Princess Health and The Collapse of Reciprocal of America. Princessiccia

Princess Health and The Collapse of Reciprocal of America. Princessiccia

Gusty 10:53 Add Comment

From the New York Times: the story of the decline and fall of Reciprocal of America, a
malpractice insurer based in Richmond, VA, which sold a substantial number of policies in the
South and the Mid-West USA. The story documents the effects of the collapse on physicians,
hospitals, and patients. Some physicians were unable to effectively defend against malpractice
law-suits after their insurer went bankrupt. A few found themselves personally liable for
malpractice judgments, and risk personal bankruptcy. Many physicians lost malpractice coverage, and found that they had to pay more than they expected for new policies. Some hospitals also lost malpractice coverage and also found that new policies cost much more than they had budgeted. Some patients have yet to receive promised compensation.
The failure of Reciprocal was not due to simply bad luck, or even less than brilliant management. Its former CEO, Kenneth R. Patterson, and former Executive Vice President Carolyn B. Hudgins have pled guilty to federal fraud charges. The US Department of Justice is pursuing investigations of other individuals involved with the company.
The Times documents what may now sound like familiar stories of a "dizzying matric of offshore accounts, secret transactions and financial sleight of hand" with "deals in luxurious surroundings, even as Reciprocal itself was falling apart." In fact, the fall of Reciprocal is now linked to larger problems affectin companies such as General Re and American International Group.
Here is yet another story of shady managers of a large health care organization whose mismanagement was to the detriment of patients, doctors, and hospitals.

Princess Health and The Collapse of Reciprocal of America.Princessiccia

Princess Health and The Collapse of Reciprocal of America.Princessiccia

Gusty 10:53 Add Comment

From the New York Times: the story of the decline and fall of Reciprocal of America, a
malpractice insurer based in Richmond, VA, which sold a substantial number of policies in the
South and the Mid-West USA. The story documents the effects of the collapse on physicians,
hospitals, and patients. Some physicians were unable to effectively defend against malpractice
law-suits after their insurer went bankrupt. A few found themselves personally liable for
malpractice judgments, and risk personal bankruptcy. Many physicians lost malpractice coverage, and found that they had to pay more than they expected for new policies. Some hospitals also lost malpractice coverage and also found that new policies cost much more than they had budgeted. Some patients have yet to receive promised compensation.
The failure of Reciprocal was not due to simply bad luck, or even less than brilliant management. Its former CEO, Kenneth R. Patterson, and former Executive Vice President Carolyn B. Hudgins have pled guilty to federal fraud charges. The US Department of Justice is pursuing investigations of other individuals involved with the company.
The Times documents what may now sound like familiar stories of a "dizzying matric of offshore accounts, secret transactions and financial sleight of hand" with "deals in luxurious surroundings, even as Reciprocal itself was falling apart." In fact, the fall of Reciprocal is now linked to larger problems affectin companies such as General Re and American International Group.
Here is yet another story of shady managers of a large health care organization whose mismanagement was to the detriment of patients, doctors, and hospitals.

Princess Health and FDA Orders "My Man" Off the Air. Princessiccia

Princess Health and FDA Orders "My Man" Off the Air. Princessiccia

Gusty 17:37 Add Comment

See the Washington Post for the story that the US Food and Drug Administration (FDA) has ordered Bayer and GlaxoSmithKline to stop broadcasting their 15 second television advertisement for Levitra, apparently entitled "My Man." This is the ad in which an attractive actress purrs "in the mood for something different?" and then touts Levitra "is the best way to experience the difference."
As a "reminder," this ad should have only called attention to the drug, but not say how well the drug works or how to use it. The FDA contended instead that the ad violated this principle by claiming that Levitra would improve the female partner's sexual experience.
I will be perfectly happy not to have to watch that ad any more.
But Bayer and GlaxoSmithKline probably already got their money's worth from it.
Rather than depending on the FDA's ponderous bureaucracy, wouldn't a more effective way to counter such expansive advertising be to run counter-advertising based on the clinical research evidence? (For example, "Here is what we know Levitra does.... Here are its side-effects.... And here is what the ad claims that is not supported by any evidence....") Maybe managed care would find this a more effective way to decrease costs than twisting physicians' arms not to prescribe such expensive drugs.

