Thursday, October 24, 2013

UnitedHealth & Simon Stevens: Your NHS! Your Money!

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© Am Ang Zhang 2009





Simon Stevens: now with UnitedHealth

Now Stevens is to play a crucial role in presenting the more responsible face of American healthcare and in persuading the key players in Britain that they need to allow companies such as his into the NHS. Recently UnitedHealth's European division won the right to take over two GP practices, in Normanton and Cresswell in Derbyshire. Stevens, who was running the European division at the time, was key to winning the contracts.

The company is a huge force within US healthcare, with 70 million Americans on its books, employing 400,000 doctors in 4,000 hospitals. UnitedHealth is America's biggest health insurer. And it's growing in influence in Britain.
It already runs two GP practices in Derbyshire and now the government has given the green light to 14 companies, including United, to bid for potentially much bigger contracts from the primary care trusts that run hospitals. They would be paid for providing data analysis and research, giving trusts a clearer idea of how to manage patients with chronic conditions such as diabetes.
But their role may be bigger than that. Companies may also be invited in to act as middlemen, negotiating with hospitals on the trusts' behalf to reduce costs, ushering in the prospect that some patients may find their care plan managed not by a doctor but by an American insurance company.
Allowing UnitedHealth and others into the NHS fills the unions and many health workers with horror. That dismay will be amplified when they watch Michael Moore's latest film, Sicko, which alleges that United and other big US insurers routinely deny care for patients who may be critically ill.

In the WSJ there was a report:
“……UnitedHealth Group Inc. (UNH) agreed to pay $912 million to settle two class-action lawsuits regarding its stock-options practices……”

Rewind to last year in the New York Times:
“In one of the largest corporate pay give-backs ever, William W. McGuire, the former chief executive of UnitedHealth Group, has agreed to forfeit at least $418 million to settle claims related to back-dated stock options.”
How very sad! $418 million is a lot of money!
“The payback is on top of roughly $198 million that Mr. McGuire, an entrepreneur who built UnitedHealth, had previously agreed to return to his former employer.”
An entrepreneur! This reminded me of Dr Crippen’s blog about NHS entrepreneurs, and I duly alerted him. UnitedHealth is said to cover the Health Insurance of 70 million US Citizens.
“As part of the settlement with the S.E.C., Mr. McGuire will pay a $7 million fine and will be barred from serving as a director of a public company for 10 years.”
Oh, no, another $7 million and 10 years! You must feel sorry for him.
“He will, however, be allowed to keep stock options valued at more than $800 million, including many that have been sharply criticized.”


Jul 20, 2010
UnitedHealth Profit Jumps as Medicare, Medicaid Grow
UnitedHealth Group Inc., the biggest U.S. health insurer by sales, raised its full-year profit forecast after increased enrollments and lower-than-projected medical costs lifted second-quarter earnings 30 percent.

The insurer forecast 2010 profit of $3.40 to $3.60 a share compared with a previous projection of $3.15 to $3.35, citing growth in sales or membership for all business units. Net income rose to $1.12 billion, or 99 cents a share, for the quarter, from $859 million, or 73 cents, a year earlier, the company said today. The earnings and forecast topped estimates.

Chief Executive Officer Stephen Hemsley boosted enrollment in Medicare Advantage, the U.S.-backed program for the elderly. Weakness in the economic recovery in the U.S. also helped, by keeping people away from doctors and hospitals, said Jason Gurda, a Leerink Swann & Co. analyst in New York. UnitedHealth did better than expected for commercial enrollment, taking business from rival insurers, he said.

October 18, 2006
UnitedHealth's Options Scandal Shows Familiar Symptoms

Stephen Hemsley, who upon being hired in June 1997 was presented with 400,000 stock options with an issue date of five months earlier. Hemsley told the Wilmer Hale lawyers that he "didn't recall focusing at the time" on the $2.9 million gimme he'd just been handed as a result of the backdating.

