LabCorp Settles with State of California Over Kickback Marketing Scheme–Lab Wars

Both Quest and LabCorp were doing this and this is funny in the information here from BNET that he had the actual PowerPoint slides.  Quest settled up for $241 million for their portion of gaining market share. 

Quest Diagnostics Agrees to Settle California Medicaid Suit for $241 Million-Overcharging for Lab Tests

Quest does not appear to be done yet though as now they have a whistle blower alleging even more fraud, maybe a billion and this case is a little more complex and has to do with billing during the time of the Uni-Lab purchase. 

Lawsuit Filed Against Quest Diagnostics–Whistle Blower Case Alleging Medicare and Medicaid Over Charges of $1 Billion Or More

Labcorp is to pay up $49.5 million to settle the claims billed to Medi-Cal during a 14 year period.  A whistle blower was also who brought it to the attention of the State of California in this case as well.  To get a discount doctors were told to refer to LabCorp versus the other lab companies.  BD   

Labcorp’s (LH) $50 million settlement with the California attorney general over a kickback scheme highlights the federal government’s bizarre lack of interest in whether Medicare is being ripped off for hundreds of millions of dollars nationally by companies that provide diagnostic tests for doctors and hospitals.

The scheme wasn’t difficult to figure out — the company described it in PowerPoint slideshows that told employees what “not” to do. Prohibiting employees from breaking the law is fine, of course, but the Labcorp slideshows only made sense if the company knew how to execute a complicated “pull-through” kickback scheme, and knew it was wrong. One PowerPoint had a chapter labelled “Kickbacks.”

http://www.bnet.com/blog/drug-business/meet-the-company-that-outlined-its-kickback-scheme-in-powerpoint/9532?utm_source=twitterfeed&utm_medium=twitter

Technorati Tags: LabCorp,lawsuit,fraud,marketing,Medi-Cal,whistle blower,medical claims

Another New Portable Device Slated to Make Fitness Fun - A Keychain to Reward for Exercise and Donate To Charities

How many more of these things are we going to see.  Folks I know that bough the Fitbit tried it for a while and got bored.  I don’t have one and this is just what others told me as they said it was something else they had to do and they had enough overload with all the other consumer IT stuff and gadgets to worry about.  I think from what I hear on these devices is just like the consumer, the attention span is short and again it something you have to do something with and most all have a smartphone today, so I guess we will see when it arrives on the market. 

You know I just try and report on all of this and that in itself makes me tired <grin>.  What I found out too that most of the time the developers and the folks who work at some of these companies don’t use their own products, one of those “it’s for those guys over there” but send money please.  You have to wait until October so we see the proverbial promo to tease and generate interest here and the price shown is $99.  BD

REDWOOD CITY, Calif., Aug. 31, 2011 /PRNewswire/ -- Fitness is about to become a lot more fun with Striiv. The Silicon Valley-based start-up today revealed its first product which takes active gaming outside of the living room to turn everyday activities into fitness opportunities.  A sleek, portable fitness device, Striiv motivates activity throughout the day via games, personal goals, and donation opportunities -- all powered by physical activity.

Striiv offers a playful approach to fitness. Comprised of social game and technology industry veterans, the team behind Striiv brings a wealth of business and development experience to defining this new product category at the forefront of gaming and personal health.  Whether it's a real workout or simple daily interactions like walking to lunch, taking the stairs, or shopping – with Striiv any activity is earned, tracked and transformed into an opportunity to get fit, give back, and have fun.

"Fitness and health are top-of-mind today. But for many people, especially moms juggling careers and family, finding time for exercise is hard to fit in to a busy day," says David Wang, CEO and co-founder of Striiv. "We've combined charities, gaming, and personal challenges with cutting-edge technology to create a seamless way to motivate physical activity.  We're building a playful and inspiring 'movement around movement' so that fitness now fits throughout your day."

Small, convenient and designed to easily move between a key chain, belt clip, or pocket, Striiv is always with you and always on.  Striiv features a high-resolution color touch screen to track your progress.  Key features include:

• Walkathon in Your Pocket:  With Striiv every step counts toward a donation to charity.  At launch, Striiv is partnering with GlobalGiving to donate clean water to children in South America or a polio vaccine to a child in India. New charitable partners will be added over time.
• Activity-Based Games: Unlike traditional time-based social games, Striiv games are completely powered by physical activity. In the first game, MyLand, the more you move, the more your enchanted island fills with exotic wildlife and plants. More games will be added.
• Daily Challenges and Trophies: Earn rewards and bonuses for walking to lunch or taking the stairs. Unlock daily challenges based on real-world distances, from climbing the Eiffel Tower to crossing the Golden Gate Bridge.
• TruMotion Technology: Striiv's proprietary TruMotion technology is always on and can sense if you are walking, running, and even climbing stairs or hiking. 

Technorati Tags: Striiv,exercise,consumer IT,games,rewards,walking

Non Profit HEALTHeLINK Partners with United Healthcare Subsidiary Optumsight to Remote Monitor Diabetics In Buffalo in Pilot Program

I try to keep track of mergers and acquisitions here and the partner Axolotl was purchased by Ingenix in August of 2010, about a year ago, so when you hear of insurers buying up technology companies here’s one and where bottom line revenues end up contributing to for profit insurers. 

Ingenix Acquires Health Information Exchange Services/EHR Provider Axolotl-United Health Group Behemoth Continues to Grow–Subsidiary Watch

Here’s another post from the past that gives a little more background on the HIE and business intelligence algorithms used by United subsidiaries. 

