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New York - Presbyterian Hospital Trustee Advocated Novel Cardiac Procedure - "Reach In, Rip Out Their Heart, and Eat It Before They Die"

The dominant theme of <a href="http://hcrenewal.blogspot.com/">Health Care Renewal</a> has been how problems with the leadership of health care organizations have lead to our current state of health care dysfunction.  We have discussed examples of <a href="http://hcrenewal.blogspot.com/search/label/ill-informed%20management">ill-informed,</a> <a href="http://hcrenewal.blogspot.com/search/label/mission-hostile%20management">mission-hostile</a> leadership rewarded with <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">excess compensation</a>, exhibiting <a href="http://hcrenewal.blogspot.com/search/label/impunity">impunity</a> in the face of alleged misbehavior, and at times descending into <a href="http://hcrenewal.blogspot.com/search/label/health%20care%20corruption">corruption</a>.  The cause of these problems is doubtless multi factorial.  However, one possible cause is that rather than exercise stewardship and hold leadership accountable, those in charge of <a href="http://hcrenewal.blogspot.com/search/label/governance">governance</a> of health care organizations, that is, boards of directors or <a href="http://hcrenewal.blogspot.com/search/label/boards%20of%20trustees">trustees</a>, have instead infected the organizations with the amoral culture now dominant in much of the business world, especially <a href="http://hcrenewal.blogspot.com/search/label/finance">finance</a>.  We have discussed, most recently <a href="http://hcrenewal.blogspot.com/2011/12/they-think-we-are-imbeciles-and-they.html">here</a> and <a href="http://hcrenewal.blogspot.com/2011/10/health-cares-99-percenters.html">here</a>, how the <a href="http://hcrenewal.blogspot.com/search/label/boards%20of%20trustees">boards</a> of health care corporations often include heavy representation of leaders of finance, including many of those who seemed responsible for the global financial collapse, great recession, or whatever we will end up calling it.  I recently stumbled upon a particularly graphic example of the sort of predatory culture that now exists on the boards of health care organizations.  (More on how I did so later.)  Below is an embedded YouTube video of a speech made by a current <a href="http://nyp.org/about/board-trustees.html">Trustee of New York - Presbyterian Hospital</a> (who has been on the board since 2007).  He is Richard Fuld, the former CEO of Lehman Brothers, whose continuing role on the hospital board, despite his failed leadership of one of the financial firms whose bankruptcy ushered in the global financial collapse, we discussed first <a href="http://hcrenewal.blogspot.com/2008/09/failed-masters-of-universe-running.html">here</a>. <iframe allowfullscreen="" frameborder="0" height="315" src="http://www.youtube.com/embed/x93EHs627GI" width="560"></iframe> Just to underline it once more, Mr Fuld, referring to short sellers of his company's stock, said he "what I really want to do is I want to reach in, rip out their heart, and eat it before they die."  Can there be a more stark reminder of what has gone wrong with the governance of health care?  Can anyone watch this video and argue that Mr Fuld ought to be on the board of a hospital system?  Why is he still on the board in January, 2012, when this video was released in October, 2011? While I suspect not many other hospital system board members have been videographed displaying equally brutal sentiments, there are likely others with similarly barbaric tendencies. So, on a more positive note.... The boards of hospitals, hospital systems, medical schools, and their parent universities ought to be populated with people who take their stewardship roles seriously.  They ought to be people who understand, agree with, and support the organizations' mission, and their dedication to patient care and teaching.  They ought to understand what good leadership of health care organizations entail.  Needless to say, they ought to be of good character and above any ethical reproach.  In short, they ought to be the opposite of the sort of person displayed in the video above. It should now be obvious that grievous problems with the leadership and governance of health care organizations are principle causes of the dysfunction in our health care system.  True health care reform will require wholesale changes in health care leadership and governance. PS - In case the video above seems too short on context, see the one below: <iframe allowfullscreen="" frameborder="0" height="315" src="http://www.youtube.com/embed/GZCmWkQuyPc" width="420"></iframe>

New York - Presbyterian Hospital Trustee Advocated Novel Cardiac Procedure - "Reach In, Rip Out Their Heart, and Eat It Before They Die"

The dominant theme of Health Care Renewal has been how problems with the leadership of health care organizations have lead to our current s...

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They Think We are "Imbeciles," and They Run Health Care Organizations

Arrogance seems to fuel many of the problems with health care leadership that we discuss, particularly <a href="http://hcrenewal.blogspot.com/search/label/mission-hostile%20management">hostility to the mission</a>, often driven by self-interest; a sense of entitlement to <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">lavish compensation</a> out of proportion to any measure of performance; and a lack of <a href="http://hcrenewal.blogspot.com/search/label/accountability">accountability</a> shading into <a href="http://hcrenewal.blogspot.com/search/label/impunity">impunity</a>.  Some recent stories hint at some of the origins of such arrogance.  The Occupy Wall Street movement drew attention to the plight of the poor and middle class, who had lost income, retirement benefits, jobs, houses, and access to health care while the richest, especially corporate executives, got richer.  The less fortunate's anger was not directed indiscriminately at the successful or the rich, but those who got wealthy by gaming the system, or flaunting the rules that lesser mortals had to obey.  Perhaps not surprisingly, some of those most vulnerable to such criticism have responded with contempt.  Anonymous or Indirect Defenses of the One Percent The initial defense of the plutocrats came from some of their political supporters, who denounced their "demonization" (see this <a href="http://www.washingtonpost.com/opinions/rich-people-demonized-for-flaunting-their-wealth-are-under-attack/2011/09/28/gIQAcJn4AL_story.html">opinion piece</a> by Barbara Ehrenreich in September, 2011) or decried the rise of "mob rule" (see <a href="http://www.nytimes.com/2011/10/10/opinion/panic-of-the-plutocrats.html">this</a> by Paul Krugman in October).  Then several articles documented the anonymous complaints of finance insiders about: <blockquote>a bunch of whiny people who are lazy and incompetent and have nothing to do with their time</blockquote>from a Reuters <a href="http://www.reuters.com/article/2011/10/11/us-usa-wallstreet-bankers-idUSTRE79A4LF20111011">article</a> in October. <blockquote>a ragtag group looking for sex, drugs and rock 'n' roll</blockquote>from a NY Times <a href="http://www.nytimes.com/2011/10/15/business/in-private-conversation-wall-street-is-more-critical-of-protesters.html">article</a> in October. The Plutocrats Strike Back However, increasingly those in the one percent are willing to be open. In late December a Bloomberg <a href="http://www.businessweek.com/news/2011-12-28/bankers-join-billionaires-to-debunk-imbecile-attack-on-top-1-.html">article</a> documented the sentiments of a number of finance and other corporate leaders. - Jamie Dimon, CEO of JP Morgan Chase, complained: <blockquote>Acting like everyone who's been successful is bad and because you're rich you're bad, I don't understand it.</blockquote> - Bernard Marcus, founder of Home Depot: <blockquote>Who gives a crap about some imbecile? Are you kidding me?</blockquote> - John A Allison IV, Chairman of BB&T: <blockquote>'Instead of an attack on the 1 percent, let’s call it an attack on the very productive,' Allison said. 'This attack is destructive.'</blockquote> - Stephen Schwarzman, CEO of the Blackstone Group: <blockquote>'You have to have skin in the game,' said Schwarzman, 64. 'I’m not saying how much people should do. But we should all be part of the system.'</blockquote> - John Paulson, President of hedge fund Paulson & Co: <blockquote>has also said the rich benefit society. 'The top 1 percent of New Yorkers pay over 40 percent of all income taxes,...'</blockquote> - Tom Galisano, founder of Paychex Inc: <blockquote>If I hear a politician use the term ‘paying your fair share’ one more time, I’m going to vomit</blockquote> - Ken Langone, founder of Home Depot: <blockquote>I am a fat cat, I’m not ashamed</blockquote> Considering how <a href="http://www.nytimes.com/2011/10/10/opinion/panic-of-the-plutocrats.html">Paul Krugman explained </a>the generation of the global financial collapse by <blockquote>people who got rich by peddling complex financial schemes that, far from delivering clear benefits to the American people, helped push us into a crisis whose aftereffects continue to blight the lives of tens of millions of their fellow citizens. Yet they have paid no price. Their institutions were bailed out by taxpayers, with few strings attached. They continue to benefit from explicit and implicit federal guarantees — basically, they’re still in a game of heads they win, tails taxpayers lose. And they benefit from tax loopholes that in many cases have people with multimillion-dollar incomes paying lower rates than middle-class families. </blockquote>Thus the responses by the very rich above only represent some or more arrogance. The Plutocrats as Health Care Leaders One wonders how much this arrogance carried over into health care. We have <a href="http://hcrenewal.blogspot.com/2011/10/health-cares-99-percenters.html">noted previously</a> how the leadership of finance has increasingly overlapped the leadership of health care, and how top executives increasingly seem to identify more with each other than with their employees, customers, or other stakeholders. Therefore, it should be no surprise that all but one of the group above also had or have leadership roles in health care organizations. - Jamie Dimon is on the <a href="http://www.med.nyu.edu/about-us/who-we-are/medical-center-leadership/trustees">board of trustees of the New York University Langone Medical Center</a>.  - Bernard Marcus formerly served as the chair of the <a href="http://www.cdcfoundation.org/who/board">board of the CDC Foundation</a>. - John A Allison IV is a member of the board of visitors of Wake Forest University Baptist Medical Center, per <a href="http://bbt.mediaroom.com/index.php?s=18&item=94">his BB&T Corp official biography</a>. - Stephen Schwarzman's Blackstone Group includes the Blackstone Healthcare Group, which invests in various health care corporations (as of 2010, Nycomed, Gerresheimer, Stiefel Laboratories, and Catalant per <a href="http://www.blackstone.com/cps/rde/xchg/bxcom/hs/news_pressrelease_6354.htm">this press release</a>), and all of whose members serve on one or more boards of directors of health care corporations (per the <a href="http://www.blackstone.com/cps/rde/xchg/bxcom/hs/news_pressrelease_6354.htm">press  release</a>, Arthur Higgins serves on the boards of Zimmer, Eco Labs, and Resverlogix Corp; Lodewijk J R de Vink serves on the <a href="http://www.roche.com/about_roche/management/board_of_directors/board_of_directors-devink.htm">board of Roche</a>; Doug Rogers serves on the <a href="http://www.codevax.com/n/who.html">boards of Codevax</a>, Charles River Laboratories, and Computerized Medical Systems.) - John Paulson is on the <a href="http://www.nyu.edu/about/leadership-university-administration/board-of-trustees.html">board of trustees of New York University</a>, - Kenneth G Langone, is vice chair again of the board of trustees of New York University, and chair of the board of trustees of the NYU Langone Medical Center. I submit that linking their sentiments above to their leadership roles in health care should be highly disconcerting.  Do we want people running medical centers who are proud to be "fat cats?"  Do we want people running medical centers who do not understand why people who have lost income, retirement funds, jobs or their homes might be upset?  Do we want people running health care corporations who do not think the poor and middle-class have any skin in the economic game?   Do we want people running health care foundations who think that those who complain about the current economic situation are "imbeciles?" Summary The problems of health care increasingly seem to be a part of the larger problems with the global political economy.  The problems we have been discussing that affect health care leadership seem to have come out of the culture of what now many are calling the larger plutocracy.  So it now seems that true health care reform will require a larger reform of the political economy.  However, we still need leaders who understand the health care context, uphold health care professionals' values, and put patients first.  We do not need leaders who are ill-informed, incompetent, self-interested, conflicted, or corrupt.  We need governance that is accountable, honest, transparent, ethical, and again puts patients first.