You might say that Hemsley comes honestly to his lack of focus and ethical sensitivity. Before coming to UnitedHealth -- I'm not making this up -- he'd spent the previous 23 years at Arthur Andersen, rising to chief financial officer. That's the same accounting firm that helped bring you Enron, WorldCom and Freddie Mac. And, you'll be shocked to learn, it's the same Arthur Andersen that served as a consultant to Spears and other members of UnitedHealth's compensation committee.

Hemsley was rewarded for his lack of focus by being named to succeed McGuire as chief executive. He was also directed to root out the senior executives in the legal, accounting and personnel departments who provided the bad advice on which the board and chief executive now say they have relied. Hemsley, too, has volunteered to reprice his options.

The reward:
Chief executive Stephen Hemsley pulled in $102 million in 2009, with $98.6 million coming from exercised stock options, according to a filing with the Securities and Exchange Commission Wednesday.    Star Tribune

Friday 16 July 2010
The Minnesota-based firm beat Bupa and Humana to win the contract from the health department to advise PCTs

The Minnesota-based UnitedHealth has already become a key adviser to primary care trusts (PCTs) on commissioning health services and operating bids to run GP practices. Earlier this month it beat Bupa and Humana, another US health insurer, to win the contract from the health department to advise PCTs.

The decision follows successful bids to run two GP practices in Derbyshire in 2006 and three practices in central London in 2008, taking over from the Brunswick Group. In April the company announced a 21% increase in profits for the first three months of the year to $1.2bn (£784m).

United said it brought high level management expertise and efficient provision of services to the UKhealth service but it has faced accusations of overcharging and malpractice in a series of legal suits.

New York Settlement:
January 15, 2009 
UnitedHealth Group Inc., the biggest U.S. health insurer, said it will spend $400 million to settle allegations it has manipulated payments to doctors and patients for the last 15 years.
The company agreed to put $350 million into a class-action restitution fund to pay physicians and policyholders for services provided by out-of-network providers, the company said in a statement today. On Jan. 13, the Minnetonka, Minnesota-based insurer settled allegations from New York Attorney General Andrew Cuomo by paying $50 million and transferring to a nonprofit group its database that set the amount to be reimbursed when patients used doctors outside their network.
UnitedHealth has been battling the largest physician group, the American Medical Association, over out-of-network costs since 2000. The settlement affects less than 10 percent of health benefits because most policyholders use their health plan’s network providers to minimize out-of-pocket expenses. Still, the AMA said it stopped rampant cheating Its California subsidiary was fined a record $3.5m in the same year for mishandled claims against patients and doctors. In 2006 The UnitedHealth chief executive William McGuire resigned after an investigation "concluded he had received stock option grants 'likely backdated' to allow insiders to maximise financial gains." During his tenure as chief executive, McGuire was granted more than $1.6bn in stock options. In 2007, McGuire avoided trial after he agreed to repay $468m.


In one example, Cuomo’s office said that when $200 was a fair-market rate for a 15-minute doctor’s visit for a common illness, Ingenix said it was $77. UnitedHealth would pay $62 when it should have paid $160, leaving the consumer with a $138 bill.


Forbes:

I recently learned that this month a class-action lawsuit has been filed against California United Behavioral Health (UBH), along with United Healthcare Insurance Company and US Behavioral Plan, alleging these companies improperly denied coverage for mental health care.
According to the class action lawsuit, United Behavioral Health violated California’s Mental Health Parity Act, which requires insurers to provide treatment for mental-health diagnosis according to “the same terms and conditions” applied to medical conditions. Specifically, the insurer is accused of denying and improperly limiting mental health coverage by conducting concurrent and prospective reviews of routine outpatient mental health treatments when no such reviews are conducted for routine outpatient treatments for other medical conditions.

The British Medical Association may now have a new role.




The future is here now:




Ex-NHS:

Patricia Hewitt: now with Cinven (Bupa Hospitals)






Related:





Tuesday, October 22, 2013

Grand Central: 100 Years!

©2013 Am Ang Zhang

©2013 Am Ang Zhang
22 million visitors a year.

10 million oysters a year at Grand Central Oyster Bar.

Book:

Saturday, October 19, 2013

PTSD: To talk or not to talk!

Angst

You never quite forget the hell of it,
the smell of it:
charred flesh and cordite;
and the never ending mortar fire
and sometimes you go mad with it.

I body-rock:
rhythmic repetitive like a ticking clock,
tick-tick-tick, to-and-fro
not side-to-side like a stick insect
and he asks:
how do you feel about this;
and I say I don’t know,
not being arboreal I have never lived in trees.







©2013Am Ang Zhang  
It seems to be against common sense to suggest that talking may not be good for severe traumatic experiences. This is more so for someone brought up on psychoanalysis; yet, the evidence is clearly against talking especially in severe trauma.
In 
The Cockroach Catcher:
The speaker was a Senior Registrar from the Maudsley.

"......He was a Registrar at the time of the King’s Cross fire. He was just coming out of the station when the accident happened, and so was at the front line so to speak not just as a pedestrian but also as a psychiatrist. He became interested in PTSD (Post Traumatic Stress Disorder) and did a fair bit of research on King’s Cross and other disasters.

He quoted a number of cases, including the Herald of Free Enterprise disaster. There were those who despite help of all kinds would commit suicide. Many were heroes in that they saved many lives. Yet the feeling that they did not deserve to live eventually overtook them and they committed suicide.

What was most surprising was how the group that had counselling generally faired worse, much worse than those without any counselling. The group that did best were the ones that drank, and drank a fair amount.

It was not his intention to promote vodka but he thought we could not be kept from the truth……

His research showed that talking about the incident seemed to make things worse, much worse than anyone ever imagined……”
Then he remembered 
Kim Phuc:
“By rights possibly one of the most damaged psychologically and physically. She underwent no fewer than seventeen operations. The photo of her running down the street of Saigon naked probably changed the course of the Vietnam War and the world’s perception of good and bad. Then came her dramatic escape in 1992 to Newfoundland and her eventual settling down in Canada. Human resilience is not to be underestimated and the imposition of psychological intervention could represent a great under-estimation of our genetical endowment. At one of her public lectures, one of the war veterans who was a helicopter gunner broke down.”
Kim Phuc never had any therapy.

We have to be aware that a whole industry has sprung up based on very inexact theories and it is nice to know that the earlier findings in England have now been 
confirmed across the pondIn cases where mental conditions are entangled with compensation claims it becomes especially difficult to be truly objective.

On the matter of psychotherapy, a good deal of current blog comments are hostile to therapists and their methods. A good therapist is hard to come by, and should be like a wise aunt or uncle to whom one turns to for advice that one may or may not accept or act on. A good therapist needs to be intelligent and broad-minded, and mature with rich life experience. A bad therapist, on the other hand, takes over and does not allow for any leeway on how one should continue with life.

We may forget too that good therapy is for life, and may be more useful for the mentally healthy than for the mentally sick. What government or insurer would allow for that?

Here I will have to quote my Guru again:

“A Therapist is like a toilet really: some may need it three or five times a week; others once in a while. Some patients may have a sort of mental diarrhoea and require therapy sessions more often.”

My only gripe is that where money is involved, one needs to be cautious: the best advice in life is free, like those from your wise aunt or uncle, if you are lucky enough to have one.




Part II:

