Texas Hospital Hiring Policy–New Employees With BMI Higher Than 35 Won’t Be Hired–But Once Hired You Can Pack on the Pounds

This one of those bizarre stories and the legality of it appears to be all over the place as if you read further with one legal interpretation that says if one is denied a job because they are “morbidly obese” and not just “fat” then you might have a case.  I would guess there might be some morbidly obese folks that might be willing to try it out and see.  The hospital also says if an applicant is obese, they will help you lose the weight to quality for a job there.

I am assuming the help offered by the hospital is not a “free lap band” surgical procedure:) 
How far will all of this go one has to wonder.  From the screenshot below it appears that fat people are now “distracting” according to this hospital?   BD
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A Texas hospital has reportedly instituted a hiring policy barring potential employees who are obese -- and officials at the Equal Employment Opportunity Commission tell FoxNews.com that the practice is not explicitly discriminatory.

The policy, which was instituted last year at the Citizens Medical Center in Victoria, requires potential employees to have a body mass index of less than 35. That equates to roughly 210 pounds for someone who is 5 feet, 5 inches tall or 245 pounds for someone who is 5 feet, 10 inches, the Texas Tribune reports.

"While our laws may not cover people who are overweight but not morbidly obese, the entire thrust of EEOC's mission is to have people considered for employment based on their qualifications and experience -- not on irrelevant factors," Lisser's email concluded.

Michigan is the only state that bans weight discrimination, although six cities -- Birmingham, N.Y.; Santa Cruz, Calif.; Madison, Wis.; San Francisco; Washington, D.C.; and Urbana, Ill. -- have also enacted weight discrimination laws. Madison first enacted its laws banning discrimination based on weight or personal appearance on March 13, 1975.

Lance Lunford, a spokesman for the Texas Hospital Association, said hospitals have the right to utilize policies to ensure the best business.

Key continued: "However, if a morbidly obese was denied employment, I would expect they would have a successful case … So we have this weird situation where you can discriminated against if you're fat, but not if you're morbidly obese."

http://www.foxnews.com/us/2012/04/05/eeoc-texas-hospital-that-bars-obese-workers-not-necessarily-discriminatory/

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More Fake Avastin Hits the US–2nd Time–Shipped From the UK And Originated in Turkey

Alzutan is the name of the drug in Turkey and it is not approved for use in the United States.  Richards’s Pharma in the UK sent 38 packs to the US and then a Canadian company shipped 82 packs so it appears there could maybe be more? 

Richards’s in the UK is already under investigation from the first batch that was sent to the US and on camera in the video you can hear him state that he’s looking into it to see how they got a hold of it. 

I have had a campaign going for about the last 2 years about using bar codes on products that could be synchronized for authenticity, more at the link below and I hope someone would take action.  BD
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Healthcare Bar Code Posts

(CBS News) Another batch of counterfeit cancer drugs have been discovered in the United States.

A batch of 120 vials of fake Avastin, labeled under its Turkish name Alzutan, was shipped through the U.K. from Turkey. The pattern mimics the first time phony Avastin was found in the U.S. in February.

The FDA told healthcare professionals that this incidence of the sham pharmaceutical involved sending it through distributors in Britain, who purchased the drug from wholesalers in Turkey.

British authorities added U.K.-based Richard's Pharma Ltd. sent 38 packs directly to the U.S. Then, additional 82 of the counterfeit vials were shipped to the U.S. by River East Supplies, which is owned by Canadian businessman Tom Haughton.

http://www.cbsnews.com/8301-504763_162-57409816-10391704/fake-cancer-drug-avastin-hits-u.s-market-for-the-second-time/

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Aetna’s 8% Rate Hike for Small Businesses in California Excessive Says State Insurance Department But Nothing They Can Do About It

There’s been a lot of “Aetna” in the news the last couple of days and you can see where they are also cutting off doctors in Texas and in other states.  The analytics did a number on the doctors and many times only one sick patient who requires specialist care does that as it throws off their average to where they are lowered to a general doctor instead of a preferred MD in the Aetna rankings. 

Aetna Notifies 130 Texas Doctors That It Will Terminate Their Contracts on July 1 – E & M Codes Primary Levels 4 and 5 Billing Analytics For Peer Comparison Used To Substantiate the Decision - Video

 

In California we actually have 2 agencies that monitor health insurance increases, the Department of Managed care and the Insurance Commission so if they don’t get an increase on one end of the type of policy, it has occurred on the other end.  Aetna paid $1.7 billion in dividends and I wonder how many of those who received payments are actual Aetna patients?

There is also a move to put this on the ballet to where the insurance commission can in fact deny such increases if not justified.  This is kind of a catch 22 situation with doctors and hospitals fearing their compensation will go down further.  Let’s also not forget that insurance companies have many owned subsidiaries today and below is one of them, so we have insurance and care on one side and then a subsidiary knocking on the doors of the doctors and hospitals to also sell them software.  BD

Medicity (Wholly Owned Subsidiary of Aetna) To Provide HIE Services In Hawaii To Integrate Medical Records–Subsidiary Watch

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SACRAMENTO — Aetna, the state's third-largest health insurance company, is raising rates for thousands of small-business customers to a level that state insurance regulators call "excessive."
California Insurance Commissioner Dave Jones on Thursday criticized Aetna Life Insurance Co. of Hartford, Conn., for raising health insurance group rates by an average of 8% a year for about 77,000 employees of small companies. The rate increases, which took effect April 1, were as high as 21% in some cases, Jones said.
Jones' questioning of the Aetna rates is the first time a commissioner has publicly declared rates unreasonable or excessive. Jones used the opportunity to also restate his support for a proposed statewide ballot initiative that would give him the same power to approve or reject changes in health insurance rates that he has for automobile, homeowners and other types of property and casualty insurance.

http://www.latimes.com/business/la-fi-aetna-rate-hike-20120406,0,618532.story

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Intuitive Surgical Sued In New York Over Death of 24 Year Old Woman Arising from the Use of the daVinci Robot During a Hysterectomy

This is unusual as the robot has been sold and delivered to many hospitals across the US but there’s a time and place for a law suit it appears as the press release states the patient died 2 weeks after the surgery as the arms of the robot are not insulated and the patient received internal burns from electrical currents that jumped over to healthy organs.
In another case related to the death of his daughter, a separate lawsuit has been filed stating the surgeon was careless with not seeing the damage done by the robot.  I was at a mall last year and saw an exhibit set up for the robot, which is kind of strange marketing. 