Axolotl (A Subsidiary of Ingenix) Creates Reporting and Analytics Solution for Health Information Exchanges–Algorithms for HIE–Business Intelligence -Subsidiary Watch

In addition other subsidiaries sell electronic medical records as well and Care Tracker has been around for a number of years, sold by Ingenix, now under the Optum name.  

ClickFreeMD Selling Software EHR, Practice Management Bundled Records Solution–Emphasis on AMA Endorsement And Software “Powered” by Ingenix–Tethered or Untethered

At a cost of $250 per patient per month that adds up to some additional income and yes it is less expensive than visits to the ER room if that can be avoided.  If this ends up being a workable solution with proper implementation for a national model, that’s a lot of profit for the subsidiary to add to the corporate bottom line too. Buffalo has has their IT issues reflected too in this story from a year ago where it was found that the City paid over $2 million in premiums for dead city employees and from what I understand, they were having to go to court to get it back?  I’m sure all the folks being monitored though are not in that group.  I’m just curios too as to who all really has access to the data as analytics are are part of the deal here as that’s the way it works out there today with everyone wanting data.   

City of Buffalo Has Paid Over $2 Million to Provide Health Insurance for Hundreds of Dead People-Some as Many as 4 Years

I’m just curios too as to who all really has access to the data as analytics I’m sure are part of the deal here as that’s the way it works out there today with everyone wanting data. Another division of United sells prescription data for underwriting and other purposes. 

The RHIO didn’t want to be in the monitoring business though so it appears this is where the technology subsidiaries of United came in to play here.  The article said there was some resistance but again if they are United approved MDs and have had any recent cuts, then that could maybe stand to reason for some of it and I don’t know how many United policy holders are in this part of New York.  BD 

BUFFALO, NY – One hundred patients with diabetes have signed up for a telemonitoring pilot spearheaded by HEALTHeLINK, the regional health information organization (RHIO) serving Western New York State. The nonprofit’s innovative approach to telemonitoring could serve as a model for the rest of the nation, according to Todd Norris, Western New York Beacon Project Director.

HEALTHeLINK is one of the 17 Beacon Communities tasked by the Office of the National Coordinator to positively impact quality, cost and population health through the use of healthcare IT. The RHIO is focusing on several initiatives to "move the needle in a positive direction" for diabetes care management, which is its specific goal under the Beacon Community Program. With more than 60,000 diabetic patients under the care of 250 healthcare providers, Western New York has one of the largest diabetic populations per capita in the country, Norris said. The telemonitoring pilot, which will accommodate 150 patients, is one of 12 interventions the RHIO is deploying for diabetic care.

Blood pressure readings and other vital signs pertinent to diabetic management are downloaded from mobile devices and transmitted to healthcare providers in the form of alerts through HEALTHeLINK's health information exchange platform, which is powered by OptumInsight, formerly Axolotl. The RHIO, however, has adjusted the traditional model to address known barriers to telemonitoring adoption.

The cost is approximately $250 per patient per month. Norris pointed out that the elimination of one emergency department visit per patient pays for the program and also contributes to better health of the diabetic population. With economies of scale, the cost per patient per month for 40,000 patients would be $150 per month. At this level, Norris said, "You're going to see lively acceptance."

Technorati Tags: HEALTHeLINKS,United Healthcare,RHIO,healthcare,health IT,remote monitoring,data,diabetes,Buffalo,Beacon,Health IT,Communities

Abbott Labs to Discontinue Distributing FreeStyle Navigator Glucose Monitor in the US

The FDA just approved the Freestyle easier to use monitor in June of 2010 and received the European CE Mark in May of 2011.  In December of 2009 there were strip recalls for the old version of the Freestyle, however other Abbott models had a lot more strips recalled in December of 2010. 

Abbott Diabetes Care Recalls Tons of Glucose Test Strips–The US Has the FDA Recall Blues-Solution Has Been Touted Here for a Year-It’s Time for a Fix–Readers Have Voted

Supply interruptions was the reason given for the discontinuing in the US; however in Europe they will continue to sell and market, so not enough money here in the US is the first question I ask and glad we have enough other glucose monitors available for diabetics.  I just hope glucose monitors don’t take the same path as some of the drugs we can’t get today and hope this is an isolated instance.  Abbott still has many other Freestyle monitors they sell and market besides this model, but this one with wireless looked to be pretty advanced.  BD   

Abbott Laboratories (NYSE:ABT) announced that it permanently discontinued its FreeStyle Navigator glucose monitor due to an inconsistent supply chain that has amounted to several disruptions in product availability for U.S. patients.

"We know FreeStyle Navigator System customers in the U.S. have lived with some uncertainty and frustration," the company wrote in its official statement. "We are grateful for the commitment patients and providers have devoted to the FreeStyle Navigator System over the years, and we are sorry that we have been unable to consistently meet their needs."

"The discontinuation of the FreeStyle Navigator System in the U.S. is not for safety reasons," Abbott wrote. "The System is safe and effective and continues to be available to patients in seven other markets outside the U.S."

http://www.massdevice.com/news/diabetes-abbott-takes-freestyle-glucose-monitor-us-market

Technorati Tags: Abbot Labs,recalls,FDA,medical devices,drugs,pharma,technology,Twitter,Microsoft,MicrosoftTags,cell phones,Freestyle

Non Profit Social Interest Solutions Group and Microsoft Partner To Advance State and Government Health Exchange Initiatives

Back in February of 2011 Microsoft Government also announced their low cost State Insurance Exchange solutions.  Microsoft’s HIX solutions eliminate the need for states to evaluate numerous point solutions from various firms to find one that works well with government policies or existing IT infrastructures.

