SutureSelf MD
By
Donald Altman M.D, M.B.A.
New Business Model for Healthcare Services
Mission Statement:
SutureSelf MD (logo/ trademark drawing pending) – Tying the “virtual”
knot between patients and healthcare providers
SutureSelf MD - Empowering people with “virtual” tools to optimize
their healthcare decisions.
SutureSelf
MD- Consumer Driven Healthcare using an interactive /
virtual / web based platform to improve communication between patients and
providers which will allow free market forces to determine pricing and increase
transparency in the value proposition of healthcare services.
Specific
Features of New Software Platform might include:
Allows for patients to share medical information and for
providers to evaluate - virtual consultation
Web based interactive / allows for interaction in real
time.
Secure - HIPPA compliant.
Cloud based – paperless
Negotiation/ bid/ auction function -
single patient interfacing with multiple providers
Absolute pricing transparency
Pricing based on capacity / availability / Value /
reputation
Allows provisions for online financing / credit
rating
Online real time transaction and immediate
payment
“Can do” Medical Brokers available to assist in putting
right parties/ services / transactions together
Embedded malpractice liability insurance attached to each
service provided – actuary risk variable to each service.
Ability to adjust visibility of patient appearance by
pixel manipulation (optional)
All language / legal and otherwise is presented in simple
and understandable terms
User friendly Apple and Android Products Apps
The service
might work something like this.
A patient needs to have medical treatment or services.
He or she goes online for a virtual consultation, assisted by a broker if
necessary; medical information is shared, in real time where possible…….
Providers of medical services respond with potential offers of rendering care
Pricing, place, and time offers are given. Both parties enter into an
agreement.
Financing, legal services, and a limited medical
liability insurance attached specifically to this service are provided promptly
to seal the deal, and the decision to move forward is completed.
An example: Mrs. Smith, a 41 year old female living in
Santa Monica, California is interested in her yearly diagnostic mammogrm. She
has heard about the latest in 3D tomosynthesis mamograms. She conveys a short
medical history online; if necessary supported by virtual examination; her
price range, the timing of the procedure, her willingness to travel, are
included in her request……….4 diagnostic radiology centers, including one major
University Medical Center, located within 5 miles respond. An appointment is
available at 4 PM, the next day at the nearby ABC radiology center,.. e exact
price including the professional component by Dr. Jones is exactly $100.00. The
patient decides to move forward with this service online ,agreeing to certain
financial and legal terms Third party financing, if necessary, is offered.
Her result is available on a cloud based secure platform within 24 hours of the
study. She tells all of her friends about SutureselfMD.
Payment of the service is immediate. Pricing is
transparent. Broker's fees, finance fees, and fee for the liability insurance
policy attached to this service are included.
The
(problem) Ailment:
Healthcare in the United States represents 15% of the
GNP, an estimated 2.5 Trillion dollars, and is responsible for as much as 50% to
60 % of individual bankruptcies. The problem is bankrupting
Americans. There are currently
no adequate systems in place to allow free market forces to control pricing and
shape the quality of healthcare in the United States. Patients do not know the
cost of their medical fees before engaging in services.
1.,2.,3,. (Jama article), (NYT article)(LA times article)
and there is no mechanism in place to “effectively” seek
comparative pricing and /or negotiate costs as individuals or collectively
through the services of a healthcare broker / specialist, particularly
online.
The
Partial
Cure:
Currently there are very few sophisticated options for
patients to use free market forces to pursue quality and cost effective
healthcare. The use of online resources, using virtual consultation as a means
to making initial decisions regarding the cost and value of care does not
currently exist, at least in any
sophisticated form. It is the contention of
this author that an interactive online software platform could exist that would
allow negotiation and bidding for medical services. The system would increase
the transparency of pricing. The technology for this service already exists in
other business sectors. This service would drive prices down, increase quality
and value for the consumer and the provider, and begin a trend that would begin
to improve the healthcare industry for many individuals.
Currently there are government plans
for healthcare insurance exchanges that will
be available in the near future, with
enrollments available possibly as early as October 1st, 2013. Theses exchanges promise that consumers will have an
improved ability to choose between health insurance policies. There is no
mention anywhere of the creation of exchanges that will allow consumers to have
an improved ability to choose their healthcare services directly - i.e. to go
outside government or insurance carriers to compare prices, value, and pay for
their services directly. Not in conflict with, but in supplement
to the best operating systems available, there is a need for healthcare
exchanges for patients to seek medical care outside of “covered” services.
