Author Archives | Richard

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Social Risk

August 23, 2017


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Check out this JAMA Article. What it says, I think, is that if payment programs ignore the special efforts that some disadvantaged subpopulations require on the part of physicians to ensure the success of their medical care, doctors trying to provide the best care that they can for such groups will get short changed at the pay window.

I say “I think” that is what it says because, as with so many physician compensation plans, it is one thing to identify a potential problem, and another thing to try to eliminate the inequities that have been identified. Talk about partnering with community agencies and turning physicians into social workers, IMHO, does little to improve the clarity of the situation.

Bottom Line. This kind of thing always scare me. The more I hear issues like this brought up, the more I start to see the inevitability of a one payer system. NHS comes to the U.S.

As usual, stay tuned!

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Yup, That’s What I Would Say…

August 22, 2017



if I were the “top executive at CVS Health.” A company that has seen its stock depressed as rumors of Amazon entering the pharmacy space have circulated through the investment community.

I’d say that there is no way Amazon is going to enter into our pharmacy space. Pharmacy is too clinical, so it can’t be done by a retailer like Amazon. Besides, there are too many relationships that need to be struck with insurers. They can’t handle that!

Bottom Line. If I were a betting man, I would wager that Amazon WILL enter the pharmacy space. And do so with great ease, actually.

My next bet would be that with Amazon’s expertise in customer engagement, they will rapidly run circles around traditional pharmacies. With technology like “dash buttons, ” that Amazon uses to let you buy all kinds of things by simply pushing a button, think what they could do for patient compliance!

Stay tuned!

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What’s in A Word?

August 21, 2017


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This physician’s post supports my notion that the right answer to this question is “A lot!!!”

More specifically, this blogging doctor believes that it is extremely important that his patients view the front of his office as the “reception area,” rather than as the “waiting room.” In fact, he works very hard to keep on schedule, thus leading to a patient experience that is consistent with this terminology.

Bottom Line. I can think of no more elegant summary statements than those provided by the blogger:

“The space is the same but the intent is different.”

“Language is powerful in healthcare.”


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Indiana Doctor Murdered for An Opioid Prescription???

August 18, 2017


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Yup. That’s what it says in this article. An Orthopedist refuses a prescription for an opioid to a patient complaining of chronic pain, and pays for that decision with his life at the wrong end of a gun in the parking lot.

I’m not sure what to add to this story, since its horror largely speaks for itself. BUT. Note the comments of his colleagues at the funeral.  Quietly whispering if refusing an opioid prescription is a wise thing for a doctor to do in 2017, while also wondering whether they should continue to prescribe opioids!!!

Bottom Line. Doctors and other health care professionals are increasingly facing the fact that their jobs are hazardous. Hell, they are on the front lines with dope crazed characters like the one that did in Dr. Todd Graham!

As is so often the case, I wish I had a few words of wisdom as to what to do to make this situation better. I don’t.

But I can tell you that if this keeps up, we can expect to see a fundamental change in the psychology of the physician as it relates to encountering patients.

And. You might start to see, even in Indiana, what I used to see in the tougher areas of Philadelphia when I started my career doing personal interviews in physicians’ offices. Armed guards at the door!

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Immediate Gratification

August 17, 2017


Screen Shot 2017-08-10 at 6.58.09 PMYup. This sort of makes sense. Check out this piece. What you will find is that as healthcare costs have gone up over recent years, employers have significantly reallocated their percentage of spending on employee benefits. Whereas the majority of their spend used to go to funding employees’ retirement, two-thirds of their investment in their work force is now going to current health insurance premiums. Reportedly, that focus on immediate gratification rather than long term planning is keeping the employers happy with a healthy work force, and the employees happy with reduced monthly premiums.

Bottom Line. YEAH, BUT. Given the minimal amounts that many Americans have put away for retirement on their own, this trend seems like one that will eventually bite us all in the rear end. 

Stay tuned! 

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The “Upside Down” World of Pharmaceutical Pricing

August 16, 2017


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Check out this NYT story. Trust me, I couldn’t make this stuff up.

