Silicon Investor (SI) -- The First Internet Community

STOCKTALK

We've detected that you're using an ad content blocking browser plug-in or feature. Ads provide a critical source of revenue to the continued operation of Silicon Investor. We ask that you disable ad blocking while on Silicon Investor in the best interests of our community. If you are not using an ad blocker but are still receiving this message, make sure your browser's tracking protection is set to the 'standard' level.

Biotech / Medical : AHTC Corp (AHTC)-formerly Advanced Health (ADVH) -- Ignore unavailable to you. Want to Upgrade?

To: Tom D who wrote (186)	5/27/1998 5:57:00 PM
From: Towntarget	Read Replies (1) \| Respond to of 371

How would a such good PPM's company be trading under 13 today??? With its fundamentals and expected growth, it should be trading at 20+. I bought some this afternoon at 12 7/8 and 12 15/16 after the market seemed stabilized. I will buy more tomorrow. Good luck all.

To: Tom D who wrote (186)	6/6/1998 11:48:00 AM
From: Tom D	Read Replies (1) \| Respond to of 371

Re: Med-E-Practice and medical decision-making.... Here is an edited lengthy discussion about how and why Med-E-Practice is valuable. It begins with a challenge to me from Sciencelad, on the Yahoo board, but its mostly my writing. Tom: I called many of doctors who are suppose to use the Med E Practice tool.....they do not like it and hardly use it. Doctors do not like to be dictated to and will choose the medications that work and are the best for the patient. That is their training and tradition. Doctors think and do not need nor like when an electronic gadget tells them what to do, especially when it is programmed to meet managed care rules and not the beat interest of the patients. Tom, how much stock do you own??? As a physician do you follow all the managed care rules or do you think of the best care for your patients? Patient care is not like playing the stock market or worrying about how much money the managed care company is saving or making. Let us know if you say what you say just because of your investment or this is really how you practice medicine. I am sure other members of the board want the best treatment from their doctor and do not want to worry if they are being treated as a money item! Sciencelad ************************************************* Tom's reply Many diseases offer a spectrum of therapeutic options which fall into the realm of the accepted standard of care in the community. There are many factors which influence the decision making. Money is NOT irrelevant. Conventional physician decision-making spends every last dollar on patient care. When physicians are motivated to be economically responsible, they can expend the energy needed to develop best practices. Best Practices are strategies which are win-win--cost effective and first-rate care for patients. You want examples? Here are a few I have personally developed over the last few months.... Take a 10 mg tablet of Lipitor. Ask your patient to buy a $3.99 tablet cutter from Walgreens and cut it in half. 5 mg of Lipitor costs 90 cents. It reduces your LDL cholesterol by 32%--same as 40 mg of Pravachol--which costs over $2.50. Some HMO's won't even cover the cost of Lipitor--talk about clueless! Or how about this...the serum glutamate-oxalate transaminase enzyme is the most sensitive test for monitoring for statin hepatotoxicity--nothing is gained by ordering a full lipid panel. It costs less than half of what a lipid panel costs--multiply the savings out by 40 internists and hundreds of tests per year and you get a glimpse. Or how about treating spinal stenosis--the standard is surgery--but if you carefully read the medical literature--most patients actually do better with a lumbar flexion corset--after this teaches them the biomechanics of their disease they discard it and are pain-free. Elderly patients are delighted to avoid the morbidity of an operation--and they can always revert to the other therapeutic option. Liquid methotrexate (the IV form) costs 12% of what the pills cost. Same bioavailability and pharmacokinetics. I prescribe a vial of it and hand the patient a tuberculin syringe--"squirt .1cc into your mouth for every 2.5 mg tablet you used to be taking". I am not afraid to ask patients to cut Lipitor in half--no matter who benefits from the savings--whether it is the patient, some HMO, or my group. Tell me why an ROQ ultrasound costs $179 at the outpatient radiology imaging center near my office, and over two times that at the nearby hospital--and then you want to imply criticism of me for NOT wasting money? I could give you several times more examples which I personally created. but I don't want to give away too many trade secrets. All the docs in my group have a PC on our desks and we discuss these kinds ideas through email. We get opinions from specialists when we really break new ground. The point is that there is often more than one "best treatment" option. We have choices if we care enough about costs to look for them. We have been conditioned to ignore costs. Global risk contracting changes that. I practice different medicine depending on many things--including the patients insurance or lack thereof. When I see patients in my office who are without insurance its different (they usually get the most costly drugs because we get free samples of them from drug companies). Frankly, I think you are clueless about how physicians make decisions in the 1990's. You are right that docs don't give a sht about saving money for HMOs. Please read the posting which with I started the ADVH thread on Silicon Investor. Doctors pretend to gatekeep and pretend to practice cost-effective medicine for HMO's because HMO's only pretend to pay them for it. The $9 per month which HMO's capitate me for being a "gatekeeper" is not going to motivate me to stop by the hospital a second time in the evening to discharge a patient. I want to get back home to my wife & young kids. I won't take that 20 minutes away