AUCTION WEBSITE FOR LOWEST COST SURGEON FOR PATIENTS

Celebrity entrepreneur and investor Sir Richard Branson gets behind telemedicine

From the FMS Global News Desk of Jeanne Hambleton
MedCityNews August 5, 2014 by Sandra G. Boodman

Francisco Velazco could not wait any longer. For several years, the 35-year-old Seattle handyman had searched for an orthopedic surgeon who would reconstruct the torn ligament in his knee for a price he could afford.

Out of work because of the pain and unable to scrape together $15,000 – the cheapest option he could find in Seattle – Velazco turned to an unconventional and controversial option: an online medical auction site called Medibid. This largely operates outside the confines of traditional health insurance. The four-year-old online service links patients seeking non-emergency care with doctors and facilities that offer it, much the way Priceline unites travellers and hotels. Vetting doctors is left to prospective patients: Medibid does not verify credentials but requires doctors to submit their medical license number for patients to check.

Velazco paid $25 to post his request for knee surgery. A few days later, he had bids for the outpatient procedure from surgeons in New York, California and Virginia, including details about their expertise. After accepting the lowest bid — $7,500, a fee that covered anesthesia and related costs — he learned that his surgeon would be William T. Grant, a Charlottesville orthopedist.

A few weeks later, after several online discussions with Grant, Velazco arrived in Charlottesville, where he had rented a $50-a-night room and would spend two weeks recuperating. On Dec. 4, 2013, he underwent knee surgery, performed in an outpatient surgery center that Grant co-owns.

“I am back working four days per week and climbing ladders,” Velazco said recently. “I am doing great.”

Far From Home

Francisco Velazco said his family thought he was crazy when he told them he planned to have major knee surgery 3,000 miles from home in Virginia, a place he had never visited and where he knew no one. His mother, he said, begged him not to go and insisted they could borrow money for surgery in Seattle. But Velazco said he felt confident in the online approach; he sold his car to raise money and received help from relatives and an employer to pay Grant’s $7,500 fee and the additional $1,000 he spent on airfare, a bus ticket, lodging and other expenses.

Velazco flew from Seattle to Durham, N.C., where a cousin lives, and then took a six-hour bus ride to Charlottesville. A day or two before surgery he met Grant and underwent a pre-op physical.

The Charlottesville retiree from whom he rented a room via Airbnb, turned out to be a godsend: He drove Velazco to medical appointments and cooked him breakfast during the two weeks he recuperated.

Grant visited Velazco twice while he was recovering and helped arrange physical therapy. “This was my first Medibid case,” the surgeon said, “and I was certainly invested in wanting this to be a positive experience for everybody.”

Medibid founder Ralph Weber, a benefits consultant, said he left his native Canada for the United States in 2005 to escape “socialized health care,” using the Internet to arrange non-emergency medical care is long overdue.

Americans, he says, are increasingly going online to book travel and even find a mate. Medibid enables them to strip away the opacity that surrounds health-care pricing, Weber maintains, where charges vary wildly even in the same market and can be nearly impossible for consumers to obtain.

Interview by Alex Nabaum for The Washington Post and KHN. “We introduce transparency and also competition,” said Weber, whose company is based in Murfreesboro, Tenn.

“We are a disruptive innovation, a free-market alternative to Obamacare.” Weber said that about 120,000 consumers — Medibid calls them “seekers” — have used the service. Faith holders of high-deductible plans or enrollees in faith-based plans, which have grown as a conservative alternative to the Affordable Care Act. Seekers are charged $25 for each request or about $60 for an unlimited number of requests per year.

Roughly 6,000 doctors or surgery centers and a handful of hospitals, most seeking patients from abroad, have registered as “bidders”; physicians pay a fee ranging from $50 to bid on one request to $250 to bid on many. Once a bid is accepted, Medibid bows out, and patients work out arrangements with the doctor. Many bids are a package deal, covering the facility fee, the surgeon’s charge and anesthesia services. Patients pay the bidder in full, upfront and in cash or by credit card.