DaVinci Surgical Robot Does a Roadshow At An Orange County Mall

I did an article a while back too with the Kinect box from Microsoft being used with the robot and what was fascinating about this was not just using hands but the fact that the Kinect device could map “off limit” areas so in other words the robot had “do not pass go zones” and stayed within the surgical area and I don’t know if that would have been of any help here though since it was electrical but worth a thought.  Johns Hopkins was experimenting with the fields and the gestures with the da Vinci. 

Kinect And daVinci Surgical Robot Do Simulated Surgery Suturing Together (Video)

The company is doing well as they have over $3 billion in assets according to the story here and again sad that a life was lost but will bring to the forefront the need for training and education again with all the new technologies we do have that can save lives.  BD 

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Over the last few years there has been a lot of debate on the web about the expense and the surgical outcomes that the robotic procedures provide. There have been many who have had no problem but with technology today it sounds like this comes back to education and training and sad to lose a 24 year old woman over a very common procedure that is done all the time.

NEW YORK, April 4, 2012 /PRNewswire/ -- The father of his deceased 24 year old daughter has commenced a lawsuit in New York against Intuitive Surgery, Inc., the maker of the da Vinci surgical robot, alleging that the device caused her death.  She was only 24 years old so at that age I am guessing she had some type of illness or complications to have this at such a young age.  Intuitive stated the surgeon had not been trained by their company and that is when unintended errors, burns, etc can occur.

In his complaint, filed by the firm of Rheingold, Valet, Rheingold, McCartney & Giuffra LLP of New York City, Gilmore McCalla asserts that when his daughter was having a hysterectomy in a Bronx hospital in August 2010, the robot caused burns to an artery and her intestines, which led to her death two weeks later.  

The complaint alleges design flaws in the da Vinci robot, including un-insulated surgical arms and use of electrical current which can jump to healthy internal organs and tissue.

It also alleges that physicians are not properly trained on the device, and that Intuitive Surgery has failed to run randomized tests as to complications with its robot. 

The McCalla complaint, filed in the federal court in New York City on April 4, 2012, 12civ2597, also asserts that the manufacturer has suppressed reports of complications, and has oversold the merits of its da Vinci robot to hospitals considering buying it. 

The machine costs of upwards of $2 million to purchase and then has a sizeable annual maintenance cost. 

McCalla is also asserting, in separate litigation, that the surgeon operating the robot and the hospital where the procedure was being done were careless, in part in not discovering the damage done by the robot. 

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Employers Are Now Including More Medical Tests When It Comes to Employee Contributions and Coverage Offered With Health Insurance

The financial incentives are getting tough in some areas and those with chronic conditions are especially concerned.  Do financial incentives lead to healthier behaviors overall?  Some do like stopping smoking but that is only one area and there’s a lot more to look at, like losing weight. 

When you look at the contents here and the video, where do you draw the line when those who have high cholesterol readings and high blood pressure are charged more?  Some of this is genetic and it’s not like smoking or being over weight.  Certainly there are healthier behaviors that help but to hold someone to the line with chronic conditions that maybe have been there for years is a bit discrimination. 

We have data and analytics running on servers 24/7 that create criteria for us mere humans to meet and some is fair and some is not.  It’s all about money and we have almost started slipping over to where some of it is not making sense when especially in current economic times.  Chapter 8 of my Killer Algorithms series explores this a bit more and on top of everything else there’s a lot of flawed data out there.  So take into effect we have medical tests required and then you have a credit agency like FICO and CoreLogic that state they can use your credit score and tell others whether you would be a good candidate to be medication compliant?  You don’t have a chance and these are numbers and not relative to care. 

Consumers Lose More Privacy With New CoreLogic Credit Reporting–”Score” Marketed For Insurers and Employers To Gain Information-California Prohibits Potential Employers – From Using As Jan 1 - Killer Algorithms Part 8

The next thing you might wonder about is maybe do you work for a company that gets your free taxpayer data and sells it?  Companies are making billions doing this with little over head and yet our little human bodies need to be more perfect. 

So where does it go next, a colonoscopy test before one gets hired?  Once we figure out that yes there are improvements we can make and do it because we want a healthier life style and not completely tied to a dollar incentive but rather use education as a backbone maybe we well get somewhere.  Too many folks out there are not trained and qualified enough to work with data today and thus they think everything fits into a table with a black and white cut off point.  It has to be handled with ethics and we are not seeing a lot of that today.  BD 
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Once a year, employees of the Swiss Village Retirement Community in Berne, Ind., have a checkup that will help determine how much they pay for health coverage. Those who don't smoke, aren't obese and whose blood pressure and cholesterol fall below specific levels get to shave as much as $2,000 off their annual health insurance deductibles.

Employee reaction has also been mixed. "It's an invasion of privacy," says Bradley Seff, 54, a court reporter who in August 2010 filed a lawsuit against his employer, Broward County, Fla., for introducing such a plan.

Nonetheless, such plans appear to be the wave of the future. Faced with crippling health care costs, the number of employers embracing such programs inched up from 49% in 2010 to 54% last year — and more say they expect to do so soon, according to a survey by consultants Aon Hewitt.

Big-name participants include insurer UnitedHealthcare, car rental firm Hertz, postage meter maker Pitney Bowes and media owner Gannett, owner of USA TODAY. More employers are expected to adopt them starting in 2014, when the health law — if the Supreme Court upholds it — would allow them to offer larger incentives or penalties.

