD

REDWOOD CITY, Calif., Aug. 31, 2011 /PRNewswire/ -- Fitness is about to become a lot more fun with Striiv. The Silicon Valley-based start-up today revealed its first product which takes active gaming outside of the living room to turn everyday activities into fitness opportunities.  A sleek, portable fitness device, Striiv motivates activity throughout the day via games, personal goals, and donation opportunities -- all powered by imagephysical activity.

Striiv offers a playful approach to fitness. Comprised of social game and technology industry veterans, the team behind Striiv brings a wealth of business and development experience to defining this new product category at the forefront of gaming and personal health.  Whether it's a real workout or simple daily interactions like walking to lunch, taking the stairs, or shopping – with Striiv any activity is earned, tracked and transformed into an opportunity to get fit, give back, and have fun.

"Fitness and health are top-of-mind today. But for many people, especially moms juggling careers and family, finding time for exercise is hard to fit in to a busy day," says David Wang, CEO and co-founder of Striiv. "We've combined charities, gaming, and personal challenges with cutting-edge technology to create a seamless way to motivate physical activity.  We're building a playful and inspiring 'movement around movement' so that fitness now fits throughout your day."

Small, convenient and designed to easily move between a key chain, belt clip, or pocket, Striiv is always with you and always on.  Striiv features a high-resolution color touch screen to track your progress.  Key features include:

  • Walkathon in Your Pocket:  With Striiv every step counts toward a donation to charity.  At launch, Striiv is partnering with GlobalGiving to donate clean water to children in South America or a polio vaccine to a child in India. New charitable partners will be added over time.
  • Activity-Based Games: Unlike traditional time-based social games, Striiv games are completely powered by physical activity. In the first game, MyLand, the more you move, the more your enchanted island fills with exotic wildlife and plants. More games will be added.
  • Daily Challenges and Trophies: Earn rewards and bonuses for walking to lunch or taking the stairs. Unlock daily challenges based on real-world distances, from climbing the Eiffel Tower to crossing the Golden Gate Bridge.
  • TruMotion Technology: Striiv's proprietary TruMotion technology is always on and can sense if you are walking, running, and even climbing stairs or hiking. 

Non Profit HEALTHeLINK Partners with United Healthcare Subsidiary Optumsight to Remote Monitor Diabetics In Buffalo in Pilot Program

I try to keep track of mergers and acquisitions here and the partner Axolotl was purchased by Ingenix in August of 2010, about a year ago, so when you hear of insurers buying up technology companies here’s one and where bottom line revenues end up contributing to for profit insurers. 

Ingenix Acquires Health Information Exchange Services/EHR Provider Axolotl-United Health Group Behemoth Continues to Grow–Subsidiary Watch

Here’s another post from the past that gives a little more background on the HIE and business intelligence algorithms used by United subsidiaries. 

Axolotl (A Subsidiary of Ingenix) Creates Reporting and Analytics Solution for Health Information Exchanges–Algorithms for HIE–Business Intelligence -Subsidiary Watch

In addition other subsidiaries sell electronic medical records as well and Care Tracker has been around for a number of years, sold by Ingenix, now under the Optum name.  

ClickFreeMD Selling Software EHR, Practice Management Bundled Records Solution–Emphasis on AMA Endorsement And Software “Powered” by Ingenix–Tethered or Untethered

At a cost of $250 per patient per month that adds up to some additional income and yes it is less expensive than visits to the ER room if that can be avoided.  If this ends up being a workable solution with proper implementation for a national model, that’s a lot of profit for the subsidiary to add to the corporate bottom line too. Buffalo has has their IT issues reflected too in this story from a year ago where it was found that the City paid over $2 million in premiums for dead city employees and from what I understand, they were having to go to court to get it back?  I’m sure all the folks being monitored though are not in that group.  I’m just curios too as to who all really has access to the data as analytics are are part of the deal here as that’s the way it works out there today with everyone wanting data.   

City of Buffalo Has Paid Over $2 Million to Provide Health Insurance for Hundreds of Dead People-Some as Many as 4 Years

I’m just curios too as to who all really has access to the data as analytics I’m sure are part of the deal here as that’s the way it works out there today with everyone wanting data. Another division of United sells prescription data for underwriting and other purposes. 

The RHIO didn’t want to be in the monitoring business though so it appears this is where the technology subsidiaries of United came in to play here.  The article said there was some resistance but again if they are United approved MDs and have had any recent cuts, then that could maybe stand to reason for some of it and I don’t know how many United policy holders are in this part of New York.  BD 

BUFFALO, NY – One hundred patients with diabetes have signed up for a telemonitoring pilot spearheaded by HEALTHeLINK, the regional health information organization (RHIO) serving Western New York State. The nonprofit’s innovative approach to telemonitoring could serve as a model for the rest of the nation, according to Todd Norris, Western New York Beacon Project Director.

HEALTHeLINK is one of the 17 Beacon Communities tasked by the Office of the National Coordinator to positively impact quality, cost and population health through the use of healthcare IT. The RHIO is focusing on several initiatives to "move the needle in a positive direction" for diabetes care management, which is its specific goal under the Beacon Community Program. With more than 60,000 diabetic patients under the care of 250 healthcare providers, Western New York has one of the largest diabetic populations per capita in the country, Norris said. The telemonitoring pilot, which will accommodate 150 patients, is one of 12 interventions the RHIO is deploying for diabetic care.

Blood pressure readings and other vital signs pertinent to diabetic management are downloaded from mobile devices and transmitted to healthcare providers in the form of alerts through HEALTHeLINK's health information exchange platform, which is powered by OptumInsight, formerly Axolotl. The RHIO, however, has adjusted the traditional model to address known barriers to telemonitoring adoption.

The cost is approximately $250 per patient per month. Norris pointed out that the elimination of one emergency department visit per patient pays for the program and also contributes to better health of the diabetic population. With economies of scale, the cost per patient per month for 40,000 patients would be $150 per month. At this level, Norris said, "You're going to see lively acceptance."

Abbott Labs to Discontinue Distributing FreeStyle Navigator Glucose Monitor in the US

The FDA just approved the Freestyle easier to use monitor in June of 2010 and received the European CE Mark in May of 2011.  In December of 2009 there were strip recalls for the old version of the Freestyle, however other Abbott models had a lot more strips recalled in December of 2010. 

Abbott Diabetes Care Recalls Tons of Glucose imageTest Strips–The US Has the FDA Recall Blues-Solution Has Been Touted Here for a Year-It’s Time for a Fix–Readers Have Voted

Supply interruptions was the reason given for the discontinuing in the US; however in Europe they will continue to sell and market, so not enough money here in the US is the first question I ask and glad we have enough other glucose monitors available for diabetics.  I just hope glucose monitors don’t take the same path as some of the drugs we can’t get today and hope this is an isolated instance.  Abbott still has many other Freestyle monitors they sell and market besides this model, but this one with wireless looked to be pretty advanced.  BD   

Abbott Laboratories (NYSE:ABT) announced that it permanently discontinued its FreeStyle Navigator glucose monitor due to an inconsistent supply chain that has amounted to several disruptions in product availability for U.S. patients. image

"We know FreeStyle Navigator System customers in the U.S. have lived with some uncertainty and frustration," the company wrote in its official statement. "We are grateful for the commitment patients and providers have devoted to the FreeStyle Navigator System over the years, and we are sorry that we have been unable to consistently meet their needs."

"The discontinuation of the FreeStyle Navigator System in the U.S. is not for safety reasons," Abbott wrote. "The System is safe and effective and continues to be available to patients in seven other markets outside the U.S."

http://www.massdevice.com/news/diabetes-abbott-takes-freestyle-glucose-monitor-us-market

Non Profit Social Interest Solutions Group and Microsoft Partner To Advance State and Government Health Exchange Initiatives

Back in February of 2011 Microsoft Government also announced their low cost State Insurance Exchange solutions.  Microsoft’s HIX solutions eliminate the need for states to evaluate numerous point solutions from various firms to find one that works well with government policies or existing IT infrastructures.

Microsoft Announces New Low-Cost Turnkey State Health Insurance Exchange Technology Solutions

From the Social Interest Solutions Website:

“Wherever possible, Social Interest Solutions utilizes the standard HIPAA transaction sets to form the basis of our interfaces as we have found that many of the entities with whom we share data have already adopted these standards. Our HIPAA companion guides are available upon request.

Social Interest Solutions is able to support a variety of data formats, including, but not limited to: HL7, HL9, X12, XML, Flat files, Comma Separated files and many others.

Social Interest Solutions is proud of our system integration capabilities and believe it is a key differentiator in making sure persons in need of benefits are efficiently supported. To learn more about the interfaces we support see interfaces.

image

“Systems using a web service to communicate with each other don’t need to go through a great deal of change, as long as they adhere to the common message format. Services that can be used by multiple systems are more easily shared through web services because of the flexibility and reusability they provide. This shared usage is more cost effective because web services allow seamless integration and use of functionalities across multiple systems without the need to make significant changes to the systems that need to exchange information”

Social Interest solutions e-apps have been deployed in Arizona and California and connects low income families to programs ranging from Medicaid to food stamps.  One-e-App has screened nearly 7 million people and generated over 9 million applications for programs so far.  The PAL imageapplication is a web based tool that allows both doctors and patients the ability to apply for co-pay assistance for medications and other services.  From what I am reading in the press release though the focus here lies with insurance exchanges.  It’s nice to see a technology company involved here instead of the technologies of the insurers as we don’t know as we can’t audit and see if the procedures and algorithms are accurate all the time ad Microsoft doesn’t have a conflicting interest of healthcare claims that are processed for bottom line share holder profits either.  BD   

Press Release:

Social Interest Solutions and Microsoft Work Together to Leverage Social Interest Solutions’ Thought Leadership, Policy, Enrollment and Integration Expertise to Advance State and Government Health Insurance Exchange Initiatives

SACRAMENTO, Calif.--(BUSINESS WIRE)--Social Interest Solutions (SIS), a mission-driven, nonprofit organization dedicated to leveraging technology innovation to improve consumers’ access to health and human services, today announced a strategic alliance with Microsoft. The relationship will involve working collaboratively to help government entities save time and money in the design and deployment of the technology and processes underlying health insurance exchanges.

“We are pleased to be working with Microsoft at this historic time”

“We are pleased to be working with Microsoft at this historic time,” said Claudia Page, co-director at Social Interest Solutions. “Both organizations have a successful track record of working closely with state agencies to help them achieve greater integration across health and human services silos and both view the implementation of health insurance exchanges as a way to reform the health delivery system and improve health outcomes.”

“With the passage of the Patient Protection and Affordable Care Act (ACA), states have new mandates to follow, deadlines to meet and risks to mitigate that require significant process improvements combined with innovative technologies,” said Brian Russon, national practice leader for Health Insurance Exchange, Microsoft.

