NHS & Wine: Simon Stevens----Sell then Sail?

Dr No:

Is this the sound of music for the NHS? Steven’s plans for the NHS are a big shake up for the NHS, but this time executed at a micro rather than macro level. His clear call for real extra public funding for a national health service – efficiency savings alone will not fill the black hole - will rattle politicians’ cages, but at the same he has a history of travelling on the other bus, including time at the giant American private health firm UnitedHealth, not to mention bowling from the pavilion end when advising the then Labour government about health in the early noughties. His answers this morning on the Today programme on the question of greater private sector involvement in health service delivery made up in broadness what they lacked in depth

My Take a while back.

The Cockroach Catcher was privileged to be having dinner with his good friend.

He covered the bottle when he served his favourite red wine.

"See what you think."

"Fully of blackberry and long with good tannin that has softened."

"1996 and the tannin will keep it going for another 5 years."

"Of all the recent great wines that you have served and that included the second wines of Lafite and Margaux, this is the most impressive. Just like our NHS!"

"But now you have one of the most impressive guys running it."

"Selling it, you mean!"

"I did not want to upset you."

"So you know about Simon Stevens. Not just wines then."

"You need to know that Britain is responsible for producing all the great doctors in the old commonwealth. My cardiologist was trained there. Look at Singapore, Australia & New Zealand, generations of doctors were all trained in the UK and in turn the next generations.

Why do you think that UnitedHealth paid so much to get one of the top UK guys to add a new perspective?

UnitedHealth is based in Minnesota, home of the famous Mayo Clinic and Simon Stevens is married to an American and they have school age children. As you well know, it is not easy for Americans to adjust to British life."

"So you think he is not going to last that long?"

"He has a very natural excuse!"

"Family!"

"Lets see what Bloomberg say:"

BRITISH EXPERIENCE

UnitedHealth followed up on June 30 with another report for lawmakers pinpointing $332 billion in savings through better use of technology and administrative simplification. If enacted, those changes would potentially benefit UnitedHealth's Ingenix data-crunching unit. Ingenix, with annual revenue of $1.6 billion, is poised to establish a national digital clearinghouse to ensure the accuracy of medical payments and provide a centralized service for checking the credentials of physicians.

Stevens, an Oxford-educated executive vice-president at UnitedHealth, once served as an adviser to former British Prime Minister Tony Blair. In that capacity, Stevens tried to fine-tune the U.K.'s nationally run health system. Today he tells lawmakers that theU.S. need not follow Britain's example. Concessions already offered by the U.S. insurance industry—such as accepting all applicants, regardless of age or medical history—make a government-run competitor unnecessary, he argues. "We don't think reform should come crashing down because of [resistance to] a public plan," Stevens says. Many congressional Democrats have come to the same conclusion.

UnitedHealth has traveled an unlikely path to becoming a Washington powerhouse. Its last chairman and chief executive, William W. McGuire, cultivated a corporate profile as an industry insurgent little concerned with goings-on in the capital. From its Minnetonka(Minn.) headquarters, the company grew swiftly by acquisition. McGuire absorbed both rival carriers and companies that analyze data and write software. Diversification turned UnitedHealth into the largest U.S. health insurer in terms of revenue. In 2008 it reported operating profit of $5.3 billion on revenue of $81.2 billion. It employs more than 75,000 people. 

Stevens argues that while UnitedHealth will likely benefit financially from health reform, the company will also aid the cause of reducing costs. He cites what he says is its record of "bending the cost curve" for major employers. 

During a media presentation in May in Washington, Stevens said medical costs incurred by UnitedHealth's corporate clients were rising only 4% annually, less than the industry average of 6% to 8%. But that claim seemed to conflict with statements company executives made just a month earlier during a conference call with investors. On that quarterly earnings call, UnitedHealth CEO Hemsley conceded that medical costs on commercial plans would increase 8% this year. 

Asked about the discrepancy, Stevens says the lower figure he is using in Washington represents the experience of a subset of employer clients who fully deployed UnitedHealth's cost-saving techniques, including oversight of the chronically ill. "These employers stuck at it for several years," he says. "We are putting forward positive ideas based on our experience of what works."

"Wow!"

"So there is not reason for him to leave UnitedHealth! They love him. The best of British & of Oxford!"

"Perhaps he has not left UnitedHealth!"

"So perhaps a sort of UnitedNHS then!"

"Well despite what people say about Obamacare, even Stevens concede that:

.....the U.S. insurance industry—accepting all applicants, regardless of age or medical history—make a government-run competitor unnecessary, he argues.

"NHS as such was the most serious competitor to the Health Insurance Industry. It is serious because there is not even any co-pay!"

"And quality is the same as the actual specialist doctor on either side are the same."

"Only the coffee is better!"

"Whatever Stevens plan to do is not something most of us can begin to guess but my suspicion is that it would not be to anyone's liking..."

"Except the Health Insurance Industry."

"So, he will not follow the US example of insurance industry accepting all applicants, regardless of age or medical history."

"No way!"

"You see, UnitedHealth has decided to leave California because of that."

"Not profitable!"

"If Insurers need to cover everything in England, they would think twice and most likely do a California thing."

"And Stevens can go back to America then!"

"So what is the wine?"

"Big Sail Boat!"                                                              

"Big Sail Boat?"

That the logo might have helped to sell a wine is unthinkable if the wine is no good. Ch. Beychevelle was fortunate enough to have a boat on its label and the Chinese just embrace it now that Lynch Bages hit the roof and there are too many fake 1982 Lafites around.

When my friend stock up on his Beychevelle, it was he told me, just a third of the price right now.

"It will be the next Lynch Bages."

"That is why 50% has been sold to the Japanese!"

"Wow!"             

So will Simon sell or sail? Or sell then sail!

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. 

New York:

Pomerantz Law Firm has filed a Class Action Against UnitedHealth Group, Inc. 
for Violations of Federal and State Mental Health Parity Laws - UNH

NEW YORK, March 12, 2013 (GLOBENEWSWIRE) Pomerantz Grossman Hufford Dahlstrom & Gross LLP has filed a class action lawsuit against UnitedHealth Group Inc. (“UnitedHealth” or the “Company”)(NYSE: UNH) and various subsidiaries, including United Behavioral Health.  The class action was filed in the U.S. District Court, Southern District of New York, and docketed under 13 CV 1599, alleging violations of federal and state mental health parity laws and other related statutes. The action has been brought on behalf of three beneficiaries who are insured by health care plans issued or administered by United and whose coverage for mental health claims has been denied or curtailed. These plaintiffs seek to represent a nationwide class of similarly situated subscribers. In addition, the action was filed on behalf of the New York State Psychiatric Association, Inc. (“NYSPA”), a division of the American Psychiatric Association, seeking injunctive relief in a representational capacity on behalf of its members and their patients.

California regulators seek up to $9.9 billion in fines from PacifiCare

The health insurer violated state law nearly 1 million times from 2006 to 2008 after it was bought by UnitedHealth Group, the Department of Insurance says. The fine, if there is one, is likely to be much less than the maximum allowed.'

UNITED HEALTHCARE INSURANCE AGREES TO PAY U.S.
$3.5 MILLION TO SETTLE FRAUD CHARGES

WASHINGTON, D.C. - United Healthcare Insurance Company has agreed to pay the United States $3.5 million to settle allegations that the company defrauded the Medicare program, the Justice Department announced today.

The government alleges that beginning in or about 1996 and continuing through 2000, United Healthcare's telephone response unit knowingly mishandled certain phone inquiries received from Medicare beneficiaries and providers and then falsely reported its performance information to the Centers for Medicare and Medicaid Services (CMS) concerning the company's handling of those calls. CMS is the federal agency charged with administering the Medicare program.

From October 2, 1995 to October 1, 2000, United Healthcare acted under contract with CMS as a Durable Medical Equipment Regional Carrier. Under that contract, United Healthcare processed Medicare Part B claims for durable medical equipment submitted to it by Medicare beneficiaries, physicians, and other health care providers and suppliers located in the northeastern United States.

"This settlement demonstrates our continuing commitment to pursue vigorously allegations of fraud and abuse in Medicare," said Peter Keisler, Assistant Attorney General for the Department's Civil Division. "Medicare contractors, along with other health care providers, can and will be held accountable for their billing practices. This settlement demonstrates our unwavering pursuit of fraud and abuse."

The allegations of improper conduct were brought to the attention of the government by a former United Healthcare employee, who filed suit under seal in November 2001 under the qui tam or whistleblower provisions of the federal False Claims Act. The United States recently intervened in the whistleblower suit.

As a result of today’s settlement, the whistleblower will receive $647,500 of the settlement amount. United Healthcare did not admit any of the allegations in the complaint in connection with the settlement. Under the False Claims Act, private citizens can bring suit on behalf of the government and share in any awards that are obtained through that legal action.

###

UnitedHealth & Simon Stevens: Your NHS! Your Money!

An Entrepreneur!         

UnitedHealth & Big Profits                                                                                                      - 

Dementia or NPH: A Challenge!

It is difficult to decipher the motivation to diagnose dementia with undignified haste by the present government when there is no real "cure" to speak of. The Cockroach Catcher was brought up to aim to diagnose treatable conditions than incurable ones. It is therefore not unreasonable to suspect that there are different motives: from refusing certain treatment such as hip replacement or organ transplants to promoting dementia medications by big pharmas.

In all the hasty announcements including paying GPs a fee for making such a diagnosis, no mention was made of a diagnosis that mimic dementia. 

 © Am Ang Zhang 2014    

Thirty years ago, I saw mountains as mountains, and waters as waters.

When I arrived at a more intimate knowledge, I came to the point

where I saw that mountains are not mountains, 

and waters are not waters. 

Thirty years on,

I see mountains once again as mountains, and waters once again as waters.

                                

 Adapted from Ching-yuan (1067-1120)

NPH: Normal Pressure Hydrocephalus

Normal pressure hydrocephalus (NPH) is a relatively new neurologic disorder of elderly patients described by Salamon Hakim in Spanish in a thesis in Bogotá, Colombia, in 1964 . It first appeared in the medical literature in English in 1965 in articles by Hakim and Adams  and Adams, Hakim, et al. NPH is characterized by an unusual triad of neurologic symptoms — impaired gait, urinary and/or fecal incontinence, and dementia — and an anatomic abnormality, i.e., enlargement of the cerebral ventricles that can be demonstrated by computerized tomography (CT) or magnetic resonance imaging (MRI) of the brain . Recently, another anatomic abnormality was described in NPH — a decrease in midbrain diameter on MRI  that is restored to normal by ventriculosystemic shunting . Surprisingly, the intracranial pressure of this unique type of hydrocephalus is normal, or nearly so.

The precise pathogenesis of NPH is not known, but it is well-known that despite the absence of increased intracranial pressure, the drainage of cerebrospinal fluid (CSF) regularly induces transient clinical improvement, and ventriculosystemic shunting (VSS) usually results in prolonged remissions . For reasons that are not clear, some “experts” still question the reversibility of NPH — and even its very existence.

The article is about the apparent lack of awareness amongst today's doctors although neurologists thankfully are more aware of it.

The article concludes:

Furthermore, other disorders of elderly people such as Alzheimer’s disease, Parkinson’s disease, and cerebral atrophy may show enlarged ventricles, and demential disorders may be difficult to differentiate from each other. As a patient with NPH who had erroneously been thought by a competent neurologist to have one of these other disorders for almost a decade [14], I know this differential diagnosis is very difficult.

Moreover, the criteria to define cerebral ventriculomegaly precisely are vague and difficult to establish, and enlarged ventricles are surprisingly common. Many neuroradiologists are reluctant to report borderline or even moderate degrees of hydrocephalus because such diagnoses raise complex, medical, and socioeconomic issues and inadvertently may lead to the performance of brain surgery in less than optimal surgical candidates. Although shunt insertion is not complex surgery and has low morbidity and mortality, it is not free of risk.

Finally, we believe strongly that elderly patients with these symptoms and their loved ones should have the right to make an informed decision as to whether they want shunt surgery, whatever the risk. The first author, having experienced end-stage NPH and having been essentially abandoned to his fate, did not feel that there was much to lose by choosing surgery. Happily, his dementia was subtle and his value center intact, which made the decision easy for him. Even though the decision may be more difficult for naive patients, they should be given the opportunity to make it after an unbiased presentation of the risks and benefits.

So please Mr Hunt and Mr Stevens, can we get the doctors to think NPH before Dementia!

Mysterious Psychosis: One Patient One Disease

Teratoma: An Extract,

It May Not Be All In The Mind

The Cockroach Catcher: NHS Reform: Choice?

The Cockroach Catcher: Empress' New Clothes

Mayo Clinic: Health Care Model? 

The Cockroach Catcher: Spring Rationing: Hospital Avoidance

NHS & Best Health Care: Private Medicine & Porsche!

Do we judge how good a doctor is by the car he drives? I remember medical school friends preferred to seek advice from Ferrari driving surgeons than from Rover driving psychiatrists.

My friend was amazed that I gave up Private Health Care when my wife retired.

“I know you worked for the NHS but there is no guarantee, is there?”

Well, in life you do have to believe in something. The truth is simpler in that after five years from her retirement, the co-payment is 90%.

He worked for one of the major utility companies and had the top-notch coverage.

“The laser treatment for my cataract was amazing and the surgeon drives a Porsche 911.”

Porsche official Website

He was very happy with the results.

“He has to be good, he drives a Porsche.”

Then he started feeling dizzy and having some strange noise problems in one of his ears.

“I saw a wonderful ENT specialist within a week at the same private hospital whereas I would have to wait much longer in the NHS.”

What could one say! We are losing the funny game.

What does he drive?

A Carrera.

Another Porsche.

We are OK then.

Or are we.

He was not any better. And after eight months of fortnightly appointments, the Carrera doctor suggested a mastoidectomy.

Perhaps you should get a second opinion from an NHS consultant. Perhaps see a neurologist.

“I could not believe you said that, his two children are doctors. And he has private health care!” I was told off by my wife.

He took my advice though and he got an appointment within two weeks at one of the famous neurological units at a teaching hospital.

To cut the long story short, he has DAVF.

I asked my ENT colleague if it was difficult to diagnose DAVF.

“Not these days!”

He had a range of treatments and is now much better.

All in the NHS hospital.

“I don’t know what car he drives, but he is good. One of the procedures took 6 hours.”

Best health care.

I always knew: Porsche or otherwise.

Related:

Best Health Care: France & The NHS

Friends moved to France after their retirement and lived in one of the wine growing districts.

 ©2008 Am Ang Zhang

They were extremely pleased with the Health Care they received from their doctor locally. After all, not long ago, French Health Care topped the WHO ranking.

Then our lady friend had some gynaecological condition. She consulted the local doctor who referred her to the regional hospital: a beautiful new hospital with the best in modern equipment. In no time, arrangement was made for her to be admitted and a key-hole procedure performed. The French government paid for 70% and the rest was covered by insurance they took out.

They were thrilled.

We did not see them for a while and then they came to visit us in one of our holiday places in a warm country.

They have moved back to England.

What happened?

Four months after the operation they were back visiting family in England. She was constipated and then developed severe abdominal pain. She was in London so went to A & E (ER) at one of the major teaching hospitals.

“I was seen by a young doctor, a lady doctor who took a detail history and examined me. I thought I was going to be given some laxative, pain killer and sent home.”

“No, she called her consultant and I was admitted straight away.”

To cut the long story short, she had acute abdomen due to gangrenous colon from the previous procedure.

She was saved but she has lost a section of her intestine.

They sold their place in the beautiful wine region and moved back to England.

The best health care in the world. 

Now we know.

Let us keep it that way.

Best Health Care: NHS GP & NHS Specialist

Does having a good hunch make you a good doctor or are we all so tick-box trained that we have lost that art. Why is it then that House MD is so popular when the story line is around the “hunch” of Doctor House?

Fortunately for my friend, her GP (family physician) has managed to keep that ability.

My friend was blessed with good health all her life.  She seldom sees her GP so just before last Christmas she turned up because she has been having this funny headache that the usual OTC pain killers would not shift.

She would not have gone to the doctor except the extended family was going on a skiing holiday.

She managed to get to the surgery before they close. The receptionist told her that the doctor was about to leave. She was about to get an appointment for after Christmas when her doctor came out and was surprised to see my friend.

I have always told my juniors to be on the look out for situations like this. Life is strange. Such last minute situations always seem to bring in surprises. One should always be on the look out for what patient reveal to you as a “perhaps it is not important”.

Also any patient that you have not seen for a long time deserves a thorough examination.

She was seen immediately.

So no quick prescription of a stronger pain killer and no “have a nice holiday” then.

She took a careful history and did a quick examination including a thorough neurological examination.

Nothing.

Then something strange happened. Looking back now, I did wonder if she had spent sometime at a Neuroligical Unit.

She asked my friend to count backwards from 100.

My friend could not manage at 67.

She was admitted to a regional neurological unit. A scan showed that she had a left parietal glioma. She still remembered being seen by the neurosurgeon after her scan at 11 at night:

“We are taking it out in the morning!”

The skiing was cancelled but what a story.

Anorexia Nervosa: Chirac & Faustian Pact

Related:

Enemy Of The People: NHS, Internal Market & Safety Net

First Emperor, Animal Farm & Allyson Pollock

NHS: Changes Or A Conspiracy Against The Public Interest

UnitedHealth & Big Profits: AMA & BMA

RBS, Lord Ashcroft, Priory & The NHS Reform

Best Health Care: France & The NHS

Tea! Tea! Tea!

BOH Tea Plantation©2014 Am Ang Zhang

Coffee in Panama – Faking Is Not ...

Myrtilles Sauvage & Geisha Coffee

Photography & Coffee Finca: Trees ...

Fakes: Breasts, Cameras, Wine & Coffee - The Cockroach ...

National Park & National Health: Lessons?

Photography : Best & Free!

Photography: Bokeh & Multiple Night Shots!

Photography: Spring Tulips.

Photography: Pictures at an Exhibition

NHS: Sunset & Endgame!

©Am Ang Zhang 2013 

It is like a game of chess! We must predict the next move by Clinical Commissioning Groups (CCGs). Or was it really the DoH?  Looks like endgame though.                            
Enter CCGs.

Soon, they may stop or refuse to pay for A&E attendances or their resultant admissions. Hospitals depend on that income. Other hospital referrals could be rationed.

Why are privateers so keen on GPs and CCGs. It is about controlling the flow to the hospital. Private patients need the specialist times and there is no better way than to control the flow.

If that takes time, help might be there: close some hospitals or what they are allowed to do. An excuse could be found easily.

In the new world order, they will fail and be closed or be bought by private companies. We have the regulator called Monitor that will see to it.

Is it really that difficult to grasp!

When there are not enough specialists to go round in any country money is used to ration care.

Rationing of Health Care is unpopular at the best of times and different ways have been tried by the previous governments first through Fund Holding and later PCTs.  

It would have been very unpopular for PCTs to continue to ration health. They have been doing it one way or another and it has been a costly exercise for some PCTs. 

It has even caused unnecessary deaths.

Like private companies, when one fails change the name, same staff, slight changes in titles. Same with regulators too. Just look around.

The current concern for the NHS Reform is perhaps too focused on privatisation. We ignore what CCGs could do at our own peril.

The main aim by some very clever people in government is that somehow there must be a way to limit health spending.

Integration of Health Care now carries a new meaning: integrated as long as it is all within the remit of Primary Care and not between Primary and Secondary Care. Yet there is only so much that Primary Care can do unless they started employing their own consultants and running there specialist hospitals. That is one way of saving money.

The other way is to refer to Any Qualified Provider, the new NHS speak for Private Providers. Better still if these are owned by the same organisations that own some of the GP practices. Believe me, it is already happening and it will spread.

How could this be done? Simple, NHS Foundation Hospitals will not stand a chance if they have to continue with the expensive and unprofitable conditions or expensive dialysis and Intensive Care that many private insurers will not touch. 

The new structure of HSCB is perfectly geared towards failing FT Hospitals. Some will survive through high levels of private work for those from wealthy countries. There is only a limited number of specialists to go round in England and in fact in most countries.

Which means that there will be a long waiting list for NHS patients!!!

Rationing by any other name.

Latest view from Hosptal Dr:

Do we really believe that CCGs, which this month ‘go live’, are going to be able to drive this? I keep hearing that hospital directors sit down with CCG representatives and agree all sorts of things for more progressive services; the CCG representative goes away, then makes contact a couple of days later saying they don’t have the authority to agree any of those issues they discussed. The hospital director shrugs their shoulders and gets back to the daily ‘fire fighting’.

The CCGs don’t have the authority, and the hospitals don’t have the resources.

So, that leaves the NHS Commissioning Board? Well, as far as I’m aware, they’re keen to offer support for reconfiguration as long as that support doesn’t actually cost them anything.

If you needed an example of how difficult reconfiguration is to broker in the NHS, just look at what a mess the national paediatric heart surgery review has become.

It leaves me to conclude that the government and the NHS can have all the policy in the world about how it is going to change, but unless it is significantly incentivised (and I’m not including ‘hospital failure’ as an incentive) then not much is going to change.

*Sigh*

A big portion of the NHS money will now be spent in the counting houses of the new Commissioning Offices. Gradually more and more of that money will be re-distributed to Privateers.

Those who could afford to will now get their own Health Insurance and when the Insurers refuse to cover some conditions you may have to return to the NHS. But who knows, it might just be too late then as those hospitals may no longer be there

In Health Care, death is irreversible.

Soon the sun will set!

The Telegraph

In the new NHS, everything will be about payment by results, because this is all the private contractors are interested in. All “clinical encounters” have to have an easily definable, objectively measurable end point.

But what about chronic conditions? Or treatments where the chances of success are low and complications high?

This is what saddens me: what were once the NHS’s strengths – resources, expertise and the united focus on the patient – are being replaced by a fragmented and atomised service, bound not by a duty of care but by a contract and driven, not by what is best for the patient, but by the cost of the encounter. It will be a slow, insidious creep but it’s coming. Be prepared. This is the way the NHS ends: not with a bang but a whimper.

                                                                

Enemy Of The People: NHS, Internal Market & Safety Net

First Emperor, Animal Farm & Allyson Pollock

NHS: Changes Or A Conspiracy Against The Public Interest

UnitedHealth & Big Profits: AMA & BMA

RBS, Lord Ashcroft, Priory & The NHS Reform

Best Health Care: France & The NHS