Employers will still have to craft plans to comply with federal and, in some cases, state requirements, Volpp says. The programs must be voluntary — meaning an employer can't require a worker to participate as a condition of coverage — and the employer must offer a "reasonable alternative" to qualify for the reward, or to avoid the penalty for those who can't achieve the goals.

The information is generally gathered by firms that run wellness programs or insurance plans. UnitedHealthcare, which offers its "Personal Rewards" program to large, self-insured clients, says it does not use the information to set premiums.

http://www.usatoday.com/money/industries/health/story/2012-04-01/employee-health-incentives/53932628/1

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Cheboygan Memorial Hospital In Michigan to Close After Sale Was Blocked–No Money to Stay Open

I sure hope I don’t have to revive my series I did a while back after the financial crash called Desperate Hospitals but in watching the news about healthcare today the closures are on the rise if they run out of money or don’t get purchased by a larger organization.  Even some of the big ones are running real tight today. 

Add on buying some software that does does some awry billing in some areas and fines levied don’t help either.  Sure there are cases of out and out fraud but on some of this there’s some algorithms in the software out there that should take some blame too as nobody certifies payer software like we do on the clinical side. 

The hospital is the largest employer in rural Cheboygan county and the ER room is slated to go first.  BD 

Cheboygan Memorial Hospital said it has been forced to shut down Tuesday after a proposed sale of the facility to McLaren Health Care Corp. was blocked, throwing hopes of preserving health services at the area's largest employer into doubt.

 

The sale of the hospital to Flint-based McLaren was expected to wrap up Tuesday but came to a halt late Monday amid regulatory issues, the Cheboygan Daily Tribune reported ( http://bit.ly/HGLSSk). The Board of Trustees of Cheboygan Memorial Hospital voted to close, saying it didn't have the money to stay open.

The hospital's Chief Executive Officer Shari Schult said the facility's emergency room will be closed and that arrangements will be made to divert ambulances to other hospitals. She said in a statement that other services also will be shut down, including outpatient clinics, laboratories and rehabilitation.

http://www.businessweek.com/ap/2012-04/D9TTISCO2.htm

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Software as a Service for Small Businesses to Name Their Price for Employee Health Benefits

Oh the software as a service never ends..we are bombed with so many offering but lets add these folks to the group while we are at it.  This is something a little different that goes after the small businesses to let them design and name their price for what they want to include for coverage and pay for health insurance for employees.

It lets the small business design what they feel they need which can be both good and bad as the price may come down but some items may be overlooked.  Businesses with less than 50 employees are not required to provide health insurance benefits so this is the target market here.  I get people telling me all the time “they don’t have time to read” and yet if you want something today, selective reading has to be on the agenda. 

They will educate you as well and the article here makes mention of their education services.  BD 

Today, Zane Benefits, Inc., a leader in Defined Contribution Health Plans and Private Health Exchanges, announced its new website, designed to educate employers, accountants, and health insurance professionals about the new federal regulations allowing simplified employer health benefits.

As group health insurance costs continue to rise, employers are looking for ways to offer health benefits at a lower price. Zane Benefits’ online defined contribution health plan allows an employer to name its price. Rather than paying the costs to provide a specific group health plan (a "defined benefit"), employers instead fix their costs by establishing a monthly dollar amount (a “defined contribution”) that employees choose how to spend.

According to the website, the two primary benefits of Zane’s online program include:

1. No Minimum Contributions Requirements – This allows a small business to define a contribution it can afford.

2. No Minimum Participation Requirements – This allows a small business to set its own eligibility and/or participation requirements.

Using the Zane program, employers make available a tax-free monthly allowance that employees use to purchase their own individual policy directly from a carrier or independent licensed health insurance agent. Or, if an employer is not able to provide an allowance for certain employees, such employees may use a portion of their pre-tax salary to purchase a policy. This increases the employee’s after-tax purchasing power by 20 to 40 percent and also reduces the company’s payroll liabilities.

“Most people don’t realize that small employers with less than 50 employees are exempt from the employer mandates in the Health Care Reform bill,” Pilzer added. “Small employers today benefit from the increased availability of affordable individual policies regardless of what the U.S. Supreme Court eventually rules on the bill.”

http://www.timesunion.com/business/press-releases/article/New-Website-Lets-Small-Businesses-Name-their-3454746.php

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Feds Reject Hawaii’s Proposal to Limit Most Adult Medicaid Recipients to 10 Days of Hospital Coverage A Year–Would Shift Expense Back to Hospitals

 

There are a few exemptions here with children, pregnant women and those who are receiving cancer treatments, seniors and the blind and disabled, so who gets the limitations, the middle working class. 

We can go back to what Arizona did with cutting back Medicaid where people died with not getting an organ transplant.  This is a tough decision as it’s very had to put a number of the days needed for hospital care and again we have this fascination that we can literally “table” all of this in data base and query for the “right” decision and Arizona showed us that was morally wrong. 

Phoenix Man Denied a Liver Transplant Due to Arizona Budget Cuts-Patient Who Had Insurance Coverage Received the Organ

So again we are humans and there’s a big unknown element here with care and how those who do not work with analytics on a regular basis can come to such conclusions is beyond me. BD

The Obama administration has rejected Hawaii’s proposal to limit most adult Medicaid recipients to 10 days of hospital coverage per year, which would have been the strictest in the nation.

Instead, Hawaii has been approved to implement a 30-day hospital coverage limit starting July 1, state and federal health officials say. Exempted from the limit are children, pregnant women, those undergoing cancer treatment, the elderly and the blind and disabled.

The Centers for Medicare and Medicaid Services is still mulling a proposal from Arizona last September to limit adult Medicaid patients to 25 days of hospital coverage  a year.