Seems that in order to hold on to market share when their product is about to go generic, branded pharmaceutical companies are striking deals with payers and PBM’s that make more money, for those organizations, if patients are made to buy the brand and pay a large copay rather than buying the generic. As you can see in this story, patients like the guy pictured above are confused, and not trivially upset, by this practice and the extra money that it costs them out of pocket.

Bottom Line. Clearly, patients being put into this situation are entitled to a bona fide explanation as to why the direction to request a generic doesn’t work in certain cases. I’ve stared at the wall for 20 minutes, and nothing has come to me for us to say that is going to make these people feel any better. 

Any ideas?

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“Patient Bias???”

August 14, 2017


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Today, a little more on the “Health Psychology” theme we talked about in our last blog. Check out this post. Then try to figure out whether it is physician bias, or patient bias, that accounts for more of the good and the bad behavior we see in the treatment world.

Obviously, a trick question. What really cooks the stew is when physician biases interact with patient biases in the treatment setting. Take “action bias,” i.e., the desire to do something, anything, that we talked about recently in our post about antibiotic abuse. Who has the action bias? Both the patient, who wants something done for her condition now, and the physician who wants to please the patient with an Rx and likely end the office visit by doing so.

Bottom Line. Actually, this time it is a BTW. Let me remind you that the seminal book referenced in this post, How Doctors Think, is a must read for anybody in our vertical. I’ve mentioned this one before. If you didn’t read it the last time that I commended it to you, this is your second (But probably not your final, it’s that good!) notice. So, download this puppy to your Kindle and read it. Now!

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The Psychology of Antibiotic Abuse

August 11, 2017


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Yup. You read that right. Antibiotic abuse, not opioid abuse!!!

Check out this article. Duh! What you will see in this piece is the revelation that there are multiple/documented reasons for physicians overprescribing, and patients over requesting/consuming, oral antibiotics. As I have been preaching for a long time, there is a body of knowledge, Health Psychology, that needs to be carefully drawn upon to understand behavior here, and to intelligently craft plans to change it.

First, we need to understand that consumers don’t act any more rationally in healthcare than they do in any other segment of their lives. There are considerations like the “action bias.” I have a chest cold with a bothersome cough. I want to do something about it, damn it! Now!!! And “discounting the future.” I have that cold now. What do I care if by prescribing an antibiotic for me, which I will probably take half of, my doctor and I are screwing up antibiotic efficacy for future generations?

As the authors sagely summarize, another educational poster is not going to alter this manner of thinking!

So, what does Behavioral Psychology say will make a difference here? Suggestion. Physicians are competitive. Enter them into competition with their colleagues and offer feedback as to which doctors are prescribing antibiotics most conservatively.  Studies indicate that seems to work!

Bottom Line. People, we need to get over the notion that simply giving people information and dire predictions of some outcome in the distant future will influence health behavior. Everybody, and I do mean everybody, in our vertical should have on their shelves for easy reference copies all of the books referenced in this article. Maybe everybody should even read them. If they did, they would get a great start toward understanding Health Psychology, and how this body of knowledge can help us to help patients behave better in the management of their healthcare.

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August 10, 2017


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“Dr. Bob,” the “academic internist” pictured above, makes an important point in this blog post.  All well and good, he maintains, to have carefully thought out guidelines for treating medical problems. BUT. He points out that as much thought must be given to figuring out which patients are appropriate for treatment with these guidelines as to the guidelines themselves. So often we talk about treatment guidelines. How about diagnostic guidelines.

Bottom Line. Yup! And there also needs to be guidelines on how to double back and reconsider what to do when guidelines fail a particular patient!!!


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The Good Old Days

August 9, 2017


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I don’t have anything very profound to say about the picture above. Not even a URL to send you to. Nope. Just a shot of nostalgia for those of us who are old enough to have been in the pharmaceutical industry when all of those pens, and myriad other giveaways (coffee mugs, clipboards, etc.) were being distributed by the car load by Pharmaceutical Sales Representatives.

Bottom Line. Seems like a long time ago that Product Managers believed that such token gifts could influence prescribing. BTW, if they did, the pictured Cardiologist must have been very busy prescribing every product in the PDR!!!



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