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

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

#71
post #41
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…

> It is almost impossible (good luck if you are trying to prove say that the chest x-ray had absolutely nothing to do with a physician making sure a cancer did not relapse - so I'll add that preexisting condition to the bill. it has a multiplier effect on the whole bill after a threshold)

This is a somewhat emotional reply, but: as someone with a pre-existing, chronic condition -- this disgusts and terrifies me. I'll never get cover for it. I'm resigned to that, and am fine with dealing with it. I've put a lot of effort into establishing a reasonable savings account that can help to cover me; something's that not easy due to my dietary requirements and constant medical expenditure.

However, because the medication I'm on is an immunosuppressant, there's a very real chance that other illnesses -- bacterial infections, for instance -- can ultimately be said to be caused by my preexisting condition. I might be able to buffer myself against immediate medical malady, but invalidating all of my insurance due to that condition is gross.

First, do no harm.

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

#72
post #57
post #52

Earlier quoted context omitted.

> 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")

Doesn't deserve a down vote but I profoundly disagree.

Profit can also mean externalising costs playing dirty and competing unfairly.

There is nothing wrong with profit, it is amoral not immoral and can be obtained and used ethically or unethically.

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

#73
post #67

Earlier quoted context omitted.

I'm in the 41st month of a Health IT startup and I'd be happy to give you a preview of the questions you havent even thought of :) Honestly if you can't fund full speed (dev, QA, support, sales, mktg, ops, clinical studies) for a minimum three years before the first hospital sale , assuming you are selling to hospitals, then get out now. Happy to shar war stories over a pint!

I have been in the health care industry for a long while. Also, working on a health care startup. If people have questions, I would love to assist.

I think I could only ask questions with more knowledge about what you've been up to. But I would love to learn more!

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

#74
post #68
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…

> If it is legal it is no scam. Making patients pay as much as legally possible is legal. Really. M.D. in U.S. here. Your profile page says you're an M.D., too. Please reassure me that you are not a licensed physician and that you have no patient care responsibilities. However, if you do see patients (or ever have), please comment on your medical licensing board's "belief system" on unethical (but legal) practices (e…

Really, it's legal in France. We have a mixed public and private for-profit system. And studies have revealed a tendency to underbill - ie forget codes.

FYI, I am licensed, board member, and I do see patients.

However I strike a line between patient care and billing analysis. And I love both.

For patient care, my consults are provided for something like $30/consult. Keep in mind these are lengthy consults (~30/45 min per patient) in a demanding specialty. I do them far below costs, in a public hospital, to help - because I know how much the only alternatives in town costs.

For billing analysis, however that's another story. If it is legal (as in allowed by the law and the code of deontology) it goes.

But given your message, there might in fact be a language difference. I'll try to clarify my terms.

Regarding "unqualified personnel", I call anyone who is not a nurse or a practicing physican "unqualified". Ex: a medical coder or medical secretary. They do not see patients, so they are "unqualified". I see it as a good thing if they can do this work, considering the alternative is putting someone "qualified" (ie who could be with a patient providing actual medical care) on an administrative job, something that worries me as a waste of rare resources. If it actually improves the profit margin, that is great : it will provide excellent arguments against wasting rare resources! Anyway, that doesn't make a lot of differences. The laws might be different in the US than in France, but here physicians are legally personally responsible for anything the law call their "subordinates" do. Your nurse leaks medical info about a patient? Your fault by default, unless you can prove otherwise.

Regarding "massaging the bill", that's not the language I use, but it seems to be what the other poster was using. I guess that's how it's called in the US. If it has a negative connotation, I'm sorry. I personally call that billing analysis. There is no need to do anything shady - it would be stupid to do so, given how profitable just following the law can be.

Regarding "tests", it is not about exposing patients to the risks of certain tests - however, if the tests have already been performed and adding them to the bill results in a higher bill, it's about making sure they are not forgotten in the bill. Just like preexisting conditions.

The laws in the US might also be different, but here it's the prescribing physician responsibility to order tests and exams. Billing happens after the patient has left, and therefore can't directly influence the patient care ex post facto.

The medicare inspired system was adopted in France for a lot of reasons - including to help standardize care a little more.

I have had a patient I send to an hospital for chest pain in an ambulance with a case highly suggestive of infarction leave the hospital without troponin, even while he had a antecedents. I've had a patient I personally brought to the ER (we call that medical transfert) with a diagnosis of pulmonary embolism and a prescription for nuclear medicine returned after an echography and a written note saying 'there was no embolism' (how can you tell that with an echography???) - and subsequently dying of pulmonary embolism.

IMHO, this is totally unacceptable - I came to that conclusion, when as a patient I also experience such grave inefficiencies, with consequences. Some people will try to slither their way out of responsibility and consequences.

I take a great pride in bearing full consequences of my actions. I have seen patient wishes completely disregarded, something I decided to refuse - and therefore got more involved in the administrative side than the clinical side, even if I still do both.

There is a quality problem with some colleagues, one that only financial incentives or legal liability can solve. The US system is far from perfect, but it can give us some inspiration on these points.

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

#76
post #60

Earlier quoted context omitted.

To make it short, where !=> mean "does not imply": satisfaction != efficient satisfaction !=> result results !=> efficient profit = efficiency => results => satisfaction

To keep it short too. assert patients.satisfaction.relevance > efficiency.relevance investment.efficiency => profit investment.efficiency !=> patients.efficiency investment.efficiency !=> patients.health Long version: I am living the consequences of this in my country itself; they make you wait months for one date, even if they suspect cancer; you know why they make you wait so much time? Because they want to make su…

"they make you wait months for one date" - that is unacceptable, just like overpricing is.

The medical market has far too much friction and rent seeking behaviour. I do not agree with the short version, but I agree with your long version.

I dream about the day when (if?) the medical market become a perfect market in the economical sense - price taking behaviour, pure and perfect competition, factors of production being paid at their marginal productivity

I believe that, among other things, the financial incentives are a step forward. We apparently have different ways, but a same goal.

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

#77
post #75

This could really be for any enterprise IT company.

Eh. If you send out two shipments of Doritos, nobody dies. If you administer a med twice, a patient very well could die. Consequently, if you make it even 1% more likely that a med will be administered twice, patients will die.

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

#78
post #2

I'm in the 7th month of starting a Health IT company and would be happy to answer (some) questions if anyone has any.

I'm in the 41st month of a Health IT startup and I'd be happy to give you a preview of the questions you havent even thought of :) Honestly if you can't fund full speed (dev, QA, support, sales, mktg, ops, clinical studies) for a minimum three years before the first hospital sale , assuming you are selling to hospitals, then get out now. Happy to shar war stories over a pint!

Your HN profile says you're at CloudAmp, which doesn't seem to be a health IT startup at all. What am I missing?

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

#79
post #34

Earlier quoted context omitted.

Yes, that's the easy part - massaging the bill, testing. Providing an accurate estimation of the expected gains however require both domain knowledge and statistical analysis. Ie if your hypothesis is to add "morbid obesity", and you know how much it will gain in the bill, how likely are you to find that in the patient file, given the patient history and (hopefully) some text from the release letter? Enough to send a…

Very true - on a slightly different note, my company cleans up in the insurance / claims management side by implementing a system of policy management not based on table lookups but by allowing our providers to build rules and flows of their own. You wouldn't (well, perhaps you would) believe how many claims processors rely on database tables hundreds of columns wide to cover every permutation for a policy possible,…

Indeed, there are many things that can be done simply at first, then you have to reach for the higher hanging fruits.

However I would not call that "the wrong way" - for me, it's moral and logical. Maybe I'm too zen about that, but for me it's about increasing efficiency.

Generally speaking, if somethings feels wrong to you, you shouldn't do it. Works for every topic - because we each have our own morals, and it's soul damaging to go against it.

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

#80

> 2. Good enough is not good enough I don't think this really sinks in until you work in the industry. As an example, I knew of a developer who accidentally forget to make a list page scrollable and it got through QA that way. I heard rumors that ultimately the bug resulted in a patient being given the same immunization twice since the user was unable to scroll down the list page. And that's a relatively benign examp…

I'm not sure the point the original article was trying to make -- in reality, a lot of HIT software is terrible. "Good enough" would be significantly better than a lot of the crap that is out there.
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