Thursday, 7 April 2016

The Macro View - General And Health News Relevant To E-Health And Health In General.

The Macro View - General And Health News Relevant To E-Health And Health In General.

April 7  Edition
The macroeconomic stresses seem to have eased a little more with markets rising around the world. Indeed the major stock market indices in the US are flat to up for the calendar year. However we are not really out of the wood just yet.
posted on 02 April 2016

Uncertainty Still Hangs Over The Global Economy

From the Dallas Fed
This post authored by Arthur Hinojosa
The global outlook has rebounded from a low point in January but remains weak due to volatile financial markets and low commodity prices. In a speech to the National Association for Business Economics, International Monetary Fund (IMF) First Deputy Director David Lipsky said, "The IMF's latest reading of the global economy shows once again a weakening baseline ... . Moreover, risks have increased further, with volatile financial markets and low commodity prices creating fresh concerns about the health of the global economy."
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In Australia, things are also looking up for the present, although the recent long weekend has slowed improvement down.
With Budget Night now May 3 we won’t have long to wait to see what is happening. COAG seems to have been a fiasco. Tax cuts of some sort and superannuation changes seem to be the favoured outcomes.
Here is a summary of interesting things up until the end of last week:
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General Budget Issues.

Big earners pump up tax take

A surge in the number of Australians earning at least a million dollars a year and paying record tax is underpinning the revenue system as more people on low wages find themselves paying almost nothing.
A breakdown of Australian Tax Office figures highlights the growing gap between those with ultra-high incomes and those on the tax-free threshold.
After falling in response to the global financial crisis, the number of people who earned more than $1 million while paying tax climbed to a record 11,082 in the 2013-14 financial year. It was an increase of more than 31 per cent over the past two years.
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Budget 2016: Cutting business taxes does not lead to growth, says study

Date March 28, 2016 - 11:45PM

Mark Kenny

Chief political correspondent

Cutting the company tax rate will neither create the jobs nor produce the economic growth that the government and the business lobby claim it would, according to a historical examination of Australia's business tax reductions and that of comparable OECD economies.
An analysis by the progressively inclined think-tank, The Australia Institute, has looked at the data and found the drop from a company tax rate that was nearly 50¢ in the dollar when it began falling in 1988 toward its current 30¢ rate in the early 2000s failed to produce the much vaunted "growth dividend" that proponents assert is the automatic result of such a move.
And the experience of other countries tends to support the finding, showing that GDP growth rates in low company tax jurisdictions are no different from higher ones.
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Health insurance: Why we have to suffer soaring premiums

Date March 29, 2016 - 11:07AM

Marc Moncrief

Despite the private health insurance premiums hike, Health Minister Sussan Ley says the average family with hospital and general health cover will save $166 a year, thanks to her intervention.
April 1 is the day those of us who buy private health insurance are hit with our annual premium increase, but what may seem like a cruel Fools' Day joke is one of the main things that make our healthcare system work.
This year's premium increase will vary from between nearly 9 per cent and just under 4 per cent, depending on the carrier, but it will average out at 5.59 per cent. That's a four-year low, but it is receiving extra attention because: 
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Federal election 2016: Turnbull discusses ditching Abbott health cuts

  • The Australian
  • March 29, 2016 11:01AM

Rachel Baxendale

 “We will be presenting to the Premiers and the Chief Ministers a proposal that’s obviously under discussion at the moment,” Malcolm Turnbull told reporters at Sydney’s Holsworthy army barracks.
Malcolm Turnbull has indicated his government will ditch Tony Abbott’s cuts to state hospital funding, but declined to comment on reports the move will put a $5 billion hole in the budget.
Asked about The Australian’s report today that state governments are confident they will be offered a four-year hospital funding agreement to 2020 based on the formula agreed upon under the Gillard Labor government, the Prime Minister highlighted the importance of federal, state and territory governments working together on health funding.
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High-powered CEDA Commission backs Labor tax policy to balance the budget

Date March 30, 2016 - 12:51AM

Peter Martin, Jessica Irvine

A high-powered independent commission has backed Labor's approach to capital gains tax and negative gearing, undercutting Prime Minister Malcolm Turnbull and Treasurer Scott Morrison who say it will "smash" housing prices.
The Balanced Budget Commission, established by the Committee for the Economic Development of Australia, includes two former heads of the Department of Prime Minister and Cabinet and one former Cabinet Secretary. Between them, Paul McClintock, Terry Moran and Ian Watt have served prime ministers Howard, Gillard, Abbott and Turnbull.
"No economic problem which is in our power to resolve is graver or more urgent in Australia than the persistence of large budget deficits," the Commission chair Mr McClintock said, launching the report at the National Press Club on Tuesday.
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States could collect income tax under radical plan to be discussed at COAG

Date March 30, 2016 - 10:41AM

Michael Koziol

States and territories would collect their own income tax for the first time since World War II under a radical proposal to be considered at a meeting of state and federal leaders this week.
Declaring himself a "pragmatist" on the issue of fixing the vertical fiscal imbalance between the Commonwealth and the states, Scott Morrison left the door open to becoming the first Australian treasurer in 75 years to allow states to control a portion of income tax.
If agreed, the proposal would adopt an idea put forward in the 2014 National Commission of Audit that was dismissed by former prime minister Tony Abbott.
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Morrison rejects budget surplus plan

