Medicynic

Our local hospital, a part of the Peacehealth system in Washington State, has been purchasing medical practices and incorporating them under their brand. It is the only hospital in town, the next one is about 25 miles south.

In addition to general physicians specialists are being added. All the the oncologists in town were added last fall and the cardiologists (except one) this year.

The medical oncologists had a new well-equipped infusion center at their practice which is located a few miles from the hospital. Last month with minimal discussion, the infusion center was moved to the hospital. No explanation was given but one can assume this “non-profit” made the decision because they can bill more for services at the hospital than in an office setting.

I’ve discussed this previously. In addition to a facility charge the reimbursement for services is significantly more for most billing codes in hospital outpatient settings

Medicynical note: At some point cost and value will need to be addressed and gaming of payments stopped. It doesn’t appear however, that this will happen soon as businesses have a fiduciary responsibility to maximize profit and consumers are insensitive to pricing when someone else pays and health issues are involved.

Addendum 12/16 PM — It’s hard not to be offended by organizations manipulating health care procedures to increase billings and ultimately patient cost.  Value, patient convenience,  efficiency does not seem to be in their vocabulary.

A number of necessary drugs are in short supply. While the full list is unavailable, one can assume that the drugs needed are off patent and lower priced.

From cancer treatments to surgical sedatives to standard emergency-room remedies, the pharmaceutical supply cabinet is increasingly bare of the drugs of choice, according to doctors, advocacy groups, and the FDA

Those include intravenous Lasix, a diuretic commonly used to treat congestive heart failure, and Cisatracurium, a muscle relaxant used in surgery, he said. Medicynic: lasix off patent for years, cisatracurium off patent this year.

As of Dec. 1, there had been shortages of 199 drugs, she said, two more than all of last year, the previous high. Anecdotally, others say, the situation is the most acute it has been in more than a generation.

Medicynical note: In a “market driven” money oriented non-system of health care drugs that are not money makers and I mean big time profit makers will not be manufactured.

If our system were truly market driven we would not be providing generation long patent protection to drug companies. Rather the drugs would compete based on merit, efficacy and cost. Given that this is not likely to change perhaps there should be a quid pro quo required of drug companies that requires manufacturing of less expensive needed medications in order to qualify and maintain patents on their expensive drugs.

Joseph Stiglitz reviews Gordon Brown’s book on the financial crisis which Brown calls the first crisis of globalization (tell that to the chronically unemployed)

As soon as Northern Rock began to teeter, he realized there were deep structural problems with the financial sector and he tried to act on what he saw. He grasped immediately that the problem was not just one of liquidity but of a weakness in the financial sector built on years of mismanagement, lax regulation and reckless speculation.

Read the article.

Medicynical note: There is a message here about the greed of unregulated markets that applies to our medical non-system. How else to explain our out of proportion, unaffordable costs–50-100% more/capita than in other industrialized nations; the mediocre outcomes; the 50 million or so people who are uninsured.

The problems in health care also were built on years of mismanagement, lax regulation and endless speculation (that people will pay more for anything related to health) and a cost plus mentality.  Value?  Cost efficiency?  Not anyone’s department.

Sad but true. NY Times and the Baltimore Sun documented the behavior of a Baltimore Cardiologist and Abbott laboratories. Among other things:

Dr. Mark Midei, had inserted 30 of the company’s cardiac stents in a single day in August 2008, “which is the biggest day I remember hearing about,” an executive wrote in a celebratory e-mail.

And:

an Abbott sales representative spent $2,159 to buy a whole, slow-smoked pig, peach cobbler and other fixings for a barbecue dinner at Dr. Midei’s home

And:

Their report, provided in advance to The New York Times, concludes that Dr. Midei “may have implanted 585 stents which were medically unnecessary” from 2007 to 2009. Medicare paid $3.8 million of the $6.6 million charged for those procedures.

And so on. Including kickbacks from St. Joseph Hospital in Baltimore to Dr. Midei’s practice. Literally hundreds of patients were so treated. Where were his “ethical” colleagues? hospital oversight committees?

Medicynical Note: No surprises here, money makes people do funny things. Other similar cases elsewhere are noted.

What in the world has happened to my profession?

The following is from the book Empire Express by David Haward Bain, Penguin Books 1999, page 670.

Over at Stanford’s car, where the Governor had entertained executives of both companies with California wine and fresh fruit and other victuals, the numerous champagne toasts were getting a little out of hand, There were several impromptu speeches and all went fine until Stanford rose to speak and launched into what Dodge recalled as “a severe attack upon the Government. He went so far as to claim that the subsidy instead of being a benefit. had rather been a detriment, with the conditions they had placed upon it.” Time and time again the companies had been scrutinized not only by its own government commissioners but by one government committee after another. Members of which, they all were aware, sometimes needed a little greasing before approving all the hard work. And now there were the “live eminent citizens” sent out by Congress, before the last special commissioners had written their report. Where was it to end? It was the wrong time and place to be complaining, and Dodge saw that everyone was discomfited by the diatribe. Dan Casement was by then feeling very merry. He climbed aboard his brother’s shoulders and called out: “Mr, President of the Central Pacific: If this subsidy has been such a detriment to the building of these roads, I move you. sir. that it be returned to the United States Government with our compliments!” This dare “brought a great cheer, ” Dodge said. “but put a very wet blanket over the rest of the time.”

Medicynical Note: It seems as if government subsidies (bailouts if you will) were written in the DNA of our country soon after it’s inception.   Also noted in the above is the need for bribes to get the attention (read that votes) of our legislators–it’s just that over the years the price has gone up and the monied influence of these donors (lobbyists) has increased.

Trying to reclaim virtue by denying our history and what is still occurring and claiming that government oversight is not needed (with many thousand times greater expenditures and lobbying budgets) is  silly and frankly a recipe for further disaster.