“The change will result in a cost shift to hospitals,” said George Greene, CEO of the Healthcare Association of Hawaii, a hospital trade group. “Health care providers in the state are already facing extremely difficult financial conditions which forced the closure of two hospitals at the end of last year, and this will further increase uncompensated care.”

http://capsules.kaiserhealthnews.org/index.php/2012/04/aloha-feds-reject-hawaiis-10-day-hospital-limit-for-most-adults-on-medicaid/

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Aetna Notifies 130 Texas Doctors That It Will Terminate Their Contracts on July 1 – E & M Codes Primary Levels 4 and 5 Billing Analytics For Peer Comparison Used To Substantiate the Decision - Video

This has been going on a long time and I have had conversations with doctors here in California who have gone through this procedure with insurers and Aetna as well.  In one case it was “one” patient who threw the numbers out of whack as they needed special care with a specialist’s specialist with some specific care and treatment that is not the norm but our bodies are not like the one next to us by all means.  If you have been around HMOs for any length of time, this is not unusual as that has gone on in California for a long time with one or two patients who need care beyond what is considered “approved” and it happens when patients are extremely sick. 

So, what happens when you have one or two patients and as a doctor you fall out of the “averages” for your peers?  The video below is from the TMA website where he posted his story and about his attempt to communicate with the CEO of Aetna, which of course did not happen, and at the salary of $8 million a year you might think there could be a little time for a phone call in between appearances at health fairs and conferences trying to win patients over.  If you are the one patient who needs expenses covered beyond the “approved” areas you will end up getting your doctor disconnected with the carrier.  In addition I have heard where a patient has been treated, recovered and then the insurer comes back and wants the doctor to pay it back!   I guess some have not seen this article from January of 2012 about many doctors going broke. 

Doctors Going Broke–You Can’t Even Give a Practice Away–Only Folks Buying Them Are Hospitals and Insurance Companies As It Relates to Reimbursement and/or Profits

 

Aetna and other insurers are also buying up Health IT companies to work with the analytics for reimbursement, so in essence if you consider medical records and billing software they are not only the payer but also the sales folks knocking on the doctor’s door to sell them software too.  If you are not within your peer goal numbers, gee they have software to help you…

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

This doctor and 129 others will no longer be on the Aetna approved list as it’s all about contracts and money.  Actually most doctors throughout the US have accepted contracts from insurers that systematically pay them less than what they bill and receive from Medicare…keep that thought if you are a patient.  You can though go to Best Buy where they hawk their healthcare software, but if you are really ill that doesn’t cut it.

Best Buy Setting Up to Hawk Software from Aetna For Consumer Wellness–Companies Still Don’t Get the Consumer Involvement Yet With a Vehicle and Creating Value

This actually seems to put the physicians groups (some of which are owned by insurers) in violation of the Medicare “Low Bid” contract that doctors  have to accept, to see Medicare patients, and if Medicare had their druthers about this they could possibly go after the insurers and maybe collect some additional funds since Medicare needs money and the insurers/physicians groups are in violation of this clause…interesting thought but has substance for sure.  BD 

Aetna and the Doctor

Aetna has notified 130 Texas physicians it will terminate them from its networks on July 1, TMA's Payment Advocacy Department has learned. Aetna says it told the physicians a year ago it was concerned about their billing patterns. Evaluation and management (E&M) codes were the only ones Aetna examined, and its concern involves primarily levels 4 and 5 E&M codes.

Aetna says in letters to the deselected physicians that its data shows their billing and coding practices caused them to be more costly than their peers. TMA secured legal protections in Texas that require Aetna to tell physicians why they are deselected.

TMA has developed a white paper on physicians' basic rights and responsibilities in network terminations. It is not specific to Aetna; any physician deselected by any health plan network can use it.

He says in the video that he is amazed a physician "trying to save lives and help individuals, is controlled by an individual that made $8 million last year. And he’s not a physician. He's directing health care. He's some great entrepreneur that's going to change the world in technology and he doesn’t have time to talk to physicians."

http://www.texmed.org/Template.aspx?id=24069&terms=aetna

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Medical Marijuana in the Picture Again As DEA Raids Oakland Oaksterdam University

 

Here we go again with the cannabis question on legality with questions between State and Federal Laws.  This school is a training facility for the medical marijuana business. 

Several cities are looking to tax it and raise revenue but this one is a bit strange as they are addressing the folks that were behind the law getting passed in California 

Long Beach California Looking to Tax Medical Marijuana – Proposal for November Ballot

In addition workers have also joined the Teamsters union and this would mean job cuts if medical marijuana was outlawed. 

Medical Marijuana News in California–First TV Ad Airs in California And Workers At Marijuana Factory Join the Teamsters

Oaksterdam is a partner with the city of Oakland as well so again what gives here I don’t know but there protesters and some of the articles in the news stated that the agents had a difficult time looking at some of the patients there as they were genuinely sick and needed pain relief.  BD 

OAKLAND -- Federal agents are conducting a search of Oakland's Oaksterdam University, a training school for the medical marijuana industry.

Agents from the Internal Revenue Service, the U.S. Marshals Service and the Drug Enforcement Administration arrived with a search warrant this morning at the school, variously called the Princeton of Pot and the Harvard of Hemp.

Arlette Lee, an IRS spokeswoman, said the agents are at the school as part of an ongoing investigation.

California's four U.S. attorneys announced in the fall that they would target for prosecution medical marijuana businesses that they believed were operating as for-profit enterprises in violation of the 1996 state ballot measure that legalized medical marijuana in California.

Dan Rush, director of the Medical Cannabis and Hemp Division for the United Food and Commercial Workers, said the union represents about 100 employees working at Oaksterdam University, Lee's Oaksterdam Blue Sky marijuana dispensary and related businesses.

He said the raid threatens the livelihood of the employees who earn up to $60,000, plus health insurance and other benefits.

