Wednesday, December 29, 2010

Cool "app'

Reading up on hospitals and their use of social media, ran into some info that The Jewish Hospital & St. Mary’s HealthCare in Louisville has developed Blackberry and iPhone apps, that allow the user to perform relevant tasks, such as:
  • Finding a physician near you and even requesting an appointment
  • Registering for events
  • Keeping track of the latest JHSMH news
  • Receiving interesting health news and tips
  • Monitoring your food intake with a calorie tracker and food diary
  • Determining if you are in a healthy weight range with a BMI calculator
Looked/sounded pretty cool, so I downloaded and installed on my BB Torch, then gave it a whirl...

Turned out to be a shortcut to a customized web site, which performed as advertised for news, events, BMI calculator, etc. It did have a small problem when I tried the 'Find a Physician' functionality...

Not exactly an "app" but pretty cool functionality to allow access to relevant info via a smartphone...

Tuesday, December 28, 2010

Random chart

Source: From the Pentagon to the private sector

In the wild...

The December 6th blog entry 'Together' pulled together previous entries related to QR codes and QR readers... Having tried many readers, this blogger is usually on the lookout for QR codes "in the wild," unfortunately without a great deal of luck... Mostly rare glimpses in magazines, such as the two examples below:

While the first (above) makes some sort of sense, the second is a little more iffy... This advertisement (see below) sends the person who gives this QR code a whirl to Twitter, specifically to Kennedy1960, "On the campaign trail with John F. Kennedy -- 50 years later. Experience the day-to-day workings of JFK's road to the White House. A project of the JFK Library."

OK, the number of people with smartphones is still quite low, and the number of these folks with QR readers on their smartphones is even lower. The number of folks in this already small demographic slice that also are on Twitter is probably minuscule! This wouldn't seem like the best implementation!

However, there is a fair amount of buzz around QR codes, even if the usage hasn't really taken off here (i.e. the U.S.). Some additional information:

Folks keep thinking up ways to make QR codes "better" for advertising e.g. 'framing':
Who Framed QR Codes?
QR Code Framing to Promote Engagement

QR code use in increasing, but sometimes advertisers go astray e.g. using QR codes in television advertising (seems a little odd, does one have to pull out a their smartphone and rush the TV screen?!?); not having meaningful experiences for the person who uses the QR code, etc:
Waitrose Offer Delia And Heston Blumenthal Recipes Via QR Code App
Lacoste QR campaign
MTS QR code campaign: you got the “quick”. Where’s the “response”?

Still, many useful, interesting, and creative examples abound:
QR codes deliver the Flamenco experience
Microsoft Tag and food (yes, this blogger understands that MS Tags are not QR)
Columbia uses QR codes
QR Wine Codes are All the Rage—the 2011 Prediction
A new tech-savvy way to keep you connected at the Library
Sales of "Santa Claus and the Lost Dog" to Benefit Stray Rescue Program

And some general reports related to QR:
R Codes: It’s Hip to Be Square
EnQii Launches QR Code-enabled Digital Signage
Générateurs de QRcodes : Le classement de QRdressCode

Monday, December 27, 2010

Random chart

Source: The Conservative World View and Prison Populations, Broken Windows. "... There’s been a massive explosion in the rate of prison population in the United States since 1970 ..."

Sunday, December 26, 2010

Random charts

Source: Building a Better America – One Wealth Quintile at a Time The first graph shows the actual distribution of wealth by quintile in the U.S. versus what various groups think the distribution is... The second shows the distributions in Sweden and The U.S. , along with a theoretical equal distribution... and opinion as to which is the "better" distribution...

The abstract: "Disagreements about the optimal level of wealth inequality underlie policy debates ranging from taxation to welfare. We attempt to insert the desires of “regular” Americans into these debates, by asking a nationally representative online panel to estimate the current distribution of wealth in the United States and to “build a better America” by constructing distributions with their ideal level of inequality. First, respondents dramatically underestimated the current level of wealth inequality. Second, respondents constructed ideal wealth distributions that were far more equitable than even their erroneously low estimates of the actual distribution. Most important from a policy perspective, we observed a surprising level of consensus: All demographic groups – even those not usually associated with wealth redistribution such as Republicans and the wealthy – desired a more equal distribution of wealth than the status quo."

