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How Terrible Health IT (And Other Healthcare Toxic Waste) Gets Pushed on Naïve and Malleable Physicians, Hospital Executives and Governments

Over at "<a href="http://brodyhooked.blogspot.com/">Hooked: Ethics, Medicine, and Pharma</a>", University of Texas Medical Branch at Galveston (UTMB) Institute for the Medical Humanities professor <a href="http://www.utmb.edu/imh/faculty.asp?FacID=53">Howard Brody MD, PhD</a> offers a fascinating piece "<a href="http://brodyhooked.blogspot.com/2010/06/how-does-drug-industry-exert-power.html" style="font-weight: bold;">How Does the Drug Industry Exert Power? An Anthropological Perspective</a>." The piece is based on writings of of <a href="http://www4.uwm.edu/letsci/anthropology/faculty/applbaum.cfm">Kalman Applbaum</a>, of the Department of Anthropology, University of Wisconsin-Milwaukee, and summarizes how the drug industry achieves its aims in today's society. In Prof. Brody's post: <blockquote>... Applbaum begins by teaching us marketing neophytes about "channels." Marketing drugs is highly complicated because there's no direct pipeline from the manufacturer to the end-user. Lots of folks control and manipulate the pathway that delivers the drug eventually to the mouth or body of the patient--most notably the physician who has to write the prescription, but also insurance companies, government regulators, managers of hospital formularies, and numerous other players. The key to selling drugs successfully today is first, to be able to control the channel: "Pharmaceutical manufacturers, like other marketing-driven enterprises, have realized that it is less in the product, the brand or even the patent where their fortunes lie, but in the stream, the marketing channel. Once you control the channel, you can insert any product you like into it, no matter how useless or dangerous." [Such as grossly <a href="http://sydney.edu.au/engineering/it/%7Ehitru/index.php?option=com_content&task=view&id=91&Itemid=146">unfit for purpose</a>, clinically disruptive, <a href="http://www.tinyurl.com/hostileuserexper">mission hostile</a> healthcare IT - ed.] But, if Rule One is control the channel, Rule Two is not to appear obviously to do so. </blockquote> Read the entire post at the above link. The observation that "once you control the channel, you can insert any product you like into it, no matter how useless or dangerous" explains many observations about the healthcare IT industry as well, such as how reports from the U.S. <a href="http://www8.nationalacademies.org/onpinews/newsitem.aspx?RecordID=12572">National Research Council</a> and many others (e.g., <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=2009">here</a>, <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=readinglist">here</a>, and <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/?loc=cases&sloc=firstnet">here</a>) can simply be ignored. In the health IT industry, that "channel" is controlled, right up to the highest levels of numerous governments. Observations such at my April 2010 post "<a href="http://hcrenewal.blogspot.com/2010/04/healthcare-it-corporate-ethics-101.html">Healthcare IT Corporate Ethics 101: A Strategy for Cerner Corporation to Address the HIT Stimulus Plan</a>"; at my post just a few days later on the "disappearance" of materials cited in my above exposé, "<a href="http://hcrenewal.blogspot.com/2010/04/corporate-ethics-101-paper-and-website.html">Cerner - Fuqua School of Business 'Corporate Ethics 101' Paper and Website Disappear</a>"; and at my Jan. 2010 post "<a href="http://hcrenewal.blogspot.com/2010/01/more-on-perversity-in-hit-world.html">More on Perversity in the Healthcare IT World: Is Meditech Employing Sockpuppets?</a>" (where I exposed a likely industry shill through IP forensics), among others, can be placed better into context as components of "controlling the channel" for health IT, and not appearing obvious in doing it. Physicians especially need to re-learn the mantra "Critical thinking always, or your patient's dead" of my late mentor, cardiothoracic surgery pioneer Victor Satinsky MD. Medical schools also should be developing and teaching courses in how the healthcare industries attempt to "control the channel." These issues go far beyond the mere "tension management" issues of forbidding students, residents and attending physicians from accepting coffee cups, lunches, stethoscopes or other gifts of nominal value from the industry. -- SS

How Terrible Health IT (And Other Healthcare Toxic Waste) Gets Pushed on Naïve and Malleable Physicians, Hospital Executives and Governments

Over at " Hooked: Ethics, Medicine, and Pharma ", University of Texas Medical Branch at Galveston ( UTMB) Institute for the Medica...

