Health Business Blog

The subtitle of Atul Gawande’s Testing, Testing article in the December 14 New Yorker is:

The health-care bill has no master plan for curbing costs. Is that a bad thing?

In Gawande’s view, the answer is: no, it’s not a bad thing at all. Because:

• No one really knows which of the many cost control ideas out there will actually work so we can’t just pick one and enact it
• There are lots of pilot programs in the bill, and from those we will learn what works
• The agricultural extension agent program, which revolutionized American farming through a diffuse, government-run model, can work in health care, too

As we’ve come to expect from Gawande, the article is readable, interesting, and thought-provoking. The background on the agricultural extension agents is especially enjoyable. He points out that agriculture used to consume 40 percent of household income and that it was overly labor intensive, small-scale and inefficient. Gradually people transitioned away from the farm and food became much more affordable as the program rolled out. The government had a big role but never took over agriculture (unlike in the Soviet Union). The same can happen in health care, he says.

As a city-dweller, I first heard about the agricultural extension agent model last month from an academic physician from Minnesota. Like Gawande he pointed to the agricultural centers as big winners. “The most successful thing the government’s ever done,” he said. But he also let me know that many people in Minnesota were quite upset that the term “regional extension center” was being applied to the health IT programs that were authorized in the ARRA/HITECH stimulus bill passed earlier this year. They’re worried about whether the model will work in health care, and are also a little upset that the existing extension centers didn’t just get to add the health IT component.

I have some serious problems with Gawande’s optimistic view:

• It’s unclear to me why pilot programs are likely to be successful in ultimately transforming the health care environment. Medicare has done a number of demonstration projects over the years. Some of these projects (like the MHS project on disease management are set up to fail and/or have the plug pulled on them). In any case, by the time the results are in and implemented we’ll be even further into the mess
• Unlike some critics who fear the government will get too deeply into health care, my issue is we’re already there. Medicare as it stands is already so dominant that private sector actors can’t make much headway in changing the system. And yet because of the political environment in which Medicare operates, it’s not really in a position to make serious changes
• Third-party payment isn’t the main driver for agricultural markets. Most people just go out and buy what they want –even if they use food stamps. Sure there are some pricing distortions in the background but it’s nothing compared to the distortion of the health care market caused by the disconnection between health care consumers and those who are paying. Even high deductible health plans don’t solve this problem, since the big ticket items are still paid for by insurance
• Doctors aren’t farmers, and while I’m not so closed minded as to completely reject the analogy, please show me a radiologist or cardiologist or dermatologist with a question analogous to the farmer in Gawande’s story who wants to know how to prevent his spinach from wilting

We have serious problems with the health care system in this country and there’s no clear path out. Even the somewhat bumpy road Gawande maps out is a lot gentler than what we’re likely to face.  I understand the appeal of those who want to get government out of health care completely (or close) but that’s not a realistic option at this point.

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Senators Herb Kohl of Wisconsin and Dick Durbin of Illinois plan to amend the Senate health care bill to ban the mining of prescription data by companies such as IMS and Verispan. The Associated Press (Sens. move to block drugmakers from mining Rx data) quotes the Senators as saying:

…the measure will combat “harassing sales practices” and “restrain undue influence” of pharmaceutical salespersons.

I don’t think this amendment is a very good idea. There are better ways to address marketing issues than restricting the legitimate use of data.

But what’s really misplaced is the use of the phrase “harassing sales practices.” Doctors who are willing to see pharma reps get a lot out of it: information, lunch, trips, CME, often eye candy. Data mining makes the interactions more specific to the physician’s practice.

Pharma sales rep harassment of physicians isn’t a big problem in my book. Those docs that don’t want to see reps can –and do– just say no. In many cases docs who work for larger organizations are told by their bosses not to see sales reps. It’s not that the docs are fleeing harassment!

Patients and payers are the ones that bear the downstream impact of anything that goes wrong with the pharma/physician relationship. But that’s a different story than the one we’re told in this article.

