27. March 2008 by Jon Moss.

Washington Post
March 18, 2008

Between now and next month, Lou Bruhn, 65, of Fairfax County will have to make an important decision about his medical care: Should he pay $1,500 a year to stick with his primary care physician of three years — a doctor who he says has given him excellent care? Or should he resign himself to finding another doctor?

Some 5,000 Northern Virginia residents are mulling the same question after learning that their Franconia family practitioners, Brett Wohler and Andrew Wise, are switching to what’s sometimes called boutique, or concierge, care. On April 15, the pair will join a national doctors’ network and will charge each patient an annual retainer of $1,500. In return, the physicians say they will offer more attention, including round-the-clock cellphone access, same-day appointments and time to accompany their patients to specialists.

The move follows a nationwide trend that began nearly 12 years ago as a reaction to what some doctors see as the excesses of managed care. More than 1,000 doctors have switched to this mode of practice, according to the Society for Innovative Medical Practice Design, a trade group in Richmond.

Under concierge plans, doctors typically reduce the size of their practice so they can stretch patient visits to 30 minutes, compared with the seven to 16 minutes that various studies have found to be average under managed care. In addition to their annual retainers, doctors collect the usual fees for service or reimbursements from patients’ health insurance plans. The doctors also accept Medicare patients.

Proponents say concierge care lets doctors give patients the time and services they deserve, and allows them to focus more on preventive care. But critics say the development exacerbates inequities in the American health-care system by limiting access and increasing the workload of doctors who don’t join such networks.

Several years ago, only a handful of Washington area doctors listed themselves as members of MDVIP, the nation’s largest retainer health-care company and the one Wohler and Wise are joining. By June 1, the area will have nearly two dozen MDVIP doctors, according to company officials, with 15 in Northern Virginia, six in Maryland and one in the District.

“It’s not really about the money; I can afford it,” said Bruhn, a retired engineer and a patient of Wise’s. “I guess I’m still curious to see if it works as well as the doctors seem to believe, and if that would be worth the price for me.”

But some other patients are less sanguine.

To convert to the new plan, Wohler and Wise plan to drop about 4,000 of their 5,000 patients. Remaining patients, up to 1,000, will be selected on a first-come, first-served basis, they say, leaving the rest to find a new physician they can trust.

Lisa Zuber, 51, of Springfield, is one of them. A patient of Wohler’s since 2004, she said that she initially considered following him into his new plan. But the more she learned about concierge care, the more it made her uncomfortable.

“I guess what bugs me so much is that even if everyone wanted to join, they couldn’t,” said Zuber, an administrator for a national professional association. “It sets up this situation where people are competing against each other to get health care. I just didn’t want to be a part of that.”

Wohler voiced regret about the situation. “There are patients that I’ve seen for years that probably will not continue, and that’s hard,” he said in an interview last week. “Part of me asked myself, ‘Is this right?’ But I firmly believe I’ll be getting back to doing the things that I set out to do when I first became a doctor.”

MDVIP requires doctors like Wohler to help each of his patients find a new primary care physician, and they don’t stop seeing them until they do.

Last week about 50 patients attended an information session in Springfield hosted by Wohler and Wise, complete with a video touting the benefits of the program. Here, too, patient views were mixed. “I’m absolutely going to join,” said Arthur Smith of Fairfax County. “There doesn’t seem to be any drawback.”

Others were more cautious.

“It makes you wonder where we’re going as a health-care system,” said a patient of Wise’s, who identified himself only as Ray and declined to give his last name. “I understand where these doctors are coming from — all the paperwork they have to fill out, no time with patients. . . . It can make you feel like you’re really not doing your job.”

Doctors and medical ethicists across the country continue to debate the trend toward concierge medicine.

In a policy statement several years ago, the American Medical Association said that while retainer contracts offer viable options for care, “they also raise ethical concerns that warrant careful attention, particularly if retainer practices become so widespread as to threaten access to care.”

Even short of that, some have expressed concern about limiting access to care for poorer, sicker and nonwhite patients.

A 2005 survey of 144 retainer doctors in the Journal of General Internal Medicine found that such practices had far fewer minority and Medicaid patients than non-retainer doctors.

“This really isn’t a solution to the chief problem in our health-care system, which is maldistribution,” said Jay Jacobson, chief of the division of medical ethics and humanities at the University of Utah School of Medicine, who wasn’t involved in the survey. “By giving more people an opportunity to opt out, they’re not addressing the problem of access to health care.”

Others have questioned how much impact retainer practices are having. The 1,000 or so retainer physicians, they say, are few compared with the more than 280,000 primary care physicians nationwide.

“Reasonable people can disagree about the practice, and they certainly have been a lightning rod for controversy,” said G. Caleb Alexander, an assistant professor of medicine at the University of Chicago, who co-authored the Journal of General Internal Medicine study. “But it’s unclear to me how viable the market is right now.”

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28. February 2008 by Jon Moss.

Google on Thursday laid out plans for one of its most anticipated new services, a digital health records system meant to give users more control over their personal healthcare.The plans would put Google’s database of health records at the heart of a broader health information system that draws in health insurers, doctors and others, potentially giving the internet company a central role as the health industry moves towards greater use of information technology.

The initiative also opens a new front in Google’s spreading confrontation with Microsoft. The software company launched its own personal health records system, known as HealthVault, late last year.

Eric Schmidt, chief executive, outlined the Google Health plans at a conference in Florida on Thursday. The system will be based on personal health records that patients authorise their health insurers, doctors and others to move into Google’s database.

Other companies will then be able to write software applications that make use of these data, for instance creating services that help patients manage their medications or warn parents when their children need inoculations.

“There are a lot of applications you can’t envisage today,” Mr Schmidt told the Financial Times, adding that the overall aim was to improve the health of users by improving the quality of care.

That “platform” strategy could one day make the Google database the foundation of a more automated health information service. “We hope to get partnerships with all the health companies, so that if you have a prescription we just suck it straight in,” Mr Schmidt said.

Personal health record systems are not new, but the idea has been slow to catch on since there have been few incentives for doctors to automate health records or for patients to try to draw all their personal information together in one database.

The biggest incentives for people to use the new system include the ability to take control of their own records when they change health insurers or doctors, Mr Schmidt said. Also, patients who obtain drugs from more than one pharmacy will benefit if their records are consolidated in one place, he added.

For now, Google has no plans to sell advertising around the health service, Mr Schmidt said. Instead, it hopes to raise awareness of the Google brand and encourage greater use of its search engine.

-FT

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27. February 2008 by Jon Moss.

Last Sunday the Wichita Eagle published a story on how a local Kansas hospital has discounted  slashed their price on a common type of heart surgery.  They did it to be more competitive in the marketplace.  Apparently they felt strongly about gaining more share of the market.  They’re even advertising in Canada and the UK (for people who don’t want to wait for their government-provided medical plans to schedule procedures, and are willing to pay)  Here’s the story in it’s entirety:

Galichia Heart Hospital says it will begin charging a flat fee of $10,000 for one of the most common types of open heart surgery — undercutting hospital charges by at least $25,000.

The discounted fee is the latest plan by the physician-owned hospital to attract more patients. The hospital also promises a 15-minute wait time and a $50 co-pay in its emergency room.

Galichia officials say the discounted rate applies to standard coronary artery bypass graft surgery, but only for cases where there is little chance for complications. Patients with risky health issues such as diabetes or who have had the surgery before are not eligible.

Hospital officials are frank about their motives: They want a bigger piece of the patient base in Wichita and beyond.

“We’re very serious about presenting cost-effective products and options for our community and for the region and nationally,” Galichia hospital chief executive Steve Harris said.

“I think it will turn some heads. This isn’t just a good rate. It’s a world-class rate.”

Getting patients

About five of every 1,000 people need open-heart surgery every year, so a community this size produces roughly 2,000 procedures annually, Harris said.

Surgeons at Galichia Heart Hospital perform about 200 open-heart surgeries a year. Harris said he would like to see that increase by 100 this year.

The idea behind the rate cut is threefold, he said. The hospital wants to attract cash-paying uninsured workers, get the attention of insurance providers and cost-conscious employers in Wichita, and tap into medical tourism — the trend of patients going out of the country to purchase affordable surgery.

“We’re making money at this rate,” Harris said. “We’re challenging our colleagues to really square off against rising health care costs.”

Physician-owned hospitals in Wichita have historically struggled for market share in a city where the two major hospital systems — Via Christi Regional Medical Center and Wesley Medical Center — contract exclusively with insurance providers.

Galichia officials are hoping their new rate causes the area’s largest insurers — Blue Cross and Blue Shield of Kansas and Via Christi-owned Preferred Health Systems — to consider steering some of their client base to Galichia.

“This is a much better rate than anybody else is giving Blue Cross or Preferred Health,” Harris said. “We’re not an in-network provider. We’re sort of challenging (them) to rethink their contracting strategies.”

Blue Cross, at least, is intrigued, although the state’s largest insurer said it would abide by its contractual obligations.

“Blue Cross… members are free to receive services from any hospital they choose with the understanding that their benefits will be applied differently when they use non-contracting facilities,” spokeswoman Mary Beth Chambers said.

“We direct members to the hospitals where we have contracts because of the discounts we receive from those contracting providers. If one hospital is charging less than others in the area then that is good for the community and could help lower overall health care costs for everyone.”

Making waves

Galichia’s new rate could threaten larger community hospitals, although executives at each declined to comment.

Administrators at Kansas Heart Hospital, of which Via Christi is a minority owner, said the Galichia plan is “very interesting” but unlikely to make a dent in their business, which is based largely on physician referrals.

“I’m not sure what impact it could have,” said Lynn Jeane, chief operating officer. “And I’m not sure how many people needing heart surgery are going to be out shopping for the lowest price.”

Supporters say physician-owned hospitals are extremely efficient, making such cost-cutting strategies possible.

“It’s a gutsy move, but I understand what they’re trying to get done,” said Jim Sergeant, past president of the Kansas Surgical Hospital Association and chief executive of Salina Surgical Hospital. “If you take a hard look at costs, you can do premier services at a very good price.”

Galichia hospital also is running ads this weekend in Canada and the United Kingdom, targeting countries where government health plans have created long waits for elective surgeries. Such environments have fostered medical tourism to such places as India, where patients can get procedures done inexpensively.

“The price… is absolutely stunning,” said Rick Baker, a Canadian who founded Timely Medical Alternatives and North American Surgery. His companies connect clients with specialty hospitals that agree to perform certain surgeries at low, contracted rates.

“The solution to America’s health care problems is (for) people to find a way to negotiate very good prices,” he said.

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19. February 2008 by Jon Moss.

Humana has a nifty little tool allowing for the access and analysis of small employer group plan utilization.  Would it be helpful for you as a small business to be able to know how often your employees:

• visit the doctor
• purchase prescription drugs
• meet deductibles & out-of-pocket maximums

 That type of information is extremely important to employee benefit specialists.  It allow us to determine which benefits are more important to the employees, and which ones are less used.  When implementing an HSA or HRA knowing this type of data is crucial to the success of the plan.

 Humana has recently updated BUD to allow brokers, and the small businesses they advise, access to actionable, group-specific benefit information previously available only to large companies, allowing employers to model the impact of different benefit designs, track health plan usage, and ultimately better budget for employee health care – a large and growing bottom-line expense for many small firms.

“BUD empowers brokers to deliver an unparalleled level of guidance to small companies as they make critical decisions about their health coverage,” said Jerry Ganoni, president, Humana Small Business. “Many companies unknowingly provide richer benefits than their employees use or want. With knowledge gleaned from BUD, small businesses are better able to choose the most appropriate health benefits solution for their workforce.”

Designed with the help of Humana’s actively-appointed brokers and agents, BUD features two primary tools to help employers choose and use their health plan with confidence: the Health Utilization Tool and the Contribution Strategy Tool, both of which protect the privacy of employee health information by removing identifying data.

The Health Utilization Tool offers employers information about employee usage of key services, including doctor office visits, prescription drug purchases, inpatient admissions, outpatient surgery and emergency room visits. Brokers can show small employers how the usage of these services by their own employees compares with that of similar accounts in the same geographic area and industry. Brokers can help employers track deductibles and out-of-pocket expenses to see how many employees have satisfied zero percent, 50 percent or more, and 100 percent of their in- and out-of-network limits.

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19. February 2008 by Jon Moss.

Healthline Networks, an upstart San Francisco-based health-care search engine and web portal company, says it’s gaining ground on industry leaders in the health search arena.

This week Healthline enhanced its offerings by adding “drug search capabilities” that let consumers research pharmaceuticals, identify drug interaction issues, and study options such as medicinal herbs and supplements. It’s also adding new content from Yardley, Pa.-based StayWell, which will provide articles, tools and quizzes for the site.

The 9-year-old company, which rebranded and retooled in 2006, has raised $35 million in capital since late 2005, including $21 million last summer, and in recent months has roughly doubled its monthly portal visitors to 15 million. Revenue doubled last year, and is expected to double again this year, says Chairman and CEO West Shell III, although he declines to provide specifics. A spokeswoman admits the company’s made more progress in signing partnerships and attracting web visitors than generating revenue so far; much of its business comes from providing the technology behind other health search engines and portals.

“We’ve got lots of money in the bank and we’re launching a major search platform for Aetna,” Shell adds, on top of the drug-search step he calls “a very significant platform enhancement.”

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11. February 2008 by Jon Moss.

The United State’s largest employer, Wal-Mart, will be expanding its services by offering health clinics inside many of its facilities. By 2010, Wal-Mart plans to open about 400 new health clinics to serve customers. The clinics will be geared for Wal-Mart’s customers who are suffering from a minor illness or for people who do not want to wait extended periods of time in emergency rooms. 

            Wal-Mart’s new health clinics will be operated by RediClinic LLC, a retail health screening service company which is based out of Texas. The clinics will staff licensed physicians and nurses and operate seven days a week. The will treat minor illnesses and will supply in store screenings, medical tests, vaccines, and basic physicals. The clinics will also have the ability to prescribe medications. The Wal-Mart Health Clinics will accept insurance from Aetna, Humana, and Blue Cross Blue Shield.

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11. February 2008 by Jon Moss.

ZocDoc is an online appointment tool for searching for doctors and scheduling appointments as easily as making a restaurant reservation for dinner online. The company launched early last autumn in the New York city area, focusing initially on dentists. 

Nearly 6 months later, ZocDoc has about 50 dentists that have signed on board to try out this free scheduling service, and is now ready to roll out its tools for doctors as well, beginning Feb 14th. When I first spoke to Cyrus Massoumi and Dr. Oliver Kharraz prior to the launch about its upcoming expansion, and was anxious to hear about how the company had grown in these past few months. “It’s all been organic,” Massoumi said. “Doctors are approaching us, asking when we’ll be ready to add them to our site.” 

In addition to layering doctors into ZocDoc, the company will be launching its service in two new cities, branching out on its nationwide plan. Users voted, and the next two cities that will have ZocDoc’s search and appointment services will be San Francisco and Washington D.C. This roll out strategy is quite typical for localized search tools such as ZocDoc, and seems to be allowing for a rather focused effort on building up databases. 

ZocDoc, along with other localized search tools like Grayboxx, has the opportunity to leverage the capabilities of its web-based service to enable doctors’ offices across the nation in an integrated manner that would have been more difficult ten years ago, as is evident by previous startups like OpenTable, which obviously has a similar business model for allowing people to take reservations for restaurants online. It will be interesting to see the “new age” version of such a service penetrate the market without the burden of having to introduce software or generally new concepts.

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