Fighting to Return My Obligation to the American Taxpayer

July 12, 2010 4:06 PM

Dirty Medicine — How medical supply behemoths stick it to the little guy, making America’s health care system more dangerous and expensive.

"This is hardly the first time Shaw has found his path to market blocked. In fact, he has spent the last fifteen years watching his potentially game-changing inventions collect dust on warehouse shelves. And the same is true of countless other small medical suppliers. Their plight is just the most visible outgrowth of the tangled system hospitals use to purchase their supplies—a system built on a seemingly minor provision in Medicare law that few people even know about. It’s a system that has stifled innovation and kept lifesaving medical devices off the market. And while it’s supposed to curb prices, it may actually be driving up the cost of medical supplies, the second largest expenditure for our nation’s hospitals and clinics and a major contributor to the ballooning cost of health care, which consumes nearly a fifth of our gross domestic product. "

posted by netbros (14 comments total)

After high school, Shaw went on to study engineering at the University of Arizona, and eventually launched his own engineering firm in a former bicycle-repair shop on a rundown strip in Lewisville, Texas.

Lewisville represent! Checkmate Engineering was on South Mill, across the street from the middle-school-whose-address-is-on-High-School-Drive. I could never get up the nerve to go in and see what was there; now I wish I had.
posted by fireoyster at 4:45 PM on July 12, 2010

In my old job my boss had some decision making authority on the purchase of medical supplies and I heard dozens of pitches for new products to him from salesmen. His first question was always "who else is using it?" There's a big risk for a healthcare executive in being the guy who brings in a new product that isn't widely used so it's got to be really hard to get your foot in the door of the industry. We almost never ended up bringing on any new products, the few times we even wanted to I think purchasing told us we were better off paying more for our Premiere pricing items and getting discounts in other areas, like on suture or something, so I guess that part definitely rings true.
posted by ghharr at 5:07 PM on July 12, 2010 [1 favorite]

It can work that way at postsecondary research institutes too; I get calls from purchasing if I try to use suppliers other than those on the "approved" list. That and/or my requisitions take weeks to go through or get 'lost'. Close to seven digits worth of supplies I'm forced to order from the biomedical equivalent(s) of Wal-Mart.
posted by variella at 6:20 PM on July 12, 2010

It seems to me that there is no shortage of medical technology startups and bio-tech innovation, but they are forced to pursue brand new treatment technology and push for its adoption in order create a market they can have access to. There is no incentive to pursue the improvement of existing technology, since small competitors can't access the market and the large suppliers have no reason to improve their product. Which is totally fucked up, since the incremental improvement of existing technology has really worked well for us. Chalk up another example where the enrichment of a few costs society as a whole.
posted by nowoutside at 6:33 PM on July 12, 2010 [3 favorites]

One of the topics that gets him most riled up these days is bloodstream infections. And with good reason—while most people rarely think about them, these are the most dangerous of the hospital-acquired bugs that afflict one in ten patients in the United States. Their spread has helped to make contact with our health care system the fifth leading cause of death in this country.

Holy shit, is this true? There are only four things more likely to kill you than a hospital visit itself? Jesus…
posted by paisley henosis at 8:18 PM on July 12, 2010

Their spread has helped to make contact with our health care system the fifth leading cause of death in this country.

I doubt that. From the CDC:

Number of deaths for leading causes of death

* Heart disease: 616,067
* Cancer: 562,875
* Stroke (cerebrovascular diseases): 135,952
* Chronic lower respiratory diseases: 127,924
* Accidents (unintentional injuries): 123,706
* Alzheimer's disease: 74,632
* Diabetes: 71,382
* Influenza and Pneumonia: 52,717
* Nephritis, nephrotic syndrome, and nephrosis: 46,448
* Septicemia: 34,828

Of these, only influenza/pneumonia and septicemia are typically caused by 'contact with our health care system.' In any event, number five is clearly 'accidents,' and medical accidents cannot possibly be a large enough fraction to warrant a number five spot on their own, since about 40,000 people are killed in vehicle accidents and about 20,000 in household accidents annually, which would leave at most about 60,000 for medical accidents. And I doubt the number is anywhere near that large.

There are (wildly varying) stats that claim that medical malpractice is a leading cause of death, but all of the numbers I saw were on malpractice attorney websites (hugesettlements.com does not strike me as particularly trustworthy, for example). Furthermore, the cold hard facts are that many if not most people who die proximate to some medical error were very likely to die soon regardless of the quality of care they received. For example, failing to resuscitate someone who went into prehospital cardiac arrest does not change the fact that their long-term survival rate (i.e., will they be discharged from the hospital alive) would still have been in the single digits even if they hadn't died in the ER.

tl;dr That statistic is inaccurate at best and fearmongering at worst.
posted by jedicus at 9:01 PM on July 12, 2010 [1 favorite]

CDC strives to understand how healthcare-associated infections happen and to develop appropriate interventions. A new report from CDC updates previous estimates of healthcare-associated infections. In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year. Of these infections:

* 32 percent of all healthcare-associated infection are urinary tract infections
* 22 percent are surgical site infections
* 15 percent are pneumonia (lung infections)
* 14 percent are bloodstream infections

As an ICU nurse i don't feel that this is fearmongering at all. Hospitals are filthy places. I work night shift, and i have to bring my own soap to work with me because sometimes we run out. I'm not even asking for fancy-pants new biotech syringes or whatever, I just want my ICU to have some fucking SOAP. That would help a lot.

I've worked in a lot of hospitals, some better than others, but the whole health care system in the NYC area has scared me off to another country. If you live there, make sure your doctors and nurses wash their hands. With soap.
posted by makonan at 10:01 PM on July 12, 2010 [4 favorites]

Well, just for giggles, I guess if one third of accidents were medical, and one third of flu, nephritis & septicemia are contracted through medical professionals, that would put it in the ~81k neighborhood, which would be 5th if "Accidents" was broken into more specific categories.

That's a whole lot of hand-waving just to get to a maybe, though, so I'm categorizing this as the third kind of lie.
posted by paisley henosis at 10:01 PM on July 12, 2010

In American hospitals alone, healthcare-associated infections account for an estimated 1.7 million infections and 99,000 associated deaths each year.

Well what the heck. The CDC's own stats contradict themselves, then.
posted by jedicus at 10:05 PM on July 12, 2010

This article, on the CDC site, places hospital acquired bloodstream infections at the #8 leading cause of death.

This one mentions a number of 100 thousand deaths a year, but it is for all hospital acquired infections, of which only 14% are bloodstream infections.

This page puts healthcare associated infections int he top ten.

The difficulty with numbers on things like the total number of deaths attributable to healthcare mistakes or accidents is controlling for the underlying problems that cause the hospital visits in the first place.
posted by Nothing at 10:11 PM on July 12, 2010 [2 favorites]

I wonder what's stopping the small guys with the more advanced new stuff from selling their wares to other countries such as Canada or places in Europe?

Don't the drug makers have to negotiate prices with those nations? If so, it seems those places would have a more level playing field for device manufacturers as well.
posted by InsertNiftyNameHere at 12:30 AM on July 13, 2010

sorta previously...
posted by kliuless at 7:28 AM on July 13, 2010

The number that is frequently thrown around is from the Institute of Medicine's (IOM)To Err Is Human report in 2000. That report estimated that the number of *preventible* medical errors each year is between 44,000 and 98,000 (which would put it between 5th and 8th place in terms of top causes of death). You wouldn't necessarily be able to get that straight from CDC's mortality stats, jedicus, because of the way that cause of death is recorded on death certificates. If you are in a horrible motorcycle accident, end up in the ICU, catch a bloodstream infection and pass away, your primary cause of death would be coded as a motor vehicle accident. Same deal with having a heart attack or gallbladder removal or hysterectomy that ultimately results in death because a surgeon left a sponge inside you or you got a bloodstream infection from your catheter. The primary cause of death is the initial condition that led to the cascade of changes that ultimately result in death, and that's what ends up on the death certificate.

That's why the IOM report was such a bombshell 10 years ago: everyone knew that people died of infections or medication errors, but since it's rarely or never coded as the primary cause of death on death certificates (and hence doesn't appear in vital statistics) the scope of the problem was unknown. The report set off a huge amount of research into hospital-acquired infections and how to prevent them, and I believe the number of deaths attributed to HAI has actually ballooned compared to what was in the original IOM report. A few hospitals have put in place relatively simple interventions and as it turns out it's not too hard to bring your HAI rate down to almost zero. (Obligatory Gawande article on the issue.)

All good reasons to try to avoid the hospital, and if you need to go (and have a choice of what hospital to go to), to check Medicare's Hospital Compare website (kinda clunky, to use, argh) to get some info on how well local hospitals perform on "process of care" measures related to surgical care. For example, if I select 3 hospitals in the D.C. area, I can see that the percentage of people having outpatient surgery who received an antibiotic one hour before surgery (considered one best practice to avoid infections) is 98% for GWU Hospital, 93% for Washington Hospital Center, and 16% for Howard University Hospital.
posted by iminurmefi at 9:11 AM on July 13, 2010 [3 favorites]

Also worth noting is that Don Berwick, who was just recess-appointed to become the head of Medicare & Medicaid after Republicans threatened to filibuster him, has made his name in encouraging hospitals and other health care providers to put systems in place that reduce infections and improve safety. He runs the Institute for Healthcare Improvement which is a big player in trying to reduce all sorts of infections but particularly MRSA in medical settings. I'm guessing that there's going to be money put in place to start actually tracking this stuff nationally--right now some states are gathering data from hospitals on the incidence and mortality of HAI but as far as I'm aware nothing is compiled at the national level, again meaning we don't exactly know how much money is wasted and how many lives could be saved by aggressively moving to stamp out infections--and that some of the new payment reforms under PPACA (the healthcare reform bill) will involve beginning to tie hospital payment to quality and outcome measures that involve infection control.

His nomination gives me hope that at least some of the perverse incentives (the linked article being a great example) that lead to really dangerous-AND-expensive outcomes are going to start coming under scrutiny, to the great benefit of patients. This is an area where it should be so easy to go after low-hanging fruit in terms of reducing Medicare costs and making everyone safer that it's a bit boggling that it hasn't been done before.
posted by iminurmefi at 9:27 AM on July 13, 2010 [1 favorite]