Concierge Practice, Maximum Direct Pay and MedAccess USA

Concierge and direct payment models are becoming more common for practices.

Now that the ACA seems to have started, without any reassurance that it will be solvent for long, the rest of us can remain creative.

Some PCPs are not waiting for the government or insurers to catch up to the reality of how their daily practices are run.  Dr. Tom X. Lee is meeting patients demand for a  high-tech,  high touch doctor visit designed for  'One Medical Group" The group was formed in 2005 near San Francisco and rapidly expanded to it's present size of 27 sites, the most recent one in Los Angeles, CA.  The group has been described as concierge medicine without the concierge price tag.  Lee describes it as a completely re-engineered doctor's office.  Lee says concierge is really designed for affluent people, our system is designed for everyone.  It's a primary care system focused on delivering higher-qualitycare and service at lower cost. We manage that through overhead reduction and support systems.

 

The support systems are proprietary technologies Dr Lee helped develop. Patients pay an annual $199 membership fee to support noncovefred services that are coverfed by technology.  They utilize a patient portal to make appointments, or using  the One Medical app.Patients may email their physician, look up lab results, request Rx Refills, all from a smartphone.

Traditionally the way a  medical practice evolves is the office starts off simple, and then grows through administrative and clinical complexity, they hire staff and layered process on top of process, continuing to use legacy systems, such as fax and paper which are less efficient in today's world of technology.  

Using technology is no longer an option, those who do not are going the way of the dinosaur. Lee states that incorporating the system reduces physician support from 4  employees to 2.

Current business models only allow for ten minute patient visits, much too short to diagnose and/or treat a patient. In the office time is the missing ingredient. The new system allows a patient volume of about 15-16 patients/day. This eliminates the FFS necessity for volume and replaces it with the new paradigm of value based care, prominently proposed for the affordable care act.

In 2006 Jay Parkinson, M.D. was a pioneer for the use of electronic health records and HIT in starting a new general practice in Williamsburg, N.Y (Brooklyn).Beginning fresh after residency training he was able to use the technology without any legacy records, or organization with multiple layers of administration.  He essentially runs a one man general practice to make house calls. He forged new ground working from home and a very small office using an online app and portal plus message. His goal was to deliver home care.  Today the HIT apps have become pervasive and have leveraged his time and scaled the method.

Forbes named Lee as one of the 12 most disruptive business names in business in 2013.  He is known for his development of Epocrates while earning an MBA from Stanford University. The success of Epocrates attracted $77 million to invest in One Medical.

The One Medical paradigm is also applicable to other specialties, such as oncology, and hematology. For a multiple doctor group it is essential to communicate and decide on a uniform treatment protocol, especially in a specialty such as oncology, where chemotherapy drugs are expensive and many protocols for multiple agents exist.

Meaning Use, Patient Portal: Engaged Patients and More :

The Patient Portal: Meaningful Use, Engaged Patients & More

Successfully Implement Patient Portal For MU2

Practices that have invested time and money in choosing, implementing, and converting to electronic health records are ready to reap the benefits—and patients portals are an important key to success. A well-implemented patient portal will help you achieve Meaningful Use incentives AND improve patient engagement and compliance while also simplifying time-consuming office tasks like reporting lab results and medical records requests. In addition to the financial and workflow benefits, patients are actually eager to connect with their physicians electronically. You just need to know how to make it all happen!

Laurie Morgan of Kareo suggests these strategies to help you.

1. Successfully implement your patient portal
2. Improve patient engagement, compliance, and outcomes
3. Meet some requirements to attest for Stage 2 of Meaningful Use

REGISTER NOW

Wednesday, April 16, 2014

1:00 PM Eastern, 10:00 AM Pacific

Although some practices have offered patient portals to their patients, the acceptance and utilization rates are poor.  This seems to be a unique issue for health care providers. It may be due to one of these, or all of the reasons listed here.

1. Poor education and/or training.

In most other industries computer registration is common, and access for information, trouble shooting and/or questions are done through a portal. Often times new patients (and old) are left to their own devices.

