Ratings and Rankings !!

Expanding rating information on nursing Homes
The US federal government plans to identify some of the more troubled nursing homes in its public database to give consumers easier access to nursing home information online. Privately maintained quality-rating sites like Consumer Reports are also improving their offerings. The population of US nursing home residents, currently around 1.4 million, is expected to grow to around 2.7 million by 2040 according to estimates.

Consumers are becoming more comfortable with the idea that healthcare can be graded for quality. In a poll carried out by the Wall Street Journal, 60 % of respondents said medical care can be measured fairly and reliably. Consumers can turn to a number of online resources to find out if a nursing home has been underperforming. The federal site, Nursing Home Compare, is the most complete national resource, and offers summarized information from inspections performed by state agencies, as well as data that the nursing homes must compile and submit to regulators about residents.

The Centers for Medicare and Medicaid Services, which began making some of the information about troubled nursing homes public, believes that more tranparency will drive better quality care. The situation in India is quite different. Forget Nursing homes, even hospitals are not properly regulated. Just a handful of states even require hospitals to be registered. The recent trend of private hospitals obtaining accreditation is good, and some media companies have started ranking hospitals. Hopefully, this will gather momentum.

Next practices !!

Addressing workforce shortages
Have you read about the "doctor nurse" ? As a response to the increasing shortage of primary care physicians, nursing schools in the US have established doctorate of nursing programs to equip graduates with skills that are equivalent to primary care physicians. The two year program, which includes a one year residency, is expected to create a hybrid practitioner with more skills, knowledge, and training than a nurse practitioner with a master's degree. Apparently Doctor Nurse Practitioners (DNP) are being trained to have more focus than doctors on coordinating care among many specialists and health care settings. By 2015, the American Association of Colleges of Nursing aims to make the doctoral degree the standard for all new advanced practice nurses, including nurse practitioners.

Some physician groups have obviously responded that blurring the line between doctors and nurses could confuse patients and jeopardize care, and want DNPs to be required to clearly state to patients and prospective students that they are not medical doctors. These groups believe that 4 years of medical school and 3 years of residency training prepares physicians to understand complex medical issues much better.

However, the primary aim of the DNP is not to usurp the role of the physician, but to deal with the fact that there simply won't be enough of them to care for patients with increasingly comples care needs. As physicians face shrinking insurance reimbursements and rising malpractice-insurance costs, more medical students are forsaking primary care for specialty practices with higher incomes. As a result, there could be a shortfall ranging from 85.000 to 200,000 primary care physicians by 2020, according to various estimates.

India is already facing shortage of physicians, and the situation is not expected to get any better. For instance, around 25,000 doctors graduate from medical school every year, but only 60-70 % go to work in healthcare. Every year only 20 new medical schools are being set up, and even these are challenged to find good faculty. What is of even greater concern is the shortage of nurses. Physician groups and policy makers need to quickly respond to this situation.

Ratings and Rankings !!

Nurses and other caregivers
In The Health Care Blog, Chiara Bell writes about how everyone is chasing after doctor and hospital ratings and why it is may be relevant to rate the most important members of the health care profession --- nurses, certified caregivers and home health aides. She wonders how it is that the largest segment of health care professionals, who provide a majority of the direct, hands-on patient care have been left out of the Health 2.0 ratings explosionals.

The Health 2.0 movement is all about the Internet’s power to transform the relationships between patients and doctors, hospitals, insurers and each other. However, there seems to be an oversupply of sites that are all doing slight variations on the same thing. There are dozens of online physican directories, health-specific search sites or health “portals” with some sort of attached social community. And plenty of sites that aim to help patients find and often compare doctors and hospitals.

The US is of course big on ratings, but this trend has not yet caught on in India. Whatever little activity in this area is restricted a few awards programs that were launched by a couple of media companies with healthcare properties. But consumer ratings programs could make a huge impact in a country where there is so little regulation. It is time, some of our Health 2.0 companies started doing some serious stuff in this space.

Online Networks !!

Social networking for physicians
Sermo, a social-networking site for physicians, thinks large investors may be willing to pay big bucks for doctors' collective insight . Sermo is an online community for physicians to post observations and questions about clinical issues and hear other doctors' opinions. It was originally imagined as an adverse effect reporting system. Reporting systems failed during the Vioxx recall from the market due to an increased risk of heart attacks. Daniel Palestrant, the founder of Sermo, believed that an online forum could collect and filter these types of observations more effectively than existing systems. The site has since grown into a discussion board covering a variety of clinical topics.

Physicians can register after verifying their status as licensed, practicing physicians and receive a pseudonym of their choice. This pseudonym and the doctor’s specialty are the only pieces of information that other doctors will be able to see automatically, making Sermo a credentialed, but anonymous community. Doctors post observations and comments, create and respond to polls, and browse medical articles within the site. They can also create profiles, revealing more information about themselves. This ability, and the closed nature of the site, has led some sources to refer to Sermo as a “MySpace" for Physicians.