Updated: 12:41 pm, Wednesday, 30 March 2016
Treasurer Scott Morrison has dismissed research from a think tank that would bring the budget back to surplus within two years.
The Committee for Economic Development of Australia report released on Tuesday recommends several options to raise revenue by $15 billion and cut expenditure by $2 billion that would return the budget to balance in 2018/19.
That would be two years earlier than what Mr Morrison predicted in his mid-year budget released in December.
But the treasurer said you don't tax your way back to a surplus.
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Australia’s 'alarming' budget deficit could be eliminated by 2018 through raised taxes, budget cuts: CEDA

By Zac Crellin @zacrellin on March 30 2016 9:28 AM
The federal budget could be returned to a surplus as soon as 2018, according to five plans released by the Committee for Economic Development of Australia (CEDA).
The plans, which anticipate that Australia’s eight-year-long deficit will continue for another four years if things don’t change, call for varying combinations of tax reform and reduced spending.
CEDA chairman Paul McClintock said that “Australia’s deficit problem is particularly alarming” due to the country’s current period of sustained economic expansion lasting a quarter of a century.
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Why the states should charge income tax

Date March 30, 2016 - 8:40PM

Peter Martin

Economics Editor, The Age

State governments will need to fill a hospital funding gap if the Prime Minister's tax plan is implemented. Fairfax's Peter Martin gives his analysis.
Suddenly the election is about something else: how our states have had it too good for too long. And about how we've had it even better.
In every previous election we've been able to vote for better hospitals, schools and roads at the state level (which of course we want) and for lower taxes or lower budget deficits at the Commonwealth level (which of course we also want).
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Why we should worry about fixing the budget

Date April 2, 2016 - 12:15AM

Jessica Irvine

Senior Writer

Individual tax cuts scrapped

Treasurer Scott Morrison indicates that individual tax cuts - which he has previously flagged - will not be possible until the budget is in better shape.
There has been no official recession in Australia for a quarter of a century, but the federal budget has been in deficit for eight years in a row.
Does that bother you? It should.
Simply passing on the tab to future generations because the current generation of taxpayers is unwilling to pay enough taxes to fund the public services they currently enjoy is deeply unfair.
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COAG: Malcolm Turnbull's radical plan on state taxing powers knocked back

Date April 1, 2016 - 8:03PM

Mark Kenny

The Prime Minister's 'full-blooded' income-tax sharing proposal to fund hospitals has been rejected by state and territory leaders, but short-term funding has been secured.
State and territory leaders have flatly rejected Malcolm Turnbull's radical plan to have them assume a portion of income taxing powers, unceremoniously consigning the idea to the political dustbin.
And they notched up another win also on short-term health and hospital funding signing a heads of agreement document with the Commonwealth for an extra $2.9 billion from July 2017, to 30 June 2020, along with a lift in the 6 per cent cap in the growth of Commonwealth funding to 6.5 per cent.
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Malcolm Turnbull's 'moment of clarity' following tax plan failure

Date April 2, 2016 - 5:55PM

Leesha McKenny

Urban Affairs Reporter

The Prime Minister says the states cannot any longer credibly ask the federal government to raise taxes for them if they are not prepared to raise taxes themselves.
The Prime Minister has hit back at the rejection of his income tax plan, painting its defeat as a "moment of clarity" that revealed the states lacked the stomach for reform and must live within their means.
Malcolm Turnbull on Saturday brushed off suggestions that the failure of what he hailed as only days ago as "the most fundamental reform to the federation in generations" marked a major humiliation for his government.
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Health Budget Issues.

Australian Medical Association welcomes prospect of COAG funding deal

Date March 27, 2016 - 4:47PM

Matthew Knott

Communications and Education Correspondent

The doctors' peak body has hailed the prospect of a $7 billion emergency hospitals funding deal between Canberra and the states as a welcome break from the policies of the previous Abbott government.
Prime Minister Malcolm Turnbull will meet premiers and chief ministers on Friday for a much-anticipated Council of Australian Governments (COAG) meeting, with health and education funding at the top of the agenda.
As well as extra money for hospitals, the leaders will also discuss NSW Premier Mike Baird's plan to spread out the final two years of Gonski school funding across four years
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Diagnostic fees may cost families 'thousands'

Labor MPs have warned that Sunbury and Macedon Ranges residents being treated for serious illnesses, including cancer, could face large bills for MRIs, X-rays and mammograms under changes to the Medicare benefits schedule (MBS).
McEwen MP Rob Mitchell and Opposition health spokeswoman Catherine King discussed federal cuts during a visit to Sunbury’s new Lake Imaging clinic last week.
The two Labor MPs said many clinics would be forced to charge patients for scans and tests that were previously bulk-billed.
Figures released by the Australian Diagnostic Imaging Association show upfront fees could range from $93 for an X-ray to $396 for a CAT scan, and up to $1000 for a positron emission tomograph (PET) scan.
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  • Mar 28 2016 at 11:45 PM
  • Updated Mar 28 2016 at 11:45 PM

Health system will be pushed past breaking point, states warn

Private health insurance will cost even more and the public health system will be pushed past breaking point unless some of the $57 billion in cuts to public hospitals inflicted on the states in the 2014 federal budget are reversed, South Australia has warned.
With federal and state leaders and Treasurers to meet on Thursday night and Friday this week in what could be the last such gathering before a federal election, the SA government will release on Tuesday a study by EY modelling the impact of the cuts if they go ahead over the next decade without redress.
Prime Minister Malcolm Turnbull, who spent Monday at home in Sydney discussing the health funding issue and other budget matters with Treasurer Scott Morrisons, has been willing to negotiate extra money for hospitals if only to neutralise it as an election issue.
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Child dental scheme a 'success' despite government's failure to promote it

