US Health Crisis » Medicine

Rock Health Makes Another Stab at Health Care Reform

francine — Thu, 28 Jul 2011 17:56:30 +0000

What are the odds that I would find myself in a room with two other women who also worked at Intel and were passionate about health care? I thought maybe a million-to-one until I met Halle Tecco and Leslie Zeigler at Rock Health. They are truly star power.

It gets better from there. Rock Health is a new nonprofit incubator in the touristy Chinatown part of San Francisco. But take the elevator past the imported knickknacks and large animal sculptures in the doorway and you will find an open, industrial workspace dedicated to software development to change health care. These women have the dream of disrupting the worst-run consumer industry in America with new mobile technologies that put power back in the hands of patients and providers.

In case you are wondering where the power lies now, it’s in the hands of the payers.

In most industries, the growth of information technology has shifted power to the customer. Or at least put it in the hands of the vendor who can target based on known customer preferences.

But healthcare has very little CRM, and no VRM. These software driven terms translated to health care would mean that the provider had adequate information about you to offer you intelligent treatment choices, and that you as the patient had the power to choose who and what gets treated and what you will pay. In healthcare, the patient has almost no choice of either treatment or cost.

Rock Health has eleven resident grantees (who have received nominal sums of $20,000) in its the first program, and twenty “member companies” who have not received money but can come to workshops and receive advice. They are focused everywhere from preventing hospital readmissions, to drawing conclusions from large data sets, to helping people find doctors who will give discounts.

But Rock Health isn’t trying to boil the ocean of our broken health care system. Instead, it is trying to work around the intransigence of the existing old guard to empower patients. It doesn’t touch the areas of data integration or flirt with privacy laws no one understands. Realizing that mobile devices can be used for prevention, monitoring, and better communication, it is trying to encourage startups that can succeed in selling into this difficult market because they are not selling to hospitals, but rather selling WITH hospitals.

What I loved most about Rock Health, and why I plan to stay involved with it, is the energy of the founders, one of whom was recently diagnosed with ulcerative colitis and got a crash course in health care systems mismanagement herself while still in her mid-20s. She has blogged a bit about her colonoscopy prep here.

There’s nothing like being a patient in our health care system to fire you up for change.

British Doctors and Patients Refute Lies About NHS

francine — Tue, 15 Sep 2009 01:14:46 +0000

Dear Senator Kerry,

Your reported call for “lies” about health care reform to be refuted is essential and requires an urgent response. To that end, may we – British health professionals and patients – respectfully expose those “lies” which are about our National Health Service, a service which our experience shows to work successfully for the benefit of all in this country.

Continue reading to see the full letter.

PATIENT CHOICE: There is NO “death panel” in the UK NHS or anywhere else in the UK health care sector.
-Termination of a pregnancy is a personal decision if approved by two doctors. NO board or organization of any kind makes any decision about termination for fetal abnormality. Such decisions are personally made by those seeking such procedures after counselling by medical and other health professionals.
-Elderly people can get counselling and advice to help them determine their requirements for their future care, but only if they wish it. It is a service that provides information about issues such as living wills. This is similar to the US proposed Section 1233, which provides counselling and assistance to those wishing voluntarily to make their own arrangements for their future, medically and physically.
-Patients are normally registered with a family doctor practice of their choice. A patient is able to see a doctor immediately for urgent care in general practice although seeing his or her own family doctor for non-urgent care may require waiting a few days. If the patient requires referral for specialist opinion or treatment, they can choose whichever hospital they prefer.
CARE FOR THOSE WITH PRE-EXISTING CONDITIONS: In the US, people with pre-existing health problems are rarely covered by private insurance companies for those problems. Many do not change jobs for fear of losing cover for such conditions from their new insurers. The NHS is literally a life saver for those with pre-existing health problems – they are not denied care. It is vitally important that the NHS, and any government financed health plan anywhere, undertakes the care of such people.
CARE FOR THE ELDERLY: There is NO cut-off age for health care in the NHS. Senator Kennedy, like anyone else of that age, or older, and with health problems such as his, would have been treated by the NHS with the same high levels of care as someone younger. Care for the elderly includes free flu vaccinations, free medication, free operations as needed, nursing care visits, and help and adaptions for the home. Many hospitals now offer “hospital to home” programs for palliative and end of life care to enable very ill people to remain at home.

