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Monday Morning Update 7/2/18

July 1, 2018 News 8 Comments

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CNBC’s talented and prolific reporter Chrissy Farr (she’s smart because she listens instead of talks, unlike most vain, vacuous TV talking heads whose raison d’etre is a buffoonishly gleaming smile rather than journalism) ponders why telemedicine “has been such a bust so far,” as 82 percent of Americans don’t use it.” Reasons:

  • People don’t know about it
  • Companies use the word “telemedicine,” which consumers don’t understand
  • Patients worry about the cost since most video visits require cash payments that aren’t affordable to a lot of people
  • They worry that doctors who are willing to offer video visits may be inexperienced or questionably skilled
  • Sick people want personal reassurance that an app can’t deliver
  • The common $75 charge is more than the co-pay of a doctor visit and not much less than a Minute Clinic cash visit

Still, I’m not sure I’d call telemedicine a bust. It only recently overcame technical and legal challenges to enter mainstream healthcare and its potential to more geographically evenly distribute medical expertise is promising. We have plenty of doctors, just not enough of them in primary care and an overabundance in big cities like Boston and New York where doctors prefer to live.

I’ve never had a video visit myself, but I would be more inclined to use it for a conversation with a skilled specialist in obtaining a second opinion since I have my $60-per-month concierge doctor available at all times anyway. 


Reader Comments

From Ms. Security: “Re: Quest Diagnostics. Their online bill password protection is a joke — MM-DD-YYYYZIPCODE.” Unverified. I registered on MyQuest to see how it works – the site requires creating a case-sensitive password that’s at least eight characters long that contains at least one alpha and one numeric or special character. Maybe it varies by the way the site is accessed.


HIStalk Announcements and Requests

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Two-thirds of poll respondents admire and respect their employer’s big boss.

New poll to your right or here: provider employees, how many work days do you spend attending conferences each year? I admit that I’m skeptical that conference attendance delivers employer value beyond giving providing an ego stroke for employees who enjoy feeling important among external peers (for which patients are paying, of course). However, I acknowledge those who say their attendance is important for building relationships with vendors and staying current (OK, I’m still skeptical).

Happy birthday, Canada (July 1) and United States of America (July 4).

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I was in Trader Joe’s early on a recent morning and was surprised to hear the immediately recognizable opening and then the growling Hammond organ of “Fire” by the bizarre 1960s psychedelic band The Crazy World of Arthur Brown, which made my day as I felt a secret, shared rebelliousness with a grocery store that is too cool to play “Daydream Believer.” In fact, I’m picturing a dramatic opening for presentations by FHIR expert Grahame Grieve, in which he takes the podium wearing a giant flaming helmet as an overdubbed version of “Fire” blares with these modified lyrics: “I am the god of health FHIR and I bring you FHIR. I’ll take you to learn.”


Webinars

None scheduled soon. Previous webinars are on our YouTube channel. Contact Lorre for information.


Acquisitions, Funding, Business, and Stock

I’m fascinated with the comments of investor and technology executive Dave Kellogg, who ponders the “does the emperor have clothes?” question in reviewing the S-1 filing of BI tech vendor Domo, about which he observes (think of Theranos as you read this):

  • The Silicon Valley goal is now to raise more capital, generate more hype, and buy the most customers.
  • The ratio of venture capital to annual recurring revenue is the “hype factor,” for which Domo’s is 6.4, meaning “you give them $1 and you get $0.15 of heat and $0.85 of light.”
  • The founder controls nearly all the voting shares.
  • The company’s growth is leveling, but its burn rate is $150 million per year and it carries an $803 million accumulated deficit.
  • Market penetration is less than 4 percent.
  • The company leases a private jet from the founder for $1 million per year and spends $300,000 per year on catering by a company owned by the founder and his brother.
  • Kellogg says Domo is “the Kardashians of business intelligence” in being famous for being famous as its product description is nearly indecipherable other than it uses a lot of VC buzzwords in concluding that its product “enables CEOs to manage their entire company from their phone.”

Sales

  • Duke Regional Hospital (NC) chooses Glytec’s EGlycemic Management System for insulin therapy.

Decisions

  • Community Hospital of Staunton (IL) will switch from Evident to Meditech in November 2019.
  • Beatrice Community Hospital & Health Center (NE) will replace Allscripts with Epic on December 1, 2018.
  • Neshoba County General Hospital (MS) will go live with Cerner in February 2019.

These provider-reported updates are supplied by Definitive Healthcare, which offers a free trial of its powerful intelligence on hospitals, physicians, and healthcare providers.


People

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T-System President and CEO Roger Davis has resigned, verified by the company in response to my query from a reader-reported rumor.