"Oaksterdam is a partner with the city of Oakland, and Richard Lee is permitted and compliant and we're here to stand by our members," Rush said.

http://blogs.sacbee.com/crime/archives/2012/04/federal-agents-raid-oaklands-pot-university.html

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CVS CareMark Puts Out A Study on Medication Compliance Based on Chronic Conditions And Where Patients Get Their Drugs

This is nice to have some “crunched” numbers based on data the company has internally and if you want to look at medication compliance, this is the way to do it with a report and not brought down to individual levels.  So many folks today don’t know how to work with data and reports and are naïve and gullible though.  I consider this report as “interesting” to look at and that’s about it and as long as it is not used to justify and reductions in drugs supplied to patients then that’s ok. 

There are issues though when folks go too far with such stats and take it down to a personal level to sell software and algorithms like the FICO software that claims they can take information from the web and combine it with your credit score to determine compliance and that is just mis-matched data to make a buck and eventually lean folks over deny the type of medications provided.  That does happen when you have employees barely trained to work in certain departments that have to rely on what’s on the screen as so much data is becoming flawed for spun marketed for the sake of money.  As the old saying goes “numbers don’t lie but people do”.  You can read more on the obnoxious efforts of FICO below and see what a sham they are trying to sell with analytics and cutting a space out to sell data. 

FICO Analytics Press Release Marketing Credit Scoring Algorithms to Predict Medication Adherence–Update (Opinion)

This brings me around to repetition of information on the web and how it creates doubt.  If I put 2+2=5 on this website and everyone retweeted it and is circulated all over and showed up again in a few months with the same marketing scheme, people might think “what is this, I keep seeing this, is there something to this?”  Again I am being obnoxious with the example to drive the point home. 

We have digital illiterates who buy in to this stuff and think everything they read is gospel when it is not, and then studies can get created from some of what is in print, we read it all the time out there, so again this report is “interesting” but is no more than that.  BD 

The State of the States Adherence Report reviews how patients in all 50 states are, or are not, taking their medications as directed by their doctors. The information was compiled using CVS Caremark's comprehensive database and looking at medication adherence factors for four common chronic disease states – hypertension, dyslipidemia (high cholesterol), diabetes and depression. Adherence was calculated based on a variety of factors including how much medication a patient has on hand, when and if they refill a prescription on time, how they access their drugs (e.g., at a retail pharmacy location or through mail order) and how often generic medications are dispensed

http://www.cvscaremarkfyi.com/rx-adherence/data-hub

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Biomet Makes Offer to Buy DePuy Business from Johnson and Johnson To Enable Regulatory Clearance for The Purchase of Synthes

Biomet is also in the artificial joint business and corporate offices are located in the UK.  On their websites outside of the US, they have somewhat of a warranty that guarantees their products as they are so durable and back in 2010 they had seen only a dozen claims.  Now this is the type of company that might be able to somehow “fix” some of the stuff going on over at DePuy when it comes to joints replacements.  Depuy has other products as well but the knee and hip failures put them on the map along with Johnson and Johnson being the corporate owner. 
Back in May of 2010 the FDA requested all hip replacement companies to begin studies on failure rates.  Johnson and Johnson bought DePuy in 1998.  DePuy did get FDA approval in June of 2011 for ceramic on metal him implants so who knows what Biomet might be able to do if technologies are combined. 

FDA Requesting Most all Manufacturers of Hip Replacements To Begin Studies On Failure Rates

DePuy Orthopedics Gets FDA Approval For Ceramic-on-Metal Hip Implant Pinnacle CoMplete System–Is This A Potential Replacement for the Other Ones Out There?

Biomet is not without their issues with recently agreeing to pay millions in penalties that they bribed doctors so it appears the may have a better product, but still got in to trouble in other areas.  Upon completion of he Synthes transaction, Synthes and the DePuy Companies of Johnson & Johnson together will comprise the largest business within the Medical Devices and Diagnostics segment of Johnson & Johnson.   BD

Indiana-based Biomet said it has made a binding offer to acquire the trauma business of Johnson & Johnson’s DePuy Orthopeadics subsidiary for approximately $280 million in cash.

The deal is expected to clear the way for New Brunswick-based Johnson & Johnson to receive regulatory approval to complete its acquisition of Synthes. The binding offer allows Depuy to comply with its consultation agreements with various Europeon works councils before it enters a negotiated sale agreement.

DePuy’s trauma business includes a range of products used in reconstructive surgery, including implants, plates and surgical nails as well as specialized technology for treating shoulder, ankle, finger and wrist injuries.

http://www.nj.com/business/index.ssf/2012/04/johnson_johnson_divests_depuy.html

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Medical Quack Has a New Blog Format–Added Resources and Some New Additional Information…

I have been working to try and make the Medical Quack a little more informative and have added some new feature so when you get a chance check it out.  You can see the bar code to go mobile.  The blog posts are still located in the same spot with some new formatting, a bit of a chore, but it’s working. 

In addition I have expanded the Sponsor and Resource area to give more exposure to the folks who are kind enough to advertise and sponsor here.  We can exist as bloggers without them.  The Micro-Cap Review Magazine current issue (sponsor) from SNNWire/StockNewsNow is always up in the left hand corner and the current issue has some interesting articles and the cover story talks about IFS, a company that makes generic implants that are 40to 60% less expensive for commonly used orthopedic devices.  SNNWire does a number of CEO interviews at various biotech conferences and the link is worth checking out to read about the latest. 
It’s kind of long but when you scroll down a bit both the right and left had sides have some additional blocks of interest.  The videos on the left hand side give some full attention to the “Attack of the Killer Algorithms” series I keep adding to which is an educational item to help explain how things happen today, it’s all about the math and the formulas that run on servers 24/7 that make life impacting decisions about all of us and the videos are well worth watching and will make you give some second thoughts and perhaps move you to think and ask sometimes today if you don’t understand how some business and government decisions are made as the amount of flawed data on the web is growing as we add more aggregated services.  Some really get it right while others…well you get the drift, so don’t be gullible and naïve and ask questions. 