They Think We are "Imbeciles," and They Run Health Care Organizations

Arrogance seems to fuel many of the problems with health care leadership that we discuss, particularly hostility to the mission , often driv...

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IT Malpractice? Yet Another "Glitch" Affecting Thousands of Patients. Of Course, As Always, Patient Care Was "Not Compromised."

At my Nov. 2011 post "<a href="http://hcrenewal.blogspot.com/2011/11/lifespan-rhode-island-yet-another.html">Lifespan (Rhode Island): Yet another health IT glitch affecting thousands - that, of course, caused no patient harm that they know of - yet</a>" I wrote: <blockquote>There's been yet another health IT "glitch" that, of course, caused no patients to be harmed. See other "glitches" <a href="http://hcrenewal.blogspot.com/2011/05/twelve-hour-health-it-glitch-at.html" style="font-weight: bold;">here</a>, <a href="http://hcrenewal.blogspot.com/2011/01/orderless-in-seattle-software-glitch.html" style="font-weight: bold;">here</a>, <a href="http://hcrenewal.blogspot.com/2010/03/will-it-take-luminosity-of-dozen.html" style="font-weight: bold;">here</a> and at other posts which can be found by searching this blog on the banal term 'glitch'.</blockquote><span class=" down" id="formatbar_CreateLink" onmousedown="CheckFormatting(event);FormatbarButton('richeditorframe', this, 8);ButtonMouseDown(this);" onmouseout="ButtonHoverOff(this);" onmouseover="ButtonHoverOn(this);" onmouseup="" style="display: block;" title="Link"> Add another case to the health IT glitch file, under the "do we feel lucky today?" patient risk category.<span class=" down" id="formatbar_CreateLink" onmousedown="CheckFormatting(event);FormatbarButton('richeditorframe', this, 8);ButtonMouseDown(this);" onmouseout="ButtonHoverOff(this);" onmouseover="ButtonHoverOn(this);" onmouseup="" style="display: block;" title="Link"> From the Pittsburgh Post-Gazette (I am quoted): <blockquote><a href="http://www.post-gazette.com/pg/11358/1199140-53-0.stm?cmpid=news.xml" style="font-weight: bold;">Computer outage at UPMC called 'rare'</a> Systemwide disruption potentially dangerous, expert warns Saturday, December 24, 2011 By Jonathan D. Silver, Pittsburgh Post-Gazette UPMC's electronic medical records system for inpatients went offline for more than 14 hours at nearly all its hospitals in the region, marking what the health system called a "rare" outage, but one that it claims did not harm patients.</blockquote> First, as my aforementioned Nov. 2011 post and its contained links point out, these events are not as "rare" as they should be. (The asteroid colliding with Earth that caused the extinction of the dinosaurs - now that's a "rare" event.) Second, as multiple posts on this blog have pointed out, the claims that "no patients were harmed" is both misleading and irrelevant: Such claims of 'massive EHR outage benevolence' are misleading, in that medical errors due to electronic outages might not appear for days or weeks after the outage, depending on what information was corrupted/lost/misindentified/or otherwise mishandled after it is 'backloaded' once the system is up. All it takes is one med lost to cause misery and death. (I can speak about that from unfortunate personal experience. Claims of 'massive EHR outage benevolence' are also irrelevant in that, even if there was no catastrophe directly coincident with the outage, their was greatly elevated risk. Sooner or later, such outages will maim and kill. <blockquote>The outage affected a system designed by Cerner Corp., a global electronic records company, and customized by UPMC that doctors and nurses rely on for communication about patient records, medical orders and prescriptions. It was unavailable from about 8:45 p.m. Thursday to 11 a.m. Friday at almost all of UPMC's hospitals except for Children's and UPMC Hamot in Erie, spokeswoman Wendy Zellner said. "This is rare. This kind of widespread, extensive downtime would be rare," Ms. Zellner said. Doctors and nurses continued to have access to patients' electronic records through backup systems, she said. They also had to resort to using old-fashioned paper records for documentation and orders. "These things happen. They have really well spelled-out procedures for what to do when something goes down," Ms. Zellner said. She acknowledged that doctors and nurses faced some challenges.</blockquote> Faced 'some challenges?' In other words, care was compromised by the outage and the 'challenges' were to avoid medical error (and, of course, to make sure billing was unaffected): <a href="http://www.thefreedictionary.com/compromised" style="font-style: italic;">Compromised</a> - <div class="sds-list" style="font-style: italic;">a. To expose or make liable to danger, suspicion, or disrepute</div><div class="sds-list" style="font-style: italic;">b. To reduce in quality, value, or degree; weaken or lower. </div>Thousands of patients were affected, again reinforcing my point about how IT can and does greatly amplify the risks of paper -- as in my Rhode Island post -- such as errors and confidentiality breaches. I cannot, for example, think of a single instance where thousands of paper records went unavailable simultaneously (unless, that is, someone lost the key to the Medical Records department), were made available to identity thieves en masse, or where thousands of medical orders were scrambled or truncated in a relatively short period of time as in Rhode Island. These amplified risks could wipe out any advantages of EHR's over paper in a microsecond. A partial list of facilities apparently affected in this latest episode of EHR mayhem, from <a href="http://www.upmc.com/HOSPITALSFACILITIES/HOSPITALS/Pages/default.aspx">this list</a>: <blockquote><ul><li><a href="http://www.upmc.com/HospitalsFacilities/Hospitals/Magee/Pages/Home.aspx" target="_blank" title="Visit the Magee-Womens Hospital of UPMC website in a new window.">Magee-Womens Hospital of UPMC</a> </li><li><a href="http://www.upmc.com/HospitalsFacilities/Hospitals/upmcbedfordmemorial/Pages/default.aspx" title="Use this link to visit the UPMC Bedford Memorial website.">UPMC Bedford Memorial</a> </li><li><a href="http://www.upmc.com/HospitalsFacilities/Hospitals/east/Pages/east.aspx" title="Visit the UPMC East website. ">UPMC East</a> </li><li><a href="http://www.upmc.com/HospitalsFacilities/Hospitals/horizon/Pages/default.aspx" title="Use this link to visit the UPMC Horizon website.">UPMC Horizon </a> </li><li><a href="http://www.upmc.com/HospitalsFacilities/Hospitals/mckeesport/Pages/default.aspx" title="Use this link to visit the UPMC McKeesport website.">UPMC McKeesport</a> </li><li><a href="http://www.upmc.com/HospitalsFacilities/Hospitals/Mercy/Pages/default.aspx" title="Use this link to visit the UPMC Mercy website.">UPMC Mercy</a> </li><li><a href="http://www.upmc.com/HospitalsFacilities/Hospitals/upmc-montefiore/Pages/default.aspx" title="Use this link to visit the UPMC Montefiore website.">UPMC Montefiore</a> </li><li><a href="http://www.upmc.com/HospitalsFacilities/Hospitals/Northwest" title="Use this link to visit the UPMC Northwest website.">UPMC Northwest</a> </li><li><a href="http://www.upmc.com/HospitalsFacilities/Hospitals/UPMCPassavant/Pages/passavant.aspx" title="Use this link to visit the UPMC Passavant website.">UPMC Passavant </a> </li><li><a href="http://www.upmc.com/HOSPITALSFACILITIES/HOSPITALS/PRESBYTERIAN/Pages/default.aspx" title="Use this link to visit the UPMC Presbyterian website.">UPMC Presbyterian</a> </li><li><a href="http://www.upmc.com/HospitalsFacilities/Hospitals/Shadyside/Pages/default.aspx" title="Use this link to visit the UPMC Shadyside website.">UPMC Shadyside</a> </li><li><a href="http://www.upmc.com/HospitalsFacilities/Hospitals/stmargaret/Pages/default.aspx" title="Use this link to visit the UPMC St. Margaret website.">UPMC St. Margaret</a> </li><li><a href="http://www.upmc.com/HospitalsFacilities/Hospitals/wpic/Pages/default.aspx" title="Use this link to visit the Western Psychiatric Institute and Clinic website.">Western Psychiatric Institute and Clinic of UPMC</a></li></ul></blockquote> That accounts for several thousand active patients, I am sure. (12/28 Addendum: Bed counts of PA hospitals are <a href="http://www.ahd.com/states/hospital_PA.html">here</a>. Searching on "University of Pittsburgh Medical Center", it can be seen that thousands of beds were indeed involved.) <blockquote>"Whenever people aren't working in their native system and workflow I have to believe that is more cumbersome for the clinicians, but these folks are well-trained in what to do when these things happen."</blockquote> This seems at best an insensitive and perhaps even inhumane bit of P.R. More "cumbersome" for the clinicians? What about the poor patients? How would Ms. Zellner feel, I wonder, if it were her mother, child or significant other on the Operating Room table or having an acute MI when the EHR/CPOE systems went down? <blockquote>Ms. Zellner said UPMC's public relations staff was unaware of the outage until contacted by a reporter.</blockquote> It appears P.R. is not very high on the list for receiving information when a crisis arises. I may have known of the outage before they did. <blockquote>The outage was caused by a "bug" or glitch in software designed by a vendor affiliated with Cerner, Ms. Zellner said. She refused to identify the company. "We're not trying to point fingers at different vendors. It's a database bug, that's all I can tell you."</blockquote> (That is, it's not our fault, it's the fault of the database vendor. Hospitals, I regret to inform you - you are responsible for unapproved medical devices used in your facilities, no matter what the source.) And there's that word "glitch" again, accompanied by the equally banal "bug." <div style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_I5WmFxtz7xMx_bhF3SbRrbCCxpaC8XWJz9sXOCfM8T3XN2iIIW7-qLzHhpbK7TTB5cgMeauukXNEObD-6khVlq4EYm098U-ifHnCkwDhmT8DmCkdz0r9NrBbItcIjfxY8fcFvlMspf_p/s1600/happybug.bmp"><img alt="" border="0" id="BLOGGER_PHOTO_ID_5691264547995216018" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEi_I5WmFxtz7xMx_bhF3SbRrbCCxpaC8XWJz9sXOCfM8T3XN2iIIW7-qLzHhpbK7TTB5cgMeauukXNEObD-6khVlq4EYm098U-ifHnCkwDhmT8DmCkdz0r9NrBbItcIjfxY8fcFvlMspf_p/s320/happybug.bmp" style="cursor: pointer; display: block; height: 94px; margin: 0px auto 10px; text-align: center; width: 76px;" /></a></div><div style="text-align: center;">It's just a "bug." Cute little critter!