Assuming
a near perfect compliance with the goal of insuring
all Americans, the dire need, particularly for the young and the healthy, and
those who are “minimally ill”, is to be able to shop
for affordable Healthcare, that which falls within the deductible and non covered
expenses.
The
timing, technology, marketplace, demand, interest, need, and motivation are
already in place to allow consumer driven medical economics to help heal this
nation's worst aches and pains.
Disruptive change in the healthcare
industry.
SutureSelf
MD will bring
costs down and improve access to healthcare for those individuals who seek
treatment for “illnesses” outside their coverage, below their deductible, and
for items-excluded from their plans, etc.
New Twist on
medical malpractice liability insurance
Embedding the medical liability insurance fee into the
transaction cost of a medical service rather than only having the liability
covered in a traditional manner from a policy purchased by the
healthcare provider, would be a disruptive
departure from an existing system. In the traditional system providers purchase
medical malpractice insurance to cover all of their acts in a given
year or career. Having a per
procedure liability policy added to the cost of a given transaction would be
similar to a “travelers or trip” insurance policy for each service. The latter
might allow for healthcare providers to order tests or participate in treatments
with less concern over malpractice repercussions knowing that this rider type
policy would be attached to each treatment. A patient who
undergoes care through this new business model agrees to pursue remedies from
the medical malpractice policy attached to a given service before attempting to
recover any losses from the provider's malpractice policy in the event he or
she finds serious fault with her care.
This concept would leapfrog current failed efforts at
tort reform as it might allow healthcare providers to pay less for their
personal liability policies, and would not be an objection to trial lawyers as
there would continue to be monetary awards for medical malpractice.
Business
feasibility Research
Given the massive framework of uncertainty in a project
of this scope3.5, a number of feasibility questions would need to be
addressed in considering this
business model.
In order to acquire
more information on this subject, invited guests knowledgeable in different
areas of specialty will be interviewed or invited to comment on the questions
and concerns presented.
The size of
the American Healthcare Industry
In dollars spent, how big is the healthcare industry in
the United States? 2.5 Trillion or 16% of
the annual GDP.
What percent of that number reflects money spent by
individuals that is outside of coverage by health insurance, government Medicare
/ Medicaid, and other sources such as foreign spending?
Regarding individuals and groups covered by health
insurance – How much money is spent on healthcare costs that fall under the
deductibles, Co-insurances, non covered services, excluded, and elective
services? Non-covered or excluded services, for example, might be coverage of a
pregnancy in a policy holder without maternity benefits. Non covered or excluded
services might be, for example, breast surgery on a patient excluded because of
the presence of breast implants. Other excluded services might be individual
seeking studies that are excluded or not covered such as cosmetic surgery,
dental surgery, holistic treatment, chiropractic treatment, those services
deemed experimental in cancer treatment ,spinal injury, treatment of dementia,
etc. and so forth….How big is that number? What will that number be predictably
after Obamacare laws are in effect? What will be the deductibles in most
insurance plans after Obamacare insurance exchanges go into
effect? My (Donald Altman) guess
,which is probably a conservative estimate, is that
there may be as much as 250 to 300 billion dollars per
year of medical services falling into this category. The
slice of pie depicted below represents the portion of medical
expenses being described, discretionary income being spent on medical
services.
It would be interesting to have the opinions of health
care experts as to the true number in this slice. How will this number change
in the future?
A note about Deductibles
Obamacare rules say deductible plus out-of-pocket costs
cannot exceed $6,350 for an individual and $12,700 for a family. Plans to
enforce deductibles have recently been delayed.
May 29th, 2013 “Reining in Luxury Health Plans” by Reed
Abelson, The New York Times. - This article is about the Cadillac Tax which is
scheduled to take effect in 2018. “Employers who spend more than $10,200.00 on
an individual will be charged a 40% tax on the amount exceeding the
threshold.”
My
thoughts - employers efforts to offer less expensive plans and therefore avoid a
Cadillac Tax, will be more likely to sponsor health plans with less benefits and
higher deductibles. This
tax, if put into effect , increases the percent of healthcare dollars spent that
will fall into the category of discretionary spending which is the subject
matter of this paper.
In the news: Covered California / Mandatory Insurance
Purchasing for companies under 50 employees - recently delayed. The Obama
administration announced on July 2, 2013 that employers would not be required
to provide insurance to their employees for one year, until Jan. 1, 2015.
Limiting deductibles has also recently delayed. Employers may have incentives to
keep deductibles higher and healthcare expenses lower, Cadillac Tax.
Most PPO plans with high deductibles also tend to push
sizable co-insurance policies onto their clients.
Liability insurance in the
healthcare industry
How much money is spent annually in the United States to
account for all medical liability insurance expenditure by all healthcare
practitioners?
Has anyone ever described or studied what percent of
healthcare dollars spent on a procedure to procedure case basis could be
attributed to liability coverage? For example, on a mammogram that costs
$100.00, what is the average cost of all liability coverage for all providers
involved for that single point of service examination? I (Dr.
Altman) estimate that the cost is roughly 5% of the cost of the service.
In a more complicated situation assume that a patient
undergoes an outpatient surgical procedure at a private hospital. What are the
cumulative costs of all liability fees paid where the total costs of these fees
are inclusive of those for the surgeon, anesthesiologist, pathologist, hospital,
radiologist, internist, and pharmacist? Is there a ratio, i.e. a number placed
in the numerator (all malpractice fees / divided by the comprehensive cost of
all the related services for that individual’s care? For example a total fee for
all service charges in a straightforward surgical hospitalization are
$50,000.00, what would the cumulative malpractice liability of fees of all the
providers be who rendered care for that patient? Again, I (Dr.
Altman) estimate that the cost of all liability
coverage is about 5% which in this case would be about $2500. This number might
vary from state to state given MICRA laws that are in place.
Who would be the best individuals, organizations or
groups to determine that number?
Currently, all providers of medical services carry
independent medical malpractice liability coverage. In what might be determined
to be a radical departure from the traditional system, would it be feasible to
have the fee for the medical malpractice liability coverage embedded within the
total transactional fee, i.e. as part of the overall charge for the service
rather than by the provider? Why or why not? Phrased differently, let’s say a
patient undergoes a mammogram for $100.00, could a certain percentage number be
placed as a surcharge that would allow for an independent insurance carrier to
provide liability coverage for the case, assigning this liability coverage by
contract to the patient, before other coverage could be accessed by a litigant?
How about $100.00 plus 5% or a total of $105.00. Is this fee too high, too low?
What experts are in a position to address this topic? Might seek
comment from experts in the medical malpractice actuarial industry who set
prices on doctors malpractice premiums. Some of the trip insurance policies are
calculated very quickly at the time of making reservations; more insight into
the nature of this industry is needed.
Insight
from health care actuary services would be helpful.
What government laws allow in
the healthcare industry regarding online services
There are numerous legal and regulatory issues that
currently shape healthcare in the United States. Could a new system coexist with
existing healthcare regulation that would allow for change?
What would be the obstacles to having patients
communicate online to physicians or providers regarding sensitive medical
information? Regarding HIPAA privacy laws, how much information does the
individual have the right to disclose? How much information can a provider
discuss in a virtual online environment given that there is adequate consent on
behalf of all parties involved?
Could information be stored in a virtual cloud that is
HIPAA compliant, such that medical written medical records would not be
required? Could a patient have access to his or own records such that could be
shared at the his or her discretion?
Is it legal to perform a virtual consultation online? Across state lines? Does an
examination online fulfill the requirement of an examination? Has this issue
been tested by medical boards?
A
number of web based businesses have begun to
appear that suggest exchange of photo information between doctor and patient can
be performed in a HIPAA compliant manner. Telecommunications have been used for
many years treating individuals at a distance from the providers;
prison systems; ambulance triage services to name a few.
Monday,
September 2nd, 2013; NBC Nightly News in Los Angeles California8, -
A hospital based robot allows
telecommunication based consultation in real time
between a stroke patient and her neurologist who was at his home more than 25
miles away.
In
my own plastic surgery practice, simple everyday use of patient initiated text
messaging and face-time exchanges have improved patient care and communication
dramatically over the past few years.
Government laws regarding
self referral and kickback
What is and what is not legal in terms of healthcare
provider ‘s care of patients with specific regard to virtual
interactive consultation online. Would a business model that allowed interactive
consultation and determination of pricing by negotiation and bidding be a
violation of any existing laws which impact the methodology in which patients
are referred to providers /specific entities? Are there any antitrust issues which might need to be
addressed?
Are there studies that demonstrate the savings and
protection to individuals that has occurred as a result of the self referral
laws that are currently in place?
How big would healthcare savings needs to be in order for
legislation to be put in place to repeal or soften enforcement of existing laws
of self referral. Is there anything abut the proposed
business that would be construed as self
referral?
At quick glance, would a service that allows interactive
/ virtual consultation with negotiation and bidding for medical services break
existing laws? Who would be qualified to answer that question?
What would be the input from those in favor of or those
opposing the proposed changes that might occur with an interactive /virtual
online platform for patients seeking healthcare as has been described in this
paper?
Liability Medical Malpractice
Companies
How would traditional medical malpractice carriers view
this type of activity by their insured physicians? My immediate
thought is that there would be no coverage for activities outside traditional
methods of consultation. However, if having the liability rider on each
procedure lowered the overall exposure to the traditional malpractice carriers,
or if doctors chose companies that differentiated themselves by allowing virtual
consultations and insurance riders, the carriers might morph into something more
user friendly to their customers which would in turn pass savings
on to patients and providers.
Software Platforms and
technology
How does one go about building a software platform that
can accomplish the following goals, to be described? How is the team organized
and financed? How long does it take to create the first prototype? How much does
something like this cost?
(above diagram) Model
of the Systems Development Life Cycle - taken from
Wikepedia
How is the technology patent protected?
How are licensing fees determined?
Many components of these systems exist already as seen on
successful internet businesses such as Priceline, Orbitz, Trip Advisor, Pay
Pal, Ebay, and
Facebook, Amazon.
Who can help put the right team together? How can the developers and
entrepreneurs from these areas be used to help or advise in the
creation of a new company.
In
the future the affordability care act has suggested that healthcare insurance
carriers will be allowed a maximum of 20% administrative fees that are not
dedicated to providing health services.
The
proposed business model of SutureSelfMD is obviously
subject to changes and modifications as it is
developed by groups of individuals who can brainstorm, and it is tested in the
marketplace. It would seem that a 3% finance fee, a 6% brokers fee, a 5 %
embedded malpractice rider fee, would still allow up to 6% transaction fees to
be returned to company investors; leaving 80% of fees to be directed to
the providers of healthcare services.
Venture Capital and Legal
Entities
How does one identify experts in raising venture capital
and providing legal services for this new healthcare service? What would be the
strengths and weaknesses in moving forward with this system? If one were to look
forward six months or even a year after the venture moves forward into the
market place, what specifically would have to take place in terms of dollars and
numbers in order for investors to feel pleased about the progress?5
Would
Kickstarter, or Indiegogo, popular sites for crowd funding be viable options
to raise money for this business?
Maybe
a contest could be held to bring the best and brightest minds into the
challenge of creating this new virtual online healthcare system. 5.5
Financial Services
Over the past few years finance companies have been
putting a significant effort into dental and plastic surgery offices attempting
to capture the population of individuals who are interested in financing their
anticipated elective services. Most notable in our office is Care Credit which
is an arm of GE capital. Currently both the patient and the healthcare provider
offer a premium to the finance company in order for the transaction to take
place.
It
is my contention that finance companies would play a strong role in the value
proposition of the service that is being described in this paper. Online payment would occur with credit
cards or with loans brokered by finance companies.
Financing
charges for services would vary by the financial risk or well being of the
client. Estimate 3% short term, for individual with good credit.
Can Do - Medical
Brokers
Maybe
better described as healthcare negotiators, these highly skilled brokers of
medical care will work on a commission basis to match the patient to the
provider, the buyer to the seller of healthcare.
Can-Do
Medical Brokers, named because of their propensity to make something positive
happen, will be able to draw on information and a network of resources to
provide value in an individual's SutureselfMD healthcare decision. This will be
in contrast to the legion / army of
knowledgeable individuals who have worked over the
past few decades within the insurance industry
solely to figure out how to deny benefits.
Brokers
will charge based on a percent of the overall medical transaction fee.
Estimated 6% may be the anticipated fee possibly shared between buyer and
seller brokers, similar to real estate. Obviously, this fee will be subject to
modifications based on market forces and value of service.
Unrelated,
ACA / Obamacare specialists, referred to as navigators, are planned to help
individuals shop for healthcare insurance through exchanges. (Article OC
register sept 1, 2013. These health care guides are
proposed to have up to 20 hours of training , be paid $15.00 per
hour and pass federal background checks. (article Carla Johnnson, The associated
press, Tuesday, September, 10th, 2013)
Market Research:
Online and personal survey with prospective
users
Discuss the relevance of the plastic surgery
industry - spending of discretionary income
by consumers.
Questions to address in Surveys - consider survey systems such asMonkey Survey
Local markets vs. travel I would imagine
that this system would work better in local markets.
Anonymity versus public - How much information are
individuals comfortable exposing in public domain? Some issues are
clearly more private than others. Aches,pains and need for annual
preventative health diagnostic exams are probably issues individuals hold less
private than other more serious medical conditions.
What is most important to doctors, healthcare providers,
and clinics that would provide services based on online virtual consultation?
I suspect the answer will be to paid a fair market price, to fill
schedules that are currently open, to minimize risk of diagnoses or treatment
error and therefore incur liability. Doctors would like to be paid quickly. Just
like in the world of retail, payment is made when services are rendered. I
imagine that incorporating a financial service to provide payment would be an
important feature of the proposed business.
Currently
physicians in private practice face an onerous process of collecting money from
the government and insurance carriers with outstanding accounts receivable
sometimes aging 6 months or more before payment is made. The last decade has
seen a mass migration of non specialty trained physicians into cosmetic spa and
surgery services. Fees and payments are upfront and rendered before services
are rendered. Doctors, healthcare providers, like the rest of the
retail community, like to be paid when services are rendered. It
is human nature. It is my contention that offering immediate payment will
incentivize the willingness of health care providers to participate
in virtual consultations, and as such this will allow prices to
fall.
Healthcare
is the only industry in The United States where we as individuals, doctors as
patients included, agree to pay for services not knowing the costs3.
Imagine
a customer going to Sears and wheeling a brand new washer dryer out of the
store into the parking lot. The store manager says, enjoy, we will figure out
the bill later, and after a few months sends you an invoice.
What is most important to
individuals seeking healthcare through a virtual consultation?
Possible question might read: List on a 1 to 5 scale,
with 1 least and 5 most what is important to you as a patient. Anonymity;
quality of service; timeliness of results; cost; financing; access to records;
access to the physician or allied healthcare provider (for diagnostic tests such
as mammograms or MRI’s). Safety, Trust.
What
is important to patients? Thoughts on malpractice.
The
ability to sue and seek compensation: Whether we accept it or not, we are a
society of victims, and the need to seek remedy or relief for perceived
wrongdoing, particularly in healthcare is deeply embedded in our way of
thinking.
Discussion /
Opinion
SutureSelfMD
is about obtaining quality healthcare, not healthcare insurance, reasonably
priced.
This
new business model is not specifically in conflict with proposed changes noted
in the Affordable Care Act, ie Obamacare.
It
is an opportunity to offer a solution that fills the real world gap that exists,
that is tapped into regularly by anyone who doesn't feel well, healthcare of non
covered services, before deductibles, before or separate from coverage by
insurance. It is for individuals who are suffering from a common cold, a
sprained ankle, an asthma attack, or one who needs an MRI of the shoulder. It
is designed for someone who wants to go online to shop for an
expensive pharmaceutical prescription for any number of common ailments,such as
eye drops for conjunctivitis, or an inhaler for asthma, or antiinflammatory
medications for arthritis.
Let
healthcare insurance be available for and provide security in the cases of
catastrophic misfortunes of illness, but let free, transparent, negotiable
market forces dictate the prices and access to
healthcare providers for the day in and day out lumps and bumps that ail
individuals and their loved ones.
The
government plans to hire 10,000 workers and to spend $ 45,000,000.00 to market
the healthcare INSURANCE exchanges. Reports indicate that some of
the workers, known as navigators, will have as much as 20 hours of training, be
paid approximately $15.00 per hour, and be required to have federal background
checks.
Theoretically,
a handful of skilled medical brokers, paid as a percentage of each
transaction, could help link patients to health care processes. I would suspect
that the number of brokers and the marketing budget would be less than that
proposed in the proposed federal program.
The
specifics of coverage and deductibles will vary with the political party of
influence at State and Federal levels. The fact remains, for a very significant
percent of our health care dollar expenditures for the foreseeable future, we
need a way to shop for our health just as we might for other retail
services.
As
a physician, I truly believe, that individuals given the proper information
will have less difficulty making decisions regarding their healthcare, than
understanding the political, financial, and insurance forces that currently
shapes the care they receive.
SutureSelf MD - Consumer
Driven Healthcare needs for the government to allow free market forces to act.
A business model has been described that will include transactional fees for
medical brokers, financial services, medical malpractice
riders attached to each transaction, and limited releases of
liability provided by legal services.
All
communications will be in lay terms and simple language.
Patients
will be able to search and negotiate for pricing of services that offer optimal
value. Feedback and reporting on the value of services will
visible online to consumers.
If
the Federal and State Government can refrain from imposing taxes on this new
business which represents a variation of internet commerce, there is a chance
that this new "virtual" access to making informed decisions in our healthcare
might play a positive role in supplementing current U.S. healthcare delivery.
About the Author
Donald Altman M.D., M.B.A. is board certified in
Otolaryngology - Head and Neck Surgery and in Plastic Surgery . He holds an MBA
from Northwestern's Kellogg School of Management. With a background in plastic
surgery, he is very familiar with pricing of medical and surgical services
outside the realm and coverage benefits of health insurance and government
allowances, particularly as it applies to discretionary spending of healthcare
dollars.
He has enjoyed over 25 years of private practice as a
successful plastic surgeon in Irvine, California. He is known for his
creativity, sense of humor, and superb communications skills.
Articles / references/
reading list
1.5
Price
for a New Hip? Many Hospitals Are Stumped By ELISABETH ROSENTHAL
http://well.blogs.nytimes.com/2013/02/11/price-for-a-new-hip-many-hospitals-are-stumped/
3.
David Lazarus LA Times recent article – shoulder MRI UCLA http://articles.latimes.com/2013/apr/18/business/la-fi-lazarus-20130419
3.5 Personal
Communication: John Sutherland
4.
Daily
Pilot: It's A Gray Area: Government is meddling in health care April 13,
2013|By James P. Gray
5. Personal
Communication - Impact Filter; DOS
question; Dan Sullivan -
Strategic Coach, Toronto, Canada.
5.5 Abundance,
The Future is Better than you Think; Peter H.
Diamandis; Steven Kotler, 2012 Free Press, a division of Simon & Shuster,
Inc.
8 . Paging Dr. Robot: Telemedicine a game changer - Video on ...
By NINA BERNSTEIN Published: August 25, 2013, New York Times
comment: Lack of transparency and negotiations in
pricing
My planned Blog for September 2nd,
2013
My “Prescriptive” wish List of the
State and Federal Government.
If the government can offer a little
breathing room, i.e. relax legislative oversight of
some aspects of healthcare law, consumer driven economics will flourish. An
example of the government choosing to put less pressure on existing laws might
be the recent stance of the Federal Government not to direct resources against
the recreational users of marijuana in Colorado and Washington State.
Variations of the
following existing laws and practices that would be helpful:
HIPAA: Allow individuals to protect or share
personal health information at their own discretion.
Loosen Stark and Self
Referral policies: In many cases, physicians,
nurses, and other allied healthcare workers are in an excellent position to
understand the economics of medicine. Allow doctors to refer to clinics or
facilities in which they are owners; allow patients the freedom to choose
clinics where physicians are owners. Free market forces will determine the
success or failure of such clinics. User’s feedback and valuation will allow
consumers to decide whether or not to choose physician owned clinics.
Allow the practice of
“virtual” medicine across State Lines. Allow patients interested in a
virtual consultation to seek input from doctors across state
line.
ACA / Obamacare:
Redefine and broaden the
scope of what is defined as a legitimate healthcare insurance policy. Allow
individuals, or groups, purchasing healthcare insurance of any deductible or
coverage benefits to be free of anticipated taxation penalties as currently
prescribed by ACA / Obamacare policies for individuals who do not purchase
health insurance.
Allow the size of the deductible portion
of healthcare insurance to be as high or low, and the coverage of healthcare
benefits to be as broad or narrow, as the individual or group chooses.
Individuals, families, or businesses that decide to purchase health insurance
with high deductibles will be able to do so at a great cost savings that should
be transparent. For example, healthy young individuals might choose
catastrophic health insurance, defined by this paper, as insurance for costs
over $10,000.00, 15,000.00 or even $25,000.00. Individuals will pay less for
high deductible health insurance, and as such, have money left to pay for
consumer driven healthcare products of their choice. Withdraw taxes upon
businesses that pay for excellent healthcare policies for their
employees.
Simplify the written
language that pertains to legislation, finance, insurance, and healthcare.
Create translators for
healthcare legislation.
Allow tax deductions
/ and broaden the scope of “hold harmless and good Samaritan acts.” for physicians, allied healthcare
workers, and institutions, that offer free care to those in need.
September 4th, 2013
Clarification of the
problem. There is a “sizable gap” between services covered or partially
covered by healthcare insurance and
Purchases and the
procurement of medical services in the “large gap” outside of.
There is a significant misunderstanding
of what health insurance covers when it comes to treating most non catastrophic
ailments and maintenance examinations An otherwise healthy individual with
healthcare insurance, still has to pay for much of his or her medical services,
including pharmaceuticals. Healthcare insurance, with deductibles, and
exclusions, will not cover the most common everyday services encountered by
most individuals.
Not in conflict with, but as a
supplement to health insurance; SutureSelfMD - is the name of a virtual service that
allows for individuals to shop within the space of medical services that are
most often needed on a daily basis and / or not covered by their healthcare
insurance plan.
Donald Altman, M.D.
To learn
more on this subject and develop further insight into the plausibility of this
business concept - interviews might be conducted with the following
individuals.
Physicians,, healthcare lawyers; lawmakers familiar with
the affordable care act /obamacare and cms ; stark Law and antikick back experts,
lawyers familiar with forming corporations, patent attorneys, risk actuaries
particularly in healthcare industry., software engineers, particularly those
familiar with negotiations and online bidding, those familiar with pricing and
supply and demand, capacity issues; possibly individuals familiar with yield
management technology, individuals with expertise in insurance, malpractice,
start-up venture experts, finance experts, doctors, nurses, patients,
administrators, medical illustrators, and graphic design experts, public
relations experts, writers, editors, publishers, social network experts; Members
of the California Medical Board.; healthcare journalists.
Question of Healthcare Lawyer: What concerns might a healthcare attorney consider
regarding the proposed system? Discussion on HIPPA and self referral. Thoughts
on virtual consultation and paperless record documentation.
more to follow:
Wish List
of interviews:
Joel Hay, USC professor for Health Policy and Economics
(The Anatomy of Health Billing, for the Orange County Register, Tuesday
September 10th, 2013);
Joel Shalowitz, M.D.,M.B.A. Clinical Professor and
Director of Health Industry Management, Northwestern University.
All of the above named authors: Elizabeth Rosenthal;
David Lazarus, Nina Bernstein, Peter H.
Diamandis, Jim Gray, Anderson Brill, Dan Sullivan,
Peter Stark - Author of Stark Laws
Entreprenuers, and Representatives from Priceline, Orbitz, Trip Advisor, Pay Pal,
Ebay, and Facebook, and Amazon.
…..to
be expanded
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Miscellaneous thoughts /
observations / notes
May 28, 2013 -http://washpost.bloomberg.com/Story?docId=1376-MN3GTT6TTDSX01-3QTG987E5CBUCMOB9HHPRDLC99
Yield management technology – Article on Greyhound buses
using airline style pricing.
Some portions of the healthcare industry might be better
suited to offer airline- style pricing than others. Radiology services, for
example, might entail very expensive fixed overhead, but far less variable
overhead, and therefore be able to sell off capacity at low cost. In other
words, like the airlines, where owning and operating jets are expensive and the
cost of filling an empty seat might amount to peanuts, and a beverage – a
radiology service that owns an expensive digital mammogram machine, might fill
the schedule for the cost of an appointment and a few forms.
Op Editorial LA Times – May 24th, 2013 “Good news on health
costs.”
The Patient Protection and Affordability Act
will rein in costs by insuring a significant percent of the 7,000,000 uninsured
Californians – a significant portion are young and healthy – premiums for these
individuals may jump 30% - the latter group will be prepared to pay $1360.00 or
more per year or accept a $95.00 per year penalty. “the challenge for the
exchange is convincing those who have been uninsured by choice that they would
be better off with coverage than without it.”
