Why Pretend An Advertising Executive and Chamber of Commerce Leader Are Public Health Experts?

Obesity as a public health problem has been the subject of considerable discussion.  So that luminaries from the prestigious Partners Healthcare system and Massachusetts Blue Cross Blue Shield would weigh in on the issue at a public meeting should surprise no one.  But see this report by the Boston Herald:

When asked about rising health-care costs, Jack Connors - chairman of the Partners chain, which includes Mass. General and Brigham and Women�s hospitals - said yesterday, 'Taking care of yourself starts at home.'

'What happened to individual responsibility?' Connors said at a Greater Boston Chamber of Commerce breakfast at the Westin Boston Waterfront. 'Why is obesity such an epidemic (when) we all know that a big part of being healthy is exercising and eating the right food?'

Blue Cross Blue Shield Chairman Paul Guzzi echoed Connors� attitude yesterday.

'What is the responsibility of the individual?' said Guzzi, who as the chamber�s chief executive hosted Senate President Therese Murray�s speech on health care yesterday, despite his dual role as Blue Cross chairman.

Jack Connors is currently chair of the board of Partners Healthcare.  A quick biography is here:

John M. Connors, Jr., 67, Chairman Emeritus of Hill Holliday (formerly Hill, Holliday, Connors, Cosmopulos, Inc). (full service marketing and communications company) since 2006. Chairman of Hill, Holliday, Connors, Cosmopulos, Inc. from 1995 until 2006, during which time Mr. Connors also served as President and Chief Executive Officer until 2003. Mr. Connors was a founding partner of Hill, Holliday, Connors, Cosmopulos. Director of Covidien Ltd. Mr. Connors� 40 years of business experience includes cofounding and developing one of the top advertising and marketing communications firms in the United States, advising many of the top branded companies in the world, and serving on the boards of dozens of entities, including public companies, private companies, hospitals and colleges. (Biographical Information as of 4/16/10)

Although Mr Connors did once run a medical education and communications company (see this post), he has no obvious direct experience or training in biology, epidemiology, public health, or medicine.

Similarly, here is biography of Paul Guzzi:

Paul Guzzi is president and chief executive officer of the Greater Boston Chamber of Commerce, one of the region�s leading business associations.

Mr. Guzzi brings extensive experience in both business and government to his work at the Chamber. A former Massachusetts secretary of state and chief secretary to the Governor, as well as a member of the management teams of two Fortune 500 companies; he is a leading advocate for economic development and job creation.

Prior to leading the Chamber, Mr. Guzzi was vice president of state and community affairs for Boston College. Previously, he was a consultant for Heidrick & Struggles, an international recruitment and consulting firm. Mr. Guzzi also served as a vice president at Data General Corporation and as a senior vice president at Wang Laboratories. During his tenure at Wang, he worked closely with Dr. An Wang to oversee the restoration and transformation of what is now the Wang Theatre.

Mr. Guzzi began his public service career as a state representative from Newton in 1970. He was elected Massachusetts secretary of state in 1974. Mr. Guzzi served as a chief of staff for Governor Edward King and chief administrator of the Board of Regents of Public Higher Education.

A graduate of Harvard University, Mr. Guzzi holds a Bachelor of Arts degree in government. He completed the Harvard Business School Management Development Program. He was also an officer in the U.S. Marine Corps Reserve.

Again, Mr Guzzi has no obvious training or experience in biology, epidemiology, public health, or medicine.

So maybe it should be no surprise that the Boston Herald article chronicled some skepticism about these worthies' public health pronouncements.

Calling the pair�s comments 'pure smoke blowing,' Boston University public health professor Alan Sager said, 'Sure individual responsibility matters, but the responsibility for efficient, affordable, high-quality health care for all Americans falls on everybody who works in health care.'

By the way,

Connors said a major reason for rising health-care costs is that a high percentage of people who leave the hospital are later readmitted, because they don�t follow their doctors� directions. He owns a company, Dovetail Health, that makes money by helping elderly patients readjust to life after hospitalization, including staying on their medications.

Every week I get piles of notices of "healthcare" conferences at which most of the speakers are health care organizational executives with no obvious expertise or experience in actual health care, or in biology, epidemiology, public health or medicine. I think I dimly remember a time when most people who gave public remarks on health care actually knew something about health care, not just about making money (often personally in large amounts) from the health care "industry."

Note that while the Herald was able to find people who were skeptical about these health care leaders' remarks, there was no report that their audience (presumably made up mainly of business people) roared with laughter at their efforts to talk about controversial topics which they did not seem to really understand.

