Tuesday, May 24, 2011

Is It Racist to Pay Doctors Based on Patient Satisfaction?

Take a moment to ask yourself whether any of these categories describe you or someone you love:

  • Never had cancer
  • Psychologically distressed
  • No regular health care provider
  • No health insurance
  • Lack confidence in self care
  • Avoid doctors
  • Minority race

If any of these terms describes you or a loved one, then you are statistically more likely to give a doctor a lower client satisfaction score. When a doctor will earn less by treating you than someone else, how long do you think it will be before you start having a hard time finding a primary care appointment?

Last week, the fiDoc Gurley's Urban Health Beat, Reporting on Health, patient satisfaction, doctor reimbursementrst article in the “Patients Rating Doctors: Let's Pay Popular People More” series discussed how paying doctors on the basis of client satisfaction surveys may actually undermine the care of our most vulnerable patients, as well as entire systems that struggle to address complex issues.

Disclaimer: Identifiable patients mentioned in this post were not served by R. Jan Gurley in her capacity as a physician at the San Francisco Department of Public Health, nor were they encountered through her position there. The views and opinions expressed by R. Jan Gurley are her own and do not necessarily reflect the official policies of the City and County of San Francisco; nor does mention of the San Francisco Department of Public Health imply its endorsement.


John Russo - City Of Oakland Debt Plans Point To Bankruptcy

Originally, this blogger was planning to run Part Three of this video recap last Wednesday, but frankly elected to stretch out the content production opportunity. The video is over 38 minutes long, and only a handful of people will watch the whole presentation at once.

But for those who do, the video interview with John Russo has a lot of information, and that it's being both referred to by some media types, and ignored by others is a clear example of how personal issues, jealously, and prejudice can block the efficient reporting of a story.

Articles referencing this video should be on the front page of both the San Francisco Chronicle and The Oakland Tribune, but that's not the case.

Just telling the truth.

Ask yourself why. Then ask yourself why print media's losing out to blogs, video, and even some Twitter accounts for ad dollars.

But I digress, though I could go on for a book-length diatribe on that issue.

Where We Left Off:

The last blog post on the Russo interview concluded with this paragraph:

Russo says that Oakland's problems in public safety and finance are "gripping the city," and he's totally opposed to the debt-based solutions being considered. And he said "The directions that the government is moving now are morally...not..uhm... They are, I think, morally questionable, and I could no longer serve, ethically, as City Attorney..." Russo, struggling to find the right words, said.

That's essentially why John left the City of Oakland. He says that while the issues of public safety and finance are "gripping" Oakland, and while he disagrees with the direction of policy and the ethical standing of the decision makers, he felt he could not work in a way he described as "ethical."

Russo says that there are "contracting" and "budgetary" issues that have been in the news and that lay out his complaints, in long form. He points to the battle over the production of weed, and some Oakland elected officials who apparently wanted to push forward in defiance of the Federal Government. And he points to the issues surrounding the police and fire retirement system.

That was where he started to think about getting another job.

Russo says the police and fire retirement system is such that it was closed to new members 35 years ago. Not that everyone was retired 35 years ago, it meant any police or fire fighters hired after 1976 will go into the big state pension system - PERS, as it's called.

But anyone who was hired before '76 was in the Police And Fire Retirement System, or what John calls "PFRS." "The public has been paying, for thirty years, a special tax override that was supposed to cover pee-fers, Russo explained. "That (revenue) has either been inadequate or not placed into the system, and the system in under-funded."

As to where that money went if it was not, to quote John, "placed into the system," Russo says "You'd have to look." When I asked if that was legal to do, Russo said "I can't comment."

But he's not saying the money was stolen. Got that.

John continues: "In 1997, the city (of Oakland) voted on a split vote, where I voted 'no', to issue bonds for 15 years that would pay the city's annual pee-fers contribution. (And) basically on the idea that we will borrow money and we'll pay the stock market, then we'll make more money in the stock market than the interest we're paying on the bonds, we win, and get 15 years where the City's General Fund isn't called upon for pee-fers."

It didn't work out at all, because of the two stock market crashes.

But in retrospect, I remember that episode in the City of Oakland's history, because the bond issue was a large business deal for a number of investment banks, and I was then-Oakland Mayor Elihu Harris' Economic Advisor, when Russo was on the Oakland City Council.

