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Department: Innovations

Virtual Doctor Visits Save Patients Time, Earn Clinicians Extra Income
The traditional doctor visit is rife with challenges and inefficiencies, such as wasted time scheduling appointments, complicated insurance claims, lack of physician time, and limited access to care for many patients. A number of clinicians are now experimenting with a potentially less expensive and less time-consuming way to provide routine medical care: the virtual doctor visit.

Introducing a New Column— Medical Makeover: Group Edition
In this issue we introduce a new department, Practice Makeover, for both group practices and solo practitioners. For this inaugural column, we interviewed Betsy Nicoletti, a physician consultant in Springfield, Vt. Nicoletti explains how one of her clients, an eight-member physician practice in rural New Hampshire, struggled to collect enough money each month to meet its financial obligations.

New Technologies Unveiled To Reduce Costs, Improve Access
The Cleveland Clinic (www.clevelandclinic.org) hosts an annual Innovations Summit for experts in medicine and technology to review the latest advances and medical devices. Each year, the top ten up-and-coming innovations for the following year are listed on the clinic’s Web site along with a “where are they now” list of past picks. This year’s list holds some promising new innovations.

Reform Should Focus on Freedom of Choice
The federal government is closer to reforming the health care system than perhaps it has ever been. The plan may pass both houses of Congress this fall. Although many of the details have yet to be worked out, a rough outline is starting to take shape as this issue goes to press.

The plans Congress is considering include a wide variety of changes for almost all Americans. Among the reforms are rules that may prohibit health insurers from denying coverage to individuals with pre-existing health problems. Medicare or Medicaid coverage could be expanded to include individuals not currently eligible.

Is a Patient- and Physician-Friendly Health Care System Possible?
One of the biggest concerns about health care reform is that it will be unfriendly to patients and physicians. Given this concern, here is my idea for a health care system that would be friendly to both parties.

PCPs Feel the Need for Innovations
There are not enough primary care physicians (PCPs), and the reasons for this shortage are numerous and difficult to fix in a short time. There are few incentives for medical students to practice patient-centered primary care. Pediatricians, internal medicine specialists, and family physicians face low pay compared with other specialists and have high debt but perhaps heavier workloads, since they need to be on call at unusual hours. In addition, there are not enough residency slots. It takes eight to 10 years to produce a PCP, meaning that even if more medical students began pursuing careers in primary care today, there would be a lag of at least eight years before the number of practicing PCPs begins to rise.

The California Dream Remains Elusive
Proponents say large, integrated systems could follow and treat patients wherever they go throughout their lives. Doctors and hospitals within a regional system would have no incentive to provide more care than a patient needs. Computers within the integrated systems would guarantee that no unsafe or duplicate tests or prescriptions were requested. Preventive tests would be promoted. As a result of all of this eliminated waste, costs would be lowered by as much as 20% to 22% at facilities like Mayo and Kaiser. But the dream is not catching on.

Physicians Promote Innovative Approaches to Care
Physicians have long used technological innovations to improve care, and, as the Cleveland Clinic (www.clevelandclinic.org) recently demonstrated, they are continuing to do so. The clinic sponsored a Medical Innovation Summit which provides a glimpse at how technology is changing health care.
The innovations are:

Conference Focuses on Innovation in Health Care
This fall, officials from the federal Department of Health and Human Services (HHS) invited innovators in health care to attend a conference in Washington, D.C. The invitation came from Benjamin E. Sasse, PhD, HHS’ assistant secretary for planning and evaluation. As the author of Innovation-Driven Health Care: 34 Key Concepts for Transformation (Jones and Bartlett, 2007), I was one of the innovators invited to participate.
Under the leadership of HHS Secretary Mike Leavitt, HHS has been working to advance patient-centered health care with payment systems that stimulate entrepreneurial ingenuity from physicians, hospitals, and others. Many experts believe innovation is of prime importance if the U.S. health care system is to be reformed successfully. But simply discussing innovation is insufficient. As one physician said recently, the word “innovation” means little without specific details involving what form these innovations will take.

Inconvenient Truths About Health Reform
Two recent articles in the New England Journal of Medicine offer lessons for health care reformers about what we can learn from the past about reform. In the first article (NEJM. 359(17):1749-51), Victor Fuchs, PhD, a retired Stanford economist, says national health reform should be initiated on the basis of three “inconvenient truths.”