Then came September 11. I remembered I was on holiday in Spain when it happened. I had just finished golf. I put my clubs away and went to the club house for a drink with my playing partners. As I approached their table, I sensed that something was wrong. There were no drinks.
         Then one of them said, “One of the World Trade Center Towers is down!”
         I was trying to see if I heard right.
         “In New York?”
         “New York.”
         Then moments later, the Spanish waitress came out and said to us, the second tower was down too.
         I rushed back to our villa and shouted to my wife to turn on CNN and tried to contact our children, one of whom worked in Manhattan.
         Lines were dead.
         Luckily, an Email came through our other daughter who was in England: Sis OK, at a meeting on 55th Street. Now trying to walk home to Brooklyn.
         What a shock.  Unlike my parents’ generation we have had a long period of peace and prosperity but now everything was shattered.
         The following day my office put a call through and I talked to my Associate Specialist.
         The clinic just had an urgent referral. A local girl was referred. Very disturbed by what happened as one of her father’s good friends was one of the pilots whose plane went down. The family spent many holidays with them in their Florida home and she was now most upset.
         “Whatever you do, by all means talk to the parents but not to the girl. No one should see her. They should not turn on the TV and avoid any reminder of what happened.”
         I then nearly said, “Give her Vodka, Gin or similar,” but I did not.
         I gave the next best thing.
         “Put her on a short course of Benzodiazepine to let her sleep for a few days.”
         It shocked my Associate Specialist. It was not a drug I normally used, if at all, and why now?
         Well, whatever happened, all I could say was that the family was in total agreement and months later my Associate Specialist told me that it was brave of me but it seemed to have worked for this girl.
        
        
         In July last year I met a young couple at the swimming pool of our holiday condo. I thought they were Chinese but it turned out they were Vietnamese Chinese.
         We started chatting. He said he left Nam (Vietnam) on the last day.
         Jokingly, I said, you mean you were on the Helicopter?
         “Yeah, how did you know?”
         “You looked too young to be working for the Embassy.”
         “My mum worked there. But my story was nothing, you should hear hers.”
         His wife, an elegant looking petite Chinese swam closer.
         “So, tell me.”
         Well, she came out later. Her mother put her and four sisters on a junk (a Chinese fishing boat), one of those that took refugees out of Nam for an exorbitant fee and generally it had to be gold. Their boat sank outside Hong Kong but they swam ashore. She spent the next three years in one of the Hong Kong camps.
         “Yes, I remember those.”
         “I know - the stench. We got used to it.”
         Those camps were run under the auspices of the United Nations but the UN never really paid Hong Kong a single dollar. However that is beside the point. Conditions were very poor and one could hardly decide if it was Hong Kong’s or UN’s fault. Every time we drove past it was like passing a local authority rubbish tip. We had to wind up the windows. Yet there were politicians who felt they needed to keep it bad to deter people. They continued to flow in right up to the handover. As it was still under British rule, Britain tried its best to keep people from going to Britain. They needed not have worried. Most wanted to go to U.S. An irony really.
         I said something that sounded like an apology, an apology for Hong Kong, and for mankind.
         “No. It’s fine. I am not bitter. We waited and we got to the U.S. There was nothing you could have done anyway.”
         She told me someone suggested that she should have some therapy. She never did.
         “Some things you can never change. If it happened it happened.”
         But she managed to get most of her family out of camps and settled in the US. She was very successful in her business and her only regret was that her parents never made it.
        
         What a story of human resilience and triumph over adversities.
         And I can still remember that lunch time meeting and the learning from King’s Cross.


©2013 Am Ang Zhang

Now mountains are once again mountains,
and waters once again waters.



NHS: The Way We Were! Free!
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Email: cockroachcatcher (at) gmail (dot) com.

Thursday, October 17, 2013

Child Psychiatry:Faking & Profiling!

©2012 Am Ang Zhang 
This really happened. The name has been changed.

