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August 7, 2018 News 10 Comments

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Doctor appointment booking service Zocdoc postpones its announced pricing changes after practices complain about being charged for each booked appointment instead of paying just an annual fee.

A dermatologist says his $3,600 per-doctor annual cost would jump 700 percent and might run afoul of Stark restrictions since the practice would then be paying a per-referral charge.

Zocdoc is valued at $2 billion in having raised $145 million in four funding rounds, with investors that include Amazon’s Jeff Bezos and Salesforce’s Marc Benioff (although the proposed pricing is sort of anti-Amazon Prime in focusing on per-item charges instead of a blanket fee).

The company claims that reducing the annual fee and adding a per-appointment fee of $35 to $100 (depending on specialty) will lower the provider cost of entry and leave most of its practices paying the same or less.

Reader Comments


From Generic Competitor: “Re: Crisis Text Line. Heard about it on TED Talks and thought you would be interested.” The non-profit Crisis Text Line offers free, 24×7, text message support from trained volunteers to “help move from a hot moment to a cool moment.” The organization supports its mission via for-profit, software-powered subsidiary Loris.ai, which teaches companies how to communicate with empathy and cultural competency using insights derived from applying data analysis to Crisis Text Line’s dozens of millions of text-based interactions.

From Monetary Exigency: “Re: medical bankruptcy. If we want to live in any sort of insurance system (and they do work in other countries) then there has to be a real imperative to have insurance. Just like car insurance. You have a lot to lose if you don’t have it. My suggestion, though, would be to allow people to be sued into medical bankruptcy, but only at the then-current Medicaid rate for those exact services. Uninsured patients are being charged against a fee schedule that no reasonable payer would ever pay against. Health systems chase the patients down to bankruptcy and still post beautiful ‘charity care’ numbers on their mission page on their website.” I like that idea, although I’m still a fan of forcing providers to charge everybody the same price to eliminate the secret contracts, cost shifting, and the absurd situation where the cash-paying customer pays more than anyone else.

HIStalk Announcements and Requests

Listening: new from the 43-year-old, Canada-born R&B singer-songwriter Tamia. I was only vaguely aware of her and thus learned two interesting factoids: (a) she’s married to former NBA player and Atlanta Hawks co-owner Grant Hill; and (b) she has well-controlled multiple sclerosis. Requiring insulin for this somewhat sugary mix, I injected myself with new music from Sweden-based melodic metalcore band Amaranthe, which to my ear sounds like Adderall-fueled Abba jamming with Nightwish. 


August 15 (Wednesday) 1:00 ET. “Raising the Digital Trajectory of Healthcare.” Sponsored by: Health Catalyst. Presenter: Dale Sanders, President of Technology, Health Catalyst. Healthcare ranks lowest in McKinsey’s Digital Quotient (data assets x data skills x data utilization) of all industries except mining and has largely ignored the digitization of patients’ state of health, but that’s changing. This webinar will describe the empathetic components of healthcare digitization strategy; the AI-enabled encounter; why today’s digital approach will never work and instead sucks the life out of clinicians; the role of bio-integrated sensors, genomics, and the “digitician;” and the technology and architecture of a modern digital platform. It’s going to happen, so let’s make it happen the right way.

Previous webinars are on our YouTube channel. Contact Lorre for information.

Acquisitions, Funding, Business, and Stock


Prescription discount card vendor GoodRx takes a private equity investment that values the company at $2.8 billion.


Family-owned Michigan and Illinois Medicaid benefits provider Meridian Health Plan sells out for $2.5 billion, giving the family of founder and former OB-GYN David Cotton a $2 billion after-tax windfall.


Medication optimization technology vendor Tabula Rasa HealthCare reports Q2 results: revenue up 65 percent, adjusted EPS $0.20 vs. $0.08.


  • England’s Maidstone and Tunbridge Wells NHS Trust chooses Allscripts Sunrise, adding to its Allscripts patient administration system deployment.
  • Hunt Regional Healthcare (TX) will use pre-bill coding analysis technology from Streamline Health Solutions.



Holon Solutions hires Renee Broadbent, MBA (UMass Memorial Medical Center) as SVP of population health.


Forward Health Group hires Kerra Guffey (WPS Health Insurance) as chief administrative officer.