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This is the transcript of part 2 of my podcast with Humedica CEO Michael Weintraub and VP Corporate Development/Marketing Allen Kamer. You can read part 1 here.

David Williams: I know Anceta has been in the works for a while, and that they’ve made some progress, but perhaps have struggled a bit. Why did they want to work with you, what did you offer that they were unable to do on their own?

Michael Weintraub: They have been working on this for a while, because from a leadership perspective, they were early. They were on this topic for five years or so, because many of the opinion leaders in health care are AMGA member organizations. They’ve been expert at the application of information to drive efficiency and effectiveness, but it’s not something that all 330 of their organizations do equally, because it’s a pretty significant investment from a portability perspective. Importantly, they’re all about collaboration; they have disease-focused collaboratives that they run all the time. They just had a hypertension collaborative, they are rolling out a diabetes collaborative, which is our first disease area for them.

When they talked to us, it was clear that we had a very common mission and vision.  Some large organizations are trying to stretch to do this, but it’s a very significant investment. Hence we raised $30 million in 2008 from three Blue Chip venture capital firms in the Boston area, Bain Ventures, Northbridge Venture Capital and General Catalyst, organizations I’ve known with or who have funded previous companies of mine.  Leerink Swann, where we spent some time hatching and incubating this idea, is also an investor.  What Anceta and AMGA saw in us is a pure play – an organization whose sole mission was 100 percent aligned with their objective, as opposed to something that was a stretch or another division.

Williams: How does what you do relate to recent Federal policy moves? I’m thinking particularly about ARRA/HITECH as it relates to meaningful use, Regional Extension Centers that will be funded starting next month, and then maybe also comparative effectiveness.

Allen Kamer: We are exploring a variety of grant opportunities right now, related to the comparative effectiveness research, and with our partners, both BBN Technologies and Anceta, as well as some of the participating medical groups from the AMGA.  We will explore and seek grants from the comparative effectiveness research activities that are ongoing.

Williams: Do you expect, with meaningful use and the greater use of electronic health records, that you’re going to be able to broaden your database, or does Anceta pretty much give you what you need?

Kamer: We definitely see the onboarding of electronic health records as a good thing overall. With the laying of the piping we believe the data that flows through it will be highly valuable. We will be the faucet that can bring it out and deliver the true value of the investment. We are very busy and focused with Anceta and AMGA members right now, but ultimately over time, we think EHR adoption will benefit us and others in the industry.

Weintraub: Anceta and AMGA is certainly a strategic partner and collaborator of ours.  Having said that, we’re focused on the health care market and the provider market at large.  The fact that Anceta has such coverage is very significant.  The other important thing to note is that EMR penetration in the provider world is roughly 20 percent.  We can have an interesting debate as to what the usage percentage is versus the penetration rate, meaning purchase decisions, but it’s roughly 20 percent.  It is significantly higher than it was five years ago.  There are all kinds of forecasts on what that percentage will be five years from now, but it’s really a bi-modal curve.

AMGA members have a 90 percent EMR penetration rate, because they’re typically medical groups with 100, 250, 1000, 2000 doctors.  If you take a look at small medical groups, 50 doctors and smaller, it’s actually a very small single digit EMR penetration rate.  We’re focused on where EMRs have been implemented, or are being implemented.  Similarly, on the hospital side, there are roughly 5,000 plus hospitals in this country, and roughly 3,000 of those 5,000 are part of a chain, a larger aggregation of hospitals, ranging from small hospital chains to very large 100-150 hospital chains.  We’re focused initially on collaborating with hospital systems, because from a leverage perspective, they typically have a common EMR or two, not always, but it’s not about 100 hospital and 100 EMRs, so there’s some technology interface leverage and data acquisition leverage for us.

We’re focused on the top 25 to 50 hospital chains in this country as our initial buyers as evidenced by the first few we’ve done business with, and eventually we’ll talk to individual hospitals as well. But for us to get the initial heft that we’re looking for and accumulating data so that we can have a census-like view of health care we’re focused on specific regions and hospital systems in those regions. So it’s not just Anceta. It’s Anceta as the key ambulatory partner, and integrated delivery networks, and many of the large hospital systems out there.