Date March 29, 2016 - 4:45PM

Julie Power

Bad brushing habits, more access to sugary snacks and bottled water has caused a gradual rise in the number of children's teeth affected by decay.
A federal government program that has provided free dental care to one million children and which Health Minister Ley indicated could be dramatically overhauled, has been judged a success in a review by Ms Ley's own department.
Headed by the country's top medical officer, the review team's report said it was "pleased" that the two-year old scheme, the Child Dental Benefits Schedule, had provided free dental care to children "at an age when preventive measures can be most effective." 
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COAG: Radical tax plan to fix hospitals

  • Business Spectator
  • March 30, 2016 12:00AM

David Uren

Sarah Martin

Malcolm Turnbull is proposing only a short-term fix to the states’ hospital funding crisis with a four-year deal to 2020.
States are divided on a radical tax plan to levy their own income taxes to secure hospital funding as premiers warn they want the federal government to foot the bill for their long-term health needs.
Malcolm Turnbull is proposing only a short-term fix to the states’ hospital funding crisis with a four-year deal to 2020, but has suggested states would be allowed to levy their own income tax surcharge beyond that to cover health and education costs.
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A $5 billion patch won’t fix hospitals

Date March 30, 2016 - 12:15AM
EDITORIAL
The archive of statements issued after meetings of the Council of Australian Governments (COAG) reads like an endless trail of disappointments. Many worthy and urgent issues are discussed at these regular meetings of state and federal leaders, topics are duly noted and scheduled to be raised again, but too often the most earnest of plans are deferred to the never-never.
Another COAG meeting looms for later this week. The context and timing of this one is important. Budget preparations are under way and, depending on how the Senate votes on bills designed to reinstate a watchdog for the construction sector, a double-dissolution election might be held in little more than three months.
This COAG meeting is especially important, though, for the health sector. Two years ago, in its poorly conceived, slash-and-burn budget, the Abbott government removed funding guarantees for hospitals and changed the indexation on funding increases for hospitals.
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Health: It’s time to change when care and cash collide

  • The Australian
  • March 30, 2016 12:00AM

Michael Owen

Senior health adviser John Maddison says health costs are growing faster than income in South Australia and the state’s 30-year-old health infrastructure needs to be more efficient.
The divisional medical director, a member of a ministerial ­advisory group for the state Labor government’s controversial health reform plan, Transforming Health, knows first-hand the scope of the problem facing state-based health networks across the country.
“What we’re trying to do is to ensure that people get the same good health outcomes no matter where they end up in the health system and there’s clear evidence that that’s not the case now in hospitals around Adelaide,” Dr Maddison said yesterday.
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Government to trial 'Health Care Homes' for chronic illness sufferers

Tom Iggulden reported this story on Thursday, March 31, 2016 06:05:00
KIM LANDERS: A Federal Government plan to provide better care for people with chronic illnesses is being cautiously welcomed by consumer health groups.
The $20 million trial of what will be called "Health Care Homes" will help GPs tailor care for their patients.
Political reporter Tom Iggulden has more from Canberra.
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Plan revealed to revolutionise healthcare

March 31, 20167:10am
authorBlockSingleThe Federal Government today is promising to revolutionise care offered to the more than four million Australians with multiple chronic diseases.
It is billing the package as one of the biggest reforms in Medicare’s 30-year history with the aim of keeping sufferers out of hospital and leading happier, healthier lives.
It could also ease the pressure on the public hospital system. Half of all potentially avoidable hospital admissions in 2013-14 were to treat chronic conditions. That is one every two to three minutes.
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Coalition's healthcare plan has pros and cons, say medical experts

Federal government’s ‘healthcare homes’ scheme gets a tick for better coordinated handling of the chronically ill but a fail on funding details
The federal health minister, Sussan Ley, announced the government’s plans for ‘healthcare homes’ on Thursday. Photograph: Mick Tsikas/AAP
Medical experts have welcomed federal government plans to trial better coordinated healthcare for people suffering multiple chronic illnesses, but have questioned funding levels and when the program will be rolled out nationally.
On Thursday the health minister, Sussan Ley, announced a plan for “healthcare homes” – primary healthcare centres or GPs – to coordinate tailored care packages for patients with multiple chronic conditions. The cost of health services would be bundled into regular quarterly payments rather than patients paying on each visit.
The plan also proposes more data collection and use of digital health records to measure patients’ progress and share information between doctors.
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COAG and hospitals: Look beyond the funding to fix our health system

Opinion
Before Malcolm Turnbull and the states start haggling over hospital funding, it's worth looking at why the system costs so much to run. Maybe it's not just cash, but waste and inefficiencies that need addressing, writes Mike Steketee.
Why do our hospitals cost so much to run? Like $55 billion a year and rising rapidly?
It is the question worth asking before Malcolm Turnbull and the premiers start haggling at today's COAG meeting over how best to pour more money into hospitals. Yes we are an ageing population and the health system is devising ever more clever ways to treat us.
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Health Insurance Issues.