Further down I have aggregated some RSS Feeds that might be of interest to see what’s going on with the big journalist companies and the US government so it’s a quick link for some recent news beyond what I blog about as if it wasn’t for the journalists out there today, I wouldn’t have anything to blog about:)  The left hand side has quite a few links and use the scroll bar to check it out. 
Thanks again to everyone who stops by and I appreciate your readership and hope you continue to keep coming back! 

Barbara Duck (The Medical Quack)

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Early PET Response To Neoadjuvant Chemotherapy In Sarcoma Patients Predicts Survival Study Finds

This study appears to say that having a PET scan after the first treatment for chemotherapy gives some indications of how medications are working or not working based on the scan.  If not working it looks like changes can be made early on with examining the condition of the tumor.  BD 

Press Release:
An early Positron Emission Tomography (PET) response after the initial cycle of neoadjuvant chemotherapy can be used to predict increased survival in patients with soft tissue sarcomas, according to a study by researchers with UCLA’s Jonsson Comprehensive Cancer Center.

           
Prior studies by this multidisciplinary team of physician scientists at the Jonsson Cancer Center had shown that use of FDG PET/computed tomography (CT) could determine pathologic response after the first dose of chemotherapy drugs. The researchers then wondered if the patients showing a significant PET response after the first round of chemotherapy also were surviving longer, said Dr. Fritz Eilber, an associate professor of surgical oncology, director of the Sarcoma Program at UCLA’s Jonsson Cancer Center and senior author of the study.

           
“We did find that patients who experienced an early PET response to treatment had significantly increased survival,” Eilber said. “This is vital because patients want to know if the drugs are working and what that says about their ultimate outcome.”

           
The study was published April 1, 2012 in Clinical Cancer Research, a peer-reviewed journal of the American Association of Cancer Research.

           
In this study, 39 patients with soft tissue sarcoma underwent a PET scan to measure their tumor’s metabolism, or how much glucose was being taken up by the tumor, prior to getting chemotherapy. The patients were given another PET scan after the first round of chemotherapy. Those whose tumors demonstrated a 25 percent or more decrease in metabolic activity – a response considered significant - were determined later to have significant increased survival rates compared to those patients who had less than a 25 percent decrease, Eilber said.

           
“It’s an important finding because we can now identify whether patients are getting the right chemotherapy very quickly,” Eilber said. “Patients don’t want to have to wait until the cancer recurs or they die to find out whether their chemotherapy worked or not.”

           
Going forward, Eilber and his team are working to design new molecular imaging tools that may tell them even more about a patient’s cancer beyond the conventional FDG probe.

           
“Just looking at the size of the tumor is not good enough anymore,” Eilber said. “We want to image what’s happening within the tumor in real time.”

The study was funded by the In vivo Cellular and Molecular Imaging Center at UCLA’s Jonsson Comprehensive Cancer Center and the Department of Energy.

“This study suggests that PET allows survival predictions after the initial cycle of neoadjuvant chemotherapy and might therefore potentially serve as an early endpoint biomarker,” the study states. “Such information cannot be derived from CT scanning based on serial tumor size measurements. The ability to assess treatment response early during the course of therapy can potentially guide management decisions. Treatment could be switched from neoadjuvant chemotherapy to immediate surgery in non-responding patients, while it would be continued in responders. Such risk adapted therapy could reduce treatment associated morbidity and costs.”

UCLA's Jonsson Comprehensive Cancer Center has more than 240 researchers and clinicians engaged in disease research, prevention, detection, control, treatment and education. One of the nation's largest comprehensive cancer centers, the Jonsson center is dedicated to promoting research and translating basic science into leading-edge clinical studies. In July 2011, the Jonsson Cancer Center was named among the top 10 cancer centers nationwide by U.S. News & World Report, a ranking it has held for 11 of the last 12 years. For more information on the Jonsson Cancer Center, visit our website at http://www.cancer.ucla.edu.

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Fist Fight and Love Triangle In Pennsylvania Costs One CEO His Job–HighMark

A job paying $4.5 million a year is not easy to come by, at least in my area of the world it’s not.  He used to have clout and now with this all over the media, I guess time will tell if it stays or goes away.  This is bizarre as his mistress as she is called moved out from her home with her husband, and then the former CEO, Melani hired a private detective to follow her.  Something must have been cooking as he showed up and the husband was there and it sounds like that’s what erupted into a fist fight.  Highmark as a company also has this battle in place with UMPC. 

Hospitals and Insurance Company Competing for Patients In Pittsburgh–Contracts In Question

From the website:

“Our history of helping families and companies with their health insurance needs dates to the 1930s, when our predecessor companies were established to help Pennsylvania's residents pay for health care.

Highmark was created in 1996 by the consolidation of two Pennsylvania licensees of the Blue Cross and Blue Shield Association — Pennsylvania Blue Shield (now Highmark Blue Shield) and Blue Cross of Western Pennsylvania (now Highmark Blue Cross Blue Shield). We are now one of the largest health insurers in the United States.”

In addition Highmark and the Blues Group, which was their origin also bought NaviNet which is a Health IT technology company that connects medical records. So there was a lot going on for sure business wise and otherwise.  BD 

Blue Cross/Blue Shield Insurers and Highmark Acquire NaviNet Transactional Portal And Medical Records Vendor–Subsidiary Watch

Video below and is appears they both the husband and the doctor had bleeding faces and the board of directors held a meeting hours after the assault.  BD

He held the CEO post of one of the largest health care providers in PA and now he is facing serious allegations following a sex scandal.
Here in Central PA, thousands are employed by Highmark and shocked to hear the news that higher-ups fired CEO Doctor Kenneth Melani Sunday morning.

Dr. Ken Melani is out as CEO of Highmark, a post that paid $4.5 million a year and gave him serious clout in the industry.
Melani is accused of getting into a fist fight in a neighborhood near Pittsburgh with the husband of Highmark employee Melanie Myler who he was allegedly having an affair with.
“The reports are scandalous in nature, it isn’t flattering,” stated attorney Robert del Greco.
Melani’s attorney went onto say they don’t know if he was fired under moral grounds or something else entirely.

http://www.whptv.com/news/local/story/Highmark-CEO-fired-over-love-triangle-brawl/ki_NJGqU1EKAeKFIwW16sg.cspx

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Neupro Patch Gets FDA Approval for Advanced Stage Idiopathic Parkinson’s Disease and Restless Leg Syndrome

The patch is worn for a day and contains a sulfite, sodium metabisulfite that some are allergic to and you have to watch for a few other drug interactions with anything that causes drowsiness and there’s a side effect of hallucinations and that side effect is higher with those who have Parkinson’s disease. 

Another side effect is an urge to behave unusually, urges to gamble or increased sexual urges.  This is right off the website with the warnings.  The drug is said to stimulate dopamine receptors that regulate movements.  BD

BRUSSELS & ATLANTA--(EON: Enhanced Online News)--UCB announced today that the U.S. Food and Drug Administration (FDA) approved Neupro^® (Rotigotine Transdermal System) for the treatment of the signs and symptoms of advanced stage idiopathic Parkinson’s disease (PD) and as a treatment for moderate-to-severe primary Restless Legs Syndrome (RLS). Neupro^® was previously approved by the FDA for the signs and symptoms of early stage idiopathic PD. Neupro^® is a dopamine agonist patch that provides continuous drug delivery for patients with PD and RLS. The FDA has also approved UCB’s new formulation of Neupro^®.

“RLS can be a serious condition with symptoms that affect patients during the day as well as at night; and Parkinson’s disease symptoms can have a broad impact on patients. Neupro^® provides a novel way of treating RLS and PD through continuous transdermal dopaminergic delivery. It can help patients manage the unpredictable nature of these chronic conditions,” said William Ondo, M.D., Professor, Department of Neurology, University of Texas Health Science Center at Houston.

http://eon.businesswire.com/news/eon/20120402006986/en/Neupro%C2%AE-Approved-U.S.-FDA-Parkinson%E2%80%99s-Disease-Restless?utm_source=dlvr.it&utm_medium=twitter

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Express Scripts and Medco Get Federal Approval To Merger Valued at $29 Billion - Is It All About Data to sell for Bigger Profits?

This means more mail order prescriptions on the way

eventually as almost all health plans today have one.  I wonder how this affects chain pharmacies like Walgreens who are still disputing contract amounts with Express Scripts.

  Blue Cross members can’t get prescriptions there so now does it all switch over to Medco? 

Express Scripts to buy Medco for $29 Billion–Medco 2nd Quarter Profits Were Down 4% And the Profit Algorithms Once Again Are Hard at Work To Control Costs via Acquisition

 

The initial announcement of Express Scripts was announced in July of 2011.  When you add in Caremark as the other large PBM that’s like a huge amount of the mail in pharma business in the US.

Walgreen Dumps Express Scripts Pharmacy Benefit Manager–Contract Dispute With Reimbursement to Retail Chain Too Low

Now let’s look at something else going on in the drug business with FICO selling software to companies such as PBM managers and now it gets interesting with analytics that are using mismatched data that has been spun and marketed, with FICO claiming they can predict medication adherence.  How man PBMs are buying this and what will it do for access for patients?  This is just one more example on how marketing today puts a wild spin on things and it goes on behind the scenes and denies due to parameters not being met, whatever they are.

FICO Analytics Press Release Marketing Credit Scoring Algorithms to Predict Medication Adherence–Update (Opinion)

One thing to keep in mind today is that with mergers and acquisitions, along comes aggregation of data for analytics and to sell for a profit and PBMs do that big time and companies are making billions selling data so again keep that thought and the acquisitions of today might look a little different to you as if Walgreens in the SEC statement in 2010 made short of $800 million selling data, just think what these two conglomerates make, it makes my head spin and wonder if selling prescriptions is merely the gateway to profits on selling data.  I’m not the first one to say this and I won’t be the last.  If you know math and see that Walgreens number, you can’t over look it.  BD

 

---

Despite potential antitrust concerns and vocal opposition by some lawmakers and consumer groups, Express Scripts and Medco Health Solutions, two of the nation’s largest pharmacy benefit managers, said Monday that federal regulators had approved their $29 billion merger.

The decision, by the Federal Trade Commission, to let the merger proceed was not unanimous, indicating conflicting views among the agency’s top regulators over whether to challenge — or impose limitations on — the combined company. After eight months of review, the F.T.C. commissioners voted 3-to-1 to close the agency’s investigation.

The acquisition of Medco by Express Scripts, based in St. Louis, creates what is now the industry’s largest player, with $116 billion in 2011 revenue. CVS Caremark, itself the product of a merger between a large drugstore chain and a benefit manager, is now the second-largest competitor with $107 billion in revenues.

Pharmacy benefit managers, known as P.B.M.’s, manage prescription drug plans for employers and insurers. They serve as middlemen between the drug companies and the payers.

Two groups, which represent community pharmacists and chain drugstores that have strenuously objected to the combination, filed a lawsuit last week seeking to block the merger. The National Community Pharmacists Association and the National Association of Chain Drug Stores, which see the combination as problematic for pharmacies, said they planned to pursue their litigation.

http://www.nytimes.com/2012/04/03/business/ftc-approves-merger-of-express-scripts-and-medco.html?_r=1&smid=tw-nytimeshealth&seid=auto

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Over Diagnosing for Breast Cancer? Report Suggests Some Treatments Were Not Needed

This is one that I know about through my mother as we had this happen.  It turned out she did not have breast cancer and a “mass” was found.  I’ll make this brief but she was over-diagnosed when the x-ray was blown up to further investigate.  That lead to a biopsy which was also messed up and if she would have gone for treatment for this tiny miniscule mass they found with radiation, she may not be here today at age 87 and this was about 3 years ago when all this occurred. 