Government and Politics

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Los Angeles prosecutors name nine new defendants, including a former hospital CFO and three orthopedic surgeons, for their alleged participation in a kickback scheme involving surgeries, compounded drugs, home health services, and hospice care as orchestrated by the former owner of Pacific Hospital on Long Beach, CA. He is charged with paying $40 million in kickbacks to generate $950 million in fraudulent bills over 15 years. Orthopedic surgeon Daniel Capen, MD (above) will plead guilty for his part in creating $142 million in fraudulent bills, for which Pacific Hospital was paid $56 million. Michael Drobot, the former hospital owner, was sentenced to 63 months in prison earlier this year for billing worker’s compensation hundreds of millions of dollars for spinal surgeries for which he paid kickbacks of up to $15,000 per case, which he funded by billing the hospital at inflated prices for spinal surgery implants used in the cases. He also bribed a state senator to keep the spinal device law in effect, for which the former senator went to prison. The federal government rather wittily refers to its investigation as “Operation Spinal Cap.”


Other

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Don’t read this if you’re of the “healthcare is a calling, not a business” frame of mind. Atrium Health (the former Carolinas HealthCare System) replaces its anesthesiology group for refusing to lower their prices, choosing instead a local group based in Charlotte. The displaced group, which is owned by a publicly traded company valued at $4 billion, launches a media campaign that warns the public that the decision will jeopardize patient safety and says the health system’s previous cost-cutting efforts simply padded its bottom line to pay for huge executive salaries and its aggressive expansion. The company also notes that its anesthesiologists signed non-compete agreements that prevent them from accepting the job offers that the new company made.

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More US healthcare system madness as uncovered by Medicare claims analysis that would make Martin Shkreli beam with pride from his prison cell:

  • An old drug whose only approved use is for a rare condition in babies was being sold by Drug Company A for $40 in 2000.
  • Drug Company B bought the drug’s rights for $100,000 in 2001 and immediately raised its price to $750.
  • Drug Company B kept raising the prices, including a 2007 jump overnight from $1,600 to $23,000.
  • Drug Company C bought Drug Company B in 2014 and raised the price another $7,000.
  • Drug Company C immediately began aggressive promotion of the drug for questionable uses that included paying speaking fees (“peer-to-peer speaking engagements”) to doctors, writing checks to 80 percent of the drug’s prescribers.
  • Medicare spent $2 billion on the drug from 2011 to 2016 even though far cheaper drugs, such as prednisone, work just as well.
  • Overall, the drug’s price has been increased from $40 to $39,000 per vial and the company boasts that “current regulatory guidelines … make a generic unlikely.”

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Don’t show up here with a medical emergency. Despite its appearance and name, CHI Health Center isn’t a hospital – the Omaha arena that hosts concerts and wrestling matches sells its naming rights to CHI Health (part of Catholic Health Initiatives) for $24 million over 20 years. 


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Currently there are "8 comments" on this Article:

  1. .. and Mr HISTalk wins the award for the most over the top FHIR reference I’ve yet seen.

    Though my wife says that picture is an improvement over my normal one

  2. Follow the trail of Roger Davis. No more than 4 years anywhere and then he takes whatever money and runs.

  3. Our company provides, as an employee benefit, Dr. on Demand for a $5 payment. It’s been excellent and especially helpful as a first step to determine whether an in-person visit is necessary. They don’t just triage, in many cases they also diagnose and prescribe which is a great saving of time and money for us.

  4. The Arthur Brown Fire song was used as an Academy Award-style walk-on theme song for FHIR demigod David McCallie when he was elected to the informatics honor society ACMI a few years ago. But it clearly would have been cooler with the hat.

    • Wow, I can’t believe someone already came up with that! I am delighted it was someone from AMIA, which I don’t usually associate with being conversant on 1960s psychedelic music. Next thing you know someone will use “Light My FHIR.”

      • Thanks Mr. HISTalk for bringing our attention to “Fire”. It is great to hear a B3 out front and not relegated to the background of the song.

      • Jim Morrison screaming, “FFFIIIIIIIIIIIIRRRRRREEEE!!”

        Now that would be a show-stopper at some staid medical conference!

  5. it is too bad the writer didn’t spend more time getting informed. For those of us out in the field working with telehealth and its various service lines we know it is a success. Children and adults are getting the care they desperately need but cannot access, stroke victims live normal lives and when tragedy strikes and you find yourself in the ICU it is telemedicine that helps get home quicker. Telehealth and telemedicine isn’t a narrow service for treating common complaints and sniffly noses as the writer only references it is so much more. I would be happy to write a thorough article on telehealth when you would like.







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