Does separate bargaining mitigate market power?

One supposed attribute of the recent agreement between the Massachusetts Attorney General and Partners Healthcare System is a provision "allowing payers to split Partners into separate contracting entities for up to 10 years."While this is offered as a remedy to PHS' market power, use of this kind of mechanism is by no mean proven.Indeed, when there was a proposed acquisition by Inova Health Systems of Prince William Hospital in northern Virginia,...

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Victory in defeat

You can't have watched the Germany-Algeria match (2-1) without having great admiration for the sprit of the Algerian team.  Even after falling behind 2-0, with virtually no time left in overtime, Algeria scored one goal (at minute 121) and then came very close to scoring another.As in previous matches, goalkeeping was a key.  Here's Raïs M'Bolhi making one of his...

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When disclosure doesn't disclose anything

A short while ago, I displayed a video from Bloomberg TV in which Dr. Michael Stifelman from NYU's Langone Robotic Surgery Center makes a number of assertions about the virtues of surgery conducted with the daVinci robot.  By all accounts, Dr. Stifelman is an excellent surgeon, but his comments were so in tune with those emitted by Intuitive Surgical, the maker of the...

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At Indian Head Farm: We like it here.

People tend to view Massachusetts as an urban state, but there are areas very close to the urban centers that house lovely farms.  On such, which is in its seventh generation of family ownership, is Indian Head Farm in Berlin.  Here's a photo of the opening paragraphs of a recent Edible Boston article.As you can see above, the strawberries are ripe and available...

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Here's how much she welcomes other views

It is useful to compare actions to words.  From the State House News, about the Attorney General's recently filed deal with Partners Healthcare:The same day the deal was filed in court, Deputy Attorney General Chris Barry-Smith sent a copy to legal officials at Beth Israel Deaconess Medical Center, Lahey Health System, Atrius Health and Tufts. “As you should be aware, this investigation and its ultimate resolution are litigation and law enforcement...

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I smell a rat!

A break from health care.One of my favorite architectural features in New York, or indeed anywhere, is a group of three rats crawling up lines into Grand Central Station.  I noticed them decades ago and have often asked friends from the City if they've seen them.  Most have not, even people who have walked by this portion of Lexington Avenue hundreds of times.What's...

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Breaking news: Boston doctor does human subject research without IRB approval

Smallpox pustule gauge -- Edinburgh, Scotland, 1870-1930Today's Massachusetts Moment from the Massachusetts Foundation for the Humanities relates a story from this day in 1721:The English colonists tried to make the New World a haven from smallpox. Boston inspected all incoming ships; if one arrived with smallpox on board, it flew a quarantine flag and remained isolated...

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The news from Milwaukee

In a world of highly variable health care reporting--some good, some fair, and some poor--you might find it unlikely that some of the best work comes from Milwaukee, Wisconsin.  But John Fauber at the Journal Sentinel has the skill to put out consistently excellent work.Here's the latest example, well worth reading, about the estimates that are bandied about by public officials and others concerning the number of people in America who suffer...

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Sock it to 'em, NHS!

Seen on Twitter: The red sock initiative by the NHS hospitals to help avoid falls.  Nice idea.  Good spirit, too, as shown he...

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Oh boy, $3.3 million

From the first paragraph in a report in the Boston Globe: Partners HealthCare System has agreed to pay $3.3 million to cover the cost of the state’s five-year investigation into its market power, and for a court-appointed monitor to scrutinize its actions for the next decade.How does that pittance even justify being put as the lede in the story? And why wasn't it put into some kind of financial context?  Like this:According to its audited...

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Deception, not irony

Mark Graban tells a good story about a union that tries to hide its sponsorship of a political agenda under the guise of patient safety website.  It's the Massachusetts Nurses Association, which is pushing for legislation to set mandatory nurse staffing ratios.Mark gave the following title to his piece: "Irony – When An Advocate for Healthcare 'Transparency' Hides Who They Are."   Wrong heading, Mark.  It's not irony.  It is deception,...

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You gotta give me something to work with!

An un-bylined story in the Boston Globe notes:"Representatives from state Attorney General Martha Coakley’s office and Partners HealthCare System continue to haggle over terms of a final settlement that would allow Partners to acquire South Shore Hospital in Weymouth and at least two other community hospitals while limiting its further expansion and capping its prices for up to a decade."You can almost imagine the conversation:Guys, you gotta give...

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Goal: To make health care safer, more accountable and more human

Please check out this new blog by Richard Corder.  He has delightful observations about many things, beyond the ostensible focus on patient safety.Please post comments and suggestions for him, ok? In his work life, Richard is Assistant Vice President, Business Development for CRICO Strategies where he helps doctors and hospitals throughout the land achieve their commiment in patient safety and quali...

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A challenge from and for Open Notes

A friend is seen by a doctor at a primary care practice that is a participant in the Open Notes experiment, which permits patients to view their doctors' notes, which are posted on the patient portal.He was recently reviewing his PCP's notes, which were written after he was diagnosed with a common ailment, important but not life-threatening.  The doctor said, that he...

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Clearly, on a need-to-know basis only!

A friend received this cost estimate as part of the consent form from the vet when a pet needed a procedure.  I wonder if people will ever get the same, an itemization with high and low estimat...

