How the medical supply industry blocks device startups from selling to hospitals • Hacker News Board

Re: How the medical supply industry blocks device startups from selling to hospitals

#61

Post by d503 » Wed, Apr 25, 2012, 7:08 PM UTC

pdeuchler wrote: post #20

rscale wrote: post #12

This caught my eye: Kaiser spokesman Jim Anderson argues that if Shaw’s products didn’t make their way to hospitals it was because of “significant supply issues” on Retractable’s end. He also says they were prone to malfunction and that, in several cases, needles detached and were left “stuck in the arms of patients.” I'm doubtful that a Kaiser spokesman would fabricate these problems, which leads me to believe that…

"BD had released its own safety syringes some years earlier. But the ECRI Institute, the Consumer Reports of the health care industry, had rated its best-selling model 'unacceptable' (it was later upgraded to 'not recommended'), whereas Shaw’s product received the top rating." I have a doctor and a nurse in my extended family that deal with Kaiser on a daily basis and I've heard horror stories that would make a battl…

Kaiser actually shut down their kidney transplant program in 2006 [1] after a number of problems came to light. The state regulator prepared a 50 page report on the matter [2]. Incidentally--and I have no personal experience with Kaiser or any other HMO and can't tell how close to reality this is--Kaiser (in California at least) does pretty well in government quality of care performance measurements and overall member ratings [3], and they are also Consumer Reports's top ranked California HMO.

[1] http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2006/05/13/... [2] http://www.dmhc.ca.gov/library/reports/med_survey/surveys/05... [3] http://www.opa.ca.gov/report_card/hmorating.aspx

Re: How the medical supply industry blocks device startups from selling to hospitals

#62

Post by anigbrowl » Wed, Apr 25, 2012, 7:10 PM UTC

robomartin wrote: post #40

As an entrepreneur I have dedicated most of the last 25 years to doing hardware (read: manufacturing) ventures. Manufacturing in the US is hard, if not impossible, save cases where the ecosystem or nature of the market can support it. Problems one could face include: ip (patents) mine field, government regulations, liability issues, lack of localized supply chains, high labor costs, high insurance costs, high taxes a…

Part of the problem is that we continue to give the keys to the shop to bureaucrats who have zero real-world, business or employed-by-a-non-government-business experience. You really can't expect much from anyone who has lived their entire life within the confines of an ecosystem where personal decisions carry almost no risk.

A lot of the time the rules are not made by bureaucrats but by politicians in receipt of lobbying money and an industry-supplied amendment which the politicians has neither read nor understood; also, when private actors dislike bureaucratic decisions, they frequently sue the bureaucratic agency in question to prevent its implementation. Blaming the problem on timid bureaucrats without acknowledging these frequently encountered situations is a hollow argument.

FTA: As it turns out, Shaw’s retractable syringe hit just as these trends were converging. In fact, the year his product came onto the market, three of the nation’s largest GPOs merged to form a company called Premier, which managed buying for 1,700 hospitals, or about a third of all hospitals in the United States. Shortly thereafter, Premier signed a $1.8 billion, seven-and-a-half-year deal with Becton Dickinson. Under the agreement, member hospitals—among them Dallas-based Presbyterian, where Shaw would hit a brick wall—had to buy 90 percent of their syringes and blood collection tubes from the company. Over the next two years, BD landed similar deals with all but one major GPO. As a result, almost everywhere Shaw turned, he found hospital doors were closed to him.

Here, for example, no government bureaucrats were involved at all.

Re: How the medical supply industry blocks device startups from selling to hospitals

#63

Post by kijin » Wed, Apr 25, 2012, 7:11 PM UTC

excuse-me wrote: post #23

kyro wrote: post #7

Earlier quoted context omitted.

Yeah, hospital-acquired infections are huge. In fact, they're a huge reason why we have so many aggressively resistant strains of organisms.