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Some Dare Call It "Corruption" - the Massachusetts Blue Cross Blue Shield Golden Parachute Scandal Continues

We have discussed many cases of health care organizations' leaders <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">reaping rewards</a> disproportionate to any concept of their performance, and especially to any concept of the effect of their conduct on patients' or the public's health.  Most of these cases have been pretty anechoic, but for some reason, the case of the huge golden parachute given to the outgoing CEO of Massachusetts Blue Cross Blue Shield despite a tenure  marked by financial losses and no particularly brilliant advances in patients' care or outcomes, (see <a href="http://hcrenewal.blogspot.com/2011/03/massachusetts-blue-cross-blue-shield.html">this post</a>) continues to generate responses.  <a href="http://www.tauntongazette.com/opinions/x698043762/OUR-VIEW-Blue-Cross-pricey-board#axzz1GbmtyVjB">One editorial</a> suggested that should the non-profit health insurance company continue to pay so lavishly, it should lose its tax exemption.  <a href="http://www.wbjournal.com/news48593.html">Another</a> noted that the company should start putting its stakeholders, defined as its policy-holders "first and its funding of overly generous compensation packages to board members and outgoing CEOs somewhere far below."  Finally, <a href="http://www.projo.com/opinion/editorials/content/ED_blue11_03-11-11_02MUBQQ_v10.1f424a3.html">an editorial</a> in the local Providence Journal used the "c" word, "corruption," to define the company's and its CEO's behavior. So it should not be surprising that defenders of the company have appeared.  The Boston Globe published <a href="http://www.boston.com/business/healthcare/articles/2011/03/13/its_not_just_pay_that_is_pushing_up_health_care_costs/">an article</a> which featured attempts to minimize the importance of the CEO's golden parachute. Further analysis of the points are in order. Executive Salaries are a Minimal Component of Cost The article quoted an expert who asserted executive salaries are not themselves a big component of cost: <blockquote>The outcry grew big enough to force Blue Cross board members to vote to suspend their own payments and to lead the insurer to make promises to curb excessive payouts to executives. There’s just one problem: Those steps will do little to fix soaring health care costs. 'I have the same outrage,' Stuart H. Altman, a national health policy professor at Brandeis University, said about Blue Cross’s payments. But, 'We need to put executive pay and board salaries in perspective. It is not the major force, or even close to the major force, in driving up health care costs.'</blockquote>My comment is that just because administrative costs are not the largest component of health care costs does not mean they do not drive health care costs. As I have argued before, the biggest problem created by excess compensation for health care organizations' leaders is not the amount of money they get, per se.  The problem is the effect of the perverse incentives created by the money.  One concern is that people paid that much may make decisions that support their pay in the short-term, but damage the organizations' mission in the long-term.  Another is that the sorts of people attracted by the possibility of big pay packages are those least likely to uphold the mission in the first place.  Another is that the huge disparity between the pay of the top leaders and of everybody else is demoralizing for the relatively poorly paid staff who actually must do the work. Finally, it may be worth quoting the former President of Princeton University, just <a href="http://blog.nj.com/njv_kelly_heyboer/2011/03/william_bowen_qa_former_prince.html">interviewed</a> about what academic leadership was like in the days before giant pay packages: <blockquote>I’m not a fan of huge salaries for presidents of academic institutions. These are hard jobs. But people don’t really do them for the money. What kind of message do you really want to convey concerning the nature of the institution and its leadership? I always thought that it was important to convey a message of we’re all in this together. If you as president earn so much more than everyone else, it’s hard to argue that we’re all in this together.</blockquote>Focusing on Executive Compensation Distracts from the Real Issues The final argument in the Boston Globe piece was that huge executive compensation just is a distraction from the real issues: <blockquote>Yet [current Massachusetts Blue Cross Blue Shield CEO Andrew] Dreyfus said he is concerned that the focus on executive and director pay will distract insurers, providers, and policy makers from addressing factors driving health care costs higher. Those factors range from an aging population to increases in obesity to expensive tests, drugs, and treatments that cure diseases and prolong lives. 'If you had a dozen health economists sitting in this room and you asked them what’s driving health care [costs], you know executive and board compensation wouldn’t be at the top of the list,' he said. 'It would be chronic illness and prices of hospitals and doctors and medical advances and discoveries and technology.'