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Going off the Grid – The Rise of ‘Direct Practice’ Medicine

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By Scott Shreeve

Grid (grĭd) n.

1. Something resembling a framework of crisscrossed parallel bars, as in rigidity or organization

2. An interconnected system for the distribution of electricity or electromagnetic signals over a wide area, especially a network of high-tension cables and power stations.

3. The interconnected system employed by the Medico-Industrial complex to create a third party payment systems which artificially creates complexity, increases costs, reduces quality, eliminates accountability, and destroys the patient-physican relationship.

As has been documented in this blog, I have been on a health care finance reform journey for the last six months. I was fortunate to be given the opportunity to work with Lemhi Ventures (outstanding group of health care innovators) on looking at new models of health care delivery, financing, and insurance. During the course of that project, I learned a ton about the nature of health insurance, current status of health plans (there has been plenty of interesting news the last six months on them here, here, here, and here), followed closely the presidential debates on health care reform and become familiar with many of the innovators within this space (Prometheus, Alan Goroll, etc)

A new article just published by MDNG Live (the same magazine that featured my cover story “Meet Your New Patients” last month) showcases Jay Parkinson with the catchy title, “Jay Parkinson Sells Out!” Catchy because one thing I don’t think you will be able to call Jay is a sellout. In fact, his “stick to my guns; this is how I believe medicine should be practiced” approach has enamored him to the public media and vicariously documented the groundswell of interest in this “new” health care delivery model. “New” in quotes, of course, because there is nothing new about this model of care delivery – a patient and a physician entering into a trusted relationship wherein the physician provides services that are valued by the consumer who pays cash for them. The millennial update is that physicians can now do this in new ways, with new devices that have become commonplace in every day life except for in the inane and archaic world of health care.

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Malpractice premiums fall in Massachusetts

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By THCB Staff

Bay State doctors paid lower malpractice insurance premiums on average in 2005 than 1990, according to a new Health Affairs study. The study clashes with popular beliefs frequently touted by sponsors of legislative efforts to cap damage awards.

“If you don’t find a crisis here, you’re probably not going to find one nationally,” lead author and Suffolk University Law School scholar Marc Rodwin told The Boston Globe. “Clearly there are some increases in premiums and high premiums for a small percentage of doctors in three specialty groups, but that’s entirely different for the rest of doctors.”

Malpractice settlements in Massachusetts are the fourth highest in the nation, and the American Medical Association lists it as one of 21 states being in a crisis due to high medical malpractice payments and lack of laws to cap settlements, the Globe reports.

The Suffolk study found that most Massachusetts physicians paid an average of $17,810 in premiums in 2005, slightly less than the $17,907 paid in 1990, after adjusting for inflation.

The researchers analyzed data from 1975 to 2005 provided by ProMutual Group, the insurer for about half of the state’s doctors.

Rates for specialists in obstetrics/gynecology, neurological surgery, and orthopedics involving spinal surgery increased on average from $66,220 in 1990 to $95,045 in 2005.

So is malpractice reform a distraction from real health reform debate? Probably, but it is one that must be dealt with to get docs on the side of real health care reform.

Wishing for a smart health search

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By Dan KoganDankogan

Health care consumers today want to use the Web to find information online about doctors, specialists and care in general. And they want it to be useful.

Unfortunately, in the vast health search space based mostly on ad revenue and keyword densities, consumers often spend hours clicking links into dead ends and wind up with no more knowledge for their trouble.

A semantic Web promises more accurate and meaningful results, yet this technology is in its infancy. And most “trusted” health sites do not yet support semantic searches. Moreover, semantic search requires some knowledge of how to construct a search query as opposed to a simple Google-style search.

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Jay Parkinson readying for re-launch

By Matthew Holt

In an interview in MDNG, Bill Schu wonders whether Jay Parkinson has sold out.

Not really, but we love him because he’s got that confidence thing down:

On the June 1 launch of Hello Health“ It’s going to kick ass. We found a space that’s a perfect location and a perfect node. [We] think the real issue is going to be managing demand.”

Whatever you think of his style, (and I’m a fan) the interface that Jay showed at Health 2.0 in March was very ,very innovative. And I for one am looking forward to the next iteration which starts June 1.

Read more about Parkinson here on THCB. The uncoventional doctor gained celebrity status last year when the media learned of his entirely virtual medical practice. Visit Parkinson’s Web site full of Health 2.0.

Advice to future nurses: ask questions, be proud

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By Kim McAllister

It’s that time of year when nursing and medical students shed their label (and protection) of student and head out to the workforce with their new licenses. Over at Emergiblog, veteran emergency room nurse Kim McAllister shared advice with new nursing graduates.

Here are her words of wisdom.

To the new nursing classes of 2008:

Your first year will be the most difficult as you acclimate to your new role as a professional nurse. Hang in there! Keep your focus on why you went into nursing to begin with.

Keep your eyes and ears open. Watch the nurses around you. You will be surrounded by role models. Take the best of what you see and incorporate it into your own practice. It may be hard to believe, but by the time the next class enters the profession YOU will be the role model they look up to.

