Saturday, November 20, 2010
Out of Order
The preceeding posts are older and transfered from my other blog where everything is mixed together. Only todays date shows. Furthermore, they are in reverse chronological order. From here forward postings will be in real-time.
Health Care Reform/Re-reform
It is no surprise that the AHA, American Hospital Association turned their back on the presidents plans for health care reform, and they will not be alone. The insurance companies defeated Secretary Clinton when she spearheaded President Clinton’s attempt at health care reform. I am afraid there is so much knowledge in DC that they miss what goes on in the world of hospitals, doctors, insurance, and drug companies. The extortion goes on at such a high level, involves so much money and has gone on for so long that the criminality is as invisible as it was with the credit default swaps. Old line New England Insurance companies with reputations above reproach find it difficult to resist this wind-fall and unfortunately allow themselves to participate. The AHA is in fact an organization of hospital administrators with a special interest agenda not of patient care but of personal gain through an expanded administrative role. Money percolates to the top.
Insurance is a wonderful thing in mitigating risk, but when it is no longer an option, when it is substituted for a basic humanitarian necessity it leads to abuse, and indeed it has. The criminal extreme of this system resembles a protection racket, and some aspects of health insurance come close. For example excluding prior conditions, cancelation of coverage and increasing rates as a result of diagnosis come close to extortion while seemingly logical to those not suffering from some of the outrageously expensive medical and surgical conditions. Of far greater significance, the subtle endorsement by insurance companies of rising costs, charges by hospitals and providers; it leads to an endless spiral of rising cost that serve only to increase the revenue of the insurance companies without affecting their margins. The end result is a massive fleecing of the American consumer/patient with no end in sight.
The percentage game makes it even worse. Pay, say, 74% of usual and customary charges to a provider with an 80% overhead and – guess what?—the charge suddenly increases 26% or more. This upward spiral applies to drugs, hospitals, laboratories, and providers. It is an ugly game and all are corrupted by it.
Facts: Insurance is the problem. Insurance will not go away. Hospitals are the problem. Hospitals will not go away. Drug companies are the problem. Drug companies will not go away. What is left? Well, it turns out there is a great deal left and that is the science and the care of academic medicine. We have centers of excellence, and medical schools that are the envy of the world despite our pathetic ranking in almost every other metric of health care.
Propose: A completely separate public health care system, run by the states and their medical schools and those centers of excellence that choose to participate: no insurance, free to anyone (or very low fee), providers paid by the state (fewer law suits) and utilizing only medical school connected teaching hospitals. Now here is the catch. The present insurance structure remains in place, encouraged and to whatever extent possible optimized as: a private sector, private practice, competitive system. (I’m not making this up; it’s what happened in Europe quietly and without fan fare.)
The private sector must be fairly treated and, indeed, private medicine may return to its humanitarian traditions. The hospitals, the insurance companies the drug companies and the doctors preferring traditional fee for service can thrive under this system unmolested and thus not inclined to fight against the absolutely essential reform that is going to happen one way or another. Who knows, the private sector may turn out to do a better job in the short run, but in the long run I doubt it.
At first the public clinics will be decried by all of the above and may get off to a slow start. Time however is on their side, and a slow start means an affordable program. Let the two systems compete, In fact let the states compete. The diversity is the very science of medicine and the best patient care formula will percolate to the top, control by academics and education, not by regulation, insurance or money. Include Medicare, Medicaid and Workman’s’ Compensation under this proposed public health care system and businesses will back the program as well. Politics is the art of the possible and this scheme is possible while – I suspect – reform under a mandatory insurance program is not.
Brain Drain on US Health Care
I received this in the mail last night. The email may be phishing but even so may foreshadow events to come. More and more Americans are choosing overseas hospitals for major surgical solutions rather than risking bankruptcy here in the US. This is not an overstatement. Between the lines in this schema lies a promise of a brain drain with US doctors and nurses migrating to Europe or where ever for salaried positions in a more relaxed and scientific atmosphere --- without so much of a threat of being sued.