What happened was that the city's then treasurer, Jan Mazyck, was then pushing a proposal by Goldman Sachs that I did not favor and advised the Mayor not to support. And for two reasons: first, after building a system dynamics model of the proposed swap-option to evaluate Goldman's proposal, I wasn't convinced that the swap-option derivative would be enough to protect Oakland in the case of a crash, and I preferred the selection of a minority investment banking firm to handle the deal, rather than Goldman, and in an entirely different way that offered better protection with redevelopment revenue as a "backing."

Elihu listened to me, and voted against the deal.

Eventually, the Council - but not Russo, Mayor Harris, and Councilmember's Dick Spees and Nancy Nadel from Districts Four and Three, respectively, selected Goldman to handle the deal and do the derivative financing system they proposed.

Back to Russo.

"It turns out, according to the (current) City Auditor (Courtney Ruby), that that decision cost the City (of Oakland) a quarter of a billion dollars," Russo continued. "The reason I wrote about it, is the city's 15 year payment holiday is up, next year. And what is the City's solution to that, according to the Mayor and the city staff? Float more debt. Use more debt, so use another credit card, to pay the interest on the second credit card, that was paying the interest on the first credit card. There's only one ending for that pyramid of debt, and it's bankruptcy. There's no other way out of it.

So what they're proposing is another five to seven year holiday, which is great because we don't have to pay the bill. Another five to seven years, we'll just push it off, push it off to the next generation, really."

Russo says that even if the City of Oakland makes a seven percent return, the City would still end up onwing $141 milllion in each year 2024, 2025, and 2026 - a total of $423 million.

The General Fund of Oakland will have to pay $141 million a year by that time. "It will break the bank," Russo says. It's also far beyond the revenue-producing capacity of the City of Oakland, given the population size and level of assessed value of property now, and into the future.

In this what Russo calls "paroxism of irresponsiblity," he claims we have the Oaklanders of the 2050s paying for people who worked for the City of Oakland in the 1950s.

A big mess, getting messier.

Russo House Cleaning

Before I end this segment of the blog posts on the Russo video interview, there's a small controversy that John did not attend City Council meetings and that he's in violation of the City Charter. He's not.

The City Charter does says that if the City Attorney misses ten meetings without being excused, he or she is in violation of the Charter, but the City Charter lacks a definition of what a meeting is. Plus, the second of the City Charter on the Police and Fire Retirement Board, which the City Attorney sits on, allows the City Attorney to send a representative.

So why doesn't that apply to the City Council? Well, by practice, it does. As not only Russo, but Jayne Williams before him, regularly appointed a representative for Oakland City Council meetings.

Also, we next look at Oakland Sports and we look at the observation that Russo bought his way into his job as Alameda's City Manager.

Stay tuned.

Vertex Pharmaceuticals Hepatitis C Drug Incivek Gets FDA Approval

The company this blogger presented last week, Vertex, which announced a new drug called Incivek, was waiting for FDA approval. Well, on Monday, they got it.

According to the Associated Press,...

The Food and Drug Administration approved Vertex Pharmaceuticals's hepatitis C drug Incivek on Monday, making it the second new treatment to be approved in the last two weeks.

Incivek is a highly - anticipated pill that is expected to have annual sales in the billions. It is approved for patients who have some liver damage from hepatitis C who either have not been treated, or were not cured by other drugs. Patients on Incivek take two pills three times per day.

The Cambridge, Mass., company started a nationwide campaign to increase awareness of the disease in advance of Incivek's approval, and it said Incivek will be available in pharmacies later this week.

The company says a 12 - week course of treatment will cost $49,200, compared to $30,000 for standard therapies.

Hepatitis C is an infectious disease that is spread through the blood, including by sharing needles or having sex with an infected person. Vertex said about 4 million people in the U.S. have the disease, and many people do not know they are infected. Hepatitis C can cause liver damage, cirrhosis, liver failure or cancer.

As I reported, Hepatitis C effects an estimated 270 million to 300 million people Worldwide, 30,000 people in Santa Clara County12,000 people in San Francisco City and County, and 2,400 new cases were reported in 2010.