Upon consulting with a veteran surgeon who went over everything in detail he said yes she has a mass but it was not cancer and he has done a ton of surgeries for breast cancers so he was experienced. 

He gave her the choice though of having it removed or not and when we discussed it we decided against it and keep in mind too this was at a time when propofol was hard to get all the time and he informed her he would need a “special anesthesiologist” to work with another drug and keep her “under” time down to an absolute minimum as even he knew after seeing her chart that her health was a bit on the fragile side with a long history of blood pressure, heart problems and diabetes. 

After all was said and done the insurance company went back to investigate the original oncologist and radiologist. 

The radiologist had called my mother about her experience with the oncologist as well and about the office since they were new partners.  The radiologist left and went elsewhere and the insurance company ended up fining the oncologist who seemed to be more interested in making my mother a case study than treating her cancer.  This is not representative of most doctors thank goodness and the pressure to sign up after the consult from the messed up biopsy was horrendous.  She could not get out the door without making her appointment for the treatment with the brand new Mammosite machine they had just purchased. 

FDA Clears Hologic's MammoSite(R) Multi Lumen Radiation Therapy – Breast Cancer

She made the appointment, went home and then cancelled the next day and the girl in the office was scared half to death over her job as she was evaluated on her patients relations and bookings for treatments for productivity.  So much for pay for performance at this level I said. 
 

So in summary screenings are still good in my opinion; however involving the patient here as we were with my mother lead to a very different outcome and results from the moment that she was told she had cancer.  Of course she signed all the releases for the doctors stating that she was declining radiation treatment.  After our experience with weighing everything and especially after the consult with the surgeon we felt we made the right decision. 

Again this was a very tiny spot and the following year her mammogram was clear!  But wait, 2 years later next mammogram and they again find a tiny spot and again blew it up to investigate and again I’m not picking apart the procedure or doctors at all, but, it was good to have case history and see almost the exact same thing as what set off whistles and bells 3 years prior and again we stopped there once more and opted out for surgery.  She’s still here today and again I can’t emphasize enough that each case is its own and we were and are lucky but I also understand that this is just her case and everyone needs to get all the information they can and make their own decisions.   BD

(Reuters Health) - A new report suggests that when a breast cancer screening program was rolled out in Norway, up to 10 women were diagnosed and treated for cancer unnecessarily for every breast cancer death that was prevented.

That’s because when doctors screen for cancer in women who don’t have symptoms, it’s impossible for them to tell whether a tumor picked up by mammography will grow quickly into advanced cancer or will only progress slowly or not at all, said lead author Dr. Mette Kalager.

You have to really consider the benefit and the harm against each other, and really think through: what is my risk of dying from breast cancer, and what is my risk of being overdiagnosed?" she said.

http://www.reuters.com/article/2012/04/02/us-breast-cancer-idUSBRE83112U20120402

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Oracle Buys Cloud Based Clinical Trial Application Company–ClearTrial

It was not too long ago that Oracle Larry Ellison received an award for his contributions

to Health IT from the NIH.  We see the move with analytics all over healthcare today so this makes sense for Oracle to be in this business.

Oracle and Clear Trial will continue to operate as separate companies and biopharmaceutical, device and diagnostic companies are under more pressure than ever today to keep things in a budget for sure.  BD

 

Larry Ellison Announced As Distinguished Medical Informatics Awardee for His Contributions to Health IT and the Ellison Foundation From the Friends of the National Library of Medicine (NIH)

Summary: Oracle plans to combine its analytics resources to ClearTrial’s cloud-based clinical trial operations applications to produce a single, cheaper option for biopharmaceutical and medical device companies.

Oracle is beefing up its health sciences suite (and its cloud-based solutions portfolio) with the acquisition of ClearTrial.

ClearTrial is a provider of cloud-based clinical trial operations applications intended to facilitate the planning, sourcing, and tracking of clinical projects while ensuring a more accurate and faster financial performance. Its customer base ranges from emerging companies to top-tier biopharmaceutical companies

.

http://www.zdnet.com/blog/btl/oracle-acquires-cloud-based-clinical-apps-provider-cleartrial/72748

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Study Suggests that Pay for Performance Incentives for Hospitals Is Not Leading to Better Patient Outcomes

Back in January of 2011 we had another study saying the same thing so we can add one more bit of information to the theories that pay for performance are worthwhile?

Does this further suggest that insurers all over are not getting their money’s worth?  If hear from their side, which if focused on reimbursements you might hear a different story but I’ll take the clinical side any day as we know all about the algorithms built for profit and it’s getting harder to do both with better clinical outcomes and at the same time apply fixes for the payments.  Sure hospitals are getting to be a lot smarter with “running the business” but what are we here for, better outcomes or better financial management and you sometimes wonder about the financial side as hospitals are still going broke all over.  BD 

Pay For Performance Is Not All That It Has Cracked Up to Be-Time to Rethink As Money Is Not Creating Better Health Outcomes

(Reuters) - A program to pay hospitals bonuses for hitting key performance measures, or dock them if they miss, failed to improve the health outcomes of patients, according to a large, long-term study.

The study could lead to a re-examination of financial incentives in healthcare, as policymakers seek ways to reward results rather than paying doctors and other providers for each service they provide, such as a diagnostic test.

Such an incentive program for hospitals is a key provision of the U.S. healthcare overhaul law that is being challenged this week before the Supreme Court.

The study looked at pay-for-performance incentives similar to those in the law and found no evidence that the program helped more patients live longer. It was published on Wednesday in the New England Journal of Medicine.

http://www.reuters.com/article/2012/03/28/us-usa-healthcare-compensation-idUSBRE82R1F720120328?feedType=RSS&feedName=healthNews&utm_source=dlvr.it&utm_medium=twitter&dlvrit=309303

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