Announcements and Implementations


Epic-focused consulting firm Bluetree Network moves to a 15,000-square-foot office in Madison, WI as it expands headcount to an eventual 450 and annual revenue to $55 million. The company will also add a managed services center to help front-line provider employees.


Piedmont Athens Regional Medical Center (GA) goes live on Epic.


Dell Medical School creates a Biomedical Data Science Hub and hires quantitative scientist Paul Rathouz, PhD from University of Wisconsin’s medical and public health schools to run it.

Phynd adds expanded health plan participation and network affiliation tracking tools to its provider profile and network management platform.

A CommonWell blog post says it’s on track to release connectivity to Carequality by the end of summer following its testing with customers of Cerner and Greenway Health in which 4,000 documents have been exchanged.

Change Healthcare releases Dual Enrollment Advocate, AI-powered technology that helps health plans identify, engage, and enroll Medicare Advantage members who are also eligible for Medicaid.


Electronic dental claims attachment technology vendor NEA Powered by Vyne announces Vyne Connect, a secure practice-patient communication system.

Privacy and Security


Interesting: consumers who get a genetic test from companies like Ancestry and 23andMe must disclose that fact when applying for long-term care insurance, and companies can then use the information to decide whether to issue a policy and how much to charge for it. The federal Genetic Information Nondiscrimination Act applies only to health insurers, not those who sell policies for long-term care, life, or disability.

Facebook asks large US banks to share customer information – including their credit card activity and checking account balances – so it can increase user engagement by allowing those users to bank via Facebook Messenger.

Singapore is studying the use of virtual browsers after hackers penetrated SingHealth and compromised the information of 1.5 million patients. A virtual browser, offered by Citrix and other companies, runs remotely, is isolated from the local computer and network, stores no information on the user device, and clears itself when the session is terminated. 



Fast Company profiles Savvy, a patient-owned data cooperative which invites patients to contribute their medical information, which is then made available to providers who are interested in performing research surveys, testing, or focus groups. Patients pay $34 to join, then share in the company’s profit from fees charged to practitioners


A small study finds that health systems are using skilled nursing facilities to improve post-discharge quality and costs under bundled payment model via two strategies:

  • Reducing referrals to SNFs by using risk stratification to decide which patients can go home instead
  • Integrating with SNFs to gain influence over their quality and costs, such as sharing EHR access and data, hiring care coordination staff, and embedding providers across facilities

The US Preventive Services Task Force finds insufficient evidence to assess the usefulness of screening symptom-free adults over 65 for atrial fibrillation to get them started on stroke-preventing anticoagulant therapy, possibly throwing shade on the remotely monitored app and patch vendors that portray such mass screening as a great medical advance compared to traditional methods.

In Japan, Tokyo Medical University apologizes for modifying its medical school application software to subtract points from the test scores of women, a change it made in 2006 in response to having too many qualified female applicants, which raised its concern that they would leave the workforce and cause a doctor shortage.


A woman whose 18-year-old diabetic daughter was turned away from the hospital ED because “our server’s down – IT’s working on it” complains to the local TV station and the board and attorney of South Central Kansas Medical Center (KS) about her resulting three-day ICU stay at another hospital. The daughter says, “I work at the local donut shop, and when we have computers go down, we write everything down and we put it in the computer later. We always have a backup plan for something. The fact that the hospital didn’t have a backup plan is kind of frustrating.”

Sponsor Updates

  • Imat Solutions introduces its C3 framework (clean, comprehensive, and current data) for HIEs, payers, and providers.
  • Aprima announces that KLAS Arch Collaborative Ambassador Mike Davis will keynote its annual user conference, August 17-19 in Grapevine, TX.
  • Audacious Inquiry publishes a new white paper, “Medicaid IT Funding.”
  • AssessURHealth and CoverMyMeds will exhibit at Greenway Health’s Engage conference August 10-13 in National Harbor, MD.
  • Burwood Group achieves Cisco Lifecycle Advisor status.
  • CarePort Health will exhibit at ACMA Florida August 16-17 in Championsgate, FL.
  • Carevive releases a new video, “Patient Engagement in Value-based Care: Real World Case Studies Using Shared Decision-Making and ePROs.”
  • CenTrak will present at the Georgia Biomedical Instrumentation Society annual conference in Atlanta on August 11.
  • CTG will exhibit at the PCMH Congress August 14-16 in San Diego.
  • Divurgent releases a new white paper, “Flying Lessons: Crew Resource Management in Healthcare.”

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Currently there are "10 comments" on this Article:

  1. I wonder how many different workflows, decision support configurations, APIs, message interfaces, unique terminologies, and sub-specialities are needed for Donut Shop Software?

  2. CommonWell hooks itself up to the rest of the world!!! Only 3 years late and still not generally available. (DoD will be first in line once it’s ready, so as to exhibit “leadership”? Right?)

    This is the great golden spike moment for interoperability – except with the Carequality Railroad traversing the entire continent to connect CommonWell San Francisco trolley network.

  3. Re: Monetary Exigency comments.

    To use a car insurance analogy to make the case for mandatory health insurance underscores the ignorance by some in healthcare. The reason for requiring insuring a car that is actually owned by the lien holder should be obvious, otherwise “car insurance” is not mandatory.

    Besides, “insurance in other countries” comment….what countries exactly mate? Are you referring to the European model or Canadian model? Or would you prefer the model in China? Cuba? Iran?. Brazil? or Greece?

    I’ve found that almost all comments pointing to healthcare in other countries are pontificated by ignorant folks who’ve never been to a hospital in those countries. I have throughout Canada, UK, S. America, Denmark, Sweden, Finland…I’ll stick with our owned system in ‘Merica…thank you.

  4. Again, if you have no assets and never intend to have any, you can always through yourself at the mercy of the state or society.

    But the original comment holds water.


    Health insurance in the Netherlands is mandatory. Healthcare in the Netherlands is covered by two statutory forms of insurance:
    · Zorgverzekeringswet (Zvw), often called ‘basic insurance’, covers common medical care.
    · Wet Langdurige Zorg (WLZ) covers long-term nursing and care. (Formerly known as Algemene Wet Bijzondere Ziektekosten (AWBZ)).


    Auto liability insurance is a type of car insurance coverage that’s required by law in most states. If you cause an accident, liability coverage helps pay for the other person’s expenses. There are two types of auto liability coverage that drivers in each state must have: bodily injury liability coverage and property damage liability coverage.

  5. Hey Jefe – not sure where you live, but auto insurance is required in all 50 states, with two limited exceptions (NH, where you are still personally liable for damage done, and VA, which requires you to pay $500 annually if you don’t want to insure). The premise for these laws actually map quite well to healthcare. Imagine without the legal requirement – one person without insurance crashes, damages a building, injures a bunch of people, and ultimately declares bankruptcy to avoid the expense for liability. Everyone else gets to cover the tab. Requiring insurance puts money into the system to spread some of the risk.

  6. You are missing the point. You buy insurance in case something bad and serious happens. So, you’re covered.

    And, if we had rational pricing for most basic healthcare and doc visits, we could cover our “annual maintenance” with very few dollars. Anything like annual maintenance isn’t really an insurance game anyways. It’s like insurance for dental and such. You insure for the unexpected (a car accident with Trauma (that maybe you caused), or Cancer (that maybe you also caused, but leave that for another topic).

    Rational pricing
    Rational insurance
    No predatory balance billing beyond what insurance fairly pays
    Mandate for coverage
    Or, if no mandate, being able to sue in bankruptcy court for collections of the “rational price” or as the original poster suggested, the then current Medicaid or Medicare rate (which by the way you would have accepted in the first place).

  7. Equating car insurance to health insurance is ignorant. Driving is a privilege if you want to enjoy that privilege you have to buy the insurance. The argument for health mandates means you are forced to buy the insurance just to live in the US. Really?! It’s the very first time in the history of America a person has been taxed or fined just for existing.

  8. Common, you know that just saying Healthcare is a right is easy, but paying for it is the trick. Either the government controls means of production and price and then taxes us for it, or we do an insurance model. There is no mythical money tree to pay for everything.

    And yes, we are taxed for existing, but only if we make a productive and profitable life. If we sit around and wait for handouts, we are not taxed and eventually get a handout.

    Time to take off the rose colored glasses!

  9. Why is it then that there are millions upon millions of Americans who continue to work low wage jobs? Shouldn’t they all be on the dole by now since once you start “giving stuff away” it only follows that eventually nobody will work anymore?

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