In a letter to the Chicago Tribune, members of the American Medical Association clarify that "the information attributed to the American Medical Association in the article 'For big surgery, Delhi is dealing' is not from an official AMA policy report. While medical tourism is an emerging issue, and one we plan to take a deeper look into at our annual policymaking meeting in June, we have no official policy on it at this point." The letter continues by saying "a higher priority for the AMA is working to determine what changes need to be made to the U.S. healthcare system so we can continue to treat patients at home.
According to the World Health Organization, there are 2.4 million too few clinicians to meet the world's essential health needs. Most of this is in the southern hemisphere, where Africa alone has only 3% of the world's healthcare workers. However, when you talk to hospital leaders anywhere, they have specific needs for highly sought after specialists and sub-specialists, including neuro and cardiac surgeons, oncologists, and endocrinologists.
While the U.S., Canada, and Western Europe are seeking physicians to attend to their aging populations, hospitals in many emerging and developing countries are seeing new levels of demand and competition that are creating a burden only qualified physicians can fill.
For instance, in Abu Dhabi a new program that provides insurance for all workers has also brought demand healthcare services to previously unseen levels, says David L. Printy, president and CEO of Oasis Hospital in the city of Al Ain. Oasis is aggressively recruiting physicians from the U.S., Europe, and Arab regions.
For entirely different reasons, Dharminder Nagar, MD, CEO, of Paras Hospital, in Gurgaon, says hospitals in India are experiencing an immense shortage of physicians, with up to 20% vacant positions. The dearth of physicians there is not because of an outflow of doctors to wealthier countries, as one might expect, but due to the surge of private hospitals competing not only for patients, but also for in-demand specialists.
Hospital leaders across the globe might have regional challenges that press the need to recruit and retain physicians, but responses to this problem often cut across geography. More and more global hospitals realize the value of the brand and reputation, says Ted Merhoff, vice president for HCCA International. Take, for example, the recent trend by some hospitals to align with well-known academic medical centers as a way of instantly adding prestige to draw in patients and physicians.
In Gurgaon, Nagar points out that good contracts and access to the latest technology are a given, so the deciding factor about where a doctor practices often comes down to the hospital's brand among fellow physicians. But it also helps to offer security in the form of long-term contracts with minimum guaranteed incomes.
Printy sees physicians placing a premium on satisfaction and empowerment. He notes they want more of a say in both clinical and operational improvements. Oasis Hospital's affiliation with the UAE Medical School gives it prominence, and Printy is especially eager to provide his medical staff with ongoing professional growth as a way to keep them satisfied and engaged in the organization.
We're not likely to see a decline in the worldwide competition for physicians any time soon. But we are starting to see some key strategies take hold that align with the changing desires of today's physicians. Hospital leaders who succeed in partnering with physicians will be those that share not only revenue, but also key management functions that give doctors more control of their professional destinies.
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A recent essay in Health Affairs (Dec. 11, 2007), "The State of Regional Health Information Organizations: Current Activities and Financing," likely won't make it to CNN. Nevertheless, for IT proponents, this is essential reading. The report suggests that many--perhaps even most--data exchanges, or RHIOs, are not going to survive. Among 145 surveyed RHIOs, nearly one in four was defunct. Only 20 were exchanging clinical data.
Despite federal support for the idea, data exchanges face plenty of hurdles. The industry is pouring plenty of effort into them. Perhaps that's why, when the well-known Santa Barbara data exchange folded up shop last year, you could practically hear the collective sigh. After all, isn't data sharing the whole point of IT? And ultimately, if you can't make it work beyond the boundaries of one hospital, what's the point?
Well, for my money, many data exchanges are the cart before the horse. Local hospitals and medical groups need to get their own acts together first before they can even begin thinking about trading data with others. I've interviewed numerous industry leaders involved with data exchanges. They invariably point to politics, not technology, as the challenge. To be sure, they are intertwined. Take the cross-community master patient index. Before that hurdle can be approached, there needs to be a community consensus--at least on the need, if not the solution.
One IT industry group, the National Alliance for Health Information Technology, is attempting to spark that consensus. The group ended 2007 with a renewed call for a national patient identifier. "One of the biggest obstacles to progress in developing an interoperable national health information network remains reaching agreement on how to correctly match medical information to patients while guarding their privacy," says Scott Wallace, Alliance president and chief executive officer.
A national identifier may be a lofty goal, especially when you reflect back on the Health Insurance Portability and Accountability Act of 1996. The original law called for a national patient identifier, but the provision generated so much controversy it was scrapped. The need, however, has not disappeared. The patient identifier is just one of many political roadblocks that can block data sharing, regionally or nationally. It is one of many horses needed to pull the cart. Kudos to NAHIT for recognizing that.