Note: Older data


You now have the ability to set up your Google/Blogger blog so that if accessed by a mobile device, it will re-format the screen for a smartphone... See instructions here. This should make your site load faster if you have a large number of pictures, widgets, etc., and help (?) increase/improve access...

"Regular" view

Optimized for a mobile device:

Friday, December 24, 2010

Random chart

Source: Breaking the filibuster in one graph

Energy™ Multimedia Color Book (1/5/11 update)

Jan 5th update: Finally received my Energy™ Multimedia Color Book in the mail... So it's legit and no rip-off, apologies for the doubts expressed (see below). Go here and here for pictures.

A rip-off?? Ordered from Energy Sistem (and was billed via Paypal) beginning November... Two shipment notifications, see below, however nothing received yet... Not a good sign!

Thursday, December 23, 2010

Random charts

Source: Russia’s Oil Exports: Economic Rationale Versus Strategic Gains

Great quotes II

"For the first time, there are rules to hold the insurance companies accountable for huge rate hikes by shining light on the financial data they claim justifies double-digit rate increases year after year. The days of insurance companies running roughshod over consumers and jacking up our rates whenever they want are over. The new rate review rules represent a key step toward finally ending the insurance companies’ stranglehold on our health care." - Ethan Rome, executive director of Health Care for America Now, in a statement Tuesday after HHS issued rules on health insurance rate hikes....

Eh? From this quote one wouldn't know that in most states insurance companies already have to get their rate increases approved by the state insurance commissioners... and that this remains the case under the HHS rules issued...

A more measured (and accurate) quote on the changes:

“Consumers across the country have struggled to keep up with health insurance rate increases that have piled up year after year—especially for those who work for small businesses or have to buy their own coverage. Until now, states have been responsible for overseeing health insurance rate increases, but many states don’t go far enough to protect consumers from unjustified rates. Under these proposed rules, insurance companies will have to explain why they are seeking a large rate hike. This should be a help for consumers in two ways. First, it provides a strong incentive for insurers to do a thorough review of their justifications before asking for big rate increases. And second, it will help consumers better understand why their rates are going up and they can decide to look for better plans.” - DeAnn Friedholm, the director of Consumers Union’s health reform campaign.

Great quotes I

"Freedom House today renewed its deep concern about the fairness and impartiality of the pending court decision in the case of former Yukos head, Mikhail Khodorkovsky, in light of comments made by Prime Minister Vladimir Putin during a call-in session with the Russian public.

Asked by a viewer about the fairness of the eight-year sentence Khodorkovsky is currently serving on charges of tax evasion, Putin borrowed a famous line from a popular Soviet film, replying “a thief must sit in prison.” He also said that the crimes of Mr. Khodorkovsky "were proven in court," before any verdict has been rendered in this latest trial. Putin concluded his remarks by calling the Russian court one of the “most humane in the world.”

“The Russian prime minister's remarks are utterly irresponsible and make a mockery of the justice system by overtly prejudging a verdict before the court issues its decision,” remarked David J. Kramer, Executive Director of Freedom House. “Mr. Putin once again has demonstrated his scornful disregard for rule of law, directly contradicting President Medvedev’s pledges to eradicate legal nihilism and dashing hopes for a justice system free from political pressure.” See Putin’s Remarks on Khodorkovsky Show Blatant Disrespect for Rule of Law.

Ok, so let's understand this. A viewer asked about the sentence Khodorovsky is currently serving i.e. Putin was asked about Khodorovsky's last trial, back in May 2005. When Putin opines that Khodorovsky got what he deserved (and would one expect anything different to come out of his mouth?), this is "utterly irresponsible" and "prejudging" the current case?

Additionally, speaking of prejudging, how is this that different from President Obama and AG Holder suggesting (in response to Republican criticism of their proposals) that convictions would be all but guaranteed if/when "terrorists" would be tried in civilian courts ??

Ed note: OK, for those readers who are turning purple with apoplexy at this 'heresy', this blogger understands that it is not free in Russia.... that the administration there is an autocratic and authoritarian kleptocracy... that the courts do what they are told versus applying the law impartially, etc. , etc. The criticism here is directed at these NGOs (Freedom House, Amnesty International, etc.), who take a comment about the past and huff and puff as if it is about the future (Note: here I'm going by their own reporting of what transpired!!), and apparently need to gin up fake outrage when there's manifestly plenty of real outrages present that need to be exposed and denounced!!