More the other way around. Widespread over-the-counter antibiotics, over prescription and agricultural use are the reason there are so many resistant organisms. Healthy people with the organisms going into hospitals full of sick people is the reason they get there. Poor hospital cleaning, high occupancy rates and especially people using keyboards is the reason they are huge.

> people using keyboards

Never thought about that before, though I do know that keyboards are filthy. Is there any evidence that the rate of infection increased since medical professionals began to use keyboards for data entry? But I guess that kind of data would be buried under a lot of other factors that emerged over the last 2-3 decades.

Also, how would you go about fixing that? Tablets might be easier to clean, but you're still touching a surface. Speech recognition would be cool, but then you're spraying microscopic drops of saliva all over the place. Is paper just as unsanitary, or does the fact that fewer people share the same sheet of paper somehow mitigate the risk?

Re: How the medical supply industry blocks device startups from selling to hospitals

#64

Post by tyree732 » Wed, Apr 25, 2012, 7:12 PM UTC

Symmetry wrote: post #54

tyree732 wrote: post #47

Earlier quoted context omitted.

Are you so sure about that? excuse-me's comment, right above yours in my view, talks about how the government has anti-competitive arrangements with big military contractors. How would the situation be different with healthcare?

I think the fix in this case would be removing the laws that encourage anti-competitive arrangements.

How is the government incentivized in any way to do that? Politicians in the US receive substantial campaign contributions from established military suppliers who would stand to lose a lot from said laws. I don't see any rallying cries from the public about the competitiveness of supply arrangements government entities currently have.

Re: How the medical supply industry blocks device startups from selling to hospitals

#65

Post by [deleted] » Wed, Apr 25, 2012, 7:14 PM UTC

gamble wrote: post #60

robomartin wrote: post #40

As an entrepreneur I have dedicated most of the last 25 years to doing hardware (read: manufacturing) ventures. Manufacturing in the US is hard, if not impossible, save cases where the ecosystem or nature of the market can support it. Problems one could face include: ip (patents) mine field, government regulations, liability issues, lack of localized supply chains, high labor costs, high insurance costs, high taxes a…

I'm not seeing how the government was an issue in this case. The article is about how private companies use kickbacks and cartel behaviour to restrict what products are available to hospitals. It seems like a lack of government action is the problem here.

[deleted]

Re: How the medical supply industry blocks device startups from selling to hospitals

#66

Post by robomartin » Wed, Apr 25, 2012, 7:15 PM UTC

gamble wrote: post #60

robomartin wrote: post #40

As an entrepreneur I have dedicated most of the last 25 years to doing hardware (read: manufacturing) ventures. Manufacturing in the US is hard, if not impossible, save cases where the ecosystem or nature of the market can support it. Problems one could face include: ip (patents) mine field, government regulations, liability issues, lack of localized supply chains, high labor costs, high insurance costs, high taxes a…

I'm not seeing how the government was an issue in this case. The article is about how private companies use kickbacks and cartel behaviour to restrict what products are available to hospitals. It seems like a lack of government action is the problem here.

No,no. Read it again. The government setup the rules that enabled exactly that behavior.

If they (government) didn't try to play entrepreneur or investor we'd be far better off. There are cases where government involvement is warranted. I'm with Ron Paul on this one: Get them off our backs, we do and did just fine when they had less hooks into us. This is particularly true with the existence of the Internet. It's pretty hard for a large company to misbehave today and not pay a serious price for it. Laws are far less powerful in this regard.

Re: How the medical supply industry blocks device startups from selling to hospitals

#67

Post by paul » Wed, Apr 25, 2012, 7:15 PM UTC

When people complain about entrepreneurs building social networks instead of curing cancer, they need to understand that this is a big part of the reason. The internet attracts so much innovation in large part because it's very open to innovation. In more regulated/corrupt (the two are closely related) fields, such as health care, there are many barriers to competition that kill innovative new companies. Mobile was actually very similar to this in the pre-iPhone era (because you needed to make deals with carriers). This in turn leads to less investment, since it's kind of dumb to invest in a doomed company.