</blockquote> That list of the "real" drivers of health care costs sounds very familiar. Wendell Potter's <a href="http://wendellpotter.com/deadlyspin/">Deadly Spin</a>, is an expose of how how insurance and managed care corporations' public relations departments used deception, propaganda, and outright disinformation campaigns to make sure health policy supported the companies' interests. Potter wrote (p.110) about how PR campaigns were designed to distract the public and policy makers from the industry's responsibility for health care dysfunction: <blockquote>Rather than admit responsibility for the failures, insurance executives pointed the finger of blame at their customers, the 'consumers' of health care, and, of course, the providers of care. In introducing the concept of their new silver bullet - consumer driven health care - insurance executives claimed that the 'real drivers of health care costs' (one of my CEO's favorite expressions) were the people who sought care when they really didn't need it and the doctors and hospitals who were all too willing to provide this unnecessary care. Sure, the aging population and expensive new technology were also factors, but the main culprits were people who just didn't realize how expensive health care had become.</blockquote>I color coded the factors listed by the current Blue Cross CEO as the real "drivers" of health care using the same colors with which I coded Mr Potter's list the specific distractors created by insurance company executives to deflect attention from the companies' inability (and probable) disinclination to control costs. So it appears that Andrew Dreyfus is working from the same playbook that Wendell Potter described, down to the "drivers of health care costs" terminology.  Summary The Massachusetts Blue Cross Blue Shield kerfuffle seems to be enlarging into a good case to teach about what health care dysfunction is really all about.  It shows how the leaders of large health care organizations seem to be putting their self-interest ahead of the missions they are supposed to uphold.  Without governance structures that hold them accountable for upholding these missions, they have set up perverse incentives to pay themselves very well regardless of the effects of their actions on patients' or the public's health.  So it appears, as the Providence Journal editorial asserted, that the leadership of health care organizations is increasingly corrupt, at least using the <a href="http://www.transparency.org/news_room/faq/corruption_faq">Transparency International definition of corruption</a>, abuse of entrusted power for private gain.  True health care reform would make leaders of health care organizations accountable for upholding their missions, and for patients' and the public's health.  Leaders of health care organizations ought to get reasonable incentives for improving health, but not incentives so large as to demoralize the people who actually do the work and take care of the patients.  Post Script: More Undisclosed Conflicts of Interest It is obvious why Andrew Dreyfus, the new CEO of Massachusetts Blue Cross Blue Shield might quote the health insurance industry public relations party line about drivers of health care costs that conveniently do not include insurance company practices and executive compensation.  It was not obvious when reading the Boston Globe article why Professor Altman might be susceptible to that party line.  Perhaps his conclusions were only based on his scholarship. However, the Boston Globe article failed to disclose Prof Altman's part-time jobs.  As per <a href="http://www.sec.gov/Archives/edgar/data/882235/000119312510074491/ddef14a.htm">this 2010 proxy statement,</a> he is a member of the board of directors of <a href="http://www.lincare.com/">Lincare</a>, a company that provides respiratory care services, including disease management, and of <a href="http://www.manta.com/c/mmnthrl/aveta-inc">Aveta Inc</a>, a privately held health insurance company.  Prof Altman's total compensation from Lincare in 2009 (per the latest proxy statement available, i.e., that issued in 2010), was over $1.7 million.   Note that corporate directors, as we have discussed previously, have a fiduciary duty to exhibit "unyielding loyalty" to the stockholders of the company and their interests  [Per Monks RAG, Minow N. <a href="http://www.amazon.com/Corporate-Governance-Robert-G-Monks/dp/1405116986">Corporate Governance</a>, 3rd edition. Malden, MA: Blackwell Publishing, 2004. P.200.].  Given Prof Altman's membership in the board of directors of a health insurance company, and his towering compensation as a director of a health care company that may need to maintain good relationships with health care insurers, it would seem that he has multiple financial relationships that could lead to sympathy with the health insurance industry's public relations party line. So it seems that regardless of the intent of the reporter who wrote it, the latest Boston Globe article about the Massachustts Blue Cross Blue Shield CEO golden parachute scandal ended up being an apologia for excess compensation of health care insurance executives that followed the script written years ago by health care insurance corporate public relations. So I need to add another conclusion.  The discussion of health care policy needs to be informed by disclosure of the financial interests of those participating, particularly those participating as experts in the media.   True health care reform would lead to such disclosure.  However, in our currently dysfunctional health care environment, be very skeptical about the interests of "health policy experts" who seem eager to support the powers that be.