We need to ask why we have become so deferential to leaders of large (and and least heretofore prestigious) health care organizations that we treat them like true experts on biology, epidemiology, public health or medicine when they have no obvious expertise, or even knowledge in these areas?

Thanks to one of our anonymous scouts for a tip on this item.

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The Stresses of Modern Life

In recent articles, I've reflected on the way humans treat each other in our modern era, competing for resources, attention and priority.

I turn 48 this month and even in my lifetime, I've seen major changes in the nature and quality of life. A few observations:

*When I was in college, faxes, FedEx, and email did not exist. Fast communication meant a land line phone call.

*The pace of each day was limited by the number of in person encounters you could have.

*Real estate was relatively inexpensive and houses in places like Marin County and Palo Alto could be found for $150,000.

*Debt was something to avoid.

*When I was growing up, a McDonald's meal cost a dollar and consisted of a small hamburger, 4 oz of fries, and 8 ounces of Coke with sugar, not high fructose corn syrup. It was under 500 calories.

*Doctors were respected members of the community. Lawsuits were rare.

*There was no expectation that you'd have a car, a VCR, a flat screen TV and an iPod. You spent what you could afford and accepted the fact that you lived within your means.

*No one had peanut allergies

*People took responsibility and accountability for their actions. If you chose to bathe with a toaster and died, your family would not sue for the toaster manufacturer for making an unsafe product.

*Government was a safety net for truly critical emergencies, not day to day life.

I realize that the items above are filtered through the haze of imperfect 40 year old memories.

However, I really do believe that something has happened in modern society that makes each day distinctly different from my childhood experience in the 1960's.

*Instant communication means that anyone can email the CEO and demand immediate action for their personal projects.

*Someone else is always to blame to everything that goes wrong.

*A baseline quality of life includes much more than in the past and if you cannot afford it, credit cards can provide it for you.

*Stress is a badge of courage.

*Information overload is the accepted norm.

When I was an undergraduate at Stanford, Herb Caen wrote many columns about the changes that took place in the 20th century that reduced the quality of life from his perspective... food, culture, and human interaction.

I hope that at some point, modern society stops and reflects about the nature of our day to day lives and realizes that we need to rethink our priorities i.e.

*Replace reality TV with a good book

*Treat your fellow humans with humility and respect

*Stop the real time communication with everyone you know

*Treat meals as an experience not as refueling

*Understand that this is the only life we have and we should savor it, not be stressed by it

After a recent particularly difficult day, I asked my wife if Ted Kaczynski's Montana Cabin was still available. Of course, as I age access to medical care will be important and cabin life would be a bit challenging, but the concept of wilderness life without an internet connection is intriguing!

No matter how challenging the stresses of modern life, as long as I remember that for everything there is a process, there will always be a path forward.

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Food Allergies and School Planning

This is Food Allergy Awareness Week (FAAW). Make an effort to talk to at least one new person about food allergies. Together we can educate the masses.

If your food allergic child is entering preschool or kindergarten next school year, now is the time to start planning. Set up meetings with the principal/director and school nurse. Grade school children are entitled to a 504 Plan. Speak up for the things your child needs. They are entitled to a safe learning environment like any other student.

To celebrate Food Allergy Awareness Week, join in on the Twitter party hosted by Ruth at Best Allergy Sites and Jen at Food Allergy Buzz. The fun begins Tuesday, May 11 at 8 pm EST. RSVP to join lots of food allergy folks as well as Julie Bradsher of the Food Allergy and Anaphylaxis Network and a representative from the International Food Information and Council Foundation. Twitter parties are a great way to meet up and share information.

Happy FAAW!

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Reduce management expenses by outsourcing medical transcription.

Management expenses can really add to the cost of transcription!

When the cost of in-house transcription is computed one of the cost components that is often overlooked is the cost of managing the in-house transcription needs. Managing medical transcription in-house would typically involve the following management activities:

Sourcing the right people: This would involve advertising for people and assessing the quality of people before recruiting them as transcriptionists.

Sourcing equipment: This would involve assessing the equipment requirements (including computers, listening devices, foot pedals, printers, stationery etc.) And then acquiring them for the right price

Sourcing technology: The technology required for starting up medical transcription like software for routing, firewalls, encryptions, uploading, downloading and archival features etc need to be assessed and acquired.

Space allocation: There would be certain space needs for carrying out transcription work in-house this needs to be assessed and allocated.

Training the people: People need to be trained on the work requirements and procedures to be followed etc.Once the resources are in place then the next step is execution of the work which involves the following steps:

Collection of dictation: Dictation of records by doctors needs to be collected in a centralized place for further processing.

Allocation of dictation: Dictated audio files need to be allocated to medical transcriptionists so that they commence with their work.

Supervising the medical transcription work: Work once collected and allocated needs to be supervised to make sure that it is being executed according to the required standards.

Assessing quality: Accuracy/quality of transcribed documents needs to be assessed to minimize errors.

Assessing turnaround time: Turnaround time of reports is very important for the treatment of patients, record keeping and managing receivables etc. hence turnaround time schedules have to be maintained.

Ensuring security: Transcription would entail transmission of confidential files of patients back and forth, care has to be taken to make sure that all the channels of transmission are secure and HIPAA compliant.

Collecting all the transcribed files: All the finished files need to be compiled at one central server for transmission back to the concerned doctors for their records and further use.

Obtaining feedback: Feedback on the quality of reports along with any special formats required needs to be collected from the doctors and communicated to the transcriptionists for implementation.

Updating/training medical transcriptionists on latest developments: Medical field has new developments on a daily basis in terms of drugs, treatments etc, medical transcriptionists need to be constantly updated about these developments.

Making arrangements for holiday/emergency medical transcription requirements: Due to unpredictability of patient inflow and staff fluctuations during holidays etc arrangements have to be made so that transcription needs are taken care of during these times.

Maintaining archives: Archiving of medical reports for easy access in case of future reference for various purposes.

Arranging Repairs and maintenance for all equipments to prevent breakdowns: Repairs and maintenance of transcription equipments is a constant process required for the smooth execution of transcription work.

The vast array of management activities required to execute transcription in-house will add to the cost per line of transcription. When the transcription needs are outsourced, effectively all the management costs and activities associated with in-house transcription will be outsourced. Assessing the medical transcription service provider on the basis of quality/accuracy, pricing, turnaround time and data security is important before making the outsourcing decision.

TransDyne is a professionally managed medical transcription service provider that offers quality medical transcription at reasonable prices, done by expert medical transcriptionists with a very quick turnaround time executed through secure HIPAA and HITECH compliant channels, with very high levels of accuracy and all this with technology that is advanced but easy to use!

To avail superior outsourced medical transcription services from TransDyne, click here.

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$19 Million Means Never Having to Say You Are Sorry?

Johnson and Johnson, the giant diversified health care company, recently shut down a factory that manufactured non-prescription childrens' medication, and recalled its products.  The findings from a US Food and Drug Administration (FDA) inspection of the plant were striking.  As described by Reuters,

The company recalled 40 widely used children's pain and allergy medications, saying some may have a higher concentration of their active ingredients, while others may be contaminated. J&J has had four recalls in the past year of over-the-counter medicines.

In an FDA report issued on Tuesday, inspectors said they found thick dust, grime and contaminated ingredients at the J&J plant that produces Children's Tylenol and dozens of other products recalled last week.

This infuriated the member of Congress who chairs a sub-committee which oversees the FDA:

Democratic Representative Rosa DeLauro sent a letter to the Food and Drug Administration asking questions about how the agency can respond to recalls and quality control lapses.

'I am concerned that the agency does not possess the authority to take appropriate action to address potentially criminal behavior by a corporation,' DeLauro wrote in the letter to FDA Commissioner Margaret Hamburg.

Furthermore,

DeLauro, in her letter, said the company's 'disregard' for manufacturing standards was 'both unnerving and unethical.'

'The corporate oversight observed at this facility appears to be symptomatic of reckless behavior that is clearly unacceptable,' she wrote.

The Reuters report then noted:

J&J has called the manufacturing problems unacceptable and vowed to fix them. The company has suspended production at the Pennsylvania plant where the recalled children's products are made.

Moreover, the company CEO took to the blogsphere (via the company's JNJ BTW blog) to give his response (below in its entirety).

To All Who Use Our Products,

We have a responsibility at Johnson & Johnson to provide you with the highest-quality products possible, and we have worked hard to fulfill that responsibility day-by-day for over a century.

The recent recalls of some over-the-counter medicines from our McNeil Consumer Healthcare operating company are a matter of great concern. They are a disappointment to me, and to the employees of the Johnson & Johnson Family of Companies. You can be confident that we will make whatever changes are needed at McNeil to fully restore the quality of its manufacturing.

As reported, McNeil has suspended all manufacturing operations at its facility in Fort Washington, Pa., until we can be sure that they are operating under the standards we demand of ourselves, and which our customers expect of us. McNeil has also retained independent quality experts to assist in this regard and is re-evaluating quality systems and manufacturing processes across the organization.

I have been assured that the chance of a serious medical event from the recalled products is remote. Even so, this does not give us comfort; one of our companies has let you down.

For now, please check your infants� or children�s forms of TYLENOL�, MOTRIN�, ZYRTEC� or BENADRYL� and discard any medicines that are being recalled. You can check the list of recalled lots, apply for refunds, and get more information about the recall at McNeil�s dedicated website (http://mcneilproductrecall.com), or by calling 888-222-6036.

We will work hard to earn back your confidence.

Sincerely,

Bill Weldon

This seems like a very important case, because it involves a pharmaceutical company apparently violating its most fundamental responsibility, to provide pure, unadulterated medicine to the public.  While the current case did not apparently lead to major health consequences to patients (as did the case of the contaminated heparin), it still suggests very basic flaws with Johnson & Johnson's operations.

Thus, what is striking about the CEO's message is its remote tone.  He characterizes the problems at the factory as a reason for "great concern" and "a disappointment."  Such language seems designed to reduce the CEO's own connection to the problems at the factory.  This is the language one might use to describe someone else's conduct.  (For example, Politician X's vote on the bill "caused me great concern," and "was a disappointment.")

On the other hand, although the CEO wrote about collective responsibility, ("we have a responsibility at Johnson and Johnson,"), he never suggested he had any responsibility or was accountable for what happened. 

Of course, we have frequently seen language like this when health care organizations are accused of practices that violate their fundamental responsibilities, or could threaten health and safety.  Rather than embracing responsibility, often leaders use language that suggests a fear of admitting anything that could create legal liability.

However,  supposedly the rationale for entrusting so much power, and providing so much compensation to CEOs and other top executives, including those of health care organizations, is the tremendous responsibility they undertake.  In fact, the Johnson & Johnson 2010 proxy statement provides this justification for the executives' stratospheric pay:

Pay for Performance �All components of compensation should be tied to the performance of the individual executive officer and his or her specific business unit or function and/or the Company overall.
� Credo Values� The manner in which financial and strategic objectives are achieved is important. While not always quantifiable, the manner in which employees achieve results should also be a key element of the individual performance review process. During the performance review process, the Company�s set of core values�trustworthiness, respect, responsibility, fairness, caring and citizenship�as set forth in Our Credo should be used to assess how objectives are achieved.
� Accountability for Short- and Long-Term Performance � Annual performance bonuses and long term incentives should reward an appropriate balance of short- and long-term financial and strategic business results, with an emphasis on managing the business for the long-term.

It then goes on the emphasize the company's Credo:

Importance of Credo Values

For more than 65 years, the Johnson & Johnson Credo has guided the actions of the Company and its executive officers in fulfilling their responsibilities to the Company�s customers, employees, community and shareholders. In assessing the executive officers� contributions to the Company�s performance, the Committee not only looks to results-oriented measures of performance, but also considers how those results were achieved� whether the decisions and actions leading to the results were consistent with the values embodied in the Credo� and the long-term impact of an executive officer�s decisions. Credo based behavior is not something that can be precisely measured and, thus, there is no formula for how
Credo-based behavior can, or will, impact an executive�s compensation. The Committee and the Chairman/CEO use their judgment and experience to evaluate whether an executive�s actions were aligned with the Company�s Credo values.

Thus, last year Mr Weldon's total compensation was $19,847,026. Such an amount ought to pay for a vast amount of responsibility and accountability. (Also, the total compensation of Ms C A Goggins, the Worldwide Chairman of the Consumer Group, who I presume to the the executive just below the CEO who is responsible for products made by the factory which had to be closed, was $5,345,737.)

So again the rules for the executives of big health care organizations seem to be heads they win, tails we lose.  They are paid enough to turn them into a new aristocracy supposedly because of the tremendous responsibility and accountability they assume.  However, when things go wrong, responsibility and accountability vanish in a haze of concern and disappointment (with other peoples' actions.)

On Health Care Renewal we continue to be concerned with and disappointed about our dysfunctional health care system, and its worsening problems with costs, quality and access as long as it is lead by people who can become rich without any responsibility or accountability for their actions.  The robber barons that arose in the late 19th century lead our country and the world into the great depression.  The new health care robber barons will soon lead us into the great health care depression. 

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Medical transcription- what to look for in a Transcription service provider: Aptitude or attitude?

What is more important, aptitude or attitude? This is a very relevant issue while deciding to outsource medical transcription needs.

What exactly is ‘APTITUDE’ when it comes to judging a Medical Transcription Service Provider?

Some of the attributes that reflect the Aptitude in the medical transcription context are:

. Quality/accuracy meaning the accuracy of the completed transcripts vis-à-vis what was dictated. An aptitude for accurate transcription.

· Turnaround time refers to the time taken to deliver the transcribed reports. An aptitude for maintaining promised deadlines.

. Data Security means having adequate security measures to ensure that confidential data transmitted back and forth is safe and secure. An aptitude for maintaining virtual security.

. Reasonable prices denote prices that are fair and reasonable for the services rendered. An aptitude for fair pricing.

. Technology that is easy to use by health professionals, without requiring extensive training. An aptitude for deploying systems that are user- friendly.

What sort of attitude should be looked at by the healthcare facility when it comes to judging a Medical Transcription Service Provider?

The Attitude of a medical transcription service provider can be judged based on the following characteristics:

Quality guidelines are the standards by which the medical transcription service provider employees perform their duties. Quality Guidelines ensure that the quality of work stays consistent at all levels of the company under all circumstances. An attitude for making quality indispensable.

In house transcription means that the medical transcription service provider that the healthcare facility is outsourcing to, is executing the work in house and not through sub contractors. An attitude for maintaining standard service.

Transparent and simple billing means having a method of billing which is verifiable, definable, measurable, consistent, fair and honest. An attitude of transparency.

Flexibility of dictation methods means offering different options for doctors to dictate their notes. A flexible and client friendly attitude.

Specialty based Medical Transcription, means training Medical Transcriptionists with special focus in one or two specialties of medicine to make them domain experts. An attitude for going beyond the ordinary

Document delivery system that allows for easy uploads and downloads and which will make checking on the status of the reports efficient and convenient. An attitude for making the customer’s work life simpler.

Free trial without any obligatory sign up giving the healthcare facility a chance to review the services of the medical transcription service provider before signing up. A confident attitude.

Testimonials make it possible to find out from others as to how they have benefited from the services of the medical transcription service provider. An honest attitude.

As can be seen it is important to choose a medical transcription service provider with both the right aptitude and attitude.

TransDyne offers medical transcription with an accuracy of above 99% with a turnaround time of 24 hours & 4-12 hours for STAT reports at a reasonable price, through secure channels and makes it easy to upload and access data. i.e. the Right Aptitude!

TransDyne has quality guidelines in place to ensure quality, executes all medical transcription work in house to ensure security & quality, has a transparent and simple billing method, offers flexible modes of dictation and gets transcription done by expert medical transcriptionists to ensure all special needs are taken care of, through a easy document delivery system, offers a free trial and the testimonials of their satisfied customers. I.e. the Right Attitude!

To avail the total TransDyne advantage of medical transcription with great aptitude and the right attitude, click here.

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Novartis Settles, Again

We certainly could not go another week without discussing another settlement of charges of unethical behavior by a major health care organization.  This time, as reported by the Wall Street Journal, it was Swiss pharmaceutical company Novartis:

Novartis AG will pay $72.5 million to settle U.S. Justice Department allegations it submitted false claims for off-label uses of a cystic-fibrosis drug.

The drug, tobramycin or TOBI, joined the Novartis portfolio as part of its 2005 takeover of biotechnology firm Chiron Corp.

In a release Tuesday, the Justice Department said that, between 2001 and 2006, Chiron, and then Novartis, marketed unapproved uses for TOBI, which the Food and Drug Administration approved as an inhaled antibiotic for treating certain cystic-fibrosis patients.

This is not even the first US legal settlement this year for Novartis:

Earlier this year, Novartis said its U.S. subsidiary struck an agreement with the U.S. Attorney's Office in Pennsylvania to settle a criminal investigation of the company's marketing of the epilepsy drug Trileptal. Novartis agreed to plead guilty to violating the U.S. Food, Drug and Cosmetic Act, and to pay a $185 million fine.

We had posted on that previous settlement here.

So the march of legal settlements continues.  It seems that practically every major pharmaceutical corporation has participated in multiple settlements since we started Health Care Renewal.  Yet the process does not seem to deter continuing bad behavior. 

In the current case, like nearly all the others, the corporation will pay what seems to be a huge fine. However, the amount is a pittance compared to the corporation's revenue, and is likely to be viewed as only a small cost of doing a very lucrative business by corporate executives. In very few cases does any individual suffer any negative consequence for approving, ordering or implementing the unethical behavior.  A large fine's impact can be spread among share-holders, employees, and clients/ customers/ patients, and hence poses no threat to executives planning the next bit of unethical behavior.
As I have said before, endlessly, we will not deter unethical behavior by health care organizations until the people who authorize, direct or implement bad behavior fear some meaningfully negative consequences.  Real health care reform needs to make health care leaders accountable, and especially accountable for the bad behavior that helped make them rich.

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