Top Healthcare Conversations of 2008

Many of the great healthcare thinkers and bloggers wrapped up 2008 with end-of-year considerations of the important developments in their fields, and some looked ahead with predictions for 2009.

The “Ashley Treatment”: Hard Choices for Life Enhancement

Life enhancement innovations like cosmetic neurology, 20-15 LASIK, non-therapeutic abortion, body modification and other elective surgeries are an inevitable part of medical care in a free society. Enhancing the life of your child should be included in that list.

Three Inventions from Fischell

Award-winning medical inventor and philanthropist Robert Fischell spoke at the TED (Technology, Entertainment and Design) conference about three disruptive healthcare innovations he’s developing.

Disgruntled Docs Go Out of Network

Hundreds of pissed off MDs gathered at a seminar in New York recently to find a way to beat the healthcare system that they say underpays, overmanages and cheats both doctors and patients.

Mustargen: A Bad Case for a Nasty Old Drug

Joyce Elkins of Georgetown, Texas saw her $77.50 cancer medication Mustargen jump to $548.01 within two weeks. Merck, the drug’s original manufacturer, sold the rights to Ovation Pharmaceuticals which promptly raised the wholesale price “roughly tenfold.”

Wal-Mart Medical Clinics

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At yesterday’s National Governors Association Winter Meeting in Washington, Wal-Mart president Lee Scott (at right) announced the opening of 50 new in-store clinics adding to the handful now run by RediClinic, a division of Interfit Health, a Houston-based firm. Interfit is backed by Revolution Health Group, the post-Time Warner venture of AOL founder Steve Case with a stellar board of tech-savvy directors.

As we wrote in Wal-Mart’s Tough Choices last December, the biggest employer in America faces the biggest employee healthcare problem, and Scott says he’s dedicating himself to getting state governments focused on realistic solutions — instead of the employer mandates they’ve been contemplating. But the most disruptive line from the speech is: “We’re making health care more affordable and accessible to our
associates.  And with the clinics, we’re using our business strengths
to do the same for our customers and our communities
.”

When Wal-Mart starts competing with ol’ Doc Welby, things will start changing.

MinuteClinic Retail Care: “You’re sick. We’re quick.”

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The sign on the wall at Minneapolis-based MinuteClinic presents the price list for common medical procedures: $49 for a Sinus Infection, $59 for Wart Removal, $39 for a Pregnancy Test. Office hours are 8 to 8 weekdays, 8 to 4 weekends, no appointment necessary. The 90 square foot clinics are located in high traffic retail locations like Target, CVS and CUB Foods stores, usually with free parking. A nurse practitioner backed up by a proprietary evidence-based diagnosis and treatment system gets you in and out in 15 minutes, faxes your primary care physician a report, and accepts most insurance plans. If you have a medical problem not on the list — about 7% of walk-ins, says MinuteClinic — you’re referred to a primary care physician, urgent care center or emergency room.

Like a JiffyLube, the MinuteClinic does a few things, and does them efficiently and well. The company says that a Sore Throat visit — including prescription medication — costs about $62 and 30 minutes versus a primary care physician’s $109 and 90 minutes versus an emergency room’s $325 and God-know-how-many hours waiting time. Patients are satisfied: 50% are referred by friends, 40% to 45% are regulars, and the firm claims 4 complaints per 10,000 visits. Employers are satisfied: many companies actively promote MinuteClinics and even discount co-pays for employees.

Price transparency. Careful quality measurement. Evidence-based practices. Electronic medical records. 21st Century customer service. You know it’s a disruptive innovation when the first item on the agenda for the NAFAC urgent care physicians conference in April is:
"Are you threatened by the recent openings of clinics inside big-box retailers or chain drug stores in your community?"

UK Consumers Get Some Choice

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In an eerie reflection of the U.S. debate over school vouchers, healthcare experts in England are divided over a new policy that allows patients covered under the National Health Service (NHS) to choose the best hospital for their non-emergency treatments. From BBC News:

Ministers say the Patient Choice reforms will cut waiting times and drive up standards of care. But union leaders fear it could force unpopular hospitals to close and that patients could make wrong choices.

The nationalized British system is notorious for its waiting lists. Last month, UK Health Minister Lord Warner bragged that the NHS will meet its commitment to deliver a maximum wait of six months for an operation. The average wait time is two months. Warner continued:

"But we want to cut waits even further. That is why the NHS is now working towards an even more challenging target. By 2008, no one will wait longer than 18 weeks from GP referral to the start of hospital treatment. Not only will this guarantee patients more certainty about their treatment, it will also finally end the NHS’ hidden waiting lists."

Motivated Patient: A Medical Tourist in Beijing

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Under-insured freelance writer Laura Moser writing in Slate — The Medical Tourist: How my shoulder sent me to Chinadescribed her journey to Beijing to get Traditional Chinese Medicine treatment for her bad back. (She got to Beijing with frequent flyer miles.) The results are a little hopeful and a lot inconclusive, but the two-part story offers a peek at the lure of medical tourism:

A bone-marrow transplant costs $2.5 million in the United States.
Doctors in India can do it for $26,000. Heart-bypass surgery runs
$60,000 to $150,000 in this country. In Asia, the average cost is
$10,000. Other less-serious procedures—tummy tucks, face lifts, breast implants, LASIK eye surgery, even MRIs and dental work—can also be had at a fraction of they cost here.

At the Health IC Summit next month, we’ll host a discussion of medical tourism and other new care models with some professionals from the field.

Tiny In Vivo Robots Roam the Abdomen

Minirobots_1A squad of lipstick-sized prototypes robots developed at the University of Nebraska are being deployed to test minimally invasive surgery techniques. Specialized devices for illumination, biopsy, clamping and cauterizing are planned, some of which could be mobile in the stomach or the abdominal cavity. Soldiers on the battlefield, astronauts in space and trauma victims on the roadside could benefit. See the developers’ web site for a remarkable video (in Real Network format) of a motorized robot roaming a patient’s abdomen.