The death of the old healthcare magazine? A public challenge

What if healthcare coverage sizzled like this?

With all due respect to the talented people who work (and have worked) at Modern Healthcare magazine, I’m here to kick it in the butt, not praise it.

Now, I have to admit that there’s a reason nobody’s put MH to sleep yet; in short, it’s probably a very successful business.  If nothing else, as an industry figurehead,  it’s deeply entrenched with the “I’m so geriatric I’ve forgotten the names of my colleagues” set.

After all, any new ideas the aforementioned reporters cleverly slip into their stories are buried in an avalanche of dull corporate-speak, and sadly, there’s usually an audience for mind-numbing jargon. I think maybe the corporate-speak makes the pointy-haired bosses feel all important and meaningful.

But tell me, folks, have you ever read a Modern Healthcare story and said “wow!” or “hmmmm” or even “I’m mildly amused”?   Do you ever change your plans based on something you’ve read in this insipid journal of record?  Or do you skim the half-baked parts (again, baked by editors when all is said and done, so don’t blame my editorial colleagues) and just drop your copy of the darned thing?

I say it’s time for a new healthcare industry publication, one which goes FAR beyond this humble blog.  I want to see an industry magazine/Webzine/podcast/TV show/you name it which covers healthcare the way it is — as one of the most critical industries in the world with a hornet’s nest of issues to address.  I want to see color, life, snark, attitude, vigor, curiousity and most of all, passion.

I say we can build such a service for our industry.  In fact, I’m immodest enough to say that *I* and a team of stalwarts can build such a resource, one which would transform healthcare to some modest degree just by existing.  I’m talking Wired and Fast Company and Forbes and Modern Healthcare’s good bits mixed into the insider smarts of the New York Times Deal Book and Heard on the Street.  Yup, you heard me — we’re talking about a paradigm changer.    And if you’re wondering why this editor thinks she can pull such a big idea off I say, with apologies for the obviousness, “Why not?”

So, are you going to help me?  Do you want to have a voice in changing how healthcare looks at itself?  I know for sure I can’t do it alone, and I doubt anybody could.   I need money, yes — details on request — but as much as anything I need people to decide that our current way of covering healthcare just doesn’t cut it.

If you’re with me, let’s go for it.  Call 571-484-4056 or write to me at anneczieger@gmail.com. I’m ready to move if you are.

So many blank spots on the clinical data map!

Image via Wikipedia

EMTs collect a lot of data on their trip to the emergency department — and usually, data treating ED physicians will want pretty badly when they see the patient. But in virtually every case, most of that critical info transfer takes place on paper or in a hurried conversation amidst much noise and distraction.

Community medical centers collect as much data on patients as private primary care practices do,  but how often are they connected with hospitals — even those that have done a big ambulatory EMR rollout?

And what about blood banks?   Independent clinical labs like LabCorp.?  School medical offices?  Is anyone paying attention to their data, or is it just being ignored?

Look, I don’t mean to be a dunce here. It’s not as though hospitals and medical practices are sitting around buffing their nails and waiting for something to happen, data-connection wise.

But it’s worth remembering, despite the labor involved in hooking up hospitals and primary care practices, that there are data leakage everywhere.  Until we look the flow of data more wholistically, whole workflows will be designed as though such relationships didn’t even exist — and that’s a Bad Thing.

I say, start with the EMT data, as it’s the closest to the point of care, but regardless of how you expand your clinical data source map, expand it. Otherwise, you’ll be left with a nasty information design problem and finding a workaround will be a nighmare.  Think about it.

(This editorial’s content draws on a speech given by Vivian Funkhouser of  Motorola at a trade show held last week by Everything Channel.)

Related Articles

• Health IT Group Tackles Data Exchange (informationweek.com)

Can Priceline-style tactics transform medical practice?

Yes, I realize the above is a pretty extravagant headline — the “real” Priceline isn’t involved here — but follow me, and tell me  if you think the question is on point.

Yesterday, I spoke to Alex Fair of FairCareMd.com, a New York-based company which lets patients and doctors directly negotiate a “fair deal” on services between themselves.  Physicians give (presumably big) discounts on services in exchange for getting cash on the barrelhead once the service is delivered.  The site is in beta but still worth a look;  seems the key pieces are in place.

Fair, a former scientist who’s been a serial entrepreneur for many years, once designed software helping doctors successfully beat claims denials, so he definitely knows the territory. And he’s obviously right that if they get cash up right away, doctors can easily beat the “retail” prices they’re sometimes forced to charge to cover health plan collection costs.