Rachel

Rachel could not get to school. She was having such bad back pain. Her family doctor wrote an urgent referral. As she would not see the psychologist at school, school was considering taking mother to court.
          There was a change in managing school refusal. Education Authorities suddenly turned trigger happy and all over the country parents were taken to court. I did wonder if this was due to a shortage of Educational Psychologists who were now too busy dealing with Formal Assessments as a result of the new Education Act, or whether it was due to years of public criticism of the inadequacy of the softly softly approach to the problem. There is some truth that there is a hard core of children whom no teacher really wants to see at school and the authorities are quite happy they are absent. These are children who are entitled to free meals and the hidden saving of them not attending school adds up to a pretty substantial sum. To assess them would take up precious Psychologist time and also may generate expenses in terms of ferrying these children by taxi to special tutorial units or schools.
          But Rachel came from a professional family. Mother was a lawyer and father an insurance executive commuting to London. Yes, Rachel had some problems a year earlier because of her height. She did stop attending school for a while, claiming she had pain in her back. She was way over the 98th percentile for height. Some strong pain killer prescribed by her doctor seemed to have done the trick and she had not been absent until the present attack of pain.
          Clinical judgment is indeed a kind of “profiling”. We judge our patients from a variety of information and we “profile” them. It may not be correct but we do.
          I had my suspicion that the Educational Psychologist never got to see her record to realise that she was not really the type anyone should ever dream of prosecuting.
          The family doctor thought that I should be given a shot before anyone should have a go. Mother was told in no uncertain term that she needed to get Rachel to see me.
          “But she was in such pain!” mother said.  She did protest but in the end succumbed. With the help of a neighbour, they managed to get her to the clinic and she was lying down in our waiting area.
          I had one look at Rachel, perhaps 6 ft tall, lying flat in the waiting area and asked my secretary to call an ambulance whilst I talked to the Radiology Consultant. An X-ray examination was ordered and if necessary an MRI scan.
          How could I come to such a decision without even spending half a minute with mother or the patient? Was I being over dramatic? Or was it what we have been trained for? Was it why psychiatrists are trained as doctors first?
          I could of course have been entirely wrong and the girl might really have been school phobic. Would I have subjected her to an unnecessary X-ray examination? Would my reputation suffer as a result?
          The ambulance came. The paramedics were excellent. They treated it as potential spinal injury and transported her that way. I accompanied her onto the ambulance. You had to see her face to know you were right. She was grateful someone believed her. For me it was worth all the drama. My only wish was we were not too late that she might not be able to walk.
          Mother too shook my hand as the ambulance got ready to go. I always told my juniors. “Trust them, most of the time.”
          I left a message for the radiologist to call me.
          The call came back from the radiologist. She had two collapsed vertebrae, a common condition among very tall children who have just had a growth spurt. The Orthopaedic Surgeon was preparing for an emergency operation.
          “Good work.” The radiologist said.
          I knew. He meant: “Good work for a psychiatrist, and a child psychiatrist at that.”
          Some time later mother arranged to see me to tell me in detail what was done.
          “She wants to thank you for believing her.”
         
          I was just doing my job.
Profiling?©2012 Am Ang Zhang 


The Cockroach Catcher on Amazon Kindle UKAmazon Kindle US

More photos in the full preview of:
” Looking For Sting Ray”

Monday, October 14, 2013

Freedom of Speech: Truth & Thalidomide!

“Only truth is libellous”, one of my Gurus told me when I was a Registrar in a psychiatric unit in a London District General Hospital, England. Before then, I always thought that if you told a lie about someone and he was “defamed”, or “hurt”, then that constituted libel.


If you look at a few famous cases, you will begin to wonder.

Case 1 – Preying on Hope, Charlatan and Sharks
The libel action brought by a former consultant cardiologist in a leading London teaching hospital against Channel 4 over the programme 
“Preying on Hope” (broadcast in 1994) eventually collapsed.
The 
BMJ reported:

“A £2m libel action brought against Channel 4 by a former consultant cardiologist at one of London's leading teaching hospitals collapsed last week after he admitted that errors in scientific papers coauthored by him appeared to be 'more than an honest slip of the pen'.

Dr Peter Nixon, a consultant at Charing Cross Hospital until his retirement six years ago, withdrew his action and agreed to pay £765,520 in costs to Channel 4, which he claimed had branded him a charlatan, unfit to practise medicine.
Dr Nixon, who claimed that hyperventilation could cause a range of illnesses, including many heart attacks, Gulf War syndrome, post traumatic stress disorder and premenstrual tension, sued Channel Four, Mr Campbell, and his company Investigation and Production (TV) Limited over the programme "Preying on Hope," broadcast in February 1994. The programme secretly filmed and recorded a consultation with an AIDS patient, Ian Hughes, who died in 1996.”


BMJ commented:

“We all make the odd error, but to ascribe HIV associated lethargy to overbreathing and treat with valium is a little stranger than odd.”