But critics, who agree hospitals’ prices are too often inflated, arbitrary and opaque, express concerns about Medibid. They say the service provides little in the way of quality indicators for prospective patients, something hospitals convey by granting a doctor privileges and insurers do by accepting doctors on a plan’s roster. Surgery or procedures such as colonoscopies are typically performed in physician-owned outpatient centers, which are more lightly regulated than hospitals and have fewer safeguards for patients. Unlike hospitals, which are required to track infections, outpatient surgery centers are usually exempt from such reporting requirements. And complications are rarely covered under the terms of Medibid.

Weber says that consumers are competent to make such decisions without relying on a provider directory or the imprimatur of a hospital. “Is there anything that says the Internet is any worse than a Blue Cross directory?” he asked. “Once they choose a physician, we will send them the license number, and there are a bunch of third-party sites” that patients can use to check out a doctor. If a patient is dissatisfied with a doctor after accepting a bid but before surgery, Medibid will repost the query free of charge

MediBid™ provides affordable quality access and choice in Health Care! When most of us make a major purchase, we usually shop around. Whether it is a hotel room, a flight, a computer, or a kitchen renovation. Most companies have done this for over 100 years. But when it comes to medical care we often simply look to see which doctor is “in-network”. This means we are shopping for price, but we usually have no indication of quality.

MediBid changes that. We give you the ability to compare quality and price, something insurance companies usually do not do. When doctors compete you win. We let you see both the quality, and the price in advance so that you can make an informed decision. Our average savings are 80% vs. billed rates and 50% vs. “Insurance discounted” rates. All this with transparency in quality!

Phenomenon & ‘Free-Market’ Care

Medibid “is a phenomenon that is in part being spawned by the absurd, nonsensical and inexplicably unfathomable pricing of American health care,” said Arthur L. Caplan, head of the division of bioethics at NYU Langone Medical Center in New York. “Cheap sounds good, but in these auctions you are not getting any information: Was the guy at the bottom of his class in medical school?”

“In the current world you buy the name — the institutional reputation of a doctor or hospital. Insurance companies or hospitals drop people who have high complication rates or costs due to errors, ” he added. “Medical care is not like buying a watch on the street or a hotel room online. The stakes are much, much higher.”

NYU’s Caplan says he worries about the lack of oversight in free-standing surgery centers. “Who is the peer review?” Caplan asked. “There is none. And it does not take a lot of qualifications to open one.”

Marty Makary, an associate professor of surgery at Johns Hopkins Hospital and the author of “Unaccountable,” a 2012 book about hospital quality, agrees. “I have concerns about the lack of good metrics of quality,” he said. “How do you know what you are getting?”

Oklahoma City anesthesiologist G. Keith Smith, co-owner of the Surgery Center of Oklahoma, was one of the first to sign up with Medibid, which dovetails with his “free-market” philosophy.

“We have been quoting prices for 17 years” to prospective patients, Smith said, ‘and posting them online for five.’ About 125 of the center’s patients have come through Medibid, for procedures including hernia repair, gallbladder removal and knee replacement.

Although cost may be the initial lure, once prospective patients “look at our Web site and see it is a beautiful, new, 40,000-square-foot facility, they are sold,” he said.

So far, no patient has had a complication serious enough to require a transfer to a hospital. But, Smith adds, “If someone pays $3,000 for a hernia [repair] and goes home and develops a wound infection that costs them another $3,000, they are still ahead.” Prices vary considerably, but the cost of a hernia repair averages about $7,900 or $9,700, depending on whether it is performed conventionally or laparoscopically, according to New Choice Health, a Florida-based company with a Web site that compares hospital charges. Some hospitals charge as much as $23,000.

Jeffrey M. Gallups, founder of one of the largest ear, nose and throat practices in the Southeast, said he recently signed up with Medibid because he believes the health-care law will make consumers more cost-conscious as a result of rising deductibles.

“I am a firm believer that non-emergency medical care will be like any other commodity,” said Gallups, whose practice has 16 offices in the Atlanta area and two — soon to be three — surgery centers.

“We are perfect for Medibid because we control the whole thing,” he said. “We have pathologists, anesthesiologists and surgeons.” His profit margin on Medibid cases — he has done only two surgeries so far but hopes to do more — is adequate, possibly “as little as 10 per cent.”