</div> Me again in the Post-Gazette: <blockquote>Scot M. Silverstein, a doctor and assistant professor Healthcare Informatics at Drexel University in Philadelphia, disagreed with the use of the terms "bug" and "glitch." "What occurred here was a disruptive, potentially dangerous major malfunction of a life-critical enterprise medical device," he said.</blockquote> Somehow, when a clinician makes a mistake, the terms "bug" and "glitch" are never used. In fact, when clinicians fail to meet accepted professional standards of healthcare practice, it is called "malpractice." I think we can all agree that a major near-full-day outage of an enterprise EHR affecting multiple hospitals and thousands of patients does not meet accepted professionals standard of life-critical computing practice. Yet, all this merits is the word "glitch." It seems to me that if patients are harmed by, in reality, what is (on its face) IT malpractice during such events, not only the clinicians affected should be held liable. <blockquote> Ms. Zellner said the problem was not a "crash" of the system because there were alternate methods used to cope that prevented patient care from being compromised.</blockquote> The usual refrain. Let me repeat my definition of "compromised:" <a href="http://www.thefreedictionary.com/compromised" style="font-style: italic;">Compromised</a> - <div class="sds-list" style="font-style: italic;">a. To expose or make liable to danger, suspicion, or disrepute</div><div class="sds-list" style="font-style: italic;">b. To reduce in quality, value, or degree; weaken or lower.</div> A simple question - if extended EHR outages like this never seem to "compromise" care, then why not eliminate health IT entirely and spend the hundreds of millions saved on patient care? <blockquote>"This is not a crash of Cerner either," Ms. Zellner said. "I think a crash is, 'Oh my God, the sky is falling,' nobody can get anything."</blockquote> I leave it to the readers to ascertain the computer expertise levels and reasonableness of what Ms. Zellner thinks a "crash" is. <blockquote>Technicians from UPMC, Cerner and the third company [the 'mystery' database company? - ed.] worked together on-site to identify and fix the problem. Ms. Zellner said she did not know why it took 14 hours to fix and the underlying cause was still unclear. "They know what the problem is and I believe it's been fixed, but we really don't know what triggered it," Ms. Zellner said. "I think the next step would be some actual software upgrades."</blockquote> They "don't know what triggered the 'problem'" - is a proper translation that they have no idea what went wrong? In fact, regarding another Cerner EHR system which was extensively studied (see "A Study of an Enterprise Information System" <a href="http://sydney.edu.au/engineering/it/%7Ehitru/index.php?option=com_content&task=view&id=91&Itemid=146">at this link</a>), Dr. Jon Patrick came to the conclusion that one of the sources of catastrophic failures is poor software engineering that has made the behavior of the studied system "non-deterministic." Further, software upgrades are not protected from incremental changes made by maintenance and customization staff, and may introduce even more instability. A software upgrade without clearly understanding "what triggered the problem" is simply asking for more trouble. (My bet, however, is that they attempt it anyway.) <blockquote>A Cerner representative could not be reached for comment.</blockquote> What's to say? How about this: <blockquote>Dr. Silverstein said based on what he was told about the computer outage, it means that hospital medical staff would have been unable to update patient charts and probably would not have been able to issue any orders through the system during the time it was off line. He also questioned how up-to-date the hospital's redundant records were.</blockquote> Repeating UMPC's statement from the article that appeared after I gave my quotes to the reporters: "Doctors and nurses continued to have access to patients' electronic records through backup systems, [the UPMC spokesperson] said. They also had to resort to using old-fashioned paper records for documentation and orders." My stated fears of disruption and increased risk due to compromised care seem well-grounded. <blockquote> In May, Allegheny General Hospital had to shut its electronic medical records computer system down because of problems with the vendor's hardware. The hospital used backup procedures to continue care for patients, including using paper orders and record-keeping.</blockquote> Wait ... I thought I'd heard these events were "rare." Two in the same city within six months? --------------------------- Truth be told: The primary rule in computing is: <blockquote> Either you are in control of your information systems, or they are in control of you. </blockquote> Clearly the latter was the case here. The following questions arise: <ul><li>Was the software containing the "bug" properly vetted before being used on live patients? This is not just the vendor's obligation.</li><li>If it was not vetted properly, why not? </li><li>Was it an "upgrade" or patch? (If so, the same vetting rules apply.)</li></ul> Further, the soft-selling of these incidents must end. The use of terms such as "bug" and "glitch" must also end. What occurred here, echoing my newspaper quote, was a disruptive, potentially catastrophic major malfunction of a life-critical enterprise medical device. System-wide EHR crashes are not merely ‘glitches’ or ‘bugs.’ They need to be considered, as in medicine itself, as 'never events.' From <a href="http://psnet.ahrq.gov/primer.aspx?primerID=3">AHRQ</a>: <blockquote> The term "Never Event" was first introduced in 2001 by Ken Kizer, MD, former CEO of the National Quality Forum (NQF), in reference to particularly shocking medical errors (such as wrong-site surgery) that should never occur. Over time, the list has been expanded to signify adverse events that are unambiguous (clearly identifiable and measurable), serious (resulting in death or significant disability), and usually preventable.</blockquote> Further, re: "patient care was never compromised." How do they know that? In fact, this is 'spin' and word games on its face. By definition, if CPOE and chart updating was unavailable, patient care was compromised, where "compromised" means "increased levels of risk for error were created, requiring workarounds." Further, as mentioned earlier, harms might not show up for some time. Lost orders, corrupted data, errors of omission or commission transcribing backup paper records into the computer ("backloading"), etc. can take their toll later. Post-outage vigilance is essential, putting even more stress on clinicians that increases likelihood of further error and that they certainly do not need. Clinicians are stressed enough already. Finally: IT personnel have not only deliberately inserted themselves into clinical affairs (e.g, via the HITECH Act of 2009), they have also done so with a stunning arrogance and unproven braggadocio about their systems "<a href="http://hcrenewal.blogspot.com/2010/01/yet-another-service-profession-to-be.html">revolutionizing</a>" medicine (whatever that means). Indeed, they need to accept the medical responsibility and obligations this territorial intrusion entails. On its face, this massive outage was the result of issues that did not meet accepted professional standards of IT practice for life-critical environments. <a href="http://en.wikipedia.org/wiki/Res_ipsa_loquitur">Res ipsa loquitur</a>. Something was not vetted properly, there was a lack of redundancy, the IT personnel were NOT in control of their systems. Just as when physicians don't provide care that meets accepted professional standards of healthcare, this incident and others like it are, by definition, a result of IT malpractice. If patients are harmed, IT personnel and their management (often non-IT C-level officers) involved in this system need to be held accountable. If they can't take the clinical heat (as clinicians do daily since the time they enter medical or nursing school), then they need to get out of the clinical kitchen. -- SS Note: see <a href="http://histalk2.com/2011/12/27/news-122811/">this take</a> on these matters at the HIStalk blog: <blockquote>UPMC’s Cerner systems <a href="http://www.post-gazette.com/pg/11358/1199140-53-0.stm" target="_blank">go down</a> for 14 hours at most campuses last Thursday and Friday, forcing them to go back to paper. The PR person blamed “a database bug,” which makes the <a href="http://www.oracle.com/us/corporate/press/422644">above Oracle press release</a> from this past summer a particularly fun read. Cerner and UPMC have an atypical vendor-customer relationship since they’ve invested big money together in innovation projects and UPMC runs a Cerner implementation business overseas. </blockquote> Now we know who the unnamed "mystery database vendor" is... -- SS Dec. 29, 2011 Addendum: Was UPMC acting as a "proving ground" for some Oracle-Cerner-UPMC experimental health IT technology that resulted in the crash? The claim of being an IT "proving ground" has been made in the past: <blockquote> Pittsburgh Tribune May 2, 2006<a href="http://www.pittsburghlive.com/x/pittsburghtrib/news/s_449506.html" style="font-weight: bold;">UPMC partners with technology provider</a> The University of Pittsburgh Medical Center is taking another step in a quest to commercialize new medical technology. UPMC on Monday signed a three-year deal with health care information technology provider Cerner Corp. to develop and market medicine-related technological advances. Both parties will contribute $10 million in cash, services and intellectual property to the effort. The deal is a smaller version of an April 2005 deal between UPMC and information technology behemoth IBM. As is the case in the IBM deal, UPMC will serve as a built-in proving ground for jointly developed technologies and products, with Cerner marketing the products and UPMC awarded a share of profits.</blockquote> As I wrote at <a href="http://hcrenewal.blogspot.com/2009/04/upmc-pioneers-in-health-it-or-pioneers.html">"Proving Ground for IT Tests On Children: Pioneers in Health IT, or Pioneers in Ignoring the Past?"</a>: "A hospital and patients are not a learning lab for HIT vendors. The appropriate "proving ground" for new medical technology is the controlled clinical trial where participants (in this case, patients and healthcare professionals alike) have freedom of choice whether or not to participate, and a chance to give (or deny) consent after being fully informed of potential risk."This is a fundamental human rights issue. -- SS

