Thinking of starting a Health IT company? Here are top three industry challenges • Hacker News Board

Re: Thinking of starting a Health IT company? Here are top three industry challenges

#51

Post by jQueryIsAwesome » Thu, Dec 20, 2012, 12:19 AM UTC

guylhem wrote: post #41

trhtrsh wrote: post #29

Earlier quoted context omitted.

> My job is to make patients pay as much as we can legally make them pay, using any mean necessary as long as it is legal. > I did not explore that much, but there seemed to be a demand for a service to selectively reduce profits, to maximize government subsidies in some units - something utterly disgusting for a libertarian. So your morality teaches that it's OK to scam patients, but not OK to scam the government?

If it is legal it is no scam. Making patients pay as much as legally possible is legal. For ex, on preexisting conditions, the burden of proof is almost reversed. I'm simplifying, but more or less in an audit the opposite party has to prove the charge could not have been caused by the preexisting condition. It is almost impossible (good luck if you are trying to prove say that the chest x-ray had absolutely nothing t…

By making patients pay as much as legally possible you are effectively denying medical attention to all the ones who otherwise could pay for it; not to mention many diseases come back (as cancer) so the patient may eventually run out of money for their treatment; making you partly responsible for their pain and death.

Not to mention the country with the best health care system is also the one with the highest taxes; so by increasing the cost for the patient and consequently decreasing the amount of money that he can pay in taxes you are indirectly hurting the quality of overall health services.

Re: Thinking of starting a Health IT company? Here are top three industry challenges

#52

Post by TillE » Thu, Dec 20, 2012, 12:23 AM UTC

guylhem wrote: post #41

trhtrsh wrote: post #29

Earlier quoted context omitted.

> My job is to make patients pay as much as we can legally make them pay, using any mean necessary as long as it is legal. > I did not explore that much, but there seemed to be a demand for a service to selectively reduce profits, to maximize government subsidies in some units - something utterly disgusting for a libertarian. So your morality teaches that it's OK to scam patients, but not OK to scam the government?

If it is legal it is no scam. Making patients pay as much as legally possible is legal. For ex, on preexisting conditions, the burden of proof is almost reversed. I'm simplifying, but more or less in an audit the opposite party has to prove the charge could not have been caused by the preexisting condition. It is almost impossible (good luck if you are trying to prove say that the chest x-ray had absolutely nothing t…

> Reducing profits is also immoral in the belief system I have.

People who tie up profit with morals utterly baffle me. Whether it's "profit is evil" or "profit is morally good", it's all nonsensical. It's just fucking money. Are your actions helping people or hurting them?

Re: Thinking of starting a Health IT company? Here are top three industry challenges

#53

Post by skue » Thu, Dec 20, 2012, 12:25 AM UTC

FireBeyond wrote: post #19

Some quite good points: "For example, inside a hospital, operating rooms (OR) are often profit centers, and emergency departments (ED) are often cost centers. The hospital may be receiving subsidies to maintain its EDs based on its ratio of OR profits to ED losses, in which case a product that ultimately makes ORs more profitable may not be worthwhile to the hospital." To an ambulance service (emergency and pre-hospi…

> DrChrono has it quite good, because the government will pay their customers

Only if their customers can document, attest, and verify that they meet the standards for Meaningful Use as required by federal law to receive their subsidies. And this can be a considerable burden for the smaller practices that DrChrono targets.

Plus consolidation within the industry means their market is shrinking as larger hospital systems buy up small practices and move fold them into to their hospital-grade EMR systems such as Epic, Cerner, and MEDITECH - all while these larger EMR companies are concurrently giving their products to small practices in order to become regional standards.

Plus, for those remaining practices they have a LOT of competition - there are literally thousands of outpatient EMR solutions, including Practice Fusion, which is well established and free, meaning providers can pocket the subsidies.

DrChrono is a great technology, but don't think they don't face their own challenges.

Re: Thinking of starting a Health IT company? Here are top three industry challenges

#54

Post by Mz » Thu, Dec 20, 2012, 12:26 AM UTC

TillE wrote: post #50

Mz wrote: post #15

Earlier quoted context omitted.

When castles were everywhere, the bigger castle won. Then airplanes came along and essentially made castles obsolete as an aspect of war. The future solutions in health IT will likely appear to be orthogonal to current conceptualizations of the problem. I am curious what type of solution you have been pondering, if you don't mind me asking. (If you don't want to post it publically, my email adress is in my profile.)

As an aside, castles mostly died after serious cannons were developed in the late middle ages, some centuries before the invention of flight.

Well, you made me smile. But my point is I am trying to build a "first airplane" and I don't much care what the 900lb gorillas controlling the healthcare castles are up to.

But now I am wondering if I need to work on my metaphor. :-/

Have a great day.

Re: Thinking of starting a Health IT company? Here are top three industry challenges

#55

Post by jerf » Thu, Dec 20, 2012, 12:30 AM UTC

jQueryIsAwesome wrote: post #51

guylhem wrote: post #41

Earlier quoted context omitted.

If it is legal it is no scam. Making patients pay as much as legally possible is legal. For ex, on preexisting conditions, the burden of proof is almost reversed. I'm simplifying, but more or less in an audit the opposite party has to prove the charge could not have been caused by the preexisting condition. It is almost impossible (good luck if you are trying to prove say that the chest x-ray had absolutely nothing t…

By making patients pay as much as legally possible you are effectively denying medical attention to all the ones who otherwise could pay for it; not to mention many diseases come back (as cancer) so the patient may eventually run out of money for their treatment; making you partly responsible for their pain and death. Not to mention the country with the best health care system is also the one with the highest taxes;…

You are also encouraging the market to produce more of the relevant test in the future, and encouraging more competition to go for those treatments because they can make it profitable at a lower cost.

The problem with your very static analysis is that you end up breaking both of those second-order effects, so while you may get to feel good in the short term, in the long term you are doing much more harm. You have to analyze this problem dynamically. It's the more subtle approach, but more fruitful long term.

(Of course hypothetical situations can be constructed in which this general principle does not hold... but nevertheless, it is the general principle and you will be producing exceptions.)

Re: Thinking of starting a Health IT company? Here are top three industry challenges

#56

Post by guylhem » Thu, Dec 20, 2012, 12:36 AM UTC

flixic wrote: post #49

guylhem wrote: post #41

Earlier quoted context omitted.

If it is legal it is no scam. Making patients pay as much as legally possible is legal. For ex, on preexisting conditions, the burden of proof is almost reversed. I'm simplifying, but more or less in an audit the opposite party has to prove the charge could not have been caused by the preexisting condition. It is almost impossible (good luck if you are trying to prove say that the chest x-ray had absolutely nothing t…

I very much disagree with this moral view. Just because something is legal doesn't make it moral. See, when I'm being up-sold almost anywhere, in a store, eating place, etc., I can make good judgement on whether it makes sense to agree to a sale. However, when it comes to medical procedures, I can't make the same good judgment, because I lack the knowledge. So I trust the doctors to make good decisions, firstly medic…

You would be shocked to know how some physicians would like to speed it up and quickly give you a diagnosis and have you out of the hospital, or just plain don't know stuff.

Like you, I do believe most people can not make a good judgement, because they lack the medical knowledge, so they expect a professional to make the decision for them.

Yet medical science is evolving - very quickly, with an ever reducing half-life for medical knowledge. Financial decision OTOH have a strong incentive (likewise for reliability checks)

I'm sorry if it would break your trust, but for someone who has been on the both sides of the hospital business, "Doctor Doom" scenarios are far more worrisome, and unfortunately not that rare.

There was a story on the NYT IIRC about a doctor his colleagues called "doctor doom and destruction" because his failings were so obvious. Yet he had a medical license and a great reputation, because of his excellent bedside skills.

There are some parts of the business I'm not comfortable with (diverting MDs from patient care to billing - that's a negative externality)

But this is something I now fully believe to be in the interest of both the patients and the hospital - ie something I would personally be very happy to pay for (or to have charged to me) if I was incapacitated and unable to take a decision by myself.

Re: Thinking of starting a Health IT company? Here are top three industry challenges

#57

Post by guylhem » Thu, Dec 20, 2012, 12:42 AM UTC

TillE wrote: post #52

guylhem wrote: post #41

Earlier quoted context omitted.

If it is legal it is no scam. Making patients pay as much as legally possible is legal. For ex, on preexisting conditions, the burden of proof is almost reversed. I'm simplifying, but more or less in an audit the opposite party has to prove the charge could not have been caused by the preexisting condition. It is almost impossible (good luck if you are trying to prove say that the chest x-ray had absolutely nothing t…

> Reducing profits is also immoral in the belief system I have. People who tie up profit with morals utterly baffle me. Whether it's "profit is evil" or "profit is morally good", it's all nonsensical. It's just fucking money. Are your actions helping people or hurting them?

Profit is a synonym for efficient. I couldn't care less about the money part.

Yet where there are no profits, efficiency is also generally lacking. (and don't mention free software, because the profits are just different - just not directly financial, but bankable - like reputation, experience, passion - people write free software for good selfish reason, "to scratch their own itch")

Re: Thinking of starting a Health IT company? Here are top three industry challenges

#58

Post by ryanteo » Thu, Dec 20, 2012, 12:44 AM UTC

Hi everyone, happy to chime in from an Asian perspective. I'm Ryan, based in Singapore and tried to co-found an online platform for procurement of medical supplies for private clinics. Faced many of the industry's frustrations as expressed in this discussion too. Would be happy to share my experience too.

Re: Thinking of starting a Health IT company? Here are top three industry challenges

#59

Post by jQueryIsAwesome » Thu, Dec 20, 2012, 12:57 AM UTC

jerf wrote: post #55

jQueryIsAwesome wrote: post #51

Earlier quoted context omitted.

By making patients pay as much as legally possible you are effectively denying medical attention to all the ones who otherwise could pay for it; not to mention many diseases come back (as cancer) so the patient may eventually run out of money for their treatment; making you partly responsible for their pain and death. Not to mention the country with the best health care system is also the one with the highest taxes;…

You are also encouraging the market to produce more of the relevant test in the future, and encouraging more competition to go for those treatments because they can make it profitable at a lower cost. The problem with your very static analysis is that you end up breaking both of those second-order effects, so while you may get to feel good in the short term, in the long term you are doing much more harm. You have to…

> and encouraging more competition to go for those treatments because they can make it profitable at a lower cost.

They can make it more profitable but only helps a smaller subset of people because is better to sell 1000 $10 needless than 10000 $1 needles (transportation, packaging, liability, etc); plus is a strong incentive to use any procedure that makes the patient believe that he is getting better even if he actually don't; because ultimately is the profit margin that matters. And that is not an exception; is the number one rule for business.

And data also goes against your view; the country I am talking is Denmark, the health system is 100% subsidized by the government itself; it haves a 95% health services satisfaction rate because all those events generated from the need to generate profits are non-existent.

Re: Thinking of starting a Health IT company? Here are top three industry challenges

#60

Post by guylhem » Thu, Dec 20, 2012, 1:03 AM UTC

jQueryIsAwesome wrote: post #59

jerf wrote: post #55

Earlier quoted context omitted.

You are also encouraging the market to produce more of the relevant test in the future, and encouraging more competition to go for those treatments because they can make it profitable at a lower cost. The problem with your very static analysis is that you end up breaking both of those second-order effects, so while you may get to feel good in the short term, in the long term you are doing much more harm. You have to…

> and encouraging more competition to go for those treatments because they can make it profitable at a lower cost. They can make it more profitable but only helps a smaller subset of people because is better to sell 1000 $10 needless than 10000 $1 needles (transportation, packaging, liability, etc); plus is a strong incentive to use any procedure that makes the patient believe that he is getting better even if he act…

To make it short, where !=> mean "does not imply":

satisfaction != efficient

satisfaction !=> result

results !=> efficient

profit = efficiency => results => satisfaction