“We can do a $20,000 surgery for $6,000,” Gallups said. Why the price difference? “Greed,” he replied. “Hospitals are making a killing.”

Hospital profit margins average about 5.5 percent, according to 2012 statistics released by the American Hospital Association. Richard Gundling, vice president of the Healthcare Financial Management Association, whose members include financial executives from hospitals, disputed Gallups’ contention.

“Hospitals provide a community benefit and are responsible for cases that cannot go to surgery centers,” he said. “Hospitals are providing things like shock-trauma units and emergency care services that have to be covered 24 hours a day, seven days a week.”

Peter LePort, a surgeon in Orange County, Calif., recently performed hernia surgery on a Medibid patient for $2,500. “Not billing insurance cuts out a huge amount of the cost,” LePort said. “I can literally make the same amount of money.” Of the $2,500 fee, which the patient charged to his credit card, LePort estimates that $1,200 to $1,400 went to the surgery center of which he is an owner, $400 to the anesthesiologist, while the remaining $600 to $800 was his surgical fee.

For Bill Lang, an engineer in Gainesville, Fla., who has a $2,500 annual deductible through a Blue Cross plan, using Medibid proved to be a boon.

Lang, 66, needed minor sinus surgery after an earlier procedure failed. His ENT told him the procedure would cost $3,000 and would be performed in a surgery center under anesthesia. Lang thought both the charge and the anesthetic were excessive and decided to try Medibid.

A few days after his request was posted, he received several bids and chose the lowest — an ENT in Tampa, a two-hour drive away. The doctor agreed to perform the operation in his office for $362 using a local anesthetic.

“The man was well-qualified, and I had seen videos of this procedure on YouTube,” Lang said. “To me it is a low-risk procedure.” Had he opted for the first choice, he said, he would have owed $2,600 out of pocket — his $2,500 deductible plus 20 per cent of the remainder.

INVESTOR SIR RICHARD BRANSON GETS BEHIND TELEMEDICINE

From the FMS Global News Desk of Jeanne Hambleton MEDICITY NEWS Posed August 6^th 2014 by Stephanie Baum

Telemedicine startup Doctor on Demand has always been surrounded by celebrity folks in one form or another, but today it supplemented the cast of characters with celebrity entrepreneur and investor Sir Richard Branson.

It not only marks Branson’s first investment in telemedicine, but it also raises some intriguing questions about the long-term plans of a company that owns mobile phone and employer wellness businesses.

Branson took part in Doctor’s $21 million Series A round. The telemedicine company also landed big fish Comcast as a customer, which will provide the service to more than 100,000 of its employees.

In a statement that reminded me of Mark Cuban’s statement when he invested in Validic “I believe in personalized medicine,” Richard Branson had something similar to say about his investment in the mobile health company.

“I invested in Doctor On Demand because I believe that mobile technology will improve the system for patients, providers, employers, and insurers,” Branson said.

“It will enable a more efficient utilization of resources and a reduction in the overall cost of healthcare provision.”

Branson is a big believer in employer wellness programs. Among the companies in his Virgin group is Virgin Pulse, led by CEO Chris Boyce.

Telemedicine as a sell for employers seems to be rising as companies view it as an efficient way for their employees to see a doctor easily and reduce unnecessary healthcare expenses.

Another telecommunications company with a mobile channel – Verizon — launched a telemedicine video consult service earlier this year.

In addition to Branson’s thoughts about the company as an investment opportunity, it could be that Branson and Doctor on Demand see in each other a useful partnership in the long term that could provide a way for Virgin to offer telemedicine to its Virgin Pulse and/or Virgin Mobile customers.

It could also help Doctor on Demand to expand beyond the U.S. where it has a presence in 46 states through 1,400 doctors. Virgin also has that airline. Maybe passengers could get access to a doctor 30,000 feet up.

Venrock led the round and Shasta Ventures also participated after investing in a $3 million seed round last year. Other investors in the company include Lerer Ventures and athenahealth CEO Jonathan Bush.

Talk show host Dr Phil McGraw is credited with conceiving of the startup and serves as its adviser, though there were plenty of variations on the non-emergency video consultation model already such as Teladoc and Sherpaa Health.