IT Malpractice? Yet Another "Glitch" Affecting Thousands of Patients. Of Course, As Always, Patient Care Was "Not Compromised."

At my Nov. 2011 post " Lifespan (Rhode Island): Yet another health IT glitch affecting thousands - that, of course, caused no patie...

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Legal Settlements Have Become So Common that They are Barely News

<a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements">Legal settlements</a> by big health care organizations have become so common that those of less than blockbuster size barely seem to qualify as news.  They have become "dog bites man" stories.  For example, the following stories barely got noticed in the media (presented chronologically). Novartis Settles Price Misrepresentation Suit for $150 Million This story was mentioned as an aside in a a <a href="http://www.businessweek.com/news/2011-09-15/watson-sandoz-pay-145-million-to-settle-drug-price-case.html">news story</a> covering a settlement by Watson Pharmaceuticals in September.  In slightly more detail, it has only appeared <a href="http://www.pharmalot.com/2011/11/novartis-pays-150m-to-settle-pricing-fraud">in PharmaLot</a> in November.  In a very small nutshell, <blockquote>the Sandoz unit of Novartis earlier this week agreed to pay $150 million to settle lawsuits filed by the states of Florida and California, as well as a whistleblower, to settle charges that it deliberately misreported pricing information in order to hike reimbursements from Medicaid.</blockquote> By the way, per <a href="http://freepdfhosting.com/0885cf397f.pdf">the settlement document</a>, the allegations were that Novartis' subsidiary knowingly maintained, set or reported "false, fraudulent, and/or inflated Reported Prices," yet, as is typical of nearly all settlements, the settlement "shall not constitute or be construed as an admission of fault, liability, or unlawful conduct." Roche Settles Off-Label Promotion, Physician Kickback Suit for $20 Million This story was reported briefly in some blogs, including again PharmaLot, and in the most detail <a href="http://www.bizjournals.com/sanfrancisco/blog/biotech/2011/12/genentech-roche-rituxan-whistleblower.html">in the San Francisco Business Times</a>. The basics of it were: <blockquote>Genentech Inc. will pay $20 million to settle a whistleblower lawsuit around off-label marketing of the cancer-fighting drug Rituxan.</blockquote> It only took eight years since a whistle-blower raised the issue: <blockquote>John Underwood, ... was a senior manager of sales development from the start of Genentech’s oncology franchise in 1997. When Underwood filed the suit in July 2003 in U.S. District Court for the Eastern District of Pennsylvania, he was a senior hospital systems specialist for Genentech.</blockquote> This suit is actually of particular interest because it was not just about off-label promotion, <blockquote>Genentech, the suit claimed, retained doctors to act as independent speakers on behalf of Rituxan and its off-label uses, paid kickbacks to doctors that were disguised as consulting payments, 'exerted significant pressure' on sales reps to increase off-label uses of Rituxan, and devised and conducted 'selling skills workshops' for sales reps devoted to non-label uses, What’s more, the suit claimed, Genentech invited doctors to attend “medical education seminars” at 'luxurious locations' and gave financial incentives to sales reps to get doctors who sold the most Rituxan to attend the events.</blockquote> These were serious allegations, involving allegedly direct efforts by the company to subvert physicians' ethics by tying their decisions for individual patients to payments for prescribing specific products whatever the benefits and risks of those products for those patients.  The allegations suggested that "consulting payments" to physicians may be nothing more than disguised bribes, and that the companies making these payments may be quite conscious of this.  Nonetheless, as usual, <blockquote>Genentech, the South San Francisco-based U.S. subsidiary of Swiss drug giant Roche, did not admit wrongdoing....</blockquote> So, as in the famous recent Citigroup case (see <a href="http://hcrenewal.blogspot.com/2011/11/will-citigroup-ruling-challenge-health.html">this post</a>), the settlement obfuscates the crucial question, did the corporation involved commit illegal acts? It seems likely that what they did was in some sense unethical, since they were willing to pay millions not make the matter go away. By the way, one member of the Executive Committee of Genentech at the time these events were allegedly occurring is now the <a href="http://ucsfchancellor.ucsf.edu/leadership/susan-desmond-hellmann-md-mph">Chancellor of the University of California - San Francisco</a> (See our post <a href="http://hcrenewal.blogspot.com/2009/05/bio-tech-u.html">here</a>). Maybe concerned students or faculty might ask her what really went on. CVS Caremark Settles Fraud Suit for about $20 Million As <a href="http://latimesblogs.latimes.com/money_co/2011/12/cvs-caremark-to-pay-20m-to-three-states-over-fraud-allegations.html">reported</a> briefly in the Los Angeles Times, <blockquote>Pharmacy and prescription drug management company CVS Caremark Corp. has agreed to pay nearly $20 million to settle three lawsuits involving allegations that the company defrauded pension systems in three states, including California’s giant pension fund, attorneys said. The whistleblower lawsuits, filed by two former CVS Caremark pharmacists, accused the company of reselling returned drugs, changing prescription orders to make them more expensive and submitting false reports about how long it took to fill prescriptions.</blockquote> Not the least bit surprisingly, the company did not admit liability in the settlement, and had no comment for the Times. Ho, hum, another big company paying millions to make allegations of fraud go away... nothing to see here, so we will just move on. Merck Settles Fraud Suit for $24 Million This story was picked up by AP, so a very brief version of it did appear in a variety of locations. A longer version was <a href="http://bostonglobe.com/business/2011/12/21/merck-pay-overcharging-case/05zJqmztpJGuD3elBs0HkM/story.html">published</a> by the Boston Globe, At this point, it should be no surprise that it took a long time to get to this settlement, eight years in fact, just as in the case above, <blockquote>Merck & Co. has agreed to pay $24 million to the state Medicaid program to settle long-running civil charges that it charged too much for some drugs, in the largest single-case Medicaid fraud settlement in Massachusetts history. The agreement, unveiled yesterday by Attorney General Martha Coakley’s office, closes out a 2003 lawsuit....</blockquote> Again, the allegations were of fraud, <blockquote>Coakley said her office’s Medicaid fraud division wanted to hold accountable drug companies that defraud taxpayers. </blockquote> Again, "hold accountable" did not translate into establish the allegations as true, <blockquote>Ron Rogers, a spokesman at Merck corporate headquarters, said the drug company did not admit liability or wrongdoing in the settlement. He said Merck agreed to resolve the claims to put the matter behind it.</blockquote>Nothing more to see here, so we will move on again. Summary Every month, it seems that<a href="http://hcrenewal.blogspot.com/search/label/legal%20settlements"> more settlements</a> are announced of cases alleging all sorts of wrongdoing by major health care organizations. Very often, the allegations are of wrongdoing that appears serious to the uninitiated. For example, most of the above cases involved allegations of fraud, and one involved allegations of kickbacks, that is, bribes to doctors. Yet, in every one of these cases - - The monetary penalties were barely more than pocket change for the corporations involved. - The payments were made by the organization as a whole, and hence would disadvantage many people who were not involved in and did not benefit from the specific actions alleged. Such de facto victims of the settlement included company shareholders, employees, and probably patients (who may have paid prices raised to pay for settlements), and the public (who may have indirectly paid these higher prices through insurance premiums or taxes.) - The organization did not have to admit any facts, leaving the record foggy, and clouding the chances for any people who might have been hurt by the actions to take legal action. - No people who actually authorized, directed, or implemented the apparent bad behavior suffered any negative consequences. Thus, these settlements, like many others we have discussed, did not appear to be any major deterrent of future bad behavior. These settlements do provide a public, if largely ignored, record that suggests how a miasma of sleazy behavior, if not outright corruption has settled over health care. These settlements do provide the context for many pithy questions that could be asked of health care organizational leaders, if anyone dared to do so. The settlements do suggest a need for wholesale, real health care reform that would make health care leaders accountable for what their organizations do, particularly when these organizations misbehave.