Microsoft Announces New Low-Cost Turnkey State Health Insurance Exchange Technology Solutions

From the Social Interest Solutions Website:

“Wherever possible, Social Interest Solutions utilizes the standard HIPAA transaction sets to form the basis of our interfaces as we have found that many of the entities with whom we share data have already adopted these standards. Our HIPAA companion guides are available upon request.

Social Interest Solutions is able to support a variety of data formats, including, but not limited to: HL7, HL9, X12, XML, Flat files, Comma Separated files and many others.

Social Interest Solutions is proud of our system integration capabilities and believe it is a key differentiator in making sure persons in need of benefits are efficiently supported. To learn more about the interfaces we support see interfaces. “

“Systems using a web service to communicate with each other don’t need to go through a great deal of change, as long as they adhere to the common message format. Services that can be used by multiple systems are more easily shared through web services because of the flexibility and reusability they provide. This shared usage is more cost effective because web services allow seamless integration and use of functionalities across multiple systems without the need to make significant changes to the systems that need to exchange information”

Social Interest solutions e-apps have been deployed in Arizona and California and connects low income families to programs ranging from Medicaid to food stamps.  One-e-App has screened nearly 7 million people and generated over 9 million applications for programs so far.  The PAL application is a web based tool that allows both doctors and patients the ability to apply for co-pay assistance for medications and other services.  From what I am reading in the press release though the focus here lies with insurance exchanges.  It’s nice to see a technology company involved here instead of the technologies of the insurers as we don’t know as we can’t audit and see if the procedures and algorithms are accurate all the time ad Microsoft doesn’t have a conflicting interest of healthcare claims that are processed for bottom line share holder profits either.  BD   

Press Release:

Social Interest Solutions and Microsoft Work Together to Leverage Social Interest Solutions’ Thought Leadership, Policy, Enrollment and Integration Expertise to Advance State and Government Health Insurance Exchange Initiatives

SACRAMENTO, Calif.--(BUSINESS WIRE)--Social Interest Solutions (SIS), a mission-driven, nonprofit organization dedicated to leveraging technology innovation to improve consumers’ access to health and human services, today announced a strategic alliance with Microsoft. The relationship will involve working collaboratively to help government entities save time and money in the design and deployment of the technology and processes underlying health insurance exchanges.

“We are pleased to be working with Microsoft at this historic time”

“We are pleased to be working with Microsoft at this historic time,” said Claudia Page, co-director at Social Interest Solutions. “Both organizations have a successful track record of working closely with state agencies to help them achieve greater integration across health and human services silos and both view the implementation of health insurance exchanges as a way to reform the health delivery system and improve health outcomes.”

“With the passage of the Patient Protection and Affordable Care Act (ACA), states have new mandates to follow, deadlines to meet and risks to mitigate that require significant process improvements combined with innovative technologies,” said Brian Russon, national practice leader for Health Insurance Exchange, Microsoft.

“We are pleased to join forces with Social Interest Solutions and look forward to working collaboratively to help our clients meet the demands of implementing effective health insurance exchanges.”

For the health insurance exchange collaboration, Microsoft will be providing technology and state government expertise, while Social Interest solutions will be providing valuable knowledge and experience focusing on enrollment, standards, interoperability.

For nearly a decade, Social Interest Solutions has been instrumental in helping to modernize the process for identifying and enrolling in health and human services programs. In early 2003, Social Interest Solutions developed One-e-App, a Web-based system streamlining the complicated eligibility and enrollment process by making it possible to transparently connect and share data across otherwise disparate state and local social services systems and programs. Today, One-e-App is deployed in Arizona, California, Indiana and Maryland and has served nearly 9 million individuals. The innovative integration and process improvements achieved with the One-e-App platform will play a critical role in helping states using One-e-App to develop and deploy health insurance exchanges.

Social Interest Solutions is also focused on effective policy development and helped to craft language in Section 1561 of the Affordable Care Act (ACA). Section 1561 requires the Federal government to establish enrollment standards to facilitate access to coverage. Subsequently, SIS directors have served as consultants to the Office of the National Coordinator for Health IT to support the development of ACA enrollment standards and protocols. Social Interest Solutions has also worked with states to conduct ACA IT gap analyses, assessing the current status of IT systems against where the state plans to be in 2014. Gap analysis work has been completed for Arizona, Maryland and New York and is underway in Alabama.

About Social Interest Solutions

Social Interest Solutions (SIS) is a nonprofit organization dedicated to leveraging technology innovation to improve consumers’ access to public and private health and social services. As an active influencer and promoter of policy reform, SIS has successfully developed and deployed pioneering technology solutions having a positive impact on the quality of life for the nation’s underserved population. www.socialinterest.org

http://www.businesswire.com/news/home/20110831005482/en/Social-Interest-Solutions-Microsoft-Join-Forces

Technorati Tags: Social Interest Solutions,Microsoft,coding,algorithms,analysis,policies,coverage,ONC,Health IT,ACA,Affordable Care Act

California Bill to Regulate Health Insurance Rates Dies Due to Lobbying By Insurers and Other Groups So No Serious Audit Algorithms for Now to Control Premium Hikes

Well here’s one more not for the consumer.  If you read through the article in the LA Times the bill died as lobbying efforts claimed here would not allow for a majority of votes to pass.  It will be tried again next year.   It’s funny that we go through great lengths and trouble to audit and certify medical records, but the payers in all of this run their business intelligence models and reconstruct and change them with their analytics and laws can’t keep up.  I said back in August of 2009 we need a Department of Algorithms but until we get lawmakers that understand how business models worth and how math moves money, we are kind of stuck here.