from my family to get an "attaboy" from an HMO. If I save MY GROUP an $800 per diem charge, I will do it (checkout time is midnight). And yes, surprise! The patients would rather go home & sleep in their own beds if they don't need to be in the hospital. So ADVH docs don't want to use Med-E-Practice to save money for HMO's. No surprise. For $9 per month, I will not deliver care which will save my HMO thousands of dollars per year. HMO's are anything but my favorite charity. For a global risk patient--whether its my groups money, or profits that are split 50:50 between ADVH and a physician group which is contracted with them--they will embrace Med-E-Practice. Try asking some of those physicians about differences between the care they give HMO (with whom they have an adversarial relationship) patients and global risk patients. And then ponder whether they will really admit the truth to you if they do not know you well & you are not one of them. I have given the ethics of this a lot of thought and I am at peace with what I am doing. I am not a slime. I have recruited over a dozen physicians in my city to go into homeless shelters in the slums and give out free medical care in the evenings. I will point out to you that there are many physicians who are unsure of themselves and still cling to the anachronistic and untrue statement "I treat all patients the same regardless of their insurance". Last year my groups Medicare global risk HMO inpatient utilization rate was the lowest for a large national medical insurance company--yet every measure of patient satisfaction was the best or nearly the best. Sounds too good to be true? Sounds like somebody has figured out how to do global risk contracting. The amazing feature about global risk contracting is that there is so much waste out there that we can afford to do expensive care when it is the right thing to do. Its just unnecessary an awful lot of the time. What ADVH offers to physician groups is the means to put physicians back in control of medical decision making. Global risk contracting is a fun way to practice medicine because it is down to earth and real. All you do is take care of your patients, free of the pseudoeffective constraints (i.e. rationing through inconvenience) of HMO's. Almost all HMO's have restricted formularies. They will only pay for certain medications. If a doctor prescribes a nonformulary medication, he or she gets a phone call from the pharmacist asking if we want to make the patient pay out of pocket for the medicine. I keep a little notebook with me which lists my 200 or so favorite medications along with their costs, doses, and formulary status for the 6 major insurance companies I use. My group is working on developing something proprietary like Med-E-Practice. I suspect what we come up with will be cheaper but not as good. From what I have read about Med-E-Practice, I would love to get my hands on the information it offers, when it comes time to make decisions about what to do for my patients. There was an article circulated on my coporate intranet a few months ago about West Coast HMO's beginning to implement capitation of physicians for pharmacy costs. Doctors did not like it at all, but had to agree to it because HMO penetration is so complete there. The idea was that HMOs would pay the docs $15 to $20 per month per patient, out of which the docs had to pay for all prescriptions which they wrote for that HMO's patients. If they spent too much, they paid out of their pockets for it. If they spent less, they kept the difference. If and when this spreads around the country, as most California medical trends do, the demand for Med-E-Practice should surge. And, yes, doctors will actually use them--even for their HMO patients. Tom **************************************************** Dear Tom, You said it yourself...there is no cookbook medicine for doctors like yourself you want to give the best care and not spend extra money. This is one reason why an electronic cookbook pad, whether it is from ADVH or others will not work in medicine. Doctors are thinkers and care for their patients. If the electronic pad world takes over, which I doubt, the patients and doctors are in trouble. I am glad to see you care and are on top of things. I just think those those who bet on electronic medicine care are going to lose. Keep thinking!! ***************************************************** There is no textbook which really helps with cost-effective care. I have looked for them without success. The medical journals which supposedly are interested in these issues also don't offer much in practical cost-saving ideas. I have a theory that many of the cost-effective strategies never get published in medical journals. The people who are interested in getting published are usually in academia, which has not been particularly interested in cost-effective care. The docs who are involved in global risk contracting treat their best cost-saving ideas as trade secrets. Until the last few years, there hasn't been much serious emphasis on the relative costs of treatment alternatives, because there hasn't been much incentive for physicians to really care about costs. Med-E-Practice presents treatment alternatives to physicians along with data on costs and efficacies of treatment alternatives. It is an invaluable tool for physicians who are interested in doing cost-effective care. I wish my group did not have to reinvent medical care in order to flourish at global risk contracting--but the information is not otherwise available. It is part of the reason why we do this better than most other medical groups. Cost-effective care didn't matter much for us when the money was being saved for some HMO which we often despised anyway. IMHO, if a medical group is going to do global risk contracting, they need Med-E-Practice or they need to create that body of knowledge for themselves, and then have the information available to their physicians at the time of medical decision-making. Best Regards, Tom