Friday, October 7, 2011

The Word "Lucrative" Should Have no Place in Healthcare

First, you should precede this discussion by reading OVERDIAGNOSED  by Welch, et al in which he discusses in depth the various test, diagnoses, and treatments which they feel do significantly more overall harm than good.  As one of many, many examples, he discusses at length the use of the PSA test for prostate cancer, which is currently under intense public debate.

I have recently received an unsolicited email invitation to enlist a company which will allow me to directly refer patients for sleep apnea testing, and with no further effort on my part they will send the patient a home test kit and, if they test positive, suggest I then arrange for the company to send the patient a CPAP machine from Philips.  This was sent specifically to me as a radiologists!  They will bill Medicare of the insurers on my behalf and send the the checks.  One of their user endorsements suggest “It’s elegant and lucrative.”  They suggest that tens of millions have asymptomatic sleep apnea, so everyone is a candidate for testing. They are not targeting specialists who deal with sleep disturbances, but anyone and everyone who has contacts with patients - "The MD Home Sleep Program is ideal for physicians and dentists regardless of specialty. Primary care physicians, nurse practitioners, physician assistants, anesthesiologists, psychiatrists, and others have joined the program."

I have no doubt that many health care providers will take them up on this as a means to "enhance" their practice revenue.  No question, sleep apnea is a real disease, with real consequences, and patients needing appropriate diagnosis and management is important.  However, this proposal seems geared primarily for profit.

I have seen similar offers for simple audiometry machines (for which insurance can be billed for the same amount as if the test were done in a full audiology suite with a sound-insulated room and sophisticated electronics)  with the pitch that "everyone" could have some hearing loss, and therefore you can justify testing every single patient that walks through your door.

And you wonder why healthcare cost are out of control?

The email I found in my inbox this morning:

Dear Doctor,
Radiologists are becoming an integral part of identifying patients with obstructive sleep apnea. (a physician recruiting company) is pleased to offer doctors of ANY specialty a new and innovative way to provide convenient care to patients who may have sleep apnea while capturing additional revenue. Doctors are provided with everything they need--including education--to diagnose and treat sleep apnea. Here is a recent press release about the program.
Please take a few moments to review this website. You can directly sign up for the program by clicking here. There is no fee to join or participate and doctors are not required to buy equipment or invest money at any time. 
What are physicians saying about the program? “The administrators are courteous and helpful and the program is easy to use. I'm not a sleep doctor, but I feel equipped to treat sleep apnea now. I was initially worried about billing and reimbursement, but that worked out wonderfully too and I received my checks on time, as promised.” -MAM, Internal Medicine from New York

If you have questions or would like to discuss this opportunity further, please contact me.

Thank you,
(a physician recruiting company)

The Pitch:

Aviisha’s MD Home Sleep Program continues its rapid growth as physicians and dentists join to diagnose and treat obstructive sleep apnea.

Los Angeles, California (PRWEB) July 19, 2011
Sleep physicians and non-sleep physicians are gathering to diagnose and treat obstructive sleep apnea (OSA) via the MD Home Sleep Program (MDHSP). Spearheaded by its Medical Director, Dr. Abraham (Avi) Ishaaya, the program was designed for the convenience of both patient and physician.
MDHSP is the creation of the Aviisha Medical Institute, LLC. Started in 2009, the program is part of a full-scale effort to fight the national sleep apnea epidemic. MDHSP simplifies the diagnosis and treatment of sleep apnea while helping patients avoid expensive lab testing.
Physicians who join the program are given a variety of screening tools to identify patients at high risk for obstructive sleep apnea. “It’s estimated that one out of every five Americans has sleep apnea,” explained Dr. Avi. The disease leads to countless serious complications including stroke, hypertension, heart disease, diabetes, weight-gain, depression, anxiety, and even death. Dr. Avi continued, “The consensus in the medical community is that patients who snore, have daytime sleepiness, or suffer from diabetes, hypertension or heart failure should be screened for OSA immediately.”
Cutting-Edge Home Sleep Testing and APAP
Using Aviisha’s revolutionary technology (patent pending) physicians can prescribe home sleep tests with the click of a button. Aviisha takes over by verifying insurance and shipping the patient a home sleep test. All patients are tested using the Philips Alice PDx portable diagnostic device, an unsurpassed, state-of-the-art device that meets the standards of Type II, III and IV diagnostic tests with up to 21 channels. The test is simple to administer and produces highly accurate results.
Aviisha scores the test and sends the physician a straightforward report with diagnostic and treatment recommendations. Physicians can prescribe Auto-CPAP therapy (APAP) just as easily as they prescribe the home sleep test. The device, a Philips System One REMstar Auto-CPAP machine with A-Flex ships directly to the patient. The device automatically adjusts its air pressure according to the patient’s individual needs, reducing unnecessary air pressure by up to 40%.
Aviisha also manages treatment compliance and generates periodic reports for physicians. “We’ve designed the program in such a way that the physician’s main responsibility is identifying patients at risk for sleep apnea,” said Alazar Yinbal, Aviisha’s Chief Executive Officer. “We do the rest.”
New Website Empowering Physicians
Physician need not be sleep specialists to participate in MDHSP. A battery of newly published webinars, articles, tools, and resources empower physicians to evaluate patients and prescribe diagnostic tests and treatment. “The program does a wonderful job of giving me the information and tools I need to feel informed and prepared to treat sleep disorders,” said Dr. A.M. Mirza, a physician specializing in Internal Medicine from New York. “It’s elegant and lucrative.”
The website features a brand new Sleep Apnea Education section containing free articles, videos, slideshows, diagnostic tools, and resources about sleep apnea. Monthly webinars hosted by Dr. Avi highlight different aspects of sleep apnea and are open to all medical professionals. Dr. Avi explains, “We wanted to educate doctors about sleep apnea and ensure that they felt not only comfortable but confident in their medical decisions.”
The hard work seems to be paying off. MDHSP physicians have reached an impressive 85% conversion ratio from home sleep test to positive diagnosis. Not only that, its current treatment compliance rate is over 74%, almost twice the industry’s average.
The MD Home Sleep Program is ideal for physicians and dentists regardless of specialty. Primary care physicians, nurse practitioners, physician assistants, anesthesiologists, psychiatrists, and others have joined the program. There is no fee to join or participate and physicians are not required to buy equipment or invest money at any time. The program serves in-network, out-of-network, and Medicare patients.

Sunday, October 2, 2011

The "Other" Color Tour

When one thinks of the fall display of color that brings on the tour buses, photographers, and Sunday afternoon drivers, most people, as did I, immediately call up images of the New England hills in late September and October. That has changed for me.

This change happened yesterday, Oct 1, 2011.  I have occasionally seen some great color in the Colorado Rockies, including here in RMNP, over in the ski areas along 70, and up in Steamboat, but have not spent enough time here in the early fall to experience the peak color very frequently.  However this year, the colors are this weekend spectacular, and we are here!

Estes Park has been busy, as usual, with all the visitors for the elk rut and the various fall festivals here and in nearby foothill communities. Add all the TV newscast telling people to head to the mountains for the color, and our town has been PACKED this weekend.  Making a run to the Safeway or to Kind Coffee for a cup is a challenge, taking 15-20 minutes each way (rather than the usual 5 min.)  I am happy for the merchants (who generally feel it has been a good season already), but look forward to getting a little sanity back.
Yesterday, another couple on our street and Barbara and I drove down Hwy 7 where there was vista after vista - literally around every turn in this mountain road - of beautiful stands of aspen, mixed among the pines, with yellow, gold, and orange leaves quaking in the gentle wind.  It was late in the day and depending on the direction of the road and where the vista was directed, the leaves would either be shining in the late day sun or glowing with the light shining through the leaves.  It was partially cloudy, so the mixture of sun and shadow, the low angle of the sun, and the continually changing views of this brief, but perfect display will probably stay with me until most everything else has faded.  We wound up the afternoon drive with a superb dinner in the restaurant a the Isle in Blackhawk.

I would still like to tour New England in a good year for color, but I don't feel too deprived anymore.