Outsourcing Healthcare

[benzocaine]

Is something I never imagined.

The hospital I work at does though... well at least x rays!

http://www.nighthawkrad.net/

[MikeK]

One of my favorites is the outsourcing of HR. Nothing says an employer values their employees better than giving them an 800 number when there is a personnel issue.

[IJ]

This is outsourcing lite. Radiologists are in demand (some believe the "lifestyle" specialties keep themselves that way so they can all get paid handsomely) and no one prefers to work at night, so what costs a lot during the day costs more at night... perfect use of modern technology to use a daytime physician on the other side of the planet.

The New England Journal ran an article about americans who can't afford our medical care (not just plastic surgery but gallbladders, etc) and instead find that the same services are much cheaper in India (etc) even after the airfair is included.

[Bill Glasheen]

With everything going digital in imaging, this is a piece of cake. Just wait until they perfect the electronic medical record (EMR). You ain't seen nothin yet.

They have JCAHO certification, so they're legit. Back when I worked for a BCBS plan, the network management people were dreaming of this day. It keeps specialists in isolated areas (with a monopoly) from holding health plans hostage with their fee demands. And on the flip side, you can get some of the most talented radiologists around servicing underserved areas.

Competition is a good thing. If they do quality services, power to them.

- Bill

[benzocaine]

Yep... the technology is great, and I think it's a good idea.

The only problem I have seen so far relates to what Bill said about perfecting the electronic record. From what I have seen the radiologists are given limited information about the patient, so we are left with readings that go like this....

Enlarged heart. There is a large opacity in the left base which could be atelectasis, or infiltrate suggesting possible pneumia, small pleural effusion noted as well. Follow up exam reccomended.

Impression: see body of report.



So then we wait until the AM and shoot an x ray which is read by a house physician who has access to the patients lab reports and can see that the white count is normal, BUN evevated, BNA peptide is 600, and then gets to say it is atelectasis caused by a pleural effusion.

How are we saving money here?

[benzocaine]

With technology moving the way it is maybee all our new Doctors will stay in India

[Glenn]

The New England Journal ran an article about americans who can't afford our medical care (not just plastic surgery but gallbladders, etc) and instead find that the same services are much cheaper in India (etc) even after the airfair is included.

This has been given the name Medical Tourism, here is some info and cost comparisons:
http://en.wikipedia.org/wiki/Medical_tourism
I attended a lecture on Thailand's medical tourism last year. Here is a site used to promote medical tourism in Thailand, other countries have similar sites:
http://www.medicaltourisminthailand.com/home.htm

[Glenn]

A Time Magazine article on Medical Tourism:
http://www.time.com/time/magazine/print ... 29,00.html

[Bill Glasheen]

Ben

If you limit information that the radiologist gets, you limit his/her ability to interpret the findings. If you add in more information, you get a more discriminating diagnosis.

No surprise there...

Intelligent consults also can be as simple as picking up a phone and having a conversation with the specialist. That's what we in the health care quality field call coordination and continuity of care. Patients call it good medicine.

- Bill

[benzocaine]

Ben

If you limit information that the radiologist gets, you limit his/her ability to interpret the findings. If you add in more information, you get a more discriminating diagnosis.

No surprise there...

Intelligent consults also can be as simple as picking up a phone and having a conversation with the specialist. That's what we in the health care quality field call coordination and continuity of care. Patients call it good medicine.

- Bill

My point exactly. When the electronic record gets sent (which is something we will have in the near future) they will have access to the labs and other pertinent information

As far as making the phone call goes you'll be hard pressed to find an attending Doctor there at the Hospital at 3 AM. That's what residents are for, and then they run skeleton crews so they can all get a good night sleep once in a while.

I'm sure they will iron out the wrinkles after enough people bich about wishy washy readings. Nighthawk's only been used for about a year now.

[IJ]

"So then we wait until the AM and shoot an x ray which is read by a house physician who has access to the patients lab reports and can see that the white count is normal, BUN evevated, BNA peptide is 600, and then gets to say it is atelectasis caused by a pleural effusion."