None of the present health-care proposed solutions takes into account the complete paradigm change in our understanding of disease --- developing in the genetics and bio-medical laboratories. The translation of this new information to clinical medicine requires mass population screening in order to equate the genetic tags with disease. We now know much but there is far more to learn. Europe is way ahead of us in these screening projects with multi-national databases. We lag far behind in these screening efforts.
CERN, in Switzerland attracts many US physicists. European medicine may soon do the same for US doctors and nurses -- especially if the patients follow. Ah -- globalization.
FW: Global Heath Care Network -- Opportunity From: Robert Davis MD - MedRe Partners [mail to:rdavis@transactors.com]
Sent: Sunday, October 18, 2009 6:32 PM
To: clancy@hughesair.com
Subject: Global Heath Care Network -- Opportunity
:
The company is looking for between $5MM and $10MM.
We have an exciting opportunity with a employer-sponsored, consumer-choice global healthcarenetwork. The network provides individuals, employers, and payers with world-class health care. The company provides the world's first global health care network specifically designed to deliver high quality health care services, share the tremendous cost savings with plan sponsors and their employees and coordinate all medical and travel services for individuals who need care. Typically the costs for a major surgical procedure will be 40-80% less than that of the US, with the same or better quality doctors, and no deductible to the patient. The company's program offers a 100% medical benefit.Patients are not going to have any financial difficulties as a result of requiring an expensive surgical procedure.
The company has assembled a network of Joint Commission International (JCI) accreditedInternational Hospitals with departments designed to cater to U.S. patients, staffed by U.S./U.K. or equivalently trained and board certified physicians and nursing staff that are English speaking. The network hospitals are "the best of the best." The company has implemented a U.S. payer style contracts with all their international providers. They have contractually obligated all of our providers to participate in ongoing quality audits, monitoring, credentialing and quarterly reporting. Their contracts recognize the US payers' regulatory obligations. Their agreements have industry leading pay-for-performance provisions as well as the requirement that all health care personnel that touch our patients speak English. Among their many contract innovations, the pricing of the surgical procedure is bundled (all inclusive - hospital, physician, ancillaries) and negotiated as a fixed price case rate. They in turn provide a single bill to the payer , which is in US Dollars and is for the total expense including their fixed price case rate, all travel and hotel costs, their mark-up for overhead and profit, and a Personal Accident Insurance Policy for each patient.
The company has recruited a management team with over 120 years of leadership experience in health care services. Additionally, the company has established a leading group of advisers for our various Boards with over 275 years of successful health services entrepreneurship, medical management, patient care, benefits, health plan leadership, government and public policy leadership.
Please call me on my mobile at: 702-416-8678 or send me an e-mail at: rdavismd@medrepartners.com
Robert Davis MD, Managing Partner
MedRe Partners
rdavismd@medrepartners.com
www.medrepartners.com
702-436-3435 (office)
DISCLAIMER: Sender is not a United States Securities Dealer nor Broker nor US Investment Adviser. Sender is a Consultant and in some instances a Private Investor. This E-mail letter and the attached related documents are never to be considered a solicitation for any purpose in any form or content. Upon receipt of these documents you, as the Recipients, hereby acknowledges this warning and disclaimer. If acknowledgment is not accepted, Recipients must return the document copies, in their original receipt condition, to Sender via postal services immediately.
None of the present health-care proposed solutions takes into account the complete paradigm change in our understanding of disease --- developing in the genetics and bio-medical laboratories. The translation of this new information to clinical medicine requires mass population screening in order to equate the genetic tags with disease. We now know much but there is far more to learn. Europe is way ahead of us in these screening projects with multi-national databases. We lag far behind in these screening efforts.
CERN, in Switzerland attracts many US physicists. European medicine may soon do the same for US doctors and nurses -- especially if the patients follow. Ah -- globalization.
FW: Global Heath Care Network -- Opportunity From: Robert Davis MD - MedRe Partners [mail to:rdavis@transactors.com]
Sent: Sunday, October 18, 2009 6:32 PM
To: clancy@hughesair.com
Subject: Global Heath Care Network -- Opportunity
:
The company is looking for between $5MM and $10MM.