Some Dare Call It "Corruption" - the Massachusetts Blue Cross Blue Shield Golden Parachute Scandal Continues

We have discussed many cases of health care organizations' leaders reaping rewards disproportionate to any concept of their performance...

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AMA, Deluded on Health IT, Begs For Doctor Penalty Extension - Not Penalty Termination

The American Medical Association (AMA) has become worse than useless: <blockquote>AMA urges issuance of EMR penalties be delayed <a href="http://library.cqpress.com/cqweekly/login.php?requested=%2Fcqweekly%2Findex.php&PHPSESSID=199il1erbvjc117chl5h4pauo7">Congressional Quarterly</a>'s CQ Weekly (3/14, Zeller) reports that "Congress strongly believes that electronic medical records will bring down the cost of healthcare, so much so that it has passed two laws providing incentives for doctors who upgrade their systems and levying penalties on those who don't." But, the American Medical Association is urging that the penalties be delayed. Notably, the association "says a Government Accountability Office study released in February bolsters its point that the two laws create competing incentives that contradict each other." [Just our <a href="http://www.gallup.com/poll/145238/congress-job-approval-rating-worst-gallup-history.aspx">sub-15%</a> approval rating Congress at work - ed.] The article adds that the Department of Health and Human Services "announced that doctors will face penalties of 1 percent of their Medicare fees if they don't start issuing electronic prescriptions this year," which the AMA says would be a waste because physicians would buy e-prescribing software that they would discard when they install records systems in 2012. [Lest they face other Medicare penalties for non-"meaningful use" of EMR's - ed.] </blockquote> Aside from the Congressional mayhem created by conflicts between e-Prescribing and EMR coercion laws, if the AMA were not completely useless, and truly represented physicians (and patients), they'd be pushing not for a delay in penalties, but for their abolition. This would help return HIT to a sensible voluntary path from the path of irrational exuberance it's now on. -- SS<a name="S2"> </a>

AMA, Deluded on Health IT, Begs For Doctor Penalty Extension - Not Penalty Termination

The American Medical Association (AMA) has become worse than useless: AMA urges issuance of EMR penalties be delayed Congressional Quarterly...

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Why The Overambitious, Cavalier Approaches of the Healthcare IT Industry Are Harmful To Health: Guest Post by Dr. Jon Patrick, U. Sydney

Apparently Holland is now veering away from a national project for health information exchange. From a researcher at Erasmus University Rotterdam: <blockquote style="font-family:arial;"> While failures of IT implementation in the UK and more recently the Cerner implementation in Australia has been dissected by [U. Sydney Professor] Jon Patrick, the Dutch initiative for a national health IT infrastructure for exchanging patient data that would start with a medication record and a summary record is about to be voted down in the upper house (Senate) of the Dutch parliament. It means that the trajectory to get this infrastructure and which lasted thirteen years will grind to a halt. Unfortunately this implementation has been poorly documented in scientific journals (to my knowledge only one paper describing the infrastructure was published in Methods of Information in Medicine).