CARE FOR THE DISABLED: Professor Stephen Hawking of Cambridge University, recently awarded the Presidential Medal of Freedom by President Obama, is disabled and has always been under the care of the NHS. Professor Hawking is an outspoken admirer of NHS care. Like thousands of others who are disabled, he is entitled to free medical care and medicine, and he can get adaptions, equipment and home care to allow him to live at home.

FREE MEDICATION: NO ONE is denied medicine if they need it. All children up to the age of 16, pregnant women and adults over the age of 60, unemployed people, patients with cancer and many with chronic conditions, don’t pay for their medication from the NHS. 88% of medicines are dispensed without charge. For the minority who pay there is a standard charge of $11 dollars per prescription, regardless of the real cost of the drug. Some parts of the UK have abolished prescription charges altogether.

INSURANCE: Like the Healthy San Francisco medical plan, those in the UK can also take out private insurance, if they can afford it, although less than 1 in 8 currently do so. The co-existence of public and private coverage ensures complete freedom of choice.
THE COST: The NHS is funded by taxes and provides universal coverage while costing 8% of UK GDP. The US system currently costs 16% of GDP but leaves 45 million without insurance and a further 25 million underinsured.

BACKGROUND: The NHS was created in 1948. Its goal was to provide comprehensive medical care through taxation, universal coverage for the population which is free of charge at the point of care. It still does that despite the huge, and increasing, demands on its financial and practical resources.
The NHS is available free of charge to all regardless of ability to pay, and does not discriminate against those with pre-existing conditions. Importantly it gives freedom from fear of the financial consequences of illness.
Survey after survey shows that British patients express a high degree of satisfaction with the care they personally receive from the NHS. On average, British users of the NHS live longer and have a lower infant mortality rate than the US.
The NHS has shown itself to be open to – and often the source of – innovation. How the US manages its own health care reform will doubtless provide us with new ideas about how to improve some aspects of our own NHS service. In the same spirit, we respectfully draw to your attention what evidently works well here

Yours sincerely,

Sir George Alberti MD, PhD, PRCP
Past President of the Royal College of Physicians
Dean of Newcastle School of Medicine

Professor Alan Maryon-Davis FFPH FRCP
President, UK Faculty of Public Health

Professor Anthony Costello FRCP FRCPCH
Professor of International Child Health
Director of Institute of Child Health, UCL

Professor Andrew JM Boulton, MD, FRCP
Professor of Medicine, University of Manchester, UK
Consultant Physician, Manchester Royal Infirmary

Professor Mark B Gabbay MD FRCGP
Professor of General Practice
Head of Division of Primary Care
University of Liverpool

Professor Rodney Grahame CBE MD FRCP FACP
Consultant Rheumatologist, UCH
Honorary Professor at UCL, Department of Medicine

Professor Ian Banks
President of the Men’s Health Forum and member BMA Council

Professor Eileen O’Keefe
Professor of Public Health
London Metropolitan University

Professor Gill Walt
Professor of International Health Policy
Health Policy Unit,
Dept Public Health & Policy,
LSHTM, Keppel Street,

Professor Rosalind Raine

Reprinted from Gary Schwitzer’s blog (one of the pre-eminent health journalists and teachers)

Class Warfare? The Insured vs the Uninsured

francine — Fri, 27 Mar 2009 21:23:06 +0000

When Coastside Family Medical Center in Half Moon Bay suddenly closed its doors, both the insured and the uninsured members of the comunity suffered. The insured had no idea that they were part of the “cause” of the problem; the CFMC was unable to get legal recognition as a clinic for the poor because we, the insured, “ruined it” for our uninsured neighbors by being too prosperous.

I look at this as a microcosm of what could happen in any community any day, so I’m sharing the information below about the economics of running a family practice under today’s health laws. The information was provided by the Half Moon Bay Chamber to its members. It shows where we are as an industrialized nation in making health care accessible to our citizens. Remember, this clinic is 30 miles from a major city.

*The Board of CFMC would like to take this opportunity to clear up som
misconceptions.*
The Board of CFMC greatly regrets having to close the clinic and wishes that
we could have done more to make the transition less painful for both the
patients and staff. We are very grateful to the staff that has worked so
hard over the years and in this difficult time to provide the best health
care possible to Coastside residents. We’re also very appreciative of
community members who jumped in and tried to provide positive assistance for
those who needed immediate help.

*Why did you have to close the clinic?*
One reason: no more money to fund the shortfall. The financial history is
well known to most. The clinic was founded when Stanford University, after
experiencing a $1.5m annual loss, abruptly closed the doors in 2001. A group
of us rallied and formed a non-profit 50( c)3 to run the clinic as it always
had been designed serving the insured, uninsured, and underinsured. We
experienced a $600,000 loss the first year and had a loss of at least
$400,000 each year thereafter.

*How did you keep it open so long?*
We relied on our fundraisers, grants, foundations, and personal
contributions. All of the board were contributors to the clinic. Stanford
Hospital and Mills Peninsula were generous. A small number of individual
donors were extraordinarily generous. The lobby displayed a giving tree and
donation box for all those who could contribute and be recognized. Numerous
articles were run over the years in the Review pertaining to CFMC’s
non-profit status and the challenges of contributions. Every year we sent an
appeal to our entire list of past donors and new prospects. Our last annual
appeal in November only brought in $18,000 and grant and foundation funding
all but dried up in this economy. The clinic ran a $50,000 monthly loss,
$70,000 if we had paid the county our rent. The board has always worked on a
volunteer basis and the dollar equivalent of the professional work
contributed by the board was immense. This was money we did not have to
spend.

*Why was it operating at a loss?*
The clinic was a ‘hybrid’ model serving insured and uninsured equally. This
was very unique. As a struggling non-profit for eight years trying to meet
the needs of all at an equal level of service, the CFMC board grappled with
major demographic shifts that changed the mix of patients. More underinsured
than insured were now being served which was not reimbursed at the rate of
Federally Qualified Health Clinics enjoyed by some facilities. For example,
FQHC clinics receive $386 per patient visit and non FQHC clinics (like CFMC)
received, between $66 and $77. This does not cover costs. This is why every
possible affiliation to try and obtain an FQHC status was explored. FQHC
status was not available to the clinic because the community as a whole was
too prosperous. The Coastside Family Medical Center hybrid illustrates the
inequality of our health system.

*Why did you not give notice?*
The clinic was caught in a ‘perfect storm’ between March 5 and March 11. We
had worked with the county to have it either merge with or operate the
clinic to use its FQHC status. We told the county we could only keep the
doors open until mid March and a slight possibility of April 1st. The county
concluded on March 5 that application of county pay and benefit scales to
the clinic made county status for the clinic unprofitable. At that point the
clinic asked for a bridge loan of $300,000. We found out that was not a
possibility on Wednesday night, March 11th. Simultaneously a $54,000 check
from a major medical organization that was agreed to arrive that week (and
unquestionably due and owing) did not come in, and we therefore did not have
the funds available to make payroll for Thursday and Friday. Staff had been
paid thru Wednesday. We consulted an attorney and determined it would be
irresponsible at a minimum and possibly fraudulent conduct for us to keep
the doors open knowing we did not have the funds to pay staff and creditors.

*Why did you not let the community know?*
Rumor, panic and disorder are the mortal enemies of negotiations. This was
occurring in 2001 with a much more ‘insured’ patient base when community
volunteers stepped in and Stanford swiftly agreed to hand the clinic over to
the community. We had to be careful what we said while negotiating with
other clinics in order to continue to be perceived as a viable partner. We
had survived close calls like this at other times in the clinic’s life. We
were also negotiating to hire three more doctors so the county could have a
full staff when they took over. These set of circumstances are regrettable,
but cannot be fairly judged in hindsight.

*Why didn’t you ask the community to chip in?*
The community was repeatedly asked through the fundraising. Unless the
community could donate $70,000 per month, the closure was inevitable without
the FQHC status. The community in general has been a helpful but frankly
small part of our fundraising. The assertion that the community would have
done much more this time than it historically did is without foundation in
experience. The fundraising histories of Coastside nonprofits, and their
results from the community at large, are well known and are entirely
consistent with our decision to close.

*Why were the locks changed?*
We were told by counsel the locks must be changed. We are responsible for
everything in the clinic to remain intact as an asset of the court (so
salaries and creditors could be paid) and also to secure the patient
records. Prescription medications were another concern and there could have
been legal liability had they not been secured.

*Can we get our records?*
Your records are secure and will be mailed to the requesting doctor when you
make your appointment despite the legal debate of protocol going on amongst
the attorneys. Further contact information will be relayed via this paper
following the appointee of a trustee.

*What next?*
The facility is there. The county could come in and set up a clinic for the
uninsured when they realize the impact this will have on San Mateo Medical
Center. And, a private practice could use a portion of the space to set up
practice for the insured. Hopefully, some of our doctors would remain should
that happen. The clinic had to close to make either of these a possibility.

The directors want the community to fully understand how hard and how
emotional this was and how hard we worked to keep the clinic open. We
realize the closing was less than smooth and that many of you are angry.
Please know that all of us deeply regret the ‘perfect storm’ that derailed a
timely notification and closure. Please also understand that we did not
cause those events to occur, whether the questionable conclusion of the
county or the unpardonable ethical lapse of the payor that held the check.
We are devastated at the loss of the clinic that we have patronized for up to 30 years and that we worked so hard to keep alive for eight years. We
hope the community will join us in trying to change the health laws thatended our vision after eight productive years.

No Providers, No Care

francine — Sat, 14 Mar 2009 19:59:25 +0000

I’m taking a moment out of the hilarity of SXSW, a geek festival for filmies, music fans, and young software developers, to write about something much more important: upcoming lack of access to medical care. It is going to get worse and worse, folks, unless we keep on the government to change the incentives, fix the system, and protect us from the rising costs.

In the summers, I live in Half Moon Bay, a coastal community south of San Francisco populated by an amazing group of fishermen, farmers, construction workers, and commuters. Some of the people are descendants of the original Portugese fishermen who caught cod and salmon in the local waters (where it is becoming harder and harder to find them). Some are migrant workers who pick the vegetables and flowers that are grown in the beautiful fields along Highway 1.

Half Moon Bay, until recently, had a family medical center in town that treated all those people. Most of its docs were primary care physicians or pediatricians. Once a unit of Stanford, Coastside Medical Center became its own nonprofit organization a few years ago.

Thursday it suddenly shut its doors, stranding its doctors (who had appointments scheduled that had to be canceled), laying off its entire staff, and leaving its patients scrambling for their medical records. Below is the statement circulated to the community on the Coastsider web site:

The Coastside Family Medical Center located in the Shoreline Center shopping
area closed its doors to business at noon Friday, and plans to file
bankruptcy papers within the next two weeks. All of the Clinic’s 35
employees are being released. Coastside is a nonprofit that logs 22,000
patient visits in a year—including a number of CUSD employees and
students.

If you are a patient of Coastside, please be advised that you will find
doors closed and locked at this time. For medical records or prescription
information, write a letter attention “Medical Records” to CFMC, 225 S.
Cabrillo Highway, Suite 100A, HMB, or fax the instruction to: 650.726.9317.
General inquiries can be directed to Bob Harless at
rharless@coastsidedocs.org.

That was my primary care center when I am in California. What do you suppose happened? A landlord himself in trouble and unable to extend terms or renegotiate a lease? A dry-up of the credit markets and the attendant small business lines of credit the Center needed for operations? Insurance payments that arrived late and squeezed the docs out of every nickel? Embezzlement in the office?

Probably all of those. It doesn’t matter what happened, but you understand the consequences. And you will see more of them untilwe fix our health care system.