Williams: It’s interesting to hear the degree of involvement on the provider side. I would have guessed that there was more balance at the outset between the customer types. I know you mentioned that you’re 100 percent aligned with AMGA or Anceta, but when I heard the description of Minedshare, it sounded to me as though it could also position you longer term to be more of an arms dealer.

With the benchmarking comparisons within and among hospitals, that same kind of information going to health plans or other payers might set off a bit of a race that would lead the benchmark levels to have to rise in order for the providers to stay in business.

Weintraub: That’s a great point.  By the way, on your earlier point about balance between markets, did you mean outside of the provider market?

Williams: That’s what I meant, yes. I meant different customer types.

Weintraub: A quick note on that before I shift to your payer point. We’re focused on the providers 100 percent because that’s where the data lives, and without the data, there is nothing else we can do with any of the other markets. We know that having valuable capabilities and assets that motivate the providers to do business with us and bringing meaningful value back to them is the only way to have long-term sustainability of the supply chain, and that is absolutely near and dear to our hearts.

We certainly intend to broaden, starting in 2010, and start doing work with the life sciences market once we have volumes of data that are large enough to allow for the analysis that matters to them in a deidentified HIPAA compliant way.  So it’s a staging issue. We happen to be a point in time where we are heavily provider focused. We will always be incredibly focused on providers because they are the foundation for this business through the perspective of the asset formation required to claim the other markets.  Relative to the other markets, we’re certainly moving into the government, as well as financial services and life sciences in 2010, and we started hiring leadership and capacity and capability with that in mind, and have started talking to those early customers, as we speak.

Relative to payers, however –a market I know quite well from my PharMetrics days and my MedStat days– I talked to several large payers over the past 6-12 months and I validated a couple of things:  number one is they’d love to get their hands on this information, and they find it to be incredibly valuable; number two is that they know me well enough as a colleague that they also agreed that if they were me, they wouldn’t do that right now.  We can put up all kinds of technology and process safeguards in place with respect to the granularity of the data we share –and we are not in the business of sharing information that names names. I don’t mean just HIPAA, that’s obvious, but I mean providers, perception becomes reality. And it becomes emotional.

And since payers negotiate with providers for rates and economics, I don’t think we can be on the leading edge of blazing that trail. My strategic belief is that over time the kind of information that we have will form the basis for dialogue and communication amongst those stakeholders, and at that point, I’m ready, willing and able to be that invaluable asset that allows them to open talks at a fact-based level. But I don’t want my providers, for a moment, worrying as to whether we’re the arms dealer arming the payers when it’s time for rate negotiations.  So while it’s a very fertile market, we need to be true to our mission and watch the evolving stages of the broader macro-economic health care market.

I just don’t feel we can go there right now. We’re looking to create a trusted brand with the providers, and we’re looking to monetize that data, in safe, secure, de-identified HIPPA-compliant ways in other markets.  I do think the payer market represents a third rail that is not worth getting into at this moment in time.  But do I believe that it’s an agenda that will change over time, not because I drive it, but because the health care industry will drive it?  I do.  And we’ll be watching and following that closely.

Williams: What’s the role, if any, for personal health records?  I’m hearing certainly data is coming from electronic health records, and that may have most of the same data.  But is there a role for patient-generated information, or information that extends beyond the traditional electronic health record boundary?

Weintraub: There is a role for that information.  We keep getting more and more inquiries regarding a variety of opportunities, such as for clinical trials. And the list goes on. Those are all on the list, but from an entrepreneurial perspective, and optimal allocation of capital, we want to pick three things and do them really well before we take on the next three. So time is our friend here. We’ll have more assets, more data, more capabilities, and then we’ll consider those other opportunities under other markets. But I don’t want to boil the ocean, and be a mile wide and an inch deep in the formative years, so we’re really focusing on the main thing is the main thing.