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Health care coverage restored — good for patients, maybe too late for plans

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By Matthew Holt

Saint Lisa Girion (and I say that without a smirk on my face!) reports in the LA Times on the latest chapter in the story she started about the ongoing saga of the retroactive cancellations of health insurance by all the big players in the California individual market.

Now Kaiser Permanente (which really should have been above this type of a mess in the first place) has decided to reinstate over a 1,000 of its cancellations, and Health Net, which was fined $9m in arbitration for one cancellation alone, has added a few more. This will intensify the pressure on Wellpoint, United Healthcare, and Blue Shield (the only one still fighting for the right to rescind coverage retroactively) to similarly cave. Kaiser, by the way, is also paying a paltry $300,000 fine. Health Net must be envious.

However, even if the others cave in and reinstate coverage, and pay for claims they previously denied, there are three remaining issues dangling from the controversy.

First, the Department of Managed Healthcare, which brokered the Kaiser deal, only regulates HMOs. Some “insurance” companies, like the Wellpoint and Blue Shield subsidiaries which did some of the cancellations, are regulated by the elected State insurance Commissioner Steve Poizner, who despite the R after his name, has been very aggressive in going after them. Adnd the City Attorney of Los Angeles, Rocky Delgadillo, is suing Health Net and Wellpoint in related cases. So the insurers legal problems with the government certainly aren’t over.

Then there are the lawyers. William Shernoff, the attorney who’s been going after Wellpoint since the stories first came out, told the LA Times that …

He would tell clients to "accept the reinstatements because that’s wonderful to get the medical care — that is important." But, he added, "as far as damages for past harm, there’s no doubt in my mind that the best place for them to get their full damages will be in court rather than in an arbitration process."

In other words, the plans can’t get away with just paying back what they owe. Shernoff is still coming after them for more. And $9 million multiplied by lots of cases smells very tempting to a lawyer who knows he’s on the winning side.

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Bitter doc wants more respect for primary care

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By Sarah Arnquist

A primary doctor ranted anonymously this weekend on Kevin MD’s blog about the lack of appreciation for primary care in his small Midwestern town and predicted its future demise.

The doctor practices in a medical shortage area, where the hospital administration has failed to sufficiently recruit and retain hospitalists. Here’s a portion of what he wrote:

"Not surprisingly, the recruitment and retention problem hit the hospitalist program simultaneously. Three hospitalists are now expected to manage 24-hour coverage with no relief in sight. And instead of offering the degree of compensation necessary to bring more physicians on board, the administration exploited the sense of crisis to convince the medical staff to consider opening the doors to Advanced Practice Nurses. This was the only solution, we were told, to the hospitalist shortage. The only way to stop taking extra call for free.""At this meeting, 100% of the subspecialists voted for allowing APNs to practice in the hospital. 75% of the primary care physicians dissented. The vote was overwhelmingly in favor of the measure. This happened in a system where some primary care doctors are making less than they would if they took a new position in a major city, and more than a couple subspecialists make seven figures. The abandonment of the greater medical good by our specialist friends eager to expand their already-overflowing coffers has filled me with renewed vitriol."

His rant has struck a chord in the medical blogosphere.

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More opportunity for online health management

By Jane Sarasohn-Kahn

Consumers, at least Californians, do a lot of looking for health
information on the Internet — but very little health management.

California HealthCare Foundation (CHCF) has taken a snapshot of
Californians’ use of the Internet in health care. The profile is
presented in CHCF’s report, Just Looking: Consumer Use of the Internet
to Manage Care.

Topline: insured, more affluent, and younger people use the Internet in health searching.

Chcfimage

As the chart at right details, the most popular care-related uses on the
Internet include searching for information about conditions and drugs,
finding a physician, checking ratings, and looking for claims and
benefit information online.

Some 13 percent of Californians are lucky enough to be making appointments online, and 12 percent are filling Rx’s online.

Continue reading…

New demands of ‘Millennial patients’

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By THCB Staff

"Millennial patients are the first generation of Americans to grow up with the Internet as a pervasive part of their lives. … They are amazed, bewildered, and ultimately angry with the inability to access their health care services in this way. They cannot understand, and they will not tolerate, this disparity in the ability to manage health care transactions as simply as they manage their financial transactions."

Those are the words of regular THCB contributor Scott Shreeve in an article he wrote for the April issue of MDNG magazine. Shreeve adeptly describes the next generation of patients, whom he calls millennial patients. All at once, he says, they are consumers, providers and partners in managing their health.

Then, he talks about what it means to be a millennial provider in a new technology-dependent world. Shreeve says the health care industry’s initial lag in adopting health IT can play out to its advantage — so long as it hurries up.

"By observing the wider technology adoption patterns in fast-adopting industries like  financial services, we can reliably predict what trends will soon be impacting health care. We can also get a  sense of how consumers, traditionally called patients within health care, will respond as they adopt—and push their providers to adopt — the technologies that will simplify their health care interactions."