“We are pleased to join forces with Social Interest Solutions and look forward to working collaboratively to help our clients meet the demands of implementing effective health insurance exchanges.”

For the health insurance exchange collaboration, Microsoft will be providing technology and state government expertise, while Social Interest solutions will be providing valuable knowledge and experience focusing on enrollment, standards, interoperability.

For nearly a decade, Social Interest Solutions has been instrumental in helping to modernize the process for identifying and enrolling in health and human services programs. In early 2003, Social Interest Solutions developed One-e-App, a Web-based system streamlining the complicated eligibility and enrollment process by making it possible to transparently connect and share data across otherwise disparate state and local social services systems and programs. Today, One-e-App is deployed in Arizona, California, Indiana and Maryland and has served nearly 9 million individuals. The innovative integration and process improvements achieved with the One-e-App platform will play a critical role in helping states using One-e-App to develop and deploy health insurance exchanges.

Social Interest Solutions is also focused on effective policy development and helped to craft language in Section 1561 of the Affordable Care Act (ACA). Section 1561 requires the Federal government to establish enrollment standards to facilitate access to coverage. Subsequently, SIS directors have served as consultants to the Office of the National Coordinator for Health IT to support the development of ACA enrollment standards and protocols. Social Interest Solutions has also worked with states to conduct ACA IT gap analyses, assessing the current status of IT systems against where the state plans to be in 2014. Gap analysis work has been completed for Arizona, Maryland and New York and is underway in Alabama.

About Social Interest Solutions

Social Interest Solutions (SIS) is a nonprofit organization dedicated to leveraging technology innovation to improve consumers’ access to public and private health and social services. As an active influencer and promoter of policy reform, SIS has successfully developed and deployed pioneering technology solutions having a positive impact on the quality of life for the nation’s underserved population. www.socialinterest.org

http://www.businesswire.com/news/home/20110831005482/en/Social-Interest-Solutions-Microsoft-Join-Forces

California Bill to Regulate Health Insurance Rates Dies Due to Lobbying By Insurers and Other Groups So No Serious Audit Algorithms for Now to Control Premium Hikes

Well here’s one more not for the consumer.  If you read through the article in the LA Times the bill died as lobbying efforts claimed here would not allow for a majority of votes to pass.  It will be tried again next year.   It’s funny that we go through great lengths and trouble to audit and certify medical records, but the payers in all of this run their business intelligence models and reconstruct and change them with their analytics and laws can’t keep up.  I said back in August of 2009 we need a Department of Algorithms but until we get lawmakers that understand how business models worth and how math moves money, we are kind of stuck here.

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?

You have to some day sooner or later start auditing this stuff or we are all screwed.  It’s easy to fleece the digital illiterates and I see it all the time with those in denial who can’t get this function yet.  On another note, we are looking at the same on Wall Street too as the hardware wars are almost over and then….we have data and the algorithms that process it and it will get really tough then with writing code that can no longer be read with layers of aggregation, so remember you heard it here first.  It too Medicare long enough to get to that point with using technology to audit medical claims for fraud. 

CMS Announces Anti-Fraud Algorithms Will Begin Auditing Claims on July 1, 2011 Just As Insurance Companies Have Done For Years

We don’t have an executive in charge of HHS that has enough Health IT in her background and thus 2 years ago when she took office she could not forecast how this was going to move forward, but folks that write code do and that’s what you see here and I’m just a tiny ant in the coding world for that matter but I can predict easy enough and add on a number of years in PR and Sales and it just flows.  Granted HHS has hired some really spiffy folks, but again as a director she has to go to them and needs additional reports where as someone with on hands experience thinks a lot different and can picture the future with the mechanics of code, so executives without this ability are just flat out behind an 8 ball when it comes to such decisions.  When she was nominated I made that call, nothing personal at all but said in 2 years the director of HHS was going to be about 80% health IT, so here we are today and I don’t think I’ll get any arguments there

Times were a little different back then too but again the code heads can see and project where others cannot.  This is what I said in February of 2009 and it makes it hard for people in those positions to function with the crazy unpredictable world we live in today and others just eat their lunch and we all suffer.  I think was politically correct and just stated facts as a coder sees them.  Are people just now starting to listen to folks who know math?  So once again we are late coming to the table but we can’t go backwards and have to some how work with what we have, and it changes every day.  image

Kathleen Sebelius, Kansas Governor for HHS – Please not! Put the “Smart” People in these key positions

In the meantime, California lawmakers are kind of behind this 8 ball too and don’t get the math here with how the algorithms with insurers work.  If you look back and read on the recent couple of years, look how many times they adjusted them and ran back to the table with justifying their increases and some were way off too.  It’s all about the math and we have lawmakers in California that don’t get it just like we have in Congress, too complicated, I don’t want to deal with it right?  I think we are seeing a lot of this today.  The COs and folks that do have this in their background are stressed and dropping like flies too all over and I understand that very well as I have dealt with that for much of my time in technology, it’s thankless, misunderstood and you deal with people who have shut off their learning faucet and fabricate a lot and its’ hard.  There are also those who read and want to learn and work with you too but we all have the folks that feel threatened and well look what we see in the news today with the GOP, craziness and to me it all comes back to not knowing what to say or do with not participating in at least a medium level of consumer IT literacy.  Makes for good OMG news but that's about it.  BD 

A bill that would allow California officials to regulate health insurance rates for millions of consumers has died in the Legislature after forceful lobbying campaigns by insurers, healthcare providers and other groups.
Assemblyman Mike Feuer (D-Los Angeles) said he is pulling his measure, AB52, because he could not muster a majority of votes in the state Senate, the final stop in a months-long effort to increase state regulators' authority over health insurance premiums.

