AcuteCare Telemedicine Blog

Physician Compensation Accounts for Only 8% of Total Health Care Costs

Physician compensation is commonly perceived as a factor in the rising cost of healthcare. According to a May 2011 report released by Jackson Healthcare, this is simply not the case. The report concluded that physician compensation accounts for only roughly 8% of the total annual healthcare costs in the U.S., and in fact, through telemedicine, doctors are able to provide a service which drastically reduces costs associated with physician clinical services.

From the report: “According to the most recent estimate from The Centers for Medicare and Medicaid Services (CMS), overall U.S. healthcare spending in 2009 was $2.5 trillion. CMS reports that physician clinical services account for $505 billion. Calculating the percentage using the most recent statistics on the number of practicing physicians in the U.S. from the American Medical Association and salary figures from MGMA, annual aggregate physician salaries total just 8.6 percent of total U.S. healthcare costs.”

AcuteCare Telemedicine, although founded by 4 practicing neurologists, is focused on improving patient access to quality care by lowering the costs for healthcare institutions.  The telemedicine services offer hospitals an affordable solution to providing 24×7 coverage to its patients relative to acute stroke care.

“As physicians, we dedicate our time to helping our patients,” comments Dr. Matthews Gwynn, CEO, AcuteCare Telemedicine.  “We may not be able to control rising healthcare costs, but we can identify cost effective solutions for healthcare providers that lower costs and improve patient care.”

Health Benefits of Medical Outsourcing

Outsourcing often carries a negative connotation as a cost-cutting measure, but can also serve as a solution for quality improvement. Relative to the healthcare industry, effective outsourcing can lead to cost reduction and improved quality of care.

As early as February 2006, the New England Journal of Medicine published an editorial by Robert Wachter, M.D., Vice-Chairman of the UCSF Department of Medicine, describing the impact of medical outsourcing. He noted that “…healthcare’s version may offer substantial advantages for patients… Outsourcing could also provide patients with access to specialized care that would otherwise be unavailable.” Particularly beneficial in emergent situations where time is of the essence; the type of ‘outsourcing’ Dr. Wachter describes leads to better patient outcomes at a reduced overall cost.

Telemedicine, the evaluation of patients via the internet using 2-way audio-visual equipment, allows ‘outsourcing’ of neurologic care to physicians within the United States (typically in urban centers or academia) who have stroke expertise. Patients with acute neurological emergencies who have no alternative treatment options can be accessed via telemedicine within 15 minutes or less. Rapid administration of tPA improves brain tissue recovery, leading to improved patient outcomes.

Management of acute stroke changed dramatically following FDA approval in 1996 of intravenous tissue plasminogen activator (tPA) for the treatment of acute stroke. The race was on to save brain tissue by administering tPA within a 3 hour therapeutic window. The sooner tPA is given, the fewer dead brain cells; in other words, “time equals brain.” Since 1996, obstacles to the utilization of tPA kept the percent of potentially treatable patients who actually got tPA at a mere 2%. The availability of neurologists to provide time specific acute stroke care has been a primary obstacle, particularly in rural hospitals.

When time equals brain, the outsourcing of stroke care is priceless. Analysis of the economic benefits of tPA use published in the Journal of the American Heart Association (2005) revealed an annual savings of $600 per treated patient. With over 600,000 new stroke patients each year, even modest increases in the use of tPA via telemedicine (e.g. increasing from 2% to 10% of eligible patients) could save over $37 million dollars annually, which, when paired with the improvement in patient care, demonstrate the indisputable benefits of outsourcing via telemedicine.

Acute Stroke Intervention via Telemedicine Saves Lives and Money

Cutting edge technology is, in part, the basis for touting the healthcare system of the United States as the best worldwide. Technology is also derided as a factor in rising healthcare costs.  Efforts to limit access to, or redistribute the cost of, healthcare have polarized the debate.  Recent research published in the journal Neurology demonstrates that the short-term cost of technology can be outweighed by long-term healthcare savings.