Princess Health and FDA Orders "My Man" Off the Air.Princessiccia

Princess Health and FDA Orders "My Man" Off the Air.Princessiccia

Gusty 17:37 Add Comment

See the Washington Post for the story that the US Food and Drug Administration (FDA) has ordered Bayer and GlaxoSmithKline to stop broadcasting their 15 second television advertisement for Levitra, apparently entitled "My Man." This is the ad in which an attractive actress purrs "in the mood for something different?" and then touts Levitra "is the best way to experience the difference."
As a "reminder," this ad should have only called attention to the drug, but not say how well the drug works or how to use it. The FDA contended instead that the ad violated this principle by claiming that Levitra would improve the female partner's sexual experience.
I will be perfectly happy not to have to watch that ad any more.
But Bayer and GlaxoSmithKline probably already got their money's worth from it.
Rather than depending on the FDA's ponderous bureaucracy, wouldn't a more effective way to counter such expansive advertising be to run counter-advertising based on the clinical research evidence? (For example, "Here is what we know Levitra does.... Here are its side-effects.... And here is what the ad claims that is not supported by any evidence....") Maybe managed care would find this a more effective way to decrease costs than twisting physicians' arms not to prescribe such expensive drugs.

Princess Health and Medical Instamatics Phenomenon Exposed. Princessiccia

Princess Health and Medical Instamatics Phenomenon Exposed. Princessiccia

Gusty 13:23 Add Comment

I've often wondered how people with seemingly-serious credentials could publish arcane, cryptic, and sometimes nonsensical pieces on computing matters. Perhaps my question has been answered. There is no legitimate excuse for this paper getting beyond the "circular file."

Computer-generated gibberish fools scholars

Fri Apr 15 09:43:00 PDT 2005

A bunch of computer-generated gibberish masquerading as an academic paper has been accepted at a scientific conference in a victory for pranksters at the Massachusetts Institute of Technology.

Jeremy Stribling said Thursday that he and two fellow MIT graduate students doubted the standards of some academic conferences, so they wrote a computer program to generate research papers complete with nonsensical text, charts and diagrams.

The trio submitted two of the randomly assembled papers to the World Multiconference on Systemics, Cybernetics and Informatics, or WMSCI, which scheduled for July 10-13 in Orlando, Fla.

To their surprise, one of the papers--"Rooter: A Methodology for the Typical Unification of Access Points and Redundancy"--was accepted for presentation.

The prank recalled a 1996 hoax in which New York University physicist Alan Sokal succeeded in getting an entire paper with a mix of truths, falsehoods, nonsequiturs and otherwise meaningless mumbo-jumbo published in the journal Social Text.

Stribling said he and his colleagues only learned about the Social Text affair after submitting their paper.

"Rooter" features such mind-bending gems as: "The model for our heuristic consists of four independent components: simulated annealing, active networks, flexible modalities, and the study of reinforcement learning" and "We implemented our scatter/gather I/O server in Simula-67, augmented with opportunistically pipelined extensions."

... Conference organizers were reviewing their acceptance procedures in light of the hoax.

Stunning. One cannot imagine this occurring in a medical journal. Of course, in my various roles I've seen and heard numerous presentations on IT that are equally as convoluted and unfathomable, as well as IT job descriptions for significant leadership roles in industry that are not very different linguistically than the student's computer-generated "research paper." For example, this recent ad:

Director of Research Information Architecture

Job Description: The Director of Research Information Architecture reports into the Senior Director of Research Shared Technologies and Services. In this role, the Director leads a team of architects to define and communicate the vision for information, technical and solutions architectures within the organization.

Working with the Enterprise Architects and functionally-aligned IS groups, the Director will define and implement processes, products, and services that support the agreed vision. This includes compliance and metrics processes, strategic divisional capabilities, new technology evaluation and introduction processes, and the definition and implementation of new shared services. As part of these deliverables, clear business value must be demonstrated through the use of business cases and results reporting.

Qualifications: Bachelor�s degree (or equivalent), and at least 10 years of relevant work experience with a demonstrated record of leadership, knowledge across a number of technology areas, and a business focus. Ability to define, communicate, and obtain agreement, both within the IS groups as well as the business areas, on strategic architectures and processes. Strong skills in business process, information, technology and solution architectures.

One wonders if this semantic blur and linguistic confusion are a cause of IT system failures frequently noted in all fields, including this interesting paper from the government sector: "Governmental Information System Problems and Failures: A Preliminary Review." Public Administration and Management: An Interactive Journal. 1997, Volume 2(3).

Abstract: Enthusiasm over information technology has led to inattention to problems and failures which have characterized many governmental information systems. This paper uses governmental reports, newspaper and periodical accounts, as well as academic literature and qualitative observations to analyze problems, limitations, and failures that are common. This is a preliminary analysis based on an inductive review of available accounts of failures. The purchasing process leads to many failures and is especially difficult in the public sector. The development process is the cause of many information system failures due to poor project management, overwhelming complexity of systems, as well as technical problems. Inadequate training means that government personnel only make use of a fraction of the power of software. Information overload is becoming a problem for which most governmental organizations have no solution. Poor quality of data is present in many cases due to organizational resistance as well as lack of oversight and use. Organizational obstacles to sharing information make sharing difficult despite technical advances in the ability to share. Inadequate payoffs characterize many investments in technology due to lack of use, poor implementation, the marginal role of technology in productivity, and failure to use the technology. In major decisions, digital data systems take a backseat to rich data gathered by executives in informal meetings and discussions.

Sounds quite familiar, with many parallels to clinical information technology failures. Certainly, allowing papers into the IT literature that are reviewed as poorly as Sokal's spoof in the social sciences does not improve the quality of management of IT.

Come to think of it, the "artifically generated paper" the students created sounds much like the presentations of CIO's I knew at various hospitals. The hospital executives were so overwhelmed by their impressive-sounding gibberish, they literally figured the guys must have been geniuses. My clarity in trying to expose the gibberish proved nearly ineffectual for a long time. These CIO's were finally disposed of, only to become CIO's at other hospital systems.

In clinical IT, when you don't understand what the "IT guys" are telling you about why the system they expect you to be dependent upon in patient care can't do this or won't do that, don't assume it's because you're "only a doctor." Ask a lot of questions.

-- SS

Princess Health and Medical Instamatics Phenomenon Exposed.Princessiccia

Princess Health and Medical Instamatics Phenomenon Exposed.Princessiccia

Gusty 13:23 Add Comment

I've often wondered how people with seemingly-serious credentials could publish arcane, cryptic, and sometimes nonsensical pieces on computing matters. Perhaps my question has been answered. There is no legitimate excuse for this paper getting beyond the "circular file."

Computer-generated gibberish fools scholars

Fri Apr 15 09:43:00 PDT 2005

A bunch of computer-generated gibberish masquerading as an academic paper has been accepted at a scientific conference in a victory for pranksters at the Massachusetts Institute of Technology.

Jeremy Stribling said Thursday that he and two fellow MIT graduate students doubted the standards of some academic conferences, so they wrote a computer program to generate research papers complete with nonsensical text, charts and diagrams.

The trio submitted two of the randomly assembled papers to the World Multiconference on Systemics, Cybernetics and Informatics, or WMSCI, which scheduled for July 10-13 in Orlando, Fla.

To their surprise, one of the papers--"Rooter: A Methodology for the Typical Unification of Access Points and Redundancy"--was accepted for presentation.

The prank recalled a 1996 hoax in which New York University physicist Alan Sokal succeeded in getting an entire paper with a mix of truths, falsehoods, nonsequiturs and otherwise meaningless mumbo-jumbo published in the journal Social Text.

Stribling said he and his colleagues only learned about the Social Text affair after submitting their paper.

"Rooter" features such mind-bending gems as: "The model for our heuristic consists of four independent components: simulated annealing, active networks, flexible modalities, and the study of reinforcement learning" and "We implemented our scatter/gather I/O server in Simula-67, augmented with opportunistically pipelined extensions."

... Conference organizers were reviewing their acceptance procedures in light of the hoax.

Stunning. One cannot imagine this occurring in a medical journal. Of course, in my various roles I've seen and heard numerous presentations on IT that are equally as convoluted and unfathomable, as well as IT job descriptions for significant leadership roles in industry that are not very different linguistically than the student's computer-generated "research paper." For example, this recent ad:

Director of Research Information Architecture

Job Description: The Director of Research Information Architecture reports into the Senior Director of Research Shared Technologies and Services. In this role, the Director leads a team of architects to define and communicate the vision for information, technical and solutions architectures within the organization.

Working with the Enterprise Architects and functionally-aligned IS groups, the Director will define and implement processes, products, and services that support the agreed vision. This includes compliance and metrics processes, strategic divisional capabilities, new technology evaluation and introduction processes, and the definition and implementation of new shared services. As part of these deliverables, clear business value must be demonstrated through the use of business cases and results reporting.

Qualifications: Bachelor�s degree (or equivalent), and at least 10 years of relevant work experience with a demonstrated record of leadership, knowledge across a number of technology areas, and a business focus. Ability to define, communicate, and obtain agreement, both within the IS groups as well as the business areas, on strategic architectures and processes. Strong skills in business process, information, technology and solution architectures.

