Princess Health and "This Pricing is a Joke:" The $1275 Physical Therapy Session. Princessiccia

Princess Health and "This Pricing is a Joke:" The $1275 Physical Therapy Session. Princessiccia

health care prices Tenet

Gusty 10:59 Add Comment

A bizarre story about health care costs from the Miami Herald: A patient required hand physical therapy after a motor vehicle accident. She went to Palmetto General Hospital, owned by Tenet.
Because she was on a UnitedHealthCare policy which included a deductible and a 10% co-pay, she asked the hospital about how much a course of therapy would cost. After talking to at least one uncooperative functionary in the hospital's finance department, another told her the physical therapy would cost about $35 to $55 a session.
She first went for an evaluation and then had 11 additional sessions, the latter lasting around 45 minutes, sometimes one on one with a therapist, sometimes as part of a small group of patients with a therapist. So far, so good.
Then she started getting bills. For her first session, Palmetto General charged a whopping
$2713. With United's discount, this was reduced to a still whopping $1275. For her additional
sessions, charges ranged from $228 to $2454.
Palmetto General refused to respond to the Herald regarding the specifics of the case, but said "We support providing patients with meaningful information about the cost of health care."
UnitedHealthcare spokesman Roger Rollman also refused to respond directly about the case because of "privacy laws," (even though the patient had provided the Herald with her side of the story.) But Rollman did say "UnitedHealthcare strongly believes in transparency of hospital costs to the public."
Teri Bielefeld, the President of the Hand Rehabilitation Section of the American Physical Therapy Association responded to the story by saying, "my heart dropped. That's way out of range. That's incredible." She thought an evaluation session ought to cost around $200 and individual sessions around $50 per half an hour. Thus she thought "This pricing is a joke. Somebody needs to do something about it."
I'm not sure which is more amazing: that the hospital would charge thousands of dollars per
therapy session, or that UnitedHealthcare would be willing to pay these charges after a 50%
discount.
It is arguable that the major rationale for the rise of for-profit managed care organizations
like United was controlling costs. Such managed care organizations often have reputations for
being extremely tough on physician reimbursement, at least for cognitive and especially primary care services. This may be one reason that primary care physicians have an increasingly hard time just staying in businees, and why primary care is having an increasingly hard time attracting new trainees.
So why would a managed care organization with a reputation for fiscal toughness be willing to pay over a thousand dollars for a physical therapy session?

Princess Health and "This Pricing is a Joke:" The $1275 Physical Therapy Session.Princessiccia

Princess Health and "This Pricing is a Joke:" The $1275 Physical Therapy Session.Princessiccia

health care prices Tenet

Gusty 10:59 Add Comment

A bizarre story about health care costs from the Miami Herald: A patient required hand physical therapy after a motor vehicle accident. She went to Palmetto General Hospital, owned by Tenet.
Because she was on a UnitedHealthCare policy which included a deductible and a 10% co-pay, she asked the hospital about how much a course of therapy would cost. After talking to at least one uncooperative functionary in the hospital's finance department, another told her the physical therapy would cost about $35 to $55 a session.
She first went for an evaluation and then had 11 additional sessions, the latter lasting around 45 minutes, sometimes one on one with a therapist, sometimes as part of a small group of patients with a therapist. So far, so good.
Then she started getting bills. For her first session, Palmetto General charged a whopping
$2713. With United's discount, this was reduced to a still whopping $1275. For her additional
sessions, charges ranged from $228 to $2454.
Palmetto General refused to respond to the Herald regarding the specifics of the case, but said "We support providing patients with meaningful information about the cost of health care."
UnitedHealthcare spokesman Roger Rollman also refused to respond directly about the case because of "privacy laws," (even though the patient had provided the Herald with her side of the story.) But Rollman did say "UnitedHealthcare strongly believes in transparency of hospital costs to the public."
Teri Bielefeld, the President of the Hand Rehabilitation Section of the American Physical Therapy Association responded to the story by saying, "my heart dropped. That's way out of range. That's incredible." She thought an evaluation session ought to cost around $200 and individual sessions around $50 per half an hour. Thus she thought "This pricing is a joke. Somebody needs to do something about it."
I'm not sure which is more amazing: that the hospital would charge thousands of dollars per
therapy session, or that UnitedHealthcare would be willing to pay these charges after a 50%
discount.
It is arguable that the major rationale for the rise of for-profit managed care organizations
like United was controlling costs. Such managed care organizations often have reputations for
being extremely tough on physician reimbursement, at least for cognitive and especially primary care services. This may be one reason that primary care physicians have an increasingly hard time just staying in businees, and why primary care is having an increasingly hard time attracting new trainees.
So why would a managed care organization with a reputation for fiscal toughness be willing to pay over a thousand dollars for a physical therapy session?

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