Williams: What might things look like in say five to seven years if you achieve your growth plan?  How big of a company are we talking about?  What kind of an impact?  I know it’s probably hard to say exactly what areas you’ll be in beyond the ones we’ve talked about, but what’s the vision for that time horizon?

Weintraub: You’ve been talking to my investors, haven’t you?

Williams: I know some of them, but no, have not talked about this!

Weintraub: Well, obviously it’s a small matter of execution. But what’s our business plan?  Our business plan is to build a formidable data asset. Whether that data asset is 50 million lives, 35 million lives, 100 million lives, depends on that small matter of execution. But for us to have the kind of impact we would like to have, we would like to have a database that is geographically and demographically representative of the U.S. Census, broadly speaking, and we used the number of 50 million lives.

It doesn’t mean we’re going to stop there, because the more data you have, the more you can slice it while maintaining the kind of statistical anonymity that you want to maintain.  We would like to have a database that is significant enough that we can (a) analyze the top 60 to 100 diseases with confidence, whatever life sciences market across all disease and therapeutic areas across multiple treatment settings, and we would like to be in as many, if not all, the major hospital systems and chains out there, who have one of the top 5 EMRs.

We would like to be in a large number of AMGA and Anceta sites, as well, contributing to that population, and we would like the data asset to be a sought-after clinical information resource by the Federal government. We’d like some of the other markets that we’re not yet talking to or considering in the areas of consumer driven health and other areas to really be on the corporate development short-list for us of things we’re thinking about.  We’d like to be the leader in clinical informatics and the de facto leader in a market that we think is moving at a rate that is absolutely supportive of our goals: evidenced-based health care, clinical effectiveness, meaningful use, all of those terms are accelerating.

We think there’s going to be a little bit of what I’ll call a ‘wait and hurry up’, as opposed to a ‘hurry up and wait.’  We’re seeing a lot of organizations now worrying about getting basic plumbing decisions in place, and in some cases, taking advantage of legislation and the stimulus money to make decisions to switch to longer term EMR decisions.

Clearly, the plumbing has to be in place for us to then take advantage of the information flowing through.  We’re focused, we’re aggressive, but we recognize that it’s a long-term game. We’d like to be working with each of the top five EMRs on the inpatient side and on the outpatient side, that occupy well north of 50 percent market share, and providing invaluable information and analytic resources to those sites that use those EMRs as a complementary tool to them.

You’ll be seeing more news from us in the coming months. I think you’ve seen us note the various partnerships we’ve formed with Anceta and AMGA, Leerink Swan, BBN.  We’ve just launched a scientific advisory board with some phenomenal members that we’re proud and privileged to have as part of our organization, and we’ll be kicking off that focus, as well, to get their guidance and expert advice moving forward.

We look forward to keeping you posted as we move forward.

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Julie Ferguson hosts the latest edition of the Health Wonk Review at Workers’ Comp Insider. Meat lovers be prepared: there’s a tasty sausage-making section.

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New research estimates that 640,000 people in the US who are living with HIV/AIDS are not in treatment. A survey commissioned by Bristol-Myers Squibb (BMS) aimed to understand the underlying causes.

The survey found significant differences in perceptions between health care providers and HIV positive people regarding barriers to treatment. Providers were more likely to cite substance abuse and financial distress as key factors keeping people out of treatment. Meanwhile people with HIV/AIDS were more likely to mention concerns about the side effects of HIV medications, denial of the need for treatment among those not feeling ill, and social stigma.

BMS and the National AIDS Fund are launching the “Positive Charge” initiative to help “break down the barriers that prevent people living with HIV from receiving HIV care, treatment and necessary support.”

In this podcast interview, National AIDS Fund President and CEO Kandy Ferree discusses the survey results and lays out the Positive Charge program.

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This is the transcript of part 1 of my podcast with Humedica CEO Michael Weintraub and VP Corporate Development/Marketing Allen Kamer.

David Williams: What is the focus of the company? What are you bringing to the market that has not been available in the past?