Wednesday, December 22, 2010

Random picture

Remember this? Powell's perversity...

Digital Video Memo Magnet

A weak magnet had it sliding down the refrigerator door... Otherwise pretty much works as advertised (and expected)... However, it remains to be seen how long a full battery charge lasts....

Digital Video Memo

Tuesday, December 21, 2010

Un dialogue de sourds

In October, the Medical Device Manufacturers Association (MDMA) placed another shot across the bow of Group Purchasing Organizations (GPOs), by publishing a study that purported to show "... that GPOs fail to deliver on their primary justification for allowing them to receive kickbacks from suppliers, and that they do not in fact reduce costs relative to a world in which GPOs are funded by hospitals ...", and that the "... elimination of GPO protections could reduce health care costs up to $37.5 billion each year ..."

First, some general background on GPOs:
Derwood Dunbar on GPOs
Hospitals, group purchasing organizations, and the antitrust laws - Business
Group Purchasing Organizations – Seriously Reviewed By GAO and Others
Group Purchasing Organizations: An Evaluation of Their Effectiveness in Providing Services to Hospitals and Their Patients
GPOs save money web site - Understanding How Group Purchasing Organizations Work & Understanding GPOs and the Safe Harbor Provision

... and related to this particular spat:
War of words heats up in GPO controversy
Hospitals slam anti-GPO report
Nation’s Largest Hospitals Respond to Recent Medical Device-Sponsored Study

The MDMA's charges brought a swift riposte... A number of VHA members wrote a letter to the MDMA stating that its conclusion was "completely unbelievable." Further, they charged that "... contrary to your report’s assertion, changing the current GPO funding mechanism would mean additional costs for hospitals and other health care organizations, thus driving healthcare expenditures even higher. Neither the healthcare community nor the country as a whole can afford the type of disruption and increased cost that your organization is advocating..."

Other GPOs characterized the MDMA report as "propaganda" and as a "slap in the face," and accused the MDMA of self-serving, for example: "The only parties that stand to benefit from disrupting a working, competitive GPO market are the manufacturers who comprise the $200 billion medical device industry. They continue to attack the GPOs because what they do works. GPOs effectively drive prices down for our hospital members and no amount of MDMA propaganda will change that."

OK, so looking past the allegations and counter-allegations, past charges of "kickbacks" and "propaganda", etc., where does the truth lie? First let us look at the MDMA report.

The report analyzed over 8,100 historical records of capital purchases (of biomedical, dietary, imaging, information technology, laboratory, laundry, monitoring, oncology, and a number of other equipment categories) from a company called MEMdata, looking at medical devices purchased by multiple hospitals; and comparing the prices actually paid to GPO contract prices for the equipment. Crunching the numbers they found that the hospitals paid the GPO price 21.7% of the time; paid less than the GPO price 76.9% of the time; and (somewhat inexplicably) paid higher than the GPO price 1.4% of the time. Overall, hospitals were able to save between 10% and 14% off GPO prices, and in fact incumbent (GPO contracted) device vendors lowered their prices by an average of 7%. This situation was attributed to the financing mechanism - " ... economic theory explains that this failure (of GPOs to secure the best price) emerges from the way in which GPOs are compensated. The current system - which allows GPOs to share in the sales revenue of those with whom they are to negotiate for the best prices - creates a perverse incentive that limits the GPOs' ability to procure the lowest prices for its member hospitals..."

The MDMA then extrapolated from those numbers, concluding "... Based on the results from our empirical analysis, we conservatively estimate that changing the incentive structure by reapplying the anti-kickback statutes would reduce private U.S. health care expenditures by roughly $25 billion annually, and would reduce federal health care spending by roughly $11.5 billion annually." (i.e. a total savings of $36.5 billion.)

