Wednesday, March 25, 2009

Veterans Care Fiasco - Disaster #2

More than 3000 southern Florida veterans are being called in for infectious disease testing after tubing on colonoscopy equipment was found to be improperly sterilized.

This follows a similar colonoscopy problem in another region, and another recent problem with ear-nose-throat equipment.

The care standards for these procedures are quite well known, and the number of exposures indicates a serious management problem (as opposed to a batch or two of sterilization problems, which can happen).

Odds of infection should be low, but low is too high for those infected.

VA Policy Proposal - Disaster #1

Last week the Obama administration floated a lead-filled trial balloon.

The administration proposed that a veteran's care could be billed to a vet's private insurer in some cases, raising $500M a year.

The feedback from veterans' groups and Congress was swift and ugly.

Veterans' feared losing private insurance coverage, and members of Congress proclaimed veterans' care a convenant not to be broken.

The administration moved on to other topics - quickly.

Wednesday, March 11, 2009

The Lastest in Physician Office IT

Who will lead the charge to install IT in physician offices?

Sam's Club and Dell.


Sam's Club will partner with Dell and eClinicWorks for software, hardware, training and maintenance. No joke.

The system will integrate patient appointments and billing (the billing modules are ultra-complex and carry significant risk of major problems).

Wal-Mart has some experience with health care IT, primarily in pharmacy and optometry. WM also has used the software in a limited number of redi-clinic settings (which are much different than a regular physician office).

Does Wal-Mart understand the complexities of physician office operation and the vagaries of dealing with physicians?

The $20B stimulus money had to attract a lot of vendors, this may be the surprise leader of the pack.

Tires, lettuce, underwear, health IT. Such a concept.

Hat tip: International Herald Tribune 3/11/2009

More Blogging

It has become clear, this blog will be dominated by health care reform and public policy.

The management issues we want to discuss simply cannot be woven in here.


A new blog, will focus on management issues and regulatory matters. There will be some cross posting.

Spread the word!

Sunday, March 8, 2009

Rediscovering the Nursing Shortage

Another administration discovers the nursing shortage.

Proposal: the federal government should channel funds to colleges and universities that provide programs we need, rather than graduating more Ph.D.s in overcrowded disciplines.

Nursing - high stress, bad hours, physical exertion, exacting standards, little respect.

Thursday, March 5, 2009

Failure to warn

The U.S. Supreme Court settled a major liability issue in Wyeth v. Levine this week.

A patient was given an IV push dose of Phenergan, apparently the administration was done in a negligent manner and the medicine entered an artery, and the patient lost her arm.

As best I can tell there was no allegation that Phenergan, a widely used drug, was hazardous, but that the drug maker Wyeth should have provided better warnings about what could happen if an IV push administration was done improperly.

(I checked with my favorite nurse, who tells me that she doesn't need to be warned not to put an IV into an artery, as she said "what do you think the "V" stands for." Nurses rarely read warning materials on commonly used drugs anyway. Just one opinion. She does administer Phenergan regularly, although not via IV.)

The legal argument?

Wyeth claimed that since the FDA had found Phenergan to be safe and effective, and because the FDA has approved very precise language on the label, there was no duty to provide further warnings and no ability to unilaterally rewrite the warning materials.

SCOTUS says the state could find a duty and that Wyeth could have unilaterally changed the labeling.

So what does label approval by the FDA mean today? How far does the unilateral rewrite authority go? What if the FDA disagrees with the unilateral rewrite.

From a liability standpoint, how much liability should a drug or device maker have for provider malpractice?

Interesting questions.

Sunday, March 1, 2009

Voodoo Finance

Governor Strickland of Ohio is going to increase his Medicaid available funds by -- taxing health care providers, specifically hospitals, nursing homes, MR facilities and managed care companies.


Dirty little secret -- some states use "bed taxes" or "provider taxes" or "provider fees" to generate match money for federal Medicaid funds, a maneuver which is legal but on shaky ethical grounds. This is "dog chases tail" gimmick financing. Who is to blame? Fed reform of Medicaid would help.

A nursing home will pay the "tax" on all licensed days of service, but will be reimbursed for the "tax" only for those days used by Medicaid recipients. This amounts to a tax on all residents not funded by Medicaid, what the federal government calls cost shifting.

When criticized for using stunts and gimmicks to balance the budget (and avoid restructuring the government), Strickland uses the everybody else has done it defense.

To be fair, the states have many difficult budget decisions. This is not a healthy balance budgeting tool, especially after the feds pouring stimulus money into the states.

For more details, excellent reporting in the Columbus Dispatch.