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Study: Most E.R. visits in N.Y. are unneeded

A study by Excellus BlueCross BlueShield says 90 percent of visits to new York State hospital emergency departments are for conditions that could be just as well treated in less expensive settings.

The annual cost of these unnecessary  visits is  $1.3 billion, according to the study.

“The best method of care for nearly all of these cases is for patients to see their primary-care doctors in office visits,” said Jamie Kerr, M.D., medical director of Excellus BCBS.  “But when the physician isn’t available, many of these potentially preventable E.R. cases can be addressed with telemedicine visits or going to urgent-care centers at considerably greater convenience and less cost.”

Florida House’s ambitious healthcare package


The Florida House has passed a healthcare package that, as nicely summarized by The Miami Herald:

  • Sets rules for telemedicine that let out-of-state physicians use technology to serve patients in Florida.
  • Lets  people contract directly with physicians to pay for primary care without involving insurance companies. Those choosing this option would still need to have some  health coverage under the Affordable Care Act.
  • Giving advanced registered nurse practitioners and physicians’ assistants the right to prescribe narcotics and other drugs.
  • Creating new recovery centers that can care for patients for 72 hours after surgery and extending the time  that patients can stay at ambulatory surgical centers to 24 hours.
  • Sets sweeping price-transparency requirements to ease patients’ shopping for non-emergency coverage.
  • Creates new recovery centers that can care for patients for 72 hours after surgery and extends the time patients can stay at ambulatory surgical centers to 24 hours.
  • Seeks to to protect consumers from “balance billing,” in which physicians directly bill patients for services not covered by insurance, which often happens when hospitals contract with outside physicians.

States can’t keep up with telemedicine rush


Governing magazine looks at  how some states are dealing with the telemedicine revolution.

“Despite the momentum, there are still plenty of gaps and question marks when it comes to telehealth policy. The 21 states without a parity {on provider reimbursement} law aren’t uniformly liberal or conservative. Kansas, South Carolina and Utah don’t have one, but neither do Illinois or Pennsylvania. Massachusetts, a state known for progressive healthcare policies, doesn’t have a parity law. It currently only covers telemedicine under Medicaid with certain managed care plans, and not for fee-for-service payments.

“Even among states that do have parity laws, the patchwork of policies can vary widely from one state to the next. Texas, for example, requires insurers to cover telehealth, but it mandates that a patient’s first appointment with a new doctor must be an in-person visit. Within Medicaid programs, about half of the states require that a patient be in a medical facility for telehealth appointments, rather than at home. The differences among states can be frustrating for telemedicine providers. Kofi Jones, vice president of public relations and government affairs for the telehealth company American Well, says she has 30 binders in her office filled with state-by-state regulations and legislation. …”

“Traditional health-care providers can be slow to integrate new technology. After all, almost half of doctor’s offices polled in 2013 still used paper records, according to a survey from the U.S. Department of Health and Human Services. Other recent surveys have found that only 2 percent of patients nationwide have access to video visits with their primary care physician. Less than half — 45 percent — even receive a traditional phone appointment reminder.”


My journey into telemedicine


Read how the offer of extra income led one physician into telemedicine.


Minn. Blue Cross invests in telemedicine hybrid startup


RetraceHealth, a  startup that melds an on-demand service for primary-care physician house calls and a telemedicine service, has raised an undisclosed amount of fresh capital from a from a group of investors that includes Blue Cross and Blue Shield of Minnesota, HealthEast Care System, in Minnesota, and McKesson Ventures.

MedCity News reports that “the company charges $60 a pop for video visits, $150 for home visits and $190 for a home visit with a lab service to assess things such as cholesterol levels, diabetes and high blood pressure. It also claims to provide an X-ray service. It claims to be able to provide a doctor within half an hour of a request.”

The news service says the “startup has found a way to overcome one of the biggest challenges with these concierge care services: reimbursement. Through a partnership with Blue Cross Blue Shield of Minnesota, RetraceHealth will offer its services to BCBS’s members throughout Minnesota.”

