Sunday, September 23, 2012

Consumers have "no meaningful information about the quality of care," but the same can't be said for Leslie Michelson

Why do consumers have "no meaningful information about the quality of care"? Because businesses are the ones buying the insurance, not the patients. And insurers have no stake in long-term results.

September 21, 2012
Leslie Michelson: Doctor to the 1% (and Maybe Someday to You)
Wall Street Journal

The rich are different than you and me. Not only—yes, yes—do they have more money, but they've also heard of, and many have hired, Leslie Michelson.

...So the health-care delivery system, to the extent it qualifies as a system, "has no quality control, no integration, no coordination." Doctors "tend to operate in an independent and isolated way, and even specialists who've been treating the same patient for years and years typically never, ever speak to one another."

Private Health is designed to backfill these gaps whenever one of its patients has a medical emergency or complex condition, say, a traumatic brain injury or newly diagnosed cancer. A personal-care team parachutes in, led by a clinician employed by the company, and compiles a brief on the patient. They centralize and digitize the patient's medical records, usually dog-eared paper piles that can run to thousands of pages. Research scientists immerse themselves in the latest findings and treatment regimens for the particular condition involved.

Tests are double-checked—biopsy tissues are sent to an outside pathologist, MRIs to another radiologist. For an era of targeted therapies, Private Health runs a full battery of molecular diagnostics "to sequence the entire three billion base pairs of somebody's DNA in a couple of hours," Mr. Michelson marvels.

The goal is to ensure an accurate diagnosis and lay out all the treatment options. Private Health functions as a kind of running, independent second opinion. It operates in the twilight zone where there isn't a "best practice" for when and how to treat, but a continuum of risks and benefits that vary from patient to patient.

The clinician helps locate the right experts, Mr. Michelson says, and then works to "fuse together all these multiple specialists in a single team with a single objective." There are "no redos, no lost scans, no ambling around going from specialist to specialist, trying to figure out what's going on." The most frequent reaction is: "This is how medicine was always supposed to be practiced."

The idea for Private Health came to Mr. Michelson when he was running the Prostate Cancer Foundation, the multibillion-dollar philanthropy Michael Milken set up in 1993. Prostate cancer is a common disease but treatment isn't straightforward. Surgeons end up recommending surgery, radiation specialists radiation, still others "watchful waiting," etc.

Mr. Michelson says people started asking him for advice, which led to the prototype for Private Health. Eventually he decided to improve his process across more diseases and help more people.

One irony is that for all its white-glove extras (a research department, genetic profiling), a lot of what Private Health does are core functions that patients would value and providers or insurers ought to be doing but rarely do (case management, using computers). Why is that?

Cost is part of it. "It's too expensive for us to do it for everybody right now," Mr. Michelson says. Another part, he thinks, is that "the incentives are attenuated because of the structure of insurance," namely, job-based coverage.

Since businesses are the customers, not the individuals who change jobs every three years on average, insurers "act rationally" and don't invest in services with "short-term costs and long-term payback." Mr. Michelson thinks the better option is for businesses to convert to cash vouchers so their workers can buy portable policies. Right now, there is "no meaningful information about the quality of care, virtually no information about price, and no sensitivity to price," but that would change if the insurance industry built "an enduring relationship with consumers," he says.

"I understand that it is woven into the fabric of our society that employers can and should continue to pay for health insurance for their employees," Mr. Michelson declares. "But why, circa 2012, should HR departments be selecting and administering one or two or three plans for a thousand or a hundred thousand workers and their dependents? You don't need a Ph.D. in economics to understand that you will guarantee suboptimization."

Friday, September 21, 2012

Kaiser incident probed as hate crime

Kaiser has a very top-down culture, which does not foster good relationships between employees.

RIVERSIDE: Kaiser incident probed as hate crime
Press Enterprise
12 September 2012

Riverside police are expected to meet with Kaiser Permanente officials Thursday, Sept. 13, to discuss why a mannequin with black paint on its face and a racial slur written on its chest was left hanging in the health care provider’s Magnolia Avenue hospital.

Police opened an investigation this week after a hospital worker walked into the Magnolia Avenue police station on Monday afternoon, Sept. 10, and said he found the black-faced mannequin hanging near his work area on Friday, Sept. 7, said Sgt. David Amador, who is in charge of the investigation.

The worker brought photos of the mannequin, which had a racial slur and the word “hang” written across its chest. The mannequin was discovered in an area that is not open to the public.

Police were just getting into the investigation as of Wednesday and were exploring a range of possibilities for what might have prompted the incident, Amador said. “We are looking at it as a hate crime,” Amador said. “We’re looking at why it was placed there, who placed it there and for what purpose.”

KNBC Ch. 4 reported the incident on its 6 p.m. newscast on Tuesday, Sept. 11, speaking to workers at the hospital.

“You’re not sure what to think,” employee Tyree Hale, who is black, told the TV station.

Kaiser was pursuing a separate investigation into the incident. Peggy Hinz, Kaiser’s director of issues and brand management, promised a thorough inquiry.

“At Kaiser Permanente, we are deeply committed to respecting diversity, preventing discrimination and providing a work environment free of harassment,” Hinz wrote in an email. “We take the matter that has been brought to our attention extremely seriously. We are moving quickly to investigate the matter and will take appropriate action. We do not tolerate any form of discrimination in our workplace and will take all appropriate measures to address the full scope of this situation.”

