Wednesday, January 29, 2025

Neglect and Cover-Up: Kaiser's Research Ethics Fail Examined

Kaiser Permanente in Northern California conducted a study that breached numerous patient protection rules. The study was meant to explore if a fish oil-derived drug could help reduce complications from respiratory illnesses like COVID in high-risk cardiovascular patients.

  • Researchers' Misconduct: Two leading researchers, Dr. Alan Go and Dr. Andrew Ambrosy, were disciplined for failing to adhere to research compliance and patient safety protocols. They withheld critical information and attempted to cover up these lapses.
  • Study Termination and Suspension: The study was halted in December 2022, and eleven other studies by these researchers were suspended. An internal audit by Kaiser's Institutional Review Board (IRB) found "persistent failure" in following regulations.
  • Patient Safety Compromised: Notably, an elderly man with a known shellfish allergy, which should have excluded him from the study, was pressured to participate and subsequently experienced health issues potentially linked to the drug. The study also included participants with other exclusion criteria like cognitive impairments or language barriers.
  • Inadequate Oversight: The FDA criticized Kaiser's oversight, highlighting that their system for monitoring research safety and ethics was inadequate. The IRB lacked the authority to act swiftly due to delays from Kaiser leadership in providing necessary information.
  • Audit Findings: The audit revealed numerous violations including:
    • Enrollment of ineligible participants with allergies, cognitive issues, or language barriers.
    • Undue influence on participants to join or continue in the study.
    • Improper management of study protocols, leading to poor documentation and data handling.
  • Corrective Actions: After complaints and the audit results, Kaiser implemented corrective action plans, but specifics were not detailed. The researchers' appeal to continue the study was denied.
  • Broader Implications: This incident not only questions the integrity of the research conducted but also casts a shadow over Kaiser's research oversight, potentially affecting its reputation and the trust of its large patient base in California.

Full story.   

Thursday, December 12, 2024

Armstrong & Getty with Craig Gottwals 12.12.24

I had a quick visit with Armstrong & Getty this morning to discuss the UHC CEO murder, America’s reaction thereto, why so much of the ire on this topic is off base, Obamacare’s medical loss ratio mandate, the Medicare cost shift, and some super simple advice on purchasing insurance products. 

Since 2009, I’ve been on air with Jack and Joe well over 100 times. It's always an honor to be on their show.  

Monday, November 4, 2024

One Mom’s Nose for Savings

Exorbitant Hospital Pricing in the U.S. Undermines Morale, Employee Compensation, and Employer Profits — It Must Stop

As the sun dipped below the horizon on a brisk spring evening, a young mother crouched behind home plate, catching for her daughter.  Already showing signs of a future softball superstar, Gisele unleashed a wicked rising fastball.  It clipped the edge of the glove and smashed into her mother’s face, cracking bone and pushing her nose sharply to the left. 

In a display of savage tenacity, Mom wiped the blood away, grimly reset her nose with a crackling snap, and resumed her catching duties for the evening.  Despite her efforts, the misshapen lump and the nose’s noticeable leftward slant gave her the hardened appearance of a seasoned mob enforcer.

Doctors told her she’d almost certainly require surgery but wanted to let the swelling subside and see how her breathing progressed before they intervened. 

Months later, she couldn’t breathe through her left nostril; she wanted her beak fixed. Luckily, she found herself on a Mahoney Group plan backed with Reference-Based Pricing and Cash-Pay options at recognized centers of excellence.

  • So no, UHC and Adventist, her plan isn’t going to pay $74,000. 
  • Nor will she pay the $58,000 sought by Cigna and El Camino Hospital. 
  • Not going to pay $73,000 either, Western Health and John Muir. 
  • And we say nay nay to the $73,000 Santa Rosa Memorial wants from EVERY commercial payer.  (Hat tip to the late, great John Pinette.)
  • She’ll pass on the $51,000 Stanford and Blue Shield want.
  • And UCSF and Aetna can only dream about that $69,000 they lustily crave.  

At 140% of Medicare, we will pay $7,811 for this surgery.  If circumstances such as geography, timing, or specialized surgeons demand a higher price, we can negotiate.  But that is seldom required.  In this case, Gisele’s Mom is getting her nose fixed up for a voluntary cash price of $7,750. 

Plus, since Mom agreed to use the cash-steerage option, her employer is paying 100% of the cost of the procedure and waving all deductibles and coinsurance

And from now on, Mom’s going to wear a catcher’s mask. 

Monday, October 28, 2024

The 5 Forces of Justice - 5 Different Forms of RBP

This ain't yo grandpappy's RBP!  Five different ways employers are installing RBP to save millions on healthcare costs.


Tuesday, October 1, 2024

Wednesday, July 24, 2024

Monday, June 24, 2024

How to Become an HR Superhero

With over 15 years of teaching benefits and human resources at the university level, coupled with exclusive experience in working alongside C-Suite executives to implement and manage highly efficient benefit plans, I have a crucial piece of advice for any HR professional looking to be seen, appreciated, and impactful in their career.

 

Thursday, June 6, 2024

Employers & Employees: Stop Buying So Much Insurance!

The insurance industry is massive, powerful, and 100% designed to win every single time. Commissions on some items you buy are more than 50%. YOU DON'T NEED ALL OF THAT!