Michael Weintraub: We’re aiming to build a census view of health care in America.  What I mean by that is to build a large-scale informatics asset that various constituents can tap into to get a perspective on whatever question they might have, whether it’s a disease or a therapeutic area. The focus will vary depending on whether you’re a hospital, a large medical practice, a pharmaceutical manufacturer, biotech, the federal government, etc.

We’re basically building a large-scale factory that is bringing in a vast amount of patient data from the provider setting.  By the provider setting I mean hospitals, integrated delivery networks (which include large ambulatory settings and doctors offices), standalone doctors’ practices, and then putting all that information into a common database. It’s protected by world-class security and adheres to the principles of HIPAA. The organizations that treat those patients can certainly see their specific information at a detailed and granular level, but other than that, everything else is done at an aggregate, encrypted, unidentified level.

We’re not studying the individual or the hospital or doctor per se, we’re studying patterns and analyzing the information and the various cohorts to understand meaningful variation; really studying that information to drive value and performance improvement.  At my last company PharMetrics, we did this with insurance data. That information provides you with a view but it’s aggregated and it’s not at the granular level that we’re talking about here.  So the state of the art today –with the big push by Obama and the federal stimulus dollars and the Health Care Recovery act– is electronic medical records capability. As the level of automation increases our aims becomes possible. We are working with organizations that have electronic medical records and we are bringing that information into our common factory, then applying scientific, statistical and medical techniques to normalize that information so it can be used in the manner I’ve just described.

We have multiple markets.  We have provider markets and we have built some exciting applications (which I’ll have some of my colleagues here talk about in a moment) on their behalf that enable the exchange of information. Data comes to us and then we provide/sell those capabilities to our customers.  We have other stakeholders in the health care industry who are very interested in understanding how their products are utilized, whether it be a biotech company, a top pharma company or a medical device company. Those organizations (and we’ll comment on that deeper in a minute) are very interested in studying large volumes of patients that might have asthma or type two diabetes and so forth.  So having a business intelligence view, a very specific kaleidoscope into a population of interest is really now at a level of clinical specificity that has not been available before, unless one conducts primary market research.

Williams: What is the time lag of the data? It sounds like you’re using the information for aggregated views –which are perhaps not so time sensitive—but also providing information back to providers on an identified basis to improve treatment. Have I got that right?

Weintraub: The state of the art has been less clinical specificity, but also data is often batched or historical.  When we implement this capability, we grab several years of retrospective data, but we also have designed our capabilities such that our information is streaming in near real time, in five-minute increments. If you’re a provider, you’re able not only to see your history, but you’re also able to study the population while they’re actually in your care. So it’s got a direct link to your electronic medical records.  It’s streaming continuously, so if you’re a hospital looking to study preventable complications that would be an obvious application.

Williams: If you’re a hospital, beyond studying it, could you also be using information for real time clinical decision support or would that be beyond the scope?

Weintraub: That’s a great question.  I think there is a fine line here. Absolutely it’s going to be utilized for real time clinical support.  What we don’t want to be is the real time patient management system for a variety of reasons.  But if you’re a large provider with a significant cardiology unit, you’re going to have an individual from a quality department with a quality nurse assigned to that unit and what has typically been done through silos of information with multiple EMR’s and lots of paperwork and checklists and highlighters can now be done online on a real time basis.

Williams: Tell me about your product offering.

Allen Kamer: We have built two products and have launched one of them. The first product is called “Humedica Minedshare.” We compare performance data and benchmark activities from one hospital or medical group to an aggregate or to others within their system.  So for example, a medical group with multiple clinics can identify on a clinic-by-clinic basis how they’re doing in treating certain patient groups and then look at overall how their organization does and then go into a greater level of detail.  Additionally, we are building the capability for that particular medical group to compare with all the other medical groups that are participating.

So that’s called Minedshare. It enables clinical analytics where you can benchmark and compare treatment of patients by disease and severity across locations.

Weintraub: If you’re a 25 or 50 or 100-hospital chain or system, you’ll likely want to utilize this for comparisons, inter-hospital as well as intra-hospital, because you have lots of hospitals in your system.  You also might want to analyze hospitals to the norms within their region because many hospital chains are structured by region. And then at a third level, as our database grows, you’ll want to analyze performance compared to the benchmark within our broader and ever growing database and based on region, specialty type and so forth.