Friday, September 14, 2012

Doctor, Hospital Deals Probed, but not Kaiser Permanente, which does the exact same thing

Isn't this exactly what Kaiser Permanente has done? Does Kaiser have the political clout to escape examination?

Doctor, Hospital Deals Probed
September 13, 2012
The Sacramento Bee/Associated Press

California's attorney general has launched a broad investigation into whether growing consolidation among hospitals and doctor groups is pushing up the price of medical care, reflecting increasing scrutiny by antitrust regulators of medical-provider deals.

The office of the attorney general, Kamala D. Harris, has sent subpoenas, known as civil investigative demands, to several big hospital operators in the state, including San Francisco-based Dignity Health and San Diego's Scripps Health and Sharp HealthCare. Northern California's 24-hospital Sutter Health system has also received one, as has Santa Barbara-based Cottage Health System, according to people with knowledge of the matter. Subpoenas have also gone to major California health insurers, those people said.

The probe, which has been under way for several months, is examining hospital systems' reimbursement from the insurers, according to people with knowledge of the matter. The regulator appears to be focusing on whether the systems' tie-ups with physicians, as well as ownership of hospitals, have given them the market power to boost prices in a way that violates antitrust law, these people said.

Nationally, health-care providers are rapidly merging into bigger health systems, moves that they say will improve efficiency. The number of hospital deals last year, 86, was the biggest since 2000, according to Irving Levin Associates, a research firm that tracks health-care transactions.

Also, nearly a quarter of all specialty physicians who see patients at hospitals are now employed by the hospitals, according to an estimate from the Advisory Board Co. ABCO +0.51% That is more than four times the 5% in 2000. Among primary-care doctors who see patients in hospitals, the employed share has doubled to about 40% in the same time frame.

The American Hospital Association said consolidation doesn't routinely drive up prices; the California Hospital Association referred questions to the national group. Hospitals are merging and employing more doctors in order to streamline and improve care, under pressure from health regulators urging a more integrated approach under the federal health overhaul law, said Melinda Hatton, AHA's general counsel. "The antitrust agencies and national health-care policy don't seem to be really in sync at this point," she said.

Some research suggests that mergers can drive up health-care prices. A 2010 study published in the journal Health Affairs said concentration among health-care providers in California had led to "a definite shift in negotiating strength toward providers, resulting in higher payment rates and premiums."...

Wednesday, September 5, 2012

Man Wins Lawsuit Against Kaiser Permanente; first time a Fresno jury finds Kaiser guilty of malpractice

I doubt that this was the first time that Fresno Kaiser failed to properly care for a patient. It's just the first time that Kaiser lawyers failed to convince a Fresno jury that Kaiser shouldn't have to pay for patient's damages.

Kerman Man Wins Lawsuit Against Kaiser Permanente
By Audrey Asistio
KSEE24 News
September 4, 2012

It's been a rough three years for Dusten Chevalier. Before the 27-year-old became confined to a wheelchair, he loved the outdoors. Racing dirt bikes, football, baseball, he did it all. But Chevalier says that all changed after he ended up in a Kaiser Permenente emergency room, in Fresno.

“It all started off with my stomach hurting and I actually got my appendix taken out. When I got home my if side was kind of hurting and was a little red. So we went back to the ER. Come to find out, I had an infection but they never told me any of this. I didn't even know I had a blood test pending,” said Chevalier.

He says the hospital failed to tell him that he tested positive for MRSA, an infection that could be fatal. The infection went untreated and he eventually lost the use of his legs and feet.

“At first it didn't seem real. It was hard to even imagine my life now, because before I was really into sports everything I did was outside. It was hard. It still is. Every day is really hard, but I don't know I'm just thankful I'm alive because I could have died,” expressed Chevalier.

Chevalier took Kaiser to court. After a month long battle, The jury verdict included damages in the total amount of $5,000,000.

Kaiser Permanente released a statement regarding this case that reads in part, “Kaiser Permanente, immediately after diagnosing the patient's infection, made repeated attempts to contact him to get him the treatment he needed. This was to no avail, as he provided inaccurate addresses and contact information. Kaiser Permanente went so far as to contact the Clovis Police Department to help locate the patient to get him to come in for treatment. Given these facts the jury found that, for the most part, much of the responsibility in this case fell upon the plaintiff himself, thus reducing the award by 70%.” This means Kaiser will only need to pay Chevalier 1.5 million dollars.

Chevalier claims he provided Kaiser with accurate contact information. Medical experts say the cost of his care will cost millions of dollars over the course of his lifetime.

Chevalier's attorney says this is the first time a Fresno County Jury ruled against Kaiser Permanente in a malpractice case.

Monday, September 3, 2012

Jury Awards $7.8M in Hospital Negligence Suit

Jury Awards $7.8M in Hospital Negligence Suit
ABC News
September 1, 2012

A western Tennessee jury has awarded $7.8 million in damages to the family of a child who suffered severe brain damage as a result of an improperly treated wound at a hospital. The Dyersburg State Gazette reported Friday ( ) that the lawsuit was filed against Dyersburg Regional Medical Center and others. It stemmed from when then-12-year-old Jonathan Reynolds was treated in 2004 after falling on a nail. The lawsuit claimed that proper procedures were not taken to avoid infection and the hospital personnel failed to give him the proper antibiotics. The boy caught a flesh-eating bacterium that required numerous skin grafts. He also developed severe brain injuries after slipping into a coma. A jury in Dyer County returned the verdict earlier this month after a 15-day trial.