His son Jay McGraw, the co-founder, is also the executive producer of tabloidesque TV show The Doctors. Today’s alarmist lede, for instance, screams “The Doctors shares what you need to know about the alarming Ebola virus outbreak in the U.S.” Former U.S. Sen. Tom Daschle is on the board of directors.

MORE OLDER AMERICANS SUFFER FROM MULTIPLE MEDICAL CONDITIONS

LIFE EXPECTANCY GAINS THREATENED

From FMS Global News Desk of Jeanne Hambleton Posted 29 July 2014 Source Johns Hopkins Bloomberg School of Public Health – Medical Care

Newswise — With nearly four in five older Americans living with multiple chronic medical conditions, a new study by researchers at Johns Hopkins Bloomberg School of Public Health finds that the more ailments you have after retirement age, the shorter your life expectancy. The analysis, one of the first to examine the burden of multiple chronic conditions on life expectancy among the elderly, may help explain why increases in life expectancy among older Americans are slowing.

A report on the findings, based on an analysis of 1.4 million Medicare enrollees, appears in the August issue of the journal Medical Care.

“Living with multiple chronic diseases such as diabetes, kidney disease and heart failure is now the norm and not the exception in the United States,” says Eva H. DuGoff, a recent PhD recipient at the Johns Hopkins Bloomberg School of Public Health and lead author of the report.

“The medical advances that have allowed sick people to live longer may not be able to keep up with the growing burden of chronic disease. It is becoming very clear that preventing the development of additional chronic conditions in the elderly could be the only way to continue to improve life expectancy.”

For their analysis, researchers used the Medicare 5% sample, a nationally representative sample of Medicare beneficiaries, enrolled as of January 1, 2008, which included 21 defined chronic conditions and the records of nearly 1.4 million people 67 and older.

Life expectancy in the U.S. is rising more slowly than in other parts of the developed world and many blame the obesity epidemic and its related health conditions for the worsening health of the American population.

The analysis found that, on average, a 75-year-old American woman with no chronic conditions will live 17.3 additional years (that’s to more than 92 years old). But a 75-year-old woman with five chronic conditions will only live, on average, to the age of 87, and a 75-year-old woman with 10 or more chronic conditions will only live to the age of 80. Women continue to live longer than men, while white people live longer than black people.

It is not just how many diseases you have, but also what disease that matters. At 67, an individual with heart disease is estimated to live an additional 21.2 years on average, while someone diagnosed with Alzheimer’s disease is only expected to live 12 additional years.

On average, life expectancy is reduced by 1.8 years with each additional chronic condition, the researchers found. But while the first disease shaves off just a fraction of a year off life expectancy for older people, the impact grows as the diseases add up.

“We tend to think about diseases in isolation. You have diabetes or you have heart failure. But many people have both, and then some,” says senior author Gerard F. Anderson, PhD, a professor in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health.

“The balancing act needed to care for all of those conditions is complicated, more organ systems become involved as do more physicians prescribing more medications. Our system is not set up to care for people with so many different illnesses. Each one adds up and makes the burden of disease greater than the sum of its parts.”

The researchers say their findings could be useful to Social Security and Medicare planners as they make population and cost predictions for the future. Policymakers are facing a different landscape as so many more people are living with multiple chronic conditions than before: 60 percent of those 67 and older in the U.S. have three or more of these diseases, the researchers found.

Eventually, there may be a tipping point, when the medical advances that have boosted life expectancy for so long can no longer keep pace with the many illnesses people are collecting as they age.

“We already knew that living with multiple chronic conditions affects an individual’s quality of life, now we know the impact on quantity of life,” DuGoff says. “The growing burden of chronic disease could erase decades of progress. We do not want to turn around and see that life expectancy gains have stopped or reversed.”

“Multiple Chronic Conditions and Life Expectancy, A Life Table Analysis,” was written by Eva H. DuGoff, PhD; Vladimir Canudas-Romo, PhD; Christine Buttorff; Bruce Leff, MD; and Gerard F. Anderson, PhD. The study was supported by the American Insurance Group.

Take care. Back tomorrow all being well. Jeanne