Saturday, July 27, 2013

Random chart - care variation

"Big health spending variations throughout the country are largely driven by differences in the use of post-acute services such as skilled nursing homes and home health care by Medicare beneficiaries, and by higher prices that some hospitals and doctors charge commercial insurers, according to an Institute of Medicine report..."

Wednesday, July 24, 2013

And the answer... (AI watch)

The June 2nd blog entry 'Random picture - AI watch' featured the 'Smile' and said 'Wonder how real this is?... October or December 2013 will tell." Well, it's only July and the answer is in - unfortunately this appears to have been vaporware (heavy sigh of regret...) 

Saturday, July 13, 2013

More Galaxy S4

Bought the Samsung S view cover for the S4... You actually pop off the back of your S4 and clip on a replacement back that has a front cover integrated, to get a good protection without really bulking up your phone very much at all. The S view cover has "... the convenience of a screen window that allows view-through access to alerts, status and vital information. The S-View window is interactive, allowing you to answer or reject incoming calls and end current calls without having to open the flip. The S-View Flip Cover also powers up your display when opened, and puts it to sleep when closed - automatically"

The S view cover on YouTube

Previous blog entries:
Galaxy S4 second look
Galaxy S4 first look

Additional Galaxy S4 resources:
Samsung Galaxy S4 forum
Galaxy S4 accessories
25 Samsung Galaxy S4 Hidden Features

Sunday, July 7, 2013

Additional BB QR readers - XXV

Another free QR code reader is QR Scanner and Generator by Newgen Photographics.

As always the first stop post installation is at the QR Code Quality Standards Test v1.02 The application decodes the QR codes directly (and not after taking a picture). Nice and speedy it decoded several 'flavors' of QR codes handily - phone number, SMS text, email address, web address, YouTube video. It did have some issues with vEvents and vCards, and once the QR codes were read they were not all fully integrated with the corresponding BB applications - while the email launched, others (urls, addresses, phone numbers) did not integrate with the corresponding BB applications but directed you to upgrade to the Pro' version ($0.99).


On the QR generator side it will generate the QR code flavors shown below. It is nicely integrated with the BB address book. One small issue - while generating a MeCard  or vCard a number of fields are mandatory... Most of them seem OK but requiring a web address for the MeCard seems excessive (you can not generate a Mecard without it...)


The bottom line? A quick and versatile application. Unfortunately for full integration you need to go to the paid app, and given the excellent and completely free competitors out there I'm not sure it is worth it (even at the bargain price of $0.99!)

Previous QR code reader entries:
Additional BB QR readers - XXIV - TinyBarcode
Additional BB QR readers - XXIII - QR CodeFX
Additional BB QR readers - XXII - QR Scan
Additional BB QR readers - XXIa - Arion & Carpet One QR Scanners
Additional BB QR readers - XXI - Arion & Carpet One QR Scanners
Additional BB QR readers - XX - Barcode
Additional BB QR readers - XIX - QR Scan Now
Additional BB QR readers - XVIII - Qrem
Additional BB QR readers - XVII - Mobio
Additional BB QR readers - XVI - intARact
BB QR readers - Biz Barcode II - Biz Barcode updated review
Additional BB QR readers - XV - CodeREADr
Additional BB QR readers - XIV - ContactScanner
Additional BB QR readers - XIII - Mception Scanner
Additional BB QR readers - XII - Biz Barcode
Additional BB QR readers - XI - QR Code Scanner
Additional BB QR readers - X - SimpleScanner
Additional BB QR readers - IX - WIMO
Additional BB QR readers - VIII - Upcode
Additional BB QR readers - VII - Lynkee
Additional BB QR readers - VI - Code Muncher
Additional BB QR readers V - Mobiletag
Further ScanLife - ScanLife
Additional BB QR readers - IV - i-nigma
Additional BB QR readers - III - Barcode Assistant
Additional BB QR readers - II - Deco, CertainTeed
Additional BB QR readers - BeeTagg, AT&T Code Scanner
BB QR Code Scanner Pro - BB QR Code Scanner Pro
Barcode Happiness - I - barcoo
No luck - Upcode
Misc update (BB/2D barcodes) - Mobiletag (also updated above)
BB & 2D barcodes - NeoReader, Microsoft Tag, ScanLife

The downside... (updated)

... of using Tor (couple of examples):

Click to enlarge:

... and of course there's the hit to your connection speed!