We have an exciting opportunity with a employer-sponsored, consumer-choice global healthcarenetwork. The network provides individuals, employers, and payers with world-class health care. The company provides the world's first global health care network specifically designed to deliver high quality health care services, share the tremendous cost savings with plan sponsors and their employees and coordinate all medical and travel services for individuals who need care. Typically the costs for a major surgical procedure will be 40-80% less than that of the US, with the same or better quality doctors, and no deductible to the patient. The company's program offers a 100% medical benefit.Patients are not going to have any financial difficulties as a result of requiring an expensive surgical procedure.
The company has assembled a network of Joint Commission International (JCI) accreditedInternational Hospitals with departments designed to cater to U.S. patients, staffed by U.S./U.K. or equivalently trained and board certified physicians and nursing staff that are English speaking. The network hospitals are "the best of the best." The company has implemented a U.S. payer style contracts with all their international providers. They have contractually obligated all of our providers to participate in ongoing quality audits, monitoring, credentialing and quarterly reporting. Their contracts recognize the US payers' regulatory obligations. Their agreements have industry leading pay-for-performance provisions as well as the requirement that all health care personnel that touch our patients speak English. Among their many contract innovations, the pricing of the surgical procedure is bundled (all inclusive - hospital, physician, ancillaries) and negotiated as a fixed price case rate. They in turn provide a single bill to the payer , which is in US Dollars and is for the total expense including their fixed price case rate, all travel and hotel costs, their mark-up for overhead and profit, and a Personal Accident Insurance Policy for each patient.
The company has recruited a management team with over 120 years of leadership experience in health care services. Additionally, the company has established a leading group of advisers for our various Boards with over 275 years of successful health services entrepreneurship, medical management, patient care, benefits, health plan leadership, government and public policy leadership.
Please call me on my mobile at: 702-416-8678 or send me an e-mail at: rdavismd@medrepartners.com
Robert Davis MD, Managing Partner
MedRe Partners
rdavismd@medrepartners.com
www.medrepartners.com
702-436-3435 (office)
DISCLAIMER: Sender is not a United States Securities Dealer nor Broker nor US Investment Adviser. Sender is a Consultant and in some instances a Private Investor. This E-mail letter and the attached related documents are never to be considered a solicitation for any purpose in any form or content. Upon receipt of these documents you, as the Recipients, hereby acknowledges this warning and disclaimer. If acknowledgment is not accepted, Recipients must return the document copies, in their original receipt condition, to Sender via postal services immediately.
Translational Medicine (old)
None of the solutions put forth in the current healthcare debate take into account the rapid advances in basic medical knowledge or the need to translate this revolutionary new knowledge into hands on clinical practice. The disagreements on other grounds are intense, but upon the science, both sides might agree.
The term translational medicine refers to a newly created bio-medical specialty that attempts to develop practical clinical tools out of the genetic and molecular discoveries now flooding the scientific literature.
Duke University and the U of Pennsylvania medical schools now sponsor an Institute of Translational Medicine. Two new peer reviewed scientific journals trace the progress of translational medicine.[1] Translating new knowledge into clinical advances challenges the ability for researchers to communicate practical applications to clinicians. These efforts clearly fill a widely recognized practical and critical need. Europe is ahead of us in this research and in the collection of necessary bio-medical databases. [2]
The legislative solutions proposed on all sides contain a dangerous element of standardization, which would tend to delay change, adaptation to environmental factors, individual patients and the implementation of new knowledge. Standards of care set by insurance companies, influenced by drug companies, or even central planners such as NIH would tend to smother the very innovation it attempts to communicate. The task is too big for central control. There are vast individual and regional differences in patient need and in patients themselves.
Medical education and an academic approach to research and clinical care offer the only viable solution to our healthcare dilemma. The government should fund medical schools with the challenge of providing the uninsured with low cost medical care. This option will require satellite clinics; many medical schools provide them now. Combining VA clinics and covering Workman’s Comp. could mean savings for the taxpayer and for employers. The system is in place. The economics of basing the public option on an existing infrastructure is obvious. An academic based public system will generate a biomedical database of the patient population, which would facilitate both the research and the translation of discovery into clinical tools and education for the participating providers. Diversity between regional medical centers will better accommodate the vast regional differences in medical problems and population. Multiple regional initiatives will foster a variety of economic strategies. Multiple initiatives will likewise both: spread the risk of unworkable solutions, and increase the probability of desirable results. Responsibility would fall to the highest levels of scientific medical leadership; it would be a nationwide effort. Salaried or semi salaried providers could better focus on quality more than quantity. There might be some shelter from frivolous lawsuits as medical school / state employees. Politically this public option could prove to be non-political -- attractive to both sides.