Unlike most social networks, Sermo does not make money by advertising to its users. Instead, it makes money by selling access to physicians’ anonymized comments and polling data to financial institutions, health care organizations, and governmental bodies. Clients have the ability to read doctor’s comments and create a limited number of postings (identified as Client Postings) to which doctors respond. Clients have different reasons for seeking access. Financial institutions may want to trade on the wisdom of crowds that polling a number of doctors can create, trusting that this group of specially trained individuals will be better at predicting events like FDA approval than the market. Health care companies and organizations such as the American Medical Association may focus on discovering doctors’ usage patterns and may value direct access to physicians’ opinions and attitudes about health care today

Next Practices !!

Reuse of medical devices to lower costs
Recycling of a growing number of medical devices labeled as single use is becoming a preferred option for hospitals in the US to save costs and stem a rising tide of medical waste. Scissors, scrubs and blades that surgeons use to saw through bones are all being recycled. Recycling medical devices labeled for single use is legal as long as certain FDA guidelines are followed, but the practice has raised concerns around safety. Medical devices companies are saying that reuse poses a higher risk of failure, whereas reprocessing companies counter that reprocessing is as safe as new thanks to modern sterilization methods. About 100 devices (just 2 % of all devices labeled for single use) are now being reprocessed.

The US medical devices market is approximately $ 75 billion, of which around $ 31.5 billion is single use devices. Of this around $ 150 million is being recycled. According to one of the reprocessors, around $ 3.6 billion worth of single use devices are safe for reprocessing, and could save the industry around $ 1.8 billion every year (not to mention the huge amount of waste that could be eliminated).

India's entire medical devices industry is only around $ 1.8-2 billion currently, and according to reports, over the next ten years, anywhere between $ 20-40 Billion worth of investment in medical devices is likely to be made. For instance current availability of CT scanners and MRI units per million population is only 1.6 and 0.4 (as compared to 2004 figures in the US of 32.2 (CT Scanners) and 26.6 (MRI units)), and will need to grow as India expands its healthcare delivery capacity. However, indian hospitals have always recycled medical devices, though there is no data available on the value of single use devices sold every year. From a waste elimination point of view, reuse is a huge benefit for India.

Caring for the elderly

Training in geriatric care
In a recent report, the Institute of Medicine says that healthcare institutions must rapidly increase training in geriatric care to ward off an impending crisis as a large number of baby boomers head towards old age. Appears the US healthcare work-force is too small and "woefully unprepared" for the growing elderly population, and the increased demand for healthcare workers is not being met by the stagnant or dwindling supply of those trained to treat the elderly.

Some nursing homes and other institutions are pairing with medical, dental and nursing schools to provide geriatric training. But such efforts are rare due to the time and expense of implementing them. In this context, the report's recommendation to train those taking care of elderly people is appropriate. After all, almost 90 % of those receiving care at home, get help from family and friends, and 80 % rely solely on them.

In coming years, a huge chunk of all medical care with go to people over 65 years of age, who account for a quarter of doctors' office visits and a third of hospital stays and prescriptions. Currently very few doctors specialise in geriatrics, probably because there is more money to be made in other specialties like surgery and radiology. Apparently the availability of physicians trained in geriatric care in the US is only one per 2500 persons (as opposed to around one physician per 350 population overall).

Most countries will have to address these challenges it they have to meet the exploding demand for geriatric care. India will need to make some serious moves in this area. Currently, the total availability of physicians is at a very low 1 per 2000 persons. And the net additions every year do not seem to be improving the ratio (the cumulative output of all medical colleges is around 25000 per year, and after netting out those that opt for careers in hospital administration, or increasingly different forms of BPO, the number that will actually practice medicine is much lower). And as the population grows older, the demand for healthcare will surely go up. Maybe India should innovate training programs that can create new types of care givers.

Next Practices !!

Mining patients personal financial information
A growing number of hospitals in the US are mining patients personal financial information to figure out how likely they are to pay their bills. Mining patient clinical data for research we are familiar with, but this one seems new. Hospitals say this practice helps them identify which patients to pursue actively for payment because they can afford to pay. They say it also allows them to figure out more quickly which patients are eligible for charity care or assistance programs, and argue that these credit checks can can help them minimize losses. According to the American Hospital Association, in 2006 nearly 5000 community hospitals provided uncompensated care costing $ 31.2 billion, the vast majority of it charity care or unpaid hospital bills.


Tenet Healthcare, Fair Isaac Corp, and a venture capital firm have contributed $ 10 million each to a start up called Healthcare Analytics (now rechristened Connance) that is assembling bill collection data from hospitals to develop methods for predicting patients' payment habits. While there is some concern that this practice creates the potential for hospitals to misuse the information by denying or cutting back on patients' care if they can't pay, it does appear that hospitals have the right to check credit reports without specific permission before care is delivered. Equifax and Experian seem to have developed a separate credit score specific to healthcare, and SearchAmerica mines the credit bureaus for data on behalf of its hospital clients.