Stroke patients in rural communities stand to gain significantly from more aggressive implementation of technology.  Many people at highest risk of stroke live in underserved, mostly rural, areas of the south known as the “Stroke Belt.” These patients typically live beyond a 30 minute drive to a certified stroke center which significantly increases the risk of dying from stroke.

Telestroke, the evaluation and treatment of acute stroke patients via internet based video-conferencing, is an established method of providing live-saving treatment in areas lacking physicians with the necessary expertise. Patient outcomes following telestroke evaluation is unsurpassed when compared to evaluations done in person. Telestroke implementation has inherent cost beyond that of routine stroke care. However, as the Neurology article points out, improved outcomes limit costs over the lifetime of the patient.

These analyses explored the “hub and spoke” model, in which a patient is transferred to a tertiary hospital (hub) after a telestroke encounter at a local (spoke) hospital. The transfer of a critically ill patient is costly, as well as potentially dangerous. An alternative to hub and spoke is “point of service” telestroke care, in which the patient could remain at their local hospital following neurologic evaluation. This approach, offered by AcuteCare Telemedicine, would be expected to be even more cost-effective. It not only reduces the costs of transfer, but keeps the patient in their community thereby reducing cost to the family and community (e.g. travel, missed work) and reducing the cost of participating in a telestroke network by the local hospital.

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Its Black and White: A Neurologist Saves the Gray
November 3, 2011, 6:06 pm
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Time is brain. Every minute during a stroke 2 million brain cells die. Starved of oxygen, neurons die when a blood clot blocks an artery. The outcome is disability and even death.  Administration of the “clot-busting” drug Alteplase (i.e. thrombolysis) within 3 hours can restore blood flow and brain cells…life. Neurologists, at the core of an acute stroke intervention team, can save brain by saving time.

The gold-standard for measuring the efficiency of acute stroke care is the time “from door to needle.” That is, the time from when a patient arrives to the emergency room to the time medication is infused with a goal of <60 minutes. However, for a neurologist to truly minimize disability a cascade of crucial steps must begin in the field with Emergency Medical Services (EMS). The emergency room (ER) must stand ready at all times to accept and treat an acute stroke.  Meanwhile, the coordinated efforts of laboratory, radiology and pharmacy staff will determine when, or if, life-saving medication is given.

Neurologists, particularly Directors of Stroke Services, are charged with the responsibility of putting a coordinated plan into place ahead of time. Stroke outcome improves when EMS notifies the ER that they are transporting a possible thrombolysis patient. Subsequently, meeting the stroke patient at the ER’s ambulance bay for immediate transport to the CT table can result in door to needle times of less than 20 minutes. Assuring stroke patient’s blood samples are given priority in the laboratory, alerting the on-call radiologist before the CT is completed and premixing thrombolytic drugs in the ER are also crucial steps in an efficient acute stroke intervention.

Neurologists also benefit future patients by rigorously reviewing the outcomes of previous stroke interventions. Scheduled meetings of a multidisciplinary “stroke team” reinforce good practices and identify inefficiencies. Ultimately, patients benefit because neurologists are taking leadership roles in the planning and implementation of acute stroke care.

Michael Woodcock Joins AcuteCare Telemedicine as Sales Executive

AcuteCare Telemedicine (ACT) continues to expand its team by adding Michael Woodcock as Sales Executive.  In this new position, Michael is responsible for executing ACT’s growth strategy to acquire new accounts while maintaining its existing client base.

“Michael is an excellent fit for ACT,” comments Dr. Matthews Gwynn, CEO, ACT.  “He is not only an accomplished sales executive, but is he passionate about what we do.  He is a welcome addition to our team.”

Michael brings more than 15 years of experience in sales with a proven track record for generating significant new revenues ultimately resulting in increased market share.  His efforts have earned him recognition and awards.  In addition, Michael’s ability to manage and drive sales strategies made him an ideal candidate for growing the business.

“His core strengths align with our needs as we extend our reach into hospitals in new regions,” said Keith Sanders, COO, ACT. “Generating new business is a vital component of ACT’s ability to attain business objectives as we move into 2012.  Michael is primed to help us achieve those goals.”