April 1 premium rises prompt half a million angry Aussies to quit health insurance

March 28, 20168:00am
Sue Dunlevy News Corp Australia Network
EXCLUSIVE
A PREMIUM rise three times the inflation rate has unleashed consumer rage on health funds with more than half a million people planning to quit their cover.
Premiums will rise by around $200 a year for a family and around $100 a year for singles on April 1.
And almost half of all health fund members plan to shop around to find a better deal a Galaxy poll commissioned by health fund iSelect has found.
More than 530,000 Australians told the survey they planned to ditch their insurance altogether, a move that could increase pressure on public hospitals.
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Half a million angry Australians are going to quit their private health insurance funds

A premium rise, signed off by Health Minister Sussan Ley, of three times the inflation rate will likely result in around 500,000 Australians giving up their private health insurance.
A Galaxy poll commissioned by iSelect has found that more than 530,000 Australians are planning to ditch their health cover, which could put a huge increase of pressure onto public hospitals.
On April 1, premiums will rise by around $100 for singles and $200 a year for families, pushing members to either shop around or drop their cover entirely.
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530,000 Australians to dump private health insurance when premiums jump $200 on April 1 

  • Up to 530,000 Australians expected to ditch private health insurance
  • Premiums are increasing an average $200 for families from next month
  • 71 per cent of those covered will 'take action' when prices go up on 1 April 
  • Almost 500,000 people dropped or changed cover last year
  • Analysts say many people are 'confused' by law around waiting periods 
  • The Private Health Insurance industry is worth more than $20 billion 
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  • Mar 29 2016 at 11:22 AM

From banking to insurance - Craig Drummond's challenges at Medibank

You could be forgiven for thinking Craig Drummond likes regulated industries considering he has jumped from the highly regulated National Australia Bank to the even more highly regulated Medibank Private.
Drummond was well versed in dealing with regulators while head of finance and strategy at NAB. His day-to-day job involved regular contact with the Australian Prudential Regulation Authority, the prudential supervisor for Australian banks.
Also, he was very familiar with the Financial Conduct Authority in the UK thanks to his handling of the sale of NAB's UK operation, Clydesdale. That sale was only allowed to go ahead after NAB agreed to put aside £986 million ($1.86 billion) in provisions to cover the potential cost of Clydesdale's mis-selling of payment protection insurance, fixed rate tailored business loans and interest rate hedging facilities.
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Why the actual hit on health insurance premiums is so much higher

  • The Australian
  • March 30, 2016 12:00AM

Andrew White

The headline figures say health insurance premiums will rise 5.59 per cent from Friday. But thousands of Australians have already been told their premiums are rising by twice that and more.
The average figure is only that: a guide to across-the-board increases, leaving funds on the defensive as they are questioned by customers whose policies now cost more than $5000 a year.
Average premium rises are nearly three times higher than wages growth of just 2 per cent in 2015, leaving some, including incoming Medibank Private chief executive Craig Drummond, to describe runaway healthcare costs as not “fully sustainable’’.
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Not-for-profit health funds ride popularity

  • The Australian
  • March 30, 2016 12:00AM

Sarah-Jane Tasker

Not-for-profit health insurers are increasing market share with customers turning away from big companies as annual premiums rise.
Members Own Health Funds, which represents 15 not-for-profit and mutual private health insurance funds, attracted 34.7 per cent of net industry growth in 2015, against a market share of 20.7 per cent.
The industry body said independent research conducted last month also showed that while overall industry growth in the private health insurance market slowed by 12.9 per cent from 2014 to 2015, MOHF’s growth increased by 24.9 per cent.
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Private health insurance ‘propping up public system’

  • The Australian
  • March 31, 2016 12:00AM

Sarah-Jane Tasker

Private health insurers have warned that the federal government’s funding battle with the states must address the increasing cost shift from public hospitals to the private sector, arguing it could reduce premiums.
The health insurance industry highlighted that there had been a substantial rise in benefits paid to public hospitals to cover private patients, with the figure hitting more than $1 billion in the past year.
In the 2014-2015 financial year, on top of that figure, private patients also brought into the public system an estimated $173.7 million in prostheses payments and $467m in medical fees.
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2 Apr 2016 - 4:40pm

Australians dropping private health cover as value for money questioned

There's growing anger and confusion over whether Australia's private health insurance industry is providing their customers value for money.
2 Apr 2016 - 4:40 PM 
Around the country, Australians are getting unwelcome news in the mail. From April 1, health insurance premiums have gone up by about $200 a year for a family and around $100 a year for singles.
The average annual cost to a family is about $4,000. The average premium is going up 5.6 per cent, or $200.
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Pharmacy Issues.

A matter of trial and error

Profession waits for more information on professional service future

Community pharmacists are waiting for further news on the timeline for the first tranche of 6CPA professional service trial programs.
Federal Minister for Health Sussan Ley announced at APP 2016 earlier this month the first three trials to be funded out of the $50 6CPA Pharmacy Trial Program.
However there is not, as yet, a timeline for the trials launch, duration, assessment or implementation.
The first three trials are:
  • Improved medication management for Aboriginal and Torres Strait Islanders through pharmacist advice and culturally appropriate services;
  • Pharmacy based screening and referral for diabetes; and
  • Improved continuity in the management of patients’ medications when they are discharged from hospital.
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Health is also clearly still under review as far as its budget is concerned with still a few reviews underway and some changes in key strategic directions. Lots to keep up with here with all the various pre-budget kites still being flown - although narrowing it seems to be largely focussed on Super! Enjoy. Only a month to the Budget.
David.
Baca selengkapnya

Wednesday, 6 April 2016

What is more important in healthcare, computers, or nurses and other human beings?  Southcoast Health cutting dozens of jobs on heels of expensive IT upgrade

What is more important in healthcare, computers, or nurses and other human beings? Southcoast Health cutting dozens of jobs on heels of expensive IT upgrade

That I even have to ask the question on the title of this post is a tragedy and a scandal.

I've written a number of posts on this blog about hospitals laying off staff and even put in financial jeopardy due to EHR implementation, e.g., my June 2, 2014 post "In Fixing Those 9,553 EHR "Issues", Southern Arizona’s Largest Health Network is $28.5 Million In The Red" at http://hcrenewal.blogspot.com/2014/06/in-fixing-those-9553-ehr-issues.html and numerous others indexed under "healthcare IT costs" at query link http://hcrenewal.blogspot.com/search/label/healthcare%20IT%20cost

This often occurs due to poor project planning, overconfidence, underestimation of complexity and even incompetence, that drives up electronic records system costs way over estimates. 

