A recent story in the NY times told the story of a doctor in Israel who offhandedly told a patient's son that, of course, a Rabbi could visit the patient in the hospital. The doctor only had second thoughts when he found the Rabbi in the hospital room, waving a live chicken around the patient's head to a unison of prayer.

The story of the rabbi, the doctor, and the chicken probably sounds a little bizarre to some. Although I'd guess that if you've been practicing for a while, it may not surprise you much. The truth is that although this particular patient's custom was a little less familiar to us, patients always have their own customs and beliefs. And as the author points out, as medical providers, we sometimes ignore, edge out, or belittle these customs or beliefs at the expense of good medical outcomes.

Maybe the little boy you just stitched up needs his twin brother to visit him in the hospital or he won't sleep well at night. Maybe the woman scheduling her surgery needs to schedule after Christmas passes or she won't actually give her wound the time to heal it needs. Maybe it's worth standing in the hallway outside the OR for a few minutes while a patient's family prays, as it will help everyone feel more comfortable, and who knows, may even help the surgery go well.

What does all of this have to do with telemedicine and medical collaboration? Well, everything, actually.

We've found that when medical providers don't collaborate, the humanity of their patients can get lost between the cracks.

If the doctor in Israel had gone off duty right before the Rabbi arrived with the chicken, maybe the new doctor would have made a different decision, without the benefit of context. The new doctor might have banished the chicken, and with it, the trust and buy-in of the patient and his family of the medical interventions at work.

With iClickCare, we find that the little things that make medicine a thoughtful, human, respectful, open practice can actually survive. The "story" of who a person is can come across in a conversation between people, or if folks are too busy or schedules don't match up, in a synchronous exchange via Hybrid Store and Forward Telemedicine. It's the little comment about "I'd say to go ahead and take the stitches out, but make sure Dad is in the room for a minimum of tears" or "Let's schedule the surgery for this week, not next, since Ramadan is coming up" that make the difference between extraordinary care and, just, medical care.

So don't banish the chicken. And use whatever collaboration tools you need, to help.

Curious whether hybrid store and forward telemedicine could help you care for your patients?

Telemedicine practitioners can feel isolated. They are often among a handful of people in their immediate practice or hospital who are using telemedicine to perfect care, improve outcomes, and make their lives easier. 

The truth, however, is that healthcare providers using telemedicine are part of a large, growing, and thriving community. When we started working in this field almost two decades ago, telemedicine was rare. Now, however, the most committed, innovative healthcare providers all use telemedicine in one form or another. 

Telemedicine is actually thriving. Here are 5 reasons why: 

• Politics are catching up. As this article details, parity laws are going into effect in several states. Also, the Telehealth Modernizaion Act -- to establish a clear definition of telehealth -- is on its way to going through. "Telehealth is a major contributing factor to increased health care quality, convenience, and lower costs," said Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio)
• Telemedicine is reaching critical mass. Research and Markets is predicting 18.5 % growth in global telemedicine in the next 4 years. 
• New providers are more familiar with technology. For some of the same reasons as we highlighted in our discussion of concierge medicine, and as this article discusses, new providers are adopting practices like telemedicine at higher rates.
• Providers are using smartphones in their practice. According to Verizon, "38% of physicians with smartphones use medical apps on a daily basis, and that number is expected to increase to 50% this year. Two-thirds of healthcare providers said that implementing or improving their use of mobile technologies is a high or mid-level priority during the next 12 months."

We're thrilled to know that providers are connecting better, people are collaborating, and patient care is improving as telemedicine becomes more widespread.

If you're looking into the options, get our Quick Guide to Telemedicine here:

Image courtesy of thomaslevinson on flickr.com, used under Creative Commons rights. 

This month, we've been covering the direct care/payment model of medicine -- termed "concierge medicine" or "direct primary care." You can see our overview here and our discussion of models for middle and lower-income folks here.

One trend in this direct care movement is that new providers are among the most common providers advancing the model, particularly in the form of the more economical "direct primary care." As healthcare providers who have been practicing for decades, we certainly aren't in the ranks of new providers! But we're noticing some interesting folks from the next generation -- providers like:

• Sherpaa, a hybrid insurance / direct primary care model aimed at small companies.
• Bespoke Surgical, a general surgeon with a direct care and payment model.
• NeuCare, a Kansas family doctor using a direct primary care model and making use of many supportive modern technologies.

So, one question is, why are new providers the ones at the front lines of the concierge / direct primary care model? There are a number of explanations for the phenomenon, but we think that a few things are particularly interesting causes to notice:

• Technology. Even over the last few years, we've seen the cost and hassle of technologies plummet. New providers are in an ideal location to take advantage of that trend -- and may be more accustomed to these technologies being a part of their workday than other providers.
• Cultural context. The new generation across all industries is having to reinvent things -- whether it's publishing, finance, or medicine. Additionally, the alternatives are worse for new providers than they were several decades ago. Healthcare provider burnout is skyrocketing. New providers in the system know that -- and are taking the steps to avoid it. 
• Idealism. Our observation is that several decades ago, most new providers went into medicine for idealistic reasons. As incomes went up, some folks started entering for less altruistic motives. But in the last several years, perhaps as medicine has become more difficult of a field, we again notice the majority of new providers doing the work out of idealism. New providers want to spend their time with patients, not with insurance companies. And we notice that many direct primary care providers share this kind of do-the-right-thing ethic -- finding the model makes it easier to do medicine in the ways they want to.
• Networks. New providers, often in urban or progressive areas, seem to have patients that are willing to try something new. This means that as a doctor makes a change to a new model, they may be able to take their old patients with them. 