It’s all about discovering variation; often variation and acting on variation is at the heart of both clinical effectiveness and operational efficiency.  The endocrinology department might want to look at average clinical information –like HbA1c scores for the diabetic population by physician– and be aware of the differences demographically or geographically rather than by overall population. Within the practices they can then try to understand attribution and cause so that they can attack it.

That product has been rolled out and is in use by our first customer Christus, a 20-hospital system in Texas. They are an active user of that product.

Kamer: Our second product is called: “Humedica Minedstream.” This a real-time and predictive clinical surveillance tool that has been developed for the hospital to reduce preventable complications and improve performance metrics and really ensure that appropriate compliance is maintained with the performance protocols.

At Humedica we gather, map and normalize the data as patients are admitted into the hospital and tests are given. We use our advanced predictive analytic capabilities and modeling techniques to identify the hospital patients that might be at risk for preventable complication or might require tracking due to the Join Commission’s core measure criteria.  The Minedstream product is a dashboard that allows you to track patients. A quality nurse can identify who they are and where they are in the hospital and the physicians whose care they’re under.

It lays out all of the requirements associated with delivering care to those patients and it has a count down mechanism and dashboard tool to ensure that those activities are being adhered to. For example, it a patient comes in with chest pains and then has testing done, we identify that those patients may be heart attack patients. Then there are a number of things that need to happen for a patient who has had a heart attack, such as aspirin needs to be given within 24 hours if their troponin is at a certain level.

There are things that need to be done at discharge so our dashboard first identifies these patients and then tracks whether or not the physician or the nurse has performed those activities that are required for those patients.

Weintraub: Our first product rolled out earlier this fall and the second product is being rolled out this month.  Those are all for the inpatient hospital settings.  The complementary applications which will leverage the same environment, the same product, the same data factory, the same scientific methods, but for the ambulatory market, will roll out in 2010.

The ambulatory market is very important to us. Much of health care spending is on the ambulatory side. Roughly three of four dollars of prescription drug spending is on the ambulatory side. It’s a heavily growing market due to chronic disease. We have established a long-term, exclusive partnership with the American Medical Group Association (AMGA).  They are a very prestigious organization in the D.C./Virginia area and are the gateway organization that is the connection to over 300 large medical groups, integrated networks in this country.

They provide care to one in four Americans.  They are in 49 states and touch about 100 million patients a year and several hundred thousand physicians. It’s a very important organization, which includes prestigious organizations you’ve heard named by Obama such as Kaiser, Cleveland Clinic, Intermountain, Mayo, Geisinger, Henry Ford and others. We are their exclusive partner in a clinical informatics capability to address the very issues we’ve been talking about for the past 15 or so minutes.

We are working with roughly ten of their organizations who are early adopters to roll out this capability in the spring of 2010 to the ambulatory market.  What’s really important is to be working with hospitals and medical groups so that we can connect patients longitudinally and get an integrated longitudinal view of health care across treatment settings.

Continued to Part 2.

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Humedica is a new, venture-backed clinical informatics company that is making a big splash in the health care industry. In part 1 of my podcast with Humedica’s CEO Michael Weintraub and VP Corporate Development & Marketing Allen Kamer we discussed a variety of topics including the company’s aspiration to offer a “census view” of health care in America, the use of EHR-based feeds instead of claims, and the use of Humedica-generated information for business intelligence and clinical decision support.