One wonders if this semantic blur and linguistic confusion are a cause of IT system failures frequently noted in all fields, including this interesting paper from the government sector: "Governmental Information System Problems and Failures: A Preliminary Review." Public Administration and Management: An Interactive Journal. 1997, Volume 2(3).

Abstract: Enthusiasm over information technology has led to inattention to problems and failures which have characterized many governmental information systems. This paper uses governmental reports, newspaper and periodical accounts, as well as academic literature and qualitative observations to analyze problems, limitations, and failures that are common. This is a preliminary analysis based on an inductive review of available accounts of failures. The purchasing process leads to many failures and is especially difficult in the public sector. The development process is the cause of many information system failures due to poor project management, overwhelming complexity of systems, as well as technical problems. Inadequate training means that government personnel only make use of a fraction of the power of software. Information overload is becoming a problem for which most governmental organizations have no solution. Poor quality of data is present in many cases due to organizational resistance as well as lack of oversight and use. Organizational obstacles to sharing information make sharing difficult despite technical advances in the ability to share. Inadequate payoffs characterize many investments in technology due to lack of use, poor implementation, the marginal role of technology in productivity, and failure to use the technology. In major decisions, digital data systems take a backseat to rich data gathered by executives in informal meetings and discussions.

Sounds quite familiar, with many parallels to clinical information technology failures. Certainly, allowing papers into the IT literature that are reviewed as poorly as Sokal's spoof in the social sciences does not improve the quality of management of IT.

Come to think of it, the "artifically generated paper" the students created sounds much like the presentations of CIO's I knew at various hospitals. The hospital executives were so overwhelmed by their impressive-sounding gibberish, they literally figured the guys must have been geniuses. My clarity in trying to expose the gibberish proved nearly ineffectual for a long time. These CIO's were finally disposed of, only to become CIO's at other hospital systems.

In clinical IT, when you don't understand what the "IT guys" are telling you about why the system they expect you to be dependent upon in patient care can't do this or won't do that, don't assume it's because you're "only a doctor." Ask a lot of questions.

-- SS

Princess Health and A Growing Proliferation of Managers. Princessiccia

Princess Health and A Growing Proliferation of Managers. Princessiccia

generic managers ill-informed management managers' coup d'etat

Gusty 13:16 Add Comment

A while back, we had a dialog with EconBlog about the myth of US health care waste. One issue I had discussed was adminstrative overhead. (See my first previous post here, and follow-up here., and on cost of high-technology, here.)
I argued that my experience as a physician (and discussion with other physicians) suggests that there is a huge administrative and bureaucratic load on physicians, and that this contributes directly and indirectly to health care costs. The best I could do at the time was to cite a study that showed that physicians in practice spend an inordinate amount (a little less than US $25K a year per physician) on "unnecessarily complex or redundant administrative tasks."
I just found some fascinating data along these lines, available from the Center for Medicare and Medicaid Services (CMS) in a series of charts (here, chart 1.13.)
See in particular Table 1.13, Health Care Employment by Occupation.
It shows that from 1983 to 2000, the numbers of health care managers grew at a rate that far outstripped any other kind of health occupation. Taking the numbers off the PowerPoint presentation,

• The number of managers grew from 91,ooo in 1983 to 174,000 in 1990, to 752,000 in 2000.
• That could be compared with the numbers of physicians in those years (519,000 to 577,000 to 719,000), and the number of registered nurses (1,372,000 to 1,667,000 to 2,111,000)

So the growth rates from 1983 to 2000 were 1.39x (39%) for physicians, 1.54x (54%) for nurses, and a whopping 8.26x (726%) for managers.
Another way to look at it is, in 1983 there was 1 manager for every 5.7 physicians and every 15.1 nurses. In 2000, there was 1 manager for every 0.96 physicians and every 2.9 nurses. Again, by 2000, the number of health care managers exceeded the number of physicians. There were more managers than any other species of health care worker other than nurses.
If health care could function in 1983 with one manager for nearly every 6 doctors, why in the world did we need one manager per doctor in 2000?
I would love hear if anyone can come up with a justification for this massive increase in numbers, or show how this proliferation has lead to any improvement in health care.
On the other hand, ecological correlations are not a good way to prove causation, of course, but I would argue that this data suggests that attributing the simultaneous rise in health care costs, decrease in access, stagnation in quality, and dissatisfaction of health professionals like physicians and nurses to the incredible proliferation of managers (and attendant bureaucracy) is not far-fetched.