A cautionary tale: Harvard's financial hubris

Stocks were tumbling last fall as the new school year began, but at Harvard University it was as if the boom had never ended. Workers were digging across the river from Harvard's Cambridge, Mass. home, the start of a grand expansion that was to eventually almost double the size of the university. Budgets were plump, and students from middle-class families were getting big tuition breaks under an ambitious new financial aid program. The lavish spending was made possible by the earnings from Harvard's $36.9 billion endowment, the world's largest. That pot was supposed to be good for $1.4 billion in annual earnings.

Behind the scenes, though, a different story was unfolding. In a glassed-walled conference room overlooking downtown Boston, traders at Harvard Management Co., the subsidiary that invests the school's money, were fielding questions from their new boss, Jane Mendillo, about exotic financial instruments that were suddenly backfiring. Harvard had derivatives that gave it exposure to $7.2 billion in commodities and foreign stocks. With prices of both crashing, the university was getting margin calls--demands from counterparties (among them, jpmorgan Chase and Goldman Sachs (nyse: GS - news - people )) for more collateral. Another bunch of derivatives burdened Harvard with a multibillion-dollar bet on interest rates that went against it.

Res ipsa.

Personal: a note on venture capital, post-Fannie/Freddie

"Life is hard," wrote M. Scott Peck, M.D.

SHEESH! No kidding! Just a year ago, so many things seemed possible. Now -- VC for bio-tech appears lifeless.

But yesterday, an MBA/JD of the HSW variety (Harvard-Stanford-Wharton) said "for the right opportunity, there's still capital. If the opportunity is big enough."

Medical Onshoring (patent-pending) is my mission in life. With a budget as large as the French economy, U.S. health care has plenty of assets to attract investors.

I decided to return full-time to health care for a lot of reasons. A key one: in technology, you get used to people, running into your office with their hair on fire, every other hour. At this stage of my life, I decided I needed to do something more meaningful and purposeful.

The meaning and purpose of MedOn (pat. pend.):

• to provide working people with affordable, high-quality medical-care options;

• try to help contain the frightening rise in medical-care costs; and

• raise the standard of medical care for working people, worldwide.

A lot better than people running around with their hair on fire, eh?

The need for accreditation: a cautionary tale

What goes around, comes around ..

Lawmaker Urges Regulation Of Dental Restorations To Protect Patient Safety

21 Feb 2008

Florida Rep. Stan Jordan, R-Jacksonville, announced that he has filed legislation backed by the Florida Dental Laboratory Association to implement more stringent regulations to protect patients receiving the dental restorations affixed into the mouths of millions of Americans each year.

Dental-restoration products - the porcelain crowns, dentures and bridges that American dental patients have permanently seated in their mouths - are currently under-regulated, with few legal requirements for technicians to be certified and no mandates for dentists to document or disclose the source of dental work to patients, Jordan said Tuesday.

Although dentists prescribe the type of device they need for a dental patient, the product is actually manufactured by a dental technician employed by a dental laboratory, which could be located in the United States or anywhere in the world. Due to the growing number of Americans seeking dental restorative treatment and the growing pressure by some dentists to cut costs and increase profit margins, much of the dental work Americans carry in their mouths is now imported from countries such as China, Pakistan, the Philippines and India.

Jordan's legislation, HB 923, will require all dental laboratories to disclose to dentists where a product was manufactured and what materials were used, and provide certificates of authenticity. It further requires dentists to include these records in a patient's dental chart so patients can request the information and so health officials can track and trace a dental restoration to its source should a health problem later emerge. Finally, the bill requires dental laboratory technicians to maintain continuing education every two years.

State of the Heart: A Medical Tourist's True Story of Lifesaving Surgery in India

The story that helped kick-start "medical tourism" ..

In 2004, at the age of fifty-three, self-employed contractor Howard Stabb learns that a leaking mitral valve in his heart needs to be repaired. Left untreated, his doctors tell Stabb, his condition may kill him at any moment. The procedure to repair the heart valve costs at least $200,000 at the Durham Regional Hospital near Stabb's North Carolina home-if there are no complications.

This gripping memoir describes Stabb and Grace's experiences from the initial diagnosis through their trek to India, the operation Stabb undergoes, and the chilling dangers he faces after the surgery. In an afterword, the book offers resources for readers considering overseas health care, including hospital recommendations, visa and inoculation information, and things to look for when choosing an overseas health care provider. In all, the memoir alludes to the collective story of the more than 43 million uninsured Americans who face, everyday, the very real possibility that their lack of health insurance may either bankrupt or kill them-if not both.