</blockquote> I wrote about the exposé by Prof. Jon Patrick of U. Sydney of poor software engineering practices, poor usability, unreliability, and dangers posed by a commercial health IT product slated for the ED's of the Australian state of <a href="http://en.wikipedia.org/wiki/New_South_Wales">New South Wales</a> (NSW) at my Mar. 5, 2011 post "<a href="http://hcrenewal.blogspot.com/2011/03/on-emr-forensic-evaluation-from-down.html">On an EMR Forensic Evaluation by Professor Jon Patrick from Down Under: More Thoughts</a>". Prof. Patrick offers the following additional pithy and highly insightful commentary, reposted here with his permission (emphases mine): <blockquote style="font-family:arial;"><div>Colleagues, Since the publication of my long report on the discontent with and weaknesses of Cerner Firstnet/Millenium in Australia (see <a href="http://www.it.usyd.edu.au/%7Ehitru/index.php?option=com_content&task=view&id=91&Itemid=146" target="_blank">http://www.it.usyd.edu.au/~hitru/index.php?option=com_content&task=view&id=91&Itemid=146</a>) I have been pondering the issue of how we can better define the "EMR" and its functions. I certainly think that the notion of an EMR in terms of current popular discussions in AMIA-WGs [American Medical Informatics Association work groups - ed.] and blogs [such as this one - ed.], government policy and vendor publicity is defined at too high a level of generalisation for analysts to create an adequate specification of it and likewise for the engineers to understand the requirements so that they can build such a system. <div>This position is further justified by the failures to create such systems in the UK, NSW and Victoria (Australia) and the loss of political support in Holland. A counterpoint to this are the successes in New Zealand, Denmark and Scotland with systems of smaller ambition and scale targeted at particular problems. </div> <div>I offer this thesis for deliberation: that large scale enterprise software implementations are an over generalisation of the EMR problem so that their lack of ability to capture local context and their intrinsically weak engineering base demonstrate that the advocates of large scale EMR don't know how to do it, have failed to do it in the past at great cost to various communities, and will continue to fail until they understand and define the task properly and in great detail of what has to be done and how to do it.</div></div></blockquote><div style="font-family:arial;"><div> In other words, the healthcare IT industry itself - starting with its leadership - does not know what it's doing and may itself be ill-suited to purpose, the purpose of facilitating better healthcare. Its overall brute-force, mass-scale, ham-fisted ideologies and approaches cannot succeed except in wasting billions of healthcare dollars. Or, more precisely, transferring that wealth to the IT sector and leaving little to show for it in the health sector. <div>I agree with Prof. Patrick's "thesis." At my own HIT website now at <a href="http://www.ischool.drexel.edu/faculty/ssilverstein/cases/" target="_blank">http://www.ischool.drexel.edu/faculty/ssilverstein/cases/</a> years ago I wrote similar words: </div> <blockquote style="margin-right: 0px;" dir="ltr"> <div> <div style="margin-top: 0px; margin-bottom: 0px;">Healthcare information technology (HIT) holds great promise towards improving healthcare quality, safety and costs ... however, this potential has been largely unrealized. Significant factors impeding HIT achievement have been false assumptions concerning the challenges presented by this still-experimental technology, and underestimations of the expertise essential to achieve the potential benefits of HIT. This often results inclinician-unfriendly HIT design, and HIT leaders and stakeholders operating outside (often far outside) the boundaries of their professional competencies. Until these issues are acknowledged and corrected, HIT efforts will unnecessarily over-utilize precious healthcare resources, will be unlikely to achieve claimed benefits for many years to come, and may actually cause harm.</div></div></blockquote> </div></div>Once again, you heard it here first. I also reiterate, our own "National Program for Health IT in the HHS" needs the same treatment that Prof. Patrick recommends for his own state of NSW, as at my Mar. 8, 2011 post "<a href="http://hcrenewal.blogspot.com/2011/03/future-pathways-for-e-health-in-nsw.html" style="font-family: arial;">The Future Pathways for e-Health in NSW</a>." -- SS