Feuer said he is putting his bill on hold until next year, when it can be taken up again. It marks the fourth time in four years that Democratic lawmakers have failed to win support for insurance oversight that would mirror the type of regulation already in place for auto policies.

http://www.latimes.com/business/la-fi-insurance-regulation-20110901,0,4400280.story?track=rss&dlvrit=52116

United Healthcare To Buy Huge Chunk of Orange County, California Managed Care Business with the Purchase of Monarch Healthcare–Subsidiary Watch

This is in my back yard in the OC and for a few doctors I know this just might be the big push to start a Concierge Medical Office.  Newport Beach which is south of where I live has a ton of affluent residents and the Boutique practices there do well as money for many in the area is not a problem.  Monarch has been around for many years and they are at all the Hoag Hospital money raising events and is very active, so things might be changing in time. 

What will be interesting though is to see if the reimbursement changes and of course that’s at the top of every MD’s mind, so I don’t see much excitement about this at all here.  I know have friends that won’t be excited with the news who are patients.  Back in March of this year they closed a big office in Orange County and you can read more about how that went down, employees bused to a hotel and given their papers after an instant message. 

UnitedHealthcare Lays Off 180 Employees In Orange County-Initial Notification Sent By Instant Message to Those Affected

With 2300 doctors in the HMO, with recent mergers and acquisitions is this a basket full of doctors to sell an EHR too as they do sell and have sold a medical records system for years under the former name of Ingenix, now known as Optum.  Sometimes you run into situations like this to where one division of a big conglomerate cuts rates with one subsidiary and then the other rushes in to sell software. 

Subsidiary Watch-Corporate Conglomerate Insurers Reduce Compensation Contracts Using One Subsidiary Then Market Same MDs With Another Subsidiary in Health IT

Also the company recently bought another huge HMO group in Long Beach and I would say the two are perhaps close in size but bottom line is both are huge

OptumHealth (Subsidiary of United Healthcare) Takes Over Memorial IPA in California-Subsidiary Watch

We never did get our government REC center started in the OC either and I just kind of wonder where the money went on that too, and again with the post above with selling medical records, does this give anyone an unfair advantage for sales?  It does make you wonder and again why the REC center never got off the ground and I’m just speaking out loud here but there’s no REC center to offer any help to the doctors in the OC. 

Orange County California REC Center For Doctor Assistance with Medical Records Appears to be a Bust So Far…

I have heard from a few doctors on how the deductions of claims that get rescinded after payment have been a hassle with United as they just take a deduction out of a check and the claim that is not being paid does not even include the patient who is being denied, a nightmare for doctors and a recent study said it costs a doctor about $83k a year to keep up with the likes of all of this.  We have one first class hospital that kicked United out the door when it came to employer provided insurance and companies all over the OC were looking for another carrier when the United/Pacificare contracts were re-negotiated.

Employers in Orange County Looking for New HMO Contracts as St. Josephs and Some Others Begin Cancelling Agreements with Pacificare (UnitedHeatlhCare) – Employer Capitation Contracts

I guess Hoag Hospital though is happy to have the affluent residents to help make up for the other side of things as who knows how new contracts will end up shaking out when they come up for renewal.  When it comes to patents too with Health IT, United is right up there too so things don’t come cheap in that department or some subsidiaries either. 

QualityMetric/Ingenix (United HealthCare) Receives Patent for Patient Health Survey Algorithms-Subsidiary Watch

And here’s a few more back posts on their subsidiaries…think they are only insurance, well they are very heavily invested in Health IT these days as well and the acquisitions have been steady for them over the last 3 years or so. 

UnitedHealth Group Owns a Bank With Deposits Surpassing a Billion – OptumHealth Bank FDIC Insured

“OptumHealth offers three types of HSAs, as well as tax-advantaged health care savings and spending accounts, debit-card services, benefits administration services, and payment products. About three-quarters of the bank’s 1.6 million accounts are employer-generated, while the other quarter are individual accounts.”

There’s also the Chinese investment the company bought early in 2010.

UnitedHealth subsidiary (Ingenix Subsidiary I3) Acquires ChinaGate – Working to Sell Chinese Products Globally

These are just a few examples of some of the subsidiaries of the company and why even sometimes judges find themselves in some potential conflict areas as the daisy chains of subsidiaries grow, they don’t even keep track or are cognizant that the company they have owned stock in for many years, due to quickly adapting business algorithms used today, is not the same.  The former Ingenix division (now Optum) makes money with pretty much just selling data and creating software algorithms

Back a year or so ago the AMA fought and won a lawsuit against the Ingenix division for short paying doctors and patients for almost 15 years and it was Andrew Cuomo of New York who got the ball rolling there.  In some parts of the country through wellness subsidiaries pharmacists even get to earn pay for performance money from signing people up in wellness programs, and what that amount is we don’t know but the retail drug chain, Walgreens says their data selling business is worth just under $800 Million. 

UnitedHealth, YMCA Expand Diabetes Prevention Program with P4P for Walgreens

Last but not least, let’s not forget the CEO is the highest paid in the US for public companies, and they are still making record profits.  I just try to break down the business areas for awareness so consumers and others understand a bit more about the big corporate world of subsidiaries today that normally may not be thought about, seen or recognized.  BD 

UnitedHealth Group Inc. will acquire the operations of a major southern California physician group, in the latest example of how lines are blurring between insurance companies and health-care providers.

