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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

#91

Post by desigooner »

FireBeyond wrote: post #26
error54 wrote: post #17

As a current developer for a health IT company, much of this is true. Even with the current incentives to go electronic, many doctors just simply prefer paper charts and are willing to forgo the $40k a year just to keep things the status quo. My particular company is growing by leaps and bounds because we started with a very simple Practice Management model and grew out from there whereas I see a lot of startups try…

You should also consider the pre-hospital field - a paramedic/EMT in the field with a Toughbook, etc (where they're not still with paper) is typically using horrible software, with little flexibility to what by nature can be a rapidly changing encounter. I see this every day, and hear the cursing that accompanies it, and think to myself that there is so much that could be done to improve this.

What I've observed is that it's hard to get the decision makers listen to you and often, they're unwilling to invest any more than they've already done towards any solution. Granted these conversations were mainly concerned with a SaaS based solution targeted towards HR & Administrative Operations vs. the field techs.

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

#92

Post by StavrosK »

guylhem wrote: post #74
logjam wrote: post #68

Earlier quoted context omitted.

> 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…

I think there's a misunderstanding here. From what you said here:

> As I like to say, this is as good as printing money - I can say precisely what should be changed in a billing statement, why, how much it will gain, and the probability to find matching evidence in the patient file.

I understand that you, or your system, adds items to patients' bills for tests that either have never been performed, or that have been performed unnecessarily.

Is that the case, or does your system check what probably was performed, and makes sure that it wasn't left out of the bill?

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

#93

Post by guylhem »

StavrosK wrote: post #92
guylhem wrote: post #74

Earlier quoted context omitted.

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…

I think there's a misunderstanding here. From what you said here: > As I like to say, this is as good as printing money - I can say precisely what should be changed in a billing statement, why, how much it will gain, and the probability to find matching evidence in the patient file. I understand that you, or your system, adds items to patients' bills for tests that either have never been performed, or that have been…

> I understand that you, or your system, adds items to patients' bills for tests that either have never been performed, or that have been performed unnecessarily.

The first one would be illegal. You can't bill for things that were not done.

The second one is a matter of interpretation : I do not judge whether it was necessary or not. If it was performed, I try to see how it logically could be argued, using the probability of finding matching evidence, that it was necessary given the case or preexisting conditions - and thus bill for it.

> Is that the case, or does your system check what probably was performed, and makes sure that it wasn't left out of the bill?

The third one, making sure things that were performed were not left out of the bill, is most of the work. The files are incomplete and it requires a probabilistic and interpretative approach, before sending in a human for fact checking.

It's all about providing incentives. The billing rules are complex, but there is some logic in them, and physicians see that too - it change their behaviour. #3 and #2 will directly result in other physicians becoming very careful that everything which should have been performed was - because doing this is highly lucrative, "it is as good as printing money". No need to do anything but following the law and the billing rules.

Truly useless tests won't increase the bill, and therefore they will be weeded out.

I see that as a financial incentive to change behaviours.

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

#94

Post by FireBeyond »

xxpor wrote: post #84
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…

Is 911 response REALLY a cost center? Around here, to get an ambulance, it's $500 (IIRC) up front + $16(!!!!!) a mile. And the closest hospital might be 10 or 15 miles away. And I dont think this includes material costs (any drugs, etc.)

911 response, unless ran very well, and / or miserly, is absolutely often a cost center. You have "frequent fliers" who you may see several times a week, without insurance. Billing sends them a bill, but there's no realistic expectation of payment.

You can't, even as a private agency (and should 't - for better or worse, I'm a proponent of "socialized" medicine, even in bastardized form) refuse a patient transport, though about the best you can do is advise a patient that their insurance is unlikely to pay if the ambulance transport does not have. "medical necessity", even with (especially with) Medicare (who requires us to get a document from the physician stating the necessity of "transport in a fully equipped BLS/ALS ambulance").

Add to that Maintenance, drug purchase (must be kept stocked and current, even if rarely used), fleet Maintenance (driving code in a truck carrying N extra 10-15000 lb at high speed places a lot of strain on a vehicle), insurance (likelihood of an accident), insurance (malpractice in this area is usually carried by the agency, not individual), regulatory and other costs, costs of maintaining sufficient crews on duty so you can respond even when others are out doing long distance transports (hospitals to nursing homes, home, or stabilized patients to bigger or more appropriate hospitals) or transporting your frequent fliers, and it begins to add up.

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

#95

Post by DanBC »

guylhem wrote: post #6

As a health IT professional who did try, and will try again in 2013, this article is spot on. There are differences between France and the US - especially in the mindset - but the payment system is very similar. In fact, the current french system (used for hospital billing since 2004, and tested for 10 years before that) was based on the US medicare DRG approach. My job is to make patients pay as much as we can legal…

I'd be interested to see if your system would work in English NHS hospitals. I suspect it would, but you'd have to be careful how you sold it.

There's currently some discussion about the numbers of managers in English health care, and there are severe cost pressures to reduce those managers.

A system that legally maximises revenues while reducing managers seems like a good fit.

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

#96

Post by Mz »

Mz wrote: post #62

For those saying they would like to chat, I have started a posterous group called Health IT: http://health-it.posterous.com/ Consider yourself invited.

For those interested in joining, you may have to shoot me an email to be added. My gmail account: talithamichele.

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

#97

Post by rficcaglia »

tkl wrote: post #85
rficcaglia wrote: post #7

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!

Hi rficcaglia, I would like to buy you a pint, or lunch, or coffee or something. Are you in the Silicon Valley area? Your email is not listed, but mine is. I am interested in natural language processing and machine learning in the medical field. Would you know anything about this?

Sure - though I couldn't find your email so here's mine... Just add @gmail at the end of my id. Happy to chat...located in SF.

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

#98

Post by rficcaglia »

wging wrote: post #78
rficcaglia wrote: post #7

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!

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

I'll spare the HN community self promotion, but I am worker bee and other roles at a few startups. Interestingly enough, Salesforce (CloudAmp's specialty) is being used in hospitals! scary, eh.

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

#99

Post by rficcaglia »

sgarg26 wrote: post #65

In the current environment, health care IT solutions will go further if they help professionals and patients do 'more with less' instead of 'more with more'. The dynamics in the article are real, but there are tons of way around the challenges posed. The article to me says that the market has yet to be cracked, but the opportunity is still pretty huge.

Unfortunately the entrenched attitude is do 'less with more'. There are ways through the challenges posed - but not 'around'. YMMV.

Until patients pay directly for their care and have transparent pricing, I don't anticipate real innovation. (of course examples exist of innovation within the current system: Athena Health, One Medical, PracticeFusion, ZocDoc - but all of these took quite a lot of time and effort and funding to punch through the barriers noted in the article...so yes, it is possible, you are correct).

That said the current (US) system rewards existing thinking and does not encourage efficiency and outcomes and patient satisfaction.

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

#100

Post by rficcaglia »

lucidrains wrote: post #44
narcissus wrote: post #30

Earlier quoted context omitted.

Technically it's delimited by whatever character is decided to be the delimiter, which is even better :) Having said that, it still seems to get data between all sorts of systems in the hospital.

lol, yeah, im sure it works. it isn't json tho... you could also say Cache (it's a post-relational database... whatever that means) is a standard database used in medical systems, but it sure isn't a postgres.

It is an object database which was all the rage back in 1996-ish. I had to use it outside of the medical market once and the sales manager was shocked!
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