Do what you can to curtail the abuses of drug and insurance companies. However, an educational and medical school centered public option will better serve the future of US medicine. Health is an issue of national security. If we do not fix the problems, we risk loosing both patients and medical doctors to a more advanced and humanitarian medical delivery system. Patients are going to Europe and Asia now for lower cost surgical care. Medicine is just one more sphere of US technological leadership we risk loosing due to selfish laissez-faire short-term choices when long-term choices in the national interest are required. Translational medicine is the tool for the US to maintain a leading role in the science of medicine and the care of patients – our vital human resource.
Whatever healthcare solution we seek, must accommodate the rapidly changing science of medicine ---funding both medical research and a close connection between that research and our front line clinicians. This translational medicine strategy must prevail.
633
[1] Science vol 326, 9 Oct ‘09, p205
[2] Nature vol 461, 24 Sep ’09 p448
The term translational medicine refers to a newly created bio-medical specialty that attempts to develop practical clinical tools out of the genetic and molecular discoveries now flooding the scientific literature.
Duke University and the U of Pennsylvania medical schools now sponsor an Institute of Translational Medicine. Two new peer reviewed scientific journals trace the progress of translational medicine.[1] Translating new knowledge into clinical advances challenges the ability for researchers to communicate practical applications to clinicians. These efforts clearly fill a widely recognized practical and critical need. Europe is ahead of us in this research and in the collection of necessary bio-medical databases. [2]
The legislative solutions proposed on all sides contain a dangerous element of standardization, which would tend to delay change, adaptation to environmental factors, individual patients and the implementation of new knowledge. Standards of care set by insurance companies, influenced by drug companies, or even central planners such as NIH would tend to smother the very innovation it attempts to communicate. The task is too big for central control. There are vast individual and regional differences in patient need and in patients themselves.
Medical education and an academic approach to research and clinical care offer the only viable solution to our healthcare dilemma. The government should fund medical schools with the challenge of providing the uninsured with low cost medical care. This option will require satellite clinics; many medical schools provide them now. Combining VA clinics and covering Workman’s Comp. could mean savings for the taxpayer and for employers. The system is in place. The economics of basing the public option on an existing infrastructure is obvious. An academic based public system will generate a biomedical database of the patient population, which would facilitate both the research and the translation of discovery into clinical tools and education for the participating providers. Diversity between regional medical centers will better accommodate the vast regional differences in medical problems and population. Multiple regional initiatives will foster a variety of economic strategies. Multiple initiatives will likewise both: spread the risk of unworkable solutions, and increase the probability of desirable results. Responsibility would fall to the highest levels of scientific medical leadership; it would be a nationwide effort. Salaried or semi salaried providers could better focus on quality more than quantity. There might be some shelter from frivolous lawsuits as medical school / state employees. Politically this public option could prove to be non-political -- attractive to both sides.
Do what you can to curtail the abuses of drug and insurance companies. However, an educational and medical school centered public option will better serve the future of US medicine. Health is an issue of national security. If we do not fix the problems, we risk loosing both patients and medical doctors to a more advanced and humanitarian medical delivery system. Patients are going to Europe and Asia now for lower cost surgical care. Medicine is just one more sphere of US technological leadership we risk loosing due to selfish laissez-faire short-term choices when long-term choices in the national interest are required. Translational medicine is the tool for the US to maintain a leading role in the science of medicine and the care of patients – our vital human resource.
Whatever healthcare solution we seek, must accommodate the rapidly changing science of medicine ---funding both medical research and a close connection between that research and our front line clinicians. This translational medicine strategy must prevail.
633
[1] Science vol 326, 9 Oct ‘09, p205
[2] Nature vol 461, 24 Sep ’09 p448
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