We're at a point in history where most of our problems are social/political. Our technology is good enough to make the world into a nice place for everyone, but we don't do it because our social "software" is broken. It's easy to make fun of Facebook or Reddit as being all about sharing cat picture, but the reality is that they also are changing the flow of information and influence to be much more peer-to-peer instead of top down (e.g. three television networks). Many will disagree, but I believe that in the long term society will evolve to match this more egalitarian structure. The most effective way to cure cancer may be to first cure the social disfunctions that lead to the types of situations described in this article.

Re: How the medical supply industry blocks device startups from selling to hospitals

#68

Post by anigbrowl » Wed, Apr 25, 2012, 7:19 PM UTC

robomartin wrote: post #66

gamble wrote: post #60

Earlier quoted context omitted.

I'm not seeing how the government was an issue in this case. The article is about how private companies use kickbacks and cartel behaviour to restrict what products are available to hospitals. It seems like a lack of government action is the problem here.

No,no. Read it again. The government setup the rules that enabled exactly that behavior. If they (government) didn't try to play entrepreneur or investor we'd be far better off. There are cases where government involvement is warranted. I'm with Ron Paul on this one: Get them off our backs, we do and did just fine when they had less hooks into us. This is particularly true with the existence of the Internet. It's pre…

No, in 1986 the government removed rules (forbidding kickbacks) designed to prevent such behavior. In 1996 the government exempted medical supply companies from many antitrust regulations. The facts laid out in the article are diametrically opposed to the point your are trying to make.

It's pretty hard for a large company to misbehave today and not pay a serious price for it.

for example?

Re: How the medical supply industry blocks device startups from selling to hospitals

#69

Post by excuse-me » Wed, Apr 25, 2012, 7:21 PM UTC

kijin wrote: post #63

excuse-me wrote: post #23

Earlier quoted context omitted.

More the other way around. Widespread over-the-counter antibiotics, over prescription and agricultural use are the reason there are so many resistant organisms. Healthy people with the organisms going into hospitals full of sick people is the reason they get there. Poor hospital cleaning, high occupancy rates and especially people using keyboards is the reason they are huge.

> people using keyboards Never thought about that before, though I do know that keyboards are filthy . Is there any evidence that the rate of infection increased since medical professionals began to use keyboards for data entry? But I guess that kind of data would be buried under a lot of other factors that emerged over the last 2-3 decades. Also, how would you go about fixing that? Tablets might be easier to clean,…

100 years ago patients died because of doctor's neck ties. He would lean over one patient with the tie dragging on their wound, then go to the next patient transferring the infection

Of course we are far too advanced to do anything so stupid today.

Now we examine a patient, go to the computer at the nurses station and type up the results, then the nurse comes along and rubs their hand over the keyboard and mouse, then you go the next patient ....

You can get washable waterproof medical keyboards but they are expensive, and get broken and replaced with whatever IT have on the shelf. Funnily enough I have never seen a waterproof mouse.

Re: How the medical supply industry blocks device startups from selling to hospitals

#70

Post by tdpeterson » Wed, Apr 25, 2012, 7:28 PM UTC

"In the case of the towel bid, hospital administrators were shown a PowerPoint presentation (a copy of which she gave to me) indicating that going with the Medline and Medical Action bids would save them between 6 and 29 percent. But this was relative to the same companies’ bids the previous year, not the bids offered by other vendors."

I'm interested in seeing these slides and sent a request to the article's author.

Were the decision makers present aware there were other vendors? If so, how was this data not called into question? It would be interesting to see if the data was presented in a completely misleading way or if there was some level of laziness and complacency on the decision-makers' part as well.

Regardless, misleading presentations are always interesting to examine, such as Tufte's assessment of the presentation given to NASA officials before the Columbia disaster (http://www.edwardtufte.com/bboard/q-and-a-fetch-msg?msg_id=0...).

Edit: Just received a reply from the author that she's unable to share the presentation as the person that originally shared it has been "subject to legal harassment." Lame!