Jun
30
JAMA study rocks hospital RFID users
Filed Under Health IT, Hospitals | Leave a Comment
A new study published last week in the Journal of the American Medical Association is rocking the hospital world–which has begun to adopt RFID for a wide range of device and patient-tracking functions–by suggesting that such tagging can wreak havoc with critical-care equipment. Researchers in Amsterdam concluded that electromagnetic interference from RFID systems could cause unintended changes in equipment functioning. Researchers detected such changes in 34 out of 123 tests of 41 different medical devices. Of those 34 incidents, 22 were “hazardous,” including total switch-offs and restarts of mechanical ventilators, complete stopping of syringe pumps and renal replacement devices and interruption of external pacemakers. In conducting the tests, researchers randomly used both passive and active RFID systems. Oddly enough, it was the passive tags, which don’t have internal power and must be activated by readers that led to 63 percent of total incidents and 41 percent of the hazardous events. Active tags, which include battery power and don’t require activation, don’t seem to be as likely to affect other systems, researchers found.
Jun
30
AT&T, Covisint and Microsoft plan to expand health network nationwide
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AT&T, Microsoft and Compuware subsidiary Covisint have announced plans to create a nationwide health information exchange which expands on a smaller network already in place state-wide in Tennessee. In Tennessee, the MidSouth eHealth Alliance and the Governor’s eHealth Council had already been running an electronic health network for doctors across the state, running on Covisint’s On-Demand Healthcare Platform.
The broader eHealth network will use Covisint’s platform and run over AT&T’s MPLS network. The new network will give consumers access to records based on Microsoft’s HealthVault PHR technology, while giving them the ability to share that information with all providers who connect to AT&T’s Healthcare Community Online. The Healthcare Community Online is a virtual private networking-based portal which allows electronic health data exchange between existing systems used by providers and physicians, including large files such as X-ray images, MRIs and CT scans. The AT&T network allows doctors, hospitals, labs, pharmacies and patients to access test results, prescription records and medical histories. It also offers physicians the ability to use e-prescribing functions.
What’s interesting here is that the parties involved don’t mention what their services will cost, or even what pricing model they’ll use (a connectivity charge, a flat fee, a fee per transaction, some other option?). I wonder if this model will be any more affordable than the costly, largely unsustainable RHIOs/HIEs not-for-profit groups and governments have attempted to bring together.
Jun
30
Private vendors may be the HIE solution
Filed Under Health IT | Leave a Comment
I’m very skeptical that non-profit healthcare information exchanges or RHIOs can sustain themselves. In fact, I’ve argued vigorously that such entities are unlikely to keep their doors open, given that no one seems to have found a financial model that works for everyone involved. Neither government projects, not-for-profits nor partnerships between the two seem to have what it takes to create workable HIE businesses.
But now, looking one item in today’s newsletter, I find myself wondering if I’ve been missing the obvious. The story, which describes how AT&T, Microsoft and Compuware subsidiary Covisint are building out a national health information exchange, reminded me that private vendors may have compelling reasons of their own to build out HIEs. And it makes sense that they should quarterback such a large network-development effort.
If you look back in history, after all, few industries have been able to spontaneously create networks of their own. The automobile and retail industry, for example, put an electronic data exchanges in place many years ago, but they relied on value-added network vendors to do much of the data carriage and establish connectivity.
And even with their VAN taken care of, those retailers and automakers took a while to get rolling, though they had much better business cases for data sharing. After all, industry officials had clear-cut supply-chain savings they could demonstrate from building out new networks–or in the case of retailers, increased sales through just-in-time distribution of hot products.
Healthcare officials, on the other hand, aren’t going to jump-start HIE efforts easily by attempting to make a financial case for them. While everyone’s pretty sure that outcomes can be improved by better access to patient medical records, it’s just not that easy to pin down HIEs’ dollars-and-cents benefits over the short term.
Now, it’s possible that AT&T, Microsoft and Covisint’s services will be too pricey for some providers (perhaps even most). However, even if big players like these don’t end up being the commercial entities leading the private HIE development industry, I’m confident some vendors in the networking and enterprise software space will find a way to deliver up such networks at a price point and on a basis that makes sense. Why am I so sure? Because there’s just too much money to be made on hooking up health data exchanges if the right solution comes along.
Don’t get me wrong, I know there are plenty of issues that can come up with an ad-hoc network of private HIEs. Questions of who owns the data, how one network connects to another and how providers switch if they’re not pleased with their current HIE are just the tip of the iceberg. But that being said, if this is an instance in which private commercial interests can move more quickly than non-profits, I say, “More power to them.” Perhaps profit-driven vendors, at long last, can get this job done.
Jun
30
US could face shortage of 44,000 primary care physicians by 2025
Filed Under Doctors, Uncategorized | Leave a Comment
MU researcher calls for incentives to increase numbers of primary care practitioners
COLUMBIA, Mo.- By 2025, the wait to see a doctor could get a lot longer if the current number of students training to be primary care physicians doesn’t increase soon, according to a new University of Missouri study. Jack Colwill, professor emeritus of family and community medicine in the MU School of Medicine, and his research team found that the U.S. could face a shortage of up to 44,000 family physicians and general internists in less than 20 years, due to a skewed compensation system that rewards specialists increasingly more than primary care practitioners. The researchers are more optimistic about the future supply of general pediatricians.
Today, generalist physicians are a third of the U.S. physician workforce and are responsible for more than half of all patient visits at doctors’ offices.
“Concern about the supply of generalists is not new,” said Colwill, who also is a member of the National Academy of Sciences Institute of Medicine. “It has been with us since the 1960s and was gradually improving. However, during the past decade, the number of generalist graduates has fallen by 22 percent and declines continue as medical school graduates enter other specialties. At the same time, the U.S. population is increasing by about one percent each year, and the baby boomer generation will significantly increase the number of Americans older than 65 by 2025.
In the study, which was published in a recent edition of Health Affairs, Colwill and co-researchers, James Cultice from the U.S. Health Resources and Services Administration and Robin Kruse from the University of Missouri, used data from the National Ambulatory Medical Care Survey to estimate the future demand for generalist care. The Census Bureau predicts that the number of adults will increase 21 percent by 2025, and the number of Americans older than 65 will rise by 73 percent.
Typically, older adults seek care from generalists nearly three times each year, double the rate of adults younger than 65. Because of this, Colwill and his researchers expect the number of doctor visits to increase by 29 percent by 2025. At the same time, they project that the supply of general internists and family physicians will increase less than 5 percent.
“As patient numbers rise, these practitioners will be doing more ‘urgent care’ and will have less time for preventive services, coordinating care with other specialists, and getting to the depth of their patients’ problems,” Colwill said. “This will increase the load on other, already overloaded specialists and lead to even more referrals and increased costs of care. We need to change the incentives by making primary care practice more manageable and income comparable with that in other specialties.”
Colwill strongly endorsed development of new models of primary care called “medical homes” where teams of physicians, nurse practitioners, physician assistants and others provide comprehensive primary care services that also focus on management of patients with chronic illnesses. These models promote more access through expanded hours and use of telephone, e-mail and electronic medical records. If appropriately reimbursed, these models should increase quality, reduce overall costs and improve both patient and physician satisfaction.
“At the same time, numbers of graduates must be increased,” Colwill said. “Students’ interest in generalist careers can be enhanced if medical schools renew their commitment to the education of generalists as they have done earlier. Further, incentives such as forgiveness of loans for primary care practice would tip the scales for many medical students and residents as they select a specialty and type of practice.”
The Association of American Medical Colleges recommends that medical schools increase their enrollment by 30 percent, but have not indicated specific specialty areas for the increase. Colwill said this enrollment increase could result in more specialists, but little increase in primary care physicians if the incentive for becoming generalists is not examined soon.
Jun
30
Private insurers in PA fight mandated coverage for autism
Filed Under health plans | Leave a Comment
Thirteen states require private insurers to cover mandated autism treatments. Pennsylvania is poised to be the fourteenth to offer such coverage. Today the state’s private insurers denied coverage for autism treatments, including speech therapy and applied behavioral analysis. The carriers claim that such treatments lack measurable achievements and that a state mandate would increase insurance costs for every customer, even those without autistic children, by as much as 6 percent, and cause budget problems for businesses that employ 50 or fewer people. However, according to a report published earlier this year by the Pennsylvania Cost Containment Council, the average monthly cost to consumers with private insurance–should an autism insurance mandate become law–would be $1 per month.
The state’s House of Representatives recently passed legislation that would require private carriers to cover treatment for autism, and the bill awaits a Senate vote.
Jun
30
Philanthropy challenges nursing homes to improve facilities
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The Robert Wood Johnson Foundation says it wants to shutter America’s nursing homes in order to save them. The foundation has already started to fund the construction of Green Houses, small environmentally friendly homes that store 10 to 12 seniors currently living in large, more conventional nursing facilities.
The philanthropy, spurred in 2003 by a grant proposal presented by Dr. Bill Thomas, will build these new alternatives to conventional nursing homes in all 50 states. So far, RWJF grantees have erected 41 houses in 10 states. Although a modest number of seniors have moved out of their old nursing homes, if the foundation has its way, all 16,000 of the nation’s conventional senior facilities will be replaced. The American Health Care Association, a lobby that represents the $122 billion nursing home industry, believes the foundations criticism of conventional nursing homes is overly harsh and claims that providers are making an effort to improve their facilities. RWJF has delegated management of the Green House projects to NCB Capital Impact, a Washington, D.C.-based not-for-profit that has been offering help in consulting, education, architecture and other areas, to organizations interested in establishing and operating the new homes.