Remedies can include information printed on your practice brochure, with brief instructions on accessing the link, and selecting a password. This can also be mailed with the monthly statement, or an email blast to patients who have an email. Followup is essential via email.  Telephone waiting trees can also be used to inform patients while they wait on hold. Include something like this,

“If you prefer you can wait on hold or if you wish go to our web site to make appointments, select a refill or leave a question. Replies are usually made the same day.”

Portals should reduce the work load at the front desk and throughout the practice.  The patient can be sent a confirmation via email (if HIPAA secure)

Portals will be required for meaningful use attestation in Stage II requirements for attestation and incentives from Medicare.

Watch for the premier broadast event “Digital Health Space Week”

Watch for the premier broadast event “Digital Health Space Week”  The premier event will be on Friday, March 7, 2014, 5PM PST, 8 PM EST.  Check the Google + Events tab, for updates on content.

During the course of the next several months topics will include the use of Google + in health care.  Topics to include are: HIPAA Compliance, Helpouts, the use of Google Cloud in Medical Practice, Secure email plug ins for Gmail.

Mobile health apps:

Medical Applications at HIMSS 2014.

Medicine at CES 2014

Medicine and Gigabit Broadband Internet

Health Information Exchange, the current landscape and the future. HIT needs for Accountable Care Organizations

We are looking for speakers who have attended HIMSS2014, CES2014, and who are knowledgable in mobile health, health information exchange, Big Data, Accountable Care Organizations and HIT.  Remote monitoring, WiFi technology,

Please share this announcement with all your health related Circles and/or Groups relatred to health and/or HIT.

Digital Health Space is fortunate to produce these events and educational content  

email: digitalhealthspace@gmail.com

The Evolution of Health Information Exchange, 2014

It can be said that the first part of the 21st Century in medicine has been the wave of information technology.  The capitalization of this relatively new department has diverted much funding from other needs in the health care industry.

The addition of HIT required federal underwriting. The ‘incentive’ was more of a negative reward/penalty instrument to force adoption of IT.  In order to maximize reimbursement from CMS hospitals are incentivized to reduce readmissions, and report meaningful use. Meaningful use follows a progressive course, escalating over time until fully implemented. Hospitals have many more stages than clinics or individual providers. Providers and hospitals alike must ‘attest’ to this functionality and demonstrate they are reporting. Failing to do so by a specific date is penalized by a reduction in reimbursement for services.

Much importance has been assigned to this effort, including improved outcomes, decreased expenses, improved patient experiences, transparency of information, accessibiliity of information for patients and providers and the unproven promises of ‘BIG DATA’

It will take some time to determine if these processes will  reduce expense or flatten the rate of inflation of health cost.  Built into and hidden from view is the cost of obtaining the data, and analytics.  A substantial IT investment and personell are added to the equation.  

The peverse nature of government is to spend more to save more…Government is fueled to expand and self-replicate ad infinitum.

Other industries such as the automotive business have profitted from BIG DATA, and it is hoped that by translating it to health care there will be dividends in treatments, cost reduction, safety, and better outcomes.

The Evolution of Health Information Exchanges

My  experience in this area began in 2005 as I led a group of physicians to consider a regional health information exchange.  It was a slow but fertile beginning.

We all focus on what is now and what lies ahead, that challenge can be justified by a brief but important look at our past accomplishments which are considerable.

Much has been accomplished, by many, and at relatively little expense in the planning phases of  HIE.  Early planning and project management time expenses were donated at no charge by physician leaders, medical societies, and interested vendors.

Well intentioned leaders do not have to spend billions of dollars to study or plan a project of this scope.  

These thoughts were corroborated as reviewed written and verbal correspondence for the early meetings of the Inland Empire Health Information Exchange (Riverside, Callifornia)

Neither can one forget the prescience of  President George W. Bush by forming the Office of the National Coordinator of Health Information Technology, Don Berwick M.D. and their successors.

Physicians were dragged into the mix as naysayers, not wanting more complex procedures to interfere with patient management responsibilities. We are now well along the way and there will be no turning back.

Even more than the abilit fo providers to exchange medical information is the added dividend for analytics, and support for accountable care organizations.