“There are many companies crowding into the telemedicine market and others providing doctor house calls on demand. Among the challenges they face in growing their business is getting enough certified physicians in each state, the logistical challenge of getting doctors to the right address and the diverse state regulations for how telemedicine is practiced,” MedCity noted.

Such telemedicine and house-call enterprises may succeed in cutting traffic at hospital emergency rooms and, for that matter, in cutting hospital inpatient populations.

4 imperatives for population-health management



This piece in Healthcare Executive discusses “four imperatives” for population-health  management. Some excerpts:

“The role of healthcare’s leaders now centers on building organizational agility, defined as the ability to nimbly operate current business while simultaneously preparing for changing/new conditions.

“Today’s successful leaders have to be both transformers-moving healthcare to a PHM-based model-and business curators-managing the traditional business while healthcare in their community(ies) transitions to the new model.”

Imperative 3: Experiment and Innovate

“Unlike the ‘tipping point’described by Malcolm Gladwell,  which happens quickly and is hard to prepare for because predictions are lacking, healthcare organizations have had ample forewarning of the basic trajectory of health system change. Organizations that use value-based payment and delivery models now, even on a limited scale as pilot tests, are better positioned for success as the delivery system continues its progress toward broad implementation of value-based care.”

“Proactive hospital and health system leaders are innovating, looking within and beyond healthcare for models that work.”

Imperative 4. Use Integrated Planning and a Blueprint for the PHM Journey

“Revisioning and redesigning an organization’s delivery system should be staged based on the entity’s unique market, capabilities, desired role and competitive factors.”

“Leadership must ensure that the foundational planning process is grounded in fact-based market, financial and clinical/quality realities, and the organization’s current and expected performance related to these realities. Certain organizations will be able to carve out a strategy to deliver only high-end acute-care services. But for most hospitals and health systems, an effective ambulatory and virtual strategy will be key to market relevance.”

4 routes to telemedicine profits

Aneel Irfan suggests in this article four routes  for physicians to make money off telemedicine:

Join a telemedicine network.

Start a telemedicine network.

Start a remote monitoring program.

Provide mobile diagnostics.


Telemedicine making headway with insurers


Telemedicine has gained momentum with insurers as they better understand how to use the new services, even as they sometimes face opposition from varied regulations, The Business Times reports that telemedicine continues to gain insurers’ approval. No surprise there: It could save them a lot of money.

Interestingly, says the publication, “Some hospitals are using telemedicine as an early form of triage for more serious conditions. ‘If it’s an acute problem, even though telemedicine doesn’t have the completeness of being in person, the value is exponentially higher,’said Randall Moore, president of Mercy Virtual in Missouri, which describes itself as a virtual care facility, in which doctors monitor patients remotely via electronic hook-ups to medical devices; patients may be at home or in a Mercy hospital.”

Still, there continues to be substantial pushback from some physician groups, and each state’s regulatory system is approaching the rise of telemedicine a bit differently.


Startup pushes CMS for telemedicine services in cities



N.Y.-Presbyterian creating population-health division


New York-Presbyterian Healthcare System’s Weill Cornell campus, on the East River.

New York-Presbyterian Healthcare System  is creating a population-health division in part to aid the system’s planning for the huge healthcare changes underway and accelerating.

The population-health division will be within the delivery network, with a leadership team of two physicians at the top to “enable its continue success under its new model of integrated care,”  the system said.

New York-Presbyterian, which is linked with the Cornell and Columbia medical schools, has been moving in the population-health direction for some time. Initiatives have included its 13 patient-centered medical homes in its ambulatory-care network and a joint venture with the two medical schools to start a Medicare Shared Savings Program Accountable Care Organization earlier this year.

Now, apparently, the system has reached critical mass to have a  formal population-health unit.

The division will, among other things, boost its ability to analyze claims data and improve care-management skills. Officials are also looking into such things as boosting partnerships with retail health clinics and dramatically increasing the use of telemedicine.

The system thinks that three to five years will be needed to get the new population-health program up to  full speed.


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