Fair’s (reasonable) assumption is that FairCareMD will be a lifesaver for patients with high deductibles or no insurance at all, as well as giving them a way to get procedures the insurance industry won’t cover.  Not only will patients have access to deeply-discounted fees, if the patient can’t find the deal he or she wants, they can push for a better price at a number they can live with. That is indeed along the lines of Priceline.com’s “name your own deal.” (I’m here to tell you that *that* mechanism works very well indeed.)

On the surface, the concept makes sense. And there’s precedent for it.  For example, a thriving market in cash-for-surgical-services, much along these lines, already exists in the bariatric surgery industry, as many health plans refuse to cover such procedures. Ah, the power of capitalism to work around other capitalists!

In his first month since launch Fair reports over 5,000 searches for care on his site, though only about 1 in 200 visitors requested a deal from a provider.  On average these deals have saved 47 percent off “list prices” so far. Fair’s surprised that so few consumers are making requests.  On the other hand, it’s only a few weeks after launch, and other sites have millions of such requests, so he’s in wait and see mode.

My guess is that a) people don’t see the value of shopping for prices just yet — so thoroughly has the health insurance industry hornswoggled them and that b) they’re likely to see more valuable in accessing such services if they pay a subscription fee. Just a human nature thing.

So hey, folks, what do you think? What will it take for consumers to feel comfortable paying doctors directly again?  Fair isn’t the only company banking on this notion  — in fact, there are several, including some with a national presence  — but my instincts suggest they haven’t won consumers over completely yet either.

An even bigger question:  Do you see the broad mass of consumers developing those sorts of relationships with hospitals anytime soon?  Now *that* would be a neat trick.

NOTE:   If you’re in the NYC region, or plan to be next week, you can meet Fair and other local social media/health entrepreneurs  at a Manahattan-based Health 2.0 meetup (details at  http://www.health20nyc.com/calendar/13913750/?eventId=13913750&action=detail#initialized).  Looks like it’s going to be a very nice group. I’ll be moderating a panel, so if you’re there please stop by and say hello!

Video: Accountable care organizations, the Steve Jobs way

This video, by healthcare consultant Anthony Cirillo, offers a neat suggestion — why not sic Steve Jobs on the accountable care organization model?  As Cirillo sees it, Jobs is one of few execs out there who really understands how to build complex things in a lean, functional way.

“When we develop products, we’re about putting as many features into them as possible, and hospitals, as many services as possible,” Cirillo says. “But Steve Jobs…wouldn’t just build an accountable care organization, he’d build your accountable care organization, where you would get just the amount of care you needed at the right time in the right place.”   More below:

Don’t be distracted by the guitars hanging on the wall in the background — they’re just symbolic of Cirillo’s other passions, singing and songwriting.  What he has to say on this subject is definitely worth a listen.

Passing the buck, or, why PCPs *are* the problem

Look, let me say up front that I’m very sympathetic to primary care practices.  I mean, truly.  My family is lucky enough to have access to a small, intimate primary care practice, and I kid you not, I love those folks.

All that being said, I just had an experience which tells me that changing PCP business models are creating a very, very large problem.

What of my experience?  Well, in theory, it was no big deal.  I called in after hours to ask about a family medical problem which worried me, and asked for a bit of guidance.   I was just concerned enough about a family member’s health to see a bit of extra help.

The response I got was another matter. Rather than asking why I had called after regular practice hours, and what my concerns were, the clinician taking call said (more or less verbatim): “Well, I didn’t see (Jill) yesterday when you brought her in, so I have no idea what’s going on with her. Take her to the ED if you want, but I can’t help you.”  I was silent for a bit, shocked by her rudeness (she’s usually very helpful), then said “If that’s what you think” and hung up.

Because I know enough to avoid the ED whenever possible, I held off, and things turned out fine. But this encounter raised a few questions which trouble me deeply:

*  Let me get this straight: Are patients supposed to go to the ED first these days so as not to inconvenience their PCP?

*  If they do contact an on-call PCP, should they be afraid that their call will be “unsuitable” or not worth addressing?

*  Has the whole notion of taking call deteriorated so much that PCPs covering the night shift will only talk to patients they’ve seen recently?  If so, they’re nudging many, many patients to the ED who might otherwise just need a word or two.