OK, so here is where the apples and oranges come in... The sample data that was analyzed was for capital equipment (device) purchases, and the savings factor calculated was applied to GPO medical/surgical supply volumes! So, what is the difference? Well, in addition to lowering overall transaction costs, in theory GPOs get better pricing by leveraging the larger, combined volumes of their members to achieve better pricing than an individual hospital should/would be able to achieve on its own. Now this works well for the members' medical/surgical supply purchases (whether they be 'commodities' such as needles, dressings, etc.; or physician preference items such as implants, etc.), as their purchase volumes can be reasonably well forecast. However, it is very different for capital equipment purchases - while a GPO can forecast and provide vendors with estimated volumes of supply purchases (which might be characterized as 'continuous') to achieve lower pricing levels, it is a different matter for equipment purchases (which are more "episodic" or "intermittent" in nature). Volumes here would depend on a number of factors, including depreciation and equipment life cycles, technology life cycles, differing fiscal years for various hospitals, etc. Once you buy, say, physiological monitors or syringe pumps, they last for perhaps five years, and in fact could be maintained for six, seven, or more... Thus while negotiating with an equipment vendor, the GPO is generally unable to forecast and leverage specific volumes (not really knowing which members will be in the market for particular models/modalities of equipment.... ). As a result, the GPOs' processes and resulting contract prices for capital equipment are more tentative, and most hospitals use the GPO contract price as a ceiling below which they negotiate individually with the equipment vendor.

The bottom line? The fact that most hospitals pay below the "GPO price" for capital equipment is in majority a reflection of this market weakness, and is not due to the GPO funding mechanisms, as posited by the MDMA study. Further, the assumption that the 'discount' achieved off GPO price for capital equipment can be similarly achieved on all supply purchases is speculative in the extreme. Reading the study it is clear that the authors make no distinction between supplies and equipment. For example, one of the authors has stated "We looked at the price of medical supplies (sic!) after GPOs have ostensibly secured best price. If original GPO auctions are done efficiently, there's no price room." Well, they manifestly did not look at the price of medical supplies, they looked at the prices of equipment purchases! And since the GPO negotiations for equipment purchases are not done as efficiently as those for supplies, there is "price room."

Having looked at the (flawed) MDMA study, next let us look at the response of the GPOs and hospitals. Rather than calmly rebutting the MDMA study by pointing out its flaws and/or weaknesses (e.g. as in the above), the response has been rather shrill... And some of the counter-claims that have been made seem a tad unlikely. For example, the hospital letter cited earlier claimed that " changing the current GPO funding mechanism would mean additional costs for hospitals and other health care organizations..." It is not at all clear why this is valid, and this seems to be an example of the GPOs engaging in "apples to oranges" comparisons of their own!

The graphic above (courtesy of 'GPOs Save Money') shows the funding flows. First, a GPO member hospital uses a GPO contract to purchase supplies from a vendor. The vendor periodically remits a percentage (up to 3%) of the purchase to the GPO in the form of administrative fees. The GPO funds its operations from the fees collected, then at the end of the year passes the "excess" back to the hospital, usually in the form of a cash distribution called a "patronage dividend" (or some similar term.) Note: the GPO will likely use portions of the administrative fees for items other than purely costs related to contracting activities; examples might include quality collaboratives, clinical and operational benchmarking, patient safety related activities, IT infrastructure build, and so on.

The percentage of the administrative fees that are 'surplus' and that are that are returned to the various member hospitals differs between the different GPOs, but an approximation of 50 cents returned on every dollar of administrative fees generated is probably in the ball park. As such, it is not at all clear why switching from the current 'administrative fee' model to a service subscription model would result in any additional costs for a member hospital. Initially the members' fees could be set at 60% of the current level of the administrative fees they are generating, to provide the GPO operational cost plus a small cushion (and they are generating these fees by paying them!). It is unclear to this blogger why this should result in the apocalypse that the GPOs claim would occur, viz. "... Limiting GPO administrative fees would require hospitals to pay more so that GPOs could continue to operate and negotiate on their behalf. This would require billions of additional dollars..." (see here). In fact it would make much more explicit the costs related to belonging to the GPO - the fee would be a clearly visible line item in somebody's budget vs. being embedded "invisibly" within, and spread across, every purchase transaction.

Now it is true that if GPOs did not exist and if every member had to have their own staff, etc. to negotiate their own contracts for supplies and equipment, then there would be a rather large incremental cost increase and overall transaction costs would rise due to a duplication of effort... However, no one (including the MDMA) is arguing for this, so it is rather a GPO straw man!

So, bottom line, while there is a solid argument to be made in changing the current GPO funding structure, the MDMA study is not it. And, the GPO special pleading is somewhat self-serving as well!

Quick note: The MDMA study does go into some other points... and also has some other statements that can be contested. However, for the purposes of this blog entry I am only addressing/discussing the main point made by the study...

Random charts

Source: OECD Programme for International Student Assessment (PISA) 2009 Results: