Alliance Staffing Group: Healthcare, Nursing & Medical Jobs

Telemedicine as a technology is advancing so rapidly that it seems like something you might have seen on Star Trek.

Telemedicine as policy has become an integral part of the law as $27 billion was earmarked for health care information technology as part of the 2009 American Recovery and Reinvestment Act (ARRA) stimulus plan.

But telemedicine as a successful practice or an everyday tool for physicians and patients has remained a mystery.  Until now.

Physicians will ask: How do I squeeze telemedicine in between my daily 35 – 40 patient visits, phone calls, hospital rounds, and insurance b.s.?  How can I make money at this?  It looks really cool, but, in the end, it’s just a high tech version of a patient calling after hours to avoid a co-pay.  Can telemedicine really succeed?

Yes.

Rapid Remedy, based in Pennsylvania, has designed a business model that allows all active participants – including doctors, patients, dependents, and employers — to benefit from telemedicine.

While most telemedicine models promote the technology as the reason to use the service, John Lawlor, Managing Partner for Rapid Remedy, gives away the secret: “It’s all about access.”

Rapid Remedy is reaching out to small, medium and large companies “as a convenient access to Board Certified licensed family practitioners,” said Mr. Lawlor.  Companies will use this service as an employee benefit to provide workers and their families with efficient access to family docs for minor illnesses and health advice.

Traditional telemedicine services often use physicians who simultaneously run their own practice and call back the patient, via video conferencing, as their schedule permits.  That’s a huge flaw in the system.  The technology provides for instant access, therefore, doctors need to be immediately available to the user on the other end – the patient.

Rapid Remedy employs its own physician network to be available whenever the patient calls during regular office hours (9AM – 5PM).  “Our physician network provides video conferencing evaluations from the controlled environment of our practice sites not from their offices or homes,” said Mr. Lawlor.  Having the docs on-site allows each patient videoconference to commence within two minutes.

The Rapid Remedy physician network includes an expanding group of board certified primary care physicians, some who continue to practice outside of Rapid Remedy and others who may seek alternatives to traditional office or hospital work. “We are focused on building a national network of board certified family physicians who provide videoconference evaluations from our practice sites,” said Mr. Lawlor.

Given that 30+ million currently uninsured people will be added to patient rolls thanks to health reform, Rapid Remedy provides an answer to potential physician shortages.  “Our physician network has already admitted they will practice longer than expected — foregoing retirement for several years due to the ease of practicing with Rapid Remedy,” explained Mr. Lawlor.

In fact, one of the doctors in the Rapid Remedy physician network is the CEO’s brother, Dr. Robert Lawlor – a board certified family practitioner with a large, successful practice based in Devon, PA and over 30 years of experience.  For Dr. Lawlor, Rapid Remedy offers a big advantage over traditional telemedicine models: “I am being paid to provide a service that usually does not get paid,” he said.

There are only 12 states that mandate reimbursement for telemedicine including California, Colorado, Georgia, Hawaii, Kansas, Kentucky, Louisiana, Maine, New Hampshire, Oklahoma, Texas and Virginia.  Each state determines its own guidelines for reimbursement.  Certain states will supplement Medicaid reimbursement, like Maine, while others, such as New Hampshire, will only qualify telemedicine in selected pilot programs.

Rapid Remedy’s model is advantageous to the participating physician, as the company does not rely on public funding or reimbursement to compensate its doctors.  “This model also benefits the patient as they have no co-pay, co-insurances or deductibles,” according to Mr. Lawlor.

The participating businesses also receive several benefits.  “Clients with self-funded insurance plans can save up to 50% on their primary care,” says Mr. Lawlor.  “In addition, it’s hard to put a dollar value on providing your employees the convenient access to a quality doctor right from their home or workplace.”

Many primary care office visits can be handled through telemedicine.  Dr. Robert Pizzaketti — a board certified family physician with a large, successful practice in York, PA, and part of the Rapid Remedy physician network — says “common problems are URI’s, skin conditions, musculoskeletal injuries, and conditions requiring medical advice.”  A visit with a Rapid Remedy physician is a seamless experience and, as Dr. Pizzaketti proudly announces, “patients are usually very appreciative.”

David Schlager, Managing Partner with Rapid Remedy, walks us through the typical visit: The patient logs on to the Rapid Remedy website –through a home computer with webcam or at an employer-based health station.  “The patient is met online via video conference by the Rapid Remedy receptionist who confirms their eligibility and chief complaint, and then transfers the patient to the physician. The physician — via videoconference with the patient  — conducts the evaluation, including the diagnosis, prescriptions, and treatment plan. The patient selects whether they or their local primary care Provider wants a consult letter of the videoconference. The patient visit ends.”

After the conference with the patient, the physician is able to create medication prescriptions and electronically forward these prescriptions to a pharmacy of the patient’s choice.  The Rapid Remedy telemedicine system will be a tremendous compliment to the traditional office visit.  Dr. Lawlor states “there are advantages to the patient in terms of saving time and cost.”

Research firm Pike & Fischer predicts that annual revenues for telemedicine services will exceed $3 billion by 2013.  Several Fortune 500 companies – including UnitedHealth, Intel, Verizon, Samsung, and more – are developing products to compete in the marketplace.  Rapid Remedy is ready to go.

Mr. Lawlor’s goal is to “establish videoconference primary care telemedicine as a common acceptable delivery model for 50% of the care that is currently provided in the primary care physician office.” The company is targeting various corporations, large and small, that want to offer their employees an added benefit to their current insurance plan, which may become a greater expense as health reform mandates take effect.  Rapid Remedy will allow those corporations to save on costs while providing a quality medical experience for patients and physicians.

Source: Physician News.com, article by Alan Lyndon.

If you think it's tough being a manager these days, try being an employee. Most are in the position of having to go with the flow because of the current economic conditions. But that doesn't necessarily mean they do so with a smile on their face. Here are ten things your employees wish you knew about them:

1. They are happy to have a job. But that doesn't necessarily mean they are happy in their job. Big difference. People who are happy in their jobs act a lot different than those grateful to have a job. They are highly engaged and will do whatever it takes to delight the customer. The other group simply floats along praying for the day they can tell you really what they are thinking. Most likely they will do this as they hand in their notice. That is if they even give notice.

2. You're not the boss of me. My five year old used to say this to me all the time. That is until I corrected her by telling her that actually I was the boss of her and that what I said goes. You may be the boss, but you don't own your people. The minute you start playing the, "Because I said so" card, you've lost the game.

3. Your girls don't like being called girls. I remember how shocked I was when my first client started speaking to me about the girls in the office, as he pointed to a sea of silver haired women. That should have been a sign that the problem was right in front of me. It is disrespectful to call females over the age of 18 girls. They are women. Keep this in mind when referring to female employees or you'll soon find yourself managing a team consisting of yourself. Then you'll be free to reference yourself in the manner that best suits you.

4. We are no longer going to take one for the team. That is after the senior team has just awarded the departing CEO an exit package that certainly could have been used to restore salary cuts.

5. We are tired of picking up the slack from the non-performers. We know who is not pulling their weight and so do you. Do something about it before we throw ourselves on top of the dead weight pile.

6. That was our idea you just shared with the CEO. We understand that tough times call for tough measures, but that doesn't give you the right to take credit for something that is not yours. Now go back in there and give us the credit we are due.

7. Measure us on results, not face time. Stop penalizing us for our ability to get work done quickly or we will give you what you want. More face time, and that's about it.

8. Stop wasting our time with surveys. You already know what's wrong. Now start fixing things before we find a work place that is willing to take action.

9. Stop micromanaging us. Micromanagement is a sign of mistrust. You've hired us for a reason. If you don't trust we'll get the job done then by all means, either find people who you think will, or leave us alone to do our jobs.

10. We are never going to act like business owners. Stop complaining that we don't act like business owners. We are not business owners nor are we compensated the same as the owner. And by the way, if we really wanted to act like owners we would have started our own businesses.

I'm sure there is a lot more your employees wish you knew about them. Perhaps they'll be brave enough to add their comments to this list.

Source: Roberta Matuson is president of Human Resource Solutions. Read her article here.

The opening anecdote of the e-patient white paper tells of a patient who impersonated a doctor in 1994, to get his hands on an article about an operation he was about to have. He got busted. Two years later episode 139 of Seinfeld had something similar – Kramer impersonates a doctor to try to get Elaine’s medical record.

It aired October 17, 1996. It was a turning point in American healthcare: eight weeks earlier the Health Insurance Portability and Accountability Act (HIPAA) had been signed into law, but the full regulations had not yet been written, so when this aired Elaine did not have a legal right to look at her record.

Today she does, but it’s often difficult. Plus, HIPAA regulations allow 30-60 days for providers to deliver, and states can set whatever price they want for the copies. But at least there’s a legal right.

Now, the Robert Wood Johnson Foundation (RWJF) is funding a study called OpenNotes to explore taking it a big step further: what happens if patients can see, online, every last bit of what their doctors wrote? Do doctors get overwhelmed with questions? Do patients freak out when they read the medical words that doctors write? Does the world go to hell in a handbasket, as some have worried aloud?

A year ago the Boston Globe voiced those concerns in the lead of an article announcing OpenNotes. Shades of Elaine:

One doctor wrote that a patient was acting paranoid. Another typed that she had ordered tests to make sure a patient didn’t have cancer. Such notes, written in a patient’s medical records after an appointment, can be candid and blunt – at times more so than doctors are to patients face-to-face.

Amid the national push to computerize medical records and make them more open to patients, one of the most intense areas of debate is whether patients should be allowed to see their doctors’ notes online.

It’s taken a year but recently, OpenNotes went live. The press release starts:

With patients across the country voicing a growing desire for greater engagement in and control over their medical care, a new study involving patients in Boston, Pennsylvania and Seattle will examine the impact of adding a new layer of openness to a traditionally one-sided element of the doctor-patient relationship—the notes that doctors record during and after patients’ visits.

Funded through a $1.4 million grant from the Robert Wood Johnson Foundation (RWJF) Pioneer Portfolio—which supports innovative ideas and projects that may lead to important breakthroughs in health and health care—the 12-month OpenNotes© project will evaluate the impact on both patients and physicians of sharing, through online medical record portals, the comments and observations made by physicians after each patient encounter. Approximately 100 primary care physicians and 25,000 patients at Beth Israel Deaconess Medical Center (BIDMC) in Boston, Geisinger Health System in Pennsylvania, and Harborview Medical Center in Seattle will participate in the 12-month trial.

Beth Israel Deaconess? Why, that’s the hospital where I see my primary Dr. Danny Sands! Not surprisingly, he volunteered to be one of the 100 doctors, and I volunteered to be one of the 25,000 patients.

I spoke about the project with RWJF’s Steve Downs. My view has always been that of course I should be able to see my records: whose data is it, anyway? But Steve points out, correctly, that you can’t shove culture change down people’s throats, so RWJF is spending big bucks to collect evidence.

To the credit of everyone involved, they’re allowing us participants to blog and chat about our participation: “Somebody might come up with good uses for the notes that we haven’t anticipated.” Hallelujah; that’s Web 2.0 / participatory thinking.

Source: read this article by Dave deBronkart here.

Yesterday, and every day, in my office we had one or two patients we call our “Oldie Goldies”.

People who have been with us since 1971 when I opened my practice, 39 years ago. People whose progress, medical and personal, I’ve shared, and who share mine. We know their parents, kids and cousins either because they call us in crisis, or they’re our ongoing patients. And every day we see at least one, and sometimes more new patients, usually sent by friends, who say at the end of the visit: “I’m so glad I found you, I’m so sick of seeing specialists who don’t really know or care about all these details and don’t pull it all together.”

Every day in my office I do some procedure which others might refer: punch biopsy, flexible sigmoidoscopy, ear lavage, endometrial biopsy, breast cyst aspiration etc. Specialists do them with equal, not better skill. But my patient is served better (and cheaper) by me, because I also address other problems often in many organ systems, without restricting myself to the “code” of the visit’s description.

Generalism in medicine is especially valuable now, with burgeoning and confusing information abounding on the Internet. Especially now, when the “baby-boomer generation” is coming of age. Its women are entering menopause; its men are facing prostate risks. These savvy people want preemptive comprehensive knowledge and management from their physicians when well. They want judgment and careful diagnosis and choice of specialists when sick. No one but the family doctor sees that as his/her role. The gynecologists are not that interested in heart disease, hypertension and diabetes and are not up on the drugs, except in their field. The general internists often don’t do procedures and few want to get into gynecology, and the urologists have no interest in anything but plumbing, though they’re very good at it.

Family doctors obsolete? Not on your life. Public wants specialists? You bet. So do we. When we/they need them. Not before. The specialists are becoming increasingly narrow in their scope and abilities. The patients know this. It is proper and understandable as special procedures advance. An important position we could take is to advocate against enabling specialists to capitalize on their exalted positions, with our aiding and abetting, by hiring “physician extenders” whose scope of practice exceeds the specialists’ abilities to “supervise” them. I am referring to the vascular surgeon who hires a nurse practitioner to “cover” all the medical problems for his patients which he himself not only hasn’t kept up with, but never knew in the first place (drugs for hypertension, diabetes, etc.). Or the cardiac surgeon who hires a PA , allowing him to round on his patients, expecting him, for example, to pick up things like confusion resulting from overdose of lidocaine combined with hyponatremia, causing a patient to pull out a femoral line, which is beyond his expertise.

Unfortunately, it may be other physicians and large groups who, for their own agendas, attempt to devalue the family doctor. Unless we oblige them and become triage officers, losing our knowledge and action edge, we do not have to comply with their judgments. Some of us feel depressed when devalued by others and are made to feel unneeded. Others of us know our own value, and are proud of it. Our patients know it for sure, as long as we deliver that value in their service, which is our job.

This debate is very akin and pertinent to the one on hospitalists. It comes at a time when studies are cited charging multiple medication errors in hospitals. This is a time when countless pressures conspire to abolish careful and caring medicine. No matter which specialist admits a seriously ill or traumatized patient, or even a routine surgical patient, often there will be multisystem disease, much of it outside the specialist’s field. Then either another specialist is called, who himself does not see his role as overseer of the whole patient, or nursing staff is depended upon to know and obtain a comprehensive view of the patient. Nurses are wonderful, but change every 8 hours. They can alert to ominous signs but are not trained to spot early emerging pathology based on vast knowledge of disease processes.

Rather than removing the family doctor from the hospital or claiming his obsolescence, he/she should be utilized as the generalist needed to fill the bill, involving one in every hospital and ICU case. Perhaps calling one in as consultant, if the patient did not have a family doctor before, but not attempting to displace him/her by someone who trains and stays only in hospital.

Nurses, even well-trained “extenders”, are not physicians; specialists are not generalists. Two true statements which, when understood with their full implications, bolster the role of the family doctor, both in office and hospital.

Often I describe to patients the family doctor’s role as the hub of a wheel, the spokes of which lead to specialists when needed, returning to the hub for ongoing care. If the family doctor were ever to be unwisely edged out of patient care, that would be one wheel that would need reinvention.

Source: Article by Dr. Pepi Granat here.

Many are concerned about the looming physician shortage, particularly in primary care. It may become worse as a result of the goal of the health care reform bill to provide health insurance for the currently uninsured. The July 2010 issue of Physicians News Digest highlighted the upcoming need for physicians in our region.  Patricia Costante, CEO of MD Advantage and writer of that article, clearly proposed numerous viable possibilities of addressing this shortage.  We suggest that another way to address the physician shortage is to return inactive physicians to clinical practice.

Returning a non-practicing physician to clinical medicine is appealing.  First, it is significantly less expensive to re-train an inactive physician than to train a new one.  Second, one can re-train physicians much faster than one can train new physicians, so more physicians would be available in less time. Also, in the current economic climate, many retired physicians are looking to return to medicine.

Read full article by Nielufar Varjavand, MD here.