“Department of Algorithms – Do We Need One of These to Regulate Upcoming Laws?

You have to some day sooner or later start auditing this stuff or we are all screwed.  It’s easy to fleece the digital illiterates and I see it all the time with those in denial who can’t get this function yet.  On another note, we are looking at the same on Wall Street too as the hardware wars are almost over and then….we have data and the algorithms that process it and it will get really tough then with writing code that can no longer be read with layers of aggregation, so remember you heard it here first.  It too Medicare long enough to get to that point with using technology to audit medical claims for fraud. 

CMS Announces Anti-Fraud Algorithms Will Begin Auditing Claims on July 1, 2011 Just As Insurance Companies Have Done For Years

We don’t have an executive in charge of HHS that has enough Health IT in her background and thus 2 years ago when she took office she could not forecast how this was going to move forward, but folks that write code do and that’s what you see here and I’m just a tiny ant in the coding world for that matter but I can predict easy enough and add on a number of years in PR and Sales and it just flows.  Granted HHS has hired some really spiffy folks, but again as a director she has to go to them and needs additional reports where as someone with on hands experience thinks a lot different and can picture the future with the mechanics of code, so executives without this ability are just flat out behind an 8 ball when it comes to such decisions.  When she was nominated I made that call, nothing personal at all but said in 2 years the director of HHS was going to be about 80% health IT, so here we are today and I don’t think I’ll get any arguments there. 

Times were a little different back then too but again the code heads can see and project where others cannot.  This is what I said in February of 2009 and it makes it hard for people in those positions to function with the crazy unpredictable world we live in today and others just eat their lunch and we all suffer.  I think was politically correct and just stated facts as a coder sees them.  Are people just now starting to listen to folks who know math?  So once again we are late coming to the table but we can’t go backwards and have to some how work with what we have, and it changes every day. 

Kathleen Sebelius, Kansas Governor for HHS – Please not! Put the “Smart” People in these key positions

In the meantime, California lawmakers are kind of behind this 8 ball too and don’t get the math here with how the algorithms with insurers work.  If you look back and read on the recent couple of years, look how many times they adjusted them and ran back to the table with justifying their increases and some were way off too.  It’s all about the math and we have lawmakers in California that don’t get it just like we have in Congress, too complicated, I don’t want to deal with it right?  I think we are seeing a lot of this today.  The COs and folks that do have this in their background are stressed and dropping like flies too all over and I understand that very well as I have dealt with that for much of my time in technology, it’s thankless, misunderstood and you deal with people who have shut off their learning faucet and fabricate a lot and its’ hard.  There are also those who read and want to learn and work with you too but we all have the folks that feel threatened and well look what we see in the news today with the GOP, craziness and to me it all comes back to not knowing what to say or do with not participating in at least a medium level of consumer IT literacy.  Makes for good OMG news but that's about it.  BD 

A bill that would allow California officials to regulate health insurance rates for millions of consumers has died in the Legislature after forceful lobbying campaigns by insurers, healthcare providers and other groups.
Assemblyman Mike Feuer (D-Los Angeles) said he is pulling his measure, AB52, because he could not muster a majority of votes in the state Senate, the final stop in a months-long effort to increase state regulators' authority over health insurance premiums.

Feuer said he is putting his bill on hold until next year, when it can be taken up again. It marks the fourth time in four years that Democratic lawmakers have failed to win support for insurance oversight that would mirror the type of regulation already in place for auto policies.

http://www.latimes.com/business/la-fi-insurance-regulation-20110901,0,4400280.story?track=rss&dlvrit=52116

Technorati Tags: California,lawmakers,digital literacy,healthcare,premiums,consumers,complcated,Health IT

United Healthcare To Buy Huge Chunk of Orange County, California Managed Care Business with the Purchase of Monarch Healthcare–Subsidiary Watch

This is in my back yard in the OC and for a few doctors I know this just might be the big push to start a Concierge Medical Office.  Newport Beach which is south of where I live has a ton of affluent residents and the Boutique practices there do well as money for many in the area is not a problem.  Monarch has been around for many years and they are at all the Hoag Hospital money raising events and is very active, so things might be changing in time. 

What will be interesting though is to see if the reimbursement changes and of course that’s at the top of every MD’s mind, so I don’t see much excitement about this at all here.  I know have friends that won’t be excited with the news who are patients.  Back in March of this year they closed a big office in Orange County and you can read more about how that went down, employees bused to a hotel and given their papers after an instant message. 

UnitedHealthcare Lays Off 180 Employees In Orange County-Initial Notification Sent By Instant Message to Those Affected

With 2300 doctors in the HMO, with recent mergers and acquisitions is this a basket full of doctors to sell an EHR too as they do sell and have sold a medical records system for years under the former name of Ingenix, now known as Optum.  Sometimes you run into situations like this to where one division of a big conglomerate cuts rates with one subsidiary and then the other rushes in to sell software. 

Subsidiary Watch-Corporate Conglomerate Insurers Reduce Compensation Contracts Using One Subsidiary Then Market Same MDs With Another Subsidiary in Health IT

Also the company recently bought another huge HMO group in Long Beach and I would say the two are perhaps close in size but bottom line is both are huge

OptumHealth (Subsidiary of United Healthcare) Takes Over Memorial IPA in California-Subsidiary Watch

We never did get our government REC center started in the OC either and I just kind of wonder where the money went on that too, and again with the post above with selling medical records, does this give anyone an unfair advantage for sales?  It does make you wonder and again why the REC center never got off the ground and I’m just speaking out loud here but there’s no REC center to offer any help to the doctors in the OC. 

Orange County California REC Center For Doctor Assistance with Medical Records Appears to be a Bust So Far…

I have heard from a few doctors on how the deductions of claims that get rescinded after payment have been a hassle with United as they just take a deduction out of a check and the claim that is not being paid does not even include the patient who is being denied, a nightmare for doctors and a recent study said it costs a doctor about $83k a year to keep up with the likes of all of this.  We have one first class hospital that kicked United out the door when it came to employer provided insurance and companies all over the OC were looking for another carrier when the United/Pacificare contracts were re-negotiated.

Employers in Orange County Looking for New HMO Contracts as St. Josephs and Some Others Begin Cancelling Agreements with Pacificare (UnitedHeatlhCare) – Employer Capitation Contracts

I guess Hoag Hospital though is happy to have the affluent residents to help make up for the other side of things as who knows how new contracts will end up shaking out when they come up for renewal.  When it comes to patents too with Health IT, United is right up there too so things don’t come cheap in that department or some subsidiaries either. 

QualityMetric/Ingenix (United HealthCare) Receives Patent for Patient Health Survey Algorithms-Subsidiary Watch

And here’s a few more back posts on their subsidiaries…think they are only insurance, well they are very heavily invested in Health IT these days as well and the acquisitions have been steady for them over the last 3 years or so. 

UnitedHealth Group Owns a Bank With Deposits Surpassing a Billion – OptumHealth Bank FDIC Insured

“OptumHealth offers three types of HSAs, as well as tax-advantaged health care savings and spending accounts, debit-card services, benefits administration services, and payment products. About three-quarters of the bank’s 1.6 million accounts are employer-generated, while the other quarter are individual accounts.”

There’s also the Chinese investment the company bought early in 2010.

UnitedHealth subsidiary (Ingenix Subsidiary I3) Acquires ChinaGate – Working to Sell Chinese Products Globally

These are just a few examples of some of the subsidiaries of the company and why even sometimes judges find themselves in some potential conflict areas as the daisy chains of subsidiaries grow, they don’t even keep track or are cognizant that the company they have owned stock in for many years, due to quickly adapting business algorithms used today, is not the same.  The former Ingenix division (now Optum) makes money with pretty much just selling data and creating software algorithms. 

Back a year or so ago the AMA fought and won a lawsuit against the Ingenix division for short paying doctors and patients for almost 15 years and it was Andrew Cuomo of New York who got the ball rolling there.  In some parts of the country through wellness subsidiaries pharmacists even get to earn pay for performance money from signing people up in wellness programs, and what that amount is we don’t know but the retail drug chain, Walgreens says their data selling business is worth just under $800 Million. 

UnitedHealth, YMCA Expand Diabetes Prevention Program with P4P for Walgreens

Last but not least, let’s not forget the CEO is the highest paid in the US for public companies, and they are still making record profits.  I just try to break down the business areas for awareness so consumers and others understand a bit more about the big corporate world of subsidiaries today that normally may not be thought about, seen or recognized.  BD 

UnitedHealth Group Inc. will acquire the operations of a major southern California physician group, in the latest example of how lines are blurring between insurance companies and health-care providers.

The purchase of the management arm of Monarch HealthCare, an Irvine, Calif., association that includes approximately 2,300 physicians in a range of specialties, establishes United's Optum health-services unit as a formidable presence in the region. Optum had previously taken over the management arms of two smaller southern California groups, AppleCare Medical Group and Memorial HealthCare Independent Practice Association.

Monarch said in a statement that it "has agreed to enter a strategic relationship with Optum to support our physicians in providing high-quality, cost-effective patient care in Orange County, California."

United has said in the past that providers acquired by Optum will not work exclusively with United's health plan, and will continue to contract with an array of insurers. But in one sign of the potential complications that might ensue, Monarch is currently in an arrangement with United competitor WellPoint Inc. to create a cooperative "accountable-care organization" aimed at bringing down health-care costs and improving quality.

Technorati Tags: Monarch Healthcare,HMOs,UnitedHealthcare,revenue,profits,layoffs,Orange County,Medicare,health insurance

Janet Tracey and Unilateral DNAR Policy in the UK

More information about the Janet Tracey case is available on the website of Leigh, Day & Co, the attorneys representing the Tracey family in its lawsuit against NHS Trust.

When Will MDs Prescribe Life Extending Drugs Such as Provenge–Reimbursement And Delivery Matters

Fierce Pharma in conjunction with Sermo, the doctor’s social network have compiled a survey of interest with regards to prescribing life extending drugs, Provenge is the big example that stands out.  It is not cheap. You can view the full results of the survey from the link below and can download the full survey report.  Over 68% voiced a concern with either reimbursement or drug delivery. 

Sermo-medical-ethics-life-extending-drugs Survey Results

Back in July Fierce Pharma and Sermo announced they would be working together to bring some of the information from Sermo, the private doctors' social network in order to bring forward what the doctor’s opinions are, rather than just seeing an investor’s take as we do on the web. 

Sermo and FiercePharma Partner to Allow Readers to Have Access to Sermo’s Online Information

With other types of oncology drugs, some of which are now in short supply, the oncologists changed their treatment from out of the office to having patients visit hospitals as sometimes the reimbursement efforts left them out of pocket to cover the cost of the drugs up front and then fighting a claim later to get paid.  In the survey,some doctors also mentioned that the cost for such drugs should not go over $60,000 while others said that $10,000 should be the cap. 

One oncologist is quoted below in the report/survey:  

"I have not used the agent and have no plans yet. FYI the majority of eligible patients are in their 80s, so placing dialysis catheter in their neck and hooking them up to pheresis machine is not a little fit." - Oncologist on Sermo

Just last week, yet another expensive drug was approved by the FDA at $13,500 a dose with several doses being the norm and I had a reader asking me about Zytiga on where he could get help as he said he had insurance but still needed to pay $25,000 out of pocket.

Seattle Genetics Receives FDA Approval for Lymphoma Drug Adcetris Set to Cost $13,500 a Dose–A Dendreon Rerun?

It’s good to get the doctor’s input for a change as they are the ones with the doctor-patient relationship and prescribe treatment.  Hopefully there will be additional surveys to follow but the question of reimbursement is big and rightly so, how can we afford the drugs as even with insurance there’s still some big potential cost involved here.  One more tidbit here relative to Provenge which was in the news of late as the FDA just approved another facility,  however it looks like they will be laying people off.  If you have followed the development of the drug over the last 3 years with all the news, it has been a rocky, bumpy and political ride.  BD 

Dendreon CEO Dumped $1M Stock Before Admitting They Will Not Meet Their Projections for the Year–Layoffs?

A new, free Sermo survey of experts on the front lines in cancer care may help address the crucial ethical question of how to measure life-extending medical treatments' cost versus benefits.  Feedback from approximately 100 oncologists and urologists in the United States shows that financial and treatment administration issues facing Dendreon's Provenge for prostate cancer could signal a trend for other life-extending medicines and provide valuable insight to the biopharmaceutical industry overall.  According to Sermo, these results provide a clearer, more relevant, real-world picture of doctors' views on the specific dollar value of a clinically-proven survival benefit.

Among the key findings:

• A large majority (68%) of the physicians believes that in order to prescribe Provenge or a similar life-extending treatment, the survival benefit must be seven months or more. 
  • More than 30 percent say a medicine needs to add at least one year of life.
• The overwhelming majority (86%) of the respondents believes that such medicines should cost no more than $60,000.  
  • More than half of the doctors (57%) believe the price should be less than $30,000.
  • Nearly one-fifth (19%) of those surveyed think the cost needs to be under $10,000.

In addition, most of the specialists participating in the survey also say they have major financial concerns for themselves and their patients when prescribing life-extending treatments.

• More than two-thirds (68%) do not believe they will be reimbursed if they have to purchase the drug out of their own pocket in advance, as is needed for Provenge.
• The same 68% indicate the co-pay is a major concern for their patients.

About SERMO
Sermo is the largest online physician network in the United States, with more than 120,000 doctors, spanning 68 specialties. Sermo surveys leverage a level of candor and openness that many doctors maintain on social media, resulting in a more accurate measurement of true prescribing behavior inside the clinic. According to the Manhattan Research study called, "Taking the Pulse^® v11.0," information physicians receive from colleague consults has the greatest influence on their clinical decisions, and healthcare provider portal sites, such as as Sermo, have the best reach amongst online physicians. The report also shows that of the nearly one-fourth of physicians already using online communities or social networks, 84% have visited Sermo in the last three months, more than three times the next largest competitor.

Technorati Tags: FierceMarkets,Sermo,partnership,doctors,regulatory information,patients,cancer,surveys,healthcare,social networks,reimbursement

Prognosis Health EHR System Buys Creative Healthcare Patient Accounting Company

Software companies continue to merge and acquire one another, the merging of the software algorithms.  In this case the EHR system will be adding more financial accounting modules, and this seems to be pretty common place today to add the financial and/or billing capabilities to medical record systems.  BD

Houston-based Prognosis Health Information Systems Inc. is acquiring Creative Healthcare Systems Inc., based in Springfield, Mo.

Creative Healthcare Systems developed MedGenix, a financial management and patient accounting system. Prognosis developed ChartAccess Comprehensive EHR, an electronic medical-records system. The acquisition will allow Prognosis to add 18 new modules to its health-record system.

“Hospitals today — both big and small — are seeking to implement comprehensive, enterprise-wide solutions that can help them optimize both their clinical and financial operations,” Jay Colfer, executive vice president of client solutions for Prognosis, said in a statement. “With this acquisition, Prognosis will be able to do just that.”

http://www.bizjournals.com/houston/news/2011/08/30/prognosis-health-acquiring-medical.html

Technorati Tags: Prognosis,Creative Healthcare,EHR,medical records,Health IT,patient accounting,medical billing

Illinois Doctors and Hospitals Refusing to Participate in Pilot Medicaid Managed Care Program Run by Commercial Insurers

The program is being run by two insurance companies, Aetna and Centene-IlliniCare and I am guessing the reimbursement rates are at the heart of the issue, what else today?  Many patients will need to change doctors and care facilities. 

As what happens today with changes with doctors and care facilities, everybody has to get their data together and it becomes a big mess for the patients and the doctors.  BD 

CHICAGO — Many doctors and hospitals are refusing to participate in Illinois’ pilot Medicaid managed care program, forcing some patients to find new health care providers, according to a published report.

Leading medical centers have refused to join the cost-saving program starting in six northern Illinois counties.

Northwestern Memorial Hospital, Rush University Medical Center and the University of Chicago Medical Center are among hospitals that so far have chosen not to take part.

In contrast, the University of Illinois at Chicago Medical Center has joined the program.

Loyola University Health System said in a statement that it wasn’t participating for now because “our expenses for Medicaid exceed our reimbursement.”

Brent Estes, a vice president at Rush Medical Center, said managed care plans can force oppressive administrative requirements and hunt for ways to restrict payments to hospitals.

Julie Hamos, director of the Illinois Department of Healthcare and Family Services, said she found it “disappointing” that health care providers were resisting the change.

http://heraldnews.suntimes.com/news/7295665-418/area-doctors-and-hospitals-snub-medicaid-managed-care-program.html

Technorati Tags: Medicaid,Chicago,Illinois,hospitals,doctors,health insurance,HMO,patients

Elder Rights - The Next Civil Rights Movement

On October 22, Temple Law (in Philadelphia) is hosting an all-day conference titled "Elder Rights - The Next Civil Rights Movement."  The speakers include elder law heavyweights Frolik and Dayton, with a keynote by Nina Kohn.  Other speakers include my Widener colleague Alicia Kelly.  

Of particular interest is a session titled "Healthcare, Self-Determination and Autonomy."  Speakers in that session include two scholars whom I have been fortunate to work with:  (1) Michele Mathes, "Health Care and the Aged: Arguing Equality in the Absence of a Right" and (2) Lois Shepherd, "The End of End of Life Law and Ethics."              

        

Governor Vetoes New Jersey POLST Bill

On Thursday, New Jersey Governor Chris Christie conditionally vetoed S-2197, legislation providing for the use of Physician Orders for Life-Sustaining Treatment (“POLST”) forms in New Jersey.

While noting the prospective benefits in guiding end of life patient care for New Jerseyans by utilizing POLST forms, Governor Christie cited concerns with the provisions of the bill that would effectively allow a patient’s wishes to be overridden by the patient’s physician or healthcare representative without the patient’s prior consent, and that would mandate an alternative dispute resolution as a prerequisite to a patient’s or his or her representative’s right to go to court to protect a patient’s wishes. Governor Christie’s recommended changes to further protect a patient’s health care wishes.

VRFF-VSED - Major Topic of Conference

Over the past decade, VSED-VRFF has not received very much attention either in the medical literature or at bioethics conferences.  But that is now changing.  Compassion & Choices has begun an educational initiative.  And a major conference this October, in Victoria, Australia, devotes two hours to the topic.





Voluntary Refusal of Food and Fluids (VRFF) by Currently Competent Persons

08:30 The reality: representative cases — Nan Maitland (7 min)

08:37 The legality of medical and nursing assistance — Ian Freckelton (12 min)

08:49 Overcoming challenges to VRFF — Dr Stanley Terman (5  min)

08:54 The nursing ethics — Susan Sherson (8 min)

09:02 Some ethical reflections on VRFF — Helga Kuhse (12 min)

09:14 The requirements for a good outcome — Tijn Hagens (7 min)

Voluntary Refusal of Food and Fluids (VRFF) by Advance Healthcare Directive

09:21 Keynote address: MyWay Cards — Dr Stanley Terman (25 min)

09:46 Legal view of refusal of assisted oral feeding — Ian Freckelton (20 min)

10:06 Progress in The Netherlands — Ans Baars (9 min)

10:15 Questions from the floor (15 min)

World Federation Right-to-Die Societies 2012 Congress

The World Federation of Right-to-Die Societies 2012 Congress will be held in Zurich from June 13-18, 2012.

New Case -- Tracey v. Addenbrooke's Hospital

David Tracey has filed a lawsuit against Cambridge University Hospitals NHS Trust and the Department of Health alleging that providers at Addenbrooke's Hospital wrote a DNR order for his wife without her consent and without any discussion with her.  (Guardian 1; Guardian 2)  Janet Tracey had been diagnosed with terminal lung cancer but died at the hospital 16 days after breaking her neck in a car accident.





Apparently, since directly applicable health law permits unilateral DNR orders, Tracey is basing his claim on the 1998 Human Rights Act. 

Paternalistic Catholic Opposition to POLST

This is not unexpected.  But this articulation of a Catholic opposition to POLST is so terribly flawed and unpersuasive. 

Rasouli - Upcoming filings with the Supreme Court

As I mentioned, the healthcare provider defendants in the Rasouli case have applied for leave to appeal to the Supreme Court of Canada.  





If I understand the rules correctly, the Rasouli-Salasel response/opposition to the Application will be filed on or about next Friday.  The CCB, as intervenor, may also file a response at that time.  The providers then have ten days to file their reply.  Then, the Application is submitted to the Court.

Update on Jordan Allen - TADA Case

Parents Fight for Son's Life: MyFoxHOUSTON.com

VSED - in the NY Times

The voluntary dehydration to hasten death case of Armond and Dorothy Rudolph is further discussed in a NY Times piece today.  Compassion and Choices is raising the profile of this peaceful and legal means to hasten death.

Hospitals Exclude Patients with "Incurable Diseases"

Boy have times changed.  In the Bulletin of the History of Medicine, Emily Abel describes "American Hospitals and Dying Patients before World War II."  Very interesting is her explanation of how hospitals excluded patients with "incurable diseases" both by not admitting them in the first place and by dumping them onto public hospitals (in a pre-EMTALA world).  For example, noting that some patients had died soon after admission, Pennsylvania Hospital urged "physicians to pay strict attention to rules that say no incurable patients can be admitted."

Negotiating Death: Does Culture Matter?

Twice a year, usually in March and September, the DeVos Foundation sponsors a Medical Ethics Colloquy.  In March 2011, the speakers were Timothy Quill and Barbara Koening.  While not the direct, primary target of the session, there was significant discussion of medical futility.  A complete transcript is here.