Jun
30
Carriers and patients are at odds over what treatments and procedures are medically appropriate, and why access is denied in some cases and not in others. Patients in California are finding themselves in the precarious position of having to fight for access to services they assumed were covered. The state has established patient and consumer advocacy services to address the growing problem. Last year, the state’s HMO Help Center received nearly 90,000 calls from consumers asking for help in resolving their health plan woes. About 7,000 Californians have taken advantage of third-party medical reviews since 2001, when the state Department of Managed Health Care started offering them. Last year, the department resolved 1,716 independent medical review, or IMR, cases. The Department of Insurance, which regulates a smaller number of plans, received 35,280 complaints and resolved 262 IMRs in 2007.
Jun
30
While some communities wonder if they can afford to build just one proton beam cancer center, providers have proposed roughly five such centers in Michigan. Final rulings on state certificate of need applications later this year will determine just how many centers may be approved.
Two rival providers–William Beaumont Hospitals and a cancer treatment consortium established by the University of Michigan–originally planned to jointly fund a single center and applied for a certificate of need to get state approval of the plan. Last week, Michigan Governor Jennifer Granholm changed all that when she vetoed the now former partners’ Certificate of Need application that had already won approval from the Michigan CON Commission. In her veto letter to the commission, Granholm stated that a single collaborative approach could violate antitrust laws under the federal Sherman Act and that the U.S. Department of Justice had raised similar concerns.
Each of the former partners plans to re-apply for a separate certificate of need approval. In fact, Beaumont Hospitals has already re-applied, having teamed with Indiana-based ProCure Treatment Centers to build its new for-profit proton beam cancer center. The University of Michigan Health Center’s proton beam consortium has only filed a letter of intent, and plans to make a presentation to the state to make its case for the center in early September. The state is expected to rule on the Beaumont application by July 1. Other providers have also submitted applications that the state is expected to rule on by the end of July and the end of September.
State business and labor leaders worry that two or more multi-million dollar cancer treatment centers could drive up health care costs for employers and individuals. Many oncologists, cancer centers, carriers and policymakers around the country also are evaluating the pros and cons of making such high-ticket investments. Proton beam therapy is a relatively new alternative to aggressive cancer treatments such as chemotherapy and more established uses of radiation. Each facility can cost as much as $200 million.
Jun
30
A new patient safety bill signed into law yesterday by New York Governor David Paterson will require that the names of doctors charged with misconduct be made public. Infection control was a key piece of the bill because of the case of Dr. Harvey Finkelstein, a doctor whose failure to follow infection control procedures exposed a number of his patients to hepatitis C.
Finkelstein, a pain-management doctor who treated patients from his Plainview office, infected at least one patient with hepatitis C by reusing syringes in multi-dose vials. More than 10,000 patients were eventually notified of possible exposure to tainted syringes. The bill allows the names of doctors formally charged by the state’s Board of Medical Professional Conduct to be made public if the three-person panel–two doctors and a lay member–vote to do so unanimously.
Jun
15
Business Plan for Health and Wellness Professionals - doctors, chiropractors, trainers, massage therapists etc…
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Medical office business plan is most likely to be completed by physicians looking to practice solo, yet this document is a good way to start any kind of a “practice”. Whether you are a physician, chiropractor, massage therapist, exercise professional, chiropractor, acupuncturist, stop for one moment and give some thought to a business plan.
The biggest reason for a business plan is to get investors, but you can create a business plan as a way to objectively look at your idea and follow a structured method to success.
If you write it down, psychologists say, you are more likely to stick to the plan!
Reasons:
- Determine the feasibility of a new practice start-up
- Raise money from investment bankers for a new practice ( applicable mostly to physicians )
- Develop an operational strategic plan and conduct due diligence
- Create a budget, time frame, or business direction for a practice
- Discover potential problems, risks, beliefs of importance to you
- Focus on market opportunities by determining revenue centers and cost drivers
- Persuade third party payers, networks, insurance carriers that your practice has a future and represents a viable partner for their organization
- Network with other health professionals in your area
So, what is the format, you might ask? First you create a Professional Executive Summary (PES). Here you create a brief synopsis of the entire plan including information about the practice, advertising and marketing opportunities, proposed financing, business operations and exit strategy.
The plan must explain to potential investors how you will make the money and produce ROI for them. What do investors want to see?
- patient benefits
- your qualifications
- amount of capital required
- current market size ( potential customers )
- potential market growth
- your market niche
.
Additional information would include office location, proximity to labor, transportation, license requirements, business entity status ( corporation, sole proprietorship etc…), technology, working arrangements with various insurance, managed care, and HMO plans.
For most physicians, this document is about explaining to the investors the reasons why this practice is a feasible opportunity and a successful one too. If you are not a physician but if you want to stay competitive in today’s health care and wellness environment, a strong understanding of the circumstances which surround your practice are vital to your success. This applies to all wellness professionals.