The purchase of the management arm of Monarch HealthCare, an Irvine, Calif., association that includes approximately 2,300 physicians in a range of specialties, establishes United's Optum health-services unit as a formidable presence in the region. Optum had previously taken over the management arms of two smaller southern California groups, AppleCare Medical Group and Memorial HealthCare Independent Practice Association.

Monarch said in a statement that it "has agreed to enter a strategic relationship with Optum to support our physicians in providing high-quality, cost-effective patient care in Orange County, California."

United has said in the past that providers acquired by Optum will not work exclusively with United's health plan, and will continue to contract with an array of insurers. But in one sign of the potential complications that might ensue, Monarch is currently in an arrangement with United competitor WellPoint Inc. to create a cooperative "accountable-care organization" aimed at bringing down health-care costs and improving quality.

Janet Tracey and Unilateral DNAR Policy in the UK

More information about the Janet Tracey case is available on the website of Leigh, Day & Co, the attorneys representing the Tracey family in its lawsuit against NHS Trust.

When Will MDs Prescribe Life Extending Drugs Such as Provenge–Reimbursement And Delivery Matters

Fierce Pharma in conjunction with Sermo, the doctor’s social network have compiled imagea survey of interest with regards to prescribing life extending drugs, Provenge is the big example that stands out.  It is not cheap. You can view the full results of the survey from the link below and can download the full survey report.  Over 68% voiced a concern with either reimbursement or drug delivery. 

Sermo-medical-ethics-life-extending-drugs Survey Results

Back in July Fierce Pharma and Sermo announced they would be working together imageto bring some of the information from Sermo, the private doctors' social network in order to bring forward what the doctor’s opinions are, rather than just seeing an investor’s take as we do on the web. 

Sermo and FiercePharma Partner to Allow Readers to Have Access to Sermo’s Online Information

With other types of oncology drugs, some of which are now in short supply, the oncologists changed their treatment from out of the office to having patients visit imagehospitals as sometimes the reimbursement efforts left them out of pocket to cover the cost of the drugs up front and then fighting a claim later to get paid.  In the survey,some doctors also mentioned that the cost for such drugs should not go over $60,000 while others said that $10,000 should be the cap. 

One oncologist is quoted below in the report/survey:  

"I have not used the agent and have no plans yet. FYI the majority of eligible patients are in their 80s, so placing dialysis catheter in their neck and hooking them up to pheresis machine is not a little fit." - Oncologist on Sermo

image

Just last week, yet another expensive drug was approved by the FDA at $13,500 a dose with several doses being the norm and I had a reader asking me about Zytiga on where he could get help as he said he had insurance but still needed to pay $25,000 out of pocket.

Seattle Genetics Receives FDA Approval for Lymphoma Drug Adcetris Set to Cost $13,500 a Dose–A Dendreon Rerun?

It’s good to get the doctor’s input for a change as they are the ones with the doctor-patient relationship and prescribe treatment.  Hopefully there will be additional surveys to follow but the question of reimbursement is big and rightly so, how can we afford the drugs as even with insurance there’s still some big potential cost involved here.  One more tidbit here relative to Provenge which was in the news of late as the FDA just approved another facility,  however it looks like they will be laying people off.  If you have followed the development of the drug over the last 3 years with all the news, it has been a rocky, bumpy and political ride.  BD 

Dendreon CEO Dumped $1M Stock Before Admitting They Will Not Meet Their Projections for the Year–Layoffs?

A new, free Sermo survey of experts on the front lines in cancer care may help address the crucial ethical question of how to measure life-extending medical treatments' cost versus benefits.  Feedback from approximately 100 oncologists and urologists in the United States shows that financial and treatment administration issues facing Dendreon's Provenge for prostate cancer could signal a trend for other life-extending medicines and provide valuable insight to the biopharmaceutical industry overall.  According to Sermo, these results provide a clearer, more relevant, real-world picture of doctors' views on the specific dollar value of a clinically-proven survival benefit.

Among the key findings:

  • A large majority (68%) of the physicians believes that in order to prescribe Provenge or a similar life-extending treatment, the survival benefit must be seven months or more. 
    • More than 30 percent say a medicine needs to add at least one year of life.
  • The overwhelming majority (86%) of the respondents believes that such medicines should cost no more than $60,000.  
    • More than half of the doctors (57%) believe the price should be less than $30,000.
    • Nearly one-fifth (19%) of those surveyed think the cost needs to be under $10,000.

In addition, most of the specialists participating in the survey also say they have major financial concerns for themselves and their patients when prescribing life-extending treatments.

  • More than two-thirds (68%) do not believe they will be reimbursed if they have to purchase the drug out of their own pocket in advance, as is needed for Provenge.
  • The same 68% indicate the co-pay is a major concern for their patients.

About SERMO
Sermo is the largest online physician network in the United States, with more than 120,000 doctors, spanning 68 specialties. Sermo surveys leverage a level of candor and openness that many doctors maintain on social media, resulting in a more accurate measurement of true prescribing behavior inside the clinic. According to the Manhattan Research study called, "Taking the Pulse® v11.0," information physicians receive from colleague consults has the greatest influence on their clinical decisions, and healthcare provider portal sites, such as as Sermo, have the best reach amongst online physicians. The report also shows that of the nearly one-fourth of physicians already using online communities or social networks, 84% have visited Sermo in the last three months, more than three times the next largest competitor.