In my next installment on this, I will talk to a person who's actually used this drug.

Stay tuned.

Top 10 Social Networking Things to Do - Social Media

Almost two years ago, this blogger wrote a blog post called "Top 10 Social Networking Things To Do." While watching TechCrunch Disrupt, I decided to revisit my video and blog post to see how well my top 10 tips held up, two years later.


Because there has been a lot of growth and change in social media over that time. Twitter has grown in use tremendously, and there are far more mobile apps for social, like Foursquare. But what do you absolutely need to be on to have a good social graph going for yourself?

Here's the original post:

Top 10 Social Networking Things to Do

1.Figure out your name. (I'm Zennie Abraham, Zenophon Abraham and Zennie62) There's a habit of using different and weird names by one person on different networks. If you want to get a job, that's a bad practice. It's better to have one name or set of related names; for all practical purposes that name set serves as the foundation of your personal brand, or who you are. It's also easier to find in a search, rather than your identity spread chaotically on the Internet.

2.What do you want to get out of this? (Business? pleasure? Information? If you're in the business of pleasure that's another story. You also need to ask yourself how you feel about having "you" out there as the negatives are the possibility of being stalked, but that written the positives far overwhelm that negative and we can talk about how to stop and expose stalkers online later.)

3.Figure out your title: CEO? Producer? Party Animal?

4.Develop an email list. Remember, email is still a form of social networking.

5.Find a photo you're proud of and nothing with you wearing a gorilla suit. (It does work for some but I don't recommend it.)


a.Join Linkedin

b.Join Ryze (Great small business membership base in the Bay Area.)

c.Join Plaxo

d.Join Facebook and turn off the relationship notifications. (We don't need know that you're dating Sven Nordgarden.)


a.Join MySpace

b.Join Facebook

c.Join FriendFeed


a.Join FriendFeed

b.Join Facebook

c.Join Technorati (I recommend creating a blog and then posting it as your website of choice in their system.)

9.Set up a blog - put your resume in it without your phone number. That's your free website. I prefer Blogger.com. It's free. Make the blog title your name. Why? To mark your place with your name on cyberspace. Link to it from your social network profile. The point is to begin to protect your name and identity by having something out there you made about you, not someone else.

10.Use your email signature as the place for your links to your Linkedin Page and Blog page. (Now you have two places pointing at your blog page, which helps with SEO and to have others see your resume.)

A word about Twitter.

Twitter is not a social network, it's a communications system and you need to have something to say to use it. It's volume-based; the more you post the more valued your account because people will follow you looking for interesting posts, or what are called "tweets". I think of Twitter as an accessory to a social network not a replacement for one.

Now, I still stand behind my Twitter observation of two years ago, mostly because it's my strategy. For me, social networking is really social broadcasting, and I see all of these apps as tools to be integrated, not to replace each other.

I did not include Foursquare, because you can actually have a really good social graph without it. But that said, I use Foursquare to help broadcast favorite places and also my Zennie62 brand, and in a way that, when I'm done, will be ubiquitous.

I'm also on a total of over 200 blogs and websites, and social networks. It's all to the point of pushing one brand, Zennie62, as much as anything.

I don't recommend that everyone do that, but the Top 10 is necessary, and not just to have a "social graph" but to also protect your online identity.

There are too many people making fake accounts representing others online, and the moment you do anything that gets attention by media, which is different forms today, that chance that someone would do that is that much greater.

Protect yourself. Get online.

Bing Gordon Of Kleiner-Perkins Talks Zynga At TechCrunch Disrupt

As this blog is written, Bing Gordon of the Venture Capital Firm Kleiner-Perkins says he likes "games, and soy latte." Mr. Gordon's almost toying with TechCrunch Editor Michael Arrington because he's not actually giving up any valuable information.

But he does make statements that do provide some news. For example, he says that since Reid Hoffman, "everyone's going to go public in four weeks."

The gaming investor says that he doesn't want to compete with Zynga, which he invested in (not enough he says), because it's got too many "smart people." And says that it's monetization's going to get to ten percent, even though it's reached that in Asia.

In other words, about 10 percent of Facebook social game users like the ones Zynga produces become paid users in Asia. That's about $60 per person, but he says it's going to be higher than that in America.

