Wednesday, October 28, 2009

I'm a doctor. So sue me. No, really

The doctors' lobby says capping malpractice suits will make healthcare cheaper.
I'm an M.D. and I don't believe it
By Rahul K. Parikh, M.D.
Oct. 27, 2009

Flu season has come early and I'm writing far too many prescriptions for Tamiflu. I'm trying my best to adhere to the guidelines set by the Centers for Disease Control for who should get the drug (kids under 5 years of age, or kids who have a chronic illness like asthma or diabetes). But in more than a few instances, I've ignored the guidelines and given Tamiflu to perfectly healthy kids with no risk factors for influenza-related complications.

Part of the reason I'm writing so many extra prescriptions stems from stories about healthy people getting sick with H1N1 and ending up critically ill or dead. One of those stories aired recently on "60 Minutes" -- a healthy high school football player in Arkansas developed a fever after a game. He went to his doctor, who thought he had a garden variety flu and sent him home. Two days later, the boy collapsed and was airlifted to the nearest pediatric intensive care unit. He developed a bacterial pneumonia on top of his H1N1 flu, which led to severe damage to his lungs. He couldn't breathe on his own, so he remains in the ICU on a ventilator.

The H1N1 strain of influenza is no more lethal than any other strain of flu. Mortality is less than 1 percent. Nevertheless, by over-prescribing an expensive drug that has only marginal benefits, I'm unequivocally practicing what is known as defensive medicine. As in, the kind of medicine that protects doctors as much as patients.

Mine isn't an extreme example of defensive medicine. I'm a pediatrician. Obstetricians and emergency room doctors are sued at far higher rates, and would have more dramatic stories to share. But my motivations are the same as theirs: I'm afraid that if I don't do something, one of my patients may get sick or die, and I'll end up in court being asked why I didn't do everything I could have.

Defensive medicine is just one of the supposed systemic ills that doctors, doctors' lobbies and doctors' insurers invoke when they shill for what they call malpractice reform. Proponents of reform say that defensive medicine, frivolous lawsuits and high premiums are behind the surge in healthcare expenses. They insist that malpractice costs are forcing doctors to close their doors and depriving patients of care. Recently, three past presidents of the American Medical Association coauthored an opinion piece for the Wall Street Journal that bundled all of these arguments into an attack on the public option. Their piece attempted to shift the blame for America's healthcare crisis away from private insurers and onto a supposed scourge of ambulance chasers. "The nation needs comprehensive medical malpractice reform," they wrote. "It is the surest and quickest way to slow down the rising cost of healthcare."

Their refrain is familiar to anybody following the healthcare reform debate. The only problem is that it's not true. There's nothing "sure or quick" about changing medical liability laws that will improve healthcare or its costs. Defensive medicine adds very little to healthcare's price tag, and rising malpractice premiums have had very little impact on access to care.

Let's look at the numbers. First, based on the current rhetoric, it's easy to assume we have an epidemic of malpractice suits in America. We don't.

There are many statistics out there, and it's not always possible to make an apples to apples comparison between one study and another. Some surveys cover the nation, some cover one group of states, some cover another cluster, and results vary. But according to the Congressional Budget Office, nationally, between the mid-1990s to the mid-2000s, the frequency of malpractice suits per capita remained stable at about 15 claims per 100 physicians per year. Another report, from the National Center for State Courts, actually shows that the number of cases between 1996 and 2006 dropped 8 percent.

Although the payout per claim has increased, the Justice Department, in a 2007 report about medical malpractice -- in fact, the same report cited by the authors of the Wall Street Journal piece mentioned above -- provided an explanation quite different from an epidemic of lawsuits. "Growing healthcare costs and an increasing effort by many attorneys to litigate only those medical malpractice claims involving severe injuries or wrongful death claims may explain some of these increases," they wrote. Still, even with the rise in payouts, the Congressional Budget Office, using statistics from the government's Centers for Medicare and Medicaid Services, estimates that malpractice costs account for less than 2 percent of healthcare spending. Saving 2 percent of the over $2 trillion we spend on healthcare isn’t going to bend the cost curve.

Next is the question of frivolous lawsuits. Tort reformers push the notion that junk lawsuits dominate the legal system. The Wall Street Journal article cited above refers to studies that show that 80 percent of claims are settled without payment to the patient and that when a case does make it to trial, doctors win 89 percent of the cases.

But the private studies cited often involve small numbers of claims, or focus on a single hospital, insurer, specialty or type of injury, or were commissioned by interested parties, aka the malpractice insurers themselves. The 2007 Department of Justice study cited by the Journal trio covers only seven states, and nowhere does it mention the numbers 80 percent and 89 percent. Repeated attempts to contact and ask one of the authors of the WSJ story about the specific source of their data were unsuccessful. The DOJ report shows that in one state, Illinois, 88 percent of claims were closed without a payout. But for the other states it examined, the number was between 62 percent and 69 percent. Regarding the percentages of cases doctors win, a 2001 analysis by the Bureau of Justice Statistics, examining malpractice trends in the 75 most populous counties in the U.S., put that number closer to 70 percent.

In 2006, researchers from Harvard published a study in the New England Journal of Medicine that was designed to avoid the limits, and the biases, of prior research. What they found kills the notion of frivolous lawsuits. It suggests that most people who sue are suing for good reason.