Selasa, 30 Agustus 2011

Prognosis Health EHR System Buys Creative Healthcare Patient Accounting Company

Software companies continue to merge and acquire one another, the merging of the imagesoftware algorithms.  In this case the EHR system will be adding more financial accounting modules, and this seems to be pretty common place today to add the financial and/or billing capabilities to medical record systems.  BD

Houston-based Prognosis Health Information Systems Inc. is acquiring Creative Healthcare Systems Inc., based in Springfield, Mo.

Creative Healthcare Systems developed MedGenix, a financial management and patient accounting system. Prognosis developed ChartAccess Comprehensive EHR, an electronic medical-records system. The acquisition will allow Prognosis to add 18 new modules to its health-record system.

“Hospitals today — both big and small — are seeking to implement comprehensive, enterprise-wide solutions that can help them optimize both their clinical and financial operations,” Jay Colfer, executive vice president of client solutions for Prognosis, said in a statement. “With this acquisition, Prognosis will be able to do just that.”

http://www.bizjournals.com/houston/news/2011/08/30/prognosis-health-acquiring-medical.html

Illinois Doctors and Hospitals Refusing to Participate in Pilot Medicaid Managed Care Program Run by Commercial Insurers

The program is being run by two insurance companies, Aetna and Centene-IlliniCare imageand I am guessing the reimbursement rates are at the heart of the issue, what else today?  Many patients will need to change doctors and care facilities. 

As what happens today with changes with doctors and care facilities, everybody has to get their data together and it becomes a big mess for the patients and the doctors.  BD 

CHICAGO — Many doctors and hospitals are refusing to participate in Illinois’ pilot Medicaid managed care program, forcing some patients to find new health care providers, according to a published report.

Leading medical centers have refused to join the cost-saving program starting in six northern Illinois counties.

Northwestern Memorial Hospital, Rush University Medical Center and the University of Chicago Medical Center are among hospitals that so far have chosen not to take part.

In contrast, the University of Illinois at Chicago Medical Center has joined the program.

Loyola University Health System said in a statement that it wasn’t participating for now because “our expenses for Medicaid exceed our reimbursement.”

Brent Estes, a vice president at Rush Medical Center, said managed care plans can force oppressive administrative requirements and hunt for ways to restrict payments to hospitals.

Julie Hamos, director of the Illinois Department of Healthcare and Family Services, said she found it “disappointing” that health care providers were resisting the change.

http://heraldnews.suntimes.com/news/7295665-418/area-doctors-and-hospitals-snub-medicaid-managed-care-program.html

Pruning Shears in a Freak Accident End Up Inside Man’s Head-Full Recovery Expected

This is a strange picture as he accidentally lost his balance and pretty much fell on imagethe clippers. 

Half the the pruning shears were in his head!  Luckily he didn’t lose either of his eyes, but the x-ray is just dumb founding.  BD 

Leroy Luetscher dropped a pair of pruning shears while working in his yard in Green Valley, south of Tucson, on July 30, the University Medical Center in Tucson said in a news release.

The shears landed in the ground point downward. When Luetscher bent down to pick them up, he overbalanced and fell face-down on the handle, which punched through his eye socket and went down into his neck.

http://www.reuters.com/article/2011/08/30/us-arizona-shears-idUSTRE77T4Y020110830

Windows Phone + Windows7 + Kinect + Surface + Speech Recognition – Wicked Technology and Integration

Wicked is about the best word I could come up with here.  When you watch the demonstration of all of these technologies together this is amazing.  I have used all imageof them separately but have never seen anything like this.  So far I’m a happy camper too with my Windows Phone and recently read where it’s the most secure device out there and that’s what I wanted.  If you have never seen any of Dr. Neil Roodyn’s material, he’s always coming up with a surprise and has been a very long time tablet developer

Cellphone Died This Week–My New Phone is Windows Mobile 7 - I Wanted Security, Privacy and Applications - In That Order

As mentioned below this is “in the wild” and done in Australia and not here in the US but they are a Microsoft partner by all means.  BD 

NSquared

What could this do in healthcare?  Any ideas?  I tried and put my thinking cap on and for some reason it was not working too well as I tried to come up with an idea that could use all of the technologies at once, and I’m sure there’s ideas out there but my tired brain couldn’t think today.  BD 

Another post, another video featuring Microsoft Surface. This time, it’s nsquared, a Microsoft Partner from Australia who showed off this impressive demo during the TechEd Australia 2011 developer keynote this week.

I thought the integration of Surface and Windows Phone was particularly impressive and seeing a developer using the voice capability of Kinect was also cool.

As Long Zheng notes, you sometimes see this kind of integrated demo in our vision videos (or sometimes in Craig Mundie demos) but to see it in the wild is testament to what’s possible and to the capability of nsquared. Kudos to them!

http://blogs.technet.com/b/next/archive/2011/08/30/windows-phone-windows-7-kinect-surface-coolness.aspx

Senator Grassley Holds a Town Hall Meeting–States He Knows Only Knows of One Member of Congress Who Really Wants to Privatize Social Security-But He’s Not Telling (Video)

Well, well we could go all kinds of places with this and based on what has been all over the news of late, does he have his facts right?  I wonder.  You can listen to the town hall meeting.  I have to say one thing though is that he does at least have a town hall meeting as in my area in the OC which is a GOP rep we get robocalls…”hi..I’m….and so you glad you could be on the line to talk with me tonight”…disgusting and pretty useless and they talk more about the tomato plants on the office patio than anything else. 