It's happened again:


Southcoast Health cutting dozens of jobs on heels of expensive IT upgrade
Mar 30, 2016, 11:25am EDT
Updated Mar 30, 2016, 11:31am EDT
http://www.bizjournals.com/boston/blog/health-care/2016/03/southcoast-health-cutting-dozens-of-jobs-on-heels.html

Stung by losses linked to costly technology upgrades, Southcoast Health is laying off 95 employees just a year after finalizing a similar staffing cut.

The cuts represent 1 percent of Southcoast’s 7,251 workforce, and will happen across the care provider's three hospitals in Fall River, Wareham and New Bedford. All levels of hospital staff will be affected, officials said.

Southcoast employees were notified of the cut Wednesday morning. The cuts come as the hospital negotiates a merger with Care New England, a four-hospital system in Rhode Island.

The care provider said the cuts stemmed from training costs associated with the installation of a $100 million records system, known as Epic. Similar operating challenges have been reported by other Massachusetts care providers in the midst of Epic upgrades and installations.

I note that $100 million can purchase an entire new hospital wing or facility.

Training costs, of all things, should have been factored into the original project plans.  It's not as if this issue is an unknown in an industry and product extant for several decades now.

Also, IMO the word "challenges" should be altered to "challenged" to describe the institutional geniuses responsible for debacles like this.

Training costs for the system, which went live in October, contributed to a $9.9 million operating loss in the first quarter of fiscal 2016, which ended Dec. 31. Hospital executives said similar expenses have impacted the bottom line in the current quarter, which ends Thursday.

So, training costs for the EHR devoured profits from an increasing revenue stream as below, plus consumed enough to leave a near $10 million loss. Stunning.

“These financial challenges are attributable to higher-than-budgeted operating expenses, largely a result of our Epic implementation,” said Southcoast president and CEO Keith Hovan, in a letter to employees. “During the first two quarters of this fiscal year, revenue has grown positively at a rate of 4 percent – a significant accomplishment, particularly given the lack of a flu season. However, expenses have grown at 6 percent during that time, which is an untenable variance that must be corrected.”

I note that the hospital system might have realized their cost underestimations via reading the literature a bit, including but not limited to my completely free academic site at http://cci.drexel.edu/faculty/ssilverstein/cases (in existence in various flavors since 1998), and this very blog.

Hovan went on to ask employees for recommendations to reduce costs, going so far as to tell employees to reach out to him directly.

How about reducing IT expenditure and laying off IT personnel responsible for the cost underestimates?  Costing is supposed to be a core competence of management information systems (MIS) personnel in those IT departments.

... Approximately 70 people were let go in October 2014, and another 35 were let go in January 2015.

The hospital still has 339 job openings for a number of clinical roles. Cohenno wouldn’t detail what kinds of jobs the hospital was eliminating, but said employees affected by today’s layoffs will be encouraged to apply to open positions.

Some consolation for being fired to maintain the good health of a computer.

The solution to this problem is for hospital executives to actually learn more about what they're getting into in HIT acquisition, implementation and operation, instead of simply believing the marketing hype coming from the HIT industry and its cybernetic hyper-enthusiasts.

That means reading far more than typical industry marketing BS, a.k.a. performing robust due diligence.

-- SS
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Thursday, 31 March 2016

What You See Is Not What You Get - Purdue Pharma Executives Pleaded Guilty, but the Oxycontin Billionaires Went Unnoticed

What you see if often not what you get.  

Nine years ago, three top executives of Purdue Pharma pleaded guilty to criminal charges of "misbranding" Oxycontin.  The case appeared to be a landmark.  In previous years, top executives of large health care corporations rarely faced legal consequences when their companies misbehaved.  Yet in the Purdue Pharma/ Oxycontin case, things were not what they seemed.  Maybe that is why this case never did yield a new era of accountability for top corporate health care leaders.

Background - the Oxycontin Guilty Pleas

In 2007, we posted about the executives' guilty pleas.  Relying on the New York Times coverage, we noted that the Department of Justice charged that the company used aggressive, deceptive marketing, including claims that Oxycontin had little potential for addiction, even though they then knew otherwise.  Unlike many other settlements, the executives and the company admitted their dishonesty, although they were not apparently charged with fraud.

In a statement, the company said: 'Nearly six years and longer ago, some employees made, or told other employees to make, certain statements about OxyContin to some health care professionals that were inconsistent with the F.D.A.-approved prescribing information for OxyContin and the express warnings it contained about risks associated with the medicine. The statements also violated written company policies requiring adherence to the prescribing information.'

'We accept responsibility for those past misstatements and regret that they were made,' the statement said.
While no executives went to jail, the three who pleaded guilty,

Michael Friedman, the company’s president, who agreed to pay $19 million in fines; Howard R. Udell, its top lawyer, who agreed to pay $8 million; and Dr. Paul D. Goldenheim, its former medical director, who agreed to pay $7.5 million.

appeared to be the top leaders of the company.  So, at the time I concluded,
At least in the Purdue Pharma/ Oxycontin case top company leaders were prosecuted, pleaded guilty, and will personally have to pay substantial financial penalties. Maybe this will convince the leaders of health care organizations that deceptive marketing practices may not be in their long term interests. Up to now, it may have been too easy to be swayed by the enormous profits deceptive marketing can bring, and regard fines paid by the company as just a cost of doing business.
No Lasting Effects

I was much too optimistic.  Alas, we have since documented numerous legal settlements, and other cases of at least alleged bribery, kickbacks, or fraud, in which the top organizational leaders who authorized or directed the questionable conduct never suffered any consequences for their actions.  That is, they demonstrated impunity.

Meanwhile, Purdue Pharma has been in the news since 2007, and not in a good way.  In particular, we noted that the company seemed to keep up manipulative, if not deceptive marketing efforts on behalf of its narcotic product.  In 2010, Canadian medical students protested that their "education" about narcotics and pain management was influenced by Purdue marketing (look here).   In 2012, we noted that a leading "key opinion leader" who had a key role promoting the liberalized, if not reckless use of narcotics to treat all sorts of chronic pain, and had financial relationships with numerous narcotic pharmaceutical manufacturers, including Purdue Phrama, later admitted that it was all "misinformation."  Yet this aggressive promotion of narcotics was likely a major factor in the ongoing narcotic epidemic which has killed thousands in the US.  And in January, 2016 we described how opposition to new CDC guidelines that suggested much more conservative use of narcotics seemed to be funded, if not orchestrated by narcotic pharmaceutical manufacturers, notably including Purdue Pharma.  Finally, there have been many other stories about Purdue Pharma about which we failed to post.

One would think, however, that a company that admitted to a crime, and whose three top executives lost their jobs and also pleaded guilty to crimes, would at least change its ways, even if these guilty pleas and admissions did not inspire more attempts to hold top corporate health care leaders accountable.

An Assumption about Unaccountable Hired Mangers

But it turns out that some obvious assumptions that I and probably many other people made about the Purdue Pharma cases of 2007 were wrong.  I implicitly assumed when I wrote my 2007 post that the three Purdue Pharma executives who pleaded guilty were the top leaders of the company.

Furthermore, as we have discussed elsewhere, the top executives of large, for-profit publicly held corporations, like most pharmaceutical companies, have become largely unaccountable.  They may seem to exist in a bubble, in which they are hailed as visionaries, and paid exceedingly well no matter how their organizations perform.  (Look here).  However, many top hired corporate managers have mainly become "value extractors."

These executives are nominally accountable to their corporate boards of directors, which are supposed to represent the owners of the companies.  However, most large pharmaceutical companies have numerous stockholders, who have no easy avenue to organize.  Many of their stockholders, in turn, are mutual funds, retirement funds, etc whose shares in turn are owned by thousands more.  These numerous, dispersed "owners" have little influence on corporate boards, who often functionally are dominated by cronies of the top management.

So when the three top Purdue executives pleaded guilty, at least it looked like in this case the unaccountable hired executives had been made accountable, if not to their boards of directors, at least to the courts.

But Who Owned Purdue?

But what you see is not always what you get.  There was a hint buried in the NY Times article,

Between 1995 and 2001, OxyContin brought in $2.8 billion in revenue for Purdue Pharma, a closely held company based in Stamford, Conn. At one point, the drug accounted for 90 percent of the company’s sales.

As part of the plea agreement, Purdue Frederick, a holding company for Purdue Pharma that is also closely held, pleaded guilty to a felony charge of misbranding OxyContin.

The article did not further discuss the meaning and implications of the twice used phrase, "closely held."  I confess I missed it entirely.  However, it seems to have meant that rather than being a public corporation with numerous, dispersed stockholders, the owners of Purdue Pharma and its parent were a smaller group, perhaps a group who should have been accountable for the actions of their executives.  However, the NY Times did not further describe this group.  Neither did reports in other outlets, such as the Wall Street Journal, CBS, or Time. Nor did a variety of other news stories that mentioned Purdue Pharma through 2010.

The Oxycontin Billionaires

There were a fewother clues available in 2007, but would have not been easily found at that time.  After the case's resolution was disclosed, an article appeared in the Corporate Crime Reporter (but was presumably only available at that time by subscription.)

Purdue is a privately held, very secretive company based in Stamford, Connecticut.

It’s controlled by the Arthur Sackler family. Arthur Sackler is the guy who, before he delivered OxyContin, brought to you the marketing for Librium and Valium. Walk on the mall in Washington and you walk by the Freer Gallery of Art and Arthur Sackler Gallery.

Art brought to you by Oxy.

New York Times correspondent Barry Meier is probably the most plugged in journalist on the topic. A couple of years ago, he wrote a book detailing the problem titled Pain Killer: A 'Wonder' Drug’s Trail of Addiction and Death (Rodale Books, 2004.)

So apparently Purdue Pharma and Purdue Frederick were privately held, the Sackler family held a controlling interest, and the Sackler family were rich enough to have their name attached to an art museum.

The relationship between the Sackler family and Purdue got no other attention I could find until 2010.  In March of that year, another member of the family, Dr Mortimer D Sackler died, and his NY Times obituary led off with evidence of his wealth, and philanthropy,

Mortimer D. Sackler, a psychiatrist who was a co-owner of the pharmaceutical company Purdue Pharma, makers of the controversial painkiller OxyContin, and whose lavish gifts to the Guggenheim Museum, the Metropolitan Museum of Art and Columbia University made him one of New York City’s most prominent benefactors, died March 24 in Gstaad, Switzerland. He was 93 and had homes in London, Gstaad and Antibes, France.

The obituary also provided evidence of a direct relationship among the Sacklers, Purdue, and the development of Oxycontin.

The Sackler brothers were all doctors, and all businessmen as well. In 1952, while the three were working at the Creedmoor state psychiatric hospital, Arthur financed the purchase of a small drug manufacturer based in Greenwich Village, the Purdue Frederick Company, which Mortimer and Raymond Sackler ran as co-chairmen and which later became Purdue Pharma, now based in Stamford, Conn.

