Continuous Productivity

It's About Time

Once an X-ray provided proof in black and white, Dr. Das Gupta, the 74-year-old chairman of surgical oncology at the University of Illinois Medical Center at Chicago, did something that normally would make hospital lawyers cringe: he acknowledged his mistake to his patient’s face, and told her he was deeply sorry.

 “After all these years, I cannot give you any excuse whatsoever,” Dr. Das Gupta, now 76, said he told the woman and her husband. “It is just one of those things that occurred. I have to some extent harmed you.”

Hospitals and doctors are taking a different approach to stave off malpractice suits. They are admitting mistakes and hoping the social interaction will lower the costs associated with the lawsuits. It will be interesting to see how the market accepts the attempts at reeling in costs. The healthcare industry, in general, and physicians, especially, are loath to admit any mistakes. I wonder (and highly doubt) that an entire industry built on covering up and hiding mistakes is going to change because a few hospitals and doctors are admitting mistakes.

Billers and Players at EconLog

A very interesting post by Arnold Kling at the EconLog.  He very concisely defines the economic differences between entrepreneurs and workers:

As Taleb points out, there are safe professions where you charge by the hour, so I might call them Billers. As a Biller, your earnings tend to have a high floor but a low ceiling. Think of an accountant.

What Taleb calls scalable professions are ones where you are not limited by what you can charge for an hour. Recording artists, professional baseball players, entrepreneurs, corporate CEO's, and financial speculators enjoy scalability. But, as Taleb points out, they have to compete in tournaments where there are a few winners and many losers. So we can call these sorts of people Players.

Both Wallstreet and the technology industries have done an amazing job in not only delineating between "players" and "billers", but also rewarding "billers" (via outsized bonuses and stock options).  That is not the case in the healthcare industry.  Although, there are certain specialty physicians that garner tremendous compensation, the bulk of the "billers" just get a standard salary that is not tied to performance.  IThat leads to tremendous inefficiencies because compensation focused "billers" are constantly jumping around for the highest paying job.  Also, "billers" not so focused on money are stagnated, never realizing the potential rewards had they been rewarded like "billers" on Wallstreet and Silicon Valley.  I can see that structure leading to "billers" looking at their profession as "just a job" and not really being motivated to innovate and foster change.  Just look at the (lack of) progress in the healthcare industry as it lags significantly behind finance and technology in the last decade. 

Doctors and Suicide

There's a grim, rarely talked-about twist to all that medical know-how doctors learn to save lives: It makes them especially good at ending their own. An estimated 300 to 400 U.S. doctors kill themselves each year -- a suicide rate thought to be higher than in the general population, although exact figures are hard to come by.

Some doctors believe the stigma of mental illness is magnified in a profession that prides itself on stoicism and bravado. Many fear admitting psychiatric problems could be fatal to their careers, so they suffer in silence.

And when the pain is too much, doctors have easy access to prescription drugs and a precise knowledge of both how the body works and the amount of a drug needed for an overdose to stop breathing and halt the heart.

This is something that I was completely unaware of. I could have guessed that policemen, firemen, and maybe even social workers are at the high end of the suicide spectrum, but not doctors. It seems to me that a profession which brings so much hope would not have these issues, but alas it's extremely common. The explanation as to why the suicide rate is so much higher for doctors is equally intriguing:

One explanation is that most suicide attempts in the broader population are unsuccessful, while doctors know how to successfully commit suicide, said Dr. Erika Frank, who specializes in research on physician health.

Google Health

Google continues its expansion into all things "data":

Google Inc. will begin storing the medical records of a few thousand people as it tests a long-awaited health service that's likely to raise more concerns about the volume of sensitive information entrusted to the Internet search leader.

The pilot project to be announced Thursday will involve 1,500 to 10,000 patients at the Cleveland Clinic who volunteered to an electronic transfer of their personal health records so they can be retrieved through Google's new service, which won't be open to the general public.

The expansion by technology companies into health care record management will inevitably lead to a revision of HIPAA.  Interestingly, as it stands, Google can use the health records they store for marketing or other analytic purposes. 

Barring the obvious privacy concerns, storing medical records (much like everything else) online is an inevitability and will provide for both greater transparency and efficiency within the healthcare industry.  Currently, a medical records request is a multi-step, tedious process that takes too much time, wastes labor resources (not to mention paper) and doesn't always get the job done on the first try.

Wii for Therapy

It was only a matter of time before the Wii was incorporated in the medical arena.  It makes sense given that most therapy (especially physical therapy) is a series of repetitive motions.  The obvious benefit is the alleviation of boredom:

In fact, many patients say PT - physical therapy's nickname - really stands for "pain and torture," said James Osborn, who oversees rehabilitation services at Herrin Hospital in southern Illinois.

Using the game console's unique, motion-sensitive controller, Wii games require body movements similar to traditional therapy exercises. But patients become so engrossed mentally they're almost oblivious to the rigor, Osborn said.