Corporate Taxes and Lack of Legal Digital Literacy Allow Big US Corporations To Stash Billions Overseas, Pharma, Tech, All Well Represented (60 Minutes) (Video)

Just one more digitally illiterate member of Congress without an Algo man and no clue on how technology and algorithms have shifted the money in the US over the last few years, they are killing us.  We have them in both parties and mixed in with executive positions too with HHS playing around with a Facebook app so more of our data can be mined and give even more profits to big business while selling our confiscated data off the web, they don’t get it.  BD 

IBM Watson Did Get a Chance to Go To Congress-Should be a Permanent Home For Greater Intelligence for Creating Laws

I wonder if Grassley anytime in the future will let us know who that “one” is?  BD  

Grassley Social Security Town Hall Meeting

During a town hall in Carroll, Iowa last night, Sen. Chuck Grassley (R-IA) fielded question after question from constituents who were furious at Republican efforts to weaken Social Security. Midway through the event, one Iowan stood and told Grassley his personal story about retiring in 2008 just as the stock market cratered, decimating his IRA and 401k retirement plans.

He implored Grassley not to privatize Social Security, asking if he should expect “to live on whatever the stock market leaves me?” After the crowd gave the constituent loud applause, Grassley responded that he only knows of “one member out of 535 who wants to privatize Social Security.”

GRASSLEY: First of all, I’ve already answered the first question. Everything’s on the table. Secondly, I only know of one member of Congress out of 535, and I won’t name him, but I only know of one member out of 535 who wants to privatize Social Security.

http://thinkprogress.org/economy/2011/08/30/308015/chuck-grassley-privatize-social-security/

UnitedHealth, YMCA Expand Diabetes Prevention Program with P4P for Walgreens

The process uses UnitedHealth claims data and other demographic information to flag people at risk of developing diabetes and invite them to a free, 16-session exercise and nutrition class at a local YMCA.  Those who already have diabetes receive a 45 minute assessment unless anything has changed.  This goes back to the original announcement of the program.  As it was originally quoted, the YMCA would get around $300 for someone who completed the YMCA program and the Walgreens pharmacists get some form of pay for performance. 

UnitedHealthCare To Use Data Mining Algorithms On Claim Data To Look For Those At “Risk” of Developing Diabetes – Walgreens and the YMCA Benefit With Pay for Performance Dollars to Promote and Supply The Tools

In March of this year the program was expanded to Atlanta. 

United Healthcare Expanding Diabetes Prevention & Predictive Algorithm Program With Walgreens And Pay for Performance Incentives In Atlanta

Again the use of analytics comes into play here as well and Walgreens not too long ago said their data selling business was worth just under $800 million.  People may get healthier with participation and data will more than likely be sold to make money off of selling the patient data at the same time.  It all seems to work hand in hand anymore.  BD 

DALLAS – UnitedHealthcare, area YMCAs and local pharmacies have announced they will partner to launch the “NOT ME” diabetes prevention program of the Diabetes Prevention and Control Alliance (DPCA), an employer- and community-based initiative aimed at diabetes prevention.

Part of the National Diabetes Prevention Program led by the Centers for Disease Control and Prevention, the program is a 16-session lifestyle intervention conducted in a group setting through local YMCAs intended to help people with prediabetes and others at risk, prevent the onset of type 2 diabetes through healthier eating, increased physical activity and other lifestyle changes.

According to UnitedHealth, the NOT ME program it is helping to sponsor marks the first time a health plan is paying for evidence-based diabetes prevention and working actively with pharmacists to help people with their diabetes management programs. The DPCA, which runs the program, was founded in 2010 by UnitedHealth Group, the YMCA and Walgreens.

The NOT ME program uses the findings of a clinical trial of the Diabetes Prevention Program the was led by the NIH with support from the CDC. The trial showed that lifestyle changes for people with prediabetes, which include modest weight reduction, can prevent or delay the onset of the disease by 58 percent.

http://www.healthcarefinancenews.com/news/unitedhealth-ymca-local-pharmacies-team-diabetes-prevention?topic=05,19

Senin, 29 Agustus 2011

Don’t Get Stuck in the IT Past–Locked in an 8 Track World–VM Limited (Video-Humor)

This is funny and we may guess who VM Limited might be and there’s a company imagehaving their big meeting this week with a similar name.  Now I do have to say, “locked in an 8 track world also very well applies to many of our members of Congress too, doesn’t this guy look like some of them <grin>.  I love the van and portable office here too, good work on some funny humor here on selling virtual and cloud services.  BD 

More Congressional Testimonies About Health IT–Members of Congress Could Entertain Getting an “Algo Man” on Staff As Wall Street and Health Insurers Have Them–Don’t Leave Home Without One

Some IT providers claim they have a cloud solution but they really offer something less. They don't offer common management tools that allow you to easily manage and migrate across your private and public clouds. They don't allow you to manage deep within your applications. And they require licensing that charges more, the more you use.
If you're ready to move to a cloud, try a private cloud solution from Microsoft. It's built for the future and ready now. Find out more at http://aka.ms/VMltd.

http://vmlimited.ctp.trafficmgr.com/

AMA Issues Response to CMS Bundled Payment Initiative–Short and Sweet-Be Prepared to Provide Technical Assistance And Data To the Doctors Beyond a Website

I like this answer as the AMA is of course stating they are pleased with the options and opportunities, but they are also real in this statement.  It’s confusing, tough and imagea lot of information to read through and practices will have a lot of questions and will need “Health IT” support (let’s not forget this involves billing) to get set up on the initiatives and it could even go beyond this level I would guess with maybe even getting to the point of helping the doctors with their discussions with the hospitals. 