Friday, July 5, 2013

Follow-up (drug shortages)

This blogger has a number of previous entries on the topic of drug shortages (see below) since an entry over eleven years ago (in March 2002) that still has the most complete list of actual reasons for drug shortages that he has seen, complete with actual examples from 2002... (Note: the drug shortage issue was just becoming a problem in 2001/2002, though it has escalated significantly since)

Well, according to 'Some MDs Blame GPOs for Chronic Drug Shortages' a group called 'Physicians Against Drug Shortages' (PADS) made up mostly of anesthesiologists, apparently think they have the answer. They blame group purchasing organizations. Phillip L. Zweig, MBA, the (pro bono) executive director of PADS explains in a white paper. Quote:

"... The reason: Giant hospital group purchasing organizations (GPOs), which control the purchasing of an estimated $200+ billion in drugs, devices and supplies for about 5,000 private acute care member hospitals, have rigged the entire healthcare supply chain, not just for generic drugs but also medical devices and supplies. The list includes everything from chemotherapy medications to cotton balls and syringes. In a throwback to the disgraced Soviet economic system, these purchasing cartels have undermined market competition and the laws of supply and demand using a myriad of anticompetitive abuses. Make no mistake: this is an artificial shortage that was entirely preventable. It was created by bad government policy and lack of regulatory oversight, healthcare industry collusion and self-dealing, and massive lobbying and campaign contributions by GPOs and other healthcare special interests to key members of Congress. It will take smart, honest government policy to remedy it... 

GPO executives and contracting officers not clinicians dictate which drugs, devices, and supplies are used in these hospitals, and which companies are allowed to sell the...

The GPOs use a variety of anticompetitive, exclusionary practices that favor dominant manufacturers that can pay them the largest kickbacks... Exclusionary, sole source, long-term contracts...  Forced compliance programs that impose stiff penalties on hospitals and wholesalers if the volume of their purchases from manufacturers on contract drops below 95%, in many cases, for a particular product or product line... A Byzantine system of manufacturers’ rebates to large, favored distributors that ensures that only those distributors can sell to GPO member hospitals..."

In a word, nonsense! One could also say 'tripe', 'codswallop', 'swill', etc., because that's exactly what it is.  Clinicians (and if not them then it is the hospital administrators) decide what drugs and supplies are used; these days contract awards are multi-source (unless the hospital in question has signed up for a standardization or commitment program, again a hospital decision); the "stiff penalties" do not exist; and the rebates, or rather administrative fees (whether you like them or not, whether you approve of them or not - and this blogger does not) are clear and applied equally to all manufacturers and distributors.

Some legislators (Markey, Waxman, Dingell et al.) appear to be jumping on this bandwagon... and have asked the GAO to investigate "the role" of GPOs in the drug shortage situation in the country...They also piggyback on the 'safe harbor exemption' criticism of the PADS/Zweig group (though one must note that they apparently have other 'experts' that level similar criticisms).

Apparently the safe harbor exemption and administrative fees charged by GPOs are the nefarious mechanism which has resulted in drug shortages. Quote: "... Incredibly, an obscure federal statute, the 1987 Medicare antikickback “safe harbor” provision, exempted GPOs from criminal prosecution for taking kickbacks from healthcare suppliers. Under this “pay-to-play” arrangement, suppliers buy market share by paying GPOs steep “administrative,” marketing and other fees (a/k/a kickbacks) in return for contracts giving their products exclusive access to GPO-member hospitals. This system has dramatically reduced the number of suppliers of vital generic drugs and discouraged potential competitors from entering the marketplace. What’s more, these practices have forced many firms to stop making these inexpensive drugs rather than produce them at a loss. They’ve also crippled the ability of others to maintain their plants, equipment, and quality control, resulting in tainted drugs, adverse FDA inspections, and plant closings..." 

Let's parse this out. According to PADS/Zweig, thanks to their 'get out of jail free' card the GPOs charge administrative fees and have steered business to favored manufacturers. However, at the same time they apparently are also gouging their favored manufacturers, as some of them have had to exit the business rather than take a loss! Simultaneously, according to PADS/Zweig, by taking administrative fees that are based on some percentage of the business, the GPOs are incentivized to make sure that prices are higher ("... decisions are based largely on how much kickback revenue these products can generate for the GPO..." and "... instead of saving money for hospital... actually inflate healthcare cost..."). OK, so which is it - are the GPOs pushing the manufacturers out of business via low pricing and 'kickbacks', or are they causing higher prices (which presumably is good for the manufacturers)? Clearly both can't be true at the same time. Yet PADS/Zweig cheerfully level these criticisms simultaneously...

(Note: this 'administrative costs lead to higher hospital cost'  argument is echoed by Markey et al.)

Other studies have suggested that the increasing number of problems at the few manufacturing facilities (especially of generic injectables, where the greatest shortages are occurring) are due to the fact that low pricing and low profitability on these items are causing the manufacturers to cut costs by "... insufficient maintenance of production facilities and equipment..." and "... suboptimal quality control testing and oversight and lack of timely responses to indicators of quality problems..."  This also would seem be contrary to the 'GPOs are actually raising drug prices' argument!

Finally, on the principle that one should never waste an opportunity to leverage any issue in the news, no matter how tangential it is to your subject, the PADS/Zweig folks tie the 'GPO and drug shortages' issue to the recent compounding deaths, implying that these are also due to the GPOs - by causing the drug shortages the GPOs have forced hospitals to turn to the drug compounders for items in shortage...  Note: It is true that PADS/Zweig are not the only ones that see this tragedy as an opportunity to advance their interests - for another example see the recent blog entry 'Deliberate conflation'.

Excellent articles on the subject:
The Drug Shortage Crisis in the United States Causes, Impact, and Management Strategies
Study on the Structural Roots of Drug Shortages and The Shortages Effects on Kids
FDA Drug Shortages: Fundamental Problem is the Inability for the Market to Observe and Reward Quality

Previous blog entries on drug shortages:
Random charts - drug shortages - Jan 31st, 2013
Random charts - drug shortages - Jul 25th, 2012
Diagnosis - muddled thinking - Jan 21st, 2012
Polarization? - Dec 2nd, 2011
Help on the way? - Jul 31st, 2011
Random charts - Apr 6th, 2011
The why's of drug shortages - Mar 30th, 2011

Previous blog entries referencing GPOs:
Un dialogue de sourds -Dec 21st, 2010

All previous healthcare-related blog entries:

P.S. One must say that anyone who buys these theories wholesale implicitly must take all the hospitals in the country (and their physicians, administrators, supply chain professionals, etc.) to be either chumps or complicit in a massive (we are talking about ten of thousands of people given the approximately 5,000 hospitals in the U.S.) conspiracy - allowing themselves to be dictated to re what drugs and supplies they use; allowing themselves to be conned into paying higher costs; allowing themselves to be forced to bear significant additional operational costs due to the drug shortages; allowing their patients to be put at additional risk (up to and including increased deaths); etc. Seems rather unlikely, don't you think?

P.P.S. One has to wonder about these anesthesiologists.... One hopes they have a better understanding of their trade than they do (and are exhibiting) on this issue! Perhaps folks who are scheduled for surgery should check if their anesthesiologists are PADS members, and steer clear of those that are....

Thursday, July 4, 2013

Follow-up (MDET)

The June 1st, 2013 Blog entry 'Consequences (MDET)' looked at medical device manufacturers and how some have responded to the medical device excise tax provision of the Affordable Care Act... A recent article 'Is 3M Being Audited By the IRS For Its Medical Device Tax Payments?' discusses if the IRS is auditing the payments. 

In the article a "tax manager" at a company "technology and biosciences practice" is quoted as saying: "... Determining who is responsible for paying the tax is very confusing and has caused a great deal of dialogue between medical device companies and their customers..." Umm, no, not at all - it's clearly the medical device company that is required to remit the tax to the IRS. 

While he is right about the complexity and confusion, it's hard to understand why national and multinational device makers are "confused" enough to believe that their customers have liability for the tax payment, when the latter apparently are sophisticated enough to understand how this is supposed to work!

Galaxy S4 second look

A few screen captures...

Samsung Galaxy S4 first look