Readers Respond to Prescribing Information

Our recent "Prescribed Information is Powerful Medicine" article stirred up some response from readers. To give us your comments on this or any other B&H article, e-mail us at Rick.Service@medec.com. Please specify if you'd like your name withheld.

I read with interest Ms. Mettler's article on information therapy. ("Prescribed Information is Powerful Medicine")

Good info for both patients and providers to know! I was a little dismayed, though, at the omission of a key info contact for both — medical librarians. Advanced-degree professionals who often have years of experience under their belts, these folks have access to vetted health care information that can help prevent patients from falling prey to quackery or marginal information often disseminated for vested interests by unqualified sources primarily, if not solely, interested in the profit motive. In addition, they have resources available that the average practitioner will not be aware of, simply because it's impossible to expect providers to be able to both heal and keep current with all the trends in healthcare information.

"Information therapy" has become a buzzword in the health care field of late, but it's hardly new, since medical librarians have been focused on this as their primary job function since long before the National Library of Medicine's MEDLINE service came online nearly 40 years ago.

Great article, and good for people to know, but please don't ignore the one type of "information professional" best able to supply high-quality information to both practitioners and their patients!

Bill Nichols
Director, Medical Library
Eglin AFB, FL

The July 1, 2003 issue of Business & Health's article "Prescribed Information is Powerful Medicine" lays out the logical case for prescribing targeted health information. The challenge of reimbursement raised in the article unfortunately evades the reality of how costs reimbursements are modeled. The author writes: "New technologies will also break down the three roadblocks to reimbursement for patient education: unverifiable quality, uncertain clinical efficacy and documentation difficulties."

Quality and efficacy are clinical issues that need to be addressed prior to incorporation into any reimbursement mode. They are not roadblocks to reimbursement but rather criteria of medicine. New technologies have little to do with quality or efficacy of the content itself, but they do allow for multiple distribution. The issue of documentation is simply mechanical and of no impediment to any reimbursement model.

From a reimbursement perspective a service must be of actuarial value, and its cost must be greater than the transaction costs. If the presumption is that the health information is both acceptable in its quality and efficacious, then the question becomes costs - its actuarial value. Health content of high quality and efficacy is widely available at little or no cost as a result of the competitive nature of the purveyors of health content and technology itself - the Internet.

The cost to reimburse any item, its transaction cost, is also so small that individually it's negligible. On an aggregate basis, however, transaction costs equals hundreds of millions of dollars in the U.S. alone. To institute the reimbursement of an information prescription, the transaction costs are likely greater than the cost of the prescription itself. Pennies vs less pennies. Even reversed, if the cost of the information prescription were greater than the transaction costs it still would not make financial sense: pennies vs less pennies.

Information prescription is certainly an important component of any course of treatment. But the attempts to segment it as an independent cost item run counter to the current trend in reimbursement. Information prescription is part of the medical care provided by clinicians. The quickest way for clinicians to establish a reimbursement model for information prescriptions is to factor it as a cost of their practice, much like electricity or rent.

Hank Kearney, MHP, RHU
PHM International - Since 1997
Fort Lauderdale, FL

Thank you for your article on Prescribed Information.

Business & Health's article "Prescribed Information is Powerful Medicine" gave our group a boost of good medicine. Our new non-profit organization Cancer Care Connection's entire program model is based on the concept of "information is good medicine." We help people access cancer information and local services more efficiently.

Employers need to know that cancer will affect a good portion of their workforce as patients, caregivers, friends or co-workers. Companies that can increase employee resources to deal with the myriad of medical and personal issues that accompany cancer; and provide regular information on prevention and healthy lifestyles, will not only help the health of their workforce, but their bottom line as well.

Offering an independent source for information therapy is important. We can help employees' access non-biased information to help in communications with their health care team and meet their needs for local services and emotional support. But most importantly employees need to have the information to make their own "more-informed" decisions.

From cancer prevention all the way to bereavement, we know that the right information at the right time can make a significant difference in health, quality of life and care. We are glad to be a part of information trend with a personal yet professional (masters level oncology social workers) touch. Thank you for helping us see that we are on the right track with our business member program.

Valerie Mullen Pletcher
Development Director
Cancer Care Connection
www.cancercareconnection.org

Have a comment about one of our articles? Then send your own letter to the editor by e-mailing us at Rick.Service@medec.com.

Readers Respond to Prescribing Information.

Business and Health

Jul. 15, 2003;21.