Legal Settlements Have Become So Common that They are Barely News

Legal settlements by big health care organizations have become so common that those of less than blockbuster size barely seem to qualify as...

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More Tales of the Hospital CEO Compensation Bubble

The hospital <a href="http://hcrenewal.blogspot.com/search/label/executive%20compensation">CEO compensation</a> bubble continues to grow. As the year draws to a close, I have found another set of stories about outsized payments to health care executives.  While their repetitive features suggest the magnitude of the issue, they featured some twists on the usual justifications given for large compensation packages. Presented in order of the size of the compensation package..... Maxis Health System, Pennsylvania The Scanton Times-Tribune <a href="http://thetimes-tribune.com/news/marian-community-hospital-to-leave-behind-more-than-19-million-in-liabilities-1.1240913">reported</a>: <blockquote>Mary Theresa Vautrinot, president and CEO of parent company Maxis Health System, earned a little more than $464,000 in salary and other compensation, according to 2010 tax forms filed by the hospital.</blockquote> These days, compensation under a half a million dollars may not seem like all that much, but it should be viewed in context. Maxis Health Systems actually actually owns only one hospital, Marian Community Hospital. In 2010, that hospital, already small, shrunk further, <blockquote>In January 2010, the 70-bed hospital scaled back operations to just 35 beds. For the past six months, Marian Community Hospital has had about 20 inpatients each day.</blockquote> Now it will close: <blockquote>Last Monday, parent company Maxis Health System announced the Carbondale hospital's impending closure, citing ongoing financial pressures and a dwindling patient population</blockquote> $464,000 seems like a lot of money to run a tiny hospital under "ongoing financial pressure" into bankruptcy. This seems like another example of pay for poor performance. Summa Health System, Akron Children's Hospital, Akron General Health System, Ohio In a survey of local hospital CEO compensation, the Akron Beacon-Journal <a href="http://www.ohio.com/news/top-stories/hospitals-disclose-executive-pay-charity-care-1.248669">noted</a>, <blockquote>Children’s President and Chief Executive William Considine received compensation and other benefits totaling $1,560,659 in 2010. Thomas J. Strauss, president and chief executive of Summa Health System, received a total compensation and bonus package worth $1,408,062 last year. For Akron General, 2010 was a year of leadership transition, with a former, interim and current leader all receiving executive pay. Alan J. Bleyer, who retired as the hospital’s leader in 2009, received $677,267 in compensation. Michael Rindler, a national health-care consultant who was interim chief executive and continued in a consulting role through the year, made $983,744. Vincent J. McCorkle, who took over as president and chief executive on July 1, 2010, received $568,605 in total compensation last year.</blockquote>Lest anyone think that these hospitals were paying their CEOs a lot of money, <blockquote>Nonprofit hospital executives could make substantially more if they worked in for-profit industries, [Ohio Hospitals Association spokesperson Mary] Yost said. 'A million dollars certainly is a decent package, but it’s not the highest thing that these people could command,' she said. 'We’re blessed that there are people who want to work for a nonprofit that has the mission of serving its community and they’re not just in it for the money.'</blockquote> Only within the protected world of top executives would $1 million a year seem only a "decent package."  The stock defense of lavish executive pay is <a href="http://www.nizkor.org/features/fallacies/appeal-to-common-practice.html">an appeal to common practice</a>, i.e., the pay is justified because so many organizations pay their executives similar amounts.  This version of the defense lacked even the common accompanying assertions that the particular executives are so brilliant and hard-working that they would be assured of a high market price. Furthermore, let us consider another comparison.  Consider the following data, <blockquote>Summa’s revenue exceeded expenses by $31.7 million, for an operating margin of about 3 percent. Akron General Medical Center’s revenue exceeded expenses by about $8 million, resulting in an operating margin of 1.7 percent. Parent company Akron General Health System posted a loss of about $1 million on revenue of $854,207, according to IRS filings. The health system's filings reflect investment income and the costs of providing health screenings to the public, not hospital operations, Akron General spokesman Jim Gosky said. Revenue at Children’s exceeded expenses by about $35.3 million for a 7.4 percent operating margin.</blockquote>These data implied that the CEOs of Summa and Childrens' each received compensation equal to about 5% of their organization's total operating margins. The two people who acted as CEO at Akron General received together an amount that was larger than their system's operating loss, so had they been paid $1 million less, their system would have broken even. In this case, the newspaper found no one to quote who would assert that the former CEOs' performance was so good as to command that much of the hospital's excees, or the latter CEO's performance was so good as to be worth putting the hospital system into a deficit.   Mercy Health Systems, Wisconsin The Janesville, Wisconsin Gazette published a story about one CEOs response to previous reporting of his compensation, <blockquote>Javon Bea saw the August article in a Madison newspaper that questioned the salaries of area health care leaders. Bea, the president and chief executive officer of Janesville-based Mercy Health System, was singled out for receiving considerably more than hospital executives in Madison. The article was based on 2009 tax filings, which show that Mercy paid Bea $3.6 million in total compensation. That included compensation of nearly $2 million and deferred pension payments of just more than $1.6 million. The newspaper reported that the national average was $630,000 and included base salaries, bonuses, pensions and other benefits.</blockquote> Many stories of executive pay have shown leaders who make many times other employees' compensation.  In this case, however, a CEO tried to assert that he did many times other employees' work.  Bea defended his salary by arguing he did the work of at least three, perhaps six people: <blockquote>Bea said the Madison newspaper story compared executives at individual operations to him, an executive of a system that has three hospitals and 61 other facilities in 24 communities in southern Wisconsin and northern Illinois. 'To equal the job description of the CEO of Mercy Health System, you'd have to (add together) the salary of the CEO of DeanCare insurance, the salary of the CEO of Dean Clinic and the salary of the CEO of St. Mary's Hospital,' Bea said. 'And then you'd better throw in the chief operating officers at all three.' Bea said Mercy doesn't have COOs and that he does that work.</blockquote>Mr Bea did not explain how he found enough time in a 24 hour day to do the work of three to six people.  This seems to be a particularly hyperbolic version of argument that the executive is so brilliant and hard-working as to command such a high market price. Perhaps Mercy does not have CEOs or COOs of individual hospitals, but its 2010 Form 990 (from Guidestar <a href="http://www.guidestar.org/FinDocuments/2010/390/816/2010-390816848-0734ca49-9.pdf">here</a>) documents that it has ten vice-presidents who each make approximately $200,000 to over $375,000 a year. Why Mr Bea would need to do the work of three or six people when he has so many other well-executives around to help was not clear. Furthermore, Mr Bea came up with an apparently unique justification for his high pay, that its source was some sort of magic money that did not add to health care costs, <blockquote>Bea said his salary has no effect on health care costs or the premiums MercyCare subscribers pay each year. He likened his salary to capital costs, which he also said don't affect what patients are charged. John Cook, Mercy's chief financial officer, said Medicare, Medicaid and private insurance companies don't pay providers based on the costs of capital improvements or salaries, which in Bea's case is determined by a board of directors that works with national consultants and attorneys. 'My salary isn't going to affect your health care cost,' Bea said.</blockquote> Maybe Mr Bea needs a second opinion from another CFO. His compensation appears to come from the hospital system's budget, per its 990 form, so it affects hospital costs as much as any other expense of the same amount. Furthermore, it is well known that hospital systems negotiate payment rates with private insurers, and that larger systems with more market power may negotiate higher rates.  Finally, it is also well known that different hospitals collect different amounts from government insurance programs for patients with apparently similar problems.  Thus, the notion that executive pay has no effect on health care costs, and the implication that it somehow comes from a magical place outside of the budget, seems to be an entirely new rationale for huge executive compensation.  From a psychological standpoint, it appears to be based on wishful or magical thinking.  Another way to look at it is as a logical fallacy, a <a href="http://www.nizkor.org/features/fallacies/special-pleading.html">special pleading</a>, an assertion without a clear basis that the usual rules or principles do not apply. Montefiore Medical Center, New York-Presbyterian Medical Center, and Others, New York, New York A brief <a href="http://www.nypost.com/p/news/local/rich_ceos_performing_cashectomy_neFNAu2KnwUlm3Wi3rWVSK">article</a> in the New York Post focused on the bonuses given to some local CEOs, <blockquote>Dr. Kenneth Davis, the head of Mount Sinai hospital and medical school, raked in a $1.2 million bonus in 2010, and Michael Dowling, the CEO of the North Shore-LIJ Health System, got $1 million. Louis Shapiro, president of the Hospital for Special Surgery, got a $1.5 million bonus and $992,215 salary. Some CEOs also got a housing allowance, car and driver, and first- or business-class air travel. Montefiore Medical Center in The Bronx paid CEO Steven Safyer $1.4 million plus a $359,845 bonus. The hospital also put $2.2 million into Safyer’s retirement fund, which he can take only when he leaves.</blockquote> In addition, <blockquote>The highest total compensation — $4.3 million — went to Dr. Herbert Pardes, the retiring head of New York-Presbyterian Hospital, who got $1.7 million in salary, a $1.9 million bonus and $648,686 as “other” compensation.</blockquote> The Post found someone to provide the usual rationale, <blockquote>Brian Conway, a spokesman for the Greater New York Hospital Association, defended the packages. 'Hospital CEO compensation reflects their myriad responsibilities, the complexity of running a medical center, and the national market for their talents,' he said.</blockquote> That was a quick one-sentence summation of the "market" and "brilliant, hard-working" arguments.  Note that, as usual, no justification of why the particular people involved should be considered particularly brilliant or hard-working, and no comparison of their dedication or brilliance to that of lesser paid hospital employees was supplied.  Note also that CEO compensation is usually determined not by the market, but by a biased <a href="http://hcrenewal.blogspot.com/2011/10/peer-benchmarking-lake-wobegone-effect.html">benchmarking process,</a> see post here. Note further that this process almost never includes comparisons with employees who are not CEOs, nor includes explicit comparison of particular CEOs dedication, brilliance, etc with either that of other CEOs or other employees. Premier Health Partners, and Others, Cincinnati, Ohio The Middletown (Ohio) Journal <a href="http://www.middletownjournal.com/news/middletown-news/some-health-ceos-earned-millions-1297729.html">reported</a>, <blockquote>Jim Pancoast, president and CEO of Premier Health Partners, the parent organization of Atrium Medical Center in Middletown, had the highest pay in 2010 of information available to date from that year. Pancoast collected about $4.6 million in 2010, most of which is a lump sum paid out through a supplemental executive retirement program.</blockquote> The year before saw someone get even richer compensation, <blockquote>Kettering Health Network’s former Chief Executive Officer Frank Perez and UC Health’s former CEO Kenneth Hanover topped the list in 2009, with each receiving more than $2.6 million. Frank Perez’ total reportable pay in 2009 of more than $5.5 million included a more than $4.5 million lump-sum, taxable retirement payment. </blockquote> Ron Seifert, executive compensation practice leader for the health care practice at Hay Group, supplied the usual rationale, <blockquote>'No one, including the boards of these organizations, denies this is a lot of money. But what they’ll tell you is this takes a special leader,' he said. 'They come with a price tag.'</blockquote> As is also usual, why the particular leader should be considered so special, particularly in comparison to other lesser paid hospital employees,  was not specified.. Northwestern Memorial Healthcare System, Chicago, Illinois Last but not least, we address the compensation given Dean M Harrison, the CEO of Northwestern Memorial Healthcare System, as discussed in an editorial in FierceHealthFinance, entitled, "<a href="http://www.fiercehealthfinance.com/story/evaluating-eight-figure-paychecks-and-near-poor-patients/2011-11-28">The problem of 8-figure hospital paychecks and near-poor patients</a>." In summary, <blockquote>Harrison was paid an astonishing $10.2 million in 2010, the result of a $7.5 supplemental retirement fund payout.</blockquote> The ire this generated, so unlike the tone in the typical news article about executive compensation,  is worth quoting: <blockquote>There are hundreds of nonprofit hospital CEOs like Harrison, compensated with millions of dollars while their institutions throw a few bread crumbs to the poor living in their service areas. Many these institutions spend more on CEO pay than charity care. Alan Sager, a professor of health policy and management at Boston University, recently told Crain's Chicago Business what a lot of healthcare pay and governance experts dare not say: 'There's an enormous sense of self-entitlement among CEOs. It started in the for-profit corporate sector, but it has sloshed over into the non-profit hospital world.' I worked up some talking points for Northwestern Chief Financial Officer Peter J. McCanna that he can bring to the next board meeting, although I'm guessing he won't do so. For those CFOs actually willing to rock the boat, these bullet points work for practically any large urban hospital in the country: • Dean Harrison's 2010 compensation was approximately 170 times that of a charge nurse on their feet 12 hours a day. Does Dean Harrison work 170 times harder? • Dean Harrison's compensation was approximately 20 times that of a cardiac surgeon performing 300 to 400 high-revenue procedures a year. Does Dean Harrison provide 20 times the benefit? • Dean Harrison's compensation could be used to cover the first 10,000 uninsured patients who come through the emergency room each year. Which would provide a greater benefit to the hospital and community? • The purpose of a supplemental retirement plan is to ensure its recipient maintains a reasonable standard of living past their working years. Given the tens of millions of dollars Dean Harrison has already received during his career and the six-figure pension and high five-figure Social Security income he is guaranteed upon retirement, will the $7.5 million payout actually accomplish its goal? Or will it merely be gravy for his heirs?</blockquote> He concluded, <blockquote>Meanwhile, if your hospital has a single patient who works hard, will be bankrupted by the bill they receive, and no one on your staff has walked them through every step of a charity care claim, that is where some imagination and original thought is sorely needed. Too much money in some places, and not enough in others. Someone needs to announce that the buck stops here. And start moving around all the other bucks.</blockquote> Summary In a health care system with ever rising costs, declining access, and stagnant quality, we no longer can tolerate the perverse incentives generated by unaccoutanably high compensation to top executives. As long as top executives continue their sense of "self-entitlement," and can continue their current management practices reinforced by ever rising pay checks, expect poor leadership to undermine any attempts to improve health care.  Tired repititions of the usual rationales, that the CEOs are brilliant and hard-working, and that their compensation is mandated by the market do not make these rationales true. We need health care leadership that has compassion for the increasing hardships that their patients have to endure, and that puts doing the right thing for patients' and the public's health ahead of self-interest.

