5 ms·

I guess McKinsey erred in accepting the work from Purdue, but it seems like the consulting provided was obvious and likely overpriced. More at fault, in my est

I guess McKinsey erred in accepting the work from Purdue, but it seems like the consulting provided was obvious and likely overpriced. More at fault, in my estimation, is the AMA and other physician standards bodies. Propublica released a search tool [0] last year based on Open Payments Data [1] and the numbers are ridiculous. My small state shows 10s of physicians receiving over $100k over the recorded 2013-2016 period and a very long tail. Many on the list are orthopedic surgeons and psychiatrists. [0] https://projects.propublica.org/docdollars/ https://projects.propublica.org/docdollars/ [1] https://openpaymentsdata.cms.gov/ https://openpaymentsdata.cms.gov/

arkades 8y ago
Know that Gell-Mann amnesia effect that comes up all over Hn? As a physician, former health insurance exec, and guy with a graduate degree in health policy: propublica deserves deep skepticism.
- dhbradshaw 8y ago
  This is worth drilling down on. What types of errors should one expect and what are their causes?
  - amsilprotag 8y ago
    Looking closer at the data, almost everyone is receiving small travel, lunch payments. Many of the higher earners are receiving large sums for "Promotional Speaker/Other", "Consulting Fee" or "Current or prospective ownership or investment interest". Comparing 10 or so names in the source data with the Propublica data, often Propublica has identical amounts and trasactions as the Open data, a few times Propublica's dollar amounts and transactions are higher. This might be evidence to support arkades's claim, but I can't be sure since I don't know the exact methodology.
    - yeahitslikethat 8y ago
      They also get paid to speak about drugs. Thousands of dollars per lecture and interestingly the only people in attendance at said lectures are the physician and a drug rep and the venue is a restaurant.
  - arkades 8y ago
    Largely they lack context to interpret what they’re seeing. One that jumped out at me a while back: They were showing physician payouts from Medicare and presenting them as though they were salaries. Problem: some specialties carry overhead in their Medicare payout. When your cardiologist prescribes you a blood pressure medication, that money goes to a pharmacy, not to the doctor. So your physician payout is X (cost of visit.) An oncologist prescribing you a chemo infusion, however, has to buy that infusion from the pharmacy. Medicare then reimbursed doc Z (cost of the drug plus a couple of percentage points). Docs Medicare payout looks like Z; his take-home salary is actually about 0.03*Z. The failure to distinguish between these meant that PP’s data massively over-inflates these specialties’ salaries. PP just presents them at face value. Or another: hospitals rarely charge their publicly posted prices. The vast majority of their pay comes via rates negotiated with insurers. PP loves to post their public numbers and go on about high variance numbers without any recognition that those numbers are in no way pegged to the actual negotiated rates. PP presents them at face value. Largely, PP just doesn’t ever seem to dig deeply enough to find the nuances and caveats in their data, to find how they relate to the actual underlying questions that they -superficially- seem to answer, like “how much are hospitals charging people for this procedure?” or “what kind of money are doctors taking home?”
    - klenwell 8y ago
      Here's the introduction at the top of the ProPublica page cited by the GP: Pharmaceutical and medical device companies are required by law to release details of their payments to a variety of doctors and U.S. teaching hospitals for promotional talks, research and consulting, among other categories. Use this tool to search for general payments (excluding research and ownership interests) made from August 2013 to December 2016. https://projects.propublica.org/docdollars/ https://projects.propublica.org/docdollars/ That seems like pretty fair context. You seem to be referencing a different article about Medicare reimbursement without actually citing it. That's a dodge. If the medical industry requires reams of context to understand its practices and pricing, it's largely because pharma, insurers, medical groups, and individual providers often go to obscene lengths to obscure their practices and pricing. I'm not going to waste skepticism on ProPublica that could better directed at the American medical-industrial complex.
- whyisthewhat 8y ago
  Very often "Gell-Mann amnesia effect" is invoked to mean "this story is complete rubbish" when what is actually meant is "I have a different, not necessarily correct, and very possibly self-interested interpretation of the facts"
  - arkades 8y ago
    In the interest of not getting unnecessarily combative: I can't tell whether your comment was stated in a tone of "I generally think Gell-Man amnesia effect is misused on HN," or whether you meant it to directly criticize my comment. Please clarify, if you don't mind.
- yeahitslikethat 8y ago
  Also deserving of skepticism: doctors who accept money from big Pharma. It motivates over prescription. That's a scientifically proven fact.
  - bitL 8y ago
    One of my doctors refused to give me a prescription for a 25mg version of a medication over a 5mg version (pill could be cut in pieces and still as efficient), as the lower dosage was classified as "cosmetic", commanding 50x higher prices/mg, whereas the higher dosage was "life-saving", therefore cheap. Then I went to another doctor and experienced the same. The same doctor was recommending me to buy the higher dosage and split it into pieces just 2 years ago.
    - arkades 8y ago
      He probably got burned at some point and got scared. We get reviewed a lot more these days. "You prescribed a 5x higher dose than he needed!" "But I told him to cut it in five." "That's not what you wrote in your documentation?" "Well, if I wrote that in the documentation, it would have been documenting my own insurance fraud. I had to write that it was for (condition that requires 25 mg)." "Did he have (condition that requires 25 mg)?" "No, he had (condition that requires 5 mg)." "So, which is it? Did you commit insurance fraud, or did you write him the wrong dosage?" One is insurance fraud, the other is malpractice. Why is it the doctor's fault that we're stuck in the middle of this shit system? Do people not understand that we aren't in control? The insurers, the federal regulators, the combination of the two, (Medicare), the state regulators, the combination of those two (Medicaid), congress, etc. They're in control. It's a happy day when our hands aren't bound from the start of our day to the finish. Don't blame us because we're the face you interact with.
      - yeahitslikethat 8y ago
        Are doctors doing anything to end the requirement that patients get prescriptions for drugs? What are you doing to change the system? The AMA lobbies congress to keep it broken in the favor of doctors and detriment of patients. Doctors control our right to live. It's contrary to life, liberty, and the pursuit of happiness, because we must get your permission to live.
- JumpCrisscross 8y ago
  > propublica deserves deep skepticism Seconded. One of their journalists, Jesse Eisinger, quoted a paper to back a particular claim. I found the paper and discovered it said the opposite. Figuring a skimming mistake, I e-mailed Mr. Eisinger. The response was a brief dismissal, nothing more.

arkades 8y ago

Know that Gell-Mann amnesia effect that comes up all over Hn? As a physician, former health insurance exec, and guy with a graduate degree in health policy: propublica deserves deep skepticism.

dhbradshaw 8y ago
This is worth drilling down on. What types of errors should one expect and what are their causes?
- amsilprotag 8y ago
  Looking closer at the data, almost everyone is receiving small travel, lunch payments. Many of the higher earners are receiving large sums for "Promotional Speaker/Other", "Consulting Fee" or "Current or prospective ownership or investment interest". Comparing 10 or so names in the source data with the Propublica data, often Propublica has identical amounts and trasactions as the Open data, a few times Propublica's dollar amounts and transactions are higher. This might be evidence to support arkades's claim, but I can't be sure since I don't know the exact methodology.
  - yeahitslikethat 8y ago
    They also get paid to speak about drugs. Thousands of dollars per lecture and interestingly the only people in attendance at said lectures are the physician and a drug rep and the venue is a restaurant.
- arkades 8y ago
  Largely they lack context to interpret what they’re seeing. One that jumped out at me a while back: They were showing physician payouts from Medicare and presenting them as though they were salaries. Problem: some specialties carry overhead in their Medicare payout. When your cardiologist prescribes you a blood pressure medication, that money goes to a pharmacy, not to the doctor. So your physician payout is X (cost of visit.) An oncologist prescribing you a chemo infusion, however, has to buy that infusion from the pharmacy. Medicare then reimbursed doc Z (cost of the drug plus a couple of percentage points). Docs Medicare payout looks like Z; his take-home salary is actually about 0.03*Z. The failure to distinguish between these meant that PP’s data massively over-inflates these specialties’ salaries. PP just presents them at face value. Or another: hospitals rarely charge their publicly posted prices. The vast majority of their pay comes via rates negotiated with insurers. PP loves to post their public numbers and go on about high variance numbers without any recognition that those numbers are in no way pegged to the actual negotiated rates. PP presents them at face value. Largely, PP just doesn’t ever seem to dig deeply enough to find the nuances and caveats in their data, to find how they relate to the actual underlying questions that they -superficially- seem to answer, like “how much are hospitals charging people for this procedure?” or “what kind of money are doctors taking home?”
  - klenwell 8y ago
    Here's the introduction at the top of the ProPublica page cited by the GP: Pharmaceutical and medical device companies are required by law to release details of their payments to a variety of doctors and U.S. teaching hospitals for promotional talks, research and consulting, among other categories. Use this tool to search for general payments (excluding research and ownership interests) made from August 2013 to December 2016. https://projects.propublica.org/docdollars/ https://projects.propublica.org/docdollars/ That seems like pretty fair context. You seem to be referencing a different article about Medicare reimbursement without actually citing it. That's a dodge. If the medical industry requires reams of context to understand its practices and pricing, it's largely because pharma, insurers, medical groups, and individual providers often go to obscene lengths to obscure their practices and pricing. I'm not going to waste skepticism on ProPublica that could better directed at the American medical-industrial complex.
whyisthewhat 8y ago
Very often "Gell-Mann amnesia effect" is invoked to mean "this story is complete rubbish" when what is actually meant is "I have a different, not necessarily correct, and very possibly self-interested interpretation of the facts"
- arkades 8y ago
  In the interest of not getting unnecessarily combative: I can't tell whether your comment was stated in a tone of "I generally think Gell-Man amnesia effect is misused on HN," or whether you meant it to directly criticize my comment. Please clarify, if you don't mind.
yeahitslikethat 8y ago
Also deserving of skepticism: doctors who accept money from big Pharma. It motivates over prescription. That's a scientifically proven fact.
- bitL 8y ago
  One of my doctors refused to give me a prescription for a 25mg version of a medication over a 5mg version (pill could be cut in pieces and still as efficient), as the lower dosage was classified as "cosmetic", commanding 50x higher prices/mg, whereas the higher dosage was "life-saving", therefore cheap. Then I went to another doctor and experienced the same. The same doctor was recommending me to buy the higher dosage and split it into pieces just 2 years ago.
  - arkades 8y ago
    He probably got burned at some point and got scared. We get reviewed a lot more these days. "You prescribed a 5x higher dose than he needed!" "But I told him to cut it in five." "That's not what you wrote in your documentation?" "Well, if I wrote that in the documentation, it would have been documenting my own insurance fraud. I had to write that it was for (condition that requires 25 mg)." "Did he have (condition that requires 25 mg)?" "No, he had (condition that requires 5 mg)." "So, which is it? Did you commit insurance fraud, or did you write him the wrong dosage?" One is insurance fraud, the other is malpractice. Why is it the doctor's fault that we're stuck in the middle of this shit system? Do people not understand that we aren't in control? The insurers, the federal regulators, the combination of the two, (Medicare), the state regulators, the combination of those two (Medicaid), congress, etc. They're in control. It's a happy day when our hands aren't bound from the start of our day to the finish. Don't blame us because we're the face you interact with.
    - yeahitslikethat 8y ago
      Are doctors doing anything to end the requirement that patients get prescriptions for drugs? What are you doing to change the system? The AMA lobbies congress to keep it broken in the favor of doctors and detriment of patients. Doctors control our right to live. It's contrary to life, liberty, and the pursuit of happiness, because we must get your permission to live.
JumpCrisscross 8y ago
> propublica deserves deep skepticism Seconded. One of their journalists, Jesse Eisinger, quoted a paper to back a particular claim. I found the paper and discovered it said the opposite. Figuring a skimming mistake, I e-mailed Mr. Eisinger. The response was a brief dismissal, nothing more.