For many years, the ED was the pressure point in the whole health system, with ED administrators secretly hoping to avoid uninsured GOMER (Get out of My Emergency Room) patients. (Yes, not very sensitive terminology.)

Now, the problem seems DCAHs (Don’t Call After Hours).  Greviously-stressed care practices just aren’t prepared to absorb the costs of after-hours care or even telephone advice, and it’s throwing the system out of balance in a new way.

As things stand, the exploding primary care clinician shortage just keeps getting worse and the need for patients to have medical homes is climbing. Pile these issues on top of the already overloaded primary care business — in which margins are so bad that practices are adding day spas, for heaven’s sake — and you’ve got real trouble.

Ultimately, I think all of these problems are going to be resolved, and I’m very clear that PCP practices want to help. In the mean time, someone’s going to have to do a better job of fielding the 5PM to 9AM gap in care.  Telemedicine, urgent care centers and retail clinics are making a dent, but they can only make a dent in the problem.   This is a very big deal, and it’s only going to get bigger.

Can hospitals be saved? Some fresh ideas

No matter what you do, there will always be people who consume more hospital resources than others, notably the chronically-ill poor with spotty access to ongoing care.  They’re sicker, over a longer time, and to boot have no way to pay their bills.  In that situation, everyone loses.

But is there a way to solve this problem without going broke?  Maybe.  Here at nextHospital we’ve been intrigued by news of a couple of proposals intended to help patients AND ensure hospital solvency:

*  Redeveloping commercial property around urban hospitals and leveraging it to bring a flow of traffic, personnel and physicians to the door. This would bring urgent care/retail clinics, primary care practices and other support mechanisms to the hospital’s doorstep. Ultimately, the idea is to tend to the of the sickest, most expensive patients first — the weakest link, if you will — freeing up more resources to improve care for everyone else.

*  Bringing together community healthcare organizations (including  hospitals) together into a self-sufficient economic unit which can afford to turn away managed care contracts — and offer affordable care. (See an overview by Dr. Jonathan James of Community MedPAC here:  http://www.box.net/shared/65h1c6sax0)

We don’t yet know enough about these models to predict whether they’ll work or not, and to our knowledge, neither has been fully implemented. However, there’s no question that there’s a big payoff, both financially and ethically, for those who can improve access to care while reducing financial strains to the system.

Are there other hospital care financing models which look like they can change the game?  If you’ve found any, we’d love to hear about it.

Theory #2: nextHospitals must provide primary care–*on site*

Conventional wisdom breaks the healthcare system into two big silos.

There’s acute-care hospitals, which tend the acutely ill, and there’s primary care providers, which handle the sniffles,  hives, chronic disease management and anything else that isn’t likely to kill a patient within a few hours.  In between, there’s a big black hole where patients pretty much sit around feeling like hell and wondering just how much worse things are going to get.

This bifurcation is absolutely insane and has got to end.  It makes an assumption which is absolutely counterintuitive–in fact, which is simply crazy–which is that hospitals have no business treating anyone who isn’t at death’s door.  The nextHospital has to completely shatter this assumption by providing appropriate care, from throat cultures to the crash cart, for anyone who shows up at its door.  

Not only is the only sane, humane and appropriate way to treat the human beings who enter your doors, it’s the cheapest way to treat those who don’t need intensive services; after all, an all-night walk in clinic is almost 50 percent cheaper than ED care! Kinda sounds like a good idea, doesn’t it?

What makes hospitals’ failure to offer step down care even more foolsh is that all they’d have to do is invite Walgreens or CVS to bring in one of their TakeCare or MinuteClinics, which I’m pretty darned sure they’d be happy to do. No fuss, no muss, virtually no overhead. Everyone wins. Explain to me why this isn’t a good idea?

The current system assumes that if the healthcare system is falling apart, it’s all the fault  of nughty patients who come to an emergency department and somehow don’t know that they aren’t that sick after all.  Remember, the learned papers that castigate patients who show up in the ED and somehow fail to need lifesaving treatment aren’t any kinder to those who simply overestimated their acuity than those who use the ED as a primary care center.

Now, I’m not suggesting that primary care physicians shouldn’t exist, and that hospitals should take over their place in the community. But I am suggesting that hospitals accept their role as caring for people, not emergencies, and govern themselves accordingly.  It’s more efficient, it’s more effective, and it’s more appropriate.  Anything else just wastes time and money, while scaring away patients who need your help.