More Tales of the Hospital CEO Compensation Bubble

The hospital CEO compensation bubble continues to grow. As the year draws to a close, I have found another set of stories about outsized pa...

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David Pogue: "The Year of C.E.O. Failures Explained" and Why IT is so Bad

David Pogue is a prolific writer on IT, having written some of the most popular books on MacIntosh, e.g., the Mac Secrets series. In an article in the Dec. 15, 2011 New York Times on "CEO's idiotic blunders" as he calls them, he reveals why IT generally, HIT included, may be so poorly done: <blockquote>The Latest in Technology from David Pogue <a style="font-weight: bold;" href="http://pogue.blogs.nytimes.com/2011/12/15/the-year-of-c-e-o-failures-explained/?ref=personaltechemail&nl=technology&emc=cta1">The Year of CEO Failures Explained</a> New York Times Dec. 15, 2011 ... But it doesn’t seem like you’d need a business degree to appreciate that these [decisions by CEO's on making major changes to businesses] would be bad decisions. Whenever I see a company shooting itself in the foot like that, I always wonder: how could anyone be so stupid? When do people become so stupid? Last spring, I taught a class at the Columbia Business School called “What Makes a Hit a Hit—and a Flop a Flop.” I focused on consumer-tech success stories and disasters. I distinctly remember the day I focused on products that were rushed to market when they were full of bugs — and the company knew it (can you say “BlackBerry Storm?”). I sagely told my class full of twentysomethings that I was proud to talk to them now, when they were young and impressionable — that I hoped I could instill some sense of Doing What’s Right before they became corrupted by the corporate world. But it was too late. To my astonishment, hands shot up all over the room. These budding chief executives wound up telling me, politely, that I was wrong. That there’s a solid business case for shipping half-finished software. “You get the revenue flowing,” one young lady told me. “You don’t want to let your investors down, right? You can always fix the software later.” You can always fix the software later. Wow. That’s right. Use your customers as beta testers. Don’t worry about burning them. Don’t worry about souring them on your company name forever. There will always be more customers where those came from, right? </blockquote> In health IT, beta-testing unregulated, experimental software medical devices on patients is commonplace. And patients do get burned. Literally. <blockquote>That “ignore the customer” approach hasn’t worked out so well for Hewlett-Packard, Netflix and Cisco. All three suffered enormous public black eyes. All three looked like they had no idea what they were doing. Maybe all of those M.B.A.’s pouring into the workplace know something we don’t. Maybe there’s actually a shrewd master plan that the common folk can’t even fathom. </blockquote> Actually, no. If anything, IMO the MBA's suffer the <a href="http://en.wikipedia.org/wiki/Dunning%E2%80%93Kruger_effect">Dunning-Kruger effect</a>. <blockquote>But maybe, too, there’s a solid business case to be made for factoring public reaction and the customer’s interest into big business decisions. And maybe, just maybe, that idea will become other C.E.O.s’ 2012 New Year’s resolution.</blockquote> I doubt it. In healthcare IT, it will take a few more years - and much more litigation - before the frankly immoral and nihilistic attitude of "we can fix the software later" becomes taboo. It may also take some of those sage MBA's realizing that their loved ones have no "reset button" when they've been "burned" by faulty health IT, and that their loved ones - unlike software - cannot be "fixed later." -- SS

David Pogue: "The Year of C.E.O. Failures Explained" and Why IT is so Bad

David Pogue is a prolific writer on IT, having written some of the most popular books on MacIntosh, e.g., the Mac Secrets series. In an arti...