The Gamifcation of Everything

Arrington asked if that idea that everything is becoming "game oriented" or the process of "gamification," is real. Gordon says that people who've grown up since the 70s have to make choices not to game. But that person sees the World differently, you can "level up," for example. "The most powerful game system is Google Search SEO" because people are always trying to game it, or figure out how to do so.

Great point.

The Ecosystem of Zynga and Facebook

Arrington asked who needs the other more, Zynga or Facebook? Bing essentially agrees that they need each other, and because people who use Facebook and game are larger in number than those who don't.

On the matter of the sour relationship between Zynga and Facebook, he says that Zynga was thinking about starting its own portal as a "counter-strategy" to Facebook's new restrictions, and that Facebook Credits would be the only method of payment, where Facebook takes 30 percent of each spend from the money apps develop.

That this will happen, with Zynga taking its 246 million active users per month away from Facebook, is still apparently very real, because Arrington said "It looks like you're giving me a signal that you don't want to talk about this any more."

The Real Bing

"I'm pretty aware of my shortcomings and try to defend or deflect them every day."

Stay tuned.

Ashton Kutcher Talks With Sarah Lacy Backstage At TCDisrupt

Ashton Kutcher continued his tech talk with Sarah Lacy Backstage At TCDisrupt.

On appearing at TechCrunch Disrupt, Kutcher says that it's not that he's less nervous about talking before tech people, just that he's found "the right words."

But it's clear, with his investments, initiatives, and programs, that Ashton Kutcher has become a full-fledged, informed, angle investor. He's got the lingo down, but more important, has a set World view which governs what he invests in.

On Tech Vs Acting

Sarah Lacy asked if he was going to lose time from acting for Tech and said "I'm not going to end up on a set in Louisiana working 16-hour days." So, he's got a plan such that he will not have to act for money as he ages.

My bet is he continues to act, though.

Stay tuned.

Ashton Kutcher Talks With Charlie Rose At TechCrunch Disrupt

Appearing in a beard and hat, and not wanting to talk about his new gig on Two And A Half Men, Actor Ashton Kutcher came on to talk with Charlie Rose at Tech Crunch Disrupt New York about his company Katalyst Media, that he started with Jason Goldberg, and a new investment company and initiative.

Ashton revealed that he was an early investor in Skype, and involved in promoting the brand as much as putting money into it.

Kutcher, who has over 6 million Twitter Followers, sees on Twitter the opportunity for mass syndication and "something that is very addictive," and, he says, satisfying in seeing your tweets retweeted.

The New Fund

Kutcher's got an investment fund called A-Grade that "puts money into tech investments," and is looking for apps that "solve a problem for a large subset of people."

On this, he says that it's best to invest in companies that are "just trying to keep their servers going," which means, if that's the case, he's going to have a lot of people knocking at his door.

Right now, A-Grade is looking at a variety of different companies, but he's not into hearing about someone's market cap, because there are so many people pitching companies who says that first. "What I look for is what is the trust level of people, and are you solving a signal-to-noise issue. The more people trust the application, the more time and money they will put into it."

A-Plus, is the name of "a really good grade, he says, and a new platform that builds an app to essentially catch real time information and sort it so that it can be seen at the time that works for the user. "I want to follow Charlie Rose's Stream, but I want to just read about tech."

He tweets every day or once or twice a day, sometimes six or seven times a day. He says he tweets everything himself, and tries to answer back to the community.

Hollywood Is Like Tech

For him, acting and movie - making is a lot like tech investing in that "you have to raise money for a movie" and then work to make sure it's made and does well, in this case, at the box office.

On The Future

Prediction" media will just become media, but on multiple consumption devices, but have one distribution device. What a lot of people are trying to capture is what consumption system we use to get media.

On Movie Canibalization

Ashton says that Hollywood's arguing about what to do about Digital Media is stopping it from coming up with an overall solution. (Hollywood) is already being caniballized," he says.

He points to his movie No Strings Attached with Natalie Portman as one example of how piracy is harming Hollywood. "The movie did fairly well at the box office, but on other platforms... So I looked it up online and found about 20 different copies (that the studio did not upload), and asked, "Are we doing anything about this," and never got an answer.

Maybe after today, Ashton will get one.

Stay tuned.