CMS Created Four Bundled Plans for Payment and Is Looking for Hospitals and Physicians to Participate

In case you missed it a couple weeks ago a report is out that states it costs doctors a ton of money already annually to keep up with the insurer red tap so add this to till?  By the time all the bills are paid, here in southern California, I have a few former MD clients that don’t even clear 100k a month for themselves!  When I spoke at the e-MDs annual meeting I spoke with a clinic that had each doctor working from 8 am to 8 pm and seeing over 100 patients a day!  They weren’t complaining but trying to figure out how to further automate and gee that is getting harder to do! Remember these practices still need to see patients as it is still the people business and the small practices are not just small data silos that see patients on the side. 

Health Insurance Paper Work Costs Doctors an Average of $83k a Year

Now if that isn’t enough, listen up and read here on the CIO side of things and how the ICD-10 is the straw that is ready to break the camel’s back.

Dr. Halamka Speaks About Health IT–“CIOs are on Overload” and It Would be A Blessing to Stall Off ICD-10 to 2016 - The Straw Breaking the Camel’s Back

This is a good statement as we have so many in positions that are making these timeline and data decisions, who don’t do any of this themselves!!  Get a clue soon, please!  Non participant executives who don’t understand Health IT and data flows are killing us as they don’t get it and have absolutely “no hands on” experience to help them in this area. 

They can’t debug themselves!!

Meaningful Use-Money And Data Being Thrown Every Which Way To See What Sticks With Limited Expertise And Not Enough Time at the Top to Lead a Full Debugging Process

Shoot CMS this is still the people business and look at how you want everyone to find the time do all of this.  Consumers have just pretty much shunned it as they want to spend all the time to learn and only get involved in tracking down information when a claim is denied.  We don’t even have an active REC center in Orange County, California either, and I guess they got the money but zero has been done and their information page is still part of the over all Cal-Optima Medicaid insurance site as that’s who received the contract. 

Does our Surgeon General get involved here as she would be a good one having her great background with doctors and patients before her appointment, as she battled this stuff but I’m guessing she’s on overload right now too.  How about this from a year ago with improving Health literacy?  I hear nothing from anyone being a role model and working with all of this data and billing themselves, so how in the world do they know what the real work load is, they don’t.  I have blogged about our lack of role models for over 2 years now and we still get these timelines and additional red tape sent the way of both doctors and patients from the “non participants” that have no clue. 

HHS National Plan to Improve Health Literacy – Not Going To Happen Until We Focus on Using Technology (The Tool for Literacy) Which Includes Role Models at HHS And Other Places in Government

Again, nice statement from the AMA with being realistic here and putting the cards on the table right up front, help the practices and do more than just put out information on websites, as that’s about all we see right now with some pretty unattainable standards. due dates,  and wishes being put forth.  BD 

Immediate Past-President, American Medical Association

"The American Medical Association (AMA) appreciates CMS' responsiveness to our interest in bundled payments.  We are pleased the initiative provides flexibility and a range of models.  This may be an important opportunity to learn how to organize these approaches to improve patient care, quality, cost of care, and practice economics.

"We look forward to reviewing the details of the application criteria, and we urge CMS to encourage applications for physician-led bundling initiatives.  We urge CMS to be prepared to provide technical assistance and data to interested physicians who may not have experience with bundled payment models."

NHS Doctors to Use “Redneck Telehealth” Also Known as “Skype”–A Good Thing

A while back I wrote about this topic with a friend who was out of town and needed to talk with his doctor long distance and the doctor wanted to know about his toe, so I said “Get on Skype put your toe up there”.  You can read more at the link below, but gee, why not?  Both the doctor and friend were happy with the suggestion and Skype is so widely known already too.  They had a great foot conference out of this:)

And Now A Word About “Redneck Telehealth” Brought to You by Skype and Microsoft

I had a ton of comments on this as well as pretty much everyone agreed and the reason for the “redneck” name is due to the fact that this is off the cuff as far as having a software system that does this automatically to document everything so in the meantime it’s Redneck healthcare, but it works!  Back when I wrote this a few months ago, Microsoft here in the US said they were also looking at incorporating Skype where they could but it may be a while before we hear anything but in the meantime, the NHS is hot after the trail of using Skype.  This is a big deal as you don’t have to sell the consumers and doctors on “value” either, it’s automatically recognized, unlike so much other software and programs that float around out there today too.  We are so over done with technologies that offer mobile apps that only do “one thing”, a huge glut and the stuff keeps coming.  I rant about it all the time and most of the developers that create consumer software don’t even think about using themselves to make matters worse.  We have ton of innovation in the US, but a big lack of collaboration. 

I read today where some VCs left their start ups high and dry so maybe a bit more of that type of action and collaboration might start getting some real attention soon, I hope!   If the VCs just only started funding software that does more than “one thing” we would be miles ahead.  BD

Patients will be able to hold online consultations with doctors as part of plans to technologically revolutionize the NHS, according to its medical director.

Professor Sir Bruce Keogh said that IT will ''completely change the way we deliver medicine'' making access to GPs at any time a reality and giving patients the ability to talk to specialists anywhere in the country.

The health expert told The Times newspaper he was looking at using online services such as Skype to make the NHS more convenient for users.

''I am looking at how we can put levers into the system to encourage doctors to do online consultations,'' he said.

''Once you have online consultations, it breaks down geographical boundaries. It opens up the specter of 24/7 access.''

http://www.telegraph.co.uk/health/healthnews/8729069/NHS-doctors-to-examine-sick-patients-over-Skype.html