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Health Care Policy of the Insiders, by the Insiders, for the Insiders - the Newt Gingrich Case Files

Newt Gingrich's rise to the top of the pack of Republican contenders for the US presidency has earned him increased scrutiny.  The resulting investigative reporting has provided a revealing set of case studies showing how insiders have come to dominate US health care policy. Below I have reorganized the information presented in a series of news articles from mid-November to mid-December, 2011. Mr Gingrich's Consulting Empire A general description of Mr Gingrich's health care "think tank" appeared in the Washington Post.(1) <blockquote>A think tank founded by GOP presidential candidate Newt Gingrich collected at least $37 million over the past eight years from major health-care companies and industry groups, offering special access to the former House speaker and other perks, according to records and interviews. The Center for Health Transformation, which opened in 2003, brought in dues of as much as $200,000 per year from insurers and other health-care firms, offering some of them 'access to Newt Gingrich' and 'direct Newt interaction,' according to promotional materials.</blockquote> Despite its name, the CHT was for-profit. Much of its actual workings are confidential, per the Post,(1) <blockquote>Susan Meyers, a center spokeswoman, declined to comment on the think tank’s income or staffing levels because it is a private-sector organization.</blockquote> Despite its pretentious name, the CHT was apparently a vehicle for its wealthy corporate clients to influence health policy to favor their business interests.  A NY Times article(2) reported that: <blockquote>His consultancy practice was centered around his ability to help big corporate interests speak the language of Republicans and navigate the corridors of Capitol Hill on issues vital to their businesses.</blockquote> According to a Bloomberg article(3), the work was quite lucrative: <blockquote>Two companies founded by Newt Gingrich announced yesterday that they had grossed $55 million between 2001 and 2010, part of an effort to quiet questions about how the former U.S. House speaker earned millions since he resigned from Congress in 1999. That revenue supports the Center for Health Transformation and The Gingrich Group LLC, which have a staff of as many as 30 people, stage health-care policy events, and provide advice to clients, Nancy Desmond, the chairman and chief executive officer of the firms, said in a written statement. </blockquote> The CHT was linked to a small corporate empire, as described by the Washington Post,(4) <blockquote>Former House speaker Newt Gingrich transfigured himself from a political flameout into a thriving business conglomerate. The power of the Gingrich brand fueled a for-profit collection of enterprises that generated close to $100 million in revenue over the past decade, said his longtime attorney Randy Evans. Among Gingrich’s moneymaking ventures: a health-care think tank financed by six-figure dues from corporations; a consulting business; a communications firm that handled his speeches of up to $60,000 a pop, media appearances and books; a historical documentary production company; a separate operation to administer the royalties for the historical fiction that Gingrich writes with two co-authors; even an in-house literary agency that has counted among its clients a presidential campaign rival, former senator Rick Santorum (R-Pa.). Separate from all of that was his nonprofit political operation, American Solutions for Winning the Future.</blockquote> Relationships with Big Health Care Corporations The Center for Health Transformation was largely funded by big health care corporations. The Post first noted,(1) <blockquote>The biggest funders, ... [included] firms such as AstraZeneca, Blue Cross Blue Shield and Novo Nordisk,...</blockquote> Also,(1) <blockquote>The center has listed scores of firms and industry groups as members over the years, amounting to a Who’s Who of the medical field, from GE Healthcare to the American Hospital Association to Wellpoint, the nation’s largest health insurer. </blockquote> Other clients were listed in a Bloomberg article,(5) <blockquote>Among the member companies were drugmaker Johnson & Johnson (JNJ) and health insurer Blue Cross and Blue Shield Association....</blockquote> Also,(5) <blockquote>Pfizer Inc. (PFE), the world’s largest drugmaker, had consulting contracts with Gingrich, according to two people familiar with the arrangements. Pfizer spokesman Ray Kerins didn’t respond to requests for comment. The Pharmaceutical Research and Manufacturers of America, the industry’s trade group, was also a client. His firm 'was retained by the PhRMA general counsel’s office at one time to provide advice on a positioning project,' the group said. </blockquote>In addition, as noted below, clients included important firms in the health care information technology (IT) sector, including GE, IBM, Microsoft, Allscripts, and Siemens. Below, we present several cases in which Mr Gingrich apparently intervened on behalf of his clients to promote their business interests in the guise of promoting his views on health policy solutions.  In some cases, the views he promoted did not fit with what is generally regarded as his political philosophy, suggesting that the interests of his paying clients overrode his political views. Case: End of Life Care The New York Times reported,(2) <blockquote>Writing on the Web site of the Washington Post, Mr Gingrich praised Gundersen Lutheran Health System of LaCrosse, Wis., for its successful efforts to persuade most patients to have 'advance directives,' saying if Medicare had followed Gundersen's lead on end-of-life care and other practices, it would 'save more than $33 billion a year.'</blockquote> Note that <blockquote>Gundersen was one of the paying clients of Mr. Gingrich's Center for Health Transformation....</blockquote> However, <blockquote>within weeks, Mr. Gingrich would find himself on the wrong end of what some Republicans labeled the 'death panel' issue.</blockquote> At that point, Mr Gingrich abruptly changed his tune, <blockquote>As it happens, shortly after Mr. Gingrich wrote his article praising Gundersen, he joined the conservative critics of the provision. 'You are asking us to trust turning power over to the government,' Mr Gingrich told George Stephanopoulos of ABC News that August 'when there are clearly people in America who believe in establishing euthanasia, including selective standards.'</blockquote> This suggested that Mr Gingrich took up the cause of end-of-life decision making not be cause he deeply believed in it, but because it was expeditious given the wishes of his clients, despite the assertion made by his spokesperson,(2) <blockquote>Mr. Hammond said that Mr. Gingrich did not take policy positions for pay; rather, he said, clients sought him out because of the views he already held and his expertise in communicating ideas.</blockquote> Case: Medicare Prescription Coverage Sans Negotiations about Drug Prices As reported by Bloomberg,(5) <blockquote>When U.S. House Republican leaders in 2003 were short of votes to pass a $395 billion Medicare prescription drug benefit, they recruited former House Speaker Newt Gingrich for help. In a hushed room on Capitol Hill, Gingrich told his former Republican colleagues that if he could endorse the measure, they should be comfortable with it, too, said two former senior House aides who attended the closed-door session. Two days later, after a vote was held open for three hours as leaders corralled the final ayes, the measure passed and was eventually signed into law by President George W. Bush. What Gingrich didn’t mention during the Republican caucus meeting was that he was also building a for-profit, health-care research company and seeking financing from drugmakers, which were investing $128.6 million in lobbying for passage of the new benefit for seniors. </blockquote> Note that the legislation that provided Medicare drug coverage forbade the government from negotiating prices with drugmakers.  This was unprecedented, because drug coverage from the US Veterans Administration and Medicaid did not come with the obligation to pay whatever the drug-makers charged.  The inability of Medicare to negotiate the prices it paid for drugs certainly helped the companies' revenues while driving up the costs of Medicare, the federal deficit and the costs of health care in general. Case: Promoting Expensive Diabetes Care The Washington Post reported,(4) <blockquote>Novo Nordisk, a Denmark-based drug firm that specializes in diabetes treatments.... paid a total of $1.2 million to Gingrich’s foundation over six years as a 'founding charter member.' 'It was strictly a business, nonpolitical relationship,' Novo Nordisk spokesman Ken Inchausti said. 'We admired his leadership on issues related to health-care delivery systems. We thought the CHT brought something to the table to us in terms of finding ways to help people prevent diabetes.' Gingrich loaned his celebrity to causes that, whatever their other merits, could also be good for Novo Nordisk’s bottom line. For instance, he was the keynote speaker at Novo Nordisk’s 'diabetes summit' in 2005 and joined the company in issuing a 'call to action' to fight diabetes in Texas and Georgia.</blockquote>One wonders how many of the widely promoted "summits" and other star-studded conferences on health care featuring corporate  and political leaders as speakers are just stealth health policy advocacy or stealth marketing. Case: Irrational Exuberance for Electronic Health Records My fellow Health Care Renewal blogger has often discussed the <a href="http://hcrenewal.blogspot.com/search/label/irrational%20exuberance">"irrational exuberance"</a> for electronic health records (EHRs) despite scant information about their benefits, and increasing data suggesting their harms.  It now appears that Mr Gingrich, sponsored by copious funds from the health care IT sector, has been a major source of such exuberance.  