Why The Overambitious, Cavalier Approaches of the Healthcare IT Industry Are Harmful To Health: Guest Post by Dr. Jon Patrick, U. Sydney

Apparently Holland is now veering away from a national project for health information exchange. From a researcher at Erasmus University Rot...

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The Massachusetts Blue Cross Blue Shield CEO's Golden Parachute - "'Have's' Greasing One Another's Pockets"

We have frequently discussed the kind of <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">compensation</a> now frequently given to leaders of health care organizations.  Although often even the most disproportionately outrageous compensation only attracts transient interest, a recent regional story in this genre has really gotten legs. How Big the Golden Parachute? The story was about the severance package given to one Cleve L Killingsworth, the former CEO of not-for-profit health care insurance company <a href="http://hcrenewal.blogspot.com/search/label/Blue%20Cross%20and%20Blue%20Shield%20of%20Massachusetts">Massachusetts Blue Cross Blue Shield</a>.  While first reported as being worth $8.6 million,(1) the estimate of his total severance was soon raised to $11 million.(2) This is a Way to Control Costs? Immediately, that amount was contrasted with the supposed emphasis of the company on controlling costs, and its recent poor performance: <blockquote>Killingsworth’s tenure at Blue Cross, which has nearly 3 million members, was marked by efforts to address skyrocketing medical costs by launching a 'global payment' pilot program, under which health care providers are given an annual budget and incentives to keep patients healthy and out of the hospital. 'Without Cleve’s leadership, we wouldn’t be where we are today in shifting from fee-for-service to global payments,' said senior vice president Jay McQuaide. But the insurer stumbled financially in recent years, recording back-to-back operating losses totaling nearly $215 million in 2009 and 2010 as the economy weakened and state regulators acted to limit premium increases for policies covering small businesses and individuals.(3)</blockquote>Then focus shifted to the company's board of trustees, which lead to recognition of some more striking contrasts. First, some prominent members of the board which approved the huge golden parachute had been vocal supporters of controlling health care costs: <blockquote>Key members of the Blue Cross Blue Shield board that gave the nod to then-CEO Cleve Killingsworth’s controversial $11 million severance have been public advocates for trimming soaring health-care costs — even as they sat on a panel that quietly approved the departing chief’s golden parachute. Greater Boston Chamber of Commerce President Paul Guzzi has crusaded to lower health-care costs in his day job representing the interests of local businesses, many of which struggle under the burden of rising premiums for their employee health plans. 'Advancing payment reform to bring health-care costs under control' is one of the Greater Boston Chamber of Commerce’s top policy agenda items, Guzzi said in a statement in January. Guzzi made $84,463 as the Blue Cross board chairman at the time of the Killingsworth vote. Robert J. Haynes, president of the Massachusetts AFL-CIO who made $72,700 as a Blue Cross board member in 2010, has championed health-care cost reduction for the thousands of union members he represents. 'Unions stand ready to be part of the solution to the health-care cost crisis in which we all find ourselves,' Haynes said in an AFL-CIO statement in January. 'The only way to ensure we are part of the solution is to guarantee that we have a voice and meaningful role in how cost savings are achieved.' Bentley University president Gloria Larson, who earned $76,400 as a Blue Cross board member last year, helped organize a confab of business, labor and political leaders in Ashland in January that addressed rising health-care costs. Those who planned to attend reportedly included two other Blue Cross board members — Haynes and former Suffolk District Attorney Ralph C. Martin II.(4)</blockquote>Why Pay a Non-Profit's Trustees? Also, as the quote above pointed out, it appears that the board members were themselves paid fairly well for a very part-time job, even though in general trustees of not-for-profit organizations serve as unpaid volunteers. However, it was soon revealed the paying board members is common practice for all Massachusetts non-profit health insurance companies.(5) Some Blue Cross board members tried to defuse the issue by minimizing the impact of their pay on the organization's total budget: <blockquote>Robert J. Haynes, president of the Massachusetts AFL-CIO and a critic of excessive corporate pay, was questioned about his role on the board following a State House news conference he held on a union-backed plan aimed at lowering health care costs. He said he would not give up his $72,000 annual payment from Blue Cross until the issue was reviewed by the company, and said the money given to board members does not play a role in rising health care costs. 'The cost of health insurance is not affected very much,' Haynes said. 'It’s about $1 million that board members get paid. On $13 billion in revenue, it’s like pennies a year.' (6)</blockquote>What Should the New CEO Be Paid? However, soon the board felt the need to suddenly stop paying itself.(7) The current Blue Cross CEO noted how little he would be paid: <blockquote>Dreyfus emphasized that he has taken 'rock-bottom-of-the-market' compensation levels -- $800,000 in base pay with the opportunity for $1.6 million in severance – for comparable positions in the insurance industry. 'I will be one of the lowest paid Blue Cross executives in the country,' he said.... (8)</blockquote>Things are tough all over. What is Mr Killingsworth Now Up To? Meanwhile, Mr Killingsworth seems to be weathering the storm. An enterprising reporter attempted to interview him in his house in New York, described as "a sprawling clapboard monstrosity with the charm of an assisted-living facility." However, "Mr Killingsworth was nowhere to be found," and Mrs Killingsworth "slammed the door" on the reporter.  (See picture in cited article.)  (9) Possibly, Mr Killingworth was away tending his other responsibilities, which include serving on the Boards of Directors of <a href="http://investor.travelers.com/phoenix.zhtml?c=177842&p=irol-govBio&ID=165042">The Traveler's Company</a> and <a href="http://www.tiaa-cref.org/public/about/governance/corporate/board-composition/tiaa-overseers/cleve_l_killingsworth.html">TIAA-CREF</a>, and apparently despite their apparently competitive nature, on the boards of the Harvard Medical School and <a href="http://www.bu.edu/trustees/boardoftrustees/members/">Boston University</a>. The Reaction There were plenty of reactions, mostly vigorously unfavorable, to the contrast between the company's non-profit status, supposed commitment to reducing costs, and financial performance, on one hand, and the compensation given to executives, and board members: "undermines the credibility of insurers when they say they're serious about bringing down the cost of care" Deidre Cummings, President of the Massachusetts Public Interest Research Group (3) "If you lose $149 million and then you get paid $11 million for doing it, it is very clear to people where their health-care dollars are going.  And it is not to health care." - Ethan Rome, Health Care for America Now (2) There were also judgments that health care had become the sandbox for wealthy and well-connected insiders, at the expense of everyone else: "What we have here today is yet another enraging story of the 'haves'greasing one another's pockets while the 'have-nots' slip beneath the waves." Margery Egan, columnist for the Boston Herald(10) "Therein lies the problem with boards.  They're supposed to provide oversight, but too often it's the same people tossing money at each other to serve on the boards of each other's companies, the operative word always being 'Yes!'" Brian McGrory, Boston Globe columnist (5) Most pessimistically: "If Massachusetts is the model, then national health care reform is ultimately doomed." Derrick Z Jackson, Boston Globe columnist (11) I am actually now more optimistic.  The coverage of this story really shows that the <a href="http://hcrenewal.blogspot.com/search/label/anechoic%20effect">anechoic effect</a> may be fading .  There is starting to be frank discussion of the role of bad leadership of health care organizations as a cause of health care dysfunction.  If we start to admit these problems, maybe we can figure out solutions. I will add just one opinion to those expressed in these articles.  The clear problem here is again perverse incentives.  The issue with how much this CEO was paid, and how his board members were paid was not mainly the diversion from direct health care of the funds involved.  Instead, the concerns ought to be: what sorts of people do these payments attract?  Are they the sorts of people who will uphold the organization's mission?  Once attracted, what sorts of incentives do the prospects of these payments supply for what sorts of decisions?  Do these sorts of incentives lead to decisions that uphold the mission in the long-term? In this case, these concerns are underlined by the Blue Cross trustees' cavalier attitude to their own pay, and the new CEO's belief that $800,000 a year is "rock-bottom."  I hope that the amount of discussion this case provoked might actually lead to some needed regional changes. More globally, as we have <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">said before</a>, far too often the leaders of not-for-profit health care institutions seem more interested in padding their own bottom lines than upholding the institutions' missions. They often seem entirely unaware of their duty to put those missions ahead of their own self-interest. Like the financial services sector in the era of "greed is good," health care too often seems run by <a href="http://hcrenewal.blogspot.com/2009/12/compensation-madness-insiders-hijacking.html">"insiders hijacking established institutions for their personal benefit."</a> True health care reform would encourage leadership of health care who understand health care and care about its mission, rather than those who see a quick way to make a small fortune. References 1.  Gil G. <a href="http://www.boston.com/business/healthcare/articles/2011/03/02/blue_cross_ceo_got_86m_in_exit_deal/">Former Blue Cross CEO got $8.6m last year</a>.  Boston Globe, March 1, 2011.  2. McConville C. <a href="http://www.bostonherald.com/news/regional/view.bg?articleid=1320386&srvc=rss">Ex-Blue Cross CEO walks away with $11M</a>. Boston Herald, March 2, 2011. 3. Weisman R. <a href="http://www.boston.com/business/healthcare/articles/2011/03/02/blue_cross_ceo_got_86m_in_exit_deal">Blue Cross CEO got $8.6m in exit deal</a>. Boston Globe, March 2, 2011. 4. McConville C, Chabot H. <a href="http://www.bostonherald.com/news/regional/view/2011_0303behind_the_hield_trio_publicly_crusaded_against_rising_health_costs/srvc=home&position=0">Trio publicly crusade against rising health costs: behind the shield</a>. Boston Herald, March 3, 2011. 5. McGrory B. <a href="http://www.boston.com/news/local/massachusetts/articles/2011/03/04/such_healthy_pay_its_sick">Such health pay, it's sick</a>. Boston Globe, March 4, 2011. 6. Levenson M, Weisman R. <a href="http://www.boston.com/lifestyle/health/articles/2011/03/08/2_blue_cross_directors_justify_stipends">2 Blue Cross directors justify stipends</a>. March 8, 2011. 7. Crimaldi L, Dwinnell J. <a href="http://news.bostonherald.com/news/regional/view/2011_0308blue_cross_to_suspend_board_member_pay/srvc=home&position=0">Blue Cross board suspends pay, CEO perks cut</a>. Boston Herald, March 8, 2011. 8. Cheney K. <a href="http://www.enterprisenews.com/business/x2011258314/Amid-outrage-Blue-Cross-chief-fights-to-reclaim-company-s-standing#axzz1GKC5WDrB">Amid outrage, Blue Cross chief fights to 'reclaim' company's standing</a>. Enterprise News, March 10, 2011. 9. Gelzinis P. <a href="http://www.bostonherald.com/news/columnists/view/2011_0311cleves_ny_castle_not_shielded_from_bad_taste">Cleve Killingsworth's New York castle not shielded from bad taste</a>. Boston Herald, March 11, 2011. 10. Egan M. <a href="http://www.bostonherald.com/news/columnists/view.bg?articleid=1320681">You call this health care? - it's nauseating</a>.  Boston Herald, March 3, 2011. 11.  Jackson DZ. <a href="http://www.boston.com/bostonglobe/editorial_opinion/oped/articles/2011/03/05/no_wonder_health_costs_are_so_high">No wonder health costs are so high</a>.  Boston Globe, March 5, 2011.