Then,

by the mid-1990s Purdue Pharma was still a small drug company. But with a new product, OxyContin, a powerful, long-acting, narcotic painkiller, the company hoped to join the ranks of industry giants. Indeed, by 2001 sales of the drug had reached nearly $3 billion and accounted for 80 percent of Purdue Pharma’s revenue.

An obituary in the London Telegraph quantitated the wealth that the Sacklers obtained from Purdue a bit more,

The lavish scale of Sackler's generosity was indicated in The Sunday Times's "Rich List" for 2008, which noted that while he and his family owned a £500 million stake in the pharmaceutical business, Purdue Pharma, huge charitable contributions had cut their wealth to £300 million. Yet few knew much about the Sacklers apart from their association with the cultural institutions that bear their name.

However, I could find no echos of this story beyond these obituaries, and certainly none that prominently made their way into the health care world.  In late 2011, about ten percent of a long piece by Fortune on Purdue made the Sackler's ownership and wealth clear, but did not discuss the implications.

The story only began to echo a little in 2014.  That year, the prospect of a trial of a civil lawsuit against Purdue filed in the state of Kentucky, one of the most hard hit by the narcotic epidemic, promised to shake things up.  A long Bloomberg story on the lawsuit was the first to suggest that the very wealthy Sackler family might bear some responsibility for how Purdue marketed Oxycontin, and the results on patients' and the public's health. 

Kentucky lawyers plan another first for Purdue: They want to elicit testimony from the company’s board, which is dominated by members of the Sackler family, the wealthy philanthropists who own the company and have until now remained largely untouched by the controversy tied to the blockbuster drug that netted their business billions of dollars.

It underlined the tightness of the ties between the Sackler's and Purdue. The family does not merely own a controlling interest, but dominates the company's governance.

Purdue today is owned through holding companies and family trusts for the benefit of Mortimer and Raymond Sackler’s families, according to Raul Damas, a company spokesman. In all, nine members of the Sackler family are Purdue directors. In January, Raymond Sackler announced the appointment of Chief Executive Officer Mark Timney. None of the Sacklers has been named in the Kentucky suit.

Raymond, who remains on the board, and his children have been the most involved in the family business. His son, Richard, a physician, worked at Purdue for three decades before being named president in 1999. Now retired, he remains a director. A grandson, David Sackler, sits on the board and runs a family investment fund, Summer Road LLC, in New York. Raymond’s other son, Jonathan, is a director, too.

By the way, the Bloomberg article also detailed another point (which had been mentioned in the obituaries and the CNN article). One member of the Sackler family was behind the aggressive, deceptive marketing campaign that sparked so many sales of Oxycontin. In fact, this Sackler brother could be viewed as the father of modern aggressive, deceptive pharmaceutical/ biotechnology/ device corporate marketing.

Raymond and Mortimer ran the company together. Arthur, the oldest, appears to have been primarily an investor and adviser.

Considered the father of modern pharmaceutical marketing, Arthur Sackler created the first medical-journal advertising insert to promote a drug and pushed for hiring sales reps long before they became as common in physicians’ waiting rooms as out-of-date magazines. Purdue used many of Arthur Sackler’s tactics when it introduced OxyContin, a time-released dose of the opioid oxycodone, in 1995.

CNN had gone into a bit more detail on Arthur Sackler's previous work:

Arthur, joined a small advertising agency that specialized in marketing pharmaceuticals. (He also funded his brothers’ purchase of Purdue, according to a 2003 book by New York Times reporter Barry Meier called Pain Killer: A Wonder Drug’s Trail of Addiction and Death.) Arthur was so successful that in 1997 he was one of the first people named to the Medical Advertising Hall of Fame, whose website credits him with helping 'shape pharmaceutical promotion as we know it today.' As early as the 1950s he was experimenting with TV marketing, and according to the entry, Arthur’s scientific knowledge and ability to expand the uses for Valium helped turn it into the first $100 million drug ever. Arthur’s philosophy was to sell drugs by lavishing doctors with fancy junkets, expensive dinners, and lucrative speaking fees, an approach so effective that the entire industry adopted it.

So at least this article credits Dr Arthur Sackler, of Purdue Pharma, with being one of the creators of the web of conflicts of interest that has ensnared many medical professionals in the last decades.  Who knew?

Just to ice this cake, in later 2015, it became apparent that the Sacklers did not merely become wealthy from Purdue profits and Oxycontin sales. They became fabulously wealthy. Forbes listed the Sackler family that year as one of the 20 richest US families, estimating their combined wealth as $14 billion.

The Sackler family, which owns Stamford, Conn.-based Purdue Pharma, flew under the radar when Forbes launched its initial list of wealthiest families in July 2014, but this year they crack the top-20, edging out storied families like the Busches, Mellons and Rockefellers.

How did the Sacklers build the 16th-largest fortune in the country? The short answer: making the most popular and controversial opioid of the 21st century — OxyContin.

Purdue, 100% owned by the Sacklers, has generated estimated sales of more than $35 billion since releasing its time-released, supposedly addiction-proof version of the painkiller oxycodone back in 1995. Its annual revenues are about $3 billion, still mostly from OxyContin. The Sacklers also own separate drug companies that sell to Asia, Latin America, Canada and Europe, together generating similar total sales as Purdue’s operation in the United States.

Forbes estimates that the combined value of the drug operations, as well as accumulated dividends over the years, puts the Sackler family’s net worth at a conservative $14 billion.

Perhaps if the Kentucky lawsuit had gone to trial, these echos would have gotten even louder.

