Occasional Brief Observations: November 2013

Saturday, November 30, 2013

Random chart - job loss

Source: Calculated Risk "... There are still almost 1.0 million fewer private sector jobs now than when the recession started in 2007..."

There are still almost 1.0 million fewer private sector jobs now than when the recession started in 2007.
Read more at http://www.calculatedriskblog.com/2013/11/schedule-for-week-of-december-1st.html#DM2G7xpfPQuPWqbg.99

The economy has added 7.8 million private sector jobs since employment bottomed in February 2010 (7.2 million total jobs added including all the public sector layoffs).

There are still almost 1.0 million fewer private sector jobs now than when the recession started in 2007.
Read more at http://www.calculatedriskblog.com/2013/11/schedule-for-week-of-december-1st.html#DM2G7xpfPQuPWqbg.99

Wednesday, November 27, 2013

Patience

patience: [pey-shuh-ns]

noun

1. The quality of being patient, as the bearing of provocation, annoyance, misfortune, or pain, without complaint, loss of temper, irritation, or the like.

2. An ability or willingness to suppress restlessness or annoyance when confronted with delay: to have patience with a slow learner.

3. Quiet, steady perseverance; even-tempered care; diligence: to work with patience.

and now:

4. Something you need in abundance when 'investing' in crowd-funded Kickstarter or Indiegogo projects.

Monday, November 25, 2013

Also vapor?

The July 24th, 2013 blog entry 'And the answer... (AI watch)' noted that this was vaporware (with a heavy sigh of regret). Well, we have another cool-looking watch, the RIST watch, that has the same flavor as the defunct AI watch. Alas, is this one also mere vapor?

Sunday, November 24, 2013

Indiegogo MVMT watch

A while back I signed up for a MVMT watch on Indiegogo, nice looking watches for just $59. Well, the campaign closed successfully and I eventually received my black/black watch, see below:

Click to enlarge:

Very nice - good looking and a very solid build, definitely recommended that you pick one (or some, given the very reasonable price) up at the MVMT Watches web site. Although the web site had the specification (case diameter: 45mm and face diameter: 40mm) I hadn't really paid attention. It is a big watch, see below for comparisons to a newer and some much older watches... When you compare it to some old Omegas, it's quite amazing how fashion has changed and larger dials are now de rigeur...

Random charts - illegal drugs

Source: 2013 National Drug Threat Assessment Summary (28-page DEA PDF)

Saturday, November 23, 2013

Random picture

Source: 50 best photos from The Natural World

More on healthcare costs

Source: Lifting the veil on wildly varied surgery charges

The October 14th, 2013 blog entry '$546 for Six Liters of Salt Water' grumbled that people seem to think that medical payments only cover the actual items and services provided, without taking into account all the overhead:

"... Second, these articles always act as if the patient charge is uniquely for the item itself... It is not, the patient charge is to generate revenue to pay not just for the item, but also for everything that goes into getting it to the patient (the organization has staff that buy the product and do the receiving, inventory control and internal distribution; a physician has to write a medical order for the saline, the order has to be verified by a Pharmacist, a Pharmacy Technician pulls the item and labels it, then the Pharmacist double-checks the item before it leaves the Pharmacy; and so on). Not to forget the costs associated with expensive hospital infrastructure - construction running at $1 million per bed; huge capital investments such as MRIs, CT scanners, etc. PET scanners, MEGs, Da Vinci surgical robots... the list is endless...."

Clearly this is illustrated, even if they do not do it explicitly, by the American Hospital Association argument against "site neutral" payments, see below:

Click to enlarge:

So, it's the "overall cost structure" that is supported by patient charges. This needs to be taken into account while examining the variation in pricing/costs across hospitals providing the same service/procedure. Cost of living also factors in, with costs in California and on the East Coast likely higher than in the Midwest; and even when you compare geographically adjacent organizations clearly an academic medical center with research and education, etc. will probably have significantly higher costs than a community hospital (even if outcomes are comparable).

Thursday, November 21, 2013

The "Good ID" - an update

Two blog entries 'Could the "Good ID" be better?' Part I and Part II reacted to the FDA's Draft Guidance for Industry on the global unique device identification database (GUDID), which was issued September 24, 2013. Well, the Association for Healthcare Resource & Materials Management (AHRMM) of the American Hospital Association has now commented on this as well...

Drug shortages - update

Blog entries from July 5th, 2013 and from September 4th, 2013 mentioned the group Physicians Against Drug Shortages (PADS) and poured cold water on their fevered allegations... Well, a GPO group dismisses them as "fringe elements" and "explores" their "unsubstantiated claims", see Physicians Against Drug Shortages.

Saturday, November 16, 2013

'So, how bad is it?' update

The blog entry from October 20th, 2013 included a look at a study of the compensation of hospital executives. A quick reminder of the relevant portion of the blog entry follows:

"Another recently issued study, also by Dr. Jha, looked at hospital CEO pay and examined if the level of pay was related to quality metrics. It concluded that they were not related and that while pay was "associated with" the number of hospital beds, whether the organization was a teaching hospital, its location (rural vs. urban), the amount of technology, and patient satisfaction, "... we found no association between CEO pay and hospitals’ margins, liquidity, capitalization, occupancy rates, process quality performance, mortality rates, readmission rates, or measures of community benefit." This reverberated like a bombshell in the news and the blogosphere, leading to thousands if not tens of thousands of articles such as 'Care, CEO pay not linked, study says.' A closer reading of the study showed that a) they looked at the hospital quality metrics, community benefit, etc. numbers from 2008 and CEO pay from 2009, and that, b) the measures chosen to be the proxy for 'quality' were a fairly limited subset of quality measures - "... composite measures of performance on processes of care for acute myocardial infarction, congestive heart failure, and pneumonia... from which we built patient-level hierarchical logistic regression models to calculate 30-day risk adjusted mortality and readmission rates..." It has been argued that the choice of metrics could have influenced the outcome... While this blogger certainly doesn't have the expertise to know if this is true, or to understand the effect this choice had on the outcome of the study, it is certainly clear to him that perhaps two of the three measures would seem to be less applicable to the quality efforts of, for example, children's hospitals! True, an argument certainly can be made that Dr. Jha and his co-authors bear no responsibility for the tsunami of articles stating that hospital CEO salaries have no relationship at all to quality of care and medical outcomes, when in fact the evidence is more nuanced and, at best, was the case in 2008 i.e. five years ago... However, this blogger is focused (as is clearly stated above) on the "uncritical and megaphone treatment" of some studies, clearly present in this case!. "

Well, in the discussion I noted that there had been some push back on the choice of metrics, but that I personally don't have "... the expertise to know if this is true, or to understand the effect this choice had on the outcome of the study..." Here is an additional data point. In all fairness to Dr. Jha's choice of "... composite measures of performance on processes of care for acute myocardial infarction, congestive heart failure, and pneumonia..." his choice of a narrower set of just three outcome measures is supported by a study that found that a composite of these three measures do track fairly well with a much broader array of measures and that it can be used as a reasonable proxy for the same! Note: this does not detract from the fact that this is not applicable to all hospitals e.g. children's hospitals, or the larger point that I was trying to make... However, credit is due where credit is due!