The healthcare industry faces a time of "fundamental economic discontinuity" that began in the mid-1990s, and managed care may be just the "most superficial" precursor of the kind of changes ahead, says Kaiser Permanente Chief Executive Officer David Lawrence, M.D.
Lawrence tells Outliers that Medicare payment woes, escalating healthcare inflation, "unfunded liabilities" imposed by state and federal regulators, skyrocketing pharmaceutical costs, pressure from purchasers and consumers, and incursions by the Internet and other new technologies will make for tough times ahead.
The result, he says, could be a "horrible specter or a huge opportunity" for American healthcare. But Lawrence believes that much of the clinical information that consumers now get from their doctors and hospitals will soon come to them from other, high-tech mechanisms, including Internet services and new "medical appliances" and home monitoring systems.
That could leave a lot of doctors, nurses and support staff looking for new opportunities. Or new jobs.
On the QT. A new firm in Nashville wants to provide stealth consulting to chief executives who need information to make decisions.
CEO Projects, founded by research veteran Robin Rose, wants to help CEOs at small to medium-sized organizations decide whether to pursue a business venture before they tell their underlings what they're pondering.
"It's often inappropriate for CEOs to rely on internal staff for decisionmaking support, particularly in their formative stages of defining an issue and the factors that impact it," Rose says.
The firm's services include market profiles and analyses, new product development, and competitive intelligence snapshots.
Rose brings with her experience handling accounts for such healthcare heavy-hitters as Cleveland Clinic Foundation and Cedars-Sinai Medical Center in Los Angeles.
Cushioning the blow. UCSF Stanford Health Care has taken a bit of heat for protecting 779 of its faculty physicians from a financial hit.
The physicians do managed-care contracting through a network run by San Francisco-based Brown and Toland Medical Group. To cover losses last year, Brown and Toland's professional services organization decided to withhold $4.5 million from its network doctors, including those at UCSF Stanford.
The four-hospital UCSF system expects to pay up to $1 million to the academic departments to cover their share of the missed revenues. In exchange, it will receive stock appreciation rights in the professional services organization.
UCSF Stanford denied the payment was a bailout as characterized by the San Francisco Chronicle, which cited criticism of the action by San Francisco-based advocacy group Consumers Union.
"It was just a decision that we wanted the departments to get what they were expecting," said UCSF Stanford spokesman Daniel Berman.
Enforcement with teeth. The Justice Department is taking a bite out of monopolies. Literally.
The antitrust division is suing Dentsply International, a manufacturer of false teeth, alleging that the company illegally strong-armed many of the nation's tooth distributors to keep them from selling rival products.
The government warned Dentsply last month that it would challenge the company's business practices.
Dentsply sells about 70% of the artificial teeth used in the U.S., the Justice Department says.
"This suit seeks to restore competition in the artificial teeth market so that consumers will receive lower-priced, higher-quality dentures," says Joel Klein, assistant attorney general for antitrust.
Dream, or pipe dream. It turns out that Hunter "Patch" Adams' dream of a free hospital in the mountains of West Virginia remains about as far from reality as some of the characters the doctor plays as a clown.
The hit Robin Williams movie "Patch Adams" ends with an epilogue telling audiences that construction of a free hospital is under way in West Virginia.
But so far Adams has raised just $1.1 million over 20 years for the $25 million hospital.
On 310 acres Adams bought on Droop Mountain there are a 6,500-square-foot workshop, a half-built Russian-style dacha, a two-hole outhouse and a cottage with an attached greenhouse.
There are no patients, just two staffers who answer an endless stream of calls and letters from people who've seen the movie and suddenly become enchanted with the concept of free healthcare.
Susan Cafoncelli, a Charleston nurse, grew disenchanted with Adams after a 1997 visit. "He is a great storyteller. He uses it to manipulate people" to give him money, she says.
Jon Luchs, who works for Adams, remains a believer. "There's a tendency to become unhappy when the ideal isn't realized or it becomes apparent it's going to take work," he says.
Insert joke here. The Journal of the American Medical Association recently updated its look, but now it seems its content is getting more topical, too.
The Jan. 20 issue of JAMA has an eye-popping report on research into what constitutes sex, and it appears to back up President Clinton's legalistic definition of the act. According to the study by Indiana University's Kinsey Institute for Research in Sex, Gender and Reproduction, 60% of college students surveyed in 1991 said oral-genital contact did not constitute "sex." Further, 85% said "manual stimulation of the genitals" wouldn't constitute having "had sex."
The authors of the study write, "Recent public discourse regarding whether oral-genital contact constitutes having `had sex' highlights the importance of explicit criteria in contrast with implicit assumptions in this area. Unfortunately, a review of the literature demonstrates that empirical exploration of what is included in definitions of having `had sex' for the general public remains scant."
Incidentally, when queried about their political position, 79% of the 600 respondents said they were moderate to conservative. Politically, that is.