Dr. Quill remarked that we "err on the side of utilizing medical technology if it has any chance of working at all."  But, he said, "we're going to have to set limits on certain kinds of things, mainly advanced technology.  We can't throw every drop of technology at every person because they want it."  "Just because something has a teeny bit of value and its costs a gazillion dollars, we're going to have to say 'no' to some of that stuff."  Dr. Quill also discussed the reverse situation where the patient is ready but providers or family get in the way.  And he did a careful job explaining the nature and mission of palliative medicine.

Dr. Koenig started with the 2011 Rachel Nyirahabiyambere case in which Georgetown got a court-appointed guardian to make treatment decisions (to stop aggressive therapy) over the objections of the patient's family.  Indeed, in describing the case, Dr. Koening mentioned this blog.  Dr. Quill also commented on the surrogate replacement situation.  He explained that when the family is asking for treatment he knows the patient would not want, "he will push that negotiation a lot harder" and even "take to court" because in that situation "our obligation is to stop." 

Colorfully, Dr. Koenig described how someone in Britain said to her: "Now wait a second.  You mean to tell me that in the U.S. you have a 99-year-old person in a nursing home and you're going to resuscitate them unless they say 'no'?  What's wrong with you people?"

Armond and Dorothy Rudolph - Successful VSED at Last

ABC News reported, today, on the deaths of Armond and Dorothy Rudolph.  In their 90s, their bodies were failing them.  “He suffered severe pain from spinal stenosis, a narrowing of the spinal column. She was almost entirely immobile. Both suffered from early dementia.”    They did not want to endure a lingering decline.  They did not want to lose their independence.  They wanted to die

They voluntarily stopped eating and drinking (VSED).  But three days into their fast, the couple told their plan to staff at their assisted facility.  Administrators immediately called 911, citing an attempted suicide.  The Village evicted the couple, and the next day, the Rudolphs moved into a private home.  Once there, the couple again stopped eating and drinking.  Ten days after he began the fast, Armond Rudolph died.  Dorothy Rudolph died the following day. 

The story discusses the legal reasons the facility may have evicted the Rudolphs.  As I argued in an article published earlier this year, those legal reasons are probably baseless.  Facilities should honor patients' decisions to VSED.

Reimbursement for Advance Care Planning: Why Should Intensivists Care?

Randy Curtis writes about “Reimbursement for Advance Care Planning:  Why Should Intensivists Care?” in the current issue of the American Journal of Respiratory and Critical Care Medicine (184 (2011): 387–400). 

“There are few professional groups that stand to lose more business by the systematic implementation of advance care planning than critical care clinicians.  Therefore, you would think this provision would be opposed by the four largest critical care societies: the American Association of Critical Care Nurses, American College of Chest Physicians, American Thoracic Society, and Society of Critical Care Medicine.  So why do these professional societies, representing more than 100,000 critical care clinicians through a collaborative known as the Critical Care Societies Collaborative, strongly support this Medicare regulation [providing reimbursement to physicians for optional annual advance care planning]?”

Curtis responds:  “Because advance care planning—when done early and effectively—increases patient autonomy, improves quality of life for patients and their families, and reduces the suffering that we observe frequently in ICUs.”  In addition to Medicare reimbursement, Curtis offers several other steps we must take “to ensure that our healthcare system truly supports patients and their families.”

Cuthbertson v. Rasouli - Supreme Court Arguments

I have posted, here, the Sunnybrook physicians' August 2011 Application for Leave to Appeal to the Supreme Court of Canada.  This 69-page filing includes a brief memorandum of argument, the affidavits of two physicians, and the affidavit of a bioethicist.  

I have spent the past week revising a new piece for the Annals of Health Law titled "Physicians and Safe Harbor Legal Immunity."  But I will post comments on the appeal shortly.  

Medical Futility Law 2009 to 2011

My next "Legal Briefing" column in The Journal of Clinical Ethics 22, no. 3 (Fall 2011), coming out next month, reviews worldwide legal developments concerning medical futility from the past two years.  I group these developments  into the following eleven categories:

1.      Texas Advance Directives Act

2.      Ontario Consent and Capacity Board

3.      Surrogate Selection

4.      Ex Post Cases for Damages

5.      Ex Ante Cases for Injunctions

6.      Coercion and Duress

7.      Assent and Transparency

8.      Brain Death Cases

9.      Criminal and Administrative Sanctions

10.     Conscientious Objection   

11.     Penalties for Providing Futile Treatment

Resuscitation over Patient Objections

Two"reverse futility" cases were reported in the past few days.  These patients were resuscitated contrary to their documented treatment preferences.  In DeGeronimo v. Fuchs, the New York Supreme Court (Richmond County) held that the Jehovah Witness plaintiff failed to state a medical malpractice claim even though she was provided blood products.  Since the CPR saved her life, there were no legally cognizable damages.  The court suggested the plaintiff should have sued for battery.

Consistent with the New York court, the Louisiana Court of Appeals held, in Jones v. Ruston Louisiana Hospital, that an action for unwanted resuscitation (an ignored DNR order) did not sound in medical malpractice.  Therefore, it did not have to go to a medical review panel.

Cuthbertson v. Rasouli - Going to the Supreme Court

In March 2011, the Ontario Court Justice held, in Rasouli v. Sunnybrook Health Sciences, that Ontario healthcare providers must use the CCB to resolve intractable medical futility disputes.  In June 2011, the Court of Appeal for Ontarion affirmed that ruling.  I discussed the Rasouli case here and here and elsewhere.  

The providers who lost before both courts have now appealed to the Supreme Court of Canada.