P.S. This issue marks the completion of the first year of HealthLeaders IT. Thanks to the many people who have commented on my essays, contributed their own articles, and directed me to newsworthy stories. I look forward to serving you in the year ahead.
First I must confess that I’m a Gen-X’er through and through (I can hardly remember life without the Internet). I have grown up with it and through the years it has metastasized into every fiber of my being. Like anyone else, I have to ‘unplug’ every now and then but for the most part I have only positive things to say about it.
Not long ago, I went to Africa to tackle Mt. Kilimanjaro. Perhaps the most significant aspect of this trip is how it was planned--yep you guessed it--on the Internet. Although I live in Arkansas, I was joining up with a team out of Kentucky. You name it and we accomplished it online. We researched the route, booked our guide (who lives in Africa), booked hotels and plane tickets, paid for the trip, communicated with our ground transportation there, researched and bought gear, communicated responsibilities, and organized a visit with local friends. In short order, we accomplished virtually everything online. We didn’t have to worry about catching people on the phone. . .the asynchronous aspect of online communication was perfect for our on-the-go lifestyles.
As I was cruising at 39,000 feet crossing the ocean, I realized I forgot one important question--the medication Diamox. Facing the prospect of a climb to 19,340 feet (Kili’s summit), I had been on the fence of using Diamox to help combat potential altitude sickness. I simply forgot to make the decision before I left. No problem. I figured I still had plenty of time. Once I hit the ground in Amsterdam, I would send an e-mail to my primary care physician and get his response once I hit African soil. That would give me two days in Africa to track down some Diamox if he felt it was the right move for me. It was a great plan...except for one thing. My PCP is not accessible through e-mail. The only way to contact him is the phone and that is typically an exercise in futility even when we are on the same continent.
My Kilimanjaro trip gave me plenty of time to ponder this question: Why does my PCP seem to be so slow in adopting email and other forms of information technology? Although I’m a patient, it seems to me my physician and his nurses would be attracted to the asynchronous aspect of the secure e-mail. It could give him the ability to take care of simple, non-emergent questions on his time and in turn give great service to me, his patient. He would be able to provide me links to quality materials that can help give me the confidence to make good decisions. It could also serve to help me make more efficient use of clinic time--only going to see him when I truly need to be there (that could save me some co-pays). To take it a step further, I can only imagine having the ability to go online and request prescription refills, make appointments, download forms prior to a visit, review follow-materials, get lab results, and communicate with office staff. As a patient I would be very attracted to a physician office with such abilities and I imagine it would help his clinic be significantly more efficient. With services like these, I believe my PCP could easily attract new patients and perhaps a better set of patients.
Implementing information technology into an everyday medical practice obviously has its challenges. I certainly don’t pretend to have answers to all those hurdles. I’m just a lone consumer with one desire--good service. As time goes on, I will expect my PCP to move forward with the right approach. In my opinion one small technological step for my PCP would be a giant leap in service for his patients. Remember, I’m an aging Gen-X’er . I expect speedy, convenient answers to everything (thanks Google) and now I’m starting to have health questions. Good thing I didn’t need Diamox.
The Tennessee Health Insurance Assistance Program will get $793,699 from the Centers for Medicare & Medicaid Services to help Medicare beneficiaries in the state get more information about their healthcare choices.The programs will use community-based networks to provide Medicare beneficiaries with local, personalized assistance.
Duke University Medical Center in Durham, NC, has received a $50 million gift from the Duke Endowment. The gift is the largest ever to the medical center, and $15 million of it will help build a new inpatient facility for Duke's McGovern-Davison Children's Health Center.
The federal government has announced it will raise payments to insurers that provide healthcare coverage to seniors by 3.6 percent in 2009, a slight increase from last year's boost.The increase applies to companies in the Medicare Advantage program. Officials from the Centers for Medicare and Medicaid Services said the increase is slightly lower than the estimated 3.7 percent expected growth increase for Medicare.
Pharmacies and walk-in health clinics are opening at more airports across the country, as operators try to capture a sizable portion of travelers and airport employees who want access to basic primary healthcare and to fill their prescriptions at the last minute before traveling. These facilities are common at large foreign airports, but domestic airports have mostly focused on services that cater to travelers' immediate needs. But now several entrepreneurs are betting that there's pent-up demand for such services at airports in the United States.
Although Venezuela is awash in oil wealth, many public hospitals have fallen on hard times. The childbirth death rate and cases of dengue and malaria are up, and doctors are in short supply in the country. For decades, the Venezualan healthcare system has been riven with corruption, mismanagement and disorganization.
Vanderbilt University School of Nursing is riding the trend of advanced training for nurses and has announced it will begin offering a new doctor in nursing practice degree. The program will offer practice-focused training that will equip graduates to have a bigger impact on issues facing healthcare. The degree is the highest level of nursing practice and is endorsed by the National Organization of Nurse Practitioner Faculties.
