Tag Archives: san francisco

Disciplined doc gets top rank in Google

In SF Weekly, Ashley Harrell investigated the disconnect between a local plastic surgeon’s record of “gross negligence” which left one patient in a fatal coma and several others with burns, and the legions of glowing reviews of her practice posted all over the internet.usha-rajagopal

The reviews, she found, were connected to the astroturfing efforts of a PR agency the doctor had hired. The group also earned the doctor a top spot in Google’s PageRank algorithm at the same time that she was serving a three-year probation set by the state medical board.

Harrell’s story, Doctoring the Web, examines ways that some doctors are trying to game online ratings systems, as well as the current weakness of enforcement, both federal and local, in the arena.

Are insurers to blame for rising costs?

The San Francisco Chronicle‘s Carolyn Lochhead and Victoria Colliver use the recent furor over insurer Anthem’s rate hikes to explore just how much of the blame for rising health care costs should be shouldered by insurers. The reporters find that, in the end, insurers are just another one of the cartels (others include device makers and providers) and operate inside the opaque world of medical pricing and snag hefty cuts for themselves. Lochead and Colliver put it thus:

While the Anthem case has raised a political storm, the underlying surge in costs gets far less scrutiny. But each sector of the health industry points fingers at the other for driving up prices, and all are raking in money.

Insurers blame hospitals and doctors, doctors blame insurers, and hospitals blame doctors and medical devicemakers in what academics call an inscrutable medical-industrial complex that rivals anything the defense industry ever invented. All these groups are combining into what many experts describe as cartels.

The reporters write that, despite their best efforts, they weren’t able to get many folks on the record. When they did find someone who was willing to talk, it was often a source we’ve seen before in other cost stories. It’s a tough theme to get quotes on, as nobody wants to burn bridges with their professional suppliers and everybody’s got some sort of skin in the game. They did, however, manage to find a local source who offered an original and illuminating anecdote:

Christina Bernstein, a medical-device engineer and independent sales representative based in San Francisco, sells disposable surgical tools made mostly out of plastic that she estimates are manufactured for about $40 each. These are marked up and sold to hospitals for as much as $350, she said, for a single use in a surgery on a patient.

“But if you were to get a detailed bill of what the hospital was charging the insurance company for the insured patient, those things get marked up to something like $1,200,” Bernstein said. “It’s ridiculous. There’s no open competition.”

(Hat tip to AHCJ Immediate Past President Trudy Lieberman, who wrote a column on CJR.org praising the Chronicle‘s story.)

Medical tourism expected to continue growth

The San Francisco Chronicle‘s Carolyn Lochhead writes that the draw of medical tourism lies with both transparency and affordability and implies that its success shows the need for an overhaul of the U.S. medical system.plane-wing

She also notes that the reform efforts don’t seem likely to change those two central systematic problems, and thus medical tourism is likely to be here to stay, at least in the foreseeable future. The piece also explores the consumer side of medical tourism, profiling an Oklahoma surgeon who competes on price and transparency.

The article also cites an executive who advises that the economics of going overseas for treatment start making sense when the American price tag for a procedure reaches about $15,000.


The latest trend in medicine? Outdoor exercise

Writing for The Washington Post, physician and University of California, San Francisco, medical professor Daphne Miller makes a strong case for what she calls a growing trend: Doctors prescribing outdoor exercise for their patients. After seeing how the lure of the outdoors can motivate those who can’t stand the sight of another treadmill or stationary trainer, Miller has started handing out detailed “park prescriptions” that direct her patients to specific parks and trails. It’s a practice she says colleagues across the country are adopting.

Tolay Lake Regional Park in Sonoma County, Calif. Photo by ultralightly via Flickr.

Eleanor Kennedy, a cardiologist in Little Rock, helped create a downtown “Medical Mile” with the support of local funders and the National Park Service’s Rivers, Trails, and Conservation Assistance Program. “If my patients feel that they can get outdoors, they are more likely to be consistent about exercise,” she told me. “Whether you are waddling, walking or running, going out and exercising will help build your confidence, flexibility and adaptability.” And it will also be good for your heart — a particular benefit in Arkansas, where rates of heart disease and stroke, as well as obesity and diabetes, are among the highest in the country.

Folks on the park side of the equation are no less thrilled about the rediscovered mental and physical health benefits of the outdoors; National Park Service officials are hoping to prepare a “park prescription” tool kit for doctors and local parks and health organizations are starting to cooperate across the country.

The NPS’s Rivers, Trails, and Conservation Assistance Program has projects in nearly every state and provides a state-by-state breakdown of the projects that might help reporters localize this story.

Perceptions affecting support of public option

In the health reform debate, the public option has emerged as the latest controversy and possible stumbling block. A Washington Post-ABC News poll found that “the vast majority of those who support the entire reform package also back it without the public option, while removing it attracts some of those who would otherwise be opposed.”

A recent poll of more than 5,000 doctors found that nearly 63 percent of them support a public option. Primary care providers were the most likely to support a public option; physicians in fields that generally have less regular direct contact with patients were less likely to support a public option, though 57.4 percent did so.

The Washington Post points out that, among consumers, support for the public option varies widely based on what its perceived effect will be.

Mother Jones‘ Washington, D.C., bureau chief David Corn, on Hardball with Chris Matthews on Monday night, said that many people still don’t know the details of how a public option fits into health care reform. Lynn Sweet of the Chicago Sun-Times, also on Hardball, argues that people who have insurance “don’t focus on the public option because they think it’s not about them.”


Do reporters fully understand the public option? Are they effectively explaining it to their audiences?

To learn more about the public option, watch this Talking Health web cast, featuring two experts who explain the public option and potential effects of a public option. The second half of the web cast features Los Angeles Times reporter Noam Levey and New York Times reporter Reed Abelson, who provide insights and suggestions for covering this aspect of health care reform.

It may be helpful to look at what’s happening in San Francisco, where a program for the uninsured offers care in clinics and covers admissions to hospitals located in the city. While it isn’t health insurance, it does include a mandate that employers “offer health coverage to employees, contribute to workers’ health savings accounts or pitch in on Healthy San Francisco.”