Concierge medicine and direct primary care are just two of the ways that providers are changing healthcare through their innovation. There is no one right answer, but we certainly support the many approaches that providers are experimenting with. And we think that all providers could learn a thing or two from our younger counterparts in this type of experimentation and the success it's having.

We also believe that medical collaboration is fundamental to these innovative models that are improving care, helping with healthcare provider burnout, upping patient satisfaction, and cutting costs.

Get our medical collaboration tips here:

The phrase "concierge medicine" conjures up visions of white glove treatment, house calls to yachts, and luxury medical experiences. Some even suggest that these luxury, tailored, out-of-pocket approaches may be unethical because they divert resources from the rest of the medical system.

New models, however, are demonstrating that concierge medicine is not just for the elite. As we detailed in our last post, concierge medicine is, at its core, a direct payment model. Rather than providers caring for patients and collecting payment primarily through government or insurance programs, providers provide care and arrange payment directly. These models are sprouting up in a variety of contexts and with a wide spectrum of payment structures -- but all are beginning to prove that concierge medicine -- or at least some kind of direct care and payment model -- may be used more broadly.

One model, often termed "direct primary care", is being used for everyone from tech entrepreneurs to long-haul truckers. Sherpaa and Qliance are two companies that are providing primary care plans for as little as $50 per month, often in combination with insurance coverage for further treatment. “The concierge model carries a lot of baggage in being health care for the wealthy,” said Dr. Erika Bliss, a family physician and Qliance’s chief executive. “We want to grow this and bring the price point down to average Americans.” The outcomes have been very promising in decreased costs, increased patient satisfaction, and improved health outcomes.

In an age of physician shortages (especially for poorer patients), healthcare provider burnout, and inflated costs, researchers and government officials are seeing opportunity in direct care. An even more populist model, which is also being looked at as a possible opportunity, are clinics in major US cities that meet the needs of the uninsured, especially Spanish-speakers. These clinics offer offer round-the-clock-hours, cultural and linguistic fluency for recent immigrants, and upfront pricing that assumes a lack of insurance -- all things that make these solutions perfect for many. It is reported that "Health officials see in the clinics an opportunity to fill persistent and profound gaps in the county’s strained safety net, including a chronic shortage of primary care physicians."

Of course, there are concerns that the standard of care with low-income clinics and even direct primary care models could suffer. Some patients may not have coverage for specialists or hospital services. Some doctors may not have admitting privileges at local hospitals. And many worry that patients with more severe health needs or more limited funds may not actually end up with the care they need. That said, models like Qliance's and Sherpaa's do seem to be meeting some significant needs, and we'll likely see plenty of innovation in this direct care model in the years to come.

Telemedicine is crucial in a direct care model. Get our guide to your options:

Daniel Diaz was peeling an avocado recently and cut himself. Five stitches later, the hospital billed him $3,355.96.

Daniel's case is far from unique. Hospital charges are skyrocketing -- California Pacific Medical Center’s prices have doubled in the past 8 years. And although recent news has focused on insurance, costs and pricing models are proving to be one area of both concern and opportunity in the medical community.

High hospital costs are symptomatic of a system that isn't aligning care with costs. Finances are evermore opaque, bills don't seem to match the service provided, and patients -- not to mention providers -- seem frustrated and disillusioned. But true costs are not necessarily driving high prices. As the New York Times reports, "The main reason for high hospital costs in the United States, economists say, is fiscal, not medical." And it is hospital costs, not doctors' fees, that are the majority of the costs billed to patients.

So healthcare providers are often stuck in a system that doesn't make sense to patients, and doesn't prove rewarding (financially or medically) to the provider. It is in this context that some providers are exiting the system entirely, cutting ties to insurance and sometimes hospitals, and moving to a "concierge medicine" model. “When I decided to abandon insurance, I didn’t want to lose my patient base and make it unaffordable,” Dr. Stanford Owen, a physician who recently switched to the model, said. “I have everything from waitresses and shrimpers to international businessmen. It’s a concierge model, but it’s also the personal doctor model.” 

Concierge medicine is defined in this article as "a growing subset of medicine where patients pay doctors anywhere from $1,500 to $25,000 a year to receive personalized attention and care." It is a model that lets providers drive care, charges patients a truer cost for the care they receive, and may decrease costs overall. While concierge medicine is often associated with "white glove" treatment for the ultra-rich, the model is most basically a model in which doctors cultivate a direct care and payment relationship with patients, circumnavigating the insurance system.

In many ways, concierge medicine (especially in the humbler family doctor model) solves many of the problems we see in healthcare today. That said, it has its limitations, especially when it comes to specialists. “The vast majority of patients I see have very little money and are very, very sick,” Dr. Lahita, an autoimmune specialist, said. “It would be unconscionable for me to take cash. I’d limit my practice, and it wouldn’t be wise.”

We'll be exploring more about the concierge medicine model this month. It may not be the definitive answer to any of medicine's problems, but we certainly salute the brave physicians that are experimenting with a new model -- failures and successes included.

Concierge medicine makes medical collaboration crucial.  Get our guide: