Health Business Blog

Health care business consultant and policy expert David E. Williams share his views

Mammo clinic agrees to pay for re-screening

According to AuntMinnie, a mammography clinic in Lock Haven, PA that failed to properly calibrate its mammography machine has agreed with the state Department of Environmental Protection (DEP) to re-screen more than 1500 women for free. Those patients were seen over the two year period when calibration was not being done.

The clinic discovered the problem in February during an internal review and reported the information to the DEP.

There are a couple of interesting aspects to this case:

  • The clinic blamed the problem on a single technologist, who has now been fired. No doubt the technologist is to blame, but the clinic also should have had an oversight mechanism in place that would have detected the problem sooner. Quality is produced by the system, not just an individual
  • The settlement is part of a trend to provide money-back guarantees or to accept lower reimbursement when fixing avoidable complications

Hospital quality –again

Yesterday I quoted a Boston Globe/AP article on hospital quality initiatives. There’s actually a better article in today’s USA Today that describes the specific best practices being followed, such as:

  • Elevating the head of the bed to prevent patients on ventilators from getting pneumonia
  • Making sure hospital staff wash hands before inserting a central line (!!)
  • Giving antibiotics before surgery
  • Not shaving pre-op patients. (Shaving can promote infections)

Pharmaceutical industry pays the price

Today’s lead story in the Wall Street Journal (Cases, Fines Soar In Fraud Probes Of Drug Pricing) describes the large increase in fraud investigations and prosecutions of pharmaceutical companies. Hundreds of cases are underway, and fines may top $1 billion this year. A common allegation is that pharmaceutical companies evaded the requirement to provide Medicaid with the lowest price.

Here’s some context, based on what I’ve seen:

In the early to mid-90s, pharmaceutical benefit managers (PBMs) and managed care companies were starting to flex their muscles. They negotiated rebates and special programs much more aggressively than Medicaid did.

The pharmaceutical companies were deathly afraid of the power of managed care to shift market share (which it turns out they over-estimated at the time) and put together some deals that seemed clever and necessary then, but which won’t look too good in today’s environment. I remember seeing a number of companies put together pricing committees to oversee these decisions, and it will be interesting to see whether the oversight they provided then will hold up to the scrutiny of today’s investigators.