Medical Tourism & Patient Data

Under "statistics, damn statistics and lies" ..

http://travel.nytimes.com/2006/10/15/business/yourmoney/15care.html?sq=thailand%20hospital&st=nyt&scp=4&pagewanted=print

In Bangkok, Bumrungrad International Hospital counts 55,000 American patients a year.

McKinsey & Company's report on medical tourism, using a very rigorous, very conservative data-approach --

http://www.mckinseyquarterly.com/Mapping_the_market_for_travel_2134?pagenum=1

"Between 60,000 and 85,000 people annually travel abroad for inpatient hospital care, a number .. far lower than commonly assumed."

Probably some of the difference is between elective and acute situations.

Harvard's Michael "Healthcare" Porter in Israel

America's best in Israel ..

"No, No , No" exclaimed Michael Porter, chastising the Associate Director of a major medical center in Israel, "You have to raise your hand." Such blatant breaches of HBS etiquette were relatively frequent over the course of the week long IXP, which drew a wide range of participants, many of whom were unfamiliar with the peculiarities of the typical HBS classroom.

The Value-Based Health Care Delivery IXP, co-led by Professor's Porter, and Elizabeth Teisberg (formerly of HBS and currently a professor at the Darden School of Business at the University of Virginia), was a multi-disciplinary immersion program based on the framework presented in the book, Redifining Healthcare. The book, which diagnoses the problem of competition in the modern healthcare system, introduces a broad set of strategies which providers, payers, employers and the government can use to improve value. The immersion program was designed as an extension of the book, and involved case studies and subsequent discussions of companies and organizations who have implemented strategies that demonstrate the principles outlined by Porter and Teisberg.

Program participants came from all corners of the healthcare sector. In addition to 17 HBS MBA students with prior healthcare experience (10 of whom were MD MBA's), there were students from Harvard School of Public Health, Kennedy School of Government, and Harvard Medical School. Participants also included many medical residents and practicing physicians, most of whom were affiliated with hospitals in the Boston area, including several heads of departments and several senior surgeons and administrators. Finally, there was also a significant international contingent, with participants flying in from Ireland, Israel, England, and Canada.

Mumbai, India attacks

In a terrorist attack -- not even a hospital is off-limits --

http://en.wikipedia.org/wiki/Cama_Hospital

The 2008 Mumbai attacks were ten coordinated terrorist attacks across Mumbai, India's financial capital and its largest city. The attacks, which began on 26 November 2008 and lasted until 29 November, killed at least 173 people and wounded at least 308. The attacks drew widespread condemnation across the world.

Eight of the attacks occurred in South Mumbai: at Chhatrapati Shivaji Terminus, the Oberoi Trident, the Taj Mahal Palace & Tower, Leopold Cafe, Cama Hospital, the Orthodox Jewish-owned Nariman House, the Metro Cinema, and a lane behind the Times of India building and St. Xavier's College. There was also an explosion at the Mazagaon docks, in Mumbai's port area, and in a taxi at Vile Parle. By the early morning of 28 November, all sites except for the Taj Mahal Palace had been secured by Mumbai Police and security forces. An action by India's National Security Guards on 29 November resulted in the death of the last remaining attackers at the Taj Mahal Palace, ending all fighting in the attacks.

EDITORIAL: USA medical costs -- next speculative bubble to burst?

AN EDITORIAL

Since the Dutch "tulip bulb" bubble of the 17th century, many speculative bubbles have exploded in the faces of the oh-so-smart. After Enron, Fannie Mae/Freddie Mac -- will U.S. medical costs be next?

IMHO, the rate of growth of USA medical costs is unsustainable. Left unchecked, with the aging of the baby-boomers, it could grow to 35% of U.S. GNP (now 16%). How can the "stimulus" be repaid, if that happens?

Medical Onshoring is dedicated to attempting to restain medical costs, while maintaining Joint Commission International standards.

And medical care and health care is more than just technology, money, bureaucracy, and politics.

It is about creating "circles of caring communities," that patients receive maximal service, with the resources available. From a simple physical exam -- to the final, precious moments of life.

Most of those in the medical-industrial complex are pushing for growth, growth, growth. Per previous -- that's unsustainable, IMHO.

Trying to restrain costs in a quality environment -- especially with so many pushing for "more, more, more" of medical services -- is a huge operational challenge. Not political -- operational.

Well -- I enjoy big challenges.

USPTO to publish patent app 4/29/09

U.S. Patent & Trademark Office (USPTO) has notified yours truly that the patent application of Medical Onshoring (pat. pend.) is scheduled for publication on the USPTO web site on 4/29/09.