Mr Gingrich had a complex relationship with the health care information technology (IT) industry. It began to come out first in a NY Times story,(6) <blockquote>When the center [for Health Transformation] sponsored a 'health transformation summit' at the Florida State Capitol in March 2006, lawmakers who attended Mr. Gingrich's keynote speech inside the House chamber received a booklet promoting not just ideas but also the specific services of two dozen of his clients. Executives from some of those companies sat on panels for discussions that lawmakers were encouraged to attend after Mr. Gingrich's address. Gerard White, president of Clearwave, which paid about $50,000 to become a center member, used the occasion to pitch his company's system for managing patient data.</blockquote> This had all began earlier, <blockquote>Two years before the Florida 'summit,' Mr. Gingrich made a presentation to Republican lawmakers in Georgia, promoting the work of his member companies by citing specific benefits if they were hired. For example, 'VitalSpring could save the State Employee Program over $20 million a year.' Minutes of the members-only conference call from March 2004 said the center had 'arranged joint meetings' for members to present their work on electronic health records to top federal officials, noting that Mr. Gingrich 'reported very positive feedback overall from these meetings.' He also pressed for passage of a federal bill to increase the use of electronic health records, collaborating with one of its co-sponsors, Representative Patrick J. Kennedy of Rhode Island, and Senator Hillary Rodham Clinton of New York, both Democrats.</blockquote> Furthermore, <blockquote>Many of the ideas he has pushed involve the increased use of information technology, and companies specializing in that are well represented in the center's roster. They also figured prominently in an early center initiative, teaming up in 2003 with the conservative Georgia Public Policy Foundation to promote changes in health care in Mr. Gingrich's home state. At his discussion with Georgia House Republicans in 2004, Mr. Gingrich gave examples of companies whose services could 'both improve health and start saving money,' according to the center's summary of his presentation.</blockquote> And there is more, <blockquote>In Washington, Mr. Gingrich's push for electronic health records illustrated how his own policy advocacy and ties to former Congressional colleagues made him a sought-out consultant for companies like Astra Zeneca and Siemens. Mr. Gingrich hailed HealthTrio, one of the center's 'founding charter members,' during a hearing held in 2003 by Senator Larry Craig, Republican of Ohio. Telling the senator that HealthTrio's chief executive had helped design the electronic records program in the United Kingdon, Mr. Gingrich said the company 'estimates we could have an electronic health record for American for about 10 cents per month, per person.' The center later arranged for HealthTrio and I.B.M to meet with senior federal health officials and congressional leaders 'to review the U.K. approach and how it might be applied in the U.S.,' according to center records. Some of the ideas promoted by the center found their way into the electronic health records legislation proposed by Mr. Kennedy, which was prepared with input from Mr. Gingrich.</blockquote>This is especially ironic, given that the UK NHS electronic health record initiative has become a crashing failure (for example, see<a href="http://hcrenewal.blogspot.com/2011/08/you-saw-it-here-first-uk-nhs-pulls-plug.html"> this post</a>). Even more involvement with the push for electronic health records (EHRs) appeared in a Boston Globe article,(7) <blockquote>Newt Gingrich seized the TV airwaves in 2009 to bash President Obama’s stimulus package, calling it 'entirely a pork-barrel bill' that would do little to solve the recession. Later, in a separate web video, the former House speaker stepped back from his blanket criticism. He explained that he strongly supported spending $27 billion of stimulus funds to encourage doctors and hospitals to create electronic medical records for their patients. Left unsaid was that the Gingrich Group, his consulting business in Washington, received large payments from medical technology companies that stand to profit from the federal money.</blockquote> In particular, <blockquote>The stimulus infusion Gingrich supported is expected to benefit health care technology companies, including those who have been clients such as GE Healthcare and Allscripts. GE Healthcare said it pays Gingrich’s center to act as a 'collaborator and facilitator' among a diverse group of health care interests. 'We work with the Center for Health Transformation in an effort to improve the effectiveness of the health system through the use of information technology,' said GE Healthcare spokesman Corey Miller. Allscripts spokeswoman Ariana Nikitas said the company ended its relationship with Gingrich’s center two years ago but considered the venture 'a think-tank to advance health care efforts.'</blockquote> It does not stop there. Per the NY Times,(8) <blockquote>Mr. Gingrich was cheering a $19 billion part of the [Obama stimulus] package that promoted the use of electronic health records, something that benefited clients of his consulting business. 'I am delighted that President Obama has picked this as a key part of the stimulus package,' he told health care executives in a January 2009 conference call. After the bill was passed a month later, Mr. Gingrich's consultancy, the Center for Health Transformation, joined two of his clients, Allscripts and Microsoft, in an 'Electronic Health Records Stimulus Tour' that traveled the country, encouraging doctors and hospitals to buy their products with billions in federal subsidies. </blockquote>We, particularly InformaticsMD, have frequently commented on how health care information technology has been promoted not just by enthusiasts in the field, and by companies that manufacture such devices, but by the government.  The bandwagon has gone down the road despite little clinical evidence that such technology is beneficial, and increasing evidence of its harms.  Now it appears that an important reason for this ruch to promote expensive, but unproven devices comes from the sort of stealth health care policy advocacy on behalf of corporate vested interests described above. Summary So Newt Gingrich parlayed his political track record into a lucrative "consultancy" which enthusiastically promoted the health policy objectives of its clients, who included some of the biggest US health care corporations.  Some of the policy positions the consultancy promoted seemed to run counter to Mr Gingrich's political record.  Worse, some of the initiative he successfully promoted seem to have contributed to US health care dysfunction. These stories, some of which are many years old, only came out after Mr Gingrich became the front runner for the Republican nomination for US President.  Had he not chosen to re-enter politics, it is not clear when reporters would have had time to due the required investigations.  One wonders how many similar stories have not been made public because they do not involve prominent presidential candidates. The bottom line seems to be that there are myriad ways corporate and political insiders push health policy agendas because of self-interest, regardless of their effects on patients' and the public's health.  Health policy in the US has become an insiders' game.  Unless it is redirected to reflect patients' and the public's health, facilitated by the knowledge of unbiased clinical and policy experts rather than corporate public relations, expect our efforts at health care reform to just increase health care dysfunction.  Physicians, public health advocates, whatever unbiased health policy experts remain must educate the public about how health policy has been turned into a corporate sandbox.  We must try to somehow activate the public to call for health care policy of the people, by the people, and for the people. References 1.  Eggen D. Gingrich think tank collected millions from health-care industry.  Washington Post.  November 17, 2011.  Link <a href="http://www.washingtonpost.com/politics/gingrich-think-tank-collected-millions-from-health-care-industry/2011/11/16/gIQAcd72VN_story.html">here</a>. 2. Rutenberg J. Gingrich faces more scrutiny over corporate clients. NY Times, November, 17, 2011. Link <a href="http://www.nytimes.com/2011/11/18/us/politics/newt-gingrich-faces-more-scrutiny-on-corporate-clients.html">here</a>. 3. Benson C, Lerer L. Gingrich health center and group paid $55M. Bloomberg, November 22, 2011. Link <a href="http://www.bloomberg.com/news/2011-11-22/corporations-pay-gingrich-health-center-and-consulting-group-55-million.html">here</a>. 4. Tumulty K, Eggen D. Newt Gingrich Inc.: how the GOP hopeful went from political flameout to fortune. Washington Post, November 26, 2011. Link <a href="http://www.washingtonpost.com/politics/newt-gingrich-and-how-he-got-rich/2011/11/21/gIQAftOglN_story.html">here</a>. 5. Davis JH, Jensen K. Gingrich campaigning as change agent profited as an insider. Bloomberg, November 18, 2011. Link <a href="http://www.bloomberg.com/news/2011-11-18/gingrich-running-as-change-agent-profits-from-washington-insider-status.html">here</a>. 6. McIntire M, Rutenberg J. Gingrich gave push to clients, not just ideas. NY Times, November 29, 2011. Link <a href="http://www.nytimes.com/2011/11/30/us/politics/gingrich-gave-push-to-clients-not-just-ideas.html">here</a>. 7. Rowland C. Newt Gingrich supported $27 billion of President Obama's stimulus for electronic medical records, helping his consulting clients. Boston Globe, December 16, 2011. Link <a href="http://www.boston.com/Boston/politicalintelligence/2011/12/gingrich-stimulus-support-benefited-his-consulting-clients/IoXiAqmY1h1A74SYCwckdJ/index.html">here</a>. 8. Rutenberg J, McIntire M. Gingrich push on health care appears at odds with G.O.P. NY Times, December 16, 2011. Link <a href="http://www.nytimes.com/2011/12/16/us/politics/gingrichs-health-care-policy-history-at-odds-with-gop.html">here</a>.

Health Care Policy of the Insiders, by the Insiders, for the Insiders - the Newt Gingrich Case Files

Newt Gingrich's rise to the top of the pack of Republican contenders for the US presidency has earned him increased scrutiny. The resul...

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