White Coat Notes
Managed care reborn at Tufts Health Plan
Tufts Health Plan is bringing back old-fashioned managed care.
In early April, the insurer, which is struggling to turn around recent losses, set up its own nurses at Beth Israel Deaconess Medical Center, Tufts-New England Medical Center, Caritas St. Elizabeth's Medical Center, UMass Memorial Medical Center, Baystate Medical Center, Children's Hospital, and Lahey Clinic, to monitor whether Tufts members are staying in the hospital too long or receiving unnecessary care.
The plan hopes to add nurses to Massachusetts General Hospital, Brigham and Women's Hospital, and Boston Medical Center by the end of the summer.
''We have our nurses in there all day," said Allen Hinkle, chief medical officer. He said the plan's internal data shows that hospital admissions for Tufts members and length of stay in the hospital are 5 to 10 percent higher than the national average. One issue is making sure patients are discharged as soon as they're ready to go home.
''The delays in the system are pervasive," he said.
Dr. Kassirer goes to Washington
Dr. Jerome Kassirer, the Tufts University School of Medicine professor, former editor of the New England Journal of Medicine, and recent book author, took his pointed comments about his profession's dependence on drug company money to Congress July 21.
Staffers for US Representative Pete Stark, the California Democrat, heard about Kassirer's book ''On The Take: How Medicine's Complicity with Big Business Can Endanger Your Health" and asked him to testify before the health subcommittee of the Committee on Ways and Means, which is considering bills on new ways for Medicare to pay doctors. The legislation calls for raising doctors pay when they meet performance standards, but Stark is interested in the other incentives dangled before doctors.
Enter Kassirer, who has not minced words when it comes to physicians who accept speaking fees, consulting contracts, and other money from pharmaceutical makers. In his testimony, Kassirer said it's not only drug companies that are to blame, asserting that ''they have willing accomplices, namely thousands of physicians in academic medical centers and in private practice." He warned that his colleagues are ''in essence becoming the modern drug reps."
Kassirer is senior and respected enough that he doesn't have to worry about his rousing comments hurting his career. And medical school dean Dr. Michael Rosenblatt, who himself once worked for
The country's second most powerful doctor
Earlier this year, the magazine Modern Physician asked its more than 26,000 readers to name the most powerful physician executives in the US. Out of the 1,100 doctors nominated, readers voted Dr. James Mongan, chief executive of Partners HealthCare, the second most powerful doctor in the country.
He lost out on the top spot to Dr. Ron Anderson, president of Parkland Health & Hospital System in Dallas. Anderson's tenure almost ended in December 2004 when his board tried to oust him as he was pushing for a new $1.2 billion hospital during a period of austerity in Texas. He fought them and won.
''It's like he's their hero; if you can be stronger than your board, that's pretty powerful," said editor David Burda.
But Mongan has become somewhat of a cause celebre himself, which may have accounted for his top billing. The voting came around the time that Mongan wrote an article in the New England Journal of Medicine calling for higher taxes and a mandate on employers to cover uninsured Americans. ''For someone to stick out their neck like that takes a lot of courage," Burda said.
Mongan, who is soft-spoken and low-key, gave an interview to the magazine that was true to form. ''I am taken aback," he said.
Liz Kowalczyk can be reached at kowalczyk@globe.com. 