In part 2 we focus on:

• The company’s strategic alliance with the American Medical Group Association (AMGA) and AMGA’s Anceta collaborative data warehouse
• The connection between Humedica and efforts by the Federal government to establish meaningful use of electronic health records
• Humedica’s potential role in comparative effectiveness research
• Expansion into additional customer segments including life sciences, financial services, the government and payers and how Humedica
• The vision for the company 5 or 7 years down the road

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Humedica is a new, venture-backed clinical informatics company that is making a big splash in the health care industry. In part 1 of my podcast with Humedica’s CEO Michael Weintraub and VP Corporate Development & Marketing Allen Kamer we discuss a variety of topics including:

• Humedica’s aspiration to build a “large-scale factory” to provide a “census view” of health care in America
• The company’s use of EHR-based feeds in comparison with earlier claims-based approaches
• Use of Humedica information for business intelligence and clinical decision support
• The company’s collaboration with AMGA’s Anceta collaborative data warehouse

In part 2 we will talk about Humedica’s longer term plans to expand its data sources, customers, and functionality.

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Just saw this somewhat disturbing piece, in Diagnostic Imaging, indicating a 31 percent defect rate in outpatient imaging services:

Chesbrough reported Monday at the 2009 RSNA meeting that 11% of the sample studies had significant quality defects that potentially led to missed pathology or inappropriate therapy. They included studies where the selected field-of-view made it impossible for the clinician to fully appreciate the presence or extent of disease. Ultrasound studies were performed with the wrong transducer. Prostate ultrasound was performed without an endorectal coil. Obsolete equipment produced spinal images so poor that the edge of the spinal facets could not be seen. Brain CT produced artifacts that mimicked brain tumors.

About 20% of the studies involved coding, compliance, or billing mistakes, Chesbrough said. These included studies that lacked physician orders for the examination or were based on inappropriate indications, he said. Some studies were billed under complete diagnostic CPT codes, yet only limited studies were actually performed. In other cases, protocol scanning was performed, with all patients receiving pre- and postcontrast exams, but without the necessary clinical indications for both procedures.

We’re used to stories about high cost and overutilization of medical services, including diagnostic imaging. That’s troubling but it’s a product of the payment system, which is hard to fix. On the other hand, it seems reasonable to expect that exams that are being done are at least being done properly. If the 11 percent figure is generalizable, that’s fairly disturbing.

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This is the transcript of my recent podcast interview with Dr. Catrise Austin.

David Williams: This is David E. Williams, co-founder of MedPharma Partners and author of the Health Business Blog.  I’m speaking today with Dr. Catrise Austin.  She is CEO of VIP Smiles.  Dr. Austin, thanks for being with me today.

Dr. Catrise Austin: Thank you David.  It’s such a pleasure to be with you today.

Williams: I understand that VIP Smiles is the first private dental practice that’s certified and trained to offer oral fluid HIV testing.

Austin: Yes.  This year I decided to incorporate a new service for HIV testing in the dental office and this was something that I really didn’t know was ground breaking.  I have always been interested in learning about the disease and I felt that it’s been 28 years since this first hit the scene.  Yet, we’re not getting better with the statistics.  Things seem to be getting worse.  A lot of people are afraid to get tested and I said: “You know what?  If I can do my part by offering the test in the dental office as patients visit us twice a year, why not give them the option to do a pain free test and get the results fairly quickly.”

Williams: Now is this something that you would suggest for all of your patients?  Whom would you include or exclude?

Austin: I actually offer the test to all of my adult patients and any teenagers who are at the age where they’re sexually active.  I don’t discriminate because the disease does not discriminate. I’ve tested people in their 60′s because literally infect anyone who doesn’t take precautions can be infected, so I don’t single out anyone.

Williams: Who actually gives the test?

Austin: My entire staff is trained to offer the test.  My office manager, my hygienists and I all did the training. Usually we’ll leave the testing to the clinical staff, but if we’re out doing a health fair in the community, we will gather all of our team members and offer the test to make sure we have enough hands to take care of this.

Williams: What would happen if I came in for my regular cleaning? What would be different?  At what point during the exam would the test be offered to me and how would that actually be done?

Austin: Here is how it works: you come to our office, at the beginning of your appointment when you check in at the front, the office manager will inform you of our new service and she will ask if you are willing to take the test.  It’s completely optional.  At the desk, you will sign a consent form if you are willing to take the test.