The Massachusetts Blue Cross Blue Shield CEO's Golden Parachute - "'Have's' Greasing One Another's Pockets"

We have frequently discussed the kind of compensation now frequently given to leaders of health care organizations. Although often even th...

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Finally, Some Upcoming Events to Announce: PharmedOut Conference, Transparency International Summer Course

In our side-bar to the right we have a section for "Upcoming Meetings and Events."  Sadly, it is often empty.  Perhaps as a result of the <a href="http://hcrenewal.blogspot.com/search/label/anechoic%20effect">anechoic effect</a>, there seem to be few talks, workshops, much less symposia, conferences, and courses on the issues we discuss on Health Care Renewal.  However, I am happy to now note two upcoming events of interest. First, and most directly related, is the <a href="http://www.pharmedout.org/2011conference.htm">2011 PharmedOut.org conference</a>, entitled, "Pharma Knows Best? -Managing Medical Knowledge," on 16-17 June, 2011 at Georgetown University in Washington, DC, USA.  PharmedOut.org is dedicated to addressing how pharmaceutical companies seek to influence medical decision making.    My editorial comment is that pharmaceutical companies, and also biotechnology, device, health care information technology, and health insurance companies spend billions on marketing to try to influence health care professionals and patients to use their products just here in the US, and probably hundreds of millions on public relations to try to influence policy-makers in favor of their interests.  The amounts spent to educate health care professionals and the public about these efforts, and particularly about <a href="http://hcrenewal.blogspot.com/search/label/deception">deceptive</a> marketing and PR, <a href="http://hcrenewal.blogspot.com/search/label/stealth%20marketing">stealth marketing </a>and <a href="http://hcrenewal.blogspot.com/search/label/stealth%20health%20policy%20advocacy">stealth advocacy</a> campaigns, etc, is minuscule by comparison.  <a href="http://pharmedout.org/">PharmedOut.org</a> is one of the few organizations trying to address the hype and spin.   Second is the <a href="http://tischool.lt/">Transparency International Summer School on Integrity</a>, to be held in Vilnius, Lithuania, on 11-15 July, to provide "intensive anti-corruption training for future leaders."  Unfortunately for the rest of us, enrollment appears to be restricted to "students, graduates, and young professionals" from the post-communist countries.    My editorial comment is that despite the prevalence and importance of health care corruption, as documented by the <a href="http://www.transparency.org./publications/gcr/download_gcr/download_gcr_2006/">2006 Transparency International Global Corruption report</a> which focused on health care, and of the importance of <a href="http://hcrenewal.blogspot.com/search/label/conflicts%20of%20interest">conflicts of interest</a> as risk factors for corruption, there are very few opportunities to teach and learn about these issues anywhere in the world.  (As I <a href="http://hcrenewal.blogspot.com/2009/12/how-to-give-course-on-corruption-in.html">once noted</a>, I could only find a single course on health care corruption and related issues in any US university.)  <a href="http://www.transparency.org/">Transparency International</a> has a record of efforts made to directly fight corruption, and to teach about related issues.  Would that such courses be available all over the world.

Finally, Some Upcoming Events to Announce: PharmedOut Conference, Transparency International Summer Course

In our side-bar to the right we have a section for "Upcoming Meetings and Events." Sadly, it is often empty. Perhaps as a result...

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Is Microsoft slowly edging towards an "exit stage left" in health IT?

Interesting item seen <a href="http://histalk2.com/2011/03/10/news-31111/">here</a>: <blockquote> From Dabney: “Re: former Sentillion exec departures from Microsoft. Microsoft transferred their 800 Health Solutions Group people into the small-to-medium commercial sector group (Microsoft Business Solutions) last Monday. Peter Neupert and his whole organization have been pushed out of the incubation group in Microsoft Research with the guys who sell Microsoft Axapta ERP and CRM for small commercial customers. That will mark the end of acquisitions and spending of Microsoft on health because they haven’t had any significant sales of Amalga UIS in the past year after already withdrawing Amalga HIS and Amalga RIS/PACS from the market. Microsoft is slowly edging towards an exit stage left in health IT.</blockquote> Why would this not surprise me if true? Because I predicted it. In July 2006, nearly 5 years ago, in my July 2006 post "<a href="http://hcrenewal.blogspot.com/2006/07/bill-have-you-lost-your-mind.html">Bill, Have You Lost Your Mind?</a>" Nobody was listening, just as nobody seems to be listening to my current dire predictions for the National Program for IT in the HHS™ . Wait until 2016... -- SS

Is Microsoft slowly edging towards an "exit stage left" in health IT?

Interesting item seen here : From Dabney : “Re: former Sentillion exec departures from Microsoft. Microsoft transferred their 800 Healt...

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