Next page: Tort reformers neglect the fact that malpractice reform won't save one extra life

Monday, October 26, 2009

Healthcare system wastes up to $800 billion a year

Healthcare system wastes up to $800 billion a year
Mon Oct 26, 2009
By Maggie Fox, Health and Science Editor

WASHINGTON (Reuters) - The U.S. healthcare system is just as wasteful as President Barack Obama says it is, and proposed reforms could be paid for by fixing some of the most obvious inefficiencies, preventing mistakes and fighting fraud, according to a Thomson Reuters report released on Monday.

The U.S. healthcare system wastes between $505 billion and $850 billion every year, the report from Robert Kelley, vice president of healthcare analytics at Thomson Reuters, found.

"America's healthcare system is indeed hemorrhaging billions of dollars, and the opportunities to slow the fiscal bleeding are substantial," the report reads.

"The bad news is that an estimated $700 billion is wasted annually. That's one-third of the nation's healthcare bill," Kelley said in a statement.

Friday, October 2, 2009

The CIO 50 West winners include David Hudson, VP IT, Keenan & Associate

Everything Channel Announces the CIO 50 West Winners
press release
Sept. 21, 2009

--New Recognition Honors IT Executives for Influence, Innovation and Ability to Collaborate with Integrators and Vendors

FRAMINGHAM, Mass., Sept 21, 2009 /PRNewswire-FirstCall via COMTEX/ -- Everything Channel, a division of United Business Media, today announced the CIO 50 West winners, a new recognition that honors IT executives for their influence, innovation and ability to collaborate with integrators and vendors. The awards were presented at Everything Channel's Midsize Enterprise Summit West 2009, which took place at the Hyatt Regency Century Plaza in Los Angeles, CA.

The CIO 50 West winners include:

1. Mohinder Chopra, SVP & CIO, OSI Systems
2. David Hudson, VP IT, Keenan & Associates
3. Tracy Cleeton, Director of IT, Saga Communications
4. Keenan Lersch, Technology Manager, American Railcar Industries
5. Thomas Smith, CTO, PSRS/PEERS of Missouri
6. Brad Cackler, IT Director, Micro Power Electronics
7. Dave McDowell, Director of IT, West Liberty Foods
8. Greg McLean, Director of Technical Services, Green Bay Packaging
9. Christopher Holda, Director, IT, Integrated Health Associates
10. Randy Nye, IT Manager, Oak Harbor Freight Lines, Inc.
11. Rita Lazar-Tippe, IS Manager, Edmonton Journal
12. Michael Gauthier, CIO, IMTT
13. Michelle George, First VP - Application Development, Securities America
14. Nathan Church, VP & IT Manager, Columbia River Bank
15. Dave Ploch, CIO/Director, IT, Novus International
16. Greg Katers, Director of IT, Green Bay Packaging
17. David Chin, Director of IT, Stanford Hotels Corporation
18. David Price, IT Director, Resource Management, Inc.
19. Michael Brown, VP of IS, Peter Piper Pizza
20. Neil Stewart, Director Technical Operations, QuikTrip Corp
21. Dirk Anderson, VP Technology, C R England
22. Paul Dupree, CIO, Assistant VP of I.S., Asbury College
23. Bruce Hagen, VP Corporate IS, Bemis Manufacturing Co
24. Robert Bence, VP, Technology, Southwest Credit Systems
25. Larry Freed, Vice President & CIO, Atrium Companies, Inc.
26. Seth Hansen, VP - IT, Daktronics, Inc
27. David Cresswell, Director, IT Planning & Strategy, British Columbia
Institute of Technology
28. Lawrence Frederick, CIO, University of the Pacific
29. Raman Krishnaswami, Director, IT, Healthcare Benefit Trust
30. John DeLuca, Director of Information Technology, Hydranautics
31. Craig Crosby, Director, Information Services, Procopio, Cory, Hargreaves
& Savitch LLP
32. Adam Farkas, VP IT, Crown Media
33. Leonardo Imana, Director of Technology, Adelman Travel Group
34. Sergey Bushlyar, CIO, IT Director, Paul Capital Partners
35. Neil Ferguson, Technology Director, Orrick, Herrington, & Sutclife
36. Peter Mills, Executive Director, Information Technology, Canadian
Tourism Commission
37. David Cropper, CIO, Mamiye Brothers
38. Susan Faulkner, Director, Information Systems and Technology, Bluewave
39. Eric Vlam, Director of Information Systems, Equipment Depot
40. Michael Gibbons, Director, Northeastern State University
41. Aaron Bukhari, CIO & CSO, SNC Lavalin Nuclear Inc.
42. Chris Daly, Director, Infrastructure & Application Support,
Corporation Service Company
43. Niel Nickolaisen, CIO, Headwaters, Inc.
44. Lawrence Frederick, CIO, University of the Pacific
45. Carl Gammon, Director, Information Systems, Minntech Corporation
46. James Fielder, Vice President Information Technology, Farm Credit
Services of Illinois
47. Matthew Sharp, Director of I.T., David and Lucile Packard Foundation
48. Brian Mackay, Associate VP and CIO, Thompson Rivers University
49. Nick Barakat, IT Manager, Clean Energy Fuels Corp

50. Gary Allen, Chief Technology Officer, Amarillo Independent School

The professionals comprising the CIO 50 West were chosen for their leadership in utilizing technology to help increase corporate efficiencies, drive revenue and achieve other key business goals within their midsize company or organization. In particular,