What's most surprising about the article is not that the Wii is being used for some sort of rehabilitative function, but rather that nobody has developed "games" specific to rehab:

The most popular Wii games in rehab involve sports - baseball, bowling, boxing, golf and tennis. Using the same arm swings required by those sports, players wave a wireless controller that directs the actions of animated athletes on the screen.

An obvious first-to-market sort of opportunity for the savvy healthcare entrepreneur.

Walk-in Clinics

Wal-Mart is adding an interesting twist to the nascent walk-in clinic model founded by MinuteClinic (I believe).  They are branding their clinics with hospitals and medical groups.  The logic being that patients are more apt to use these clinics inside of Wal-Mart if there is a trusted name behind the facility.  It will be interesting to see if the hospital/medical group branding will actually increase patient volume.  It seems to me that the typical patient would be uninsured, lower-income, and not really focused on the "brand" of the clinic.  There is obviously a huge need for these types of facilities, as evidenced by Wal-Mart's patient profile:

The typical customer is a mother with runny-nosed children in tow. About one in five customers pay cash. Wal-Mart says 55 percent of patients at its store clinics do not have health insurance, like 47 million other Americans.

But, I wonder if the branding is just more pandering to hospitals, physician groups, and physicians rather than a real business need.  I don't believe any Walgreen's or CVS pharmacies are affiliated with hospitals,  nor should they be. 

Obesity Genetic?

University College London researchers examined more than 5,000 pairs of identical and non-identical twins.

Their American Journal of Clinical Nutrition study found that differences in body mass index and waist size were 77% governed by genes.

I am always intrigued by nature vs nurture studies that use twins.  Whether they be identical or fraternal, you can really isolate either the "nature" or "nurture" variable:

Identical twins have exactly the same genes, while non-identical twins are genetically different, like brother and sister.

However, because they were born at the same time, and raised in the same household, they can be assumed to have roughly similar upbringing in terms of food.

This allows scientists to measure differences in weight and calculate how much of that difference can be blamed on environment, and how much on genes, even though it doesn't identify individual genes which might be linked to obesity.

Pot or Pepsi?

Via the great Gizmodo, LA is now going to provide medicinal marijuana vending machines:

To use them, you'll need to go with a prescription in hand, get fingerprinted and get a prepaid credit card that's loaded up with your dosage and what strain of weed you want. Yeah, no joke, the pharmacists in LA give you a choice between OG Kush and Granddaddy Purple. In the future, the machines may also be outfitted to sell other popular drugs such as Viagra, Vicodin and Propecia.

Autism Video

I was recently forwarded this video by a loyal reader:

It's a sad and real problem.  What's striking that even in this day and age, autism affects 1 in 150 children.

Healthcare Worker as Commodity

I had a conversation with an employee of mine about the role of healthcare worker within our company.  As the conversation progressed, I indicated that the typical healthcare worker is now a commodity (in economic terms) within our company and in the healthcare industry in general. 

It's important to note that by commodity I am speaking strictly of a homogeneous service (or good) that is fungible.  As you could imagine, given that I was speaking to a registered nurse, my view did not sit well with her. 

The point I was trying to make (and one which she quickly understood) was that the typical front-line healthcare worker (registered nurse, physical therapist, respiratory therapist, certified nursing assistant, etc) is readily available to companies like mine.  There is an entire cottage industry, in which my company is both a participant and provider, built on the premise that a healthcare worker is accessible within minutes simply by making a phone call or sending an email.  It is called per diem in industry lingo and is the equivalent of a temp employee in a non-healthcare setting.  Unlike temps, though, these people are highly skilled specialists that deal with peoples' lives. 

Having said that, though, that labor pool is still a commodity.  For instance, we needed a physical therapist for a few of our patients.  I simply picked up the phone and called an outside company to schedule a physical therapist for a few hours.  This commodity status of the modern healthcare worker is not necessarily an indictment on the labor pool, but rather a testament to our accreditation process, the educational institutions that produce the labor, and the advancement of science so that patient care is "standardized".

I contrasted that with what would happen if I needed a knowledge worker (an overused term, but apropos here) at a moments notice.  Unfortunately, it would be impossible to make a phone call and have a replacement within hours.   Imagine I had an analyst that was going through reams of data for a proposal we were working on.  Now further imagine that he got sick and was bed-ridden for a few days.  Would I be able to make a phone call and find an immediate replacement?  No.  Sure, someone else could go through the data and come up with the same (or similar) analysis, but it would come at a great cost - time.  Hence, the knowledge worker at my organization, or any organization is not a commodity.  He is not homogeneous.  His skill set is unique and although he is partially fungible, he is not immediately fungible.

Now, one can easily argue that specialist physicians, etc are not easily replaceable with a phone call.  And I would agree.  But, I would also argue that those are knowledge workers with a non-fungible skill set.

The above is actually one of the reasons we are in the healthcare business.  The commodity status of the front-line labor pool proffers us a distinct advantage as we try and build up our knowledge worker team.  We can continue growing revenues and servicing our patients because labor is always available to service the patients.  Labor is a huge problem in healthcare, but if you view it as a commodity and focus on process and standardization, it eliminates some daunting management obstacles.