The crowd at a ballyhooed Microsoft healthcare stage show last week started out intent and polite. But after 90 minutes of speeches and big-screen graphics about computer power, the spontaneous chant began: "Cos-by, Cos-by, Cos-by."
The audience became antsy for the payoff -- a free comedy act by Bill Cosby -- after being bombarded with claims of information system "scalability" from such industry powers as IBM, Digital Corp., Data General Corp., Shared Medical Systems and HBO & Co.
A background buzz of chatter steadily rose to compete with microphoned marketers, video clips and visual aids. During the demos, about 3,000 of the 7,000 seats were empty in a rented cavern of the Orange County Convention Center, adjacent to the annual Healthcare Information and Management Systems Society conference in Orlando, Fla.
The chanters had to wait another half hour for Cosby to amble onstage as the final act. By then nearly all the seats were filled. In retrospect, Microsoft's healthcare manager John Carpenter said, "Clearly it could have been a little shorter." But hardware vendors paid a reported $75,000 each for the chance to work up a pitch for their computers before a captive, if not captivated, audience. Cosby delivered, though, staying onstage for about 80 minutes.
Tell him to tone it down. Kenneth Kizer, M.D., the chief of the U.S. Department of Veterans Affairs' healthcare system, has become a rare public target of one of his fellow Democrats.
Kizer and Sen. John D. Rockefeller (D-W.Va.), senior Democrat on the Senate Veterans Affairs Committee, have been engaged in a discreet letter-writing battle over a report critical of VA quality-improvement efforts. Rockefeller and other committee Democrats issued the report. Kizer contends the VA outperforms the private sector in many quality areas.
Last week Rockefeller went public and took it to the top level of the VA. In a confirmation hearing for Togo West, President Clinton's nominee to become the next VA secretary, Rockefeller pleaded for West to emphasize the importance of Congress' oversight, which frequently puts administration officials on the hot seat.
"What I would like very much to see is for you to prevail on Dr. Kizer to accept that oversight is not a hostile act," Rockefeller said. "There's a feeling I get that he disdains the oversight process."
Kizer was not present at the hearing to defend himself.
Lose the fine print. The federal government suffered a temporary setback in the legal defense of its Physicians at Teaching Hospitals, or PATH, anti-fraud initiative last week, all because it failed to use the correct type font.
A lawsuit was brought by a group of provider organizations, including the Association of American Medical Colleges, the American Hospital Association, the American Medical Association and the Medical Group Management Association. It charges that the government has retroactively applied current regulations surrounding the billing of Medicare by teaching physicians.
Both sides filed motions last week in U.S. District Court for the Central District of California, and the government applied for an exemption to the 35-page maximum length for such filings. Judge Alicemarie Stotler allowed the feds 11 additional pages but said they still had to comply with the other rules. One of those guidelines is that the document must be in a type font that has no more than 10 characters to the inch. That's where the feds got in trouble.
Their motion came in at 14 characters to the inch. Stotler tossed the motion out and gave the feds until March 2 to resubmit their filing. It's unlikely the screw-up will have any long-term effect on the lawsuit, but providers hope it's a sign of good things to come.
Donation or sale? The fertility clinic at Saint Barnabas Medical Center in Livingston, N.J., has doubled the usual payment for human eggs, raising concerns that the quest for egg donors is becoming a market-driven bidding war. The move also has prompted an ethical debate over whether human eggs are a gift to be given for minimal compensation or a commodity to be bought and sold.
"Egg donation? $5,000 a pop? I don't think so," Art Caplan, director of the Center for Bioethics at the University of Pennsylvania, told the Associated Press. "It's a sale."
Saint Barnabas placed ads in several New York-area publications, seeking donors and offering to pay $5,000 for each donation, which can produce several eggs. That's double the going rate.
Clinic officials say they are only trying to increase the supply of eggs to accommodate infertile couples, who often wait up to a year for a suitable donor.
Richard Scott, M.D., director of assisted reproduction at Saint Barnabas, says the cost is fair considering the arduous nature of the donation process. To donate eggs, a woman much inject herself with hormones for several weeks to get her ovaries to swell. She must have blood tests and ultrasounds during that period to monitor the eggs. The woman then goes to a medical center, where doctors insert a needle through her vagina to suction out the eggs.
An alarming jump in injuries. Follow the bouncing toddler straight to the emergency room. Trampoline-related injuries to children have skyrocketed to epidemic proportions, according to a report in the March issue of Pediatrics by Gary Smith, M.D., a pediatrician at Children's Hospital in Columbus, Ohio. As a result Smith concludes that children should not use trampolines at home, where 93% of the injuries occurred, and that sales of the devices for home use should be halted. Nearly 500,000 trampolines for backyard use are sold each year.
Smith estimates that in 1995 hospital emergency departments treated 58,400 trampoline-related injuries -- up a stunning 98% from 29,600 in 1990. About half of children treated in ERs had sprains or other soft-tissue injuries. Younger children tended to injure their arms, necks and heads while older kids hurt their knees and ankles more often.
To put the problem in context, Smith writes that the number of trampoline injuries serious enough to require emergency treatment is double that of injuries from baby-walkers, an already well-documented hazard.
Quotable. "Sen. Rockefeller just corrected me. He's had more experience with these numbers than I've had." -- Sen. Arlen Specter (R-Pa.), chairman of the Senate Veterans Affairs Committee, after being reminded to use "billions" rather than "millions" in discussing VA healthcare budget matters by Sen. John D. Rockefeller (D-W.Va.), an heir to the Rockefeller oil fortune.