Then after the patient is escorted back, we conduct the test at the beginning of the treatment.  We offer pretest counseling, explain the test, and then administer the test.  It’s very easy. It takes about 20 minutes for the results of your test to be ready, so at the end of your treatment we will offer your results. So far we’ve been very lucky to not have any positive results.

Williams: That’s certainly encouraging and I’m sure peace of mind for the folks that have the test. But at some point, especially if you offer this for a long period of time, you will get a positive result. What happens if somebody gets a positive result in your office?

Austin: The rapid test that we’re using which is called OraSure Advance only offers a preliminary positive result, so the next step would be to give a little bit of counseling, but also refer them to either their primary care physician. If they don’t have a primary care physician then we will send them to one of our partner hospitals.  The test that they will get at their primary care physician would be a confirmatory test.

Williams: Is the test something that people usually need to pay for out of pocket or is it typically covered by dental insurance or health insurance?

Austin: The test is considered a medical procedure so unfortunately in the dental office you’re not able to use your insurance.  I currently offer the test at no cost. That is even more of a reason why my patients should be tested in my office, because it doesn’t cost anything.  If you decide to utilize the test, unfortunately in the dental office you would have to pay out of pocket for those dentists who are not offering the test at no cost.

There is a specific medical code that should be submitted, but again dental providers are not recognized for submitting medical codes. So right now since this is new in the dental practice you cannot utilize your insurance, however my goal in getting out into the public and doing interviews like this is to get more dentists to offer the test. The more the dental community embraces this procedure, the more we can push towards making it a recognizable code and billable code for dental procedures, so the more people who do it the more we’ll be able to get it paid for by insurance.

Williams: What kind of reaction are you getting from patients when you ask them at the start of their appointment if they’d like to have the screening test?

Austin: I am so thrilled because so far the patient response has been amazing.  After testing, most patients have stated that they prefer doing it in the dental office because the test was effortless.  I’ve had patients say: “Hey, you know what?  You just saved me a trip to the doctor.  It was so convenient to do it here and kill two birds with one stone.”

The dental environment makes it a little less threatening. Often people are not getting tested because they’re just afraid of going to the doctor because it’s such a scary environment.  I think my office is in a position where it’s less threatening.  We check for cavities and gum disease, so this is just another service that we’re adding that’s quick and easy and painless.  It’s really just a swab of the mouth.  You put the swab into a developing solution.  I think patients are really enjoying having it done in the dental office.

Williams: About how many patients have you tested or about how many do you expect to test in a given year?

Austin: We just started actively testing in August and since then we’ve tested over 100 patients.  Right now about 60 percent of the patients who are offered the test accept the testing in our office.  There is a comfort level that we all have to get used to in terms of offering the patient the test on a routine basis.  We offer the test in just the matter of fact way that we would any other service in our office and I expect to have more and more people test as we continue this journey.

It’s been really great to know that I am helping people to learn their status in such an easy way because it’s so important.  The stats are not getting better over the years so anywhere that I can do my part in making sure that we help people know their status and help prevent the spread of the disease is my goal.

Williams: You have a new book out and I understand that you’re donating a portion of the proceeds to an HIV organization.  Can you tell me a little bit about that?

Austin: Yes, the book is called: Five Steps to the Hollywood ‘A’ List Smile; How the Stars Get That Perfect Smile and How you Can Too.  I wanted to give back proceeds to an organization called Hope’s Voice International.  I found them as I did some research.  They actively do campaigns with MTV.  Their campaign is called: “Does HIV Look Like Me?” and I really like the organization because they’re working, not only in the United States but also internationally.  Tomorrow is world AIDS day and finding out that there are over 73 million people right now living with HIV.  So I like the organization because they are working tirelessly across the world to make sure that they get speakers out to tell people about the disease and hopefully prevent the spread of the disease even further.  So I’m giving a portion of the proceeds of the book to Hope’s Voice International and I hope together we can do some great things.

Williams: I’ve been speaking today with Dr. Catrise Austin, CEO of VIP Smiles.  Dr. Austin, thanks so much for your time today.

Austin: Thank you so much for having me. Let’s keep spreading the word about HIV.

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