Health Wonk Review: Business Edition, Aug. 2008

(MoneyWatch)  The biweekly healthcare blog carnival Health Wonk Review is up, and although I'm a tad late, here are some of the highlights from a business perspective:

• Roy Poses of Health Care Renewal recounts the story of Rodney Miller, an administrator at Memorial Regional Hospital in Hollywood, Fla., who lost his job after a newspaper reported on alleged widespread financial abuses by Miller at his previous job running a Virgin Islands medical center and the administrator's previous undisclosed 10-month Navy prison sentence for credit-card theft. Poses argues that it's time to consider state licensure for hospital administrators, given a history of "bad leadership" in many other cases.
• Similarly, Maggie Mahar of Health Beat picks up the Miller story but runs in a different direction, critiquing the "CEO culture" of hospital administration that has largely supplanted the older model of doctor-run healthcare facilities. Citing some well-known but still shocking cases of crooked hospitals -- particularly Tenet Healthcare, whose former unit National Medical Enterprises paid bounties to fill its psychiatric beds with allegedly troubled adolescents, and whose Redding Medical Centers were raided by the FBI earlier this decade after heart specialists conducted a vast number of cardiovascular procedures, many of them allegedly unnecessary -- to argue that maybe physicians should still be running hospitals, or at least deeply involved in their management.
• At the Health Care Blog, Matthew Holt outlines the workings of the U.K.'s comparative-effectiveness agency NICE (the National Institute for Clinical Excellence). NICE gets a lot of publicity for rejecting the use of extremely expensive drugs that have, in its view, limited effectiveness, but after attending a talk by NICE head Andrew Dillon, Holt notes that the agency only rejects about three percent of the drugs and devices it assesses. (A full 72 percent are approved in full, and another 25 percent are approved in part and rejected in part.) As for whether a NICE-like outfit could work in the U.S. -- something many on Capitol Hill are interested in -- Holt emphasizes that NICE operates in a more conservative and resource-constrained medical culture than in the U.S., which may limit the success of any similar agency here.
• Brian Kleppner, also writing at the Health Care Blog, waxes enthusiastic about the potential for new "Health 2.0" systems to dramatically improve care and drive down healthcare costs. In particular, Kleppner focuses on the evolution of tools that could grow out of existing health-related "wikis" by assembling both expert knowledge and real health-outcomes data into recommendations that feed back to clinicians. It's on the abstract side at the moment, and Kleppner is a bit glib about exactly how such a system would work and how doctors would learn to trust it, but it's certainly an intriguing vision.