After being landed with a bill of nearly £2m for this case, the Medical Defence Union announced that it would no longer defend libel action for its members as a matter of course.

Case 2 – The MMR Autism scareDr Wakefield, who started the MMR Autism scare in 1998, sued Channel 4, 20/20 Productions, and the investigative reporter Brian Deer, who presented the Dispatches programme MMR: What They Didn't Tell You in November 2004. The programme criticised his methods and accused him of undisclosed conflicts of interest. His action was funded by the Medical Protection Society.
In 2007, he dropped his libel action, as reported by 
BMJ.

Case 3 – The Politician and his Paris hotel billThe most famous libel case in recent times must belong to, you have guessed it, a politician: Jonathan Aitken. The Guardian claimed that he (then Defence Minister) stayed at The Ritz in Paris at the expense of his Saudi friends, whilst he swore on oath that his wife paid the bill. He lost and was sentenced to 18 months for perjury. He once famously declared:

"If it falls to me, to cut out the cancer of bent and twisted journalism in our country, then with a simple sword of truth, and the trusty shield of traditional British fair play, then so be it."

In a BBC article on the retirement of the renowned libel lawyer 
George Carman QC, the BBC commented:

“But Mr Carman's defence of the Guardian newspaper when disgraced former minister Jonathan Aitken took a libel suit against it, was one of his most celebrated cases.”

Case 4 – Defamation of McDonald’s?   


What about defamation of big corporations? Can anything be bigger than 
McDonald's Restaurants v Morris & Steel case? The English court action for libel filed by McDonald's Corporation against the two penniless environmental activists McDonald’s lasted seven years and was eventually declared by European Court of Human Rights (ECHR) to be in violation of the Convention on Human Rights.

The 
Guardian reported:
“……two penniless environmental campaigners who were sued by McDonald's, the global burger chain, yesterday won a ruling at the European court of human rights……Despite the obstacles, the two campaigners won a ruling from the high court that some of the claims in the leaflet were true, in what was described as 'the biggest corporate PR disaster in history'. Mr Justice Bell ruled that the leaflet was correct when it accused the company of paying low wages to its workers, being responsible for cruelty to some of the animals used in its food products, and exploiting children in advertising campaigns.”

Notice the word “true”!


Case 5 – The Truth about Thalidomide Given the lack of a constitution enshrining free speech, we do need some protection against frivolous libel actions and injunctions which try to prevent the truth from being revealed. Otherwise the truth about thalidomide would never have been told.

Luckily, the 
European Court eventually ruled for The Sunday Times:

“The newspaper then decided to fight the injunction on its investigation into the origins and testing of the drug. The case went right through the British legal system and up to the European Court of Human Rights, which decided that the injunction violated the right of ‘freedom of expression’. The full story of thalidomide could eventually be told in 1976, revealing that both GrĂ¼nenthal (the maker) and Distillers had not met the basic testing requirements of the time.”

I mentioned thalidomide also because in 2002 Gordon Brown, the then chancellor, attempted to tax the benefits payable through the Thalidomide Trust.



Unbelievable.

Saturday, October 12, 2013

Hello Autumn: BBG1 & Eugene Onegin!

Brooklyn Botanic Garden©2013 Am Ang Zhang 
Brooklyn Botanic Garden©2013 Am Ang Zhang 
Brooklyn Botanic Garden©2013 Am Ang Zhang 
Brooklyn Botanic Garden©2013 Am Ang Zhang 
Brooklyn Botanic Garden©2013 Am Ang Zhang 
Brooklyn Botanic Garden©2013 Am Ang Zhang 

Book:
Netrebko describes the challenge of Tchaikovsky’s deceptive simplicity in this score. When she was first learning the Letter Scene a decade ago with Gergiev, “he told me: ‘There are four phrases with the same melody, but you have to sing them in different ways!’ It ultimately sounds very simple, but that’s the hardest part of all. But I love the Letter Scene because, as challenging as it is, it’s so full of color and internal feelings, impressions, experience.” 


Hello Summer: BBG 2.
Hello Summer: BBG 3.

Hello Summer: BBG4.