In 2007, Thailand attracted 1.5 million medical tourists from around the world, attracting 80 billion Thai baht (approximately 2.48 billion U.S. dollars) in revenue. The massive number of medical tourists is thanks to Bangkok's efforts to nurture its medical industry and make Thailand Asia's medical hub. The target for 2010 is two million medical tourists.
A new study has found that if each medical school adds a rural training program, they would more than double the number of new graduates going into rural practice. The study's authors reviewed outcomes of programs designed to increase the rural physician supply and developed a model to estimate the impact of widespread replication. The study defined rural programs as those that focused admissions on candidates with a rural background or had an extended rural clinical curriculum of six months or longer. The study estimated that if each of the 125 allopathic medical schools committed 10 seats per class to rural training, the schools would produce 1,139 new rural doctors a year, or 11,390 physicians over a decade.
A federal appeals court has upheld a ruling by the Federal Trade Commission that North Texas Specialty Physicians, a group of about 600 doctors, engaged in unlawful price-fixing in its negotiations with various health insurers. In September 2003, the FTC issued a complaint accusing the doctors group of anti-competitive practices that raised the price of healthcare in the region. The commission argued that the North Texas doctors had broken the law by negotiating contracts collectively and by inappropriately polling participating physicians ahead of time about what fees they deemed acceptable.
Columbia, SC-based Palmetto Health Richland is celebrating the completion of its newly renovated children's hospital, which will become the first such free-standing facility in the state. The renovated facility features 20 extra inpatient beds, 15 new outpatient beds and an updated intensive care unit. In addition, administrators say the new children's hospital is expected to ensure a deeper level of personal care for young patients and their families. Some of the features of the 150,000 square-foot facility are brightly colored walls, themed floors and quiet rooms for family members.
Florida Hospital has signed a contract with Radiology Specialists of Florida, which is a new addition to the Adventist Health System subsidiary Florida Physicians Medical Group. Adventist Health is Florida Hospital's parent company, and the exclusive contract covers Florida Hospital's seven Florida campuses and five outpatient offices.
Physicians across the country have been slow to embrace electronic prescribing, despite its advantages for patient safety and office efficiency. But our physician services organization, Medical Network One (MNO), has persuaded most of our 345 primary-care doctors in six Michigan counties to adopt e-prescribing. The key to our success has been going from office to office to show physicians and staffers how e-prescribing can benefit them and how to adapt their workflow to it.
As of March 2008, 244 MNO physicians have access to prescribing electronically. From October 2007 through March, our physicians wrote 96,481 e-prescriptions for the 71,053 patients enrolled in the system. That’s 37% more than they wrote during the same period a year earlier.
MNO’s involvement with e-prescribing began in 2005, when we became the first physician organization to join the Southeast Michigan e-Prescribing Initiative (SEMI). This is a coalition that includes the Big Three auto makers, Blue Cross Blue Shield of Michigan, and a number of healthcare providers. SEMI aims to minimize prescription medication errors and to improve patient safety.
When we looked at the existing e-prescribing products, we were impressed by RelayHealth because it offers a secure, web-based messaging platform with minimal hardware requirements. All the physician practices needed was a computer and an Internet connection. The SEMI provides an incentive of $500 per physician when he or she agrees to adopt the system, and another $500 after using e-prescribing. So in effect, most physicians who took up e-prescribing received a $1,000 bonus to buy equipment, if necessary.
My own office has three computers, including desktops for billing and scheduling and another for receiving lab results. Using those computers, we can access the e-prescribing software and our patient medication lists. So we’ve been able to e-prescribe without purchasing extra computers; and, via the Internet, we can view our patient data whenever and wherever we need it.
Blue Cross Blue Shield of Michigan provides ongoing incentives for raising generic drug usage, deploying health information technology, and improving chronic care. MNO also has a risk-sharing arrangement with Blue Care Network (HMO) that includes pharmaceutical costs. Because e-prescribing enables us to monitor generic and brand name prescriptions, it helps save money for our whole network. Also, we view e-prescribing as a step toward adoption of electronic health records. For both of these reasons, MNO pays the doctors’ monthly subscription and training fees for the RelayHealth service.
Despite the fact that it cost physicians virtually nothing to try the online connectivity service, many initially feared that e-prescribing would be too difficult and would slow them down. We’ve overcome those fears by having our representatives explain the benefits of e-prescribing to practice staffers. The most influential factor in any office is the staff, because they’re the ones who need to understand how the system works. If they decide e-prescribing is going to help them, the physicians will be more likely to adopt it.
It’s also important to remember that every office is at a different level in terms of technology adoption and efficiency. You have to tailor everything to that level so that each office can figure out how to improve its own workflow. We’ve approached the e-prescribing initiative the same way that we handle disease management. MNO’s disease management organization, the Michigan Institute for Health Enhancement, has contracts with several health plans to supply disease management services to patients with chronic conditions. Besides offering self-management programs in areas like weight loss and diabetes, MNO has persuaded many physicians to accept “chronic care travel teams.” Including RNs, registered dieticians, diabetes educators, and exercise and behavioral specialists, these teams go into practices to meet with chronic disease patients as part of their regular office visits. We help the offices modify their workflows to accommodate these visits, just as they do with e-prescribing.