However, in December, 2015, Purdue settled the suit for $24 million, admitting no liability, and keeping the Sackler name out of the limited press coverage (although see this in STAT by Ed Silverman.)

I, for one, only found out about the Sackler / Purdue linkage when STAT published a followup in March, 2015.  It turns out that in the run up to the Kentucky trial, a member of the Sackler family was actually deposed.  This may have been the only direct discussion of the Oxycontin case by a member of the family.

The settlement required the attorney general to 'completely destroy' or return to Purdue all documents it received from the company or from any other party through a subpoena. The attorney general was given 60 days from the Dec. 18 agreement to comply. The agreement also prohibits the attorney general from sharing the documents with any other entity investigating or litigating against Purdue.

The attorney general’s office destroyed millions of pages of documents within the 60-day period, according to spokesman Terry Sebastian.

While the attorney general destroyed the records in its possession, copies of some of those records remain under seal in the Pike County courthouse, including the Sackler deposition.

The STAT article noted that millions of pages of records from other Oxycontin litigation were destroyed or returned to the company as stipulated by previous settlements. This time,

STAT is making a motion to intervene in the settled Kentucky lawsuit. The motion was sent to the Pike Circuit Court Monday via overnight courier.

The motion argues that STAT and the public have a constitutional right to the records that trumps Purdue’s interest in keeping them secret. The motion also states there is a substantial public interest in the case, citing the epidemic of drug addiction and related crime stemming from the abuse of OxyContin in Kentucky and other states. STAT is requesting the court make the documents available immediately.

We will see how this attempt to shine a little light on the long running Oxycontin story goes. I am not optimistic, since this long-running case has vividly shown how those who have the biggest vested interests in keeping our commercialized, overutilizing, over-marketed health care system going can use money and influence to keep it all so anechoic.

Summary

So now we see, dimly, reasons why the penalties handed out to "top" Purdue Pharma executives for the deceptive "misbranding" of a dangerous narcotic failed to end the impunity of top health care leaders.  Those supposed "top men" were not really the top.

Just like in "Raiders of the Lost Ark,"




They were hired managers with fancy titles who worked for a secretive family which owned Purdue Pharma, which was apparently directly involved in the engineering of the aggressive, deceptive, "misbranding" sales campaign which sold so much Oxycontin, which became fabulously wealthy from the ownership of the company, and which managed to conceal their relationship to the company from nearly all prying eyes.  So far, the family seems to either have befuddled or intimidated law enforcement sufficiently to prevent any direct consequences from befalling them.

This case vividly demonstrates, first, how those who have personally gained the most from our current dysfunctional health care system have often brilliantly covered up what they were doing (part of what we have called the anechoic effect).  As long as we do not know where the money goes, and how it is made, we do not know what needs to be done to make things better.  True health care reform requires bright sunlight to be shown on how the health care sausage is made, who makes it, and how they profit from it.  As long as we the people let ourselves stay in the dark, we will continue to endure our woefully overpriced, inaccessible, mediocre quality, and all too often frankly corrupt health care system.  

A piece this long and heavy deserves a musical interlude. Here is a live performance by the Dramatics of "What You See Is What You Get," (if only that were the case here).





 
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Wednesday, 30 March 2016

Medstar Health CEO basically admits EHRs are unnecessary after hackers take out its HIT

Medstar Health CEO basically admits EHRs are unnecessary after hackers take out its HIT

It's corporate spin, of course, but that's the plain meaning of what he says:

http://baltimore.cbslocal.com/2016/03/29/medstar-paralyzed-as-hackers-take-aim-at-another-us-hospital/
For a second day, the region’s second-largest health care system deals with a crippling computer virus. MedStar Health says it is making progress, but WJZ is learning some patients are still feeling the effects.

... Despite the challenges affecting MedStar Health’s IT systems, the quality and safety of our patients remains our highest priority, which has not waned throughout this experience. Fortunately, the core ways in which we deliver patient care cannot be altered, manipulated or harmed by malicious attempts to disrupt the services we provide [that is, by taking down the EHRs -ed.],” Stephen R.T. Evans, MD, executive vice president, Medical Affairs and chief medical officer, MedStar Health. “Our ability to serve our patients and their families depends first and foremost on our caregivers, and their expert knowledge and compassion focused on each patient.”

He likely does not realize just how correct his spin actually is.

-- SS

3/30/2016 Addendum:

This is not the first time for EHR outages at MedStar.

As in my May 16, 2015 post "Another day, another EHR outage: MEDSTAR EHR goes dark for days" at http://hcrenewal.blogspot.com/2015/05/another-day-another-ehr-outage-medstar.html, I cited Politico. 

The doctor's observation I highlighted below is of interest.

4/9/15
http://www.politico.com/morningehealth/0415/morningehealth17818.html

MEDSTAR EHR GOES DARK FOR DAYS: MedStar’s outpatient clinics in the D.C. and Baltimore area lost access to their EHRs Monday and Tuesday when the GE Centricity EHR system crashed. The system went offline for scheduled maintenance on Friday and had come back on Monday when it suffered a “severe” malfunction, according to an email from Medstar management that was shared with Morning eHealth.

“All of a sudden the screens lit up with a giant text warning telling us to log off immediately,” a doctor said. “They kept saying it would be back up in an hour, but when I left work Tuesday night it was still down.”

This doctor told us that the outage was “disruptive and liberating at the same time. I wrote prescriptions on a pad for two days instead of clicking 13 times to send an e-script. And I got to talk to my patients much more than I usually do.

But of course we didn’t have access to any notes or medication history, and that was problematic.” MedStar notified clinicians in the email that any information entered in the EHR after Friday was lost.

-- SS
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