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MDLive: We have virtual mental-health services in all states


Photo by Robert Huffstutter

Couch now in London on which reclined Sigmund Freud’s patients as they were psycho-analyzed.

Telehealth provider MDLive says that it’s   the first company to offer telepsychiatry and other virtual mental-health services in all 50 states. The Sunrise, Fla.-based company recently added practitioners in Mississippi and Vermont to fill out the map, Med City News reported.

“It’s national now,”  MDLive Chief Behavioral Health Officer John Sharp, M.D., told the news service. “In a way, it’s not earth-shaking because we’re all going to everywhere soon.”

“I think it’s going to be one of the new norms. You can’t imagine banking without ATMs or online services anymore.”

MDLive, founded in 2009, says it now has more than 1,300 behavioral-health practitioners in its network of online healthcare professionals. “We had to go scouting around,” Dr. Sharp said. “We had to get board-certified, licensed doctors” in every state.

Med City noted: “Indeed, with the exception of physicians employed by the federal government, state licensure has long remained a hurdle to wider deployment of telehealth and telemedicine. A physician providing remote medical services generally must be licensed in the state where the patient is located, though the situation has improved somewhat in recent years.”

To read the full piece, please hit this link.

Report: Many children still lack enough healthcare access


A  new study says that more than 20.3 million American children may have insurance but still face severe barriers in accessing essential healthcare.

Analyses by the Children’s Health Fund  showed that 28 percent of the population under 18 lack adequate healthcare. This includes uninsured children; those who have private insurance  but don’t get regular primary care, and  those who are publicly insured  (e.g., Medicaid and CHIP) and connected to primary care, but don’t get essential and timely specialty care.

“While children’s healthcare has experienced increased and significant attention in recent years, our analyses show there is still a long way to go before we can claim that all U.S. children have access to the care they need. There has been a persistent misconception that simply providing health insurance is the same as assuring effective access to appropriate healthcare. It isn’t,” Irwin Redlener, M.D., co-founder and president of CHF, and the paper’s lead author, said.

“Although Medicaid, the Children’s Health Insurance Program and most recently the ACA {Affordable Care Act} insure more children than ever before, millions of kids are not getting the care they need.”

Among the researchers’ recommendations to improve access: increasing incentives to get providers to practice in poor communities; improving access through telehealth and mobile clinics; promoting health literacy, and helping parents with limited English.

To read the report, please hit this link.

Not too few physicians but bad distribution, not enough non-physician clinicians

It’s sort of a cliche to say that America has a  dangerous shortage of physicians. But a New York Times story challenges that.

It says, among other things:

“Some people think there’s no shortage at all — just a poor distribution of the doctors we have.”

“Adding data to this argument, the United States has fewer practicing physicians per 1,000 people than 23 of the 28 countries that reported data in 2013 (among nations in the Organization for Economic Cooperation and Development).”

“But there is strong evidence that we are thinking about this the wrong way. In 2014, the Institute of Medicine released a thorough analysis on graduate medical education that argued there was no doctor shortage, and that we didn’t really need to invest more in new physicians.

“The system isn’t undermanned, it said: It’s inefficient. We rely too heavily on physicians and not enough on midlevel practitioners, like physician assistants and nurse practitioners, especially because evidence supports they are just as effective in primary care settings. We don’t account for advances in technology, like telehealth and new drugs and devices that lessen the burden on physician visits to maintain health.”

“And we fail to recognize that what we really have is a distribution problem. Parts of this country have lots of doctors, perhaps too many. These are mostly in cities, especially in cities where it seems desirable to live. The problem is made worse by the ways we reimburse for care. Medicare, for instance, pays more to doctors who live in places that are more expensive. The argument for this is that the cost of living is higher, so reimbursements must be, too. But that also means that doctors can earn more in places where they already might want to live. A result is that many rural areas, and less popular cities, experience more of a doctor shortage than others.”

“The other distribution issue is in specialization. When it comes to generalists, we ranked 24th of 28 countries in doctors per 1,000 people. Specialists are a different story. There, we were 11th. This is an important fact about the American health care system. We sometimes hear that we have too many specialists and too few generalists. That’s not necessarily the case. We have an average number of specialists compared with other advanced countries, and even shortages in some specialties. It’s the ratio of specialists to generalists that’s the problem. …”

To read the full Times story, please hit this link.

Population health: Partner with Uber?


Uber driver on his way to customer.

Nick van Terheyden, M.D.,  chief medical officer of Dell Healthcare Services, writes in Becker’s Hospital Review that population health must, of course, focus on primary care. But his specific suggestions include:

On data analysis, he cites:

“A western Massachusetts integrated health system includes in their risk algorithms factors such as distance from a patient’s home to a primary-care provider and availability of transportation and family support. Their thinking is that if you live too far from a clinic or don’t have transportation or family support, you are less likely to get regular care.”

“This is just one example of the kind of challenges we face in population health. It’s going to be as much about social support as it is about medical intervention. Income, location, health literacy, family support and a dozen other factors will have far more power over outcomes than anything that happens in the exam room.”

“….I wrote about high-value primary-care providers, those who got stellar outcomes with only about half the per-capita healthcare expense as other practices. These primary-care teams (and they are teams, not just physicians) exhibit significant cultural differences from other practices, starting with a laser-like focus on patient needs that go beyond diagnoses and medications. When they invest in technology, they choose carefully….”

“Notably, all of these practices make sure their physicians have mobile access to the electronic health records of their patients. That means a physician on call will have all the information needed to help a patient and to make good care decisions. ”

“Physicians  {should} take their own after-hours calls most of the time, making use of mobile access to the EHR to ensure all knowledge of each patient’s condition is available for decision-making.”

“Transportation is also a barrier for many patients, and some healthcare systems are partnering with Uber to get patients to checkups. While the cost may not always be covered I’m willing to bet the data will quickly show the payoff from this will justify the expense of providing the transportation.”

“But telehealth, remote monitoring and even free rides with Uber won’t make a lasting difference unless they are part of a culture that cares more about patient convenience than provider convenience.”

To read Dr. van Terheyden’s entire essay, please hit this link


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