Having patient-physician connectivity has helped us reach out to chronic-disease patients in other ways. For example, my diabetic patients can record their blood sugar levels a few times a month and e-mail them to me, using the secure messaging. The patients like this because they don’t have to take time off from work, and their compliance has improved.
The online service also enables my patients to communicate their non-urgent symptoms with me through clinically structured interviews, eliminating the need to come into my office for routine conditions. I can even prescribe a medication for the patient, if deemed necessary, when I respond. An increasing number of insurers cover RelayHealth’s “webVisit” and the service allows me to collect a copay or fee for each consultation. I’ve set the charge at $25, which is hardly more than the copays in many plans. While I don’t make as much off of this distinct online service as I would from in office visit, it opens up time slots for patients who really need to be seen.
The e-prescribing system also helps me deliver higher-quality care. It tells me whether a medication is in the formulary of a patient’s plan, and alerts me if that pill might cause an adverse reaction with another drug the patient is taking.
E-prescribing has increased our efficiency, as well. For example, the service transmits our prescriptions electronically to local pharmacies. The local pharmacies with electronic capabilities also send our office refill requests electronically. This is a big improvement from receiving refill requests via fax and receiving calls from the pharmacy--another time-saver. Some patients even request prescription refills online.
The ability to view a patient’s medication record online has enhanced efficiency by reducing chart pulls. And it’s quite easy to click through refills when the patient’s record is right in front of me. The MGMA has estimated that administrative work related to prescriptions costs the average doctor about $15,700 a year.
My biggest reward from e-prescribing, aside from avoiding medication errors, is to see how pleased my patients are when I tell them that their prescription will be waiting at the pharmacy. Patient satisfaction is not something you can put a dollar value on, but I can’t think of anything more valuable to my practice.
Dr. Al Juocys is the chief medical officer of Medical Network One, based in Rochester, MI.
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It was encouraging to see my May "Behind the Wires" magazine feature pop up near the top of our "most e-mailed list." In its fifth year, this profile series highlights the technology leaders—medical groups, health plans, and hospitals—who are making headway toward the often lofty goals of clinical IT. This month's feature covers Eastern Maine Healthcare Systems, a Bangor-based system with seven hospitals. It's an example of how often sprawling health systems are attempting to standardize clinical practices and documentation on a common platform. By the end of the year, Eastern Maine is on course to attaining the "one patient, one record" goal.
What the print magazine story, however, does not detail is the organization's efforts to reach beyond its own institutional walls. CIO Cathy Bruno described to me how the system is hosting a regional picture archiving and communications system for some 15 other organizations. The so-called "regional PACs" includes several small hospitals, some imaging centers, and a physician practice. Eastern Maine hosts the system, with the participating members paying for the service on a per-exam basis. According to Bruno, the members wanted to easily exchange images and reports, so the network was constructed to facilitate that. If an image is destined to be read by a certain radiologist, the system will direct the picture straight to the facility. And if a patient is referred to a given hospital, their images can follow along.
This is the type of set-up—in which clinical data traverses even "competing" organizations–that the industry so dearly needs. Not only does the model eliminate duplicate testing, it expedites clinical decision-making. The distributed cost model makes sense too, as I am sure the smaller facilities in the network could not have afforded—or necessarily needed—a PACs on their own. These systems are notoriously expensive. Despite that, they are becoming commonplace. Nearly 80% of the respondents to our 2007 IT survey have one in place, with another 13% planning to deploy within three years. I would be curious to know how many of the organizations are linked to a regional PACs, like Eastern Maine's. Probably not very many if my read on the marketplace is accurate. "The culture in Maine is not as competitive as in some other states," Bruno told me. "There are limited resources, so we cooperate as much as we can."
Gary Baldwin is technology editor of HealthLeaders magazine. He can be reached at gbaldwin@healthleadersmedia.com.
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Attorney Steve Gravely discusses the key legal issues around exchange of patient information at the national level. A partner in the Richmond, Virginia office of Troutman Sanders, he's co-chair of a workgroup formed by the HHS Office of the National Coordinator for Health IT.
McKesson will handle all billing and collection operations for Lucile Packard Medical Group. The group includes the more than 650 physicians associated with Lucile Packard Children’s Hospital, an academic medical center on the Stanford University campus in Palo Alto, CA. The medical group selected McKesson after a two-year evaluation. McKesson says more than 17,000 physicians use its revenue management services.
Hewlett-Packard has signed an agreement to purchase Electronic Data Systems for approximately $13.9 billion. With the acquisition, Hewlett-Packard said it expects to more than double its services revenue, which amounted to $16.6 billion in fiscal 2007. The companies' collective services businesses had annual revenues of more than $38 billion and 210,000 employees while doing business in more than 80 countries.