As the medicine doctor reading the reports, *I* should interpret them. *I* have access to the labs. Further, ordering docs can put in whatever data they want in those requests... AND you wouldn't have to reshoot the film, just look at it at home. LASTLY, I've seen a number of overreads and resulting FUBARS--for example, "PAtient with HIV short of breath." The film shows diffuse infiltrates, the radiologist calls PCP or other opportunistic infection, the patient gets antibiotics for days and a pulmonary consult--and it turned out the patient's immune system was preserved and he had heart failure, no infection at all. I call this diagnostic inertia and it occurs when physicians overrely on another doctors (inadequately educated) opinion and become unwilling to consider the possibility they've erred.

These companies do save money, imperfect or not. Rads costs you $$, rads all night costs you $$$$$$$.

[benzocaine]

As the medicine doctor reading the reports, *I* should interpret them. *I* have access to the labs. Further, ordering docs can put in whatever data they want in those requests... AND you wouldn't have to reshoot the film, just look at it at home. LASTLY, I've seen a number of overreads and resulting FUBARS--for example, "PAtient with HIV short of breath." The film shows diffuse infiltrates, the radiologist calls PCP or other opportunistic infection, the patient gets antibiotics for days and a pulmonary consult--and it turned out the patient's immune system was preserved and he had heart failure, no infection at all. I call this diagnostic inertia and it occurs when physicians overrely on another doctors (inadequately educated) opinion and become unwilling to consider the possibility they've erred.

These companies do save money, imperfect or not. Rads costs you $$, rads all night costs you $$$$$$$.

I see what you are saying Ian.

Do they utilize these types of services where you work?

All of this remonds me of robotic surgery. The military is working on(or may already have) a mobile operating room that can go close to the battlefeild. The surgeon is miles away doing the surgery remotely in a safe location, while being assisted by someone with the training a Physicians assistant would recieve.

Maybee that's in the future for rural outlying hsopitals?

[benzocaine]

http://www4.army.mil/news/article.php?story=8991

Remote surgeries

Robotic telesurgeries from long distances are making steady progress, Moses said, but are in a “very experimental time period.” In 2001, though he was physically in New York, Dr. Jacques Marescaux removed a gallbladder from a 68-year-old woman in Strasbourg, France, marking the first-ever transatlantic telesurgery.

“It did demonstrate the possibility of remote intervention surgery,” Moses said, adding that many safeguards were put in place for that procedure, including a back-up surgical team waiting to intervene and a dedicated transatlantic line to ensure continuous signal connection.

As another success story, Moses offers the example of Canadian telesurgeon, Dr. Mehran Anvari, who has performed more than two dozen telesurgeries from Ontario on patients who are nearly 250 miles away. Anvari, a scientific partner with the Telemedicine and Advanced Technology Research Center, uses a specially configured laparoscopic robot that measures and transmits the movements of his hands and fingers to perform minimally invasive surgeries on stomachs, kidneys and spleens.

“None are as complicated as brain or heart surgeries, but every time he conducts a successful surgery, he is reinforcing the point that telesurgery is possible,” Moses said.

[mikex1337]

This is outsourcing lite. Radiologists are in demand (some believe the "lifestyle" specialties keep themselves that way so they can all get paid handsomely) and no one prefers to work at night, so what costs a lot during the day costs more at night... perfect use of modern technology to use a daytime physician on the other side of the planet.

The New England Journal ran an article about americans who can't afford our medical care (not just plastic surgery but gallbladders, etc) and instead find that the same services are much cheaper in India (etc) even after the airfair is included.

That is sad when you have to fly halfway across the world to get affordable medical treatment.

[IJ]

"Do they utilize these types of services where you work?"

No, I work in an academic medical center, so we have indentured servants to read x-rays (and admit patients) all night. However, with the work hours regulations, that is changing, and soon my job will entail 24 hour coverage (in shifts) of our hospital. I was there at 10 pm last night already.