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Peel me a grape -- Part 2

A colleague was intrigued by Intuitive Surgical's use of a grape to demonstrate the efficacy of its Da Vinci surgical robot:Thank you for bringing this bizarre advertising ploy to our attention.  I found the Youtube video of the robot peeling a grape absolutely agonizing to watch.  As you may have noticed, it was not doing a very good job. It was slow and awkward (ten minutes to peel half a grape??) and stabbed and sliced the poor grape...

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Peel me a grape!

Whenever I promise myself not to write another post about robotic surgery, I see an ad or an interview doubling as an ad so full of misrepresentations that I have to reach out for an antiemetic.Here's the latest, a June 18 piece on Bloomberg TV.  It is shocking because Bloomberg is so careful about accuracy in its news reports.  Of course, the video starts with a...

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Two heists

There are two major unsolved robberies in Boston.  The one that has received the most press attention is the 1990 theft of thirteen masterpieces, including this piece by Rembrandt, from the Isabella Stewart Gardner Museum.  That theft remains unsolved to this day, notwithstanding thousands of hours of detective work.Wikipedia makes an error in its summary of the...

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The AG-Partners deal: A view from a reader

It isn't often that I publish a comment as its own blog post, but this one is so thoughtful and comprehensive that I thought more people should see it.  The topic is the agreement reached by the Massachusetts Attorney General and Partners Healthcare System, one several of us believe to be a way of cementing PHS' market power for years to come.  [I have embedded explanatory links.]There are so many aspects of this deal that are tailored...

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Annie's story

I have a shorthand saying about finding the underlying cause when a clinician is involved in harming a patient: If you can say, "It could have happened to anybody," the cause is not personal.Unfortunately, though, there have been too many stories about nurses being blamed for errors in hospitals when the actual causes were underlying human factors problems or work flow poor designs or other systemic issues.  There are very few stories about...

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New roles and routes on WIHI

Madge Kaplan writes:The next WIHI broadcast — New Roles, New Routes for Managing Populations — will take place on Thursday, June 19, from 2 to 3 PM ET, and I hope you'll tune in.Our guests will include:Trissa Torres, MD, MSPH, FACPM, Senior Vice President, Institute for Healthcare ImprovementD. Clay Ackerly II, MD, MSc, Associate Medical Director, Population...

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Julia's blog

Would you please help encourage one of our thoughtful and committed young doctors?  Julia Meade, one of the residents who attended last week's Telluride Patient Safety Resident Physician Summer Camp, was inspired by the experience to start a blog called The Hospital Docent.  She's posted a couple of entries in the last few days.Would you please take a moment to welcome her to the blogosphere and comment on her posts? Perhaps you might want...

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Negotiating in the Colorado mountains

One of my roles as a faculty member to the Telluride Patient Safety Student and Resident Physician Summer Camps is to conduct a three-hour workshop on principles and strategies of negotiation.  The camps, after all, have a strong focus on the power of effective communication in reducing patient harm.  Negotiations occur all the time in clinical settings--between...

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Learning patient safety in Telluride

It's such a privilege to return as a faculty member to the Telluride Patient Safety Student and Resident Physician Summer Camps, organized by Dr. David Mayer, vice president of quality and safety at MedStar Health. This is a lovely opportunity to meet a few dozen residents and medical students who compete to attend an intensive seminar or quality, safety, transparency, disclosure,...

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Lessons from Hacking Medicine at MIT SDM

Hacking Medicine and the Rx It Offers for Innovation in All Industries MIT SDM Systems Thinking Webinar SeriesDate: June 16, 2014Time: Noon – 1 p.m. EDTFree and open to allRegisterAbout the PresentationIn this webinar, you will learn how to apply the hacking approach to your industry and domain. Based on their experience with MIT Hacking Medicine, MIT's Andrea...

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Full steam ahead at Partners

For those of you in Massachusetts who still think that the deal between the AG and Partners Healthcare System will restrain the growth in this system's market power, check out excerpts from this current job posting from ZurickDavis, a health care executive search firm.  It sure doesn't look like PHS is feeling very constrained about network growth.Partners Community Healthcare, Inc. (PCHI) is seeking a Vice President of Network Development...

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Watch here for backsliding

Look at this comment in a story by WBUR's Martha Bebinger by a spokesperson for the Massachusetts Attorney General--as concern arises about her announced sell-out, er deal, with Partners Healthcare System:Coakley’s spokesman says she is “committed to being transparent and allowing for feedback should a final agreement [with Partners] be reached.”This is the same AG who plastered the airwaves a few weeks ago with this message:In a resolution that...

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Oh, some of them are awake after all

A group of hospitals and a major multispecialty practice has finally woken up to the negative impact the AG-Partners deal will have in the Massachusetts health care market.  Here's the Boston Globe story and a companion from WBUR.The problem, of course, is that these will be viewed as self-serving comments by the competitors of PHS.  More powerful comments would be those that come from the business community (like Associated Industries...

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Considering informed consent

After watching the Michael Skolnik story here at Telluride, the residents and faculty broke into small groups to consider the issues involved in getting proper informed consent from patients who are about to undergo procedures.  Faculty member Kim Oates later reminded the residents, "The consent form doesn't replace the conversation. And the conversation is not a conversation...

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