Leave it to Wal-Mart to continue to grow its franchise in health through yet another
revenue center. This time it’s telemedicine.
The company will pilot telemedicine through retail clinics in Houston, and will be trademarked as Walk-In Telemedicine Health Care. Wal-Mart will be partnering with My Healthy Access and NuPhysicia, the private company that comes out of the long-successful telemedicine program at the University of Texas Medical Branch at Galveston. Telemedicine was been pioneered at U-T in Galveston over the past 10 years, and the program has global reach.
Instead of employing nurse practitioners, the medical model for this program will use paramedics working under the supervision of physicians via various scopes technologies — electronic stethoscopes and beyond. NuPhysicia describes this process as, "interactive physician visits."
Jane’s Hot Points: While the retail clinic business may be flat, as I wrote on July 25, this new model will enhance patient choices on the retail health front beginning in Houston. If this program pans out in terms of process and outcomes measures, you can be sure Wal-Mart will replicate it in other metropolitan markets. Telemedicine in retail health clinics could differentiate Wal-Mart’s offering from other emerging clinic brands such as Minute Clinic, RediClinic, Take Care, and the many other storefronts among the 900+ clinics currently operating across the U.S.
Over at Spot-on I’m writing about the primary care crisis in partial response to the great stuff from Bob Wachter last week on THCB and also from Maggie Mahar and Brian Klepper. Hopefully, it’s a primer for the politico types over there about the primary care crisis and also what the likely results of it are. Hint, no pay equality, but more retail clinics and online visits.
Meanwhile, my piece at Spot-on two weeks back about the Two Ted Kennedy’s appears rather smarter than it probably was given the long piece in the NY Times today about exactly how risky his surgery was and exactly the level of agreement (i.e. not much) that existed among the wide medical team he convened. Evidence based medicine? Well let’s just say that the oft heard rumors of Medicare’s impending bankruptcy may be truer than I tend to believe if every patient wants that level of service.
At any rate, please take a look at the new piece and the older piece and as ever come back here to comment.
Ask any health care wonk and they’ll tell you that within the larger
health care crisis is a primary care crisis. There is more and more
demand for primary care physicians – the person you probably call your
"family doctor" – but America’s medical schools are producing fewer of
Why? Well in a word, money.
It’s not actually medical school that’s the problem. It’s what happens next. A newly graduated physician, looking a big chunk of debt used to pay for medical school tuition gets to chose their residency and, as such, decides what type of doctor to become.In the U.S. we let medical students choose what to do. Not being dummies, most of them notice that diagnostic radiologists and orthopedic surgeons make three times what primary care doctors make, and choose their career path accordingly. Why the vast difference in compensation? Doing something to a patient – fixing a broken hip, reading an x-ray – has always been better rewarded more than talking to them about their high blood pressure or their son’s excema.
Read the rest.
The online magazine Amateur Economists launched this month to explain the factors that influence how people and organizations make choices for non-economists.
The expert writers will explore current economic issues their respective fields, such as health care, law, politics, literature and art
and science and technology.
In "The Dismal Side of Health care" section, a physician and nurse discuss the latest issues affecting health care economics. In "Fictionomics," an English professor explores the subject of economics in fiction, and in "Economically Correct," a lawyer and law student look at the economics of laws.
Hospital & Health Networks magazine announced America’s "100 Most Wired" hospitals for 2008 this week.
You can compare this list to the list of "top hospitals," as recently ranked by U.S. News and World Report.
Hospital & Health Networks created the "most wired" ranking a decade ago. This issue’s cover story says that wired hospitals have happier patients and higher quality measures than their less technologically advanced peers.
"Taken together, the patient satisfaction and quality indicator analyses
provide the strongest evidence in the 10-year history of the Most Wired
Survey and Benchmarking Study that information technology makes a
difference in both the patient experience and the quality of care."
Mr. HISTalk has a more cynical take on the ranking.
At a health care forum held last year in Las Vegas, then-presidential candidate Hillary Clinton declared that she was intent on “taking money away from people who make out really well right now” in order to fund health care reform. When asked exactly which fat cats she was referring to, Clinton responded, “Well, let’s start with the insurance companies.”
Clinton’s sentiment — that private insurers are making out like bandits while our health care system crumbles — is part of the received wisdom these days, especially among progressives who believe that for-profit health insurance doesn’t add much value to our health care system. But the reality is that in recent years, private insurers haven’t been doing so well financially.
Consider United Health Care (UHC), the nation’s biggest private insurer. Joe Paduda of Managed Care Matters reports that UHC will be cutting 4,000 jobs as part of a restructuring plan that includes eliminating Uniprise, one of its major brands. Since last fall, UHC stock has plummeted from $53 to $22 a share. WellPoint, another huge private insurer, has watched its stock drop from $82 a share in 2007 to $49 a share in June.
Maui AgeWave, a company working to expand the use of digital telehealth technologies to help people age in place, is in the early planning stages of a Maui Connected Care System ("MCCS") conference. If any of THCB readers would like to get involved as a speaker, new product exhibitor, sponsor, or attendee, we’re eager to hear from you.
We’re going for a high quality "Aloha" experience for our attendees. Besides having fun on Maui, we’ll be looking for help mapping a "Maui Connected Care" model, which participants will have a chance to help design in workshops and implement after the conference with their products and services. In this sense, the conference may be viewed as a unique "have fun, meet interesting people and produce something timely and useful" conference experience for everyone who attends. Equally important, designing, implementing, and tracking costs/benefits/health outcomes of this MCCS is intended to serve as a validating model which can be replicated across Hawaii and elsewhere.
Anyone with experience designing and implementing RHIO, H.I.E, EHR and EMR concepts should be interested in helping us sponsor and inform this conference. Likewise, we strongly encourage companies to attend who believe they can empower people to age-in- place with their innovative home care devices. We will, of course, also be inviting key stakeholders and health care executives across Hawaii to attend.
Quite frankly, we’re hoping that this conference will enable Maui AgeWave LLC to meet and enter into strategic alliances with attendees whose expertise, services and products will enable us to create the MCCS we describe here.
For details, contact Peter Durkson.
LeapforPatientSafety.org is hosting a patient safety barbecue in Aiken South Carolina July 4 to commemorate Patient Safety Day. The organization also has an online petition requesting increased protection for physicians who complain to hospital administrators regarding poor quality patient care.
Congress is bowing to pressure (read: financial contributions) from medical equipment makers that stand to lose money if Medicare expands its competitive bidding program.
The NY Times reports today that the House approved legislation Tuesday that would delay the launch of the competitive bidding program for 18 months — all to appease a few companies that are scared of staying viable in, gasp, a competitive market.
The results of the pilot bidding program show this is good policy that will save Medicare and individuals money. The Times reports:
"When Medicare awarded competitively bid contracts to some 325
companies to serve the 10 metropolitan areas, it reduced equipment
prices by 26 percent on what it would have paid for the same equipment
under the current fee schedule. That means that if the contracts were
allowed to proceed, beneficiaries would save 26 percent on their
co-payments. Medicare would save $125 million the first year and as
much as $1 billion a year if the program went nationwide."
Yet, good policy may lose this battle.
As NY Times columnist David Leonhardt and an accompanying editorial aptly point out, this small battle is ominously prophetic of the impending battles over health care reform.
"By standing in the way of this competition, Congress is really standing up for higher health care costs," Leonhardt wrote.
It will be interesting to see which Congressmen and women vote against competitive bidding now and then assail the rising costs of health care from the podium this fall.
For the cynical out there, this is a reminder of what you already know.
As industry veteran Brian Klepper told me yesterday, "Only innocents and little children think health care reform is going to happen through policy. It’s not going to happen because half of all the money is unnecessary and because Congress is on the take."
Consumers, employers, payers and providers agree that information flows are critical to helping stem health care costs. While there is shared concern about health care costs, there is also a shared desire for more, accessible information and better online tools for managing it.
TriZetto’s report, Research Shows Healthcare Market Constituents Seek Information as Key to Solving the Affordability Crisis, surveys the landscape of stakeholders in American health care and lays out a rational approach to what the IT services firm calls integrated health care management.
TriZetto lays out five key themes that drive the imperative toward integrated health care management:
- Health care affordability
- Aligning incentives to change activities
- Information access as king
- The importance of leveraging information technology
- Payers as change agents.
Every now and then HealthBeat takes a look at health care systems in other countries So far we’ve tackled Germany and China. Next on our list was the Netherlands, but it turns out Health Affairs beat us to the punch. In May, Wynand van de Ven and Frederik T. Schut, two professors at Erasmus University in Rotterdam, authored an excellent profile of the Dutch health care.
Why should we care how they deliver health care in a tiny country most of us will never visit? Few European health care systems have garnered the kind of attention from Americans that the Dutch system has received — especially from folks not known for their Euro-philia, including the Bush Administration. In the fall, the White House sent a delegation to the Netherlands to learn more about the Dutch system. The Wall Street Journal also has praised the Dutch system for accomplishing “what many in the U.S. hunger to achieve: health insurance for everyone, coupled with a tighter lid on costs.”
What could make conservatives entertain the possibility that we might learn from Europeans? Under the Health Insurance Act of 2006, the Dutch have created a system of universal coverage delivered entirely through private insurers. In this, the Dutch plan is very much like the plan Dr. Ezekiel Emanuel proposes for the U.S. in his new book Healthcare, Guaranteed. (We wrote about Emanuel’s plan here and here), calling it a “fresh” proposal for reform.)